Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.202
Filtrar
3.
J Vet Cardiol ; 25: 61-73, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31675525

RESUMO

INTRODUCTION: This case series describes early experience and technical aspects of cutting balloon dilation followed by high-pressure balloon pulmonary valvuloplasty in dogs with dysplastic pulmonary valve stenosis. ANIMALS: Seven client-owned dogs were enrolled in this study. METHODS: Dogs were prospectively enrolled based on echocardiographic diagnosis of severe pulmonary valve dysplasia, defined as marked valve thickening with variable degrees of annular hypoplasia or subvalvar fibrous obstruction and a peak echocardiography-derived transpulmonary pressure gradient higher than 100 mmHg. Preinterventional and postinterventional hemodynamic data and transthoracic pressure gradients were obtained for all dogs. Recheck echocardiography varied in timing by client convenience, with maximum follow-up 35 months after intervention. RESULTS: No intraprocedural or periprocedural mortality was observed. The only major complication was partial avulsion of a cutting blade related to exceeding recommended burst pressure of the device, which was not associated with obvious clinical consequence. Invasive hemodynamic measurements demonstrated an average reduction of 46% in peak systolic right ventricular-to-pulmonary artery pressure gradient (range, 31-77%). The echocardiographic results 24 h after procedure demonstrated an average reduction in pressure gradient of 43% (range, 20-66%), with late follow-up demonstrating an average reduction of 35% (range, 10-57%) compared with preprocedural echocardiography. CONCLUSIONS: This procedure is a feasible therapeutic transcatheter intervention for dogs with dysplastic pulmonary valves and appears safe in this small cohort. The ideal selection criteria and rate of restenosis for this procedure is under investigation, and long-term follow-up and a large, randomized, controlled study are necessary to demonstrate efficacy.


Assuntos
Valvuloplastia com Balão/veterinária , Doenças do Cão/cirurgia , Doenças das Valvas Cardíacas/veterinária , Animais , Valvuloplastia com Balão/métodos , Doenças do Cão/diagnóstico por imagem , Cães , Ecocardiografia/veterinária , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Masculino , Projetos Piloto , Estudos Prospectivos
4.
Methodist Debakey Cardiovasc J ; 15(3): 223-225, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687103

RESUMO

Anomalous origin of the right coronary artery (ARCA) is an extremely rare cardiac pathology. The coronary artery can potentially course between the aorta and the pulmonary artery, putting the patient at risk for sudden cardiac death. Even rarer is an ARCA that arises from the left main coronary artery (LMCA). To our knowledge, this is the first case where an ARCA arising entirely from the LMCA is associated with critical bicuspid aortic valve stenosis.


Assuntos
Estenose da Valva Aórtica/etiologia , Valva Aórtica/anormalidades , Anomalias dos Vasos Coronários/complicações , Doenças das Valvas Cardíacas/complicações , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
Pan Afr Med J ; 33: 156, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565118

RESUMO

Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease. This study was designed to assess cardiac abnormalities in patients with SLE by echocardiography and to compare the 2 groups of patients with and without cardiac manifestations. It was a transversal, descriptive study, conducted in the Internal Medicine Department at the Military Hospital of Tunis from January 2016 to June 2018. Eighty lupus patients, diagnosed on the basis of ACR (American college of rheumatology) criteria, were enrolled in the study and were evaluated by standard echocardiography with color Doppler. Out of 80 patients 42 (52%) had abnormal echocardiographic findings. Pericardial effusion was found in 55%, valvular abnormalities in 52% and 38% had pulmonary hypertension. Patients with pleural effusion (45 vs 15%) were more vulnerable to cardiac involvement as well as renal impairment (57 vs 44%). The difference, however, were not statistically significant (p>0.05) in the renal involvement. Active disease with low complement (80%) was associated with higher frequency of cardiac involvement than disease in remission (64%) but the result was not statistically significant (p=0.11). Cardiac abnormalities are very common in lupus patients even when clinically asymptomatic form. Echocardiography is an excellent non-invasive tool for cardiac evaluation. Their research must be systematic with echocardiography in order to reduce subsequent cardiac morbidity and mortality among the lupus patients.


Assuntos
Ecocardiografia/métodos , Cardiopatias/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/etiologia , Hospitais Militares , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/epidemiologia , Derrame Pericárdico/etiologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Tunísia
6.
J Radiol Case Rep ; 13(1): 1-10, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31565162

RESUMO

Soft-tissue masses or mass-like lesions involving the mitral valve include a wide range of diseases such as tumors, abscesses, vegetations, thrombus and, rarely, caseous calcifications of the mitral annulus. Caseous calcifications of the mitral annulus is a rare variant of mitral annular calcification that is usually asymptomatic and diagnosed incidentally. Echocardiography is the first-choice imaging modality. Cardiac computed tomography is an ideal tool to confirm the presence of calcifications and caseous necrosis. In cases where there is doubt, cardiac magnetic resonance imaging may be used. We present the case of a 62-year-old patient with an intra-cardiac mass diagnosed by echocardiography. Imaging modalities to achieve a correct diagnosis and avoid unnecessary surgical intervention are discussed.


Assuntos
Calcinose/diagnóstico por imagem , Ecocardiografia/métodos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Calcinose/patologia , Feminino , Doenças das Valvas Cardíacas/patologia , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem
7.
Heart Surg Forum ; 22(5): E372-E374, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31596714

RESUMO

As a bridge to heart transplantation or destination treatment, implantation of the Heartmate 3 (HM3) left ventricular assist device is a viable option for patients with end-stage congestive heart failure. The recent Momentum 3 trial has shown favorable outcomes compared with Heartmate 2. We report the first case of aortic root thrombus occurring early after HM3 implantation as a bridge to heart transplantation. Our case suggests that bridging with an Impella 5.0 preceding HM3 implantation could potentially predispose patients to aortic root thrombus after HM3 implantation, due to Impella-related injury to the aortic valve and aortic root stasis after durable LVAD support.


Assuntos
Aorta/lesões , Valva Aórtica/lesões , Doenças das Valvas Cardíacas/etiologia , Coração Auxiliar/efeitos adversos , Complicações Pós-Operatórias/etiologia , Trombose/etiologia , Aorta/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Trombose/diagnóstico por imagem , Trombose/cirurgia
8.
Heart Surg Forum ; 22(5): E390-E395, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31596718

RESUMO

BACKGROUND: The development of minimally invasive mitral valve surgery has created the motivation for using this approach in young patients with chronic rheumatic valve disease. We report our recent experience with patients undergoing minimally mitral valve surgery in this group of patients. METHODS: Between July 2014 and June 2018, 142 patients with rheumatic mitral valve dysfunction underwent minimally invasive surgery through a right thoracotomy approach at the University Medical Center of Ho Chi Minh City in Vietnam. Diagnosis was confirmed with transthoracic and transesophageal echocardiography (TTE and TEE). We analyzed the in-hospital and midterm follow-up outcomes of this group. RESULTS: The mean age was 42.6 ± 9.6 years. Sixty patients (42.3%) were male. Sixty-three patients were diagnosed with functional severe tricuspid regurgitation, 29 patients were identified with moderate tricuspid regurgitation, and tricuspid annulus was more than 21 mm/m²). Mitral valve repair was performed in 16 patients (11.3%), and 126 patients underwent mitral valve replacement. Mitral valve repair techniques included annuloplasty, leaflet peeling, and commissurotomy. Thirty-day mortality was 0.7%. Two patients had to be converted to conventional sternotomy, due to left atrial appendage laceration and mitral annular rupture. The overall survival rate was 98.6%. Freedom from reoperation was 97.1%. CONCLUSIONS: In patients with rheumatic valve disease, minimally invasive mitral surgery safely and effectively can be performed with few perioperative complications and good midterm results.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Cardiopatia Reumática/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Adulto , Conversão para Cirurgia Aberta/estatística & dados numéricos , Ecocardiografia Transesofagiana , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Masculino , Ilustração Médica , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/diagnóstico por imagem , Valva Mitral/lesões , Cardiopatia Reumática/diagnóstico por imagem , Esternotomia , Taxa de Sobrevida , Toracotomia/métodos , Insuficiência da Valva Tricúspide/diagnóstico
10.
J Clin Ultrasound ; 47(9): 568-571, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31392732

RESUMO

Primary cardiac tumors are rare, but papillary fibroelastoma (PFE) is reportedly the most common form, which usually occurs on the left-side valves of the heart. However, PFE involving the tricuspid and pulmonary valves has also been documented. Although PFE is benign and seldom associated with valvular dysfunction, the associated embolic complications may lead to serious consequences. Most patients with PFE lack specific clinical symptoms and the diagnosis is incidental. Surgical resection is the mainstay treatment for PFE in order to prevent the occurrence of embolic complications. In this report, we present a case of a rare asymptomatic PFE of the pulmonary valve, which was incidentally noted during a routine examination with transthoracic echocardiography (TEE). There was neither valvular dysfunction nor hemodynamic change. The PFE was surgically removed, and the diagnosis was further confirmed with histopathology.


Assuntos
Ecocardiografia/métodos , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Achados Incidentais , Valva Pulmonar/diagnóstico por imagem , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/cirurgia
11.
Heart Surg Forum ; 22(4): E298-E300, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31398096

RESUMO

Subclinical and clinical thrombosis of bioprosthetic cardiac valves is more common than has been previously recognized. We present a unique case of acute thrombosis of a bioprosthetic mitral valve in a 40-year-old female patient undergoing hormonal stimulation as part of in vitro fertilization therapy, who also had concomitant protein C deficiency that was undiagnosed at the time. To the best of our knowledge, this is the first reported case of acute bioprosthetic valve thrombosis in this complex thrombophilic milieu, and suggests the need for increased screening for prothrombotic risk factors in female patients with bioprosthetic valves before they commence gonadotropin stimulation therapy.


Assuntos
Bioprótese/efeitos adversos , Fertilização In Vitro/efeitos adversos , Doenças das Valvas Cardíacas/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral , Deficiência de Proteína C/complicações , Trombose/etiologia , Doença Aguda , Adulto , Feminino , Fármacos para a Fertilidade Feminina/administração & dosagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Humanos , Leuprolida/administração & dosagem , Valva Mitral/cirurgia , Reoperação , Fatores de Risco , Trombose/diagnóstico por imagem , Trombose/cirurgia
12.
Ann Thorac Cardiovasc Surg ; 25(5): 265-273, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31378750

RESUMO

PURPOSE: Our study aimed to investigate the potential pathogenetic theories of different phenotype prevalence in bicuspid aortopathy. METHODS: A total of 407 bicuspid aortic valve (BAV) patients with aortic dilation were retrospectively reviewed. Association was determined between aortic valve lesion types and aortic configurations to confirm the homogeneous BAV subsets, and then, dominance analysis was used to evaluate the relative importance of two components of aortic valve lesion (BAV phenotype and valvular dysfunction) that associated with aortic configurations in each subgroup. RESULTS: Dominance analysis showed that Type-1 LR was the dominant contributor (79.0% and 79.6%) associated with the higher prevalence of the dilation of aortic root (AoR) and ascending aorta (AAo) in BAV patients with Type-1 LR and aortic regurgitation (AR) or aortic stenosis (AS) + AR. However, AS was the main contributor (60.0%) associated with the raised incidence of the dilation of AAo and proximal aortic arch (PArc) in Type-0 LAT and AS. CONCLUSIONS: Different dominant pathogenetic theory determined the phenotype of BAV aortopathy. In patients of Type-1 LR with AR, inherent disposition is mainly responsible for the higher frequency of AoR dilation. Valve-related hemodynamics determined greater prevalence of the dilation of AAo and PArc in patients of Type-0 LAT with AS.


Assuntos
Aneurisma Aórtico/epidemiologia , Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/epidemiologia , Adulto , Idoso , Aorta/diagnóstico por imagem , Aorta/patologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Pequim/epidemiologia , Dilatação Patológica , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Prevalência , Estudos Retrospectivos
13.
Yonsei Med J ; 60(9): 816-823, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31433579

RESUMO

PURPOSE: The present study aimed to investigate the prevalence, characteristics, and clinical significance of concomitant specific cardiomyopathies in subjects with bicuspid aortic valves (BAVs). MATERIALS AND METHODS: A total of 1186 adults with BAV (850 males, mean age 56±14 years) at a single tertiary center were comprehensively reviewed. Left ventricular non-compaction, hypertrophic cardiomyopathy, and idiopathic dilated cardiomyopathy were confirmed when patients fulfilled current clinical and echocardiographic criteria. Clinical and echocardiographic characteristics, including comorbidities, heart failure presentation, BAV morphology, function, and aorta phenotypes, in BAV subjects with or without specific cardiomyopathies were compared. RESULTS: Overall, 67 subjects (5.6%) had concomitant cardiomyopathies: 40 (3.4%) patients with left ventricular non-compaction, 17 (1.4%) with hypertrophic cardiomyopathy, and 10 (0.8%) with dilated cardiomyopathy. BAV subjects with hypertrophic cardiomyopathy had higher prevalences of diabetes mellitus and heart failure with preserved ejection fraction, and tended to have type 0 phenotype, while BAV subjects with dilated cardiomyopathy showed higher prevalences of chronic kidney disease and heart failure with reduced ejection fraction. BAV subjects with left ventricular non-compaction were significantly younger and predominantly male, and had greater BAV dysfunction and a higher prevalence of normal aorta shape. In multiple regression analysis, cardiomyopathy was independently associated with heart failure (odds ratio 2.795, 95% confidential interval 1.603-4.873, p<0.001) after controlling for confounding factors. CONCLUSION: Concomitant cardiomyopathies were observed in 5.6% of subjects with BAV. A few different clinical and echocardiographic characteristics were found. The presence of cardiomyopathy was independently associated with heart failure.


Assuntos
Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/epidemiologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Adulto , Idoso , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Comorbidade , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fenótipo , Prevalência , Estudos Retrospectivos , Disfunção Ventricular Esquerda/fisiopatologia
14.
Braz J Cardiovasc Surg ; 34(4): 499-502, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454208

RESUMO

Cardiac papillary fibroelastoma are rare, benign cardiac tumors that may lead to lethal complications from embolization or valvular dysfunction if left untreated. When working up symptomatic tumors with concomitant angina, traditional diagnostic studies such as cardiac catheterization may predispose the patient to embolic complications if the mass is located in the path of the catheter. Newer, non-invasive diagnostic testing, such as cardiac magnetic resonance imaging or dynamic computed tomography angiography, may be considered in lieu of invasive approaches to avoid potentially devastating complications. We herein present a case report of a 77-year-old female with a symptomatic aortic valve tumor and describe our diagnostic strategy and management.


Assuntos
Valva Aórtica/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Idoso , Angiografia por Tomografia Computadorizada/métodos , Feminino , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Humanos
15.
Int J Cardiovasc Imaging ; 35(11): 2029-2036, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31297671

RESUMO

To evaluate the accuracy, reproducibility, and transcatheter heart valve (THV) sizing efficiency of an automated 3-dimensional transesophageal echocardiographic (3D-TEE) post-processing software in the assessments of aortic roots, intra-individually compared with multidetector computed tomography (MDCT). We prospectively studied 67 patients with normal aortic roots. We measured diameters of aortic annulus (AA), sinus of Valsalva (SOV), and sino-tubular junction (STJ) by full-automated and semi-automated methods using 3D-TEE datasets, then compared them to corresponding transthoracic echocardiography and MDCT values. THV sizes were chosen based on echocardiography and MDCT measurements according to recommended criterion. Taking MDCT planimetered diameters as reference, the full-automated (r: 0.4745-0.8792) and semi-automated (r: 0.6647-0.8805) 3D-TEE measurements were linearly correlated (p < 0.0001). The average differences between semi-automated or full-automated measurements and reference were 0.3 mm or 1.3 mm for AA, - 1.9 mm or - 0.5 mm for SOV, and - 0.1 mm or 1.9 mm for STJ, respectively. The intra-class correlation coefficients of semi-automated method were 0.79-0.96 (intra-observer) and 0.75-0.92 (inter-observer). THV sizing by semi-automated measurements using echocardiographic criteria was larger than that by MDCT measurements using MDCT criteria (p < 0.0001) but equivalent (p > 0.05) if both using MDCT standards. The new automated 3D-TEE software allows modeling and quantifying aortic roots with high reproducibility. Measurements by the semi-automated method closely approximate and well correlate with the corresponding MDCT, thus THV sizing by this modeled 3D-TEE measurements should adopt recommended MDCT criteria but not echocardiographic criteria. The full-automated 3D-TEE segmentations are yet immature. (Semi-automated assessMent of Aortic Roots by Three-dimensional transEsophageal echocaRdiography [SMARTER], NCT02724709).


Assuntos
Valva Aórtica/diagnóstico por imagem , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Doenças das Valvas Cardíacas/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Interpretação de Imagem Assistida por Computador , Desenho de Prótese , Seio Aórtico/diagnóstico por imagem , Adolescente , Adulto , Idoso , Algoritmos , Valva Aórtica/cirurgia , Automação , Feminino , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
16.
Heart Lung Circ ; 28(9): 1436-1446, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266726

RESUMO

Multivalvular heart disease (MVD) is a highly prevalent condition causing significant morbidity and mortality. The complex haemodynamic interactions between coexisting valve lesions makes the diagnosis and treatment challenging. Current guidelines may not be adequate for managing the varying clinical scenarios of MVD and, therefore, the expertise of a multidisciplinary Heart Valve Team is of paramount importance. The indications for intervention should be based on a global assessment of the consequences of the multiple valve lesions after a careful estimation of the added surgical risk of combined procedures, the long-term risk of morbidity and mortality associated with multiple valve prostheses and the risk of reoperation if less-than-severe valve lesions are left untreated at the time of first evaluation. Echocardiography plays an important role in assessing patients and, as a general rule, an accurate echo diagnosis needs to combine different measurements. The emerging transcatheter valve therapies should be considered an option for high risk patients. More data on the natural history of MVD and the impact of intervention on outcome are required to better define the optimal management strategy.


Assuntos
Ecocardiografia , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valvas Cardíacas , Hemodinâmica , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/cirurgia , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Valvas Cardíacas/cirurgia , Humanos
17.
Cardiol Young ; 29(8): 1099-1100, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31280738

RESUMO

We present a case of infective endocarditis caused by Streptococcus gordonii in an 11-year-old girl with Barlow's mitral valve disease. The differential diagnosis of rheumatic carditis and infective endocarditis was difficult as the patient fulfilled the Jones criteria. Vegetation on the mitral valve which became evident later in course of the disease and positive blood culture allowed diagnosing "definite" infective endocarditis.


Assuntos
Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Streptococcus gordonii/isolamento & purificação , Criança , Diagnóstico Diferencial , Ecocardiografia , Endocardite Bacteriana/cirurgia , Feminino , Doenças das Valvas Cardíacas/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Resultado do Tratamento
18.
Nat Commun ; 10(1): 3111, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31308376

RESUMO

Biomedical repositories such as the UK Biobank provide increasing access to prospectively collected cardiac imaging, however these data are unlabeled, which creates barriers to their use in supervised machine learning. We develop a weakly supervised deep learning model for classification of aortic valve malformations using up to 4,000 unlabeled cardiac MRI sequences. Instead of requiring highly curated training data, weak supervision relies on noisy heuristics defined by domain experts to programmatically generate large-scale, imperfect training labels. For aortic valve classification, models trained with imperfect labels substantially outperform a supervised model trained on hand-labeled MRIs. In an orthogonal validation experiment using health outcomes data, our model identifies individuals with a 1.8-fold increase in risk of a major adverse cardiac event. This work formalizes a deep learning baseline for aortic valve classification and outlines a general strategy for using weak supervision to train machine learning models using unlabeled medical images at scale.


Assuntos
Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/patologia , Aprendizado de Máquina , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Cardiopatias/patologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Aprendizado de Máquina Supervisionado
19.
Mayo Clin Proc ; 94(8): 1488-1498, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31279542

RESUMO

OBJECTIVE: To explore the burden and clinical correlates of valvular heart disease in Hispanics/Latinos in the United States. PATIENTS AND METHODS: A total of 1818 individuals from the population-based study of Latinos/Hispanics from 4 US metropolitan areas (Bronx, New York; Chicago, Illinois; San Diego, California; and Miami, Florida) underwent a comprehensive clinical and echocardiographic examination from October 1, 2011, through June 24, 2014. Logistic regression analysis was used to examine the associations of clinical and sociodemographic variables with valvular lesions. RESULTS: The mean age was 55.2±0.2 years; 57.4% were female. The prevalence of any valvular heart disease (AVHD) was 3.1%, with no considerable differences across sex, and a higher prevalence with increasing age. The proportion of US-born vs foreign-born individuals was similar in those with vs without AVHD (P=.31). The weighted prevalence of AVHD was highest in Central Americans (8.4%) and lowest in Mexicans (1.2%). Regurgitant lesions of moderate or greater severity were present in 2.4% of the population and stenotic lesions of moderate or greater severity in 0.2%. Compared with those without AVHD, individuals with AVHD were more likely to have health insurance coverage (59.6% vs 79.2%; P=.007) but similar income (P=.06) and educational status (P=.46). Univariate regression models revealed that regurgitant lesions were associated with lower body mass index whereas stenotic lesions were associated with higher body mass index. CONCLUSION: Our data provide the first population-based estimates of the prevalence of valvular heart disease in Hispanic/Latinos. Valvular heart disease is fairly common in the Hispanic/Latino population and may constitute an important public health problem.


Assuntos
Efeitos Psicossociais da Doença , Ecocardiografia/métodos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etnologia , Hispano-Americanos/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Feminino , Seguimentos , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Estados Unidos , População Urbana
20.
Pediatr Cardiol ; 40(7): 1450-1459, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342116

RESUMO

Bicuspid aortic valve (BAV) disease demonstrates a range of clinical presentations and complications. We aim to use cardiac MRI (CMR) to evaluate left ventricular (LV) parameters, myocardial strain and aortic hemodynamics in pediatric BAV patients with and without aortic stenosis (AS) or regurgitation (AR) compared to tricuspid aortic valve (TAV) controls. We identified 58 pediatric BAV patients without additional cardiovascular pathology and 25 healthy TAV controls (15.3 ± 2.2 years) who underwent CMR with 4D flow. BAV cohort included subgroups with no valvulopathy (n = 13, 14.3 ± 4.7 years), isolated AS (n = 19, 14.5 ± 4.0 years), mixed valve disease (AS + AR) (n = 13, 17.1 ± 3.2 years), and prior valvotomy/valvuloplasty (n = 13, 13.9 ± 3.2 years). CMR data included LV volumetric and mass indices, myocardial strain and aortic hemodynamics. BAV patients with no valvulopathy or isolated AS had similar LV parameters to controls excepting cardiac output (p < 0.05). AS + AR and post-surgical patients had abnormal LV volumetric and mass indices (p < 0.01). Post-surgical patients had decreased global longitudinal strain (p = 0.02); other subgroups had comparable strain to controls. Patients with valvulopathy demonstrated elevated velocity and wall shear stress (WSS) in the ascending aorta (AAo) and arch (p < 0.01), while those without valve dysfunction had only elevated AAo velocity (p = 0.03). Across the cohort, elevated AAo velocity and WSS correlated to higher LV mass (p < 0.01), and abnormal hemodynamics correlated to decreased strain rates (p < 0.045). Pediatric BAV patients demonstrate abnormalities in LV parameters as a function of valvular dysfunction, most significantly in children with AS + AR or prior valvotomy/valvuloplasty. Correlations between aortic hemodynamics, LV mass and strain suggest valvular dysfunction could drive LV remodeling. Multiparametric CMR assessment in pediatric BAV may help stratify risk for cardiac remodeling and dysfunction.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/fisiopatologia , Adolescente , Aorta/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estudos de Casos e Controles , Criança , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Hemodinâmica , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Remodelação Ventricular
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA