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OBJECTIVE: It is not known whether direct-acting oral anticoagulants (DOACs), such as dabigatran, apixaban, and rivaroxaban increase the risk of bleeding complications during or after coronary catheterization. The aim of this study was to investigate the safety of uninterrupted DOAC treatment during diagnostic radial coronary angiography (CAG). METHODS: This study included 160 patients who underwent diagnostic radial cardiac catheterization. The 60 patients in the group who were using a DOAC (apixaban, rivaroxaban, or dabigatran) were enrolled in a Group A. Post-procedure results from patients in Group A were compared with those of an age- and sex-matched control group (Group B) that included 100 patients who underwent radial CAG who did not use a DOAC. RESULTS: There was no significant difference in the procedure and compression times, creatinine level, or presence of hypertension, diabetes mellitus, smoking, alcohol use, vascular disease, or congestive heart failure between the 2 groups. During the 1 -month follow-up period, only 1 radial occlusion was registered in the control group (Group B). There was no case of a large hematoma (>5 cm or extending to the forearm), dissection, fistula, perforation, or compartment syndrome. Hematomas smaller than 5 cm were seen in 2 patients (1 in each group). No thrombotic events were observed during follow-up examinations. CONCLUSION: Performing radial CAG with uninterrupted DOAC treatment appears to carry no risk of increased early or short-term complications. The simple, uninterrupted DOAC strategy is comfortable, easy, and safe.
Assuntos
Anticoagulantes , Cateterismo Cardíaco , Angiografia Coronária , Idoso , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/estatística & dados numéricos , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Feminino , Hematoma/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Piridonas/efeitos adversos , Piridonas/uso terapêutico , Rivaroxabana/efeitos adversos , Rivaroxabana/uso terapêutico , Trombose/epidemiologiaRESUMO
BACKGROUND: The classification of pulmonary stenosis (PS) severity based on the transpulmonary pressure gradient, which is affected by flow rate. CASE REPORT: We report the first case of a pregnant patient with atrial septal defect (ASD) and pulmonary stenosis that was misclassified by conventional echocardiographic methods. Most importantly, three-dimensional transoesophageal echocardiographic assessment of pulmonary stenosis changed the entire treatment strategy. CONCLUSION: The planimetric calculation of the pulmonary valve (PV) opening area using three-dimensional transoesophageal echocardiographic may be helpful, especially in encounters with specialized conditions such as ASD and/or pregnancy, which can cause inaccurate recordings of the transvalvular peak gradient.
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Ecocardiografia/métodos , Comunicação Interatrial/classificação , Estenose da Valva Pulmonar/classificação , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Feminino , Comunicação Interatrial/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Gravidez , Estenose da Valva Pulmonar/diagnóstico por imagem , Adulto JovemRESUMO
The development of an aorto-right ventricular fistula is a rare complication of cardiac surgery. The most common treatment is surgical closure of the fistula, but percutaneous closure of the fistula has become an attractive alternative option. We present a case of successful utilization of live/real time three/four-dimensional transoesophageal echocardiography (3/4DTEE) to select the correct device size for percutaneous closure of an adult patient presenting with an aorto-right ventricular (AO-RV) fistula following aortic valve replacement. To the best of our knowledge, this is the first case in which 3/4DTEE was used to select the device size and guide percutaneous closure of an iatrogenic AO-RV fistula.
Assuntos
Valva Aórtica/cirurgia , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Ventrículos do Coração/cirurgia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia , Valva Aórtica/diagnóstico por imagem , Ecocardiografia Quadridimensional/métodos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-IdadeRESUMO
We report a case of renal artery pseudoaneurysm at the anastomosis site complicated with arterioureteral fistula (AUF) in a 57-year-old kidney transplant recipient who presented with intermittent massive hematuria at one month post-transplant. We successfully treated the pseudoaneurysm and AUF with endovascular covered stent implantation. The diagnosis of AUF is rare and it is a condition that occurs in patients with previous pelvic or vascular surgery, chronic ureteral catheterization and radiotherapy. This diagnosis requires the expertise of the urologist, vascular surgeon and interventional radiologist. The fistula most often occur in the iliac arteries and are often associated with pseudoaneurysms or abscesses. Angiography and ureteral contrast studies (antegrade or retrograde pyelography) are the most valuable diagnostic tools. Treatment of AUF via endovascular approach using covered stents is effective and safe, and is becoming the reference treatment in AUFs.
Assuntos
Falso Aneurisma/cirurgia , Hematúria/cirurgia , Transplante de Rim/efeitos adversos , Artéria Renal/cirurgia , Fístula Urinária/cirurgia , Fístula Vascular/cirurgia , Falso Aneurisma/fisiopatologia , Procedimentos Endovasculares , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Renal/fisiopatologia , Resultado do TratamentoRESUMO
The newly developed three dimensional speckle-tracking echocardiography (3D-STE) technology provides quick and comprehensive quantitative assessment of biventricular myocardial dynamics. The impact of coronary slow flow phenomenon (CSFP) on biventricular functions has not been comprehensively evaluated using this new technology. Therefore, the aim of this study was to evaluate the effects of CSFP on biventricular systolic functions using 3D-STE. Forty patients with CSFP and otherwise normal coronary arteries (NCAs) and 40 age- and sex-matched controls with normal coronary angiograms (CAGs) were prospectively enrolled. Biventricular systolic function was evaluated by 3D-STE. Left ventricular (LV) global longitudinal, circumferential and radial strains, ejection fraction (EF) were significantly lower and LV end-systolic volume (ESV) was significantly higher in the CSFP group compared to the control group. There were no significant differences in LV mass, LV end-diastolic volume (EDV) or LV stroke volume (SV). Additionally, Right ventricular (RV) free wall, septal wall and global longitudinal strains, and RV EF were significantly lower in the CSFP group, but there were no significant differences in RV EDV, ESV and RV SV. The present study demonstrated that CSFP has a notable negative effect on not only 3D strain parameters but also biventricular EF. There was a strong correlation between the strain parameters of the affected vessel's myocardial area and the TIMI frame count of same vessel.
Assuntos
Circulação Coronária , Ecocardiografia Tridimensional , Fenômeno de não Refluxo/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Esquerda , Função Ventricular Direita , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenômeno de não Refluxo/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Volume Sistólico , Sístole , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/fisiopatologiaRESUMO
Functional mitral regurgitation may have different haemodynamic consequences, clinical implications and treatment options, such as surgical or percutaneous interventions or implanting a pacemaker. Here we present two cases with haemodynamically significant intermittent functional mitral regurgitation as the underlying mechanism of heart failure. The cases underline the importance of a high index of suspicion in patients with intermittent heart failure, and a careful analysis of echocardiographic images with simultaneous ECG, in order to delineate systolic and diastolic mitral regurgitation.
Assuntos
Insuficiência Cardíaca/diagnóstico , Insuficiência da Valva Mitral/diagnóstico , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/fisiopatologiaRESUMO
Inflammation and genetics have key roles in the pathogenesis of atherosclerosis, and the etiology of myocardial infarction (MI). Recent studies have indicated that lower serum levels of fetuin-A may accelerate the vascular mineralization process, which leads to pathophysiological conditions, such as coronary heart disease and chronic renal failure. The aim of the present study was to evaluate the association between specific fetuin-A polymorphisms (742 and 766) that are associated with circulating serum levels, and MI cases. The study consisted of 292 participants; 146 healthy control subjects and 146 patients with MI. The patient group was divided into two subgroups: 56 MI ≤ 40 years and 90 MI ≥ 40 years. The genotype distribution of fetuin 742 (C/T) and fetuin 766 (C/G) were determined by restriction enzyme digestion of polymerase chain reaction products. A significant difference was determined between the patients with MI and the control subjects with regards to fetuin-A 742 C/T gene polymorphism (P=0.028), regardless of age. Genotype distributions of fetuin-A 742 (C/G, P=0.004) and 766 (C/T, P=0.017) were statistically different in the older patients with MI (MI ≥ 40 years old), as compared with the healthy controls; however, there were no significant differences between the younger patients with MI and the controls, with regards to fetuin-A 742 C/T (P=0.519) and 766 C/G (P=0.653) gene polymorphisms. In addition, an association was observed between the presence of fetuin-A 742 T and 766 G alleles, and MI cases. The present study demonstrates that fetuin-A 742 (C/T) and 766 (C/G) genotypes may be risk factors for MI in patients older than 40 years of age.
Assuntos
Fatores Etários , Inflamação/genética , Infarto do Miocárdio/genética , alfa-2-Glicoproteína-HS/genética , Adulto , Feminino , Frequência do Gene , Estudos de Associação Genética , Genótipo , Humanos , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Polimorfismo de Nucleotídeo Único , Fatores de RiscoRESUMO
OBJECTIVES: The aim of this study was to retrospectively evaluate the morphologic and functional features of myocardial bridging (MB) and to investigate the impact of morphologic features on presence of atherosclerosis with multi-detector computed tomography (MDCT) coronary angiography. STUDY DESIGN: The study population consisted of 191 consecutive patients. Besides coronary lesions, morphologic features of the MB (depth, length and the distance of the tunneled artery from the left coronary ostium) were analyzed. RESULTS: MDCT detected MB on left anterior descending artery in 41 patients (21.5%). The prevalence of atherosclerotic plaques proximal to the MB of LAD was 49% (20/41). There was a statistically significant correlation between percentage of systolic compression and depth of the tunneled segment (r=0.538, p<0.01). There was no relation between distance of the tunneled segment from the ostium and degree of systolic compression. No significant correlation was found between percentage of systolic compression and length of the tunneled segment (r=0.058, p=0.721). Morphologic features of MB were not related to the presence of CAD in proximal segments. CONCLUSION: MDCT coronary angiography depicts the morphologic and functional features of the MB in detail. The depth of MB segment was correlated with systolic compression of MB. There was no relationship between distance of the tunneled segment from the ostium and systolic compression.
Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Ponte Miocárdica/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte Miocárdica/complicações , Ponte Miocárdica/fisiopatologia , Prevalência , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: At present, there are no definite criteria for selecting patients eligible for same-day discharge after percutaneous coronary interventions (PCI). With rapid ambulation and reduced vascular complication rates, transradial PCI have many features that favorably reduce costs and hospital stay. This study aimed to demonstrate the possibility of early ambulatory discharge following transradial percutaneous coronary interventions. METHODS: 254 consecutive patients undergoing transradial PCI (elective, urgent, and emergent) at our center was observed during hospital stay. Patient demographics, angiographic characteristics, post-procedural complications, and timing of these post-procedural events were recorded. RESULTS: A total of 336 lesions were treated among 299 vessels with 277 stents. One hundred fifty-two (45.2%) lesions were Type C. There were 26 chronic total occlusions (CTO). One hundred fifty-five (61%) patients were discharged on the same day after the procedure. 24 complications (12.6%) occurred and were divided into three groups according to occurrence time. 13 (54.2%) occurred within the first 2 h and 11 (45.8%) occurred after the 24-hour period. No complications were observed between the 2nd and 24th hours. CONCLUSIONS: Same-day discharge with a 2-hour observation period is safe and feasible after successful transradial PCI in appropriate patients. Although a minor number of complications occurred, these did not occur between the 2nd and 24th hours. Same-day discharge after successful transradial PCI could be an alternative for better utilization of resources.
RESUMO
Emboli are among the most feared complications of interventional cardiology. Although surgery is needed in most cases for the removal of peripheric foreign body emboli, some may be extracted by percutaneous intervention. We present a case of retrieval of a femoral sheath fragment via contralateral femoral access, wiring of the sheath fragment, and retrieval with an 'anchoring balloon' system.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Embolia/etiologia , Artéria Femoral/cirurgia , Infarto do Miocárdio/terapia , Complicações Pós-Operatórias/etiologia , Embolectomia com Balão/métodos , Intervalo Livre de Doença , Eletrocardiografia , Embolia/cirurgia , Artéria Femoral/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Complicações Pós-Operatórias/cirurgiaRESUMO
The use of coronary artery bypass grafting (CABG) in primary treatment of acute myocardial infarction is still debated. We evaluated the predictors of mortality in patients undergoing primary CABG for ST-elevated myocardial infarction (STEMI). Between January 2003 and January 2008, all patients referred to our institution with STEMI who did not qualify for primary angioplasty and required CABG were included in this study. Survivors and nonsurvivors were compared retrospectively in terms of demo-graphics, preoperative, intraoperative, and postoperative characteristics. Preoperatively confirmed cases of STEMI (n = 150) were included in the analysis. There were 114 survivors and 36 nonsurvivors. In-hospital mortality rate was 22%. In Cox regression analysis age, cardiogenic shock (Killip ≥3), preoperative cardiac troponin levels, preoperative use of intra-aortic balloon counterpulsation (IABP), previous myocardial infarction, and percutaneous coronary intervention were independent predictors of in-hospital mortality. After multivariate analysis, factors predicting in-hospital mortality were age, preoperative cardiac troponin levels, and preoperative IABP. Age, preoperative cardiac troponin levels, and preoperative IABP use were predictive factors of in-hospital mortality in patients undergoing primary CABG for STEMI.
Assuntos
Ponte de Artéria Coronária , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaAssuntos
Coração Triatriado/complicações , Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/etiologia , Coração Triatriado/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , UltrassonografiaRESUMO
A 44-year-old female, with no medical history, was admitted to the cardiology department because of mild exertional dyspnea. Transthoracic and transesophageal echocardiography showed highly mobile, mass-like lesion in the aortic root. The patient was operated in the same week and a 1 cm × 6 cm soft tissue was excised from the ascending aorta. Pathological examination revealed a fibrin clot surrounded by a fibrous cap.
Assuntos
Aorta/diagnóstico por imagem , Ecocardiografia , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Achados IncidentaisRESUMO
OBJECTIVES: We investigated the incidence, predictors, and prognosis of gastrointestinal bleeding (GIB) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). STUDY DESIGN: We reviewed 2,541 consecutive patients (2,111 males, 430 females; mean age 56.5+/-11.8 years) who underwent primary PCI for STEMI. Data on clinical, angiographic findings, and in-hospital outcomes were collected. Gastrointestinal bleeding was defined as apparent upper or lower GIB or melena requiring cessation of antiplatelet or anticoagulant therapy and administration of erythrocyte infusion. RESULTS: Gastrointestinal bleeding was observed in 27 patients (1.1%). Compared to 2,514 patients without GIB, patients with GIB were older (65.9+/-13.5 years vs. 56.4+/-11.8 years; p<0.001), exhibited higher frequencies of female gender (p=0.016), renal failure (p<0.001), and admission anemia (p<0.001), and had a lower procedural success rate (77.9% vs. 91.5%; p=0.02). The development of GIB was associated with significantly higher in-hospital mortality (18.5% vs. 2.9%; p<0.001), longer hospital stay (13.1+/-6.8 days vs. 7.0+/-3.7 days, p=0.02), and increased inotropic requirement (37% vs. 6.7%; p<0.001). In multivariate analysis, inotropic requirement (OR 4.17, 95% CI 1.7-10.4; p=0.002), age above 70 years (OR 3.33, 95% CI 1.4-8.0; p=0.007), and glomerular filtration rate lower than 60 ml/min/1.73 m(2) (OR 2.96, 95% CI 1.2-7.4; p=0.02) were independent predictors of in-hospital GIB. CONCLUSION: The development of GIB is not an uncommon complication after primary PCI for STEMI. These patients have a prolonged hospital stay and increased in-hospital mortality. Increased inotropic requirement, age above 70 years, and impaired renal function are independent predictors of this complication.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Hemorragia Gastrointestinal/epidemiologia , Infarto do Miocárdio/terapia , Adulto , Idoso , Demografia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Resultado do TratamentoRESUMO
OBJECTIVES: We analyzed a large patient group to develop a clinical risk score that could be applied to patients after primary percutaneous coronary intervention (PCI). METHODS: We reviewed 2529 consecutive patients treated with primary PCI for ST-elevation myocardial infarction between 2003 and 2008. All clinical, angiographic and follow-up data were retrospectively collected. Independent predictors of in-hospital cardiovascular mortality were determined by multivariate Cox regression analysis in all study patients. RESULTS: Five variables (Killip class 2/3, unsuccessful procedure, contrast-induced nephropathy, diabetes mellitus, and age >70 years) were selected from the initial multivariate model. Each of them was weighted with 1 point according to their respective odds ratio for in-hospital mortality and then total risk score was calculated for each patient with a range of 0-5 points. For simplicity, four strata of risk were defined (low risk, score 0; intermediate risk, score 1; high risk, score 2 and very high risk, score > or =3). Each risk strata had a strong association with in-hospital cardiovascular mortality (P<0.001 for trend). Moreover, among survivors after an in-hospital period, our risk score continued to be a powerful predictor of long-term mortality (P<0.001 for trend). CONCLUSION: In patients treated with primary PCI, a risk score, which was developed from five risk factors readily available after intervention, may be useful to predict in-hospital and long-term cardiovascular mortality.
