RESUMEN
Accessory mitral valve (AMV) is a rare congenital anomaly which can cause left ventricular outflow tract (LVOT) obstruction. Patients with isolated AMV usually present with exertional dyspnea, chest pain, or syncope during the first ten years of life. In patients with AMV, detection of latent LVOT obstruction can be clinically challenging. We here present a case of AMV causing latent LVOT obstruction in an adolescent, which was diagnosed by echocardiography with dobutamine provocation and finally treated by successful surgical resection.
Asunto(s)
Estenosis de la Válvula Mitral/etiología , Mucopolisacaridosis II/complicaciones , Adulto , Amilasas , Diagnóstico Diferencial , Disnea/etiología , Electrocardiografía , Urgencias Médicas , Terapia de Reemplazo Enzimático , Glicoproteínas/uso terapéutico , Glicosaminoglicanos/análisis , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Válvula Mitral/química , Válvula Mitral/patología , Estenosis de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/fisiopatología , Estenosis de la Válvula Mitral/cirugía , Mucopolisacaridosis II/tratamiento farmacológico , Mucopolisacaridosis II/enzimología , Reacción del Ácido Peryódico de Schiff , Cardiopatía Reumática/diagnóstico , Coloración y Etiquetado , UltrasonografíaRESUMEN
Although hemolytic anemia after mitral valve replacement (MVR) is well recognized, hemolytic anemia associated with mitral valve repair is an uncommon condition. Furthermore, persistent and severe hemolytic anemia despite of medical treatment subsequently requiring reoperation is extremely rare. We here report three cases of intractable hemolytic anemia after mitral valve repair leading to MVR. Collision of regurgitant jet into the annuloplasty ring was the speculated mechanism of hemolysis in all cases. After MVR, all of them experienced immediate resolution of the hemolytic anemia.
Asunto(s)
Anemia Hemolítica/diagnóstico por imagen , Anemia Hemolítica/etiología , Prótesis Valvulares Cardíacas/efectos adversos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Adulto , Anciano , Anemia Hemolítica/cirugía , Femenino , Humanos , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Resultado del Tratamiento , UltrasonografíaRESUMEN
BACKGROUND: Mycobacterium tuberculosis is one of the most clinically significant infectious agents. Especially during mass outbreaks, accurate identification and monitoring are required. The proportion of Beijing family members is very high among infecting strains, and spoligotyping is not suitable for strain typing. Therefore, we studied the homogeneity of isolates using the mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) method and identified its utility for carrying out molecular epidemiologic analysis. METHODS: Eighty-one clinical M. tuberculosis isolates that had previously been analyzed by spoligotyping were used in this study. We used the 12 standard MIRU loci and further four exact tandem repeat (ETR) loci (ETR-A, -B, -C, and -F). Four strains each of randomly selected Beijing and Beijing-like families were subjected to IS6110- restriction fragment length polymorphism analysis. RESULTS: All 81 samples showed amplification products of all VNTR loci, and all of them showed differences in at least one locus. The calculation of the Hunter-Gaston diversity index (HGDI) for MIRU-VNTR gave the value of 0.965. Discriminatory index in the six loci (MIRU-10, -16, -26, -31, -39, and ETR-F) were found to be highly discriminated (HGDI >0.6). Beijing and Beijing-like family isolates were discriminated into different MIRU-VNTR types. CONCLUSIONS: MIRU-VNTR analysis by using well-selected loci can be useful in discriminating the clinical M. tuberculosis isolates in areas where the Beijing family is predominant.
