BACKGROUND: Use of the current echocardiography-based indications for aortic regurgitation (AR) surgery might result in late valve replacement at the stage of irreversible myocardial damage. Therefore, we aimed to identify simple models combining multiple echocardiography or magnetic resonance imaging (MRI)-derived indices and natriuretic peptides (BNP [brain natriuretic peptide] or NT-proBNP [N-terminnal pro-B type natriuretic peptide]) to predict early disease decompensation in asymptomatic severe AR. METHODS: This prospective and multicenter study included asymptomatic patients with severe AR, preserved left ventricular ejection fraction (>50%), and sinus rhythm. The echocardiography and MRI images were analyzed centrally in the CoreLab. The study end point was the onset of indication for aortic valve surgery as per current guidelines. RESULTS: The derivative cohort consisted of 127 asymptomatic patients (age 45±14 years, 84% males) with 41 (32%) end points during a median follow-up of 1375 (interquartile range, 1041-1783) days. In multivariable Cox regression analysis, age, BNP, 3-dimensional vena contracta area, MRI left ventricular end-diastolic volume index, regurgitant volume, and a fraction were identified as independent predictors of end point (all P<0.05). However, a combined model including one parameter of AR assessment (MRI regurgitant volume or regurgitant fraction or 3-dimensional vena contracta area), 1 parameter of left ventricular remodeling (MRI left ventricular end-diastolic volume index or echocardiography 2-dimensional global longitudinal strain or E wave), and BNP showed significantly higher predictive accuracy (area under the curve, 0.74-0.81) than any parameter alone (area under the curve, 0.61-0.72). These findings were confirmed in the validation cohort (n=100 patients, 38 end points). CONCLUSIONS: In asymptomatic severe AR, multimodality and multiparametric model combining 2 imaging indices with natriuretic peptides, showed high accuracy to identify early disease decompensation. Further prospective studies are warranted to explore the clinical benefit of implementing these models to guide patient management. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02910349.

• MeSH
• aortální insuficience * diagnostické zobrazování   etiologie   chirurgie   MeSH
• dospělí MeSH
• echokardiografie MeSH
• funkce levé komory srdeční MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• natriuretický peptid typu B MeSH
• tepový objem MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Chylous pericardial effusion is a rare complication of cardiac surgery. We report a case of a patient who underwent pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension and was diagnosed with chylopericardium after the procedure. We present the surgical management of this condition, which included bilateral pedal lymphangiography followed by ligation of injured lymph vessel.

• MeSH
• arteria pulmonalis chirurgie   MeSH
• chronická nemoc MeSH
• chylus * MeSH
• endarterektomie škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• perikardiální efuze etiologie   terapie   MeSH
• plicní embolie komplikace   chirurgie   MeSH
• plicní hypertenze etiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Femoropopliteal bypass is a common vascular reconstructive procedure. A significant proportion of bypasses become ineffective within 1 year because of occlusion due to progression of intimal hyperplasia (IH). METHODS: The clinical part of the study involved an analysis of 43 patients with proximal femoropopliteal bypass, which became occluded no later than 1 year from the procedure, who were successfully treated with thrombolysis. Morphological changes of intima in the anastomosis (evaluated angiographically) and the angle of the distal end-to-side anastomosis were evaluated. In the second part of the study, blood flow in the distal end-to-side anastomosis was modeled experimentally (by particle image velocimetry) and numerically (by computational fluid dynamics). The results were correlated with the previously identified locations of IH. RESULTS: We proved that the locations of IH correlate with the locations of disturbed blood flow, increased wall shear stress, and stagnation points as documented by experimental visualization and angiographic findings. We also confirmed that anastomoses with more acute angles are less prone to IH and occlusion of the lumen. CONCLUSION: We suggest that a better understanding of the hemodynamics and its influence on IH should lead to an optimized graft design by adopting a more acute angle of the anastomosis.

• MeSH
• anastomóza chirurgická MeSH
• arteria femoralis chirurgie   patofyziologie   radiografie   MeSH
• arteria poplitea chirurgie   patofyziologie   radiografie   MeSH
• arteriální okluzní nemoci chirurgie   patofyziologie   radiografie   MeSH
• časové faktory MeSH
• hemodynamika MeSH
• hyperplazie MeSH
• lidé MeSH
• mechanický stres MeSH
• modely kardiovaskulární MeSH
• okluze cévního štěpu etiologie   farmakoterapie   patofyziologie   radiografie   MeSH
• počítačová simulace MeSH
• průchodnost cév MeSH
• recidiva MeSH
• trombolytická terapie MeSH
• tunica intima radiografie   MeSH
• výkony cévní chirurgie metody   škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH