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4.
Open Heart ; 7(2)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33020258

RESUMO

BACKGROUND: Cardiac involvement with COVID-19 is increasingly being recognised. Clinical characteristics and outcomes of patients with COVID-19 complicated by secondary Takotsubo cardiomyopathy (TC) is poorly understood. METHODS: This retrospective case series was conducted between March and April 2020 at four hospitals of Steward Health Care Network of Massachusetts, USA. Seven patients out of 169 who had echocardiogram were identified to have features of TC. Demographic, clinical, laboratory, management and outcome were gathered from their electronic medical records. We also reviewed all the published cases of COVID-19 and TC in the literature to recognise their common clinical characteristics, risk factors and outcomes. RESULTS: In our series of seven patients, three typical, two inverted, one biventricular and one global TC were recognised. Three were females and four were males. The mean age was 71±11 years. In-hospital death was observed in 57% of patients. Patients who belonged to the high-risk group and had high-risk echocardiographic features in our series had a 100% mortality rate. CONCLUSIONS: COVID-19 complicated by TC has a high mortality rate. Early identification of patients with COVID-19 who are at higher risk for developing secondary TC is important for the prevention of complications, and thus improved outcomes.


Assuntos
Causas de Morte , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/epidemiologia , Distribuição por Idade , Idoso , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/diagnóstico , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Coração Auxiliar , Mortalidade Hospitalar/tendências , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Cardiomiopatia de Takotsubo/terapia
5.
Int Heart J ; 61(5): 896-904, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999195

RESUMO

Identifying the optimal atrioventricular (AV) or interventricular (VV) delay is beneficial for patients using cardiac resynchronization therapy (CRT) devices. Ultrasonic echocardiography (UCG) has been the most commonly used method; however, it requires high technical knowledge. Impedance cardiography (ICG) can calculate stroke volume by measuring changes in transthoracic electric impedance. This study sought to assess the clinical utility of ICG in comparison with that of UCG for the optimization of CRT devices.Patients who underwent CRT device implantation were retrospectively analyzed. One week after implantation, optimization of AV delay (AVD) was performed in every patient with ICG (AVD-ICG) and UCG (AVD-UCG). VV delay (VVD) was then determined according to the optimal AVD using these two methods.Forty-two patients were enrolled. Average AVD-ICG was significantly shorter than AVD-UCG (128 ± 49 versus 146 ± 41 milliseconds, P = 0.018). Five patients (12%) had the same optimized AVD with two methods, and the difference between AVD-ICG and AVD-UCG was ≤ 20 milliseconds in 19 patients (45%). In the multivariate analysis, the presence of postoperative mitral regurgitation (MR) was an independent predictor of AVD-ICG/AVD-UCG mismatch, defined as a difference over 20 milliseconds (odds ratio = 10.71; 95% confidence interval = 1.72 to 66.72; P = 0.018). The results of optimized VVD were similar using both methods.ICG might be a promising tool for the rapid optimization of CRT devices. However, in patients with moderate-to-severe MR, ICG may not be able to optimize AVD.


Assuntos
Arritmias Cardíacas/terapia , Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Cardiografia de Impedância , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral , Complicações Pós-Operatórias , Estudos Retrospectivos
6.
Int Heart J ; 61(5): 970-978, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999196

RESUMO

The mechanism of systolic annular expansion in mitral valve prolapse (MVP) is not clarified. Since annular expansion is systolic outward shift of MV leaflet/chorda tissue complex at superior and outer ends, annular expansion could be related to inward (superior) shift of the complex at another inferior and inner end of the papillary muscle (PM) tip and/or systolic lengthening of the tissue complex, especially MV leaflets.MV annulus systolic expansion, PMs' systolic superior shift, and MV leaflets' systolic lengthening were evaluated by echocardiography with a speckle tracking analysis in 25 normal subjects, 25 subjects with holo-systolic MVP and 20 subjects with late-systolic MVP.PMs' superior shift, MV leaflets' lengthening, MV annular area at the onset of systole and subsequent MV annulus expansion were significantly greater in late-systolic MVP than in holo-systolic MVP (4.6 ± 1.6 versus 1.5 ± 0.7 mm/m2, 2.5 ± 1.4 versus 0.6 ± 2.0 mm/m2, 6.8 ± 2.5 versus 5.7 ± 1.0 cm2/m2 and 1.6 ± 0.8 versus 0.1 ± 0.5 cm2/m2, P < 0.001, respectively). Multivariate analysis identified MV leaflets' lengthening and PMs' superior shift as independent factors associated with MV annular expansion.Conclusions: These results suggest that systolic MV annular expansion in MVP is related to abnormal MV leaflets' lengthening and PMs' superior shift.


Assuntos
Ecocardiografia/métodos , Prolapso da Valva Mitral/fisiopatologia , Valva Mitral/fisiopatologia , Músculos Papilares/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/diagnóstico por imagem , Músculos Papilares/diagnóstico por imagem , Estudos Retrospectivos , Sístole
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1548-1551, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018287

RESUMO

This paper proposes an automatic method for classifying Aortic valvular stenosis (AS) using ECG (Electrocardiogram) images by the deep learning whose training ECG images are annotated by the diagnoses given by the medical doctor who observes the echocardiograms. Besides, it explores the relationship between the trained deep learning network and its determinations, using the Grad-CAM.In this study, one-beat ECG images for 12-leads and 4-leads are generated from ECG's and train CNN's (Convolutional neural network). By applying the Grad-CAM to the trained CNN's, feature areas are detected in the early time range of the one-beat ECG image. Also, by limiting the time range of the ECG image to that of the feature area, the CNN for the 4-lead achieves the best classification performance, which is close to expert medical doctors' diagnoses.Clinical Relevance-This paper achieves as high AS classification performance as medical doctors' diagnoses based on echocardiograms by proposing an automatic method for detecting AS only using ECG.


Assuntos
Estenose da Valva Aórtica , Aprendizado Profundo , Eletrocardiografia , Estenose da Valva Aórtica/diagnóstico , Ecocardiografia , Humanos , Redes Neurais de Computação
8.
Ther Umsch ; 77(8): 349-356, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33054648

RESUMO

A heart murmur - a frequent incidental finding Abstract. Heart murmurs are very common and are present in up to 80 % of school children and 52 % of adults. They originate from the transition from laminar to turbulent blood flow in patients with a structural cardiomyopathy (so-called "organic" murmurs) or in patients with normal hearts (so-called "innocent" murmurs). A detailed history and physical examination help to discriminate innocent from organic murmurs. With the wide availability of transthoracic echocardiography (TTE) cardiac auscultation has lost a lot of its importance, although it remains an important skill for the initial evaluation and triage. An innocent murmur is a minor (1 / 6 - 2 / 6), crescendo-decrescendo, mostly position-dependent, mid-systolic murmur without radiation, which needs no further workup in asymptomatic patients with normal physical capacity. A TTE should be ordered if signs for a cardiac disease are present based on history, physical examination or other tests. Diastolic and continuous murmurs are mostly pathologic and warrant further workup.


Assuntos
Sopros Cardíacos , Achados Incidentais , Adulto , Criança , Ecocardiografia , Auscultação Cardíaca , Sopros Cardíacos/diagnóstico , Humanos , Exame Físico
10.
J Cardiothorac Surg ; 15(1): 297, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008444

RESUMO

BACKGROUND: While the aneurysms of the membranous septum (AVS) are rare, the possibility that they lead to obstruction is even rarer. To the best of our knowledge, 11 similar cases have been reported since 1982. CASE PRESENTATION: Initially, the five-year-old boy was evaluated for dyspnoea that had been present since birth. He did not receive any medical treatment until the previous year. At the age of four, the transthoracic echocardiography showed a large aneurysm extending to the right ventricular outflow tract (RVOT) and causing RVOT stenosis. Complete surgical resection of the aneurysmal tissue was performed, and the boy was discharged home in satisfactory condition. CONCLUSIONS: As the occurrence of RVOT obstruction by a membranous ventricular septal aneurysm is very rare, we are reporting the second case in which an aneurysm of the membranous septum dynamically obstructed the RVOT in a child. We are also reviewing all the previously reported similar cases in the literature. Further studies are needed to obtain a more comprehensive understanding of aneurysms of the membranous septum (AVS).


Assuntos
Aneurisma Cardíaco/cirurgia , Cardiopatias Congênitas/cirurgia , Comunicação Interventricular/cirurgia , Septo Interventricular/cirurgia , Pré-Escolar , Dispneia/etiologia , Ecocardiografia , Aneurisma Cardíaco/complicações , Cardiopatias Congênitas/complicações , Comunicação Interventricular/complicações , Ventrículos do Coração , Humanos , Masculino
11.
J Cardiothorac Surg ; 15(1): 293, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008456

RESUMO

PURPOSE: To summarize the diagnosis and treatment of 13 patients with mixed-type total anomalous pulmonary venous connection (TAPVC) and propose another classification for mixed TAPVC. METHODS: A retrospective review of 13 patients with mixed TAPVC undergoing repair at a single institution was conducted between January 2010 and November 2019. The diagnosis of mixed-type TAPVC was made in all patients using echocardiography combined with computed tomography angiography. According to the mixed TAPVC anatomy, there were 3 patients with type I TAPVC (2 + 2 veins), 10 patients with type II TAPVC (3 + 1 veins) and no patients with type III TAPVC. Correspondingly, there was 1 patient with the "SVC + VV" subtype, 2 patients with the "CS + C" subtype, 8 patients with the "CS + VV" subtype, 1 patient with the "CS + SVC" subtype and 1 patient with the "RA + SVC" subtype according to our classification system. All patients underwent cardiopulmonary bypass surgery. RESULTS: The median weight at surgery was 4.6 ± 1.0 kg (3.4-7.3 kg), and the median age at surgery was 96.2 ± 81.2 days (10-242 days). The median cardiopulmonary bypass time was 132.7 ± 25.1 min (range, 100 to 190 min). The cross-clamping time was 69.2 ± 14.4 min (range, 45 to 88 min). The hospital mortality rate was 7.7% (1 of 13), with late mortality occurring in 1 patient because of pulmonary venous obstruction (PVO) 7 months after surgery. The average follow-up after surgery was 3.4 ± 2.2 years (range, 5 months to 8 years). The survival rates at 3 and 5 years were both 90.9% ± 8.7% (95% CI: 73.8-108%). All remaining surviving patients were asymptomatic. CONCLUSION: Mixed TAPVC can be repaired with good results in children and can be correctly diagnosed with echocardiography combined with computed tomography angiography. The classification system we propose is pragmatic and can guide the surgical approach.


Assuntos
Síndrome de Cimitarra/cirurgia , Ponte Cardiopulmonar , Angiografia por Tomografia Computadorizada , Ecocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Síndrome de Cimitarra/diagnóstico por imagem , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2019-2022, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018400

RESUMO

Echocardiography is the modality of choice for the assessment of left ventricle function. Left ventricle is responsible for pumping blood rich in oxygen to all body parts. Segmentation of this chamber from echocardiographic images is a challenging task, due to the ambiguous boundary and inhomogeneous intensity distribution. In this paper we propose a novel deep learning model named ResDUnet. The model is based on U-net incorporated with dilated convolution, where residual blocks are employed instead of the basic U-net units to ease the training process. Each block is enriched with squeeze and excitation unit for channel-wise attention and adaptive feature re-calibration. To tackle the problem of left ventricle shape and size variability, we chose to enrich the process of feature concatenation in U-net by integrating feature maps generated by cascaded dilation. Cascaded dilation broadens the receptive field size in comparison with traditional convolution, which allows the generation of multi-scale information which in turn results in a more robust segmentation. Performance measures were evaluated on a publicly available dataset of 500 patients with large variability in terms of quality and patients pathology. The proposed model shows a dice similarity increase of 8.4% when compared to deeplabv3 and 1.2% when compared to the basic U-net architecture. Experimental results demonstrate the potential use in clinical domain.


Assuntos
Ecocardiografia , Ventrículos do Coração , Ventrículos do Coração/diagnóstico por imagem , Humanos , Manejo de Espécimes
14.
Rev Med Suisse ; 16(705): 1618-1623, 2020 Sep 09.
Artigo em Francês | MEDLINE | ID: mdl-32914593

RESUMO

Transthoracic echocardiography (TTE) performed by a cardiologist is the first choice for exploring cardiac function and anatomy. Its performance and availability increase the demand for this examination, but this is not always justified. According to criteria published in 2011, the practice of a TTE is classified as appropriate, inappropriate or of uncertain value, depending on the clinical indication. This article explores the frequent indications for which TTE by the cardiologist is considered useful and/or appropriate for patients hospitalized in an internal medicine department.


Assuntos
Ecocardiografia/métodos , Medicina Interna/métodos , Hospitalização , Humanos , Guias de Prática Clínica como Assunto
15.
Rev Med Suisse ; 16(705): 1626-1633, 2020 Sep 09.
Artigo em Francês | MEDLINE | ID: mdl-32914594

RESUMO

Intermediate-risk pulmonary embolism (PE) is usually defined as PE associated with right ventricular dysfunction (echocardiographic, radiological and/or biological) without hemodynamic instability. It is associated with significant mortality, and its management is challenging for the clinician due to its variable clinical presentation. In its recent recommendations, the European Society of Cardiology proposes to differentiate high intermediate risk from low intermediate risk, based on clinical, biological and radiological criteria. The management strategy differs for these two categories, particularly about the need for monitored surveillance. Beyond therapeutic anticoagulation, which remains the first-line treatment in intermediate-risk PE, other therapeutic modalities can be considered, and will be discussed.


Assuntos
Embolia Pulmonar/terapia , Cardiologia , Ecocardiografia , Humanos , Embolia Pulmonar/complicações , Medição de Risco , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/terapia
16.
Kyobu Geka ; 73(8): 627-630, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32879295

RESUMO

A 15-year-old boy with Noonan syndrome, who had been diagnosed with hypertrophic cardiomyopathy (HCM) at 4 and treated by drugs, was referred to our hospital because of progression of left ventricular outflow tract obstruction (LVOTO). Transthoracic echocardiogram (TTE) revealed left ventricular hypertrophy( LVH), LVOTO( systolic gradient:102 mmHg), and systolic anterior motion of the mitral valve( SAM) with mild mitral regurgitation(MR). We performed septal myectomy by transaortic and transapical approaches. Postoperative TTE revealed significant reduction in left ventricular outflow tract (LVOT) gradient (9 mmHg), resolution of SAM, and reduction in MR grade. The postoperative course was uneventful except for transient atrial tachyarrhythmia. Myectomy for HCM in a patient with Noonan syndrome is rare. This case suggests that myectomy is useful for the patients with Noonan syndrome.


Assuntos
Cardiomiopatia Hipertrófica , Insuficiência da Valva Mitral , Síndrome de Noonan , Obstrução do Fluxo Ventricular Externo , Adolescente , Ecocardiografia , Humanos , Masculino , Valva Mitral/diagnóstico por imagem
17.
J UOEH ; 42(3): 291-295, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32879194

RESUMO

We report a case of a 77-year-old male who had been diagnosed with normal-flow high-pressure gradient severe aortic stenosis (AS) two years previously. In accordance with his wishes, it was decided not to perform surgery. He visited our hospital with anorexia and weight loss and was diagnosed with gastric cancer. Echocardiography showed a change to paradoxical low-flow low-pressure gradient severe AS (PLFLPG AS). A decrease in stroke volume is typically associated with a smaller LV size, but the reason for a smaller LV size in PLFLPG AS remains unclear. In this case, the change to PLFLPG AS was thought to be due to a decrease in whole body oxygen consumption, and this may help to understand the pathology.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Idoso , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/patologia , Baixo Débito Cardíaco , Progressão da Doença , Ecocardiografia , Ventrículos do Coração/patologia , Humanos , Masculino , Consumo de Oxigênio , Índice de Gravidade de Doença , Neoplasias Gástricas/complicações , Volume Sistólico
18.
G Ital Cardiol (Rome) ; 21(10): 739-749, 2020 Oct.
Artigo em Italiano | MEDLINE | ID: covidwho-791898

RESUMO

Coronavirus 2019 disease (COVID-19), caused by SARS-CoV-2, can lead to cardiac impairment with various types of clinical manifestations, including heart failure and cardiogenic shock. A possible expression of cardiac impairment is non-ischemic ventricular dysfunction, which can be related to different pathological conditions, such as myocarditis, stress and cytokine-related ventricular dysfunction. The diagnosis of these pathological conditions can be challenging during COVID-19; furthermore, their prevalence and prognostic significance have not been elucidated yet. The purpose of this review is to take stock of the various aspects of non-ischemic ventricular dysfunction that may occur during COVID-19 and of the diagnostic implications related to the use of cardiac imaging techniques.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Miocardite/diagnóstico por imagem , Pneumonia Viral/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Doença Aguda , Infecções Assintomáticas , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico por imagem , Síndrome da Liberação de Citocina/complicações , Ecocardiografia , Eletrocardiografia , Insuficiência Cardíaca/etiologia , Humanos , Miocardite/sangue , Miocardite/etiologia , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico por imagem , Volume Sistólico/fisiologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/etiologia , Troponina/sangue , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/etiologia
19.
BMJ Case Rep ; 13(9)2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32948531

RESUMO

We are reporting a middle-aged male patient with polycythaemia vera comorbidity. The patient was exhibiting symptoms including fever, cough and shortness of breath and was found to have acute pulmonary embolism. He was diagnosed with SARS-CoV-2. This case suggests that a high index of suspicion should be taken into consideration for thromboembolic events, when treating patients with COVID-19 with breathing difficulty and low oxygen saturation levels, especially in those who have underlying predisposing conditions for coagulopathy.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Policitemia Vera/complicações , Embolia Pulmonar/etiologia , Betacoronavirus , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/sangue , Diabetes Mellitus Tipo 2/complicações , Ecocardiografia , Fibrinolíticos/uso terapêutico , Heparina/uso terapêutico , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Policitemia Vera/sangue , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia
20.
Int Heart J ; 61(5): 1084-1087, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921661

RESUMO

Diazoxide, a drug used to treat hyperinsulinemic hypoglycemia (HH), is associated with pulmonary hypertension (PH), as reported by the US Food and Drug Administration. However, no report has detailed the association between diazoxide dose and PH development. We report a case of an infant with HH, subsequently complicated by diazoxide-induced PH. When diazoxide was introduced, PH did not appear initially, but it developed during increased dosing. We monitored PH via regular echocardiography examinations. PH gradually improved with tapering of the diazoxide dose and disappeared after drug discontinuation. Our case suggests a diazoxide dose threshold might induce PH. Therefore, close echocardiography examinations should accompany diazoxide treatment.


Assuntos
Síndrome de Beckwith-Wiedemann/diagnóstico , Hiperinsulinismo Congênito/tratamento farmacológico , Diazóxido/efeitos adversos , Hipertensão Pulmonar/induzido quimicamente , Fator Natriurético Atrial/sangue , Síndrome de Beckwith-Wiedemann/complicações , Cateterismo Cardíaco , Hiperinsulinismo Congênito/etiologia , Desprescrições , Diazóxido/administração & dosagem , Diuréticos/uso terapêutico , Relação Dose-Resposta a Droga , Ecocardiografia , Eletrocardiografia , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/tratamento farmacológico , Lactente , Recém-Nascido , Masculino , Peptídeo Natriurético Encefálico/sangue , Citrato de Sildenafila/uso terapêutico , Vasodilatadores/uso terapêutico
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