Tag Archives: echocardiography

Echocardiographic factors associated with prolonged duration of inotrope therapy and ICU length of stay in a retrospective study of cardiac surgery patients

Kelly Tankard1, William Vasquez McTeigue2, Matthew Smith2, Ariel Mueller2, Timothy Houle2, Eriberto Michel2, Judy Hung2, Adam Dalia2, Jerome Crowley2, Kenneth Shelton2

1 Department of Anesthesiology, University of Kansas Medical Center, Kansas City, USA
2 Department of Anesthesiology, Massachusetts General Hospital, Boston, USA

DOI: 10.2478/jccm-2026-0032

Introduction: Post-operative heart failure following cardiac surgery carries risk and can impact patient outcomes. Preoperative echocardiography can be useful for stratifying risk. Although there has been a historical focus on left ventricular ejection fraction (LVEF), the importance of left ventricular (LV) size, as measured by left ventricle end-diastolic diameter (LVEDD), may be an underappreciated echocardiographic factor which can help predict risk in patients undergoing cardiac surgery.
Aim of the study: To investigate the association between LVEF and LVEDD with inotrope use, inotrope duration, and intensive care unit (ICU) length of stay (LOS) in patients undergoing cardiac surgery.
Materials and methods: Retrospective cohort study including 2,965 adult patients undergoing non-emergent cardiac surgery at a single academic institution between February 2017 and October 2021. Primary outcomes were the use of inotropes and duration of inotrope therapy. The secondary outcome was ICU LOS.
Results: In adjusted analyses, a one standard deviation increase in LVEF was associated with decreased odds of inotrope initiation (OR 0.45, 95% CI: 0.41 to 0.50; P < 0.001), while a one standard deviation increase in LVEDD was associated with increased odds of receiving inotropes (OR 1.18, 95% CI: 1.07 to 1.31; P = 0.001). Among those receiving inotropes, a one standard deviation increase in LVEF was associated with a 25% decrease in inotrope hours in adjusted analyses (0.75, 95% CI: 0.68 to 0.82; P < 0.001). An interaction was observed such that LVEDD modified the association between LVEF and ICU LOS (0.98, 95% CI: 0.95 to 0.99; P = 0.03).
Conclusions: Preoperative LVEDD, particularly when combined with LVEF, can predict risk after cardiac surgery.

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Cardiological Monitoring – A Cornerstone for Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19 Outcome: A Case Report and a Review from the Literature

Lorena Elena Melit1, Oana Marginean1, Tudor Fleșeriu2, Alina Negrea3, Maria Oana Săsăran4, Simina Ghiraghosian-Rusu4, Andrei Călin Dragomir5, Mirela Oiaga6, Carmen Șuteu7

1. Discipline of Pediatrics I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Discipline of Infectious Disease I, Mures County Hospital, Targu Mures, Romania
3. Pediatrics Clinic, Emergency County Hospital Targu-Mures, Romania
4. Discipline of Pediatrics III, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
6. Emergency County Hospital Targu Mures, Romania
7. Pediatrics Cardiology Clinic, Institute of Cardiovascular Diseases Targu Mures, Romania

DOI: 10.2478/jccm-2022-0022

Introduction: Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a rare life-threatening condition requiring a complex management and multidisciplinary approach, whose outcome depends on the early diagnosis.
Case report: We report the case of a 2 years and-5-month-old boy admitted in our clinic for fever, abdominal pain and diarrhea. The clinical exam at the time of admission revealed influenced gen-eral status, bilateral palpebral edema and conjunctivitis, mucocutaneous signs of dehydration, and abdominal tenderness at palpation. The laboratory tests performed pointed out lymphopenia, thrombocytopenia, anemia, elevated C-reactive protein – CRP, erythrocyte sedimentation rate and ferritin levels, hyponatremia, hypopotassemia, hypertriglyceridemia, elevated D-dimer, in-creased troponin and NT-proBNP. The real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection was negative, but the serology was positive. Thus, established the diagnosis of PIMS-TS. We initiated intravenous immunoglobulin, empirical antibiotic, anticoagulation therapy and symptomatic drugs. Nevertheless, the clinical course and laboratory parameters worsened, and the 2nd echocardiography pointed out minimal pericardial effusion, slight dilation of the left cavities, dyskinesia of the inferior and septal basal segments of the left ventricle (LV), and LV systolic dysfunction. Therefore, we associated intravenous methylprednisolone, angiotensin converting enzyme inhibitors, spironolactone and hydrochlorothiazide, with outstanding favorable evolution.
Conclusions: Echocardiographic monitoring might be a lifesaving diagnostic tool in the management of PIMS-TS.

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Right Heart Thrombus in an Adult COVID-19 Patient: A Case Report

Enrico Merlo, Giuseppe Grutta, Ivo Tiberio, Gabriele Martelli

Intensive Care Unit “U.O.C. Anestesia e Rianimazione” Department of Medicine (DIMED) Padua University Hospital, Padua, Italy

DOI: 10.2478/jccm-2020-0039

Introduction: Right heart thrombus (RiHTh) can be considered a rare and severe condition associated with thromboembolic phenomena. A case is described of a COVID-19 patient presenting with an isolated thrombus in the right ventricle.
Case presentation: An 80-years-old Caucasian male was admitted in an intensive care unit (ICU) for COVID-19 related acute respiratory distress syndrome. The patient showed signs of hemodynamic instability, elevated cardiac troponin I and altered coagulation. On further assessment, a thrombotic mass near the apex of the right ventricle was detected. Moreover, the apex and the anteroseptal wall of the right ventricle appeared akinetic. Following the administration of a therapeutic dose of unfractionated heparin over a forty-eight hour period, re-evaluation of the right chambers showed that the thrombotic mass had resolved entirely.
Conclusion: COVID-19 patients could constitute a population at risk of RiHTh. Routine use of echocardiography and a multidisciplinary approach can improve the management of this condition.

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