Asunto(s)
Cardiomiopatías/diagnóstico , Cardiomiopatías/terapia , Síndrome de Churg-Strauss/diagnóstico , Síndrome de Churg-Strauss/terapia , Vasoespasmo Coronario/diagnóstico , Vasoespasmo Coronario/terapia , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
We present the case of a 41-year-old woman who was admitted to our centre with progressive symptoms of congestive heart failure (NYHA class III) 5 years after a radical nephrectomy for renal cell carcinoma. Magnetic resonance imaging demonstrated a 5 x 3 cm homogeneous intracardial mass causing right ventricular outflow tract obstruction, not accessible to surgical resection. Serial echo-guided, percutaneous coil embolization of the cardial metastasis was performed with Contour SE Microparticles (150-250 or 300-500 microm) after identification of the target region of the metastasis by contrast injection (Levovist) through the balloon catheter into the coronary artery under transoesophageal echocardiographic control prior to induction of the necrosis, corresponding to the technique which has been described for septal ablation in hypertrophic obstructive cardiomyopathy. Follow-up after serial embolization showed a good haemodynamic and a marked clinical response (dyspnoea NYHA I-II) which lasted during the 19 month of survival after the index procedure.
Asunto(s)
Carcinoma de Células Renales/secundario , Ecocardiografía , Embolización Terapéutica/métodos , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/terapia , Ventrículos Cardíacos/patología , Neoplasias Renales/patología , Obstrucción del Flujo Ventricular Externo/etiología , Obstrucción del Flujo Ventricular Externo/terapia , Adulto , Cateterismo , Femenino , Neoplasias Cardíacas/secundario , Humanos , Imagen por Resonancia MagnéticaAsunto(s)
Aneurisma de la Aorta Torácica/diagnóstico , Coartación Aórtica/cirugía , Rotura de la Aorta/complicaciones , Hemoptisis/etiología , Prótesis e Implantes/efectos adversos , Adulto , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/patología , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/etiología , Aneurisma de la Aorta Torácica/patología , Rotura de la Aorta/etiología , Niño , Diagnóstico Diferencial , Femenino , Humanos , Angiografía por Resonancia Magnética , Tereftalatos Polietilenos , Complicaciones Posoperatorias , Radiografía , Recurrencia , ReoperaciónRESUMEN
BACKGROUND: Blood flow can be quantified noninvasively by phase-contrast cine MRI (PC-MRI) in adults. Little is known about the feasibility of the method in children with congenital heart disease. METHODS AND RESULTS: In 50 children (mean age 6.2 years, range 1.1 to 17.7 years) with an atrial- or ventricular-level shunt, blood flow rate in the great vessels was determined by PC-MRI, and the ratio of pulmonary to aortic flow (Qp/Qs) was compared with Qp/Qs by oximetry. We found a difference of 2% and a range of -20% to +26% (limits of agreement, mean +/-2 SD). In another 7 children with congenital heart disease but no cardiac shunting (mean age 7.9 years, range 1.3 to 13.5 years), Qp/Qs by PC-MRI was 1.02 (SD +/-0.06). No difference between systemic venous and aortic flow volumes was found (range -17% to +20%, n=37). Blood flow through a secundum atrial septal defect as assessed by PC-MRI (n=24) overestimated the shunt compared with the difference between pulmonary and aortic flows. The mean difference between 3 repeated PC-MRI measurements in each location was 5.3% (SD +/-4.0%, n=522), demonstrating good precision. The interobserver variability was low. The accuracy of PC-MRI was confirmed by in vitro experiments. CONCLUSIONS: Determination of Qp/Qs by PC-MRI in children is quick, safe, and reliable compared with oximetry. Systemic venous flow can be quantified by PC-MRI, whereas through-plane shunt measurement within an atrial septal defect is inaccurate.
Asunto(s)
Circulación Coronaria , Cardiopatías Congénitas/fisiopatología , Niño , Preescolar , Femenino , Cardiopatías Congénitas/patología , Humanos , Imagen por Resonancia Cinemagnética , Masculino , Oximetría , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
A newly developed technique to reduce the local air contamination level in operating rooms is described. After physical and hygienic evaluations a mobile clean field-equipment has been used at 97 traumatic operations. At 66 operations about 300 aerobiological samples of the contaminated room air and simultaneously of clean field-air at the wound site were collected. It is shown that the bacterial level of clean field-air is comparable with those levels in a sterile operating enclosure. The advantages of the new technique and first experiences under practical operating conditions are discussed.