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G Ital Cardiol (Rome) ; 20(2): 117-119, 2019 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-30747927


The majority of myxomas are located in the left atrium (75%) followed by the right atrium (20%). In rare cases, myxomas can be found in the ventricles, with 2.5% reported for myxomas in the left ventricle. Systemic emboli, mostly cerebral, occur in two thirds of such patients, while coronary emboli are rare. Here we report a case of left ventricular myxoma causing infero-postero-lateral myocardial infarction, successfully treated by intracoronary thromboaspiration of myxoma embolus.

Embolia/diagnóstico , Neoplasias Cardíacas/complicações , Infarto do Miocárdio/etiologia , Mixoma/complicações , Adulto , Embolia/complicações , Feminino , Neoplasias Cardíacas/diagnóstico , Ventrículos do Coração/patologia , Humanos , Mixoma/diagnóstico
J Interv Card Electrophysiol ; 54(1): 49-54, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30187250


BACKGROUND: Before subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, the adequacy of sensing is required to be verified through surface ECG screening. Our objective was to determine whether S-ICD can be considered as a supplementary therapy in patients who are receiving biventricular (BIV) pacing. METHODS: We evaluated 48 patients with BIV devices to determine S-ICD candidacy during BIV, left ventricular (LV), right ventricular (RV) pacing, and intrinsic conduction (left bundle branch block-LBBB) by using an automated screening tool. Eligibility was defined by the presence of at least one appropriate vector in the supine and standing positions. RESULTS: Eligibility was verified during BIV pacing in 34 (71%) patients. In patients screened-out, QRS duration was longer (p = 0.035) and ischemic cardiomyopathy was more frequent (p = 0.027). LV-only pacing was associated with a lower passing rate (46%) (p < 0.001 versus BIV). The LBBB QRS morphology during inhibited ventricular pacing was acceptable in 51% of patients. The QRS generated by RV pacing was acceptable in 25% of patients. In patients who passed the screening test during BIV, the QRS was not acceptable in 76% during RV pacing (i.e., accidental loss of LV capture). The concomitant adequacy during inhibited ventricular pacing (i.e., possible intrinsic conduction) was not assessed in 40% of patients. CONCLUSIONS: S-ICD may be a supplemental therapy in the majority of CRT patients. Standard BIV pacing should be preferred to the LV-only pacing mode, as it is more frequently associated with adequacy of S-ICD sensing. Spontaneous LBBB and RV-paced QRS morphologies are frequently inadequate. Therefore, in patients selected for concomitant S-ICD and CRT implantation, accidental loss of LV capture or possible intrinsic conduction must be prevented.

Mapeamento Potencial de Superfície Corporal/métodos , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial/métodos , Desfibriladores Implantáveis , Insuficiência Cardíaca/terapia , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/mortalidade , Terapia de Ressincronização Cardíaca/métodos , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Humanos , Itália , Masculino , Seleção de Pacientes , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Taxa de Sobrevida , Resultado do Tratamento
J Cardiovasc Med (Hagerstown) ; 9(11): 1120-6, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18852584


BACKGROUND: The purpose of coronary revascularization in stable patients is anginal relief, yet there is no linear relationship between stenosis severity and clinical significance. A major factor in this complex lesion-myocardium interaction is collateral flow. We aimed to define which collateral flow cut-offs separate asymptomatic from symptomatic patients during coronary occlusion. METHODS: Patients undergoing percutaneous transluminal coronary angioplasty for a single stenotic lesion were selected, collaterals were appraised angiographically, and fractional flow reserve was used during prolonged balloon occlusion to measure collateral flow index (FFRcoll). Changes in anginal symptoms, ST-T segment, and left ventricular wall motion were appraised before and during/shortly after balloon dilation. Receiver-operating-characteristic curves and area under the curve were computed to identify the most appropriate FFRcoll cut-offs. RESULTS: Twenty consecutive patients were enrolled. At baseline, 10 patients had angiographic evidence of collaterals, whereas 10 had no angiographic evidence of collateral flow distal to the target lesion. FFRcoll had an excellent discriminatory performance for the presence of angiographic collaterals (area under the curve = 0.90, P = 0.003), a good discriminatory performance for the occurrence of angina (area under the curve = 0.80, P = 0.025), and a trend toward a good discriminatory performance for the occurrence of asynergy (area under the curve = 0.81, P = 0.06). On the basis of receiver-operating-characteristic curves, an FFRcoll cut-off greater than 0.26 could reliably distinguish patients with adequate collaterals (sensitivity = 0.90, specificity = 0.80), whereas a greater than 0.41 cut-off distinguished patients having angina or wall motion abnormalities from those remaining asymptomatic. CONCLUSION: This study shows that distal collateral pressure greater than 41% of proximal perfusion pressure protects from anginal symptoms or regional systolic dysfunction during coronary occlusion, whereas a greater than 26% cut-off is more appropriate to identify angiographically evident collaterals ensuring distal myocardial viability.

Angina Pectoris/fisiopatologia , Circulação Colateral , Estenose Coronária/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Isquemia Miocárdica/fisiopatologia , Idoso , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/terapia , Angioplastia Coronária com Balão , Oclusão com Balão , Pressão Sanguínea , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/terapia , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC