Multiple Intracardiac Masses Involving 3 Chambers of the Heart.
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ABSTRACT:
SUBMITTER: Yamat M
PROVIDER: S-EPMC9794497 | biostudies-literature | 2022 Dec
REPOSITORIES: biostudies-literature
Publications
Multiple Intracardiac Masses Involving 3 Chambers of the Heart.
Yamat Megan M Wali Eisha E Lee Linda L Henry Michael M Ward R Parker RP Paul Jonathan J Lang Roberto M RM
CASE (Philadelphia, Pa.) 20220928 10
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Project description:ObjectiveThe aim of this cross-sectional, retrospective, descriptive study was to review and classify cardiac masses systematically and to determine their frequencies.MethodsThe medical records of 64,862 consecutive patients were investigated within 12 years. Every patient with a cardiac mass imaged by transthoracic echocardiography (TTE) and confirmed with an advanced imaging modality such as transesophageal echocardiography (TEE), computed tomography (CT) and/or cardiac magnetic resonance imaging (CMR) was included. Acute coronary syndromes triggering thrombus formation, vegetations, intracardiac device and catheter related thrombi were excluded.ResultsData demonstrated 127 (0.195%) intracardiac masses consisting of 33 (0.050%) primary benign, 3 (0.004%) primary malignant, 20 (0.030%) secondary tumors, 3 (0.004%) hydatid cysts and 68 (0.104%) thrombi respectively. The majority of primary cardiac tumors were benign (91.67%), predominantly myxomas (78.79%), and the less malignant (8.33%). Secondary cardiac tumors were common than the primary malignant tumors (20:3), with male dominancy (55%), lymphoma and lung cancers were the most frequent. Intracardiac thrombi was the majority of the cardiac masses, thrombi accompanying malignancies were in the first range (n = 17, 25%), followed by autoimmune diseases (n = 13, 19.12%) and ischemic heart disease with low ejection fraction (n = 12, 17.65%).ConclusionsThis retrospective analysis identified 127 patients with cardiac masses. The majority of benign tumors were myxoma, the most common tumors that metastasized to the heart were lymphoma and lung cancers, and the thrombi associated with malignancies and autoimmune diseases were the most frequent.
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Project description:A 43-year-old male with history of pulmonary embolism defaulted on anti-coagulation and presented with recurrent massive pulmonary embolism. Echocardiography revealed a serpiginous freely floating right atrial thrombus prolapsing through the tricuspid valve into the right ventricle. Thrombus was also seen crossing the interatrial septum into the left atrium and prolapsing into the left ventricle. Right-sided chambers were dilated with right ventricular dysfunction. Left ventricle was functioning normally. After evaluation by the pulmonary embolism response team, thrombolysis was done with alteplase which resulted in dramatic improvement of the symptoms and complete resolution of the intra-cardiac thrombus. Regular follow-up and counselling are advised henceforth to ensure drug compliance.Learning objectives1.In patients with right heart thrombus crossing an intracardiac communication into left-sided chambers carries an additional risk.2.Pulmonary embolism response team is essential for clinical decision-making.3.Echocardiography plays a critical role to diagnose and assess the extent of the intracardiac thrombus and ventricular function.4.On computed tomography, right ventricular (RV)/left ventricular diameter ratio of >0.9 and the presence of septal bowing signifies the presence of RV strain.5.Adequate counselling ensuring patient compliance and regular follow up is of utmost importance.
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Project description:A 26 year primigravida, 8 days after delivering a still born baby presented with gradually progressive dyspnea from New York Heart Association (NYHA) class II to class III over a period of 1 week. 2D-Echocardiography showed severely compromised left ventricular systolic function with evidence of thrombi in three different chambers of the heart. All the clots disappeared after an effective anticoagulation therapy without any embolic complications. The hypercoagulable state of the peripartum period and the severe biventricular dysfunction led to the formation of clots. <Learning objective: This case underscores the importance of careful screening of the right side of the heart in cases of peripartum cardiomyopathy. In cases of doubt, cardiac magnetic resonance imaging can be performed to determine the nature of the masses. This case also highlights the importance of effective anticoagulation therapy and the need to be vigilant for any thromboembolic phenomenon during the anticoagulation therapy.>.
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Project description:AimsThe mechanisms underlying the acute decompensation of heart failure (HF) remain unclear. The present study examined intracardiac dynamics during decompensated HF using echo-vector flow mapping.Methods and resultsFifty patients admitted for decompensated HF were prospectively enrolled, and intracardiac energy loss (EL) was assessed by echo-vector flow mapping at admission (decompensated HF) and discharge (compensated HF). Outcome measures were average EL in the left ventricle (LV) in decompensated and compensated HF and were compared with those in 40 stable non-HF patients with cardiovascular diseases. The mean age of HF patients was 80.8 ± 12.4 years. The prevalence of both females and atrial fibrillation was 48.0%. The prevalence of HF with a reduced ejection fraction (<40%) (HFrEF) was 34.0%. The prevalence of decompensated HF classified into clinical scenario 1 was 33.3%. Blood pressure and NT-proBNP were significantly higher in decompensated HF than in compensated HF, while the ejection fraction (EF) was significantly lower. Average EL was significantly higher in compensated HF patients than in non-HF patients (40 mW/m·L vs. 26 mW/m·L, P = 0.047). A multivariable analysis identified age, systolic blood pressure, LVEF, and the absence of chronic obstructive pulmonary disease as independent risk factors for high LV-EL regardless of the presence of HF. Furthermore, average EL in HF patients was significantly higher under acute decompensated conditions than under compensated conditions (55 mE/m·L vs. 40 mE/m·L, [+18 mE/m·L, P = 0.03]). Higher EL under decompensated HF conditions was significant in non-HFrEF (+19 mW/m·L, P = 0.009) and clinical scenario 1 (+23 mW/m·L, P = 0.008). The multivariable analysis identified eGFR as an independent risk factor for a decrease in average LV-EL under decompensated conditions.ConclusionsEnergy inefficiency in LV was apparent even in stable HF patients and significant under acute decompensated conditions, particularly in HF with preserved EF and clinical scenario 1.
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