Assuntos
Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia por Agulha , Ecocardiografia/métodos , Seguimentos , Humanos , Imuno-Histoquímica , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Imageamento por Ressonância Magnética/métodos , Masculino , Radiografia Torácica/métodos , Medição de Risco , Síndrome da Veia Cava Superior/patologia , Parede Torácica/diagnóstico por imagem , Parede Torácica/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoAssuntos
Bioprótese , Implante de Prótese de Valva Cardíaca/efeitos adversos , Imageamento Tridimensional , Insuficiência da Valva Mitral/cirurgia , Falha de Prótese , Tomografia Computadorizada por Raios X/métodos , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Seguimentos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Reoperação/métodos , Resultado do TratamentoRESUMO
Vacuum-assisted thrombectomy (VAT) is a mechanical suction device that can be deployed to aspirate thrombi in the heart and vascular system. Successful percutaneous aspiration of iliocaval, right heart, and pulmonary arterial thrombi have been reported, in addition to the debulking of intravascular and intracardiac masses and vegetations. VAT is indicated for patients who are poor surgical candidates and/or have a contraindication to thrombolysis. This review discusses the mechanism, current results, potential clinical indications, and limitations of VAT for iliocaval and intracardiac mass removal.
Assuntos
Trombose Coronária/cirurgia , Cardiopatias/cirurgia , Embolia Pulmonar/cirurgia , Trombectomia/métodos , Trombose/cirurgia , Vácuo , Trombose Venosa/cirurgia , Átrios do Coração , Humanos , Veias CavasAssuntos
Cateterismo Cardíaco/métodos , Endocardite Bacteriana/microbiologia , Infecções Estafilocócicas/complicações , Abuso de Substâncias por Via Intravenosa/complicações , Insuficiência da Valva Tricúspide/cirurgia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Cateteres Cardíacos , Ecocardiografia/métodos , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Infecções Estafilocócicas/diagnóstico , Abuso de Substâncias por Via Intravenosa/diagnóstico , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/microbiologiaRESUMO
Congenital abnormalities of the pericardium are a rare group of disorders that include congenital absence of the pericardium, pericardial cysts, and diverticula. These congenital defects result from alterations in the embryologic formation and structure of the pericardium. Although many cases are incidentally found, they can present as symptomatic, life-threatening disease. Owing to their rarity, many cases are inappropriately diagnosed. Alterations in the embryologic formation and structure may result in the formation of these congenital abnormalities. We review the presentation, diagnosis, and management of congenital absence of the pericardium, pericardial cysts, and diverticula. A summary of multimodality imaging features is provided.
Assuntos
Divertículo/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Cisto Mediastínico/diagnóstico por imagem , Pericárdio/anormalidades , Angiografia Coronária , Divertículo/embriologia , Divertículo/fisiopatologia , Divertículo/terapia , Ecocardiografia , Cardiopatias Congênitas/embriologia , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Imageamento por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Cisto Mediastínico/embriologia , Cisto Mediastínico/fisiopatologia , Cisto Mediastínico/terapia , Pericárdio/diagnóstico por imagem , Pericárdio/embriologia , Radiografia Torácica , Tomografia Computadorizada por Raios XAssuntos
Amiloidose/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Mapeamento Potencial de Superfície Corporal , Cardiomiopatia Restritiva/diagnóstico por imagem , Imagem Multimodal , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Diagnóstico Diferencial , Ecocardiografia/métodos , Feminino , Humanos , Imageamento Tridimensional , Amiloidose de Cadeia Leve de Imunoglobulina , Imagem Cinética por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodosRESUMO
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
Assuntos
Ecocardiografia Transesofagiana/normas , Cardiopatias/complicações , Guias de Prática Clínica como Assunto , Tromboembolia/etiologia , Diagnóstico Diferencial , Cardiopatias/diagnóstico por imagem , Humanos , Tromboembolia/diagnósticoAssuntos
Falso Aneurisma/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração/cirurgia , Complicações Pós-Operatórias , Cirurgia Assistida por Computador/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Estenose da Valva Aórtica/cirurgia , Cateterismo Cardíaco/métodos , Feminino , Fluoroscopia , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Reoperação , Dispositivo para Oclusão Septal , Tomografia Computadorizada por Raios XRESUMO
AIMS: Structural deterioration and paravalvular leak (PVL) are complications associated with surgically implanted prosthetic valves, historically requiring reoperation. We present our experience of complete transcatheter repair of a degenerated mitral bioprosthesis. METHODS AND RESULTS: From March 2012 to October 2012, we reviewed consecutive, high-risk surgical patients (n=5) who underwent transcatheter repair of a failed mitral bioprosthesis with severe paravalvular regurgitation (PVR). Manufacturer valve sizes ranged from 27 to 33 mm, regurgitation (n=1), stenosis (n=1), or both (n=3). Percutaneous transapical and transseptal access were achieved with PVL closure performed transapically. An arteriovenous rail was created for transseptal delivery of a Melody valve. All patients had successful PVL closure with no residual PVR. Valve-in-valve (ViV) implantation was successful in four patients. Overall, mean transvalvular mitral gradient was 11.2 mmHg pre-procedure which improved to 5 mmHg post-procedure. Improvement of NYHA Class ≥2 was achieved in all patients (19±3 months). One patient had controlled Melody valve embolisation which required emergent surgical replacement. Inner valve diameter was 26 mm, too large for Melody valve implantation. CONCLUSIONS: Complete transcatheter repair of a degenerated mitral bioprosthesis with PVR can be performed in the high-risk patient. Accurate measurement is necessary prior to intervention, with concern for embolisation among the larger valve sizes (>31 mm).
Assuntos
Bioprótese , Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Falha de Prótese/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
AIMS: Transcatheter techniques can theoretically be applied to the treatment of para-annular ring (PAR) leaks. Little is known about their potential application and resultant complications in such cases. We describe the first-in-man percutaneous transapical-transseptal Melody valve-in-ring (ViR) implantation after a complication from percutaneous PAR leak closure. METHODS AND RESULTS: A 49-year-old woman, at high operative risk, presented with congestive heart failure secondary to severe para-ring/extravalvular regurgitation two months after bypass surgery and mitral ring annuloplasty. Successful percutaneous closure of the leak was performed using an AMPLATZER Vascular Plug IV. One month later, she developed haemolysis with severe PAR regurgitation, through and around the device. After device retrieval and placement of an AMPLATZER Muscular VSD occluder, the patient developed severe intravalvular regurgitation. Completely percutaneous, transseptal delivery of a Melody ViR was performed over a transapical-transseptal, arteriovenous rail. Echocardiography revealed trivial residual regurgitation through the implanted valve with mild transvalvular gradients. CONCLUSIONS: Percutaneous closure of mitral PAR leaks after ring annuloplasty in the high-risk patient is feasible (proof-of-concept), particularly when the leak is para-ring/extravalvular. Potential complications include severe intravalvular mitral regurgitation caused by disruption of the mitral apparatus and/or ring deformation during device deployment, which can be successfully treated via percutaneous transapical-transseptal ViR implantation.
Assuntos
Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Falha de Prótese , Dispositivo para Oclusão Septal , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Left ventricular pseudoaneurysm and ventricular septal defect are rare but devastating complications of myocardial infarction. With medical treatment alone, the majority of patients will die from these complications. Until recently, the recommended treatment was surgical closure. These surgeries carried extreme risk due to abnormal hemodynamics, necrotic substrates and the comorbidities of these patients. Recently, trans-catheter closure was shown to be an acceptable alternative to open surgical intervention. 3D echocardiography identifies the location, size, and shape of the defect and can assess, guide, and follow up the closure procedure.
