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1.
Arch Cardiol Mex ; 89(3): 233-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31588125

RESUMO

Background: Nowadays, 49% of patients with pacemakers are older than 80 years old. Nevertheless, mortality and change in functional status after pacemaker implantation are not well documented in elderly patients. Objective: We designed a prospective study to analyze cardiovascular mortality and change in functional status of elderly patients, medium-long term after pacemaker implantation. Methods: Observational study including pacemaker implants in individual older than 70 years old in a single center university hospital between 2012 and 2014. Analysis testing for an association between pacemaker system, medium-long term mortality and functional status after implantation were undertaken. Results: 60% of patients were older than 80 years old. Third-degree atrio-ventricular block (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent electrocardiogram abnormalities, while bicameral DDD was the sort of pacing our department used the most (38.6%) (VVI in octogenarian patients, 38.7%). Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (p = 0.001 respectively). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p = 0.001). We found no significant improvement in Barthel index and functional status in this subgroup of patients, 3 years after pacing. Conclusion: Long-term mortality in individuals older than 80 years old with pacemaker implantation, was significantly higher comparing with general population, especially in ventricular devices. No significant improvement in functional status was detected in this subgroup of patients.

4.
Rev. colomb. cardiol ; 26(2): 112-112, mar.-abr. 2019. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1058394

RESUMO

Resumen La infección por Citomegalovirus en adultos sanos suele cursar de forma asintomática o como un cuadro de mononucleosis. La afectación cardiopulmonar en individuos inmunocompetentes es infrecuente y se asocia a mal pronóstico. Su diagnóstico exige una elevada sospecha clínica. Se presenta el caso clínico de un paciente joven que debutó con clínica de neumonía atípica y en el estudio posterior se descubrió miocardiopatía dilatada con disminución de la contractilidad miocárdica. La serología para citomegalovirus fue positiva y el paciente recibió terapia antiviral específica con excelente resultado.


Abstract Cytomegalovirus infection in healthy adults is usually asymptomatic or as signs and symptoms of a mononucleosis. Cardiopulmonary involvement in immunocompetent individuals is uncommon and is associated with a poor prognosis. Its diagnosis requires a high clinical suspicion. The case is presented of a young patient in whom the first clinical sign was an atypical pneumonia, and in the subsequent study a dilated cardiomyopathy with a decrease in myocardial contractility was discovered. The serology for cytomegalovirus was positive, and the patient received specific antiviral therapy, with an excellent outcome.

6.
Cardiovasc Revasc Med ; 20(8): 681-686, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30243961

RESUMO

BACKGROUND: The stent length as well as the stent overlap for the percutaneous treatment of diffuse coronary disease have been considered predictors of adverse events. However, there are no comparative data on the use of very long stents or overlapping stents in this scenario. OBJECTIVE: To compare the clinical results of very long stents (≥40 mm) or overlapping stents in real clinical practice. METHODS: We included 643 lesions in 628 consecutive patients treated with a single very long stent (≥40 mm) (251 lesions) or ≥2 overlapped stents (392 lesions). We analyzed the procedural characteristics and the presentation of the combined endpoint [cardiovascular death, non-fatal myocardial infarction, need for target lesion revascularization or stent thrombosis] after a follow-up of 20 months. RESULTS: Total stent length was 54 ±â€¯18 mm and minimum diameter was 2.9 ±â€¯1.2 mm. At the end of follow-up, the rate of adverse events was 8.3% (cardiac death: 4.9%, myocardial infarction: 1.7%, target lesion revascularization: 3.1%, stent thrombosis: 0.7%). There were no significant differences between both groups in the presentation of the combined endpoint. Procedures with overlapping stents had more contrast volume (309 ±â€¯115 vs 273 ±â€¯127 ml; p = 0.002), longer duration (47 ±â€¯22 vs 39 ±â€¯18 min; p < 0.0001), higher fluoroscopy time (20 ±â€¯13 vs 16 ±â€¯9 min; p < 0.0001) and higher number of stents to treat the index lesion (2.2 ±â€¯0.5 vs 1; p < 0.0001). CONCLUSIONS: New designs of very long stents allow not only treating increasingly complex lesions, but also simplifying the procedure and decreasing the number of stents with very favorable results similar to those obtained with stent overlap.


Assuntos
Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea/instrumentação , Desenho de Prótese , Stents , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Trombose Coronária/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Sistema de Registros , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
Arch Cardiol Mex ; 89(3): 212-220, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31967592

RESUMO

Background: Nowadays, 49% of patients with pacemakers are older than 80 years old. Nevertheless, mortality and change in functional status after pacemaker implantation are not well documented in elderly patients. Objective: We designed a prospective study to analyze the cardiovascular mortality and change in functional status of elderly patients, medium-long term after pacemaker implantation. Methods: An observational study including pacemaker implants in individual older than 70 years old in a single-center university hospital between 2012 and 2014. Analysis testing for an association between pacemaker system, medium-long-term mortality, and functional status after implantation was undertaken. Results: About 60% of patients were older than 80 years old. The third-degree atrioventricular blockage (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent electrocardiogram abnormalities, while bicameral DDD was the sort of pacing our department used the most (38.6%) (VVI in octogenarian patients, 38.7%). Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (p = 0.001). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p = 0.001). We found no significant improvement in Barthel Index and functional status in this subgroup of patients, 3 years after pacing. Conclusions: Long-term mortality in individuals older than 80 years old with pacemaker implantation was significantly higher comparing with general population, especially in ventricular devices. No significant improvement in functional status was detected in this subgroup of patients.


Assuntos
Fibrilação Atrial/cirurgia , Bloqueio Atrioventricular/cirurgia , Marca-Passo Artificial , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/mortalidade , Bloqueio Atrioventricular/epidemiologia , Bloqueio Atrioventricular/mortalidade , Eletrocardiografia , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo
13.
Ann Thorac Surg ; 104(2): e131-e132, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28734433

RESUMO

Pacemaker-induced superior vena cava syndrome (SVCS) is a rare but incapacitating adverse event that can occur years after implantation. Inasmuch as it is a rare disease, there is no consensus about its treatment. The most widely used option is balloon angioplasty and venous stent implantation, with preservation of the lead or previous extraction and subsequent reimplantation after the procedure, which is associated with new episodes of thrombosis. The epicardial implantation reduces the risk of thrombosis. We report a case of pacemaker-induced SVCS for which we used a hybrid approach for epicardial lead implantation and electrode extraction, balloon angioplasty, and stent implantation.


Assuntos
Bloqueio Atrioventricular/terapia , Cateterismo Periférico/métodos , Remoção de Dispositivo/métodos , Marca-Passo Artificial/efeitos adversos , Síndrome da Veia Cava Superior/cirurgia , Toracotomia/métodos , Idoso , Veia Femoral , Humanos , Masculino , Flebografia , Síndrome da Veia Cava Superior/diagnóstico , Síndrome da Veia Cava Superior/etiologia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Veia Cava Superior/diagnóstico por imagem
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