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1.
Braz J Cardiovasc Surg ; 34(5): 535-541, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719007

RESUMO

INTRODUCTION: Metabolic syndrome (MetS) is defined as an association between diabetes, hypertension, obesity and dyslipidemia and an increased risk of cardiovascular disease. Mitral annular calcification (MAC) is associated with several cardiovascular disorders, including coronary artery disease, atrial fibrillation (AF), heart failure, ischemic stroke and increased mortality. The CHA2DS2-VASc score is used to estimate thromboembolic risk in AF. However, the association among MAC, MetS and thromboembolic risk is unknown and was evaluated in the current study. METHODS: The study group consisted of 94 patients with MAC and 86 patients with MetS. Patients were divided into two groups: those with and those without MAC. RESULTS: Patients with MAC had a higher MetS rate (P<0.001). In patients with MAC, the CHA2DS2-VASc scores and the rate of cerebrovascular accident and AF were significantly higher compared to those without MAC (P<0.001, for both parameters). The results of the multivariate regression analysis showed that history of smoking, presence of MetS and high CHA2DS2-VASc scores were associated with the development of MAC. ROC curve analyses showed that CHA2DS2-VASc scores were significant predictors for MAC (C-statistic: 0.78; 95% CI: 0.706-0.855, P<0.001). Correlation analysis indicated that MAC was positively correlated with the presence of MetS and CHA2DS2-VASc score (P=0.001, r=0.264; P<0.001, r=0.490). CONCLUSION: We have shown that CHA2DS2-VASc score and presence of MetS rates were significantly higher in patients with MAC compared without MAC. Presence of MAC was correlated with CHA2DS2-VASc score, presence of MetS, AF and left atrial diameter and negatively correlated with left ventricular ejection fraction.


Assuntos
Calcinose/complicações , Doenças das Valvas Cardíacas/complicações , Síndrome Metabólica/complicações , Valva Mitral , Tromboembolia/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Calcinose/fisiopatologia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Tromboembolia/fisiopatologia
4.
Heart Lung Circ ; 28(9): 1310-1319, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266725

RESUMO

Degenerative or fibrocalcific aortic stenosis (AS) is now the most common native valvular heart disease assessed and managed by cardiologists in developed countries. Transthoracic echocardiography remains the quintessential imaging modality for the non-invasive characterisation of AS due to its widespread availability, superior assessment of flow haemodynamics, and a wealth of prognostic data accumulated over decades of clinical utility and research applications. With expanding technologies and increasing availability of treatment options such as transcatheter aortic valve replacements, in addition to conventional surgical approaches, accurate and precise assessment of AS severity is critical to guide decisions for and timing of interventions. Despite clear guideline echocardiographic parameters demarcating severe AS, discrepancies between transvalvular velocities, gradients, and calculated valve areas are commonly encountered in clinical practice. This often results in diagnostically challenging cases with significant implications. Greater emphasis must be placed on the quality of performance of basic two dimensional (2D) and Doppler measurements (attention to detail ensuring accuracy and precision), incorporating ancillary haemodynamic surrogates, understanding study- or patient-specific confounders, and recognising the role and limitations of stress echocardiography in the subgroups of low-flow low-gradient AS. A multiparametric approach, along with the incorporation of multimodality imaging (cardiac computed tomography or magnetic resonance imaging) in certain scenarios, is now mandatory to avoid incorrect misclassification of severe AS. This is essential to ensure appropriate selection of patients who would most benefit from interventions on the aortic valve to relieve the afterload mismatch resulting from truly severe valvular stenosis.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Valva Aórtica/patologia , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Ecocardiografia sob Estresse , Ecocardiografia , Hemodinâmica , Imagem Multimodal , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/prevenção & controle , Estenose da Valva Aórtica/terapia , Calcinose/prevenção & controle , Calcinose/terapia , Humanos , Substituição da Valva Aórtica Transcateter
5.
Georgian Med News ; (290): 63-68, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31322517

RESUMO

Little is known about the gender differences of left ventricular (LV) remodeling in patients with aortic valve calcification (AVC). The aim was to assess gender differences of structure functional changes and LV myocardial remodeling in patients with AVC depending on the type of valve lesion. 293 patients (131 men) with revealed AVC by transthoracic echocardioscopy without aortic stenosis and 76 patients (50 men) without AVC were examined. Men had normal geometry of LV more often than women (15.7% vs. 4.4 % in isolated AVC and 11.9% vs. 2.8 % in combined lesion of aortic valve (AV) and mitral valves ring (MVR), р<0.052), and eccentric hypertrophy was registered more often in man with combined AV and MVR lesion (38.1% vs. 15.5 % in women with combined AV and MVR lesion and vs. 20.2 % in men with isolated AVC, р<0.029). LV systolic function was worse in men with combined valves lesion (ejection fraction was 54.0 (48.0; 65.0) vs. 66.0 (60.0; 71.0) % in women with combined valves lesion and vs. 63.0 (55.0; 70.0) % in men with isolated AVC, р<0.022). Men with combined valves lesion also had a larger right ventricle (RV) size (RV index was 1.3 (1.2; 1.5) vs. 1.2 (1.1; 1.4) cm/m2 in women with combined valves lesion and vs. 1.2 (1.1; 1.4) cm/m2 in men with isolated AVC, р<0.036) and had tricuspid regurgitation more often (76.2% vs. 56.3 % in women with combined valves lesion and vs. 58.4 % in men with isolated AVC, р<0.029). Women had higher peak aortic jet velocity (1.5 (1.4; 1.7) vs. 1.4 (1.2; 1.6) m/s in man, р<0.0001). Dominating models of LV remodeling in women were concentric, mainly concentric hypertrophy (61.5% vs. 31.5 % in men in groups with isolated AVC and 64.8% vs. 31.0 % in combined valves lesion groups, р<0.001). Also women had a higher left auricle index than men (2.3 (2.0; 2.5) vs. 2.1 (1.9; 2.4) cm/m2, р<0.015). There were revealed differences in distribution of LV remodeling types depending on the gender and the type of valve lesion.


Assuntos
Estenose da Valva Aórtica/patologia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Calcinose/sangue , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiologia , Valva Aórtica/cirurgia , Biomarcadores/sangue , Calcinose/complicações , Calcinose/patologia , Calcinose/fisiopatologia , Calcinose/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
6.
Rev. bras. cir. plást ; 34(2): 295-298, apr.-jun. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1015997

RESUMO

A calcinose escrotal idiopática é uma entidade rara, benigna. Não costuma ter outros sintomas associados. O caso reportado se trata de um paciente de 30 anos com diversos nódulos calcificados em bolsa escrotal, com 15 anos de evolução. Como medida terapêutica, foi realizada excisão cirúrgica completa dos nódulos, apresentando boa evolução cirúrgica e resultados estético e funcional satisfatórios.


Idiopathic scrotal calcinosis is a rare benign entity. Patients affected by scrotal calcinosis usually do not have other associated symptoms. We report the case of a 30-yearold man with several calcified nodules in the scrotal sac with onset at age 15 years. A complete surgical excision of the nodules was performed, and the patient recovered well with satisfactory aesthetic and functional results.


Assuntos
Humanos , Feminino , Adulto , Patologia Cirúrgica/métodos , Escroto/cirurgia , Escroto/fisiopatologia , Calcinose/cirurgia , Calcinose/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos/métodos
8.
Osteoporos Int ; 30(7): 1529-1531, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30887076

RESUMO

PURPOSE: T50 is a novel serum-based marker that assesses the propensity of calcification in serum. Shorter T50 indicates greater propensity to calcify and it has been associated to cardiovascular disease (CVD) and mortality among patients with kidney disease. In the general population, neither the correlates of T50 nor the relationships of T50 with bone mineral density (BMD) are known. METHODS: We performed a nested cross-sectional study selecting 150 individuals at random among participants from the Osteoporotic Fractures in Men (MrOS) Study, a study of community-living older men. We categorized individuals into tertiles of T50 and compared demographics and disease indicators across tertiles. We utilized linear regression to evaluate the cross-sectional association between T50 and hip and spine BMD in multivariable models. RESULTS: Older age was associated with shorter T50. Kidney function tended to be lower in those with shorter T50 and the prevalence of CVD and peripheral arterial disease in those with shorter T50, albeit these findings did not achieve statistical significance. We found no statistically significant associations between T50 and total hip or total spine BMD in either unadjusted or multivariable adjusted models. CONCLUSIONS: T50, a novel indicator of serum calcification propensity, is not associated with BMD in community-living older men. Future larger studies should determine if T50 may give insights to CVD in the general population above and beyond traditional risk factors.


Assuntos
Densidade Óssea/fisiologia , Osteoporose/sangue , Fraturas por Osteoporose/sangue , Idoso , Biomarcadores/sangue , Calcinose/sangue , Calcinose/fisiopatologia , Estudos Transversais , Articulação do Quadril/fisiopatologia , Humanos , Vida Independente , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complexos Multiproteicos/sangue , Nanopartículas/metabolismo , Osteoporose/fisiopatologia , Fraturas por Osteoporose/fisiopatologia
10.
Arterioscler Thromb Vasc Biol ; 39(4): 613-622, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30727754

RESUMO

Inflammatory cytokines are necessary for an acute response to injury and the progressive healing process. However, when this acute response does not resolve and becomes chronic, the same proteins that once promoted healing then contribute to chronic inflammatory pathologies, such as atherosclerosis. OPN (Osteopontin) is a secreted matricellular cytokine that signals through integrin and CD44 receptors, is highly upregulated in acute and chronic inflammatory settings, and has been implicated in physiological and pathophysiologic processes. Evidence from the literature suggests that OPN may fit within the Goldilocks paradigm with respect to cardiovascular disease, where acute increases are protective, attenuate vascular calcification, and promote postischemic neovascularization. In contrast, chronic increases in OPN are clinically associated with an increased risk for a major adverse cardiovascular event, and OPN expression is a strong predictor of cardiovascular disease independent of traditional risk factors. With the recent finding that humans express multiple OPN isoforms as the result of alternative splicing and that these isoforms have distinct biologic functions, future studies are required to determine what OPN isoform(s) are expressed in the setting of vascular disease and what role each of these isoforms plays in vascular disease progression. This review aims to discuss our current understanding of the role(s) of OPN in vascular disease pathologies using evidence from in vitro, animal, and clinical studies. Where possible, we discuss what is known about OPN isoform expression and our understanding of OPN isoform contributions to cardiovascular disease pathologies.


Assuntos
Inflamação/metabolismo , Osteopontina/fisiologia , Doenças Vasculares/metabolismo , Processamento Alternativo , Animais , Aterosclerose/fisiopatologia , Calcinose/fisiopatologia , Glicosilação , Humanos , Receptores de Hialuronatos/fisiologia , Inflamação/fisiopatologia , Integrinas/fisiologia , Isquemia/fisiopatologia , Camundongos , Modelos Cardiovasculares , Neointima/patologia , Osteopontina/química , Osteopontina/genética , Fosforilação , Isoformas de Proteínas/fisiologia , Processamento de Proteína Pós-Traducional , Fatores de Risco
11.
Circ Cardiovasc Imaging ; 12(2): e008513, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30712363

RESUMO

BACKGROUND: Mitral annular calcification (MAC) is associated with cardiovascular events and mitral valve dysfunction. However, the underlying pathophysiology remains incompletely understood. In this prospective longitudinal study, we used a multimodality approach including positron emission tomography, computed tomography, and echocardiography to investigate the pathophysiology of MAC and assess factors associated with disease activity and progression. METHODS: A total of 104 patients (age 72±8 years, 30% women) with calcific aortic valve disease, therefore predisposed to MAC, underwent 18F-sodium fluoride (calcification activity) and 18F-Fluorodeoxyglucose (inflammation activity) positron emission tomography, computed tomography calcium scoring, and echocardiography. Sixty patients underwent repeat computed tomography and echocardiography after 2 years. RESULTS: MAC (mitral annular calcium score >0) was present in 35 (33.7%) patients who had increased 18F-fluoride (tissue-to-background ratio, 2.32 [95% CI, 1.81-3.27] versus 1.30 [1.22-1.49]; P<0.001) and 18F-Fluorodeoxyglucose activity (tissue-to-background ratio, 1.44 [1.37-1.58] versus 1.17 [1.12-1.24]; P<0.001) compared with patients without MAC. MAC activity (18F-fluoride uptake) was closely associated with the local calcium score and 18F-Fluorodeoxyglucose uptake, as well as female sex and renal function. Similarly, MAC progression was closely associated with local factors, in particular, baseline MAC. Traditional cardiovascular risk factors and calcification activity in bone or remote atherosclerotic areas were not associated with disease activity nor progression. CONCLUSIONS: MAC is characterized by increased local calcification activity and inflammation. Baseline MAC burden was associated with disease activity and the rate of subsequent progression. This suggests a self-perpetuating cycle of calcification and inflammation that may be the target of future therapeutic interventions.


Assuntos
Calcinose/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Imagem Multimodal/métodos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/fisiopatologia , Calcinose/epidemiologia , Calcinose/fisiopatologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Progressão da Doença , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Prevalência , Prognóstico , Fatores de Tempo
12.
Ann Biomed Eng ; 47(4): 1116-1128, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30710186

RESUMO

Several studies have shown the variation of aortic sinus structures' hemodynamics with different flow and geometric characteristics. They have also correlated aortic sinus hemodynamics with the progression and evolution of calcific aortic valve disease (CAVD). This study aims at visualizing aortic sinus fluid structure variations as functions of different leaflet calcification degrees and assessing their potential relationship with CAVD. A degenerated 23 mm Carpentier-Edwards Perimount Magna valve extracted from a redo-surgery patient was implanted in an aortic root model and tested in a pulse duplicator left heart simulator. The valve has 3 leaflets with 3 different levels of calcium distribution: mild, moderate and severe. High-speed imaging and particle image velocimetry were performed to assess sinus vortices, leaflet tip position and velocity along with shear stress. Results have shown that (a) aortic sinus vortices initiation, entrapment and evolution varied with different calcified leaflet exposure; (b) higher velocities in the sinus were calculated with the mildly calcified leaflet compared to the moderately and severely calcified ones; (c) during systole, the mildly calcified leaflet sinus case shows the most spread-out and higher ranges of shear stress probabilities and highest magnitudes going from (- 1.5 to + 1.8 Pa) compared with (- 1.0 to + 1.0 Pa) for moderately and severely calcified leaflets. The higher the calcification degree the lower the shear stress range and likelihoods of having higher shear stress. This holds in diastole as well. This study shows the impact of calcification on the aortic sinus flow structures.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Valva Aórtica/patologia , Calcinose/fisiopatologia , Simulação por Computador , Modelos Cardiovasculares , Seio Aórtico/fisiopatologia , Estresse Mecânico , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Humanos , Seio Aórtico/diagnóstico por imagem
13.
Brain Nerve ; 71(1): 59-66, 2019 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-30630130

RESUMO

Idiopathic basal ganglia calcification (IBGC), which is also called Fahr's disease or recently referred to as primary familial brain calcification (PFBC), is an idiopathic and intractable disease characterized by abnormal deposits of minerals including calcium in the basal ganglia and other brain regions such as the thalamus and cerebellum. Mutations in SLC20A2, PDGFRB, PDGFB, XPR1, MYORG have been reported in the past several years. The pathophysiological basis presumed by the genetic studies is the impairment of the transport of inorganic phosphate (Pi) into and out of cells in the brain. We reported high levels of Pi in the cerebrospinal fluid (CSF) of IBGC patients, especially in IBGC patients with SLC20A2 mutations. The flow of Pi between the CSF and interstitial fluid (ISF) in the brain and the drainage flow through the perivascular space in the perivascular drainage pathway can explain the distribution and pathology of mineralization in IBGC. Thus, it is very important to further elucidate the pathophysiology of IBGC and consequently develop pharmacological agents based on the pathophysiology of IBGC in the near future in order to benefit patients with IBGC and their families.


Assuntos
Doenças dos Gânglios da Base/fisiopatologia , Calcinose/fisiopatologia , Gânglios da Base/fisiopatologia , Humanos , Fosfatos/líquido cefalorraquidiano , Proteínas Cotransportadoras de Sódio-Fosfato Tipo III/genética
14.
JACC Cardiovasc Interv ; 12(2): 182-193, 2019 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-30678797

RESUMO

OBJECTIVES: The aim of this study was to evaluate the predictors of left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR). BACKGROUND: LVOT obstruction is a major concern with TMVR, but limited data exist regarding its predictors and impact on outcomes. METHODS: Patients with pre-procedural multidetector row computed tomography (MDCT) undergoing TMVR for failed mitral bioprosthetic valves (valve-in-valve), annuloplasty rings (valve-in-ring), and mitral annular calcification (valve-in-MAC) were included in this study. Echocardiographic and procedural characteristics were recorded, and comprehensive assessment with MDCT was performed to identify the predictors of LVOT obstruction (defined as an increment of mean LVOT gradient ≥10 mm Hg from baseline). The new LVOT (neo-LVOT) area left after TMVR was estimated by embedding a virtual valve into the mitral annulus on MDCT, simulating the procedure. RESULTS: Among 194 patients with pre-procedural MDCT undergoing TMVR (valve-in-valve, 107 patients; valve-in-ring, 50 patients; valve-in-MAC, 37 patients), LVOT obstruction was observed in 26 patients (13.4%), with a higher rate after valve-in-MAC than valve-in-ring and valve-in-valve (54.1% vs. 8.0% vs. 1.9%; p < 0.001). Patients with LVOT obstruction had significantly higher procedural mortality compared with those without LVOT obstruction (34.6% vs. 2.4%; p < 0.001). Receiver-operating characteristic curve analysis showed that an estimated neo-LVOT area ≤1.7 cm2 predicted LVOT obstruction with sensitivity of 96.2% and specificity of 92.3%. CONCLUSIONS: LVOT obstruction after TMVR was associated with higher procedural mortality. A small estimated neo-LVOT area was significantly associated with LVOT obstruction after TMVR and may help identify patients at high risk for LVOT obstruction.


Assuntos
Calcinose/cirurgia , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Obstrução do Fluxo Ventricular Externo/etiologia , Idoso , Idoso de 80 Anos ou mais , Calcinose/diagnóstico por imagem , Calcinose/mortalidade , Calcinose/fisiopatologia , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Ecocardiografia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/mortalidade , Estenose da Valva Mitral/fisiopatologia , Tomografia Computadorizada Multidetectores , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/mortalidade , Obstrução do Fluxo Ventricular Externo/fisiopatologia
17.
Circ Cardiovasc Imaging ; 12(1): e007508, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30636515

RESUMO

BACKGROUND: The risk of conduction system abnormalities (CSA) after transcatheter aortic valve implantation remains high. We aimed to evaluate the impact of mitral annular calcium (MAC) score on the development of CSA after transcatheter aortic valve implantation. METHODS: Consecutive patients (n=168), with severe AoV stenosis, without prior CSA, underwent computed tomography transcatheter AoV implantation followed by device implantation; CoreValve (n=72) and SAPIEN (n=96). MAC, AoV, and left ventricular outflow tract calcium (Ca++) scores were quantitated from noncontrast ECG-gated computed tomography using Agatston method. The primary end point was a combination of complete left bundle branch block or high-degree atrioventricular block. Logistic regression was used to analyze the predictive value of Ca++ scores of different locations. RESULTS: The primary end point was documented in 62% of the fourth quartile MAC score (>2700) patients as compared with 31% of the first quartile (<140); P=0.03. Logistic regression analysis documented MAC score as an independent predictor either of primary end point as a continuous variable (odds ratio: 1.02, 95% [CI]: 1.00 - 1.03, p = 0.021) or as quartile cutoffs, whereas Q4 was a strong and independent predictor (odds ratio: 3.69, 95% [CI]: 1.37 - 9.95, p = 0.010). CONCLUSIONS: MAC score was found to be an independent predictor of CSA in patients undergoing transcatheter aortic valve implantation without preexisting CSA. Therefore, the current study suggests that patients with high MAC score category (fourth MAC score quartile) should be considered at high risk for CSA, warranting closer monitoring. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02023060.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Calcinose/diagnóstico por imagem , Bloqueio Cardíaco/etiologia , Valva Mitral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Calcinose/complicações , Calcinose/fisiopatologia , Bases de Dados Factuais , Eletrocardiografia , Feminino , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/fisiopatologia , Humanos , Masculino , Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
18.
J Foot Ankle Surg ; 58(2): 236-242, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30612865

RESUMO

Calcific insertional Achilles tendinopathy (CIAT) is a relatively common musculoskeletal entity that results in significant pain and disability, as well as posterior muscle group weakness. There is a lack of evidence criteria to support the timing of operative intervention, choice of procedures, or whether equinus requires treatment. The purpose of this study was to retrospectively review 45 patients (48 feet) who have undergone surgical management of CIAT with concomitant posterior muscle group weakness with the single heel rise testing. All patients underwent debridement and repair of the Achilles tendon with reattachment of the Achilles tendon to the calcaneus, ostectomy of the calcaneus, and flexor hallucis longus tendon transfer. Those patients with equinus also underwent gastrocnemius recession. The focus includes patient-reported satisfaction, time to return to normal shoe gear, and the incidence of revision surgery. The overall average of time to weightbearing was 4.3 weeks. After surgery, 73.3% (n = 33) of the 45 patients responded to the following question: "Would you have this surgery done again?" Of these patients, 93.9% (n = 31) responded "Yes" and 6.1% (n = 2) responded "Unsure." Of the same 33 patients, 84.8% (n = 28) responded that they were "Very Satisfied" with the procedure and 15.2% (n = 5) responded that they were "Satisfied." Twelve patients (26.7%) did not respond to either question. One of the 12 patients (8.3%) who did not respond had bilateral procedures. None of the patients experienced tendon rupture, deep vein thrombosis, or the need for revision surgery. Four patients (8%) experienced a superficial infection, whereas 1 patient (2%) had development of a deep infection. No correlations were found when looking at the relationship between body mass index and return to weightbearing/normal shoe gear with Spearman analysis.


Assuntos
Tendão do Calcâneo/cirurgia , Calcinose/cirurgia , Imagem por Ressonância Magnética/métodos , Satisfação do Paciente , Tendinopatia/cirurgia , Transferência Tendinosa/métodos , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/fisiopatologia , Adulto , Idoso , Calcâneo/cirurgia , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Estudos de Coortes , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Osteotomia/métodos , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco , Tendinopatia/diagnóstico por imagem , Tendinopatia/fisiopatologia , Resistência à Tração , Resultado do Tratamento
20.
Curr Probl Cardiol ; 44(1): 10-35, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29731112

RESUMO

Mitral stenosis (MS) is characterized by obstruction of left ventricular inflow as a result of narrowing of the mitral valve orifice. Although its prevalence has declined over the last decade, especially in developed countries, it remains an important cause of morbidity and mortality.  The most often cause of MS worldwide is still postrheumatic mitral valve disease. However, in developed countries, degenerative or calcific changes cause MS in a siginificant proportion of patients. Although the range of treatment for mitral valve disease has grown over the years in parallel with transcatheter therapies for aortic valve disease, these improvements in mitral valve disease therapy have experienced slower development. This is mainly due to the more complex anatomy of the mitral valve and entire mitral apparatus, and the interplay of the mitral valve with the left ventricle which hinders the development of effective implantable mitral valve devices. This is especially the case with degenerative MS where percutaneous or surgical comissurotomy is rarely employed due to the presence of extensive annular calcification and at the base of leaflets, without associated commissural fusion. However, the last few years have witnessed innovations in transcatheter interventional procedures for degenerative MS which consequently hinted that in the future, transcatheter mitral valve replacement could be the treatment of choice for these patients.


Assuntos
Calcinose/fisiopatologia , Estenose da Valva Mitral/fisiopatologia , Antiarrítmicos/uso terapêutico , Calcinose/epidemiologia , Calcinose/terapia , Cateterismo Cardíaco , Diuréticos/uso terapêutico , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/terapia , Implante de Prótese de Valva Cardíaca , Humanos , Anuloplastia da Valva Mitral , Estenose da Valva Mitral/epidemiologia , Estenose da Valva Mitral/terapia , Índice de Gravidade de Doença
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