Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 806
Filtrar
1.
Rev Fac Cien Med Univ Nac Cordoba ; 76(4): 211-216, 2019 11 19.
Artigo em Espanhol | MEDLINE | ID: mdl-31833743

RESUMO

Background: Transesophageal echo (TEE) bubble study is the current gold standard for patent foramen ovale (PFO) diagnosis, but it has the disadvantage of being semi-invasive and not exempted from risks. The aim of this study was to determine the accuracy of TTE compared to TEE for PFO diagnosis. Methods and results: a systematic review was done on Medline with the terms "transthoracic echocardiography, transesophageal echocardiography, patent foramen ovale, diagnosis" yielding published literature of the last ten years. The search was completed in february 2018. Of 715 articles, 10 were analyzed. The total of patients were 1268 (mean age of 47 years +/-14) with a global prevalence of PFO of 48%. The sensibility of ETT was 90 % (IC 95: 88 % - 92 %) and the specificity 92% (IC 95: 89 % - 94 %). The positive predictive value was 93% (IC 95: 90 % - 94 %) and the negative predictive value 89 % (IC 95: 87 % - 91 %). The area under the curve and Q index value were 0,97 and 0,93 respectively. The positive and negative likelihood ratio were 18,989 and 0,072 respectively. Conclusion: The ETT shows a good specificity and sensibility for PFO diagnosis with last generation equipments, contrast use and valsalva maneuver; according to the analyzed studies.


Assuntos
Ecocardiografia Transesofagiana , Ecocardiografia , Forame Oval Patente/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Sensibilidade e Especificidade
2.
J Vet Intern Med ; 33(5): 2227-2234, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31380593

RESUMO

A 2-year-old American Pit Bull dog was presented for surgical evaluation of imperforate cor triatriatum dexter (CTD) and patent foramen ovale (PFO). Echocardiography identified an imperforate CTD associated with a right-to-left shunting PFO and valvular pulmonary stenosis. A 2-step interventional and surgical approach was used. Initially, a pulmonary balloon valvuloplasty was performed, and subsequently the dog underwent a surgical correction of the atrial anomaly under cardiopulmonary bypass.


Assuntos
Coração Triatriado/veterinária , Doenças do Cão/cirurgia , Forame Oval Patente/veterinária , Estenose da Valva Pulmonar/veterinária , Animais , Valvuloplastia com Balão/veterinária , Ponte Cardiopulmonar/veterinária , Coração Triatriado/diagnóstico por imagem , Coração Triatriado/cirurgia , Doenças do Cão/diagnóstico por imagem , Cães , Ecocardiografia/veterinária , Forame Oval Patente/diagnóstico por imagem , Masculino , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/cirurgia
3.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466979

RESUMO

A 65-year-old man presented in a peri-arrest situation after collapse, he was found hypoxic with ischaemic arms. CT imaging showed massive bilateral pulmonary embolisms (PEs) and an aortic arch embolus extending from brachiocephalic trunk to left subclavian artery. Following intravenous thrombolysis, repeat imaging revealed that the aortic embolus had migrated distally into both axillary arteries and had occluded the right carotid from origin to skull base. Bilateral upper limb embolectomies were carried out from the brachial arteries together with forearm fasciotomies. Left hemianopia related to a right middle cerebral artery territory infarct was managed conservatively; forearm fasciotomy wounds were primarily closed and the patient was discharged on lifelong anticoagulation. A transoesophageal echocardiogram revealed a patent foramen ovale. This case demonstrates a very unusual presentation of concomitant PE and paradoxical saddle aortic arch embolism. A multidisciplinary approach has resulted in an excellent clinical outcome for this complex patient.


