Texas Heart Institute Journal Volume 46: Issue 1

To determine whether body mass index ≥30 kg/m² affects morbidity and mortality rates in patients undergoing surgery for type A acute aortic dissection, we conducted a retrospective study of 201 patients with type A dissection. Patients were divided into 2 groups according to body mass index (BMI): nonobese (BMI, <30 kg/m²; 158 patients) and obese (BMI, ≥30 kg/m²; 43 patients). Propensity score matching was used to reduce selection bias.

The overall mortality rate was 19% (38/201 patients). The perioperative mortality rate was higher in the obese group, both in the overall cohort (33% vs 15%; P=0.01) and in the propensity-matched cohort (32% vs 12%; P=0.039). In the propensity-matched cohort, patients with obesity had higher rates of low cardiac output syndrome (26% vs 6%; P=0.045) and pulmonary complications (32% vs 9%; P=0.033) than those without obesity. The overall 5-year survival rates were 52.5% ± 7.8% in the obese group and 70.3% ± 4.4% in the nonobese group (P=0.036). In the propensity-matched cohort, the 5-year survival rates were 54.3% ± 8.9% in the obese group and 81.6% ± 6.8% in the nonobese group (P=0.018).

Patients with obesity (BMI, ≥30 kg/m²) who underwent surgery for type A acute aortic dissection had higher operative mortality rates and an increased risk of low cardiac output syndrome, pulmonary complications, and other postoperative morbidities than did patients without obesity. Additional extensive studies are needed to confirm our findings.

The right ventricle provides systemic circulation in individuals with congenitally corrected transposition of the great arteries (CCTGA) and in those with complete transposition who have had an atrial switch repair (DTGA). The aim of this study was to evaluate how the systemic right ventricle adapts to increased workload and oxygen demand during exercise.

From November 2005 through December 2015, 3,358 adult patients with congenital heart disease were treated at our institution; we identified 48 (26 females, 22 males; median age, 25.4 ± 8.1 yr) who met the study criteria; 37 had DTGA and atrial switch repair, and 11 had CCTGA. We studied their echocardiographic and cardiopulmonary exercise test results. A control group consisted of 29 healthy sex- and age-matched volunteers.

On exercise testing, oxygen uptake at anaerobic threshold, peak oxygen uptake, peak heart rate, and percentage of maximal heart rate were significantly lower in the group with systemic right ventricle than in the control group (all P <0.001); in contrast, the peak ventilatory equivalent for carbon dioxide was higher in the study group (P=0.013). Impaired systemic right ventricular function reduced peak oxygen uptake. The peak heart rate was lower in the CCTGA group than in the DTGA group.

Our results indicate that reduced exercise capacity is related to impaired systemic right ventricular function, severe tricuspid valve regurgitation, and chronotropic incompetence. There was no correlation between cardiopulmonary exercise test results and time after surgery. Chronotropic efficiency is lower in individuals with CCTGA than in those with DTGA.

Carcinoid heart disease is the collective term for all cardiac manifestations in patients who have carcinoid syndrome. Carcinoid heart disease has a multifactorial pathophysiology, and the right side of the heart is usually involved. Symptoms and signs vary depending upon the affected cardiac components; most typical is right-sided heart failure secondary to diseased tricuspid and pulmonary valves. Despite no single ideal diagnostic test, strong suspicion, coupled with serologic and imaging results, usually enables diagnosis. Advances in imaging, such as speckle-tracking echocardiography and cardiac magnetic resonance, have improved the diagnostic yield. Treatment is challenging, warrants a multidisciplinary approach, and can be medical or surgical depending on the cardiac manifestations. Investigators are exploring the therapeutic use of monoclonal antibodies and new somatostatin analogues. In this review, we cover current knowledge about the pathophysiology, diagnosis, and treatment of carcinoid heart disease.

A 61-year-old man with coronary artery disease presented with volume overload caused by medication noncompliance. His medical history included percutaneous coronary intervention; ischemic cardiomyopathy (left ventricular [LV] ejection fraction, <0.15); and placement of a biventricular implantable cardioverter-defibrillator (ICD), model and programming unknown. Chest radiographs showed properly positioned ventricular and right atrial leads. Figure 1 shows the patient's electrocardiogram (ECG) on presentation.

Fig. 1

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On the basis of the ECG, what is the patient's diagnosis?

A) Supraventricular tachycardia with biventricular pacing response
B) Pacemaker-mediated tachycardia
C) Sinus tachycardia with normal atrioventricular delay programming

Immunosuppression is mandatory after organ transplantation, to prevent rejection of allografts. Discrete steps in the alloimmune responses that mediate rejection of transplanted organs have been discovered, enabling the development of immunosuppressive agents that can suppress specific immune responses, thus preventing rejection and minimizing adverse events.^1–4 All toxicities related to immunosuppression are dose-related, and combination therapies enable subtoxic doses of individual drugs.⁵ Combination immunosuppression permits precise, personalized therapeutic approaches to transplant recipients and to patients who have immune-mediated diseases.^1–5

Our comprehension of these issues began decades ago. The urgent need for skin grafting in World War

In Memoriam: David J. Sugarbaker, MD (1953–2018)

Waiting for Test Results

Anxiety, Anger, and Frustration

Chicken-Fried Steak Changed My Outlook on Medicine

Influence of Body Mass Index on Outcomes of Patients Undergoing Surgery for Acute Aortic Dissection: A Propensity-Matched Analysis

Clinical Evaluation of Exercise Capacity in Adults with Systemic Right Ventricle

Carcinoid Heart Disease: Review of Current Knowledge

Role of Multimodal Cardiac Imaging in Diagnosing a Primary Intimal Sarcoma of the Left Atrial Appendage

Coxsackie B2 Virus Infection Causing Multiorgan Failure and Cardiogenic Shock in a 42-Year-Old Man

Surgical Repair of a 13-cm Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula in a 63-Year-Old Tuba Player

Preventing a Catastrophe: Increasing Awareness of Loeys-Dietz Syndrome

Spontaneous Resolution of Residual Shunting in 2 Compromised Patients after Amplatzer Occlusion of Postinfarction Ventricular Septal Defects

Catastrophic Antiphospholipid Syndrome Presenting as Congestive Heart Failure in a Patient with Thrombotic Microangiopathy

Tachycardia in the Presence of Ventricular Pacing

Hepatocellular Carcinoma Involving the Left Ventricle

Penetrating Atherosclerotic Ulcer of the Ascending Aorta Found Incidentally in a 71-Year-Old Man

Cardiac Replacement in Our Lifetime

Improving Access to Liver Transplantation through the ECHO Telehealth Model

Hand Transplantation: The Benefits, Risks, Outcomes, and Future

Unique Empathy Gained: Liver Transplant Specialist as a Liver Transplant Patient

Extracorporeal Liver Support in Patients with Acute Liver Failure

Progress in Immunosuppressive Agents for Solid-Organ Transplantation

The Benefits of a Local Kidney Exchange

The Future of Tissue Engineering in Heart Transplantation

Outcomes in Solid-Organ Transplantation: Success and Stagnation

Successes

The State of Artificial Heart Therapy

Portable Normothermic Ex Vivo Lung Perfusion to Reduce Warm Ischemia Time and Increase Graft Usage

Solid-Organ Transplantation Services in the Veterans Health Administration

Coronary-Cameral Fistula Following Myectomy in Hypertrophic Obstructive Cardiomyopathy

Rhabdomyosarcoma Involving the Left Atrium and the Mitral Valve

Double Atrial Septum With Interatrial Space in Patients Experiencing Ischemic Attack

A Case of a Multistent Scaffold Approach for Treatment of a Coronary Artery Aneurysm

Platypnea-Orthodeoxia and Patent Foramen Ovale in a Patient in the Setting of COVID-19