Assuntos
Estenose da Valva Aórtica/diagnóstico , Valva Aórtica/diagnóstico por imagem , Calcinose/diagnóstico , Cardiomiopatias/diagnóstico , Adulto , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/etiologia , Calcinose/complicações , Cardiomiopatias/complicações , Ecocardiografia , Feminino , HumanosAssuntos
Arritmias Cardíacas/etiologia , Cardiomiopatia Hipertrófica Familiar/diagnóstico por imagem , Vasos Linfáticos/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Arritmias Cardíacas/diagnóstico , Biópsia , Cardiomiopatia Hipertrófica Familiar/complicações , Cardiomiopatia Hipertrófica Familiar/cirurgia , Fibrose , Transplante de Coração , Humanos , Vasos Linfáticos/ultraestrutura , Masculino , Microscopia Eletrônica de Transmissão , Miocárdio/patologia , Valor Preditivo dos Testes , RecidivaRESUMO
Caseous mitral annulus calcification involving aortomitral curtain is a rare occurrence. We report a case of a 64-year-old woman with end-stage renal failure and a candidate for renal transplant who presented with late ST-elevation myocardial infarction. Intracoronary imaging, computed tomography cardiac imaging, and histopathology confirmed coronary embolus into the left main stem artery from an extensive caseous mitral annulus calcification.
Assuntos
Vasos Coronários/diagnóstico por imagem , Embolia/diagnóstico , Valva Mitral/diagnóstico por imagem , Imagem Multimodal , Infarto do Miocárdio/complicações , Anticoagulantes/uso terapêutico , Angiografia Coronária/métodos , Embolia/tratamento farmacológico , Embolia/etiologia , Feminino , Doenças das Valvas Cardíacas/complicações , Humanos , Falência Renal Crônica , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Valor Preditivo dos Testes , Medição de Risco , Sensibilidade e Especificidade , Tomografia Computadorizada Espiral/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Calcificação Vascular/complicações , Varfarina/uso terapêuticoRESUMO
INTRODUCTION: Direct catheter ablation for atrial fibrillation does not yield reproducible permanent control as for other atrial arrhythmias. Therefore, there is a need for an alternative intervention, i.e., left atrial exclusion, based on elective ablation of the interatrial connecting bundles. METHODS AND RESULTS: We describe the "operative anatomy" of the three major interatrial connections: the Bachmann bundle, the coronary sinus bundle, and the left atrial-atrioventricular node connection, based on macroscopic dissections of human and porcine hearts and our previous experience. We identified the three right atrial attachments, with the coronary sinus (CS) and left atrial (LA)-atrioventricular (AV) nodal connection being most problematic for safe ablation. CONCLUSIONS: To obtain a complete isolation of the left from the right atrium, all three connections must be ablated. The CS connection must be ablated distal to the ostium. If present, the LA-AV nodal connection can be safely ablated from the left atrium.
Assuntos
Fibrilação Atrial/patologia , Fibrilação Atrial/cirurgia , Átrios do Coração/anatomia & histologia , Átrios do Coração/cirurgia , Sistema de Condução Cardíaco/anatomia & histologia , Sistema de Condução Cardíaco/cirurgia , Modelos Anatômicos , Modelos Cardiovasculares , HumanosRESUMO
A 14-year-old female was brought to the emergency room with chest pain, shortness of breath and cyanosis. She was previously well with the exception of one previous post-exertion seizure-like event. On this day, she had been jogging when she complained of chest pain and collapsed. Her initial vital signs were heart rate 58/min, blood pressure 70/40 mmHg, respiratory rate 50/min, temperature 37 °C, and SaO2 68%. Electrocardiogram showed significant ST changes. She received multiple fluid boluses and dopamine was initiated (5-20 µg/kg/min). She was intubated and started on norepinephrine (0.05-0.5 µg/kg/min) for refractory hypotension. During the resuscitation, echocardiography showed poor left ventricular function with an ejection fraction of 38%. The coronary arteries could not be visualized clearly. To maintain cardiac output, epinephrine by infusion (0.1-3.0 µg/kg/min) was added, and she received multiple epinephrine boluses. Despite maximum ventilatory support and escalating inotropes, cardiac output rapidly deteriorated, and she developed an agonal rhythm with non-reactive pupils. Resuscitation was discontinued. Autopsy demonstrated an anomalous origin of left coronary artery from the right aortic sinus of Valsalva with acute myocardial ischemia. We describe the sudden coronary death of a young patient, and we review congenital coronary artery pathophysiology, screening difficulties and potential interventions.
RESUMO
The overall 5-year survival of patients with urothelial carcinoma of the bladder (UC) is about 78%; however, there are some rare subtypes. One of these is the lipoid cell subtype, which bears a very poor prognosis. Another rare disease entity with a poor prognosis is metastasis to the lower gastrointestinal tract in the form of secondary linitis plastica of the rectum. We describe an extremely rare and unique case of rectal linitis plastica secondary to the rare lipoid cell variant of UC.
RESUMO
A 25-year-old woman presented at 12 weeks gestation, with symptoms and laboratory investigations consistent with pheochromocytoma. Imaging modalities available during pregnancy were limited and MRI scan of the abdomen and the neck failed to localise the tumour. Postpartum imaging, including 131-metaiodobenzylguanidine and octreotide scans, cardiac CT, cardiac MRI and cardiac catheterisation, allowed accurate localisation of the tumour and helped plan for successful surgical removal.
Assuntos
Neoplasias Cardíacas/diagnóstico , Feocromocitoma/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , 3-Iodobenzilguanidina , Adulto , Cateterismo Cardíaco , Feminino , Neoplasias Cardíacas/cirurgia , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Octreotida , Feocromocitoma/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Calcinose/etiologia , Dermatopatias/etiologia , Pele/patologia , Injúria Renal Aguda/etiologia , Adenoma/diagnóstico , Adenoma/cirurgia , Idoso , Biópsia , Calcinose/patologia , Evolução Fatal , Feminino , Gangrena/etiologia , Humanos , Hiperparatireoidismo/etiologia , Hiperparatireoidismo/cirurgia , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Dermatopatias/patologiaRESUMO
Aggressive angiomyxoma is a rare locally invasive non-metastasizing soft tissue neoplasm that is most commonly located in the female pelvis and perineum. We report a case of aggressive angiomyxoma arising from the epididymis of a young male, which was treated by radical orchiectomy.