Assuntos
Falso Aneurisma/cirurgia , Comunicação Interventricular/cirurgia , Infarto do Miocárdio/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Cateterismo Cardíaco/métodos , Ecocardiografia Tridimensional/métodos , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/etiologia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Dispositivo para Oclusão Septal , Ultrassonografia de Intervenção/métodosRESUMO
An 86-year-old man with severe symptomatic aortic stenosis underwent an aortic valve replacement. A transesophageal echocardiogram (TEE) was performed during the surgery and demonstrated mild mitral regurgitation (MR). The patient's symptoms persisted despite surgery, and subsequent TEE demonstrated prolapse of the posteromedial commissural leaflet, with evidence of a severe, very eccentric MR jet which was directed laterally and superiorly. The jet was almost missed in most imaging planes and could finally be exposed by withdrawing the probe to the level of the aortic valve and left atrial appendage.
Assuntos
Estenose da Valva Aórtica/cirurgia , Apêndice Atrial/fisiopatologia , Ecocardiografia Transesofagiana/métodos , Insuficiência da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Apêndice Atrial/diagnóstico por imagem , Humanos , Masculino , Insuficiência da Valva Mitral/fisiopatologiaRESUMO
Atrial fibrillation is a common, clinically significant arrhythmic disorder that results in increased risk of morbidity and mortality in affected patients. Atrial fibrillation is more prevalent among men compared with women and the risk for developing atrial fibrillation increases with advancing age. Ischaemic stroke is the most common clinical manifestation of embolic events from atrial fibrillation. While anticoagulation treatment is the preferred treatment, unfortunately, many patients have contraindications for anticoagulation treatment making this option unavailable to them. Previous data have shown that most thrombi that form in association with non-valvular atrial fibrillation occur in the left atrial appendage (LAA). It has been suggested that isolating the LAA from the body of the left atrium might reduce the risk of embolic events and that LAA obliteration may be a treatment option for patients with atrial fibrillation who are not candidates for anticoagulation treatment. Several procedures have been developed for isolation of the LAA, including surgical procedures as well as catheter-based ones. In this paper, we will review the currently available techniques, emphasizing the catheter-based ones. We will examine the increasing role of real-time three-dimensional transoesophageal echocardiography for appropriate screening and patient selection for these procedures, intra-procedural guidance, and follow-up care.
Assuntos
Angioplastia Coronária com Balão/métodos , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Fibrilação Atrial/epidemiologia , Seguimentos , Humanos , Programas de Rastreamento , Seleção de Pacientes , Politetrafluoretileno , Prevalência , Próteses e Implantes , Desenho de Prótese , Fatores de Risco , Distribuição por Sexo , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: The purpose of this study was to evaluate the feasibility and efficacy of the percutaneous device closure of a consecutive series of patients with periprosthetic paravalvular leaks referred to our structural heart disease center with congestive heart failure and hemolytic anemia. BACKGROUND: Clinically significant periprosthetic paravalvular leak is an uncommon but serious complication after surgical valve replacement. Percutaneous closure has been utilized as an alternative to surgical repair of this defect in high-risk surgical patients. METHODS: This is a retrospective review of 57 percutaneous paravalvular leak closures that were performed in 43 patients (67% male, mean age 69.4 ± 11.7 years) between April 2006 and September 2010. Integrated imaging modalities were used for the evaluation, planning, and guidance of the interventions. RESULTS: Closure was successful in 86% of leaks and in 86% of patients. Twenty-eight of 35 patients improved by at least 1 New York Heart Association functional class. The percentage of patients requiring blood transfusions and/or erythropoietin injections post-procedure decreased from 56% to 5%. Clinical success was achieved in 89% of the patients in whom procedure was successful. The survival rates for patients at 6, 12, and 18 months after paravalvular leak closures were 91.9%, 89.2%, and 86.5%, respectively. Freedom from cardiac-related death at 42 months post-procedure was 91.9%. CONCLUSIONS: Percutaneous closure of symptomatic paravalvular leaks, facilitated by integrated imaging modalities has a high rate of acute and long-term success and appears to be effective in managing symptoms of heart failure and hemolytic anemia.
Assuntos
Cateterismo Cardíaco/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Reoperação/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Insuficiência da Valva Mitral/mortalidade , Falha de Prótese , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
PURPOSE OF REVIEW: To describe cholesterol embolization syndrome (CES) and its risk factors, pathophysiology, clinical presentation, diagnosis and treatment. RECENT FINDINGS: To date, no specific diagnostic test (other than biopsy) for CES has been developed. Effective treatments for CES are yet to be developed. SUMMARY: CES (also referred to as cholesterol crystal embolization, atheromatous embolization or atheroembolism) occurs when cholesterol crystals and other contents of an atherosclerotic plaque embolize from a large proximal artery to smaller distal arteries, causing ischemic end-organ damage. Clinical manifestations of CES include constitutional symptoms (fever, anorexia, weight loss, fatigue and myalgias), signs of systemic inflammation (anemia, thrombocytopenia leukocytosis, high erythrocyte sedimentation rate, elevated levels of C-reactive protein, hypocomplementemia), hypereosinophilia, eosinophiluria, acute onset of diffuse neurologic deficit, amaurosis fugax, acute renal failure, gut ischemia, livedo reticularis and blue-toe syndrome. CES may occur spontaneously or after an arterial procedure. There is no specific laboratory test for CES. Retinal exam demonstrating Hollenhorst plaques supports the diagnosis of CES. Biopsy of target organs (usually skin, skeletal muscles or kidneys) is the only means of confirming the diagnosis of CES. Treatment consists of supportive care and general management of atherosclerosis and arterial ischemia.
Assuntos
Embolia de Colesterol/complicações , Embolia de Colesterol/diagnóstico , Proteína C-Reativa/metabolismo , Progressão da Doença , Embolia de Colesterol/tratamento farmacológico , Humanos , Inflamação/etiologia , Inflamação/patologia , Nefropatias/etiologia , Nefropatias/patologia , Fatores de Risco , Dermatopatias/etiologia , Dermatopatias/patologia , SíndromeAssuntos
Apêndice Atrial/diagnóstico por imagem , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Feminino , Fibroma/complicações , Fibroma/patologia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/patologia , Humanos , Pessoa de Meia-Idade , Paresia/etiologia , UltrassonografiaRESUMO
BACKGROUND: Left ventricular pseudoaneurysm is a rare but serious complication from myocardial infarction and cardiac surgery. Although standard treatment is surgical intervention, percutaneous closure of left ventricular pseudoaneurysm has become an option for high-risk surgical candidates. Experience with percutaneous treatment is limited to a few single case reports. This is the first series of percutaneous treatment of the left ventricular pseudoaneurysms. METHODS AND RESULTS: This is a retrospective analysis of 9 procedures of percutaneous repair of left ventricular pseudoaneurysm in 7 consecutive patients (ages 51 to 83 years, 6 men) completed in our Structural Heart Disease center from June 2008 to December 2010. All patients were considered as a high risk for surgery because of multiple comorbidities. Multiple imaging modalities were used before, during, and after the procedures to improve success and efficacy. The left ventricular pseudoaneurysms of all 7 patients were successfully repaired. Fluoroscopy time on average was 36.5±24.0 minutes (range, 12.4 to 75.7 minutes). All patients were followed up for a period ranging from 3 to 32 months after the procedure. Each patient improved by at least 1 New York Heart Association functional class, and 4 patients improved by 2 classes. CONCLUSIONS: Transcatheter closure of the left ventricular pseudoaneurysm is a feasible alternative for high-risk surgical candidates. The use of multiple imaging modalities is required for a detail planning and execution of the procedure.