Assuntos
Aorta Torácica/patologia , Embolia Paradoxal/complicações , Equipe de Assistência ao Paciente/normas , Embolia Pulmonar/complicações , Idoso , Aorta Torácica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Ecocardiografia Transesofagiana/métodos , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/terapia , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Masculino , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/terapia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Terapia Trombolítica/métodos , Resultado do Tratamento
4.
Int J Cardiovasc Imaging ; 35(11): 2049-2056, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31325066

RESUMO

Left atrial (LA) enlargement is a marker of LA cardiopathy and, in patients with patent foramen ovale (PFO), is associated with an increased risk of ischemic stroke. The primary study outcome was the comparison of LA diameter between patients undergoing percutaneous PFO closure versus those treated conservatively. The secondary endpoints were the association of LA diameter with the Risk of Paradoxical Emboli (ROPE) score and the presence of Atrial septal aneurysm (ASA) and Right-To-Left Shunt (RLS). Retrospective analysis of clinical and instrumental data of 1040 subjects referred to a single tertiary center for PFO evaluation and treatment. Seven hundred and nineteen patients were enrolled: 495 patients (closure group, mean RoPE score 7.6 ± 0.8) underwent PFO closure while 224 patients (control group, mean RoPE score 4.1 ± 0.9. p < 0.001) were left to medical therapy. Preoperative LA diameter was significantly larger in closure group and reduced from 44.3 ± 9.1 to 37.3 ± 4.1 mm (p = 0.01) 1 year after the procedure to the size of controls. A larger LA diameter was associated with permanent RLS, RLS curtain pattern, ASA presence and multiple ischemic brain lesions pattern at neuroimaging. A LA diameter ≥ 43 mm was a predictor a RoPEscore > 7. In our patients' cohort, LA diameter was associated with the clinic severity of PFO and RLS. The reversal of LA enlargement after PFO closure suggests a role for RLS to induce LA cardiopathy. LA enlargement has the potential to be considered per se as an indication to transcatheter PFO repair.


Assuntos
Função do Átrio Esquerdo , Remodelamento Atrial , Cateterismo Cardíaco , Tratamento Conservador , Forame Oval Patente/terapia , Adulto , Cateterismo Cardíaco/efeitos adversos , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/etiologia , Tratamento Conservador/efeitos adversos , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/etiologia , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/fisiopatologia , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
5.
Biomed Res Int ; 2019: 9828539, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211145

RESUMO

Purpose: To compare the sensitivity and specificity of modified and traditional methods of contrast echocardiography of the right portion of the heart in patients with a suspicion of patent foramen ovale (PFO). Methods: The study population consisted of 506 patients with high clinical suspicion of PFO. The traditional Valsalva maneuver consists of expiration against a closed glottis after a full inspiration. A modified Valsalva maneuver was performed with a handmade pressure monitoring device, which measured pressure during performance of the Valsalva maneuver. Modified and traditional methods of contrast echocardiography were performed among all patients. Contrast transesophageal echocardiography (TEE) was regarded as the gold standard. Results: A total of 279 patients with PFO were confirmed by TEE. 259 cases (sensitivity: 92.83%) were detected by a modified method of contrast echocardiography of the right portion of the heart, while 234 cases were detected using the traditional method (sensitivity: 83.87%). The sensitivity of modified contrast echocardiography of the right portion of the heart was significantly higher than that of the traditional method (92.83% vs. 83.87%, P=0.001). However, there was no significant difference in the specificity of the two methods for the diagnosis of PFO (97.35% vs. 96.03%, P=0.431). Additionally, the results of semiquantitative evaluation of PFO using modified method failed to show a more positive rate than shown by the traditional method (Z=-1.782, P=0.075). Conclusions: Modified contrast echocardiography of the right portion of the heart yielded a higher sensitivity than the traditional method, which contributed to the diagnosis of cardiac PFO. The research was a part of a register study (https://register.clinicaltrials.gov/ ClinicalTrials ID: NCT02777359).


Assuntos
Meios de Contraste/administração & dosagem , Ecocardiografia , Forame Oval Patente/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Manobra de Valsalva
9.
Ann Intern Med ; 170(11): 756-763, 2019 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-31060047

RESUMO

Background: Pulmonary embolism (PE) is associated with increased risk for ischemic stroke, but the underlying mechanism remains unclear. The authors hypothesized that paradoxical embolism through patent foramen ovale (PFO) should be the main mechanism. Objective: To determine the frequency of recent ischemic stroke in patients with symptomatic PE according to whether PFO was detected. Design: Prospective cohort study with masked assessment of stroke outcomes. (ClinicalTrials.gov: NCT01216423). Setting: 4 French hospital centers. Participants: 361 consecutive patients with symptomatic acute PE from 13 November 2009 through 21 December 2015. Intervention: Systematic contrast transthoracic echocardiography (TTE) and cerebral magnetic resonance imaging (MRI) within 7 days after enrollment. Measurements: Recent symptomatic or silent ischemic stroke was diagnosed on the basis of clinical examination and cerebral MRI showing a hypersignal on the trace diffusion-weighted image with reduction or pseudonormalization of apparent diffusion coefficient. Results: Contrast TTE was conclusive in 324 of 361 patients and showed PFO in 43 patients (13%). The median age was 66 years (interquartile range, 54 to 77 years). In total, 51% of patients (145/284) had associated deep venous thrombosis, 91% (279/306) had cardiovascular risk factors, and 10% (16/151) presented with arrhythmia (no difference between PFO and non-PFO groups). Cerebral MRI was conclusive in 315 patients. Recent ischemic stroke was more frequent in the PFO group than in the non-PFO group (9 of 42 patients [21.4%] vs. 15 of 273 patients [5.5%]; difference in proportions, 15.9 percentage points [95% CI, 4.7 to 30.7 percentage points]). Limitation: Because of inconclusive contrast TTE or MRI, 46 patients were excluded from analysis. Conclusion: Frequency of recent ischemic stroke in patients with symptomatic PE was higher in patients with PFO than in those without PFO. This finding supports the hypothesis that paradoxical embolism is an important mechanism of ischemic stroke in patients with PFO. Primary Funding Source: French Ministry of Health.


Assuntos
Isquemia Encefálica/etiologia , Forame Oval Patente/complicações , Embolia Pulmonar/complicações , Idoso , Arritmias Cardíacas/complicações , Isquemia Encefálica/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Ecocardiografia , Feminino , Forame Oval Patente/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
10.
Undersea Hyperb Med ; 46: 189-196, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31051064

RESUMO

Decompression illness (DCI) is an uncommon problem but can be significant in terms of morbidity and, very rarely, mortality. The mechanisms of DCI are pulmonary barotrauma and decompression sickness due to inert gas supersaturation. After the initial management phase, identification of predisposing factors is important to help advise divers regarding future risk and avoidance. Here we present four cases of DCI where pulmonary barotrauma was the likely causative mechanism. We highlight the important features in assessment for pulmonary barotrauma and advising divers on the risk of a recurrence.


Assuntos
Barotrauma/complicações , Doença da Descompressão/etiologia , Mergulho/efeitos adversos , Forame Oval Patente/diagnóstico por imagem , Lesão Pulmonar/complicações , Adulto , Braço , Vesícula/diagnóstico por imagem , Feminino , Forame Oval Patente/complicações , Hemiplegia/diagnóstico , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Masculino , Mucocele/complicações , Mucocele/diagnóstico por imagem , Paralisia , Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Volta ao Esporte , Adulto Jovem
12.
Heart Vessels ; 34(10): 1657-1662, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30868214

RESUMO

The efficacy of percutaneous transcatheter closure for preventing recurrent cerebrovascular events in elderly patients with high-risk patent foramen ovale (PFO) remains unclear, whereas in young patients, it has been shown to effectively prevent the recurrence of embolic stroke. The aim of this study was to investigate the safety and efficacy of percutaneous PFO closure in elderly patients with high-risk PFO. Between September 2012 and October 2018, 14 patients ≥ 60 years old with high-risk PFO underwent percutaneous closure to prevent recurrence of cerebrovascular events. The primary end point was recurrence of cerebrovascular events after closure in elderly patients with high-risk PFO, and the secondary end points were occurrence of device-related complications, cerebral hemorrhage, and new-onset atrial fibrillation (AF). The mean patient age and number of cerebrovascular events before closure were 75.2 ± 6.5 years and 1.7 ± 0.7, respectively. All procedures were successfully performed under general anesthesia by transesophageal echocardiography and using a 25-mm Amplatzer Cribriform device. No procedure-related complications occurred. Patients were followed up for a mean 2.6 ± 1.8 years. No patients experienced device-related complications or recurrent cerebrovascular events. However, one patient had AF-related device closure complications at 1 month postoperatively. In addition, other patient had a cerebral hemorrhage with unknown relationship to PFO closure 3 years postoperatively. Percutaneous closure of high-risk PFO in elderly patients may be as effective and safe as in younger patients. It is crucial to evaluate PFO morphology regardless of age in cases of paradoxical embolism.


Assuntos
Cateterismo Cardíaco , Embolia Paradoxal/complicações , Forame Oval Patente/complicações , Forame Oval Patente/terapia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etiologia , Ecocardiografia Transesofagiana , Embolia Paradoxal/terapia , Feminino , Forame Oval Patente/diagnóstico por imagem , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Dispositivo para Oclusão Septal/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
13.
Heart Vessels ; 34(9): 1499-1508, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30895384

RESUMO

Percutaneous closure of atrial septal defect (ASD)/patent foramen ovale (PFO) can influence systemic hemodynamics. The aim of this research was to evaluate the influence of the closure procedure on morphological and functional characteristics of systemic vascular walls. Fourteen ASD (mean age 40 ± 16 years) and 14 PFO (45 ± 8 years) patients were enrolled in this retrospective study. All underwent percutaneous closure procedure; physical, clinical and biochemical evaluations; echocardiography; carotid evaluation; and brachial artery flow-mediated vasodilatation (FMD). All the evaluations were performed at the time of enrollment, 24 h post-procedure, at 1-6-12-month follow-up. FMD at enrollment was higher in PFO patients as compared to ASD (8.5% [7.6-10.7%] versus 6.5% [5.6-7.6%], p < 0.0001). FMD values in ASD patients significantly increased during follow-up (enrollment: 6.5% [5.6-7.6%], 12-month follow-up: 8.8% [7.2-10.3%], p < 0.01). PFO patients showed reduced FMD values 24 h after the procedure (enrollment: 8.5% [7.6-10.7%], 24 h post-procedure: 7% [6.3-9%], p < 0.001), while recovering endothelial function during follow-up period to baseline values (FMD at 12-month follow-up: 8.2% [7.6-10.5%]). At one-year follow-up, FMD remained inversely related to systolic pulmonary arterial pressure and right and left atrial/ventricle chambers dimensions (RV proximal diameter efflux tract, right atrium [RA] longitudinal diameter, RA transverse diameter, RA area, left ventricle [LV] end-diastolic diameter, left atrium [LA] anteroposterior diameter, LA area; p < 0.01) in ASD patients. Endothelial function improved after percutaneous closure of ASD, while remaining stable after PFO closure. Therefore, ASD patients seem to improve their cardiovascular risk profile after percutaneous closure of their defect.


Assuntos
Cateterismo Cardíaco/métodos , Forame Oval Patente/cirurgia , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Adulto , Ecocardiografia , Feminino , Forame Oval Patente/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
J Cardiovasc Med (Hagerstown) ; 20(5): 290-296, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30921267

RESUMO

AIM: An underlying atrial vulnerability or a preexisting misdiagnosed atrial fibrillation in some patients who are candidates for patent foramen ovale (PFO) closure may lead to an unnecessary percutaneous intervention. The aim of this work was to define paroxysmal atrial fibrillation rate, through a 6-month insertable loop-recorder monitoring, in patients over 55 years old with cryptogenic stroke and PFO. METHODS: PFO closure criteria: significant right-to-left shunt and at least one high-risk feature (permanent right-to-left shunt, atrial septal aneurysm, prominent Eustachian valve, recurrent brain ischemia, previous deep vein thrombosis, thrombophilia). Insertable cardiac monitoring criteria: previous cryptogenic stroke, more than 55 years and at least one atrial fibrillation risk factor (heart failure, hypertension, age older than 65 years, diabetes, atrial runs, left atrium dilatation, left ventricle hypertrophy, pulmonary disease, thyroid disease, obesity). Atrial fibrillation detection threshold: arrhythmia duration longer than 5 min. RESULTS: From January 2008 to March 2017, 195 patients underwent to loop-recorder monitoring. A total of 70 (36%) patients were candidates for PFO closure. The 6-month silent atrial fibrillation rate was 11.4%. In the arrhythmia-free cohort, 28 patients (45.2%) underwent percutaneous foramen ovale closure (group A) and 34 (54.8%) were medically treated (group B). Atrial fibrillation detection rate was 14.3% in group A and 0% in group B. The 36-month atrial fibrillation-free survival was 76%. CONCLUSION: An occult preexisting atrial fibrillation may lead to unnecessary percutaneous foramen ovale closure in a significant proportion of patients. A 6-month loop-recorder monitoring may improve the patient oriented decision-making.


