ABSTRACT
The prevalence of hepatopulmonary syndrome (HPS) and its influence on survival before and after liver transplantation (LT) remain controversial. Additionally, the chronology of post-LT reversibility is unclear. This study prospectively analyzed 316 patients with cirrhosis who were evaluated for LT in 2002-2007; 177 underwent LT at a single reference hospital. HPS was defined by a partial pressure of arterial oxygen (PaO2 ) <70 mmHg and/or an alveolar-arterial oxygen gradient (A-a PO2 ) ≥20 mmHg in the supine position and positive contrast echocardiography. The prevalence of HPS was 25.6% (81/316 patients), and most patients (92.6%) had mild or moderate HPS. High Child-Pugh scores and the presence of ascites were independently associated with HPS. Patients with and without HPS did not significantly differ in LT waiting list survival (mean 34.6 months vs. 41.6 months, respectively; log-rank, p = 0.13) or post-LT survival (mean 45 months vs. 47.6 months, respectively; log-rank, p = 0.62). HPS was reversed in all cases within 1 year after LT. One-fourth of the patients with cirrhosis who were evaluated for LT had HPS (mostly mild to moderate); the presence of HPS did not affect LT waiting list survival. HPS was always reversed after LT, and patient prognosis did not worsen.
Subject(s)
Hepatopulmonary Syndrome/complications , Liver Cirrhosis/surgery , Liver Transplantation , Female , Hepatopulmonary Syndrome/mortality , Hepatopulmonary Syndrome/physiopathology , Humans , Liver Cirrhosis/complications , Liver Cirrhosis/physiopathology , Male , Middle Aged , Prevalence , Severity of Illness Index , Survival Analysis , Waiting ListsABSTRACT
Visualization of the apex of the left ventricle is crucial in the diagnosis of many of the diseases that affect the heart. Sometimes echocardiography cannot image this region of the heart adequately, which could lead to diagnostic error. Magnetic resonance imaging (MRI) is ideal for the correct definition of the left ventricular apex. We report three cases in which MRI provided valuable information that was unavailable at echocardiography.
Subject(s)
Heart Diseases/diagnosis , Heart Ventricles , Magnetic Resonance Imaging , Adult , Aged , Female , Humans , MaleABSTRACT
La visualización del ápex del ventrículo izquierdo es determinante en el diagnóstico de muchas de las enfermedades que afectan al corazón. En ocasiones la ecocardiografía no es capaz de mostrar una imagen adecuada de esta región cardiaca, pudiendo inducir a un error diagnóstico. La resonancia magnética (RM) es una técnica ideal para la correcta definición del ápex ventricular izquierdo. Presentamos tres casos en los que la RM aportó una valiosa información que no había sido precisada por la ecocardiografía
Visualization of the apex of the left ventricle is crucial in the diagnosis of many of the diseases that affect the heart. Sometimes echocardiography cannot image this region of the heart adequately, which could lead to diagnostic error. Magnetic resonance imaging (MRI) is ideal for the correct definition of the left ventricular apex. We report three cases in which MRI provided valuable information that was unavailable at echocardiography
Subject(s)
Humans , Male , Female , Adult , Aged , Ventricular Dysfunction, Left/diagnosis , Cardiomyopathies/diagnosis , Echocardiography/methods , Magnetic Resonance Spectroscopy/methods , Aneurysm/diagnosis , Thrombosis/diagnosisABSTRACT
El ecocardiograma de estrés con dobutamina (ESD) es una técnica de uso cada vez más rutinario en el diagnóstico de la enfermedad coronaria. La aparición de alteraciones en el electrocardiograma durante la prueba corresponde habitualmente a una depresión del segmento ST y en raras ocasiones a una elevación del ST, relacionándose con lesiones coronarias graves o infarto agudo de miocardio (IAM) previo. La elevación del ST, en ausencia de lesiones coronarias significativas, es muy infrecuente y se supone relacionada con un mecanismo vasoespástico. Presentamos el caso de un varón joven y con factores de riesgo cardiovascular, ingresado para estudio de dolor torácico y con ergometría negativa, que durante la prueba de dobutamina presenta positividad clínica, eléctrica en forma de ascenso del ST y alteraciones segmentarias de la contractilidad. Coronariografía sin lesiones coronarias significativas. Se comenta el caso y se revisa la literatura. (AU)
Subject(s)
Adult , Male , Humans , Dobutamine , Heart/physiopathology , Coronary Disease , Myocardial Contraction , Electrocardiography , Coronary Vasospasm , Exercise TestABSTRACT
We present a 45-year-old patient on chronic hemodialysis who suffered aortic endocarditis by Staphylococcus haemolyticus after bacteremia associated with a venous catheter, which was used temporarily during the maturing phase of a Cimino-Brescia arteriovenous fistula in the left forearm. Three weeks after starting antibiotic therapy, the patient suffered a septic pulmonary embolism. The catheter had been removed 4 weeks before the embolism. Thrombophlebitis of lower limbs, infection or thrombosis of the vascular access, and the involvement of right-sided cardiac structures were all discarded. We assumed that the pulmonary episode was probably a consequence of the paradoxical passage of embolic material, detached from the aortic valve, from arterial to venous circulation through the arteriovenous fistula.
Subject(s)
Aortic Valve , Embolism, Paradoxical/etiology , Endocarditis, Bacterial/etiology , Heart Valve Diseases/etiology , Pulmonary Embolism/etiology , Renal Dialysis , Staphylococcal Infections/etiology , Arteriovenous Shunt, Surgical/adverse effects , Bacteremia/etiology , Catheters, Indwelling/adverse effects , Humans , Male , Middle AgedABSTRACT
The aim of this study was to assess the effects a long-acting somatostatin analogue (octreotide) had on the heart function of acromegalic patients. Five patients fulfilling clinical criteria of active acromegaly without symptoms of heart dysfunction, were treated with increased doses of octreotide (300, 600, 900, 1,200 and 1,500 micrograms/daily) over a period of six months. Growth hormone (GH) profiles were carried out during each different dose of octreotide. M-Mode, two dimensional and Doppler echocardiographic evaluation were performed both before and after treatment. Although the GH levels of all patients dropped after each increment of the octreotide, the responses were not homogeneous. Six months after the onset of treatment, echocardiographic studies revealed a significant reduction in the interventricular septum thickness (IVST) (p less than 0.05) and Doppler analyses showed an increase in the early diastolic transmitral flow velocity (p less than 0.05). Our results indicate that octreotide is capable of reversing acromegalic cardiopathy, since it not only reduces GH levels to within normal limits but improves left ventricular hypertrophy and distensibility without modifying contractility.