News - Part 7

Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease: Ventilatory Efficiency and Symptomatology of Patients

Based on the data we obtained, it remains difficult to differentiate whether these eight patients actually did not recruit anaerobic metabolism during exercise or the determination of AT was obscured by alterations in ventilatory pattern and control. Thus, VO2AT values should be carefully interpreted in patients with cyanotic heart disease.
An increased VE had been reported for different causes of hypoxemia, eg, for persons living at high altitude, and patients affected by cyanotic congenital heart disease. As previously described, the increase in ventilation correlates with the magnitude of the right-to-left shunt and therefore the severity of cyanosis. To our knowledge, no data were available describing the correlation between parameters of ventilatory efficiency and symptomatic state in this patient group. Our data show significantly elevated ventilatory requirements secondary to a marked reduction in ventilatory efficiency. The impaired ventilatory efficiency strongly correlates with the extent of cyanosis as determined by PaO2 values at rest and under exercise. In contrast, no correlation between Pa02 and ventilatory efficiency exists in healthy volunteers. add comment
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Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease: Vo2 and Symptomatology of Patients

Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease: Vo2 and Symptomatology of Patients  Reductions of maximal V02 and exercise tolerance in comparable patients have been described by others. Maximal V02, originally defined as the V02 at which exercise of increasing intensity fails to increase V02 by at least 150 mL/min despite increasing work rates, was rarely seen in our patients. Read more »

Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease: Acid-Base Balance and Ventilation

As shown in Figure 2, despite large SDs there were marked and significant differences in the Ve/ VC02 ratio and the VE vs VC02 slope in patients with various NYHA and ability classes, while peak V02 did correlate to the symptomatic state to some extent.
The results of blood gas analysis are shown in Table 3. At rest, reduced Pa02 and increased VE (Table 2) were associated with slightly lowered PaC02 and HCO3 in cyanotic patients. During exercise, cyanosis worsened with a mean decrease in Pa02 of 25.8 ± 8% to 35.6 ± 9.8 mm Hg at end of exercise. In contrast, HCO3 was held within the normal range and PaC02 showed a nonsignificant increase with exercise.
Although mean pH at rest remained within the normal range, this parameter was closely correlated to VE/VC02 ratio (R2 = 0.56, p < 0.05), as well as to resting VE (R2 = 0.37, p < 0.05). However, this correlation was not apparent during exercise. Read more »

Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease: Statistical Analysis

Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease: Statistical AnalysisDuring the exercise period, Vo2AT (primarily according to the V-slope method and, if necessary, with further inspection of the Vo2, Vco2, Ve/Vo2, and Peto2 kinetics) and Ve vs Vco2 slope were determined, and at maximal exertion (peak Vo2), Peto2 and Petco2 were assessed. The terminal nonlinear part of the VE vs Vco2 relationship was excluded from the analysis of the VE vs Vco2 slope. Great effort was taken not to stop exercise prematurely. Blood was sampled in a capillary tube from a cut earlobe during rest and maximal exertion in 23 patients. Read more »

Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease: Control Group

Two patients (patient 12/13 and patient 23/24) underwent evaluation twice with an interval of at least 6 months. Both patients were surgically palliated (with significant changes in clinical presentation, extent of cyanosis, and shunt volume) between both evaluations. The remaining patients did not undergo surgical corrections. Individual diagnoses are presented in Table 1.
The control group consisted of 101 healthy volunteers aged 16 to 75 years (mean age, 37 years). Forty-five of them were women (mean weight, 60 ± 8 kg; mean height, 165 ± 6 cm), and 56 were men (mean weight, 78 ± 12 kg; mean height, 179 ± 9 cm). All persons were free of any cardiovascular, pulmonary, or other systemic disease, had physiologic resting and exercise ECGs, physical examinations, pulmonary function tests, and had no medications. The results have been published in part elsewhere. website
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Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart Disease

Assessment of Symptoms and Exercise Capacity in Cyanotic Patients With Congenital Heart DiseaseApproximately 1.0% of all children are affected by congenital heart defects. In 1994, it was estimated that > 500,000 patients with significant functional cardiac malformations reach adulthood in the United States. Supplementing echocardiography and cardiac catheterization data with cardiopulmonary exercise testing (CPX) offers an objective method to further characterize the limitations of the cardiovascular system in these patients. fully
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Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies: Conclusion

Although SHR-CT scanning and VB presently cannot be utilized for the identification of preneoplastic lesions, these imaging modalities have a tremendous potential for clinical application. SHR-CT scanning and VB are noninvasive. The radiation exposure associated with these scans is comparable if not less than that of conventional CT scans of the chest. SHR-CT scanning and VB provide unique opportunities to assess extraluminal and intraluminal airway pathology by allowing visualization from multiple angles. Thus, highly effective, objective, and reproducible investigation of poststenotic regions beyond the reach of endoscopy with either SHR-CT scanning or VB is possible. As these modalities provide accurate information regarding tracheobronchial anatomy, SHR-CT scanning and VB may become invaluable for assessing the feasibility of resections as well as laser or photodynamic ablations of airway stenoses. Read more »

Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies: Discussion

Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies: DiscussionAs with SHR-CT scans and VBs, additional obstructive lesions were appreciated by CT scans that were not visualized by FB. Three of six of these obstructive lesions (50%) were confirmed to be positive by histologic evaluation. The locations of these lesions were in the left lower lobe (two lesions) and the right lower lobe (one lesion) [Fig 3, bottom right, F],
Rapid technological advances in image processing have permitted the simulation of endoscopic procedures using sophisticated, but relatively inexpensive, computer workstations. In thoracic imaging, the trachea, mainstem bronchi, and many of the segmental bronchi can be readily visualized by new diagnostic modalities. Although standard methodologies are readily available, their limitations may lead to an inaccurate characterization of airway pathology. Read more »

Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies: Conventional CT Scanning

On the other hand, SHR-CT scans revealed 10 additional lesions, and VB demonstrated 11 additional lesions that were not evaluable by FB (Fig 3, bottom left, D, and bottom middle, E) due to the size limitation of the bronchoscope (9 cases) or to the location distal to high-grade stenoses (2 cases). Because many patients went on to undergo resection of a lesion for palliation or cure, pathologic correlation was attainable in nine cases. Of these nine cases, six obstructive lesions (67%) that had not been detected by FB but were visualized by SHR-CT scans and VBs were confirmed to be positive by pathology, With respect to the location of these pathology-proven distal lesions, two were located in the right lower lobe, two were located in the left lower lobe, one was located in the right middle lobe, and one was located in the left upper lobe (Fig 3, bottom left, D, and bottom middle, E). this
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Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies: Results

Comparative Evaluation of Super High-Resolution CT Scan and Virtual Bronchoscopy for the Detection of Tracheobronchial Malignancies: ResultsImage Acquisition
Image acquisition and anatomic simulation of the tracheobronchial tree were successful in all patients, No adverse events were noted in the study group, There were no respiratory or cardiac motion artifacts that precluded image reconstruction,
SHR-CT and VB
Of the 32 patients who underwent correlative FBs, 9 (28%) had normal examination findings. In all patients with normal anatomy, the results of SHR-CT scans and VB accurately correlated with those of FBs (Web movie 1). Read more »

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