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1.
Medicina (Kaunas) ; 57(11)2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34833472

RESUMO

Background and Objectives: Our study aimed to investigate the gross anatomy aspects of the fossa ovalis (FO) and the presence of some anatomical variation resulting from the incomplete fusion of septum primum and septum secundum, such as an atrial septal pouch (SP) and left atrial septal ridge. Materials and Methods: Thirty-one adult human hearts removed from formalin-fixed specimens were examined to provide information about the morphology of the FO. The organs were free of any gross anatomically visible pathological conditions. Results: The most common variants were the FO located in the inferior part of the interatrial septum (64.51%), circular (61.3%), with a net-like structure (51.62%), prominent limbus (93.55%), and patent foramen ovale (PFO) (25.8%). The right SP was observed in 9.67% of specimens, the left SP was observed in 29.03% of cases, and in 51.61% of cases, a double SP was observed. One sample presented a right SP and a double left SP, and one case showed a triple left SP, which was not reported previously to our knowledge. Conclusions: Knowledge of the interatrial septal anatomy becomes important for interventional cardiologists and should be documented before transeptal puncture.


Assuntos
Apêndice Atrial , Septo Interatrial , Forame Oval Patente , Adulto , Septo Interatrial/diagnóstico por imagem , Formaldeído , Átrios do Coração , Humanos
2.
Ann Card Anaesth ; 24(4): 476-478, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747758

RESUMO

Although a patent foramen ovale (PFO) is relatively common, confirmed reports of thrombus entrapped within a PFO are uncommon. Management of impending paradoxical embolism (IPE), also called a thrombus in transit, lacks consensus but includes systemic anticoagulation (e.g., heparin), systemic thrombolysis, or surgical thrombectomy. We present a case of IPE diagnosed with intraoperative transesophageal echocardiography (TEE) as well as a novel en bloc approach to atrial septal aneurysmectomy to minimize embolism and facilitate repair of the interatrial septum. Timely use of intraoperative TEE may aid in diagnosis and help guide the surgical approach to minimize embolic risk with an IPE.


Assuntos
Embolia Paradoxal , Forame Oval Patente , Comunicação Interatrial , Embolia Pulmonar , Trombose , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/prevenção & controle , Embolia Paradoxal/cirurgia , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/prevenção & controle
3.
Aerosp Med Hum Perform ; 92(11): 919-923, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34819219

RESUMO

BACKGROUND: Cryptogenic stroke leading to cerebellar infarction is a rare but serious cause of acute nausea and vomiting. This has the potential of devastating consequences if this occurs in aviators during flight. We present a case of cryptogenic stroke causing incapacitating nausea and vomiting in a U.S. Air Force pilot.CASE REPORT: A 36-yr-old active-duty U.S. Air Force male pilot developed acute onset severe vertigo, nausea, and vomiting during initial descent. Initial computed tomography imaging was normal and his initial assessment yielded a diagnosis of benign paroxysmal positional vertigo. MRI-Brain at 1 mo revealed a small right inferomedial cerebellar infarct. Echocardiography revealed a patent foramen ovale and bilateral atrial enlargement. He made a full neurological recovery and was eventually returned to active flight status with Flying Class IIC waiver.DISCUSSION: Cryptogenic stroke caused by patent foramen ovale (PFO) is uncommon. However, this is increased in patients younger than 50 yr of age. This can lead to an acute incapacitation with varying degrees of dysfunction. There is controversial discussion of treatment options for secondary stroke prevention with PFO. However, there is no significant literature on primary prevention in these patients. A small subset of patients benefit from closure of PFO and most patients benefit from antiplatelet therapy after a stroke occurs. There may also be a significant subset of patients with PFO that may benefit from antiplatelet therapy as a primary prevention of stroke.Lytle ME, Martin BR. Acute cerebellar stroke in a military active-duty pilot. Aerosp Med Hum Perform. 2021; 92(11): 919-923.


Assuntos
Forame Oval Patente , Militares , Acidente Vascular Cerebral , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Masculino , Inibidores da Agregação Plaquetária , Recidiva , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia
4.
BMJ Case Rep ; 14(11)2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789526

RESUMO

Platypnea-orthodexia syndrome (POS) is a rare but well-characterised condition where hypoxaemia and breathlessness occur while upright but resolve once recumbent. Early recognition can result in excellent outcomes for patients and can prevent unnecessary investigations for patients, especially if they present repeatedly to hospital after missed diagnosis. We present a case of a 75-year-old woman with a chronic history of breathlessness who was picked up after observations at a routine outpatient clinic. Early recognition of the POS allowed for appropriate investigations to take place identifying a patent foramen ovale (PFO). She was referred to the tertiary centre for closure of her PFO with complete resolution of her symptoms.


Assuntos
Dispneia , Forame Oval Patente , Idoso , Dispneia/etiologia , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Hipóxia/etiologia , Síndrome
5.
Neurol India ; 69(5): 1371-1373, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747816

RESUMO

The management of established pulmonary thromboembolism (PTE) coexisting with acute ischemic stroke (AIS) is quite challenging. We report the case of a 52-year-old man with concurrent massive right middle cerebral artery AIS and acute PTE, who was successfully managed despite the contradictory guidelines to manage them simultaneously. The patient underwent decompression craniotomy followed by anticoagulant therapy. The current case report demonstrates that full-dose heparin, despite being relatively contraindicated in an AIS, can achieve a good outcome when given under close monitoring. The transesophageal echo with bubble contrast during the Valsalva maneuver demonstrated patent foramen ovale with a right to left shunt as a cause of AIS and PTE in this patient.


Assuntos
Isquemia Encefálica , Forame Oval Patente , Embolia Pulmonar , Acidente Vascular Cerebral , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Manobra de Valsalva
6.
Rev Med Chil ; 149(7): 1090-1092, 2021 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-34751313

RESUMO

In patients with severe COVID-19, it has been proposed as mechanism of respiratory failure, intra and extrapulmonary shunt. However, there are no reported or documented cases of this mechanism. Also, there are studies showing this mechanism is not relevant. In this report, we present the case of a patient with severe COVID-19 pneumonia, who after two months, during his rehabilitation period, presented persistent hypoxemia with orthodeoxia. Persistent oval foramen with shunt from right to left was diagnosed. The patient underwent a percutaneous closure of the defect and at 48 hours oxygen therapy could be discontinued and the patient discharged.


Assuntos
COVID-19 , Forame Oval Patente , Pneumonia , Dispneia , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Hipóxia/etiologia , SARS-CoV-2
8.
Curr Cardiol Rep ; 23(12): 183, 2021 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-34718891

RESUMO

PURPOSE OF REVIEW: Patent foramen ovale (PFO) is widely prevalent and studies have suggested an association with ischemic stroke. In this review, we aim to highlight current management of patients with ischemic stroke in the setting of PFO and discuss some areas of controversy. RECENT FINDINGS: Upon reviewing the literature, we have found that the evidence regarding the management of patients with cryptogenic stroke and PFO has come a long way in the past several years, and many uncertainties remain in clinical practice. The Risk of Paradoxical Embolism (RoPE) score helps to predict the probability of a pathogenic PFO, and recent trial data confirms the benefit of closure in carefully selected patients. The benefit of closure in older patients and in patients with alternate, competing mechanisms is still uncertain, and the long-term risks of closure are not known. Finally, the efficacy of direct oral anticoagulants (DOACs) in this patient population as compared to other medical therapy or mechanical closure has not yet been investigated. Randomized data is needed to help answer these questions. PFO closure is a safe and effective strategy in reducing stroke risk in carefully selected patients with cryptogenic stroke in the setting of a PFO. More studies are needed to test optimal medical treatment strategies and the safety and efficacy of PFO closure in patient subgroups not included in prior PFO closure trials.


Assuntos
Embolia Paradoxal , Forame Oval Patente , Acidente Vascular Cerebral , Idoso , Anticoagulantes/uso terapêutico , Embolia Paradoxal/etiologia , Embolia Paradoxal/prevenção & controle , Forame Oval Patente/complicações , Forame Oval Patente/cirurgia , Humanos , Recidiva , Prevenção Secundária , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
9.
J Invasive Cardiol ; 33(11): E870-E876, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34653956

RESUMO

BACKGROUND: A patent foramen ovale (PFO) is found in nearly half of patients with cryptogenic stroke. Little guidance on the use or necessity of coronary angiography at the time of percutaneous PFO closure exists. We aimed to characterize the presence of coronary artery disease (CAD) in patients undergoing PFO closure following a cryptogenic stroke. METHODS: A retrospective analysis of consecutive patients who underwent concurrent percutaneous PFO closure and coronary angiography was performed. Patients were ≥40 years of age and had a preceding diagnosis of cryptogenic stroke with no known CAD. Visual analysis of coronary angiograms was performed. RESULTS: Of 180 patients, 8 (4%) had severe CAD, 15 (8%) had moderate CAD, 32 (18%) had mild CAD, and 12 (7%) had luminal irregularities. Of those with moderate-to-severe CAD, 9 (5%) had proximal disease and 9 (5%) had multivessel disease. Of those with moderate-to-severe CAD, 8 (35%) underwent further risk stratification with stress testing, 4 (17%) were medically managed, and 1 (4%) underwent concurrent angioplasty. CONCLUSIONS: Coronary angiography identified a low prevalence of CAD in patients with cryptogenic stroke undergoing PFO closure, suggesting that coronary angiography is not routinely indicated in patients undergoing PFO closure.


Assuntos
Doença da Artéria Coronariana , Forame Oval Patente , AVC Isquêmico , Acidente Vascular Cerebral , Adulto , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Forame Oval Patente/diagnóstico , Forame Oval Patente/diagnóstico por imagem , Humanos , Recidiva , Estudos Retrospectivos , Prevenção Secundária , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
10.
J Invasive Cardiol ; 33(11): E857-E862, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34653958

RESUMO

OBJECTIVES: To evaluate the short- and long-term clinical and echocardiographic outcomes of the percutaneous closure of the patent foramen ovale (PFO) with an atrial septal aneurysm (ASA) using 2 different devices. METHODS: We enrolled 100 patients with PFO and ASA. Fifty consecutive patients had transcatheter closure of the PFO with the Gore Cardioform septal occluder (GSO) (Gore Medical) and a second group of 50 consecutive patients with the Amplatzer PFO occluder (APO) (Abbott). A clinical and transthoracic echocardiographic follow-up was performed at 1, 3, 6, and 12 months after the implant procedure. The primary endpoint was the incidence of moderate-to-severe residual right-to-left shunting (rRLS) at the 6-month follow-up. The procedural results and the recurrence of embolic events at 1 year were also investigated. RESULTS: The procedure was successful in all patients. The immediate postprocedural moderate-to-severe rRLS incidence was similar between the 2 groups (GSO 14% vs APO 12%; P=NS) as well as the incidence of moderate-to-severe rRLS at the 6-month follow-up (GSO 4% vs APO 4%; P=non-significant). In only 1 patient of the GSO group, there was a persistent moderate rRLS at the 1-year follow-up. The 6-month and 1-year complete occlusion rate for all subjects was 93% and 96%, respectively. No devices embolized and no death or recurrent embolic events were observed during hospitalization through the 1-year follow-up. CONCLUSIONS: GSO and APO devices appear to be safe and effective devices for the percutaneous closure of a PFO with ASA, showing similar results for the presence of rRLS at the 6-month follow-up, complete occlusion rate, and clinical embolic recurrences.


Assuntos
Forame Oval Patente , Aneurisma Cardíaco , Dispositivo para Oclusão Septal , Cateterismo Cardíaco , Ecocardiografia , Seguimentos , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico , Forame Oval Patente/cirurgia , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgia , Humanos , Resultado do Tratamento
11.
Curr Cardiol Rep ; 23(12): 174, 2021 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-34657187

RESUMO

PURPOSE OF REVIEW: Cryptogenic stroke represents a heterogenous but clinically important collection of stroke etiologies for which our understanding continues to grow. Here, we review our current knowledge and most recent recommendations on secondary prevention for common causes of cryptogenic stroke including paroxysmal atrial fibrillation, atrial cardiopathy, patent foramen ovale, and substenotic atherosclerotic disease as well as the under-recognized mechanisms of occult malignancy, heart failure, and, most recently, infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). RECENT FINDINGS: The results from recent observational studies and randomized clinical trials have provided greater insight into the causal relationship and attributable risk of these suspected etiologies and have identified potential strategies to reduce the rates of recurrence. However, further clinical trials are needed to confirm the benefits of specific stroke prevention strategies, including the patient populations most likely to benefit from anticoagulation. There is ongoing research aimed at both reducing the proportion of ischemic strokes classified as cryptogenic and resolving much of the clinical equipoise that still exists. The results of these studies have the potential to provide us with a better understanding of these occult mechanisms and allow for more targeted interventions.


Assuntos
COVID-19 , Forame Oval Patente , AVC Isquêmico , Acidente Vascular Cerebral , Forame Oval Patente/complicações , Humanos , SARS-CoV-2 , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
12.
J Interv Cardiol ; 2021: 6955791, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34602869

RESUMO

Objectives: The purpose of our survey is to analyze the clinical approach used by interventional and imaging cardiologists to diagnose, treat, and follow-up patients with PFO-related left circulation thromboembolism in different parts of the world with particular emphasis on adherence to current guidelines. Background: Firm guidelines do not cover many aspects of PFO-related patient care. Consequently, very disparate approaches exist among clinicians in the real-world. Methods: A 24-item electronic questionnaire was sent directly to experienced cardiology specialists practicing at consultant/attending positions directly involved in PFO closure management in the United States, United Kingdom, Gulf countries, and other countries. There were no unanswered questions. Responses were recorded between October 2019 and July 2020. Results: Seventy-one responses were obtained: 31 from the UK, 19 from the US, 16 from Gulf countries, 2 from Poland, and 1 response from Australia, Italy, and Switzerland. The overall response rate was 76%. Significant differences between regions were noted in the duration of ECG monitoring during the diagnostic process, PFO closure for left circulation thromboembolism other than stroke/transient ischemic attack, and intraoperative use of intracardiac echocardiography. A similar pattern was noted in the lack of routine screening for thrombophilia and the use of the long-term single antiplatelet therapy. Conclusions: The study shows a vast spectrum of opinions on the optimal approach to PFO closure with significant differences between the US, UK, and Gulf countries. The results stress the need for systematic, high-quality data on the diagnostic work-up and follow-up strategies to inform the standardized approach.


Assuntos
Cardiologistas , Forame Oval Patente , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Forame Oval Patente/diagnóstico , Forame Oval Patente/diagnóstico por imagem , Humanos , Recidiva , Inquéritos e Questionários , Resultado do Tratamento
13.
Indian Heart J ; 73(5): 656-659, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34627589

RESUMO

Patent foramen ovale closure (PFO) is an underutilized therapy, and our study explored the challenges and feasibility of PFO closure in the Indian setting. Eighty patients with Embolic Stroke of Undetermined Source (ESUS) were screened by transcranial Doppler (TCD) for PFO. Twenty-nine patients underwent successful closure. High-risk features of a long tunnel, inter-atrial septal aneurysm, and large defect were present in 31%, 28%, and 59%. Transcranial Doppler had a sensitivity and specificity of 78% and 53% (p = 0.02) to detect PFO. Anticoagulation was withdrawn in 85% of patients post closure. Two patients had residual shunts at follow-up of 19 (9,34) months.


Assuntos
Forame Oval Patente , Aneurisma Cardíaco , Dispositivo para Oclusão Septal , Acidente Vascular Cerebral , Estudos de Viabilidade , Forame Oval Patente/diagnóstico , Forame Oval Patente/epidemiologia , Forame Oval Patente/cirurgia , Humanos , Índia/epidemiologia , Recidiva , Resultado do Tratamento
16.
Arq Neuropsiquiatr ; 79(10): 859-863, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34706014

RESUMO

BACKGROUND: Patent foramen ovale (PFO) has been considered a potential mechanism of embolic stroke of undetermined origin. OBJECTIVE: The aim of the present study was to identify the features of the right-to-left shunt (RLS) in patients with undetermined embolic ischemic stroke and compare them with those of patients with non-cardioembolic ischemic stroke. METHODS: A retrospective study was conducted with 168 patients with stroke and RLS separated into the following two groups: the undetermined embolic stroke group (UES group) and non-cardioembolic stroke group (NCES group). All patients were assessed by transcranial Doppler to evaluate the presence and quantification of microembolic signals (MES) at rest and under Valsalva maneuver. RESULTS: Of all patients evaluated in the current study, 96 were included in the UES group and 72 in the NCES group. In the UES group, 65 patients had RLS with ≥10 MES (67.7%), which was higher than that observed in the NCES group (51.4%, p=0.038). According to the moment of the cardiac cycle, 75 patients (78.1%) in the UES group had a positive test at rest compared to 42 (58.3%) in the NCES group (p=0.007). CONCLUSIONS: The current study demonstrated that almost 70% of patients with undetermined embolic stroke and PFO presented a large RLS and more than 75% had RLS at rest. These findings suggest that the size of the shunt should be taken into account when evaluating whether PFO could be a possible mechanism underlying cryptogenic stroke.


Assuntos
Isquemia Encefálica , Forame Oval Patente , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Ultrassonografia Doppler Transcraniana
17.
Acta Med Port ; 34(6): 460-463, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34715952

RESUMO

Paradoxical embolism is an uncommon phenomenon, accounting for only 2% of all cases of systemic arterial embolism. This condition suggests the presence of a patent foramen ovale, present in 20% - 25% of the adult population. The authors report the case of a 63-year-old male patient with a history of lung adenocarcinoma and hereditary thrombophilia admitted to hospital with acute onset of dyspnea, diplopia, confusion and decreased motor strength of the right limbs. Cranial computed tomography scan showed acute ischemic injury in the left posterior cerebral artery and computed tomography pulmonary angiography revealed bilateral pulmonary thromboembolism. A transesophageal echocardiogram confirmed the presence of patent foramen ovale. The patient was treated with anticoagulant therapy with progressive clinical improvement. Due to a high risk of recurrent thromboembolic episodes, the percutaneous closure of patent foramen ovale was performed and anticoagulant therapy was maintained indefinitely.


Assuntos
Embolia Paradoxal , Forame Oval Patente , Embolia Pulmonar , Trombofilia , Adulto , Anticoagulantes , Embolia Paradoxal/etiologia , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Trombofilia/complicações
18.
J Card Surg ; 36(12): 4564-4572, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34610180

RESUMO

INTRODUCTION: In patients with total anomalous pulmonary venous connection (TAPVC), left atrium (LA) is small and suprasystemic pulmonary artery (PA) pressures may be present in some patients. In our study, we studied the relationship between surgical LA enlargement and patent foramen ovale (PFO) creation separately on the outcomes of patients with TAPVC. MATERIALS AND METHODS: Out of the 130 patients operated in our institute between January 2014 and December 2020, LA was enlarged in 60 patients. LA enlargement was done using a larger patch for atrial septal defect (ASD) closure. Thus, the LA volume was increased by shifting the patch towards the right atrium (RA). Suprasystemic or high PA pressures were present in 60 patients. In 33 patients, PFO was created. Early surgical outcomes were determined on the basis of vasoactive inotropic score (VIS), hours of ventilation, hours of inotropic support, intensive care unit (ICU) stay, and hospital stay. RESULT: Between the LA enlarged and nonenlarged group there was statistically significant less VIS score (18 [13-27.5] vs. 24 [18-30], p value .019), hours of ventilation (23 [16-46.5] vs. 26 [18-60], p value .039), hours of inotropic support (45.5 [30-72] vs. 55 [38-84], p value .038), and ICU stay (7 [5-9] vs. 8 [7-10] p value .0352) and statistically nonsignificant less hospital stay (11.5 [9-13] vs. 12 [9-14], p value .424). In patients with preoperative suprasystemic or high PA pressures, there was a statistically significant less VIS score (16 [11-23.5] vs. 18 [13-25], p value .044), hours of ventilation (20 [14-37] vs. 22 [18-39], p value .038), hours of inotropic support (34 [29.5-71] vs. 38 [30-78], p value .042), and hospital stay (9 [5-12] vs. 11 [9-14], p value .038) and statistically nonsignificant less ICU stay (7 [5.5-9] vs. 7 [6-9], p value .886) in the group with a PFO with respect to the other group in which no PFO was created. CONCLUSION: In patients with TAPVC, LA can be enlarged by using a large ASD patch and thus shifting the septum towards RA. Early surgical outcomes were improved with LA enlargement. In patients with suprasystemic or high PA pressures, leaving a PFO improved the postoperative outcomes.


