PMC4573215_01
Preoperative CMR scan before meal showing intrathoracic stomach (a); increase in size of the hiatus hernia after a standard meal (b); postoperative CMR scan showing disappearance of the hernia and regular shape of the inferior vena cava (c). (LA Left atrium, LV Left ventricle, S stomach, IVC Inferior vena cava).
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Compared to baseline, a marked decrease of right atrial volume (from 113 to 92 ml) and left atrial volume (from 69 to 59 ml)was noted after meal (Fig. 1a and b). At 3-month follow up the CMR scan showed a decreased right atrium volume and an increase of the left heart section volumes presumably due to improved venous inflow (Fig. 1c).
VO2 (oxygen consumption) and VE (ventilatory equivalent) versus time, before and after (black and white circle) surgery, showing the consistent improvement of both parameters.
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CPET showed a dramatic improvement of exercise (peak VO2 27.5 ml/kg/min, corresponding to 78% of predicted O2 consumption) and ventilatory capacity (peak ventilatory equivalents 103 l/min, corresponding to 83% of the predicted) (Fig. 2).