RESUMO
BACKGROUND: Cardiac magnetic resonance (CMR) has demonstrated its utility in the noninvasive diagnosis of cardiac amyloidosis (CA). Our aim was to evaluate the ability of standard Look-Locker sequences to quantify amyloid deposition in CA. METHODS AND RESULTS: Consecutive patients referred for CMR for possible CA were retrospectively evaluated. Positive cardiac biopsy and/or typical pattern of late gadolinium enhancement were required for the diagnosis of CA. Postcontrast T1 values were obtained from Look-Locker sequences and correlated with markers of severity of disease and major events. When cardiac biopsies were available, histological validation was determined. A total of 174 patients were included. A final diagnosis of CA was reached in 37.4%. Myocardial and endocardial T1 times, as well as the respective ratios with blood and skeletal muscle, were lower among patients with CA and demonstrated good diagnostic performance. The best parameters were myocardial/blood (area under the curve 0.83; P < .001) and endocardial/blood (area under the curve 0.84; P < .001) T1 ratios. Among patients with CA, no associations were found between T1 ratios either with markers of amyloid burden or with prognostic variables. However, all T1 indexes showed significant correlations with histological quantification of amyloid deposition. CONCLUSIONS: Look-Looker derived postcontrast T1 shows good diagnostic accuracy to detect CA and correlation with histological amyloid burden.
Assuntos
Amiloide/metabolismo , Amiloidose/diagnóstico , Cardiomiopatias/diagnóstico , Imagem Cinética por Ressonância Magnética/métodos , Miocárdio/metabolismo , Idoso , Amiloidose/metabolismo , Biópsia , Cardiomiopatias/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
OBJECTIVE: We sought to investigate mid-term clinical outcomes and identify risk factors in one of the largest comprehensive series reported of femoro-ilio-caval (FIC) vein stent placement. BACKGROUND: Endovascular intervention with balloon angioplasty and stenting of the iliac and common femoral veins has become first-line treatment for symptomatic deep venous outflow obstruction. METHODS: We conducted a single-center, retrospective analysis of 180 patients who underwent FIC stent implantation between May 2017 and May 2019; 327 procedures were performed. Our primary objective was to evaluate a composite of stent thrombosis and stent restenosis. Secondary outcomes included individual predictors of in-stent restenosis (ISR) and in-stent thrombosis (IST), primary and secondary patency, access-site complications, major bleeding, pulmonary embolism, cardiovascular death, any death, intracranial bleeding, all-cause mortality, and components of major adverse cardiac and cerebrovascular events (MACCE) in a 24-month period. RESULTS: A total of 327 procedures were performed for 180 patients. At 2-year follow up, 78.3% of cases remained free of any complication. Primary outcome occurred in 53 procedures (16.2%) and was highest at early (<30 days) follow-up. Primary patency at 2-year follow-up was 78.43%. There were no deaths, 1 patient (0.3%) had a subdural hematoma, and 3 patients (0.9%) had MACCE. Age and post-thrombotic syndrome (PTS) were significant predictors of primary outcome. PTS and Venous Clinical Severity score (VCSS) ≥10 were found to have higher rates of thrombosis. Active smokers, the elderly, history of deep vein thrombosis (DVT), and VCSS ≥10 had a statistically significant elevated risk of ISR. CONCLUSION: Endovascular treatment with stent implantation for non-thrombotic iliac vein lesion and PTS is safe, with low morbidity, zero mortality, low complications, and persistent improvement of symptoms. Age and PTS were significant predictors of primary outcome.
Assuntos
Procedimentos Endovasculares , Síndrome de May-Thurner , Síndrome Pós-Trombótica , Idoso , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
Coronary revascularization is accomplished either by percutaneous coronary intervention (PCI), with low risk of immediate complications, or coronary artery bypass graft (CABG), with improved long-term, event-free survival attributable to use of the left internal mammary artery graft. Hybrid coronary revascularization (HCR) combines both. The left internal mammary artery graft is done by sternal-sparing approaches or by robotic-assisted, endoscopic surgery. HCR reduces bleeding, ventilator time, and length of stay compared with traditional CABG. Compared with PCI, HCR offers the durability and survival advantages of the left internal mammary artery. The large-scale National Heart, Lung, and Blood Institute-sponsored, randomized Hybrid Trial (Hybrid Coronary Revascularization Trial) was initiated to examine whether HCR is superior to multivessel PCI. However, enrollment was suboptimal, triggering premature study discontinuation. HCR integrates the positive features of both PCI and CABG, albeit requiring 2 procedures rather than 1. Adequately powered randomized trials are required to evaluate the outcomes and cost-effectiveness of HCR compared with CABG and multivessel PCI alone.
Assuntos
Cardiologia , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos , Revascularização Miocárdica/métodos , Publicações Periódicas como Assunto , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Humanos , Resultado do TratamentoRESUMO
Three dimensional (3D) printing is rapidly gaining interest in the medical field for use in presurgical planning. We present the case of a seven-year-old boy with double outlet right ventricle who underwent a bidirectional Glenn anastomosis. We used a 3D cardiac model to assess his suitability for a biventricular repair. He underwent a left ventricle-to-aorta baffle with a right ventricle-to-pulmonary artery conduit placement. He did well postoperatively and was discharged home with no evidence of baffle obstruction and good biventricular function. A 3D printed model can provide invaluable intracardiac spatial information in these complex patients.
Assuntos
Dupla Via de Saída do Ventrículo Direito/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Modelos Anatômicos , Aorta/diagnóstico por imagem , Aorta/cirurgia , Criança , Dupla Via de Saída do Ventrículo Direito/diagnóstico por imagem , Dupla Via de Saída do Ventrículo Direito/patologia , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Imageamento Tridimensional , Masculino , Modelos Cardiovasculares , Impressão Tridimensional , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Resultado do TratamentoRESUMO
46 year old female with history of progressive shortness of breath for 3 years associated with recurrent right lung infiltrates and hemoptisis. A computed tomography of the chest showed a left atrial mass suggestive of atrial myxoma confirmed with transesophageal echocardiogram. Contrary with findings from a dedicated EKG gated cardiac computed tomography suggestive of cor triatriatum with associated thrombus and less likely a neoplasm; findings later on confirmed during surgery. Cardiac CT offers superior spatial resolution and multi-planar image reconstructions, allowing improved characterization of cardiac structures and cardiac masses compared to other traditional cardiovascular imaging modalities.
Assuntos
Coração Triatriado/diagnóstico por imagem , Trombose Coronária/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Edema Pulmonar/etiologia , Técnicas de Imagem de Sincronização Cardíaca , Coração Triatriado/complicações , Coração Triatriado/cirurgia , Trombose Coronária/etiologia , Trombose Coronária/cirurgia , Erros de Diagnóstico , Ecocardiografia Transesofagiana , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios XRESUMO
A 56-year-old man with a history of complex atrial-septal defect repair, atrial fibrillation, and severe mitral regurgitation presented with progressive shortness of breath. A cardiac CT examination was done as part of a preoperative protocol before mitral valve replacement and it showed a severely enlarged left atrium and an anomalous hepatic vein draining into the left atrium. These findings were totally unsuspected and changed the patient management, highlighting the benefit of cardiac CT beyond the coronary finding.