Publications by authors named "Constantine Athanasuleas"

Asymptomatic primary mitral regurgitation due to myxomatous degeneration of the mitral valve leaflets may remain so for long periods, even as left ventricular function progresses to a decompensated stage. During the early compensated stage, the ventricle's initial response to the volume overload is an asymmetric increase in the diastolic short axis dimension, accomplished by a diastolic shift of the interventricular septum into the right ventricular cavity, creating a more spherical left ventricular diastolic shape, increasing diastolic filling and stroke volume. Early valve repair is recommended to reduce postoperative left ventricular dysfunction.

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Paroxysmal interventricular septal motion (PSM) is the movement of the septum toward the right ventricle (RV) during cardiac systole. It occurs frequently after uncomplicated cardiac surgery (CS), including coronary bypass (on-pump and off-pump), valve repair or replacement, and with all types of incisions (sternotomy or mini-thoracotomy). It sometimes resolves quickly but may persist for months or become permanent.

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Ideal heart performance demands vigorous systolic contractions and rapid diastolic relaxation. These sequential events are precisely timed and interdependent and require the rapid synchronous electrical stimulation provided by the His-Purkinje system. Right ventricular (RV) pacing creates slow asynchronous electrical stimulation that disrupts the timing of the cardiac cycle and results in left ventricular (LV) mechanical asynchrony.

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Article Synopsis
  • Mitral regurgitation (MR) happens when the components of the mitral valve and ventricle are disrupted, leading to changes in the left ventricle (LV) shape and potential heart failure.
  • If left untreated, an increased left ventricular end-systolic volume index (over 55 ml/m2) can result in serious complications like heart failure and dangerous arrhythmias.
  • The study aims to outline the process of LV remodeling in MR and highlight new treatments that not only fix the valve but also reshape the ventricle for better heart function.
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Objective: The objective of this study was to evaluate left ventricular free wall and interventricular septal function by 2-dimensional transthoracic echocardiography and live/real-time 3-dimensional transthoracic speckle tracking echocardiography before and after on-pump cardiac surgery and to assess the effect of mode of cardioplegia delivery.

Methods: A total of 22 patients were studied 1 day before and 4 to 5 days after surgery. Cold blood cardioplegia was delivered by intermittent antegrade infusion or by the integrated method.

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The surgical treatment for ischemic heart failure (STICH) trial concluded that the addition of surgical ventricular restoration (SVR) to coronary bypass grafting did not lead to improved survival in patients with dilated ischemic cardiomyopathy. Observational studies at multiple centers over the last 15 years have shown consistent improvement in global ventricular function and approximately 70 % long-term survival. The causes of this discrepancy are reviewed here and likely relate to how the STICH trial was conducted.

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A bronchopulmonary vein fistula (BVF) establishes a communication between a pulmonary vein and the alveolar space presumably secondary to alveolar rupture from increase in alveolar pressure. This rare fistula allows air to move continuously from the lungs to a pulmonary vein and into the left side of the heart causing systemic air embolization which is often fatal. We describe an adult patient undergoing a second mitral valve replacement surgery in whom intra-operative transesophageal echocardiography proved crucial in diagnosing BVF by showing persistent and increased streaming of air bubbles into the left heart from the left superior pulmonary vein during each positive pressure ventilation cycle with consequent inability to de-air the heart.

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Covered stents are the standard of care when coronary perforations complicate percutaneous coronary interventions and have also been utilized in the treatment of coronary aneurysms. We present the clinical and histologic features of a patient who developed a coronary perforation and pseudoaneurysm 4 years following deployment of intracoronary stents. Although the covered stent successfully sealed the perforation, subsequent thrombosis led to a fatal acute myocardial infarction.

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Heart failure (HF) is an emerging epidemic affecting 15 million people in the USA and Europe. HF-related mortality was unchanged between 1995 and 2009, despite a decrease in the incidence of cardiovascular disease. Conventional explanations include an aging population and improved treatment of acute myocardial infarction and HF.

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Ventricular torsion and untwisting are essential for normal ventricular function and their mechanisms are related to the temporal responses of the helical and circular muscle fibers that comprise cardiac architecture. Explanation of the presystolic isovolumic contraction (IVC) period is essential for analysis of these interactions. Structural and imaging studies by magnetic resonance, speckle tracking, velocity vector encoding, and sonomicrometer crystals are described to define why and how different muscular components contract asynchronously.

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Background: Cardiac output is the fundamental determinant of peripheral blood flow however; optimal regional tissue perfusion is ultimately dependant on the integrity of the arterial conduits that transport flow. A complete understanding of tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations.

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Postoperative right ventricular (RV) failure is difficult to treat and develops from functional impairment of the underlying free wall and septum. This report describes the vital importance of the ventricular septum in RV structure /function relationships, demonstrates how the helical ventricular myocardial band model defines spatial geometry of the free wall and septum to provide architectural reasons for RV dynamic action, and focuses upon pathophysiologic reasons for adverse perioperative events resulting in right ventricular failure. Myocyte fiber orientation is the key to ventricular performance in health and disease.

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Function follows form and this maxim provides an understanding of the pathophysiology of congestive heart failure following myocardial infarction. The heart fails as it enlarges and becomes more spherical. Surgical methods to treat dilated ischemic cardiomyopathy have evolved and been applied to thousands of patients worldwide.

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Article Synopsis
  • Surgical restoration of the failing heart focuses on reconstructing its normal shape, shifting from a dilated spherical form back to an ideal elliptic configuration.
  • Understanding the heart's fiber orientation is crucial, as it directly affects heart function and outcomes of surgical interventions.
  • Imaging guidelines should prioritize measures of heart volume and muscle condition rather than just ejection fraction, leading to better surgical results and long-term heart health.
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