Assuntos
Forame Oval Patente , Síndrome de Cimitarra , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Humanos , Tempo de Internação , Resultado do Tratamento
19.
Am J Case Rep ; 22: e933975, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34697281

RESUMO

BACKGROUND Platypnea orthodeoxia syndrome (POS) presents with positional dyspnea and hypoxemia defined as arterial desaturation of at least 5% or a drop in PaO2 of at least 4 mmHg. Causes of POS include a variety of cardiopulmonary etiologies and has been reported in patients recovering from severe COVID-19 pneumonia. However, clinical presentation and outcomes in a patient with multiple interrelated mechanisms of shunting has not been documented. CASE REPORT An 85-year-old man hospitalized for hypertensive emergency and severe COVID-19 pneumonia was diagnosed with platypnea orthodeoxia on day 28 of illness. During his disease course, the patient required supplemental oxygen by high-flow nasal cannula but never required invasive mechanical ventilation. Chest imaging revealed evolving mixed consolidation and ground-glass opacities with a patchy and diffuse distribution, involving most of the left lung. Echocardiography was ordered to evaluate for intracardiac shunt, which revealed a patent foramen ovale. Closure of the patent foramen ovale was not pursued. Management included graded progression to standing and supplemental oxygen increases when upright. The patient was discharged to a skilled nursing facility and his positional oxygen requirement resolved on approximately day 78. CONCLUSIONS The present case highlights the multiple interrelated mechanisms of shunting in patients with COVID-related lung disease and a patent foramen ovale. Eight prior cases of POS after COVID-19 pneumonia have been reported to date but none with a known patent foramen ovale. In patients with persistent positional oxygen requirements at follow-up, quantifying shunt fraction over time through multiple modalities can guide treatment decisions.


Assuntos
COVID-19 , Forame Oval Patente , Idoso de 80 Anos ou mais , Dispneia/etiologia , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Hipóxia/etiologia , Masculino , SARS-CoV-2
20.
BMJ Case Rep ; 14(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598956

RESUMO

A 78-year-old female patient presented to the emergency department with syncope and dyspnoea. The left arm appeared to be cold and radial pulse was not palpable. A CT scan of the chest and left arm with intravenous contrast displayed bilateral central pulmonary embolisms in combination with a left subclavian artery embolism and an atrial septal aneurysm. Transthoracic echocardiography identified a patent foramen ovale with right-to-left shunting confirming the diagnosis of paradoxical embolism. The patient was treated with anticoagulants. In a patient presenting with a combination of a pulmonary embolism and a peripheral arterial embolism, the clinician should consider a right-to-left shunt with paradoxical embolism. In line with this, when diagnosing a peripheral arterial embolism, a central venous origin should be considered. Furthermore, when diagnosing a pulmonary embolism or other forms of venous thromboembolism, the clinician should be aware of signs of a peripheral arterial embolism.


Assuntos
Embolia Paradoxal , Forame Oval Patente , Doenças Vasculares Periféricas , Embolia Pulmonar , Idoso , Embolia Paradoxal/complicações , Embolia Paradoxal/diagnóstico , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/diagnóstico por imagem , Humanos , Isquemia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico
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