RESUMEN
A unicuspid aortic valve (UAV) is a rare congenital defect that may manifest clinically as severe aortic stenosis or regurgitation in the third to fifth decade of life. This report describes two cases of UAV stenosis in adult patients diagnosed by transesophageal echocardiography (TEE). The utility of three-dimensional TEE in confirming valve morphology and its relevance to transcatheter valve replacement are discussed.
Asunto(s)
Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/etiología , Válvula Aórtica/anomalías , Válvula Aórtica/diagnóstico por imagen , Ecocardiografía Tridimensional/métodos , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Angioplastia de Balón/instrumentación , Aorta Abdominal , Enfermedades de la Aorta/terapia , Arteriopatías Oclusivas/terapia , Stents , Enfermedad Aguda , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/fisiopatología , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/fisiopatología , Aortografía/métodos , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/fisiopatología , Angiografía por Tomografía Computarizada , Femenino , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Spontaneous coronary artery dissection and vertebral artery dissection are rare, life-threatening conditions. The pathophysiology of spontaneous coronary artery dissection during the peripartum period is poorly understood. We present a case of spontaneous multivessel dissection in a 32-year-old postpartum woman who presented with neck and chest pain. The patient's coronary and vertebral artery dissections were diagnosed with use of multiple imaging methods, and dissection of the internal mammary artery was discovered during surgery. The patient underwent successful coronary artery bypass grafting and remained asymptomatic 2 years later. To our knowledge, this is the first report of simultaneous coronary, vertebral, and internal mammary artery dissection in a postpartum woman. Early recognition and treatment is crucial, given the high mortality rate associated with spontaneous dissection.
Asunto(s)
Disección Aórtica/etiología , Aneurisma Coronario/etiología , Arterias Mamarias , Trastornos Puerperales/etiología , Disección de la Arteria Vertebral/etiología , Adulto , Disección Aórtica/diagnóstico , Disección Aórtica/cirugía , Aneurisma Coronario/diagnóstico , Aneurisma Coronario/cirugía , Angiografía Coronaria , Puente de Arteria Coronaria , Electrocardiografía , Femenino , Humanos , Arterias Mamarias/diagnóstico por imagen , Arterias Mamarias/cirugía , Parto , Periodo Posparto , Embarazo , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/cirugía , Vena Safena/trasplante , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Disección de la Arteria Vertebral/diagnóstico , Disección de la Arteria Vertebral/cirugíaRESUMEN
BACKGROUND: Cerebral hyperperfusion syndrome (HPS) results from autoregulatory failure of cerebral blood flow following carotid endarterectomy (CEA) or carotid artery stenting (CAS) and encompasses a range of neurological findings including headache, seizure, intracranial hemorrhage (ICH), altered mental status and focal neurological changes. This report is the largest single-operator series evaluating the incidence and predictors of HPS following CAS. METHODS: A retrospective review was conducted on 482 consecutive patients who underwent CAS between August 1999 and December 2007 at Baptist Medical Center--Princeton, Birmingham, Alabama. All interventions were performed by a single operator (FM). The mean patient age was 70.4 +/- 10.3 years and 36% were symptomatic. All patients were high-risk for CEA. After cerebral protection catheters were routinely available, they were used in all but 6 cases (98.1%) where the anatomy precluded delivery. Brain computed tomography (CT) was performed immediately for any neurological change or significant headache following CAS. After neurological consultation and imaging, HPS was diagnosed if: 1) a neurological change occurred (not simply a headache); 2) CT revealed ipsilateral sulcal effacement/cerebral edema; and 3) stroke or transient ischemic attack (TIA) was excluded. RESULTS: Seven patients (1.45%) developed HPS following CAS. All patients achieved complete neurological recovery 6-24 hours following the procedure. Patients who developed HPS were significantly more likely to have had recent transient ischemic attack (TIA) symptoms than patients without HPS (p = 0.04). Unlike previous reports, there were no significant differences in procedural details, lesion characteristics and post-procedure blood pressure between the HPS and non-HPS patients, although the number of cases was small. Overall, the HPS cohort had a higher prevalence of comorbidities, though these differences did not reach statistical significance. Hypertension was present in all 7 HPS patients. Other complications in the series were death (0.83%), stroke (1.87%) and TIA (1.45%). CONCLUSIONS: The incidence of HPS is low (1.45%) following CAS, but it is an important complication to distinguish from stroke and TIA. Patients with a recent TIA may be predisposed to HPS. This report may underestimate the incidence of HPS, since patients with an isolated headache did not meet our diagnostic criteria and routine post-procedure brain CT imaging was not performed. The clinical predictors of HPS and its optimum management remain to be determined.