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1.
Medicine (Baltimore) ; 99(25): e20570, 2020 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-32569181

RESUMEN

The CHA2DS2-VASc scale does not include potential risk factors for left atrial appendage thrombus (LAAT) formation such as a form of atrial fibrillation (AF) and impaired kidney function. The real risk of thromboembolic complications in AF patients is still unclear as well as an optimal anticoagulant treatment in males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2.The aim of this study was to compare the predictive value of the CHA2DS2-VASc scale and other scales to estimate the risk of LAAT formation in AF patients treated with non-vitamin K oral anticoagulants (NOACs) and to assess the prevalence of thrombi in patients at intermediate risk of stroke.The observational study included consecutive patients with a diagnosis of non-valvular AF treated with NOACs, admitted to 3 high-reference institutions between 2013 and 2018. All individuals underwent transoesophageal echocardiography before cardioversion or ablation.Out of 1163 enrolled AF patients (62.1% male, mean age 62 years) the LAAT had been detected in 50 individuals (4.3%). Among patients with LAAT, 1 patient (2.0%) was classified as a low-risk category, 9 (18.0%) were at intermediate-risk, and 40 (80.0%) were at high risk of thromboembolic complications according to CHA2DS2-VASc scale. All patients were treated with NOACs: 51.0% rivaroxaban, 47.1% dabigatran, and 1.9% apixaban.Patients at intermediate stroke-risk with detected LAAT had higher R2CHADS2 score (2.1 ±â€Š1.2 vs 1.2 ±â€Š0.8, P = .007), higher CHA2DS2-VASc-RAF score (6.4 ±â€Š4.4 vs 3.7 ±â€Š2.6, P = .027) and more often had an estimated glomerular filtration rate below 56 mL/min/1.73 m (44.4% vs 13.2%, P = .026) compared to patients without LAAT. The receiver operating characteristics revealed that the CHA2DS2-VASc-RAF scale had better predictive ability to distinguish between patients with and without LAAT in the study group than CHA2DS2-VASc (P = .0006), CHADS2 (P = .0006) and R2CHADS2 scale (P = .0140).The CHA2DS2-VASc scale should be supplemented with an assessment of renal function and form of AF to improve stroke risk estimation. The application of additional scales to estimate the risk of LAAT might be especially useful among males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2.


Asunto(s)
Fibrilación Atrial/tratamiento farmacológico , Dabigatrán/administración & dosificación , Inhibidores del Factor Xa/administración & dosificación , Pirazoles/administración & dosificación , Piridonas/administración & dosificación , Rivaroxabán/administración & dosificación , Anciano , Apéndice Atrial/efectos de los fármacos , Ecocardiografía Transesofágica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Tromboembolia/prevención & control
2.
Internist (Berl) ; 61(7): 746-753, 2020 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-32533196

RESUMEN

A 57-year-old woman underwent esophagogastroduodenoscopy due to a continuous drop in hemoglobin levels reaching 7.4 g/dl after treatment with intravenous thrombolytic therapy 1 week earlier because of an ischemic insult. Numerous erosive lesions were found in the gastric corpus. Histological staining of a specimen from the gastric lesions revealed a poorly differentiated adenocarcinoma. Immunohistochemical examination confirmed the diagnosis of gastric metastasis from lung cancer based on positive staining for thyroid transcriptional factor­1 (TTF-1) and cytokeratin 7 (CK7) as well as via negative staining for caudal-type homeobox­2 (CDX-2). Chest computed tomography demonstrated a mediastinal mass, measuring 3.2 cm and involving the cervical and supraclavicular lymph nodes. A lymph node was subsequently extirpated. Immunohistochemical examination confirmed the diagnosis of lymph node metastasis from lung cancer by positive staining for TTF­1 and CK7. Symptomatic gastric metastasis from lung cancer is an extremely rare clinical entity. Transesophageal echocardiography detected a mass measuring 1.6 cm at the mitral valve with pericardial effusion. On the basis of the echocardiographic findings, a malignant origin was suggested after exclusion of infectious endocarditis. We assumed that the multiple organ infarctions (spleen, kidney, and brain) and gastric hematogenous metastasis must have been caused by disseminated arterial tumor embolism from the intracardiac metastasis. The patient was treated palliatively and died.


Asunto(s)
Adenocarcinoma/patología , Gastritis/patología , Hemoglobinas/efectos de los fármacos , Accidente Cerebrovascular/terapia , Terapia Trombolítica/efectos adversos , Ecocardiografía Transesofágica , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad
4.
Medicine (Baltimore) ; 99(19): e20058, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384471

RESUMEN

RATIONALE: A cardiac foreign body can cause thrombosis or infection, but sometimes it may not cause any symptoms in a patient. The diagnosis is mainly performed using a radiological examination. Especially, ultrasound is useful not only for detecting the foreign body but also for hemodynamic findings. However, the disadvantage of ultrasound is that it cannot be used where shadows are generated because of poor permeability. The transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) for identifying posterior cardiac structures because the probe is located in the esophagus behind the heart. Here, we report on the incidental finding of a foreign body in the left atrium through TEE during cardiac surgery. It did not cause any symptoms or signs for 20 years. PATIENT CONCERNS: A 75-year-old female patient with severe tricuspid regurgitation underwent tricuspid valve replacement (TVR) under general anesthesia. She had a history of mitral valve replacement (MVR) and tricuspid annuloplasty surgery 20 years ago. DIAGNOSIS: A hyper-echoic floating intracardiac foreign body was observed in the left atrium during TEE examination. It was not detected in the preoperative imaging studies such as X-ray, computed tomography, TTE. INTERVENTIONS: The cardiac foreign body found using TEE was visually confirmed through an incision in the left atrium. A long and thin foreign body was located in the right upper pulmonary vein to the left atrium, which was considered to be a left atrial catheter used during the MVR surgery performed 20 years ago. After removing the foreign body, the planned TVR operation proceeded. OUTCOMES: After removing the intracardiac foreign body and TVR, the patient was admitted into the intensive care unit followed by the general ward as planned, and discharged without any complications. LESSONS: TEE was very useful for diagnosing a foreign body in the posterior part of the heart. TEE performed during the perioperative period should be performed beyond the level of re-confirming the findings of TEE performed prior to surgery. If a retained catheter is detected, it may be appropriate to remove it considering the risk of complications.


Asunto(s)
Catéteres Cardíacos , Ecocardiografía Transesofágica , Cuerpos Extraños/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Tricúspide/cirugía , Válvula Tricúspide/cirugía , Anciano , Femenino , Humanos , Hallazgos Incidentales , Periodo Intraoperatorio
5.
J Card Surg ; 35(6): 1348-1350, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32445276

RESUMEN

The novel coronavirus, now termed SARS-CoV-2, has caused a significant global impact in the space of 4 months. Almost all elective cardiac surgical operations have been postponed with only urgent and emergency operations being considered in order to maximise resource utilisation. We present a case of a 69-year old lady with an infected prosthetic aortic valve for consideration of urgent inpatient surgery. Despite being asymptomatic and testing negative initially for COVID-19 RT-PCR swab, further investigations with CT revealed suspicious findings. She subsequently tested positive on a repeat swab and unfortunately deteriorated rapidly with complications including gastro-intestinal and intracerebral haemorrhage.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Neumonía Viral/diagnóstico , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Relacionadas con Prótesis/virología , Tiempo de Tratamiento , Anciano , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Técnicas de Laboratorio Clínico , Ecocardiografía Transesofágica/métodos , Servicio de Urgencia en Hospital , Resultado Fatal , Femenino , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Pandemias , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Radiografía Torácica/métodos , Reoperación/métodos , Tomografía Computarizada por Rayos X/métodos
6.
Medicine (Baltimore) ; 99(18): e19928, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358362

RESUMEN

RATIONALE: Point-of-care ultrasound is widely used in patients with cardiac arrest, allowing for diagnosing, monitoring, and prognostication as well as assessing the effectiveness of the chest compressions. However, the detection of intraoperative cardiac arrest by Point-of-care ultrasound was rarely reported. PATIENT CONCERNS: A 21-year-old male with Marfan syndrome which manifested Valsalva sinus aneurysms was admitted for aortic valve replacement. After endotracheal intubation, TEE transducer was inserted to evaluate the cardiac structure and function with different views. Severe aortic valve regurgitation was observed in the mid-esophageal aortic valve long and short axis view. DIAGNOSIS: TEE showed that cardiac contraction was nearly stopped, the spontaneous echo contrast was obvious in the left ventricular and hardly any blood was pumped out from the heart despite the ECG showing normal sinus rhythm with HR 61 beats/min. Meanwhile, the IBP was dropped to 50/30 mm Hg. INTERVENTIONS: Chest compressions were started immediately and epinephrine 100 µg was given intravenously. After 30 times of chest compressions, TEE showed that cardiac contractility increased and the stroke volume was improved in the TG SAX view. OUTCOMES: The patient was discharged 18 days later in a stable condition. LESSONS: Continuous echocardiography monitoring may be of particular value in forewarning and detecting cardiac arrest in high-risk patients.


Asunto(s)
Ecocardiografía Transesofágica/métodos , Paro Cardíaco/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Complicaciones Intraoperatorias/diagnóstico por imagen , Síndrome de Marfan/complicaciones , Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Sistemas de Atención de Punto , Adulto Joven
7.
Medicine (Baltimore) ; 99(15): e19817, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282747

RESUMEN

RATIONALE: Two-dimensional echocardiography (2D echo) is a major tool for the diagnosis of Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). However 2D echo can skip regional localized anomalies of the right ventricular wall. We aimed to determine whether transesophageal and intracardiac ultrasound can provide additional information, on the right ventricular abnormalities compared to 2D echo. PATIENT CONCERNS: Case 1 is a 30-year-old patient that presented in the Emergency Department with multiple episodes of fast monomorphic ventricular tachycardia (VT) manifested by palpitations and diziness. Case 2 is a 65-year-old patient that also presented with episodes of ventircular tachycardia associated with low blood pressure. DIAGNOSIS: Both patients had a clear diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy confirmed by cardiac magnetic resonance imaging. INTERVENTION: In both patients transesophageal and intracardiac ultrasound was performed, which brought more information on the diagnosis of ARVD/C compared to transthoracic echocardiograpy. OUTCOMES: The first patient was implanted with an internal cardiac defibrillator and treated with Sotalol for VT recurrences. He presented episodes of VT during follow-up, treated with antitachycardia pacing. The second patient was implanted with an internal cardiac defibrillator and treated with Sotalol without any VT recurrence at 18 month-follow-up. LESSONS: Transesophageal echocardiography and intracardiac echocardiography can provide additional information on small, focal structural abnormalities in patients with ARVD/C: bulges, saculations, aneurysms with or without associated thrombus, partial or complete loss of trabeculations and hypertrophy of the moderator band. These changes are particularly important in cases with "concealed" form of the disease in which no morphological abnormalities are evident in transthoracic echocardiograpy.


Asunto(s)
Displasia Ventricular Derecha Arritmogénica/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Trombosis/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Anciano , Antiarrítmicos/uso terapéutico , Displasia Ventricular Derecha Arritmogénica/complicaciones , Displasia Ventricular Derecha Arritmogénica/terapia , Técnicas de Imagen Cardíaca/instrumentación , Desfibriladores Implantables , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Recurrencia , Trombosis/patología , Resultado del Tratamiento , Ultrasonografía/tendencias
8.
Open Heart ; 7(1): e001176, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32257245

RESUMEN

Objective: The role of transoesophageal echocardiography (TOE) in identifying ischaemic stroke aetiology is debated. In 2018, the American Heart Association/American Stroke Association (AHA/ASA) issued class IIa recommendation for echocardiography, with the qualifying statement of use in cases where it will alter management. Hence, we sought to determine the rate at which TOE findings altered management in cases of confirmed ischaemic stroke. Methods: We retrospectively analysed TOE cases with confirmed ischaemic stroke at our centre between April 2015 and February 2017. We defined a change in management as the initiation of anticoagulation therapy, antibiotic therapy or patent foramen ovale closure as a direct result of TOE findings. Results: There were 185 patients included in this analysis; 19 (10%) experienced a change in management. However, only 7 of the 19 (4% of all subjects) experienced a change in management due to TOE findings. The remaining 12 were initiated on oral antigoagulation as a result of discoveries during routine workup, mainly atrial fibrillation on telemetry monitoring. Conclusions: This work suggests an overuse of TOE and provides support for the 2018 AHA/ASA stroke guidelines, which recommend against the routine use of echocardiography in the work up of cerebrovascular accident due to a cardioembolic source.


Asunto(s)
Isquemia Encefálica/etiología , Ecocardiografía Transesofágica , Embolia/diagnóstico por imagen , Foramen Oval Permeable/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Anciano , Antibacterianos/administración & dosificación , Anticoagulantes/administración & dosificación , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/prevención & control , Toma de Decisiones Clínicas , Bases de Datos Factuales , Embolia/complicaciones , Embolia/terapia , Femenino , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/terapia , Cardiopatías/complicaciones , Cardiopatías/terapia , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/prevención & control
9.
Rev Cardiovasc Med ; 21(1): 93-101, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-32259907

RESUMEN

We performed a meta-analysis comparing the procedural and outcomes data and related to left atrial appendage occlusion guided by intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) in nonvalvular atrial fibrillation patients. Technical success with ICE was significantly similar to that of TEE (odds ratio [OR] 1.38, 95% CI [0.62, 3.09], I2 = 0%, P = 0.43). The peri-procedural complications showed no significant difference between the two groups (OR 0.84, 95% CI [0.57, 1.23], I2 = 0%, P = 0.37). Mortality was similar in procedures using ICE vs TEE (OR 0.89, 95% CI [0.51, 1.57], I2 = 0%, P = 0.69). Landing zones, procedural time and fluoroscopic times between ICE and TEE showed no significant differences (MD 1.96, 95% CI [-0.01, 3.94], I2 = 90%, P = 0.05; MD -1.64, 95% CI [-13.45, 10.17], I2 =95%, P =0.79; and MD 0.49, 95% CI [-2.18, 3.16], I2 = 87%, P = 0.72, respectively). Imaging with ICE or TEE is associated with similar outcomes in left atrial appendage occlusion procedures.


Asunto(s)
Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/terapia , Ecocardiografía Transesofágica , Anciano , Anciano de 80 o más Años , Apéndice Atrial/fisiopatología , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/mortalidad , Fibrilación Atrial/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Factores de Riesgo , Resultado del Tratamiento
10.
Isr Med Assoc J ; 22(4): 249-254, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32286030

RESUMEN

BACKGROUND: The innovation that has taken place in medicine, combined with state-of-the-art technological developments, provides therapeutic options for patients in conditions that were previously considered incurable. This promotion at the same time presents us with new ethical challenges. In this article, we review the journey through life of an advanced heart failure patient, covering a variety of potential clinical and ethics subjects in the field of heart failure treatment. We review the ethical principles of the Hippocratic Oath against the background of the realities of practicing medicine and of the enormous advances in therapeutics.


Asunto(s)
Cardiología/tendencias , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/terapia , Juramento Hipocrático , Pautas de la Práctica en Medicina/ética , Resultado del Tratamiento , Cardiología/normas , Terapia Combinada , Ecocardiografía Transesofágica/métodos , Femenino , Predicción , Humanos , Masculino , Pautas de la Práctica en Medicina/tendencias
13.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(3): 223-227, 2020 Mar 24.
Artículo en Chino | MEDLINE | ID: mdl-32234180

RESUMEN

Objective: To investigate the relationship between high sensitivity C-reactive protein (hs-CRP) level and incidence of left atrial spontaneous echocardiographic contrast (LASEC) in the patients with nonvalvular atrial fibrillation (AF). Methods: Four hundred and ninety consecutive patients with nonvalvular atrial fibrillation who underwent radiofrequency ablation for the first time from January 1, 2018 to June 30, 2018 in the Department of Cardiology, Beijing Anzhen Hospital were enrolled. According to the results of transesophageal echocardiography before radiofrequency ablation, patients were divided into the group without LASEC (n=338) and the group with LASEC (n=152). hs-CRP was determined by latex enhanced immunoturbidimetry. The relationship between hs-CRP and LASEC in patients with nonvalvular atrial fibrillation was investigated by univariate and multivariate logistic analysis. Results: LASEC was detected in 152 (31%) of 490 patients. Significant differences in age, type of atrial fibrillation, previous embolic events, fibrinogen, D-dimer, the left atrial anteroposterior diameter and CHA(2)DS(2)-VASc scores were found between patients with and without LASEC (all P<0.05). Compared with the group without LASEC, the serum hs-CRP level was significantly higher in the group with LASEC (3.16 (1.30, 5.23) mg/L vs. 0.67 (0.37, 1.48) mg/L, P<0.001). Multivariate logistic regression analysis showed that hs-CRP (OR=1.136, 95%CI 1.060 - 1.217, P<0.001) and D-dimer (OR=1.040, 95%CI 1.011 - 1.070, P=0.007) were independent determinants for LASEC in this patient cohort. Conclusions: hs-CRP is an independent determinant for LASEC in patients with nonvalvular atrial fibrillation. Inflammation may thus be involved in the formation of prethrombotic state in patients with nonvalvular atrial fibrillation.


Asunto(s)
Fibrilación Atrial , Apéndice Atrial , Fibrilación Atrial/epidemiología , Proteína C-Reactiva , Ecocardiografía Transesofágica , Electrocardiografía , Atrios Cardíacos , Humanos , Incidencia , Factores de Riesgo
14.
Am Surg ; 86(3): 190-194, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32223796

RESUMEN

Resuscitation of critically ill trauma patients can be precarious, and errors can cause acute kidney injuries. If renal failure develops, continuous renal replacement therapy (CRRT) may be necessary, but adds expense. Hemodynamic transesophageal echocardiography (hTEE) provides objective data to guide resuscitation. We hypothesized that hTEE use improved acute kidney injury (AKI) management, reserved CRRT use for more severe AKIs, and decreased cost and resource utilization. We retrospectively reviewed 2413 trauma patients admitted to a Level I trauma center's ICU between 2009 and 2015. Twenty-three patients required CRRT before standard hTEE use and 11 required CRRT after; these are the "CRRT" and "CRRT/hTEE" groups, respectively. The hTEE group comprised 83 patients evaluated with hTEE, with AKI managed without CRRT. We compared the average creatinine, change in creatinine, and Acute Kidney Injury Network (AKIN) of "CRRT" with "CRRT/hTEE" and "hTEE." We also analyzed several quality measures including ICU length of stay and cost. "CRRT" had a lower AKIN score (1.6) than "CRRT/hTEE" (2.9) (P = 0.0003). "hTEE" had an AKIN score of 2.1 (P = 0.0387). "CRRT" also had increased ICU days (25.1) compared with "CRRT/hTEE" (20.2) (P = 0.014) and "hTEE" (16.8) (P = 0.003). "CRRT" accrued on average $198,695.81 per patient compared with "CRRT/hTEE" ($167,534.19) and "hTEE" ($53,929.01). hTEE provides valuable information to tailor resuscitation. At our institution, hTEE utilization reserved CRRT for worse AKIs and decreased hospital costs.


Asunto(s)
Lesión Renal Aguda/terapia , Terapia de Reemplazo Renal Continuo/métodos , Ecocardiografía Transesofágica/métodos , Hemodinámica/fisiología , Mortalidad Hospitalaria/tendencias , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/mortalidad , Anciano , Reanimación Cardiopulmonar/métodos , Enfermedad Crítica/mortalidad , Enfermedad Crítica/terapia , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Centros Traumatológicos , Resultado del Tratamiento
15.
Medicine (Baltimore) ; 99(11): e19392, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176064

RESUMEN

RATIONALE: Renal carcinoma is a common malignant tumor of the urinary system, 4%-10% of which are complicated with tumor thrombi in the renal vein and the inferior vena cava; in about 1% of patients, the inferior vena cava tumor thrombus invades the right atrium. Surgery is the treatment of choice. Real-time monitoring with transesophageal echocardiography (TEE) has been widely used in various operations, including cardiac and non-cardiac operations for congenital heart diseases, coronary diseases, vascular heart diseases, and aorta diseases, etc. In this article, a case of a patient with right renal carcinoma complicated with an inferior vena cava tumor thrombus is reported. PATIENT CONCERNS: A 52-year-old man who was admitted to our hospital for lumbar pain lasting for one month. DIAGNOSIS: Right renal carcinoma complicated with an inferior vena cava tumor thrombus. INTERVENTIONS: Radical nephrectomy of the renal carcinoma and removal of an inferior vena cava tumor thrombus under real-time monitoring with TEE were performed. OUTCOMES: Radical nephrectomy was successfully performed within 5 minutes after the inferior vena cava was clamped, and then the inferior vena cava tumor thrombus was removed. On the second day after the operation, the patient's conditions improved; his consciousness was clear; he was transferred to a general ward. On the third day after the operation, the patient was able to get out of bed and was discharged on the sixth day after the operation. LESSONS: Real-time monitoring with TEE played an important role in many aspects in the radical nephrectomy of the renal carcinoma and removal of the inferior vena cava tumor thrombus.


Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Nefrectomía/métodos , Trombectomía/métodos , Vena Cava Inferior/cirugía , Trombosis de la Vena/cirugía , Carcinoma de Células Renales/diagnóstico por imagen , Ecocardiografía Transesofágica , Humanos , Neoplasias Renales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Ultrasonografía Intervencional , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/patología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/patología
16.
BMC Infect Dis ; 20(1): 212, 2020 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-32164584

RESUMEN

BACKGROUND: Pulmonary endarteritis is a rare clinical phenomenon with congenital heart that can potentially lead to major complications. CASE PRESENTATION: We report a 47-year-old man with pulmonary endarteritis. This patient presented with hypertension, chest pain and a previous history of pulmonary valve disease during childhood. Also, eight-months prior, he was hospitalized with dyspnea (Functional Class III), cough, phlegm, and night sweats without fever. Echocardiographic diagnosis in the first transtransthoracic echocardiography (TTE) was intense pulmonary valve stenosis (PVS) an, thus, the pulmonary valve vegetation and PVS, established by transesophageal echocardiography (TEE). He was referred for surgery after 1 weeks of intravenous antibiotic therapy for removal of the vegetation. CONCLUSIONS: Finally he was asymptomatic at 3-months of follow-up and was clinically in good condition. Therefore, the detection of infective endocarditis of the lung valve must not lengthy be prolonged.


Asunto(s)
Endarteritis/diagnóstico , Endocarditis Bacteriana/diagnóstico , Embolia Pulmonar/diagnóstico , Sepsis/diagnóstico , Antibacterianos/uso terapéutico , Ecocardiografía Transesofágica , Endarteritis/diagnóstico por imagen , Endarteritis/terapia , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/terapia , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/terapia , Válvula Pulmonar/cirugía , Estenosis de la Válvula Pulmonar/diagnóstico por imagen , Sepsis/terapia , Tomografía Computarizada por Rayos X
20.
Expert Rev Med Devices ; 17(3): 209-221, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32085683

RESUMEN

Introduction: Prosthetic heart valve thrombosis is a life-threatening complication after valve replacement surgery. Although subtherapeutic anticoagulation is the main cause, there are many other conventional and esoteric predisposing factors.Areas covered: The etiopathogenesis, diagnosis, and management of prosthetic heart valve thrombosis with particular focus on conventional and esoteric predisposing factors, diagnosis with multimodality imaging and current therapeutic approaches were covered.Expert opinion: Subtherapeutic anticoagulation remains the key driving force for the development of prosthetic valve thrombosis. However, cardiologists should be cognizant of other frequent or rare conventional and esoteric causes. The diagnosis is now more straightforward with the use of multimodality imaging. Transthoracic and transesophageal echocardiography with or without real-time three-dimensional imaging are the current gold standard modalities. Multidetector computed tomography is now a major complementary tool. The favorable clinical outcomes with recently introduced slow or ultra-slow infusions of alteplase, as compared to relatively poor surgical results, have rendered thrombolytic therapy the first-line treatment option in most eligible patients with prosthetic valve thrombosis. Surgical treatment could be reserved in whom thrombolytic therapy is contraindicated or has already failed. The efficacy and safety of thrombolytic therapy as compared to surgery should be confirmed with large observational cohorts, and ideally randomized trials.


Asunto(s)
Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/terapia , Prótesis Valvulares Cardíacas/efectos adversos , Trombosis/diagnóstico , Trombosis/terapia , Ecocardiografía Transesofágica , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Humanos , Terapia Trombolítica , Trombosis/epidemiología , Trombosis/etiología , Activador de Tejido Plasminógeno/uso terapéutico
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