RESUMEN
OBJECTIVES: The objective of this study is to analyze the clinical outcomes and treatment strategies of coronary wire perforations (WPs) in the era of heparin use compared to the era of bivalirudin use. BACKGROUND: Percutaneous coronary intervention (PCI) advances have led to progressive decrease in complications. Therefore, complex coronary lesions such as chronic total occlusions and calcified lesions are being attempted with stiff/hydrophilic wires with resultant higher incidence of coronary WP. METHODS: A single-center retrospective data analysis of coronary perforation (CP) for the last 4 years with review of coronary angiograms was done and WPs were identified. A simple classification scheme based on angiographic appearance of CP was made: Type I ("myocardial stain," with no frank dye extravasation) and type II ("myocardial fan," with dye extravasation to pericardial cavity or cardiac chambers). RESULTS: Overall incidence of CP was 0.49% (82/16,859). Of these 50 (61%) were caused by WP; 30 occurred with heparin use (Group A) and 20 with bivalirudin use (Group B). WPs always occurred in type B2/C lesions (100%) and commonly with use of hydrophilic guidewires (70%). Major adverse cardiac events and cardiac tamponade were frequent in group A (50%) and none in group B (0%); P < 0.01. All WP in group B responded to stopping anticoagulation and prolonged balloon inflation, while group A type II perforations frequently required additional interventions (pericardiocentesis, coil embolization). CONCLUSIONS: Cardiac tamponade and major adverse cardiac events from WPs were less frequent with bivalirudin use compared to heparin use. This beneficial effect of bivalirudin may be explained on the basis of its short half-life and reversible thrombin inhibition property. Therefore, bivalirudin may offer a safer alternative for anticoagulation in complex PCI.
Asunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Anticoagulantes/efectos adversos , Taponamiento Cardíaco/terapia , Enfermedad de la Arteria Coronaria/terapia , Vasos Coronarios/lesiones , Heparina/efectos adversos , Hirudinas/efectos adversos , Fragmentos de Péptidos/efectos adversos , Heridas Penetrantes/terapia , Anciano , Angioplastia Coronaria con Balón/instrumentación , Angioplastia Coronaria con Balón/mortalidad , Oclusión con Balón , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/mortalidad , Cineangiografía , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Antagonistas de Heparina/uso terapéutico , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Pericardiocentesis , Proteínas Recombinantes/efectos adversos , Sistema de Registros , Estudios Retrospectivos , Resultado del Tratamiento , Heridas Penetrantes/diagnóstico por imagen , Heridas Penetrantes/etiología , Heridas Penetrantes/mortalidadRESUMEN
OBJECTIVES: The aim of the present study was to study the outcome of coronary stenting in patients with symptomatic myocardial bridging refractory to standard medical therapy. BACKGROUND: Medical therapy constitutes the first line treatment for patients with symptomatic myocardial bridge, surgical correction may be offered to select patients with refractory symptoms. Limited data exists on the outcome of coronary stenting in this patient cohort. METHODS: Twenty-nine patients with symptoms of angina, documented myocardial ischemia and angiographically documented myocardial bridge of the left anterior descending artery (defined as [mt]50% systolic compression) were identified retrospectively. Seventeen (59%) patients responded to maximized medical therapy (mean age 51 +/- 16 years, range 29-80, 7 female) and 12 (41%) patients received coronary stents following a failed attempt of minimum 3 months of maximal medical therapy (mean age 49 +/- 15 years, range 32-76 years, 5 females). Medical therapy responders were compared with intracoronary stent group for recurrent severe angina, target vessel revascularization (TVR), myocardial infarction (MI), and death at follow-up. RESULTS: Intracoronary stents were placed in all patients successfully. The incidence of recurrent severe angina and TVR were significantly greater in the stent group (P = 0.04) while MI and death in two groups were similar at mean follow-up of 15 +/- 3 months. CONCLUSIONS: Coronary stent placement for medically refractory symptomatic myocardial bridge failed to relieve severe angina and is associated with high clinical restenosis and hence should be avoided.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Puente Miocárdico/tratamiento farmacológico , Puente Miocárdico/terapia , Stents , Adulto , Anciano , Anciano de 80 o más Años , Cineangiografía , Reestenosis Coronaria/epidemiología , Stents Liberadores de Fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Retratamiento , Estudios Retrospectivos , Insuficiencia del TratamientoAsunto(s)
Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Cardiopatías Congénitas/diagnóstico por imagen , Ventrículos Cardíacos/anomalías , Disfunción Ventricular/diagnóstico por imagen , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Índice de Severidad de la Enfermedad , Disfunción Ventricular/etiología , Disfunción Ventricular/fisiopatologíaAsunto(s)
Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/patología , Sistemas de Computación , Ecocardiografía Tridimensional , Anciano , Estenosis Aórtica Supravalvular/diagnóstico por imagen , Estenosis de la Válvula Aórtica/etiología , Estenosis de la Válvula Aórtica/cirugía , Calcinosis/diagnóstico por imagen , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Estenosis de la Válvula Mitral/diagnóstico por imagen , Índice de Severidad de la EnfermedadRESUMEN
Ochrobactrum anthropi is an emerging pathogen increasingly affecting the immunocompromised host. Only four cases of infective endocarditis have been documented in literature. Therapeutic approach is a rising challenge as it is resistant to most of the currently available beta lactam antibiotics with the exception of carbapenems. We report a case of prosthetic valve endocarditis secondary to Ochrobactrum anthropi infection; the host was temporarily immunocompromised due to disseminated herpes zoster after surgery.
Asunto(s)
Válvula Aórtica/microbiología , Carbapenémicos/uso terapéutico , Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , Ochrobactrum anthropi/aislamiento & purificación , Anciano , Endocarditis Bacteriana/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , MasculinoRESUMEN
OBJECTIVES: The objectives of the present study were to evaluate the feasibility and safety of implanting a prophylactic left ventricular (LV) assist device prior to high-risk percutaneous coronary intervention (PCI) and to assess the impact of suturemediated preclosure of the arteriotomy site on minimizing vascular complications. BACKGROUND: Patients with multivessel disease, left main coronary artery disease (LMCA) or left main equivalent and/or moderate-to-severe LV dysfunction with elevated LV end-diastolic pressure are at increased risk of complications during PCI. The TandemHeart (TH) is a nonpulsatile percutaneous transseptal ventricular assist device (PTVA) that offers vital temporary hemodynamic support during high-risk PCI. METHODS: Between April 2004 and November 2005, the TH was implanted in 20 patients undergoing high-risk PCI. Eight patients underwent unprotected LMCA stenting, and rotational atherectomy was used in 17 patients. Suture-mediated femoral artery preclosure was performed prior to inserting a large-bore arterial cannula. RESULTS: The TH was successfully implanted in all 20 patients. Mean LV ejection fraction of the study patients was 38 +/- 18%. Time-to-implantation of the TH, duration of hemodynamic support and mean flow of the TH device were 31 +/- 9 minutes, 74 +/- 40 minutes and 2.5 +/- 1.3 L/minute, respectively. At the end of PCI, the TH was removed in all cases and Perclose sutures were deployed in 18/20 (90%) patients. There was only 1 minor vascular complication, and the average length of stay was 2 +/- 1 days. Periprocedural and inhospital mortality was 0%. CONCLUSIONS: Implantation of the TH PTVA is safe and feasible in patients undergoing high-risk PCI with excellent hemodynamic support. Application of suture-mediated devices prior to large arteriotomies can significantly reduce the incidence of vascular complications.
Asunto(s)
Angioplastia Coronaria con Balón , Implantación de Prótesis Vascular , Enfermedad de la Arteria Coronaria/cirugía , Corazón Auxiliar , Disfunción Ventricular Izquierda/cirugía , Anciano , Enfermedad de la Arteria Coronaria/complicaciones , Reestenosis Coronaria/prevención & control , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del Tratamiento , Disfunción Ventricular Izquierda/etiologíaRESUMEN
The TandemHeart is a recently-introduced percutaneous ventricular assist device that may be used for short-term hemodynamic support. Its utility has been shown for assisting the left ventricle in a variety of high-risk percutaneous interventions, in helping the left ventricle recover from myocarditis, in cardiomyopathies and in cardiogenic shock following acute coronary syndromes. Limited data exist on its applications in patients with right ventricular failure. We report our experience, possibly the first human case description, of a patient in cardiogenic shock secondary to severe pulmonary artery hypertension where the TandemHeart was used as a short-term hemodynamic support tool.
Asunto(s)
Corazón Auxiliar , Hipertensión Pulmonar/complicaciones , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia , Adulto , Cineangiografía , Enfermedad Crítica/terapia , Ecocardiografía , Resultado Fatal , Femenino , Humanos , Hipertensión Pulmonar/fisiopatología , Arteria Pulmonar/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Choque Cardiogénico/diagnóstico por imagenRESUMEN
TandemHeart is a recently-introduced percutaneous left ventricular assist device that can be used for hemodynamic support during high-risk interventional procedures in severely compromised patients. Angioplasty and stent placement in patients with coronary artery disease and high-risk coronary anatomy including the left main coronary artery have been described using this device. We report the first human case description of a high-risk percutaneous balloon aortic valvuloplasty for critical bicuspid aortic stenosis using the TandemHeart for periprocedural hemodynamic support. Also not previously reported is the use of bivaluridin as the periprocedural antithrombin agent during and after high-risk aortic valvuloplasty.
