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Enfermedades de la Aorta/terapia , Procedimientos Endovasculares/instrumentación , Fístula/terapia , Cardiopatías/terapia , Fístula Vascular/terapia , Enfermedades de la Aorta/diagnóstico por imagen , Aortografía/métodos , Diseño de Equipo , Fístula/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagenAsunto(s)
Aterectomía Coronaria/efectos adversos , Aneurisma Coronario/etiología , Reestenosis Coronaria/terapia , Adulto , Calcinosis/etiología , Aneurisma Coronario/diagnóstico por imagen , Angiografía Coronaria , Reestenosis Coronaria/diagnóstico por imagen , Progresión de la Enfermedad , Femenino , Humanos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Ultrasonografía IntervencionalRESUMEN
BACKGROUND: Cardiac involvement is one of the most important prognostic factors in systemic AL amyloidosis. The aim of our study was to assess the role of cardiovascular magnetic resonance (CMR) imaging in prognosis evaluation in AL amyloidosis. METHODS: We retrospectively analyzed 29 consecutive patients with AL amyloidosis who had undergone CMR. Clinical, laboratory, echocardiographic, and CMR characteristics were compared between CMR-positive (ie, with CMR signs of cardiac localization of AL amyloidosis) and CMR-negative patients. Univariate and multivariate analyses were performed to assess the prognostic value of positive CMR in comparison with other prognostic factors. RESULTS: CMR was positive in 11 patients (38%). The overall survival rates for CMR-positive patients were 28%, 14%, and 14% versus 84%, 77%, and 45% at 1, 2, and 5 years, respectively, for CMR-negative patients (P=.002). Late gadolinium enhancement patterns, biventricular hypertrophy, and pericardial effusion on CMR were more frequent in nonsurvivors. Congestive heart failure, abnormal echocardiography, Eastern Cooperative Oncology Group grade >1, brain natriuretic peptide, and left ventricular ejection fraction <55% also were associated with a decreased survival. The presence of congestive heart failure was the only significant variable associated with survival on multivariate analysis. CONCLUSION: We found that the presence of a positive CMR in AL amyloidosis was associated with a significantly increased risk of death, in particular of cardiac origin, but was not independent of clinical congestive heart failure.
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Amiloidosis/diagnóstico , Cardiomiopatías/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Imagen por Resonancia Magnética , Adulto , Anciano , Anciano de 80 o más Años , Amiloidosis/mortalidad , Análisis de Varianza , Biomarcadores/sangre , Cardiomiopatías/mortalidad , Ecocardiografía , Femenino , Francia/epidemiología , Gadolinio , Insuficiencia Cardíaca/mortalidad , Humanos , Estimación de Kaplan-Meier , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Volumen SistólicoRESUMEN
BACKGROUND: ß-blockers improve the prognosis of patients with cardiac failure due to left ventricular systolic dysfunction. The aim of this study was to assess the efficacy of ß-blockers in patients with dysfunctional systemic right ventricle. METHODS: Fourteen patients with systemic right ventricle following a Mustard or a Senning operation for the transposition of the great arteries, or congenitally corrected transposition were included in the study. All had a decreased systemic right ventricular ejection fraction despite having standard cardiac failure therapy. Quality of life, New York Heart Association class, aerobic capacity, and systemic right ventricular function were assessed before treatment with ß-blockers and at the end of the follow-up period, mean of 12.8 months with a range from 3 to 36 months. RESULTS: Change in New York Heart Association class was significant (p = 0.016). Quality of life improved significantly throughout the study from a median grade 2 with a range from 1 to 3 to a median grade 1 with a range from 1 to 2 (p = 0.008). Systemic right ventricular ejection fraction assessed by radionuclide ventriculography improved significantly from a median of 41% (range: 29-53%) to 49% (range: 29-62%; p = 0.031). However, the change in thee ejection fraction assessed by magnetic resonance imaging was not significant from a median of 29% (range: 12-47%) to 32% (range: 22-63%; p = 0.063). CONCLUSION: In patients with cardiac failure due to systemic right ventricular dysfunction, ß-blockers improve New York Heart Association class, quality of life, and systemic right ventricular ejection fraction assessed by radionuclide ventriculography.
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Antagonistas Adrenérgicos beta/uso terapéutico , Disfunción Ventricular Derecha/tratamiento farmacológico , Adulto , Bisoprolol/uso terapéutico , Femenino , Insuficiencia Cardíaca/etiología , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno , Volumen Sistólico , Transposición de los Grandes Vasos/cirugía , Disfunción Ventricular Derecha/etiología , Disfunción Ventricular Derecha/fisiopatología , Adulto JovenRESUMEN
A 16-year-old boy was hospitalized for fever, chest pain, and cardiovascular collapse. Transthoracic echocardiography revealed a 30-mm circumferential echogenic "porridge-like" pericardial effusion with signs of cardiac tamponade. Tuberculosis (TB) was suspected because of its prevalence in Djibouti. Emergency pericardiocentesis was attempted, but only 10 ml of pericardial fluid was obtained. Subxiphoid pericardiotomy and drainage were then performed, and pericardial fibrinous pockets were surgically collapsed. Antituberculosis chemotherapy was given, and the pericardial effusion progressively disappeared without corticosteroids. The diagnosis of TB was subsequently confirmed by cultures of the pericardial fluid. A pericardial biopsy was normal. After 3 months of follow-up, there was no sign of constrictive pericarditis. Pericardiocentesis may fail in cases of advanced-stage fibrinous TB pericardial effusion. Thus, pericardiotomy with complete open draining is the only lifesaving procedure.
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Taponamiento Cardíaco/cirugía , Drenaje , Derrame Pericárdico/cirugía , Pericardiectomía , Pericardiocentesis , Pericarditis Tuberculosa/cirugía , Adolescente , Antituberculosos/uso terapéutico , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/etiología , Djibouti , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/etiología , Pericarditis Tuberculosa/complicaciones , Pericarditis Tuberculosa/diagnóstico por imagen , Resultado del Tratamiento , UltrasonografíaRESUMEN
BACKGROUND: We sought to determine whether online use of a beat-by-beat cardiovascular index, CARDEAN (Alpha-2, Lyon, France), modifies the incidence of patient movement during colonoscopy under anesthesia. METHODS: Monitoring included an electrocardiogram, oscillometric and noninvasive beat-by-beat arterial blood pressure, O2 saturation, bispectral index (BIS), and CARDEAN. CARDEAN consists of beat-by-beat Finapres (Ohmeda, Madison, WI) combined with an algorithm that detects hypertension followed by tachycardia and produces an index scaled 0 to 100. The anesthesiologist was denied access to Finapres and CARDEAN. Propofol was adjusted to keep 40
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Alfentanilo/administración & dosificación , Analgésicos Opioides/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Colonoscopía , Frecuencia Cardíaca/efectos de los fármacos , Monitoreo Intraoperatorio , Movimiento/efectos de los fármacos , Propofol/administración & dosificación , Adulto , Alfentanilo/efectos adversos , Algoritmos , Analgésicos Opioides/efectos adversos , Anestésicos Intravenosos/efectos adversos , Presión Sanguínea , Determinación de la Presión Sanguínea , Monitores de Conciencia , Electrocardiografía , Femenino , Humanos , Hipertensión/inducido químicamente , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/instrumentación , Monitoreo Intraoperatorio/métodos , Oscilometría , Oximetría , Oxígeno/sangre , Valor Predictivo de las Pruebas , Propofol/efectos adversos , Estudios Prospectivos , Diseño de Software , Taquicardia/inducido químicamenteRESUMEN
The May-Thurner syndrome is a well-known anatomical anomaly where the left common iliac vein (LCIV) is compressed between the right common iliac artery and the fifth vertebral body. This report describes the case of a "right-sided" May-Thurner syndrome where the right common iliac vein (RCIV) is compressed by the left common iliac artery in a patient with a left-sided inferior vena cava (IVC). A 26-year-old woman was admitted to our institution with acute edema of the right lower limb. The diagnosis of May-Thurner syndrome was done by CT scan and confirmed by phlebography. An endovascular treatment with stenting was carried out, with good patency and clinical result at 12-month follow-up.
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Angioplastia/métodos , Arteria Ilíaca/anomalías , Vena Ilíaca/anomalías , Enfermedades Vasculares Periféricas/cirugía , Vena Cava Inferior/anomalías , Adulto , Angioplastia/instrumentación , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/cirugía , Constricción Patológica , Femenino , Estudios de Seguimiento , Humanos , Arteria Ilíaca/diagnóstico por imagen , Vena Ilíaca/diagnóstico por imagen , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Enfermedades Vasculares Periféricas/patología , Flebografía , Stents , Síndrome , Vértebras Torácicas , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Vena Cava Inferior/diagnóstico por imagenRESUMEN
PURPOSE: To review the use of thoracic endovascular aortic repair (TEVAR) for late pseudoaneurysm formation after surgical repair of aortic coarctation. METHODS: From May 2001 to May 2005, 8 patients (5 men; mean age 47.6 years, range 18-73) with a history of aortic coarctation repairs 17 to 40 years prior were referred to our institution for an anastomotic thoracic pseudoaneurysm. TEVAR was performed successfully in 7 patients; 1 died of suspected aneurysm rupture before the scheduled procedure. A carotid-subclavian bypass was performed in 3 patients. RESULTS: All the procedures were immediately successful. No type I endoleaks were seen on the final control angiogram, but 2 of the patients with carotid-subclavian bypasses required additional left subclavian artery embolization due to type II endoleak. One of these patients died before embolotherapy on the 5th postoperative day from presumed aneurysm rupture (14% 30-day mortality rate). Over a follow-up period ranging from 15 to 72 months (mean 37), all the false aneurysms have remained thrombosed and the mean diameter has decreased from 44 to 23 mm. No endograft-related complications have occurred, and no further interventions have so far been necessary. CONCLUSION: TEVAR is a feasible alternative treatment for patients who have already undergone surgical repair of aortic coarctation. Technical issues regarding the endovascular strategy should be discussed with a multidisciplinary team to define the correct interventional plan.
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Aneurisma Falso/cirugía , Aorta Torácica , Coartación Aórtica/cirugía , Enfermedades de la Aorta/cirugía , Complicaciones Posoperatorias/cirugía , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Factores de Tiempo , Procedimientos Quirúrgicos Vasculares/métodos , Adulto JovenRESUMEN
BACKGROUND: Bleeding is the most serious complication of oral anticoagulant therapy used for the prevention of thromboembolic complications. Drug-drug interactions are an important concern, as they may increase drug toxicity and, in the case of anticoagulant therapies, increase the risk of hemorrhage. CASE SUMMARY: An 84-year-old woman presented to the emergency department with a bilateral cervical hematoma and symptoms of upper-airway obstruction that had been increasing for 72 hours, with dyspnea and difficulty speaking developing in the previous 24 hours. Transnasal fiberoptic laryngoscopy revealed a significant laryngeal hematoma, as well as a hematoma on the floor of the mouth and in the tonsil area. Laboratory abnormalities included a prothrombin time < 10%, an international normalized ratio exceeding the laboratory limits, and an activated partial thromboplastin time >120 seconds. The patient had been receiving acenocoumarol 4 mg/d for 10 years for episodes of atrial fibrillation and recurrent deep venous thrombosis. Seventeen days earlier, she had received a prescription for topical econazole lotion 1% to be applied 3 times daily for 1 month to treat a dermatitis affecting 12% of the body surface. The patient was admitted to the intensive care unit for treatment of respiratory failure, where oxygen was delivered by face mask. The coagulation disorders were treated with prothrombin complex concentrate 30 IU/kg IV and vitamin K1 10 mg IV, and values normalized within 36 hours. Surgical evacuation of the laryngeal hematoma was not necessary. After 48 hours, improvement in the patient's respiratory symptoms allowed transfer to the ear, nose, and throat unit, where daily endoscopic examination was performed. Aspirin was substituted for acenocoumarol, and the patient returned home after 10 days without sequelae. Based on a Naranjo score of 7, this episode was probably related to an interaction between acenocoumarol and econazole. CONCLUSION: This report describes a case of a probable interaction between topical econazole lotion 1% and acenocoumarol that resulted in overanticoagulation and a life-threatening laryngeal hematoma in this elderly patient.
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Acenocumarol/efectos adversos , Anticoagulantes/efectos adversos , Antifúngicos/efectos adversos , Trastornos de la Coagulación Sanguínea/diagnóstico , Disnea/inducido químicamente , Econazol/efectos adversos , Enfermedades de la Laringe/inducido químicamente , Administración Tópica , Anciano de 80 o más Años , Antifúngicos/administración & dosificación , Aspirina/uso terapéutico , Trastornos de la Coagulación Sanguínea/sangre , Trastornos de la Coagulación Sanguínea/tratamiento farmacológico , Interacciones Farmacológicas , Econazol/administración & dosificación , Femenino , Hematoma/etiología , Hematoma/patología , Humanos , Laringoscopía , Inhibidores de Agregación Plaquetaria/uso terapéutico , Protrombina/uso terapéuticoRESUMEN
Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure. Only half of the patients recover normal cardiac function. We assessed the usefulness of magnetic resonance imaging (MRI) and late enhancement imaging to detect myocardial fibrosis in order to predict cardiac function recovery in patients with peripartum cardiomyopathy. Among a consecutive series of 1,037 patients referred for heart failure treatment or prognostic evaluation between 1999 and 2006, eight women had confirmed PPCM. They all underwent echocardiography and cardiac MRI for assessment of left ventricular anatomy, systolic function and detection of myocardial fibrosis through late enhancement imaging. Mean (+/- SD) baseline left ventricular ejection fraction (LVEF) was 28 +/- 4%. After a follow-up of 50 +/- 9 months, half the patients recovered normal cardiac function (LVEF = 58 +/- 4%) and four did not (LVEF = 35 +/- 6%). None of the eight patients exhibited abnormal myocardial late enhancement. No difference in MRI characteristics was observed between the two groups. Patients with PPCM do not exhibit a specific cardiac MRI pattern and particularly no myocardial late enhancement. It suggests that myocardial fibrosis does not play a major role in the limitation of cardiac function recovery after PPCM.
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Cardiomiopatías/diagnóstico , Imagen por Resonancia Cinemagnética/métodos , Complicaciones del Embarazo/diagnóstico , Adulto , Femenino , Humanos , EmbarazoRESUMEN
AIMS: This prospective study was undertaken to analyze the outcomes of conservative surgery with the "clover technique" for active infective tricuspid valve endocarditis. METHODS: Five consecutive patients underwent surgery for active infective tricuspid valve endocarditis. The mean age was 36.6 years. Four of the patients were men. In all patients, the tricuspid valve had become mutilated and infected. One patient had associated mitral endocarditis, and one had aortic endocarditis. Staphylococcus aureus was the most common bacterial species. Conservative surgery was indicated in all patients with infection limited to the leaflets and/or subvalvular apparatus of the tricuspid valve. Total resection of infected tissues was achieved in all cases. The tricuspid valve was then reconstructed according to the clover technique. A tricuspid annular ring was used in 2 patients. RESULTS: All 5 patients survived surgery. Intraoperative transesophageal and predischarge transthoracic echocardiographic evaluations showed good results in all patients. The mean follow-up time was 26.4 +/- 12.5 months. No recurrent bacterial tricuspid endocarditis occurred during follow-up. All patients were in New York Heart Association functional class I. A transthoracic echocardiography evaluation at the latest control examination showed trivial leakage (3 patients) or no residual regurgitation (2 patients); no transvalvular gradient was found in any of the patients. No tricuspid valve calcification has been detected to date. Cardiac magnetic resonance imaging analyses showed no postoperative void flow and confirmed the preservation of right ventricular function and thus the reliability of this technique. CONCLUSIONS: This novel technique is indicated for tricuspid valve endocarditis and should be considered as an adequate approach in cases of uncontrollable infection involving the tricuspid valve that is responsible for extended valve destruction.
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Procedimientos Quirúrgicos Cardíacos/métodos , Endocarditis Bacteriana/cirugía , Procedimientos de Cirugía Plástica/métodos , Insuficiencia de la Válvula Tricúspide/cirugía , Válvula Tricúspide/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Implantación de Prótesis Vascular , Puente de Arteria Coronaria Off-Pump , Estenosis Coronaria/diagnóstico por imagen , Diafragma/cirugía , Tomografía Computarizada por Rayos X , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/fisiopatología , Aneurisma de la Aorta Abdominal/cirugía , Estenosis Coronaria/complicaciones , Estenosis Coronaria/cirugía , Humanos , Interpretación de Imagen Radiográfica Asistida por Computador , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/instrumentación , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
PURPOSE: To retrospectively evaluate the sensitivity and specificity of contrast material-enhanced magnetic resonance (MR) angiography by using digital subtraction angiography as the reference standard in patients with hypertension and renal artery fibromuscular dysplasia (FMD). MATERIALS AND METHODS: Institutional review board approval was obtained, with waiver of informed consent. The results of renal contrast-enhanced MR angiography were retrospectively analyzed in 25 patients with hypertension (24 women, one man; mean age, 48 years +/- 19 [standard deviation]; age range, 18-72 years) who had FMD diagnosed on the basis of clinical and angiographic features. All examinations were performed at 1.5 T. Results were analyzed by two readers, and a third reader established a consensus in case of discrepancy. Sensitivity, specificity, and 95% confidence intervals (CIs) were calculated for FMD and for each possible type of FMD lesion ("string of pearls" appearance, stenosis, and aneurysm). A linear-weighted kappa statistic was calculated to determine agreement between digital subtraction angiography and contrast-enhanced MR angiography for the diagnosis of FMD and to determine inter- and intraobserver agreement regarding FMD diagnosis. RESULTS: Fifty main renal arteries were analyzed, 35 of which demonstrated abnormal arteriographic features of FMD (stenosis, 22 arteries; string of pearls, 21 arteries; and aneurysm, four arteries). The sensitivity and specificity of contrast-enhanced MR angiography for the diagnosis of FMD were 97% (95% CI: 83%, 100%) and 93% (95% CI: 66%, 100%), respectively. Sensitivity was 68% (95% CI: 83%, 100%), 95% (95% CI: 74%, 100%), and 100% (95% CI: 40%, 100%) for the diagnosis of stenosis, string of pearls, and aneurysm, respectively. Linear-weighted kappa statistics for inter- and intraobserver agreement regarding FMD diagnosis were 0.63 and 0.92, respectively. CONCLUSION: In patients with renal FMD, contrast-enhanced MR angiography can reliably facilitate diagnosis by demonstrating characteristic lesions.
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Angiografía de Substracción Digital/métodos , Displasia Fibromuscular/diagnóstico , Angiografía por Resonancia Magnética/métodos , Arteria Renal , Adolescente , Adulto , Anciano , Medios de Contraste , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Meglumina , Persona de Mediana Edad , Compuestos Organometálicos , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To compare quantitative and qualitative parameters obtained from digital subtraction angiography (DSA) with multislice computed tomographic angiography (MSCTA) in the follow-up of superficial femoral artery (SFA) stents. METHODS: Thirteen patients who had SMART stents implanted in the SFA were examined systematically with DSA and MSCTA (16-row scanner) at 6 months. Quantitative analysis and morphological assessment were performed on DSA images by an independent core laboratory, while the MSCTA images were analyzed by 2 radiologists in consensus. DSA measurements included stent length, minimal lumen diameter and reference diameter at mid stent and 5 mm either side of the stent, and percentage of stenosis. For MSCTA images, lumen area and the minimum, maximum, and mean diameters were also recorded. The images were analyzed qualitatively for diameter stenosis (<50%, 50% to 70%, 71% to 99%, and occlusion), bends, fractures, and calcifications. RESULTS: There were no statistical differences between lengths of stented segments, diameter measurements, or percentages of stenosis from DSA and MSCTA images. The Bland-Altman method showed good agreement between the 2 methods of measurement. MSCTA detected in-stent proliferation with a diameter stenosis <50% in all 13 cases diagnosed on DSA (there was no stenosis >50%). There were no bends or stent fractures on either set of images. The agreement between DSA and MSCTA for the presence and grading of calcifications was moderate (kappa=0.5). CONCLUSION: MSCTA provided quantitative and qualitative data comparable with DSA in the analysis of SFA nitinol stents.
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Aleaciones , Angiografía de Substracción Digital , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Stents , Tomografía Computarizada por Rayos X , Anciano , Anciano de 80 o más Años , Aterosclerosis/diagnóstico por imagen , Aterosclerosis/cirugía , Implantación de Prótesis Vascular , Calcinosis/diagnóstico por imagen , Calcinosis/cirugía , Femenino , Arteria Femoral/patología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Interpretación de Imagen Radiográfica Asistida por Computador , Proyectos de Investigación , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoAsunto(s)
Mediastinitis/microbiología , Osteólisis/microbiología , Complicaciones Posoperatorias , Infecciones Estafilocócicas/complicaciones , Esternón/patología , Adulto , Antibacterianos/uso terapéutico , Antibióticos Antituberculosos/uso terapéutico , Clindamicina/uso terapéutico , Puente de Arteria Coronaria/efectos adversos , Quimioterapia Combinada , Humanos , Masculino , Mediastinitis/tratamiento farmacológico , Mediastinitis/patología , Osteólisis/patología , Rifampin/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/patologíaRESUMEN
PURPOSE: To evaluate aortic diameter outcomes after stent-graft implantation for aortic dissection in the descending thoracic aorta. METHODS: Fifty patients with type A dissection after ascending aortic surgery (n = 10), type B dissection (n = 34), or intramural hematoma (n = 6) underwent stent-graft repair in 3 centers. Thrombosis and aortic diameter were analyzed by computed tomographic angiography at different levels of the aorta before stent-graft implantation, at discharge, and at follow-up. Measurements were standardized. RESULTS: In all, 67 stent-grafts were implanted for acute (n = 18) and chronic (n = 32) dissection. Stent-graft placement was successfully performed with high technical success (100%) despite 4 major complications (iliac thrombosis in 2 cases, aortic rupture, and a type A dissection) in 3 (6%) patients. Complete thrombosis of the thoracic false lumen was observed in 42% and 63% of cases at discharge and at follow-up (mean 15 months), respectively. At follow-up, the diameters of the entire aorta (mean 5 mm, p < 0.05) and the false lumen (mean 11 mm, p < 0.0001) decreased. Diameters of the abdominal aorta remained stable in association with persistent false lumen perfusion at this level. Aortic diameter results were better in the subgroup of patients with intramural hematoma compared to patients with Marfan syndrome. Three early deaths unrelated to the stent-graft procedure occurred; 2 patients with partial thrombosis of the false lumen died in follow-up secondary to aortic diameter growth. CONCLUSION: Complete thrombosis of the false lumen by stent-graft coverage of the entry tear results in decreased diameter of the entire aorta. In patients with partial thrombosis of the false lumen, the aneurysm continues to enlarge.
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Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/métodos , Stents , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/patología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/patología , Aortografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: To report the fortuitous discovery of a false aneurysm 7 years after cutting balloon angioplasty for severe renal artery fibromuscular dysplasia in a child. CASE REPORT: A 3-year-old girl with neurofibromatosis was referred to our institution because of high blood pressure (220/160 mmHg). Computed tomography identified coarctation of the aorta and severe bilateral renal artery stenoses. The coarctation was successfully resected. One month later, bilateral renal artery angioplasty with a 3-mm balloon was unsatisfactory, so a second angioplasty one month later was done with a 3.25-mm cutting balloon. This procedure was complicated by a minimal arterial rupture, which resolved spontaneously after inflation of a regular balloon. Normal blood pressure was restored. The child was lost to follow-up until 7 years later, when recurrent hypertension (200 mmHg systolic) prompted referral again. Arteriography showed a very severe stenosis on the right side and a 30-mm false aneurysm of the left renal artery at the rupture site. Due to her age, the patient underwent surgery, which brought the blood pressure under control. CONCLUSIONS: False aneurysm of the renal arteries is a rare complication of percutaneous angioplasty. In a child, the cutting balloon would appear to be contraindicated for concentric dysplastic stenoses that are resistant to regular balloon angioplasty.
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Aneurisma Falso/etiología , Angioplastia de Balón/efectos adversos , Displasia Fibromuscular/terapia , Arteria Renal , Aneurisma Falso/cirugía , Preescolar , Femenino , HumanosRESUMEN
BACKGROUND: Interstitial pregnancy is a rare and dangerous form of ectopic pregnancy which is treated by surgery, medical treatment, or both. Management options are not standardized. Currently, conservative nonsurgical treatment seems to be an alternative method in case of interstitial pregnancy. CASE: A right interstitial pregnancy was diagnosed in a 28-year-old woman. She was successfully treated by 2 courses of systemic methotrexate (1 mg/kg) 24 hours apart followed by selective uterine artery embolization. The postembolization course was uneventful, and no rupture occurred. Ten weeks after embolization, human chorionic gonadotropin level was negative. CONCLUSION: Uterine embolization associated with methotrexate can be used successfully in treating selected cases of early interstitial pregnancy. We hypothesize that this procedure combined with methotrexate could reduce hemorrhagic risk.