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BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518188


A 48-year-old man presented to the emergency department (ED) with exertional chest pressure associated with palpitations and lightheadedness. He was found to have non-sustained ventricular tachycardia (NSVT) in the ED, which resolved spontaneously. Given his history of hyperlipidaemia, unknown family history due to being adopted and episode of NSVT in the ED, he underwent cardiac catheterisation, which showed non-obstructive coronary artery disease and distal left anterior descending artery myocardial bridge (MB). The patient subsequently underwent ECG treadmill stress test with reproduction of chest pressure and NSVT. The patient was referred to cardiac surgery for definitive management of symptomatic MB and underwent resection of MB.

Doença da Artéria Coronariana , Taquicardia Ventricular , Artérias , Cateterismo Cardíaco , Teste de Esforço , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia
BMJ Case Rep ; 14(7)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285025


Transcatheter aortic valve replacement (TAVR) is becoming the standard of care in the management of severe aortic stenosis for patients in all risk stratifications. Many causes have been identified for acute drop in blood pressure during TAVR. Mitral regurgitation (MR) is a rare, but important acute intraprocedural complication that requires rapid assessment and treatment. Two important reasons for acute MR during TAVR include entanglement of the guide wire in papillary muscles and extension of the guidewire into the left atrium. Here, we report a case of acute reversible MR which was assessed using an echocardiogram and rapidly reversed by removing the stiff preshaped Safari2 wire from the left ventricle post valve deployment.

Estenose da Valva Aórtica , Insuficiência da Valva Mitral , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
Pacing Clin Electrophysiol ; 44(7): 1236-1252, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34085712


The thromboembolic complications of Atrial fibrillation (AF) remain a major problem in contemporary clinical practice. Despite advances and developments in anticoagulation strategies, therapy is complicated by the high risk of bleeding complications and need for meticulous medication compliance. Over the past few decades, the left atrial appendage has emerged as a promising therapeutic target to prevent thromboembolic events while mitigating bleeding complications and compliance issues. Emerging data indicates that it is a safe, effective and feasible alternative to systemic anticoagulation in patients with non-valvular AF. A number of devices have been developed for endocardial or epicardial based isolation of the left atrial appendage. Increasing experience has improved overall procedural safety and ease while simultaneously reducing device related complication rates. Furthermore, increasing recognition of the non-mechanical advantages of this procedure has led to further interest in its utility for further indications beyond the prevention of thromboembolic complications. In this review, we present a comprehensive overview of the evolution of left atrial appendage occlusion, commercially available devices and the role of this modality in the current management of AF. We also provide a brief outline of the landmark trials supporting this approach as well as the ongoing research and future prospects of left atrial appendage occlusion.

BMJ Case Rep ; 13(9)2020 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-32907862


A 54-year-old man with stage IV B metastatic colorectal cancer with liver and peritoneal metastasis was treated with cytoreductive surgery (extended left colectomy, right partial hepatectomy, resection of right diaphragm nodule) and perioperative oxaliplatin-based chemotherapy. The patient was cancer-free for 6 months, at which point a surveillance positron emission tomography-CT scan showed metabolically active hepatosplenic lesions and mediastinal and bilateral hilar lymph nodes. An endobronchial ultrasound bronchoscopy-guided fine needle aspiration of the mediastinal and hilar lymph nodes revealed non-necrotising granulomas. The workup was negative for bacterial, fungal or mycobacterial infection, cancer or autoimmune disease. Carcinoembryonic antigen and COLVERA (a circulating tumour DNA liquid biopsy test for the detection of recurrent colon cancer) tests were negative. Subsequently the rare diagnosis of a sarcoidosis-like reaction from oxaliplatin-based chemotherapy was made. Repeat imaging after 3 months showed resolution of the hepatosplenic lesions and lymphadenopathy, alike.

Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Colo/terapia , Granuloma/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Oxaliplatina/efeitos adversos , Sarcoidose/diagnóstico , Adenocarcinoma/sangue , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Antígeno Carcinoembrionário/sangue , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Colecistectomia , DNA Tumoral Circulante/sangue , Colectomia , Neoplasias do Colo/sangue , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Diagnóstico Diferencial , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Granuloma/induzido quimicamente , Granuloma/patologia , Hepatectomia , Humanos , Fígado/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Sarcoidose/sangue , Sarcoidose/induzido quimicamente , Sarcoidose/patologia , Baço/diagnóstico por imagem