Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
Mais filtros

Base de dados
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
Circulation ; 145(5): 345-356, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34865500

RESUMO

BACKGROUND: Understanding the clinical course and short-term outcomes of suspected myocarditis after the coronavirus disease 2019 (COVID-19) vaccination has important public health implications in the decision to vaccinate youth. METHODS: We retrospectively collected data on patients <21 years old presenting before July 4, 2021, with suspected myocarditis within 30 days of COVID-19 vaccination. Lake Louise criteria were used for cardiac MRI findings. Myocarditis cases were classified as confirmed or probable on the basis of the Centers for Disease Control and Prevention definitions. RESULTS: We report on 139 adolescents and young adults with 140 episodes of suspected myocarditis (49 confirmed, 91 probable) at 26 centers. Most patients were male (n=126, 90.6%) and White (n=92, 66.2%); 29 (20.9%) were Hispanic; and the median age was 15.8 years (range, 12.1-20.3; interquartile range [IQR], 14.5-17.0). Suspected myocarditis occurred in 136 patients (97.8%) after the mRNA vaccine, with 131 (94.2%) after the Pfizer-BioNTech vaccine; 128 (91.4%) occurred after the second dose. Symptoms started at a median of 2 days (range, 0-22; IQR, 1-3) after vaccination. The most common symptom was chest pain (99.3%). Patients were treated with nonsteroidal anti-inflammatory drugs (81.3%), intravenous immunoglobulin (21.6%), glucocorticoids (21.6%), colchicine (7.9%), or no anti-inflammatory therapies (8.6%). Twenty-six patients (18.7%) were in the intensive care unit, 2 were treated with inotropic/vasoactive support, and none required extracorporeal membrane oxygenation or died. Median hospital stay was 2 days (range, 0-10; IQR, 2-3). All patients had elevated troponin I (n=111, 8.12 ng/mL; IQR, 3.50-15.90) or T (n=28, 0.61 ng/mL; IQR, 0.25-1.30); 69.8% had abnormal ECGs and arrhythmias (7 with nonsustained ventricular tachycardia); and 18.7% had left ventricular ejection fraction <55% on echocardiogram. Of 97 patients who underwent cardiac MRI at a median 5 days (range, 0-88; IQR, 3-17) from symptom onset, 75 (77.3%) had abnormal findings: 74 (76.3%) had late gadolinium enhancement, 54 (55.7%) had myocardial edema, and 49 (50.5%) met Lake Louise criteria. Among 26 patients with left ventricular ejection fraction <55% on echocardiogram, all with follow-up had normalized function (n=25). CONCLUSIONS: Most cases of suspected COVID-19 vaccine myocarditis occurring in persons <21 years have a mild clinical course with rapid resolution of symptoms. Abnormal findings on cardiac MRI were frequent. Future studies should evaluate risk factors, mechanisms, and long-term outcomes.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Miocardite/diagnóstico por imagem , Miocardite/fisiopatologia , Adolescente , Criança , Eletrocardiografia/métodos , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Miocardite/sangue , Miocardite/etiologia , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
2.
Echocardiography ; 34(12): 1956-1958, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28942609

RESUMO

Mitral valve construction using extracellular matrix (ECM) is a relatively new procedure. In this case, a 15-month-old boy with a history of severe mitral valve regurgitation secondary to endocarditis underwent mitral valve surgery. Mitral valve repair was not possible, and thus, a 17 mm extracellular matrix cylinder valve (ECM-CV) was constructed for valve replacement. The ECM-CV is clearly imaged using echocardiography, especially three-dimensional imaging, that helped define valve function. As the use of ECM for valve construction increases, echocardiography will play an essential role in evaluating the function and mechanics of these novel valves.


Assuntos
Ecocardiografia/métodos , Matriz Extracelular/transplante , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Humanos , Lactente , Masculino
3.
Heliyon ; 10(1): e23898, 2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-38223706

RESUMO

This case describes an asymptomatic child with incidental identification of a supradominant right coronary artery with absent left circumflex coronary artery. The coronary variant was identified due to concern for an unexplained, dilated right coronary artery demonstrated initially during an evaluation for a functional heart murmur. Cardiac CTA provided a non-invasive diagnosis of the coronary variant. This variant is mostly thought to be benign though some have reported concern for associated exertional ischemia. Our patient is asymptomatic with no segmental wall motion abnormalities. Supradominant right coronary artery with absent left circumflex coronary is therefore a variant therefore which may create concern when partially visualized on echocardiography but cardiac CTA can provide reassurance against potentially ominous diagnoses such as coronary fistula or prior Kawasaki disease. This variant likely has no ischemic effects though rarely some reports suggest a mechanism of ischemia which warrants long term follow up.

4.
Indian J Thorac Cardiovasc Surg ; 37(6): 698-701, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34054231

RESUMO

We present a case of a neonate with trisomy 21, ductal-dependent aortic coarctation, and severe respiratory failure secondary to coronavirus disease 2019 (COVID-19) pneumonia. The neonate was managed with venoarterial extracorporeal membrane oxygenation (VA ECMO), palliative stenting of the coarctation, and a vascular plug occlusion of a large patent ductus arteriosus. The patient was successfully weaned off extracorporeal membrane oxygenation (ECMO). The patient is currently awaiting a definitive surgical repair in the near future.

5.
Neuromuscul Disord ; 28(9): 711-716, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30064893

RESUMO

Patients with Duchenne muscular dystrophy suffer debilitating muscle destruction, resulting in loss of ambulation, diminished respiratory function, gastrointestinal disturbances and cardiomyopathy. Although it is the most common cause of death in these patients, cardiomyopathy is poorly understood in terms of distinct pathogenesis, natural history, and specific, effective therapeutic interventions. We review the state-of-the-art knowledge of Duchenne muscular dystrophy-associated cardiomyopathy including clinical evaluation, imaging, medical and perioperative management, and prospects for gene therapy. We also review cardiomyopathy in heterozygote carriers. By describing our current understanding and best practices, we hope to improve harmonization of care across institutions and identify collective knowledge gaps to guide future research efforts.


Assuntos
Cardiomiopatias/etiologia , Distrofia Muscular de Duchenne/complicações , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Gerenciamento Clínico , Humanos
6.
J Neuromuscul Dis ; 4(4): 307-314, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28984614

RESUMO

BACKGROUND: Improved neuromuscular and respiratory therapies have altered the natural history of Duchenne muscular dystrophy (DMD) such that the most common cause of mortality is progressive cardiomyopathy. Despite imaging evidence of progressive cardiomyopathy, troponin I (cTn) is not significantly elevated in asymptomatic DMD patients. RESULTS: We describe eight boys with DMD evaluated for acute chest pain (ACP) and found to have acute cTn elevation with depressed left ventricular ejection fraction (LVEF). Of our eight patients, five presented with a primary complaint of ACP, while three presented with secondary myocardial injury in the context of systemic illness requiring hospitalization. Electrocardiograms showed diffuse ST changes and mean peak cTn level was 44±15.4 ng/mL (reference range <0.03 ng/mL). cTn levels normalized with only supportive care. Cardiac magnetic resonance imaging (CMR) was performed during the event on all but one patient, demonstrating increased late gadolinium enhancement (LGE) from 12.4±11.4% to 36.5±10.3% with associated deterioration of LVEF from 61±4.4% to 47.6±6.6% which remained depressed on follow-up CMR study (49.1±7.8%). All viral studies were negative. Additional investigations varied among patients, but no causative findings were demonstrated. CONCLUSIONS: ACP with cTn elevation occurs in DMD boys and may be indicative of cardiomyopathy progression as evidenced by acute left ventricular dysfunction and development or progression of myocardial fibrosis. This clinical presentation is under recognized. These events may represent an important pathophysiological mechanism in cardiomyopathy progression.


Assuntos
Dor no Peito/fisiopatologia , Distrofia Muscular de Duchenne/fisiopatologia , Troponina I/sangue , Adolescente , Biomarcadores/sangue , Dor no Peito/diagnóstico , Dor no Peito/terapia , Criança , Progressão da Doença , Eletrocardiografia , Seguimentos , Coração/diagnóstico por imagem , Coração/fisiopatologia , Humanos , Masculino , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/terapia , Função Ventricular Esquerda , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA