RESUMO
OBJECTIVE: To describe the echocardiographic and clinical findings of patients with accessory mitral valve (AMV). METHODS: Four adult patients were diagnosed to have AMV by Doppler echocardiography. RESULTS: All the four patients had cardiac murmur but 2 were asymptomatic. Echocardiogram showed that two cases had isolated AMV with significant left ventricular outflow tract (LVOT) obstruction. Another patient was complicated by idiopathic hypertrophic subaortic stenosis and his systolic pressure gradient across the LVOT reduced to normal after taking negative inotropic drugs. The fourth patient was associated with complex congenital cardiac anomalies but without LVOT obstruction. CONCLUSIONS: AMV may not be very rare as previously reported. An echocardiographic examination can detect AMV and differentiate it from other causes of LVOT obstruction.
Assuntos
Cardiopatias Congênitas , Valva Mitral/anormalidades , Adolescente , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Doppler em Cores , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagemRESUMO
BACKGROUND: This study was to investigate the relationship among aortic artery calcification (AAC), cardiac valve calcification (CVC), and mortality in maintenance hemodialysis (MHD) patients. METHODS: All MHD patients in Shanghai Ruijin Hospital in July 2011 were included. To follow up for 42 months, clinical data, predialysis blood tests, echocardiography, and lateral lumbar X-ray plain radiography results were collected. Plasma FGF23 level was measured using a C-terminal assay. RESULTS: Totally, 110 MHD patients were involved in this study. Of which, 64 (58.2%) patients were male, the mean age was 55.2 ± 1.4 years old, and the median dialysis duration was 29.85 (3.0-225.5) months. About 25.5% of the 110 MHD patients had CVC from echocardiography while 61.8% of the patients had visible calcification of aorta from lateral lumbar X-ray plain radiography. After 42 months follow-up, 25 (22.7%) patients died. Kaplan-Meier analysis showed that patients with AAC or CVC had a significant greater number of all-cause and cardiovascular deaths than those without. In multivariate analyses, the presence of AAC was a significant factor associated with all-cause mortality (hazard ratio [HR]: 3.149, P = 0.025) in addition to lower albumin level and lower 25-hydroxy Vitamin D (25(OH)D) level. The presence of CVC was a significant factor associated with cardiovascular mortality (HR: 3.800, P = 0.029) in addition to lower albumin level and lower 25(OH)D level. CONCLUSION: Lateral lumbar X-ray plain radiography and echocardiography are simple methods to detect AAC and CVC in dialysis patients. The presence of AAC and CVC was independently associated with mortality in MHD patients. Regular follow-up by X-ray and echocardiography could be a useful method to stratify mortality risk in MHD patients.
Assuntos
Doenças da Aorta/complicações , Calcinose/complicações , Doenças das Valvas Cardíacas/complicações , Valvas Cardíacas/patologia , Diálise Renal/mortalidade , Doenças da Aorta/sangue , Calcinose/sangue , China , Feminino , Fator de Crescimento de Fibroblastos 23 , Fatores de Crescimento de Fibroblastos/sangue , Seguimentos , Doenças das Valvas Cardíacas/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos ProporcionaisRESUMO
OBJECTIVES: To evaluate the association of left ventricular (LV) diastolic function and N-terminal pro-brain natriuretic peptide (NT-proBNP) with renal function in essential hypertension. METHODS: LV diastolic function was estimated by the ratio of early diastolic velocities (E) from transmitral inflow to early diastolic velocities (E') of tissue Doppler at mitral annulus (septal corner); NT-proBNP was measured in 207 hypertensive patients (mean age 56±14 years). The subjects were classified into 3 groups: E/E'≤10 group (n = 48), 10
Assuntos
Diástole , Taxa de Filtração Glomerular , Hipertensão/etiologia , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Disfunção Ventricular Esquerda , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Insuficiência Renal Crônica , Fatores de RiscoRESUMO
Thoracic pheochromocytomas account for less than 2% of reported cases, while primary cardiac paragangliomas are even rare. The following case illustrates a 15-year-old patient with primary right atrium paraganglioma. This patient was referred for paroxysmal hypertension and excessive perspiration. Pheochromocytoma was suspected and then confirmed by very high serum nor-metanephrine which increased more than 30-fold above the upper limit of normal. 131I-metaiodobenzylguanidine (MIBG) scintigraphy showed high uptake only in the middle mediastinum, but not in the adrenal glands or elsewhere. Both contrast CT and gated MRI of the chest disclosed a 5.0 x 4.0 cm2 mass in the right atrium. Coronary angiography demonstrated the mass with feeding vessels from the right coronary artery. When the patient's blood pressure was well controlled with doxazosin and metoprolol, surgery was then performed. A 6.0 x 4.9 x 4.0 cm3 round solid right atrium paraganglioma weighing 41.7 g was resected. The second day after surgery, serum nor-metanephrine and urinary noradrenaline levels dropped rapidly to normal range, and the patient was free of clinical symptoms with normal BP. Postoperative cardiac function, as measured by echocardiogram, was normal. Although cardiac paraganglioma may be difficult to resect, it can be cured.