ABSTRACT
The role of patent foramen ovale (PFO) in patients with cryptogenic stroke (stroke of unknown cause) remains controversial, although an association seems likely in younger patients with atrial septal aneurysms and PFO. The mechanism of cryptogenic stroke in these patients is presumed to be paradoxical embolism via right-to-left shunt across the PFO. The available options for treatment include medical therapy with antiplatelet or anticoagulant therapy or closure of the PFO surgically or with use of transcatheter PFO closure devices. We describe 2 cases of bilateral device thrombosis associated with use of a transcatheter PFO closure device (CardioSEAL). To our knowledge, only 1 other case of thrombosis associated with use of this device has been reported.
Subject(s)
Catheterization/adverse effects , Catheterization/instrumentation , Heart Septal Defects, Atrial/therapy , Ischemic Attack, Transient/etiology , Thrombosis/etiology , Female , Heart Septal Defects, Atrial/complications , Humans , Middle AgedABSTRACT
This review focuses on diastolic dysfunction with special emphasis on isolated diastolic dysfunction where impairment in diastolic function occurs in the absence of concomitant reduction in systolic function. The phenomena which influence diastolic function, the clinical spectrum of diastolic dysfunction, the physiological perturbations which may serve as therapeutic targets for pharmacological therapy and recent therapeutic trials are reviewed. Recommendations regarding the therapeutic approach to the patient with diastolic dysfunction are summarised.
Subject(s)
Ventricular Dysfunction/physiopathology , Animals , Clinical Trials as Topic , Coronary Disease/complications , Coronary Disease/drug therapy , Diastole/physiology , Guidelines as Topic , Heart Failure/drug therapy , Heart Failure/physiopathology , Humans , Stroke Volume , Ventricular Dysfunction/drug therapy , Ventricular Dysfunction/etiologyABSTRACT
We report a case of posttraumatic meningitis due to Mycobacterium abscessus, treated initially with oral clarithromycin and intravenous amikacin plus intrathecal amikacin. Despite cerebrospinal fluid (CSF) levels of clarithromycin and amikacin in excess of their in vitro minimum inhibitory concentrations for the organism, the CSF cultures remained continuously positive for M. abscessus. To our knowledge, this is the first documented case of M. abscessus meningitis and the first report of measured CSF levels of clarithromycin in a patient with meningitis, showing that even therapeutic CSF levels of clarithromycin and amikacin might not be successful in eradicating M. abscessus meningitis.
Subject(s)
Amikacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Clarithromycin/therapeutic use , Meningitis, Bacterial/cerebrospinal fluid , Meningitis, Bacterial/drug therapy , Mycobacterium Infections/cerebrospinal fluid , Mycobacterium Infections/drug therapy , Amikacin/cerebrospinal fluid , Anti-Bacterial Agents/cerebrospinal fluid , Clarithromycin/cerebrospinal fluid , Female , Humans , Meningitis, Bacterial/blood , Microbial Sensitivity Tests , Middle Aged , Mycobacterium/isolation & purification , Mycobacterium Infections/blood , Spinal Puncture , Treatment FailureABSTRACT
Echocardiographic characterization of cardiac masses involving the left atrium are defined by morphologic shape and appearance, site of attachment, type of margins, and presence or absence in the left atrial appendage. Most reports use location in the LAA as strong supportive evidence of thrombus, especially if associated with other suggestive findings (i.e., atrial fibrillation, spontaneous echo contrast, or both). Other reported masses (non-thrombi) in the left atrial appendage are considered extremely rare. We report a case of a patient with coexisting aortic stenosis and atrial fibrillation diagnosed intraoperatively by transesophageal echocardiography with myxoma of the left atrial appendage.
