Snare vegetectomy for right-sided endocarditis.

INTRODUCTION: A middle-aged male developed right-sided endocarditis from an infection of an implantable cardiac defibrillator (ICD) system. Following percutaneous device and lead explantation, a very large pedunculated vegetation (19 mm × 14 mm) was found on the Eustachian valve. We decided to remove the vegetation percutaneously using a wire snare instead of open heart surgery. CASE REPORT: Real-time three-dimensional transesophageal echocardiography and fluoroscopy were used to guide the procedure. Access was from the right femoral vein. Using a triple-loop wire snare through a deflectable sheath, the vegetation was successfully removed in its entirety without complications. CONCLUSION: Percutaneous snare vegetectomy is feasible and may be a viable option in place of open heart surgery in selected patients.

Superior performance of N-terminal pro brain natriuretic peptide for diagnosis of acute decompensated heart failure in an Asian compared with a Western setting.

AIMS: This study was conducted to test the diagnostic performance of NT-proBNP for discrimination of acute decompensated heart failure (ADHF) among breathless patients presenting in an Asian compared with a Western centre. METHODS AND RESULTS: Patients with breathlessness were prospectively and contemporaneously recruited in Emergency Departments in Singapore and New Zealand (NZ). The diagnosis of ADHF was adjudicated by two clinician specialists. A total of 606 patients were recruited in Singapore and 500 in NZ. The discriminative power of NT-proBNP for ADHF was superior in Singapore compared with NZ [area under the curve (AUC) 0.926 vs. 0.866; P = 0.012] both overall and among selected subgroups stratified according to age, renal function, body mass index, and presence or absence of AF or diabetes. Previously established cut-off point values of plasma NT-proBNP yielded comparable sensitivity and negative predictive values, but superior specificity and accuracy in Singapore compared with NZ. The difference in test performance was driven by the younger age (median age 56 years vs. 73 years; P < 0.001), associated with better renal function (estimated glomerular filtration rate 89 vs. 62 mL/min/1.73 m2 ; P < 0.001), and lower prevalence of AF (9.7% vs. 25.7%; P < 0.001) in acutely breathless patients in Singapore. CONCLUSION: Considering emerging evidence of a lower average age of presentation with ADHF over most of Asia compared with Western countries, NT-proBNP is likely to be more accurate when applied in Asian centres than in the West.

[Effects of Tangshenling Mixture and benazepril on rats with diabetic nephropathy and its mechanism].

OBJECTIVE: To investigate the effects of Tangshenling Mixture (TSLM) and benazepril on rats with diabetic nephropathy (DN) and its mechanism. METHODS: Diabetic nephropathy was induced in rats by intraperitoneal injection of streptozotocin. Fifty-eight rats with DN were randomly divided into four groups: untreated group, TSLM-treated group, TSLM plus benazepril-treated group and benazepril-treated group. Another seven normal rats were included in normal control group. Then, rats in each group were accordingly given normal saline, TSLM, TSLM plus benazepril and benazepril orally for six weeks respectively. Blood and urine biochemical indexes, plasma atrial natriuretic factor (ANF), pathomorphology of renal tissue, transforming growth factor beta1 (TGF-beta1) and glucose transporter 1 (GLUT1) mRNAs in renal tissue were observed. RESULTS: Both TSLM and benazepril could decrease urinary albumin excretion rates, creatinine clearance and ratio of kidney weight to body weight of the rats with DN as well as reduce the pathological damages of the renal tissues. TSLM could reduce the level of plasma ANF and the expression of GLUT1 mRNA, but had no significant effect on the expression of TGF-beta1 mRNA. Benazepril could reduce the expression of TGF-beta1 mRNA, but had no significant effect on plasma ANF and the expression of GLUT1 mRNA. CONCLUSION: TSLM can reduce the pathological damages of renal tissues in rats with early-stage DN, and its mechanism may relate to decreasing the level of plasma ANF and the expression of GLUT1 mRNA which is different from that of benazepril. It seems that TSLM has synergetic effect with benazepril.

[Efficacy and safety of azosemide in patients with edema and ascites].

OBJECTIVE: To assess the efficacy and safety of azosemide in patients with edema and ascites. METHODS: A multicentral, randomized, double-blind, controlled clinical trial was applied. All 223 patients (cardiac edema 92, hepatogenic edema 63, renal edema 68) were randomized to azoesmide and furosemide group, and all patients were treated for 2 weeks. Patients with cardiac or renal edema took azosemide (30 mg/d) or furosemide (20 mg/d); patients with hepatogenic edema took azosemide (60 mg/d) or furosemide (40 mg/d). The dosage were adjusted to azosemide 60 mg/d (cardiac, renal edema), 90 mg (hepatogeic edema); or furosemide 40 mg/d (cardiac, renal edema), 60 mg (hepatogeic edema), if diuretic effects were not obtained at the end of third day. RESULTS: At the end of the study, the weight changes were (2.87+/-3.10) kg and (2.81 +/-2.84) kg; the total effective rate of edema lessen was 89.19% and 89.81%; the total effective rate of heart function improvement was 64.44% and 66.66%; the 24 h urine output increased (321.85 +/-669.52) ml and (273.80 +/-645.72) ml for azosemide and furosemide, respectively. The total effective rate of ascites lessen (tested by B-ultrasound) was 89.28% and 86.66%; abdominal girth decreased (5.20 +/-3.58) cm and (5.03 +/-3.74) cm for azosemide and furosemide, respectively. The adverse event rate was 23.01% in azosemide group and 21.01% in furosemide group; the main adverse effects were hypokalemia, hyperuricemia, hypertriglyceridemia and thirsty. CONCLUSION: Azosemide could effectively lessen edema, improve heart function and decrease ascitesûit is well tolerated and is particularly useful for the diuretic treatment.

[Diagnosis and therapy of the nutcracker phenomenon: long-term follow-up].

OBJECTIVE: To study the diagnosis of adult nutcracker phenomenon (NCP) and assess the therapeutic value of endovascular stenting (ES) and superior mesentery artery transposition (SMAT) for the treatment of NCP in long-term follow-up. METHODS: Six patients (6 men) aged 16 and 34 years old (mean age, 22.7 +/- 18.0 years) were diagnosed as having NCP using the examination of the doppler ultrasound and/or magnetic resonance of artery/digital radiography (MRA/DSA). Three patients underwent ES and 3 patients received SMAT for the treatment of the NCP patients associated with recurrent gross hematuria and left flank pain. Doppler ultrasound and urine examination were used at pre- and post-operation. RESULTS: In 3 patients who underwent SMAT, the postoperative complications comprised retroperitoneal hematoma necessitating surgical revision (n = 1). Functional disorder of intestine (n = 1) and paralytic ileus (n = 1) that were resolved by conservative management. In 3 patients who experienced ES, 1 patient received surgical revision because the position of stent was not suitable in left renal vein but no other complication took place. During the follow-up of 6 approximately 50 months (mean 24.7 +/- 18.0 months), except that 1 patient's hematuria disappears at rest and reappears after motion while the other 5 patients remain asymptomatic and free of hematuria. The dopplar ultrasound showed the left renal vein diameters of the angel segment between superior mesentery artery and aorta were (0.18 +/- 0.05) cm preoperation and (0.65 +/- 0.17) cm postoperation, P < 0.001; the left renal vein diameters of the portal segment were (0.89 +/- 0.22) cm preoperation and (0.79 +/- 0.20) cm postoperation, P = 0.003; the left renal vein diameter's ratio between portal and angel segment were (4.99 +/- 0.79) preoperation and (1.23 +/- 0.16) postoperation, P < 0.001. CONCLUSIONS: Dopplar ultrasound plays a very important role in the diagnosis of adult NCP. SMAT is an efficient surgical approach to the treatment of the nutcracker phenomenon and is associated with an acceptable risk of complications. But ES is safer and more efficient than SMAT and may represent a valuable approach to lessening the morbidity of surgical procedures. ES is a new therapeutic method for adult NCP.