Non-contrast transcatheter aortic valve implantation for patients with aortic stenosis and chronic kidney disease: a pilot study.

Background: Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI). Of note, it is associated with a threefold increase in all-cause and cardiac death. We propose a new non-contrast strategy for evaluating and performing the TAVI procedure that can be especially valuable for patients with aortic stenosis (AS) and chronic kidney disease (CKD) to prevent AKI. Methods: Patients with severe symptomatic AS and CKD stage ≥3a were evaluated for TAVI using four non-contrast imaging modalities for procedural planning: transesophageal echocardiogram (TEE), cardiac magnetic resonance, multidetector computed tomography (MDCT), and aortoiliac CO2 angiography. Patients underwent transfemoral (TF) TAVI using the self-expandable Evolut R/Pro, and the procedures were guided by fluoroscopy and TEE. Contrast MDCT and contrast injection at certain checkpoints during the procedure were used in a blinded fashion to guarantee patient safety. Results: A total of 25 patients underwent TF-TAVI with the zero-contrast technique. The mean age was 79.9 ± 6.1 years, 72% in NYHA class III/IV, with a mean STS-PROM of 3.0% ± 1.5%, and creatinine clearance of 49 ± 7 ml/min. The self-expandable Evolut R and Pro were implanted in 80% and 20% of patients, respectively. In 36% of the cases, the transcatheter heart valve (THV) chosen was one size larger than the one by contrast MDCT, but none of these cases presented adverse events. Device success and the combined safety endpoint (at 30 days) both achieved 92%. Pacemaker implantation was needed in 17%. Conclusion: This pilot study demonstrated that the zero-contrast technique for procedural planning and THV implantation was feasible and safe and might become the preferable strategy for a significant population of CKD patients undergoing TAVR. Future studies with a larger number of patients are still needed to confirm such interesting findings.

Combined transcatheter aortic valve replacement and left atrial appendage occlusion in patients ineligible for oral anticoagulation: A case series.

Patients presenting with aortic stenosis and atrial fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR) are commonly at increased risk for stroke and bleeding complications. Concomitant left atrial appendage occlusion (LAAO) after TAVR may be an alternative to oral anticoagulation (OAC).Between 2018 and 2022, 7 consecutive patients who were ineligible for OAC underwent simultaneous TAVR and LAAO. The mean age was 84.9 ±â€¯4.9 years. The mean CHA2DS2-VASc, HAS-BLED, and STS predicted risk of mortality scores were 5.9 ±â€¯0.7, 3.9 ±â€¯1.1, and 8.8 ±â€¯3.4%, respectively. The median follow-up time was 23 (1 to 27) months. All procedures achieved technical success and no adverse events were observed during follow-up. This case series shows that concomitant TAVR and LAAO is feasible and safe among patients with severe aortic stenosis and AF who are deemed ineligible for OAC. Learning objectives: Atrial fibrillation is the most common arrhythmia in the transcatheter aortic valve replacement (TAVR) population. In those who experience major or life-threatening bleeding, mortality is doubled. We report a case series of 7 concomitant left atrial appendage occlusions (LAAO) after TAVR in patients ineligible for oral anticoagulation. All procedures achieved technical success and no adverse events were observed. The simultaneous approach with TAVR and LAAO was feasible and safe in this case series.

Natural History of Adapted Leaman Score Assessing Coronary Artery Disease Progression by Computed Tomography Angiography: A 7-Year Follow-Up Report.

BACKGROUND: Coronary computed tomographic angiography (CCTA) provides a non-invasive assessment of the coronary artery tree. Computed Tomography - adapted Leaman Score (CT-LeSc) has been shown to be an independent predictor of cardiac events in coronary artery disease (CAD) patients with a score greater than 5 (high). PURPOSE: To investigate the relationship between CT-LeSc and the progression of CAD and to provide vessel- and segment-level CAD qualification and quantification at baseline and 7-year follow-up. METHODS: Patients with multivessel CAD and CCTA assessments at baseline and follow-up were included. The CT-LeSc analysis was performed in a paired fashion. The patient-level scores and the differences between each phase were assessed by 2 analysts in an independent core laboratory. RESULTS: This study analyzed 248 coronary segments from 17 patients with a mean follow-up interval of 7.5 ± 0.6 years. The mean CT-LeSc at baseline and follow-up were 14.6 ± 4.2 and 16.9 ± 1.5, respectively, with an absolute increase of 2.3 ± 1.8. The mean cumulative increase of new lesions was 0.2 ± 0.2 per year. Over time, 14.6% of the non-obstructive lesions became obstructive, and 15.0% of the non-calcified plaques became calcified. There were 29 new lesions found at follow-up, and out of these, 16 were obstructive and 19 were non-calcified. CONCLUSION: In patients at high risk for cardiac events, as determined by CT-LeSc, there was an increase in CT-LeSc, obstructive lesions, and calcified plaques over the 7-year follow-up period. Most of the new lesions were obstructive and non-calcified. This is the first report showing long-term serial imaging CCTA changes in a high-risk population.

Correlation between computed tomography adapted leaman score and computed tomography liver and spleen attenuation parameters for non-alcoholic fatty liver disease as well as respective inflammatory mediators.

Metabolic syndrome is a primary driver of vascular inflammation, plaque development, and atherosclerotic disease. The Computed Tomography-adapted Leaman Score (CT-LeSc) has been shown to be an independent predictor of cardiac events in coronary artery disease (CAD) patients but has never been studied for broader applicability. Non-alcoholic fatty liver disease (NAFLD) is associated with similar systemic inflammatory processes as CAD, and its presence as assessed by Computed Tomography Liver and Spleen Attenuation (CT-LSA) may impact on the extension of the CT-LeSc. The purpose of this study was to investigate the association between the CT-LeSc and NAFLD and to characterize and compare the inflammatory processes of each disease state. This was an exploratory study in which patients with known multivessel CAD who were scheduled to undergo percutaneous coronary intervention were included. CT-LeSc were graded on pre-existing criteria by two independent CoreLab analysts. CT-LSA parameters analyzed included the liver absolute attenuation value, liver and spleen attenuation difference and liver-to-spleen attenuation ratio and were scored by two independent CoreLab analysts as well. Inflammatory mediator analysis included routine laboratory draws for a variety of known signal molecules. The overall liver absolute attenuation value did not correlate significantly with the CT-LeSc, but the subgroup 50 to 65 HU showed moderately negative correlation (R = - 0.629; p = 0.008). The overall liver and spleen attenuation difference did not correlate significantly with the CT-LeSc, but the subgroup 1 to 18 HU showed moderately positive correlation (R = 0.513; p = 0.017). The overall and subgroup liver-to-spleen attenuation ratio did not correlate with the CT-LeSc. The eosinophil and leukocyte ratio showed weakly negative correlation with the overall CT-LeSc (R = - 0.4602; p = 0.008), and VCAM-1 showed moderately negative correlation with CT-LeSc < 16.0 (R = - 0.5678; p = 0.022). Some CT-LSA parameters correlate with high risk CT-LeSc and may both provide complementary information for cardiovascular risk stratification. The significant metrics of liver absolute attenuation value and liver and spleen attenuation difference can be quickly completed in the clinical setting and may support a suspicion of CAD.

Síndrome de Waardenburg: relato de casos / Waardenburg syndrome: case reports

JUSTIFICATIVA E OBJETIVOS: A síndrome de Waardenburg é uma doença genética que na forma clássica, os pacientes apresentam várias características físicas marcantes e também surdez neurossensorial. Assim, a partir da exposição dos casos espera-se que os profissionais de saúde tomem conhecimento da doença e possam levantar a hipótese diagnóstica diante de um pacientecom fenótipo sugestivo, tendo em vista que possui baixa frequência na população e seu diagnóstico precoce melhora muito a qualidade de vida dos pacientes.RELATO DOS CASOS: Trata-se de três casos dentro de uma mesma família com características diferentes, inclusive, em relação à surdez genética. Características marcantes estão presentes nos casos, como: dystopia canthorum, epicanto, base nasal proeminente e alargada, maxila encurtada, poliose, encanecimento precoce e surdez congênita neurossensorial. CONCLUSÃO: A grande maioria dos casos desta síndrome é acompanhada de surdez congênita. As características físicas que acompanham a doença permitem o seu diagnóstico clínico, e o ideal seria que esses pacientes fossem diagnosticados ainda na infância para que possam ter acesso precocemente à reabilitação auditiva, contribuindo para melhor desenvolvimento neuropsíquico, levando-se em conta que eles também deverão receber aconselhamento genético.

BACKGROUND AND OBJECTIVES: Waardenburg syndrome is a rare genetic disease that shows variable penetrance and expressivity. In its classic form, patients have several outstanding characteristics, such as deafness. Thus, from the exposure of cases, it is important to be aware of this clinical disease, to health professionals, for early diagnosis, avoiding unnecessary examinations, and achieving effective therapeutic approach.CASE REPORTS: These are three cases in one family with different characteristics, including in relation to genetic deafness. Striking features are present in cases like: dystopia canthorum, epicanthus, prominent and broad nasal base, shortened jaw, poliosis, premature graying and congenital sensorineural deafness. CONCLUSION: Most cases of this syndrome is accompanied by congenital deafness. Therefore, early diagnosis will certainly help in hearing rehabilitation, improving the capacity of developing hearing and communication skills of these individuals.

Infecção em humanos por varíola bovina na região de Ibertioga, estado de Minas Gerais / Human infection with bovine smallpox in the Ibertioga region, State of Minas Gerais, Brazil

Introdução e objetivo: a varíola bovina é uma zoonose causada pela proliferação do vírus do gênero ortopoxvírus, sendo os bovinos a fonte primária de infecção humana. É importante apresentar relatos de casos dessa doença para que os profissionais de saúde, em especial os médicos, fiquem atentos para seu diagnóstico e tratamento corretos. Resultados: quatro casos de varíola bovina em humanos foram identificados e comprovados por exames sorológicos na região de Ibertioga, Minas Gerais. Todos os pacientes apresentavam sintomas em comum, como febre alta, falta de apetite, mialgia e lesões de pele. Conclusão: deve ser dada mais atenção aos casos dessa zoonose, no sentido de seu correto diagnóstico, adequada terapia de suporte e boa orientação para os pacientes, para que possa se evitar a transmissão intrafamiliar, bem como para animais com os quais venham a ter contato, considerando que a quase totalidade dos casos ocorre em áreas rurais.

Introduction and objective: Bovine smallpox is a zoonosis caused by Ortopxvirus proliferation, bovines being the primary source for human infection. Case reports of this disease are important to raise health professionals? consciousness of correct diagnosis and treatment.Results: Four cases of human infection with bovine smallpox were identified and confirmed by serologic exams in the Ibertioga region, State of Minas Gerais, Brazil Patients shared common symptoms such as high fever, decreased appetite, myalgia, and skin injury. Conclusion:The cases of this zoonosis should be paid more attention in order to enhance diagnosis, support therapy and guidance for patients witha view to avoiding intra-familiar and further animal transmission (as virtually all cases are reported in rural areas).

Doença ateromatosa multivascular: relato de caso / Multivessel atherosclerotic disease: case report

Objetivos: O envelhecimento da população representa um desafio para o sistema de saúde pelo aumento da incidência de doenças crônico-degenerativas, o que leva a crescentes custos econômicos e sociais. A mortalidade por doenças cardiovasculares aumenta com a idade: a partir dos 50 anos passa a ser a maior e a principal causa de óbitos no Brasil. A aterosclerose é uma dessas doenças, tendo diferentes fatores de riscos. Este relato de caso mostra uma doença multissistêmica grave, e visa mostrar a relação direta dos fatores de risco do estudo de Framingham na gênese da doença aterosclerótica arterial sistêmica. Os conhecimentos gerados poderiam facilitar o planejamento de ações para uma melhor avaliação de pacientes com essas morbidades, assim como a implantação de programas e estratégias que contribuam para melhorar o atendimento e a qualidade de vida de pacientes nesta faixa etária. Relato de Caso: Paciente do sexo masculino, 72 anos, hipertenso, diabético e dislipidêmico, internado no serviço de cardiologia do Hospital Ibiapaba em Barbacena, com quadro de dor precordial e claudicação intermitente. Foi submetido a estudo cineangiocoronariográfico que evidenciou ateromatose coronariana significativa com obstrução de 90% em coronária direita, 50% da circunflexa, e 40% na descendente anterior, além de extensa dilatação aneurismática do ventrículo esquerdo e acinesia de parede inferior e apical. No estudo angiográfico das artérias de membros inferiores foi constatado oclusão de 70% das ilíacas, entre outros vasos. Conclusões: Atualmente, existe consenso entre os pesquisadores de que são necessárias mais pesquisas sobre a simplicações dos fatores de risco para doenças cardiovasculares em idosos, devido a sua importância e impacto significativos. A doença neste segmento da população não é uma consequência inevitável do envelhecimento biológico, mas um processo patológico com fatores de risco que podem ser evitados.

Objectives: The rapidly aging population represents a major challenge for the health system, because of the higher incidence of chronic degenerative diseases, which leads to increasing economic and social costs. Mortality from cardiovascular disease is greatly increased with the passage of age, and from fifty years become the largest and the leading cause of deaths in Brazil. Atherosclerosis is one of these diseases, with different risk factors. This article, from a case report of a severe multisystem disease, aims to show the direct relation of risk factors in theFramingham study in the genesis of atherosclerotic arterial disease. The knowledge generated could facilitate the planning of actions to better access patients with these illnesses as wellas to develop programs and strategies that contribute to benefit the care and quality of life in this age group. Case Report: A male patient, 72 years, hypertensive, diabetic and dyslipidemic internship at the hospital’s cardiology service Ibiapaba in Barbacena withchest pain and intermittent claudication. He underwent coronaryangiographic study showed that significant atheromatous coronaryobstruction 90% in right coronary artery, the circumflex 50% and 40% left anterior descending, and extensive aneurysmal dilatation of the left ventricle and akinesis of inferior wall and apical. In the angiographic study of arteries of lower limbs was found 70% occlusion of iliac arteries, among other vessels. Conclusions: There is now consensus among researchers that more research is needed on the implications of risk factors for cardiovascular diseasein the elderly because of their importance and impact. The diseasein this population segment is not an inevitable consequence of biological aging, but a pathological process with risk factors can be avoided.