Assuntos
Angioplastia Coronária com Balão , Eletrocardiografia , Infarto do Miocárdio/cirurgia , Índice de Gravidade de Doença , Stents , Fatores Etários , Idoso , Meios de Contraste/efeitos adversos , Angiografia Coronária , Diabetes Mellitus , Feminino , Mortalidade Hospitalar , Humanos , Nefropatias/induzido quimicamente , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Razão de Chances , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , TurquiaRESUMO
An 84-year-old female patient with a past medical history significant for hypertension and diabetes mellitus, was admitted to the Emergency Department with acute coronary syndrome and complete atrioventricular block. She underwent a successful primary percutaneous coronary intervention. Ten minutes following tirofiban administration, the patient complained of hemoptysis and severe dyspnea. After chest X-ray and diagnostic bronchoscopy, she was diagnosed with diffuse alveolar hemorrhage. She died because of respiratory insufficiency on the third day of hospitalization. We present the first tirofiban-related diffuse alveolar hemorrhage case caused with half of the recommended dose of tirofiban used in the setting of non-ST-elevation myocardial infarction.
RESUMO
Left ventricular (LV) pseudoaneurysm is a rare complication of myocardial infarction. It may also occur as a complication of mitral valve surgery, chest trauma, and bacterial endocarditis. It forms when a cardiac rupture contains adherent pericardium or scar tissue and is typically located on the posterior or inferior LV wall. Pseudoaneurysms have a propensity to spontaneous rupture; hence, immediate surgical intervention is the treatment of choice for LV pseudoaneurysms diagnosed in the first months after myocardial infarction. The management of chronic LV pseudoaneurysms is still a subject of debate.
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OBJECTIVES: We sought to determine in-hospital and intermediate-term outcomes of primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) in young adults. METHODS: We reviewed 2424 consecutive patients treated with primary angioplasty for acute MI; 465 were aged 45 or less (young group) and 1959 were 46-74 years of age (nonyoung group). Clinical characteristics, in-hospital and intermediate-term outcomes of primary PCI were analyzed. RESULTS: Compared with nonyoung patients, the young patients had significantly lower in-hospital and intermediate-term mortality (for in-hospital mortaliy: 5.4 vs. 1.2%, P<0.001; for intermediate-term mortality: 5 vs. 1.3%, P<0.001). By multivariate Cox regression analysis in all 2424 patients; cardiogenic shock, diabetes mellitus, anterior MI and unsuccessful procedure were independent predictors of both in-hospital and intermediate-term mortality whereas age [odds ratio (OR): 1.07, P<0.001], female sex (OR: 1.88, P = 0.04), MI history (OR: 3.05, P = 0.001) and multivessel disease (OR: 2.15, P = 0.01) were independent predictors of only intermediate-term mortality. The young group had lower unsuccessful procedure rates of primary PCI for STEMI (4.9 vs. 10.1%, P = 0.001). CONCLUSION: These results suggest that young adults who underwent primary PCI have favorable in-hospital and intermediate-term outcomes. Moreover, primary PCI for young adults with STEMI is safer, more feasible and effective than for a relatively older population.