Asunto(s)
Angioplastia de Balón/métodos , Estenosis de la Válvula Aórtica/terapia , Corazón Auxiliar , Fragmentos de Péptidos/uso terapéutico , Anticoagulantes/uso terapéutico , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Cateterismo Cardíaco , Ecocardiografía Transesofágica , Estudios de Seguimiento , Hirudinas , Humanos , Contrapulsador Intraaórtico/métodos , Masculino , Persona de Mediana Edad , Proteínas Recombinantes/uso terapéutico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Volumen Sistólico , Resultado del TratamientoRESUMEN
Periprocedural hemodynamic stability is the cornerstone of success for complex percutaneous interventions. Percutaneous left ventricular assist devices (VSD) are increasingly being used to perform complex percutaneous coronary and non-coronary interventions. We report our experience in utilizing the TandemHeart, a percutaneous VSD, to successfully perform complex tandem procedures; balloon aortic valvuloplasty and angioplasty.
Asunto(s)
Angioplastia Coronaria con Balón , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Corazón Auxiliar , Angiografía Coronaria , Humanos , Masculino , Persona de Mediana Edad , Disfunción Ventricular Izquierda/cirugíaRESUMEN
We describe an adult patient in whom the valve of foramen ovale and its opening and closing movements were well visualized by live/real time three-dimensional transthoracic echocardiography.
Asunto(s)
Ecocardiografía Tridimensional/métodos , Foramen Oval/anomalías , Cardiopatías Congénitas/diagnóstico por imagen , Válvulas Cardíacas/anomalías , Adulto , Diagnóstico Diferencial , Femenino , Foramen Oval/diagnóstico por imagen , HumanosRESUMEN
Twenty-one patients (mean age 47.5 years, 9 females) with left ventricular noncompaction (LVNC) diagnosed by both two-dimensional transthoracic echocardiography (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE) were included in the study. Left ventricular (LV) mass was calculated with epicardial and endocardial border tracings first including the LV trabeculations and then excluding them. LV trabecular mass was then derived as the difference between the two measurements. This was done by 2DTTE using the modified biplane Simpson's method and by live/real time 3DTTE using the Tom Tec imaging system. The number of trabeculations arising from each segment of LV walls as well as the segmental distribution of trabeculations were also assessed by both 2DTTE and 3DTTE. The calculated LV trabecular mass by 3DTTE (mean 11.8 +/- 5.5 g) was significantly greater than 2DTTE (mean 7.3 +/- 4.3 g, P = 0.005). The total number of trabeculations assessed by 3DTTE (mean 11.2 +/- 3.3) was also significantly greater than 2DTTE (mean 3.76 +/- 1.2, P < 0.0001). The values for inter- and intraobserver variability were lower for 3DTTE than 2DTTE. In conclusion, both LV trabecular mass as well as the total number of trabeculations in patients with LVNC were significantly underestimated by 2DTTE as compared to 3DTTE.
Asunto(s)
Ecocardiografía/métodos , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Adulto , Anciano , Ecocardiografía Tridimensional/métodos , Femenino , Humanos , Aumento de la Imagen/métodos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
We describe a patient in whom a mycotic aneurysm involving the distal descending thoracic aorta could be definitively diagnosed by live/real time three-dimensional transthoracic echocardiography.
Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Aneurisma Infectado/diagnóstico por imagen , Aorta Torácica/diagnóstico por imagen , Ecocardiografía Tridimensional , Anciano , Ecocardiografía Tridimensional/métodos , Ecocardiografía Transesofágica , Humanos , MasculinoRESUMEN
The differential diagnosis of a cardiac valve mass includes fibroelastoma, myxoma, lipoma, Lambl's excrescences, thrombus, and vegetation. Fibroelastomas are extremely rare primary cardiac tumors. Their incidence is 0.00017-0.033% in autopsy series and 0.019% in clinical series identified on echocardiography. Although rare, fibroelastomas are the most common tumors affecting the cardiac valves with aortic, mitral, tricuspid, and pulmonary valves being involved in this order. In the current report we describe a case of pulmonary valve mass in which a confident prospective diagnosis of fibroelastoma could be made utilizing the technique of three-dimensional transthoracic echocardiography.
Asunto(s)
Sistemas de Computación , Ecocardiografía Tridimensional , Fibroma/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/patología , Adulto , Procedimientos Quirúrgicos Cardíacos , Fibroma/cirugía , Neoplasias Cardíacas/cirugía , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Válvula Pulmonar/cirugía , Insuficiencia de la Válvula Pulmonar/diagnóstico por imagen , Insuficiencia de la Válvula Pulmonar/cirugíaRESUMEN
We report a 49-year-old morbidly obese female with a poor acoustic window in whom live/real time three-dimensional transthoracic echocardiography was able to make a confident diagnosis of cor triatriatum sinister. En face views of the membrane facilitated accurate assessment of the size and shape of the large nonobstructing opening in the membrane. Maximum dimensions of the opening were 3.06 x 1.03 cm and area was 2.3 cm(2).
Asunto(s)
Sistemas de Computación , Corazón Triatrial/diagnóstico por imagen , Corazón Triatrial/patología , Ecocardiografía Tridimensional , Femenino , Humanos , Persona de Mediana EdadRESUMEN
We studied nine patients (five newborns and infants, two children, and two adults) with atrioventricular septal defects (four complete, one intermediate, and four partial) utilizing live/real time three-dimensional transthoracic echocardiography (3DTTE) and a 4-MHz matrix array transducer. In all patients, 3DTTE provided additional morphological and/or functional information as compared to standard two-dimensional transthoracic echocardiography (2DTTE). 3DTTE may be a useful supplement to 2DTTE in the assessment of atrioventricular septal defects.
Asunto(s)
Ecocardiografía Tridimensional/métodos , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interventricular/diagnóstico por imagen , Adulto , Anciano , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadRESUMEN
We describe two adult patients with left ventricular noncompaction in whom live/real time three-dimensional transthoracic echocardiography (3DTTE) supplemented two-dimensional transthoracic echocardiography in making a definitive diagnosis of clots coexisting with trabeculations in the left ventricle. Mobility of clots and the presence of central echolucencies consistent with clot lysis were best demonstrated by 3DTTE and served to confidently differentiate clots from adjacent trabeculations.
Asunto(s)
Cardiomiopatías/diagnóstico por imagen , Sistemas de Computación , Ecocardiografía Tridimensional , Trombosis/diagnóstico por imagen , Adulto , Cardiomiopatías/fisiopatología , Resultado Fatal , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico , Trombosis/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Tissue Doppler imaging (TDI) in 38 adult patients with pulmonary artery hypertension of varied etiology and normal left ventricular systolic function by two-dimensional transthoracic echocardiography showed significantly reduced peak systolic strain (SS) in all three segments of left ventricular free wall and ventricular septum and two of three segments of right ventricular free wall when compared to 29 adults with no clinical or echocardiographic evidence of heart disease and normal left and right ventricular systolic function. A similar reduction in peak diastolic strain (DS) was also noted in all three segments of left ventricular free wall and ventricular septum and one of three segments of right ventricular free wall. This reduction in strain indices in patients with pulmonary hypertension was noted irrespective of whether right ventricular systolic function was normal or reduced as assessed by two-dimensional transthoracic echocardiography. SS and DS rates also showed reductions in patients with pulmonary artery hypertension. Our study shows the potential value of TDI indices in identifying reduced regional left ventricular systolic and diastolic longitudinal function in patients with pulmonary artery hypertension and normal left ventricular systolic function by two-dimensional transthoracic echocardiography. This reduction in left ventricular function was noted in patients with both normal and reduced right ventricular systolic functions by two-dimensional echocardiography.
Asunto(s)
Ecocardiografía Doppler , Hipertensión Pulmonar/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Derecha/diagnóstico por imagen , Adulto , Anciano , Estudios de Casos y Controles , Diástole , Femenino , Humanos , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Arteria Pulmonar/fisiopatología , Presión Esfenoidal Pulmonar , Proyectos de Investigación , Índice de Severidad de la Enfermedad , Volumen Sistólico , Sístole , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Derecha/fisiopatologíaRESUMEN
In this report, we present 12 patients (range 14-76 years, mean 40 +/- 22.7 years) who underwent surgical repair of a ventricular septal defect (VSD). Location, size, and surrounding anatomy of the VSD were assessed prior to intervention in all patients with live/real time three-dimensional transthoracic echocardiography (3DTTE). In 9 patients, measurements of maximum dimension, circumference, and area by 3DTTE correlated well with the same measurements from intraoperative three-dimensional transesophageal echocardiographic (3DTEE) reconstruction. 3DTTE measurement of maximum dimension of VSDs also agreed well with maximum dimension by surgery in 10 patients. Live/real time 3DTTE accurately defined VSD location, size, and surrounding anatomy in all patients studied by us. VSD characterization by live 3DTTE agreed well with surgery descriptions and 3DTEE measurements.