Assuntos
Fibrilação Atrial/diagnóstico , Cateterismo Cardíaco , Eletrocardiografia/instrumentação , Forame Oval Patente/terapia , Frequência Cardíaca , Acidente Vascular Cerebral/prevenção & controle , Telemetria/instrumentação , Procedimentos Desnecessários , Idoso , Doenças Assintomáticas , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Tomada de Decisão Clínica , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
16.
J Vet Cardiol ; 21: 28-33, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30797442

RESUMO

A two-month-old Red Angus heifer calf presented to the University of Wisconsin Veterinary Care for evaluation of suspected severe bronchopneumonia. Pertinent physical exam findings included tachycardia, tachypnea, dyspnea with a significant abdominal component, and cyanotic mucous membranes. On thoracic auscultation, wheezes were present bilaterally, as well as a grade 2/6 right apical systolic murmur. Thoracic radiographs revealed cardiomegaly, most severely affecting the right side. Echocardiography showed tricuspid valve dysplasia, resulting in severe tricuspid regurgitation and right-heart dilation, as well as a patent foramen ovale. A postmortem examination confirmed the presence of the aforementioned cardiac abnormalities and revealed only mild pulmonary changes. This case report is the first to describe tricuspid dysplasia in the absence of multiple, complex congenital cardiac abnormalities in a calf, and it highlights the value of echocardiography for an antemortem diagnosis.


Assuntos
Cardiomiopatia Dilatada/veterinária , Doenças dos Bovinos/patologia , Forame Oval Patente/veterinária , Insuficiência da Valva Tricúspide/veterinária , Animais , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/etiologia , Bovinos , Doenças dos Bovinos/diagnóstico , Doenças dos Bovinos/diagnóstico por imagem , Ecocardiografia/veterinária , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Radiografia Torácica/veterinária , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem
17.
Echocardiography ; 36(4): 783-786, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30803022

RESUMO

Patent foramen ovale (PFO) is the most common type of inter-atrial shunt, with prevalence as high as 30%. Detection of PFO has implications in patients with stroke, peripheral embolism, decompression illness, and other conditions. Transesophageal echo (TEE) with saline contrast injection is the current standard for PFO detection, but even with TEE, PFOs are sometimes missed. With advances in percutaneous PFO closure therapies and proven long-term benefit of closure, accurate PFO detection takes on cardinal importance. Various provocative maneuvers to enhance PFO detection are in clinical use and have been studied. The Valsalva maneuver has long-held position as the ideal provocation to unmask PFO, but other maneuvers such as cough, sniff, Müller's, and more have gained relevance. In this article, we will examine various maneuvers and discuss their utility in PFO detection.


Assuntos
Tosse , Ecocardiografia Transesofagiana/métodos , Forame Oval Patente/diagnóstico por imagem , Manobra de Valsalva/fisiologia , Forame Oval/diagnóstico por imagem , Forame Oval/fisiopatologia , Forame Oval Patente/fisiopatologia , Humanos
18.
J Interv Card Electrophysiol ; 55(1): 63-71, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30706256

RESUMO

INTRODUCTION: We investigated the feasibility to proactively stimulate subsequent closure of a patent foramen ovale (PFO) by injuring (mechanical trauma or radiofrequency [RF] energy) the opposing surfaces of the septum primum (SP) and septum secundum (SS). METHODS: 1. Mechanical Injury: The interatrial septum of patients who underwent multiple left atrial (LA) ablations over 6 years, where a PFO was used for LA access, were examined. Patients whose PFO was absent during a later procedure were identified. Eleven patients with LA accessed via a PFO also underwent subsequent LA procedures. 2. Ablation: Ten patients undergoing ablation for drug-resistant atrial fibrillation (AF), who also had a PFO, were studied. RF delivery was extended along the upper SP. Transthoracic echocardiogram (TTE) bubble study was repeated after 3 months. RESULTS: 1. Mechanical Injury: Seven were male with a mean age of 58.3 ± 9.99. LA size was 42.73 ± 3.52 mm. The mean left ventricular ejection fraction (EF) was 62 ± 7.4%. During the repeat procedure, in 4 patients, the PFO could not be visualized and the fossa ovalis (FO) was punctured. The fourth patient had three procedures. During the second procedure the PFO was accessed, but with difficulty. During the third procedure, it was no longer present. All four patients had subsequent TTE showing no PFO. 2. Ablation: Seven were male with a mean age of 61.1 ± 9.8 years. The mean EF and LA diameters were 55 ± 5% and 4.4 ± 0.8 cm respectively. The mean RF time was 5.4 ± 2.2 min. At 3 months, 9 patients out of 10 showed no interatrial communication. CONCLUSION: Injury of tunnel surfaces of the SP and SS by mechanical trauma or ablation can fuse the foramen ovale.


Assuntos
Fibrilação Atrial/cirurgia , Septo Interatrial/lesões , Septo Interatrial/cirurgia , Forame Oval Patente/cirurgia , Ablação por Radiofrequência/métodos , Fibrilação Atrial/diagnóstico por imagem , Septo Interatrial/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Feminino , Forame Oval Patente/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
19.
Echocardiography ; 36(4): 654-658, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30767261

RESUMO

AIM: To explore the value of cough maneuver (CM) in detecting right-to-left (RLS) during contrast transthoracic echocardiography (cTTE) and its mechanism. METHOD: We enrolled 196 patients with a high level of clinical suspicion of RLS underwent cTTE for RLS detection. Valsalva maneuver (VM) (blowing into a face mask connected to a sphygmomanometer at 40 mm Hg for 10 seconds) and CM were performed to provoke RLS, respectively. A comparison of the two provocative maneuvers in terms of the RLS-detection rate, the degree of RLS, the mobility of septum primum was done. RESULTS: The detection rates of RLS for CM were significantly higher than that for VM (38.3% vs 32.1%), (P < 0.001). There was no significant difference between VM and CM in terms of detecting moderate- or severe-extent RLS (P > 0.05), however, CM was significantly better than VM in detecting mild-extent RLS (P = 0.004). CM caused a greater mobility of septum primum than VM (20.1 ± 0.2 mm vs 6.3 ± 0.1 mm), (P < 0.001). CONCLUSION: Cough maneuver had a higher detection rate for RLS than VM during cTTE, maybe due to its greater mobility of septum primum than VM caused.


Assuntos
Meios de Contraste , Tosse , Ecocardiografia , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/fisiopatologia , Aumento da Imagem/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Adulto Jovem
20.
Medicine (Baltimore) ; 98(4): e14276, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30681631

RESUMO

The objective of this study is to investigate the sensitivity of contrast-enhanced transthoracic echocardiography (c-TTE) versus transesophageal echocardiography (TEE) to detect a residual right-to-left shunt (RLS) following a transcatheter patent foramen ovale (PFO) closure.A self-controlled study was conducted in a tertiary referral hospital. 57 patients with PFO who had experienced migraines underwent percutaneous PFO closure. c-TTE, TEE, and contrast-enhanced transcranial Doppler (c-TCD) at resting and Valsalva maneuver were performed during the 3-month follow-up after the closure.The closure devices were successfully implanted in all patients without complications. Three months after closure, TEE did not detect residual Valsalva shunts in any of the 57 patients; residual valsalva shunts were found via c-TTE in 15 of the 57 patients and were also observed via c-TCD. When c-TTE and/or c-TCD were used, the rate of residual RLSs detected in patients who underwent PFO closure was 26.32%, which was significantly different than the rate detected using TEE (P < .05)c-TTE and c-TCD showed equivalent sensitivity in evaluating transcatheter closure of a PFO. c-TTE could be a more cost-effective and reliable method to detect the residual shunt after PFO closure.


Assuntos
Meios de Contraste , Ecocardiografia/estatística & dados numéricos , Forame Oval Patente/diagnóstico por imagem , Intervenção Coronária Percutânea/estatística & dados numéricos , Ultrassonografia Doppler/estatística & dados numéricos , Adulto , Derivação Arteriovenosa Cirúrgica , Ecocardiografia/métodos , Feminino , Forame Oval Patente/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Sensibilidade e Especificidade , Resultado do Tratamento , Ultrassonografia Doppler/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA