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1.
Lupus ; 28(4): 560-564, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30791856

RESUMO

We reported uveal effusion and transient myopia as the initial presentation of systemic lupus erythematosus with pulmonary arterial hypertension. Choroidal retinopathy is rare but extremely destructive to visual function. Therefore, prompt diagnosis and effective treatments will result in complete resolution of the uveal effusion and functional restoration of vision.


Assuntos
Doenças da Coroide/diagnóstico , Hipertensão Pulmonar/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Miopia/diagnóstico , Miopia/etiologia , Úvea/patologia , Adulto , Anticorpos Antinucleares/sangue , Antirreumáticos/uso terapêutico , Corioide/diagnóstico por imagem , Corioide/patologia , Doenças da Coroide/tratamento farmacológico , Doenças da Coroide/etiologia , Corpo Ciliar/diagnóstico por imagem , Corpo Ciliar/patologia , Feminino , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Hipertrofia Ventricular Direita/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Microscopia Acústica , Miopia/tratamento farmacológico , Prednisona/uso terapêutico , Qualidade de Vida , Doença de Raynaud/complicações , Retina/diagnóstico por imagem , Retina/patologia , Descolamento Retiniano/diagnóstico por imagem , Descolamento Retiniano/tratamento farmacológico , Descolamento Retiniano/etiologia , Tomografia de Coerência Óptica , Resultado do Tratamento , Baixa Visão/tratamento farmacológico , Baixa Visão/etiologia
2.
Int J Cardiovasc Imaging ; 35(3): 441-450, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30350115

RESUMO

Pulmonary arterial hypertension (PAH) is more prevalent in females. Paradoxically, female patients have better right ventricular (RV) function and higher survival rates than males. However, the effects of 17ß-estradiol (E2) on RV function in PAH has not been studied. Twenty-four male rats were exposed to monocrotaline (MCT) to induce experimental PAH, while treated with E2 or vehicle respectively. Together with eight control rats, thirty-two rats were examined by echocardiography 4 weeks after drug administration. Echocardiographic measurement of RV function included: tricuspid annular plane systolic excursion (TAPSE), RV index of myocardial performance (RIMP), RV fractional area change (RVFAC) and tricuspid annular systolic velocity (s'). RV free wall longitudinal strain (RVLSFW) and RV longitudinal shortening fraction (RVLSF) were also used to quantify RV function. RV morphology was determined by echocardiographic and histological analysis. TAPSE, RVFAC and s' were reduced, and RIMP was elevated in the MCT-treated group and vehicle-treated group, when compared with control group (P < 0.01). TAPSE, RVFAC and s' in the E2 group were higher, while RIMP was lower than those in the MCT-treated group and vehicle-treated group (P < 0.01). Myocardial functional parameters (RVLSFW and RVLSF) were also higher in the E2 group. Enhanced serum E2 levels were closely correlated with the improvement in RV functional parameters and enhancement of serum BNP levels (P < 0.01 for all groups). RV function decreased significantly in male rats with MCT-induced PAH, while E2 exhibited a protective effect on RV function, suggesting that E2 is a critical modulator of sex differences in PAH.


Assuntos
Ecocardiografia , Estradiol/farmacologia , Ventrículos do Coração/efeitos dos fármacos , Hipertensão Pulmonar/tratamento farmacológico , Hipertrofia Ventricular Direita/prevenção & controle , Disfunção Ventricular Direita/prevenção & controle , Função Ventricular Direita/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos , Animais , Biomarcadores/sangue , Modelos Animais de Doenças , Estradiol/sangue , Fibrose , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Hipertrofia Ventricular Direita/sangue , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/fisiopatologia , Masculino , Monocrotalina , Peptídeo Natriurético Encefálico/sangue , Ratos Sprague-Dawley , Fatores de Tempo , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia
3.
Ann Thorac Surg ; 107(1): e23-e25, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29944878

RESUMO

A 26-year-old woman with a diagnosis of congenital heart disease was admitted to the hospital with exertional dyspnea, cyanotic complexion, and bilateral lower limb edema. All tests revealed isolated severe right ventricular hypertrophy. She was in poor condition, with a diminishing chance for routine surgical treatment, so she was scheduled for orthotopic homologous heart transplantation. After the operation, isolated severe right ventricular hypertrophic cardiomyopathy was confirmed histologically and pathologically. After the operation, the patient's cardiac function was normal. Exertional dyspnea, cyanotic complexion, and bilateral lower limb edema all improved postoperatively.


Assuntos
Ecocardiografia , Hipertrofia Ventricular Direita/diagnóstico por imagem , Adulto , Tamponamento Cardíaco/etiologia , Erros de Diagnóstico , Dispneia/etiologia , Anomalia de Ebstein/diagnóstico , Edema/etiologia , Emergências , Feminino , Transplante de Coração , Humanos , Hipertrofia Ventricular Direita/complicações , Hipertrofia Ventricular Direita/patologia , Hipertrofia Ventricular Direita/cirurgia , Imagem por Ressonância Magnética , Derrame Pericárdico/etiologia
4.
Int J Cardiovasc Imaging ; 35(1): 143-151, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30094564

RESUMO

Cardiac tachyarrhythmias are the leading cause of morbidity and mortality in patients with repaired tetralogy of Fallot (TOF). We evaluated risk factors for sustained ventricular tachyarrhythmia (VT) and atrial tachyarrhythmia (ATA) in these patients. Patients (n = 319) who underwent cardiac magnetic resonance (CMR) imaging at two tertiary centers between 2007 and 2016 were assessed. Potential risk markers, based on history, cardiac magnetic resonance imaging (CMR), electrocardiography (ECG) and echocardiography, were analyzed for prediction of the primary endpoint of VT, and the secondary endpoint of ATA. During a follow-up of 3.5 (0.9-6.1) years, 20 (6.3%) patients reached the primary endpoint, and 30 (9.4%) the secondary endpoint. Multivariable cox hazards regression identified right ventricular (RV) end-diastolic volume (Hazard ratio [HR] 2.03, per 10 ml/m2 increase; p = 0.02), RV end-systolic volume (HR 3.04, per 10 ml/m2 increase; p = 0.04), RV mass (HR 1.88, per 10 g/m2 increase; p = 0.02), and RV ejection fraction (HR 6.06, per 10% decrease; p = 0.02) derived from CMR to be independent risk factors of VT. In addition, QRS-duration (HR 1.70, per 10 ms increase; p = 0.001) and body mass index (BMI: HR 1.8, per 5 kg/m2 increase; p = 0.02) were independent markers of VT. Older age at TOF repair (HR 1.33, per 2 months increase; p = 0.03) and BMI (HR 1.76, per 5 kg/m2 increase; p < 0.001) independently predicted ATA. RV systolic dysfunction, hypertrophy and dilatation on CMR, together with QRS prolongation, and obesity are predictive of VT in TOF patients. Older age at TOF repair and obesity were associated with the occurrence of ATA.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Imagem Cinética por Ressonância Magnética , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Ventricular/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , Feminino , Frequência Cardíaca , Humanos , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/fisiopatologia , Masculino , Países Baixos , Obesidade/complicações , Obesidade/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/fisiopatologia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Tetralogia de Fallot/complicações , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita , Adulto Jovem
5.
Int J Cardiovasc Imaging ; 35(1): 195-206, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30143921

RESUMO

The anteroposterior (AP) portable chest radiograph is routinely performed to evaluate cardiopulmonary status, however heart size can be misrepresented by inherent technical factors. Our aim was to determine diagnostic accuracy of cardiothoracic ratio (CTR) on AP chest radiographs relative to echocardiography, as well as relative to axial computed tomography (CT) and frontal CT scout images in predicting cardiac chamber enlargement. 200 subjects with both chest CT and AP chest radiograph within 1 month were retrospectively identified. Patients with pericardial effusion or obscured heart borders were excluded. 130 of these subjects had also undergone echocardiography. Transverse diameters of the heart and thorax were used to calculate CTRs on AP chest radiograph, scout CT, and axial CT images. A second reader was used to verify measurement accuracy and reproducibility. Statistical analysis of CTRs for AP chest radiograph, CT scout, and axial CT images were calculated using echocardiography as gold standard. AP chest radiographs had higher CTR values than axial and scout CT images (by 0.075, p < 0.001), larger measured heart diameters by approximately 3 cm (p < 0.001), and larger thoracic diameters by approximately 2 cm (p < 0.001). CTRs on AP chest radiographs calculated with a cutoff of 0.50 had sensitivity of 86% and specificity of 32%. Sensitivity and specificity were 61% and 66% respectively when using a cutoff of 0.55, and 34% and 92% respectively when using a cutoff of 0.60. A CTR of 60% is more appropriate than 50-55% when evaluating an AP chest radiograph for cardiac chamber enlargement due to its much higher specificity.


Assuntos
Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Direita/diagnóstico por imagem , Radiografia Torácica/métodos , Função Ventricular Esquerda , Função Ventricular Direita , Remodelação Ventricular , Ecocardiografia Transesofagiana , Humanos , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Direita/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
6.
Medicine (Baltimore) ; 97(48): e13307, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30508919

RESUMO

The prognosis of right heart enlargement varies according to different etiologies. The purpose of this study was to investigate the characteristics of echocardiogram, surgical treatment, chromosome and prognosis for fetal right heart enlargement.The foetal echocardiogram was performed on 3987 pregnant women, and then 88 fetuses with right heart enlargement were identified. The data about prenatal and postnatal echocardiograms, postnatal cardiac surgical treatment, karyotype analysis and autopsy after induced labor were analyzed in the 88 fetuses.Except the 1111 cases that had loss of follow-up, 2876 cases had complete data. Among the 2876 cases, right heart enlargement was identified in 88 fetuses. Of the 88 fetuses, 15 had total atrioventricular septal defect (unbalanced type: right ventricular dominance), 15 Ebstein's anomaly, 18 fallot tetrad, 14 double outlet right ventricle, 13 total anomalous pulmonary venous drainage, and 13 premature closure of ductus arteriosus. Chromosomal abnormality was found in 12 cases.There are many etiological factors causing right heart enlargement. The prognosis is better in the fetuses with single heart malformation than in the fetuses who have extracardiac malformation or/and chromosomal abnormality besides heart malformation. Fetal echocardiography combined with karyotype analysis can provide important bases for evaluating the prognosis of fetuses with right heart enlargement.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ecocardiografia , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/genética , Ultrassonografia Pré-Natal , Adolescente , Adulto , Aberrações Cromossômicas , Feminino , Seguimentos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/genética , Cardiopatias Congênitas/cirurgia , Humanos , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/cirurgia , Cariótipo , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
7.
J Electrocardiol ; 51(4): 658-662, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29997007

RESUMO

Predominant or isolated right ventricular involvement in cardiac sarcoidosis is uncommon, but should always be considered in a case of right ventricular hypertrophy combined with ventricular arrhythmia and/or conduction disturbance. Although improvement in right ventricular hypertrophy and atrioventricular conduction disturbance following corticosteroid therapy has been reported, the detailed serial electrocardiographic responses during corticosteroid therapy, as well as temporal changes in the electrocardiographic, biochemical, and morphological responses, have not been reported. We describe the clinical course and supportive imaging findings of reversible right ventricular hypertrophy and cardiac conduction disturbance in a case of right ventricular-predominant cardiac sarcoidosis.


Assuntos
Cardiomiopatias/tratamento farmacológico , Eletrocardiografia/efeitos dos fármacos , Glucocorticoides/farmacologia , Prednisolona/farmacologia , Sarcoidose/tratamento farmacológico , Bloqueio Atrioventricular/diagnóstico , Bloqueio de Ramo/diagnóstico , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Glucocorticoides/uso terapêutico , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertrofia Ventricular Direita/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Prednisolona/uso terapêutico , Sarcoidose/complicações , Sarcoidose/diagnóstico , Taquicardia Ventricular/etiologia
8.
Rev Chil Pediatr ; 89(3): 361-367, 2018 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-29999142

RESUMO

INTRODUCTION: Tetralogy of Fallot (TOF) is the most frequent cyanotic congenital heart disease. Pulmonary regurgitation (PR) and right ventricle (RV) enlargement and dysfunction are the most common long-term complications. Cardiac magnetic resonance (CMR) is the gold standard for RV evaluation. OBJECTIVE: To analyze CMR results in the follow-up of TOF patients. PATIENTS AND METHOD: All CMR performed between 2007 and 2012 in TOF patients with transannular patch (TAP) repair or infundibular widening, and without pulmonary valve replacement (PVR) were included. Pulmonary regurgitant fraction (PRF), ventricular end-diastolic (EDV) and end-systolic volume (ESV), and ejection fraction (EF) were examined. RESULTS: 122 CMR were performed in 114 patients. Average age at CMR was 15.4±7.4 years. 53.3% of them presented severe PR (> 40%). RVEDV was 157.3 ± 38.6 ml/m2, RVESV was 85.3 ± 27 ml/m2 and RVEF was 46.4 ± 7.1%. RVEDV was > 150 ml/ m2 in 48.4% and > 170 ml/m2 in 32.8% of patients. Patients with TAP showed larger RV volumes compared with those with infundibular widening. RVEDV > 170 ml/m2 showed worse RVEF that those with lower RVEDV (47.9 ± 7% vs 43.2 ± 6.4%, p < 0.01). CONCLUSION: Almost half of the pa tients showed significant RV enlargement, demonstrating that the indication of CMR is late in their follow-up. TAP was associated with higher RVEDV and RVESV, but no worse RVEF.


Assuntos
Hipertrofia Ventricular Direita/diagnóstico por imagem , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Disfunção Ventricular Direita/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hipertrofia Ventricular Direita/etiologia , Lactente , Masculino , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia
9.
Biomed Res Int ; 2018: 4606053, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29850519

RESUMO

Introduction: Several diagnostic tests have been recommended for risk assessment in pulmonary hypertension (PH), but the role of electrocardiography (ECG) in monitoring of PH patients has not been yet established. Therefore the aim of the study was to evaluate which ECG patterns characteristic for pulmonary hypertension can predict hemodynamic improvement in patients treated with targeted therapies. Methods: Consecutive patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) were eligible to be included if they had had performed two consecutive right heart catheterization (RHC) procedures before and after starting of targeted therapies. Patients were followed up from June 2009 to July 2017. ECG patterns of right ventricular hypertrophy according to American College of Cardiology Foundation were assessed. Results: We enrolled 80 patients with PAH and 11 patients with inoperable CTEPH. The follow-up RHC was performed within 12.6 ± 10.0 months after starting therapy. Based on median change of pulmonary vascular resistance, we divided our patients into two subgroups: with and without significant hemodynamic improvement. RV1, max⁡RV1,2 + max⁡SI,aVL - SV1, and PII improved along with the improvement of hemodynamic parameters including PVR. They predicted hemodynamic improvement with similarly good accuracy as shown in ROC analysis: RV1 (AUC: 0.75; 95% CI: 0.63-0.84), PII (AUC: 0.67, 95% CI: 0.56-0.77), and max⁡RV1,2 + max⁡SI,aVL - SV1 (0.73; 95% CI: 0.63-0.82). In Cox regression only change in RV1 remained significant mortality predictor (HR: 1.12, 95% CI: 1.01-1.24). Conclusion: Electrocardiogram may be useful in predicting hemodynamic effects of targeted therapy in precapillary pulmonary hypertension. Decrease of RV1, max⁡RV1,2 + max⁡SI,aVL - SV1, and PII corresponds with hemodynamic improvement after treatment. Of these changes a decrease of R wave amplitude in V1 is associated with better survival.


Assuntos
Eletrocardiografia , Hemodinâmica , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Feminino , Seguimentos , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/terapia , Hipertrofia Ventricular Direita/complicações , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
10.
Int J Cardiovasc Imaging ; 34(10): 1595-1605, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29850969

RESUMO

Pulmonary embolism onset is frequently neglected due to the non-specific character of its symptoms. Pocket-size imaging devices (PSID) present an opportunity to implement imaging diagnostics into conventional physical examination. The aim of this study was to test the hypothesis that supplementation of the initial bedside assessment of patients with suspected pulmonary embolism (PE) with four-point compression venous ultrasonography (CUS) and right ventricular size assessment with the use of PSID equipped with dual probe could positively influence the accuracy of clinical predictions. A single-centre, prospective analysis was conducted on 100 patients (47 men, mean age 68 ± 13 years) with suspected PE. Clinical assessment on the basis of Wells and revised Geneva score and physical examination were supplemented with CUS and RV measurements by PSID. The mean time of PSID scanning was 4.9 ± 0.8 min and was universally accepted by the patients. Fifteen patients had deep venous thrombosis and RV enlargement was observed in 59 patients. PE was confirmed in 24 patients. If the both CUS was positive and RV enlarged, the specificity was 100% and sensitivity 54%, ROC AUC 0.771 [95% CI 0.68-0.85]. The Wells rule within our study population had the specificity of 86% and sensitivity of 67%, ROC AUC 0.776 (95% CI 0.681-0.853, p < 0.0001). Similar values calculated for the revised Geneva score were as follows: specificity 58% and sensitivity 63%, ROC AUC 0.664 (95% CI 0.563-0.756, p = 0.0104). Supplementing the revised Geneva score with additional criteria of CUS result and RV measurement resulted in significant improvement of diagnostic accuracy. The difference between ROC AUCs was 0.199 (95% Cl 0.0893-0.308, p = 0.0004). Similar modification of Wells score increased ROC AUC by 0.133 (95% CI 0.0443-0.223, p = 0.0034). Despite the well-acknowledged role of the PE clinical risk assessment scores the diagnostic process may benefit from the addition of basic bedside ultrasonographic techniques.


Assuntos
Técnicas de Diagnóstico Cardiovascular/instrumentação , Ventrículos do Coração/diagnóstico por imagem , Hipertrofia Ventricular Direita/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Ultrassonografia/instrumentação , Trombose Venosa/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Técnicas de Imagem Cardíaca/instrumentação , Computadores de Mão , Técnicas de Apoio para a Decisão , Feminino , Humanos , Hipertrofia Ventricular Direita/etiologia , Masculino , Pessoa de Meia-Idade , Testes Imediatos , Estudos Prospectivos , Embolia Pulmonar/etiologia , Trombose Venosa/complicações
13.
Int J Cardiovasc Imaging ; 34(9): 1439-1449, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29605901

RESUMO

To characterize the morphological change in the right ventricle (RV) of patients with pulmonary artery hypertension (PAH) and further explore the correlation between septomarginal trabeculation (SMT) and right ventricular (RV) function, myocardial fibrosis, and exercise capacity in patients with PAH. Sixty untreated PAH patients were prospectively included from May 2016 to April 2017. All patients underwent comprehensive clinical evaluation and cardiac magnetic resonance (CMR). The area and diameter of the basal segment of SMT, and the mass of SMT were measured on cine SSFP images. Relationship between parameters of SMT and RV ejection fraction (RVEF), 6 min walking distance (6MWD), myocardial fibrosis and pulmonary vascular resistance (PVR) were evaluated by Pearson's correlation and logistic regression. Predictive performance of SMT parameters for reduced RVEF or impaired 6MWD was evaluated by receiver operating characteristics (ROC) analysis. Compared with SMT diameter index and mass index, SMT area index (SMT Ai) in basal segment was the best parameter to show correlation with RVEF (r = - 0.496, P < 0.001), 6MWD (r = - 0.619, P < 0.001), and inferior insertion point (I IP) extracelluar volume (ECV) (r = 0.365, P = 0.008). ROC showed that SMT Ai had the strongest predictive value for reduced RVEF (AUC = 0.756), and impaired 6MWD (AUC = 0.813). SMT parameters were closely correlated with RV systolic function and 6MWD in patients with PAH. SMT Ai is a simple imaging indicator for the severity of PAH.


Assuntos
Hipertensão Pulmonar/fisiopatologia , Hipertrofia Ventricular Direita/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia , Adulto , Feminino , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico por imagem , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Volume Sistólico , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Adulto Jovem
14.
J Am Heart Assoc ; 7(5)2018 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-29502109

RESUMO

BACKGROUND: Little data exist regarding the functional capacity of patients following acute pulmonary embolism. We sought to characterize the natural history of symptom burden, right ventricular (RV) structure and function, and exercise capacity among survivors of massive and submassive pulmonary embolism. METHODS AND RESULTS: Survivors of submassive or massive pulmonary embolism (n=20, age 57±13.3 years, 8/20 female) underwent clinical evaluation, transthoracic echocardiography, and cardiopulmonary exercise testing at 1 and 6 months following hospital discharge. At 1 month, 9/20 (45%) patients had New York Heart Association II or greater symptoms, 13/20 (65%) demonstrated either persistent RV dilation or systolic dysfunction, and 14/20 (70%) had objective exercise impairment as defined by a peak oxygen consumption (V˙O2) of <80% of age-sex predicted maximal values (16.25 [13.4-20.98] mL/kg per minute). At 6 months, no appreciable improvements in symptom severity, RV structure or function, and peak V˙O2 (17.45 [14.08-22.48] mL/kg per minute, P=NS) were observed. No patients demonstrated an exercise limitation attributable to either RV/pulmonary vascular coupling, as defined by a VE/VCO2 slope >33, or a pulmonary mechanical limit to exercise at either time point. Similarly, persistent RV dilation or dysfunction was not significantly related to symptom burden or peak V˙O2 at either time point. CONCLUSIONS: Persistent symptoms, abnormalities of RV structure and function, and objective exercise limitation are common among survivors of massive and submassive pulmonary embolism. Functional impairment appears to be attributable to general deconditioning rather than intrinsic cardiopulmonary limitation, suggesting an important role for prescribed exercise rehabilitation as a means toward improved patient outcomes and quality of life.


Assuntos
Teste de Esforço , Tolerância ao Exercício , Embolia Pulmonar/diagnóstico , Adulto , Idoso , Ecocardiografia Doppler , Feminino , Nível de Saúde , Humanos , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/fisiopatologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Valor Preditivo dos Testes , Estudos Prospectivos , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita
15.
Catheter Cardiovasc Interv ; 91(6): 1125-1129, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29521437

RESUMO

Current balloon expandable transcatheter valves have limited applicability to patients with "native" right ventricular outflow tracts (RVOT), meaning those who have had previous surgery and are left with large, compliant, irregular RVOT. The Alterra Adaptive PrestentTM is a self-expanding, partially covered stent that was designed to internally reconfigure these types of RVOT, making them suitable for implantation of a commercially available balloon expandable heart valve, the SAPIEN 3. Herein, we describe the first human implant of this device.


Assuntos
Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Hipertrofia Ventricular Direita/cirurgia , Insuficiência da Valva Pulmonar/cirurgia , Stents , Função Ventricular Direita , Remodelação Ventricular , Cateterismo Cardíaco/métodos , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/fisiopatologia , Pessoa de Meia-Idade , Modelos Cardiovasculares , Desenho de Prótese , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/fisiopatologia , Resultado do Tratamento
17.
JACC Cardiovasc Interv ; 11(6): 541-550, 2018 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-29566799

RESUMO

OBJECTIVES: The authors sought to assess the intermediate-term effects of percutaneous placed valves in the branch pulmonary artery (PA) position. BACKGROUND: Most patients with large right ventricular outflow tracts (RVOTs) are excluded from available percutaneous pulmonary valve options. In some of these patients, percutaneous branch PA valve implantation may be feasible. The longer-term effects of valves in the branch PA position is unknown. METHODS: Retrospective data were collected on patients with significant pulmonary regurgitation who had a percutaneous branch PA valve attempted. RESULTS: Percutaneous branch PA valve implantation was attempted in 34 patients (18 bilateral and 16 unilateral). One-half of the patients were in New York Heart Association (NHYA) functional class III or IV pre-implantation. There were 2 failed attempts and 6 procedural complications. At follow-up, only 1 patient had more than mild valvar regurgitation. The right ventricular end-diastolic volume index decreased from 147 (range: 103 to 478) ml/m2 to 101 (range: 76 to 429) ml/m2, p < 0.01 (n = 16), and the right ventricular end-systolic volume index decreased from 88.5 (range: 41 to 387) ml/m2 to 55.5 (range: 40.2 to 347) ml/m2, p < 0.01 (n = 13). There were 5 late deaths. At a median follow-up of 2 years, all other patients were in NYHA functional class I or II. CONCLUSIONS: Percutaneous branch PA valve implantation results in a reduction in right ventricular volume with clinical benefit in the intermediate term. Until percutaneous valve technology for large RVOTs is refined and more widely available, branch PA valve implantation remains an option for select patients.


Assuntos
Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Hipertrofia Ventricular Direita/fisiopatologia , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita , Remodelação Ventricular , Adolescente , Adulto , Angiografia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Criança , Europa (Continente) , Estudos de Viabilidade , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Hipertrofia Ventricular Direita/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Disfunção Ventricular Direita/diagnóstico por imagem , Adulto Jovem
18.
Clin Physiol Funct Imaging ; 38(5): 830-839, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29235722

RESUMO

BACKGROUND: Regional ventricular pumping mechanisms in patients with volume-loaded right ventricles (RV) are altered, but the cause is unknown. The aim was to determine whether these changes in ventricular pumping mechanisms are influenced by the RV dilatation itself or the aetiology behind it. METHODS: Seventeen patients with atrial septal defects (ASD) and 10 healthy controls underwent cardiovascular magnetic resonance (CMR) at rest and during dobutamine/atropine stress. Sixteen patients underwent transcutaneous ASD closure. Follow-up CMR at rest was performed the following day. Thirty patients with RV overload due to pulmonary regurgitation (PR) underwent CMR at rest. Cine images were used to measure left ventricular (LV) and RV volumes as well as septal, longitudinal and lateral contributions to LV and RV stroke volume (SV). RESULTS: At rest, septal contribution to LVSV was lower in ASD patients than controls (-1% versus 7%, P<0·05), but there was no difference in longitudinal or lateral contribution to SV. Patients with PR had lower longitudinal contribution to RV with increased lateral and septal contribution. During dobutamine stress, longitudinal contribution to LV and RVSV decreased and lateral contribution increased for ASD patients and controls. The day after ASD closure, septal contribution to LVSV was 6%, longitudinal contribution had increased for RVSV (P<0·05) and decreased for LVSV (P<0·01). CONCLUSION: Pumping mechanisms in patients with RV volume overload depend on the aetiology for the RV dilation and not the size of the RV.


Assuntos
Cateterismo Cardíaco , Cardiotônicos/administração & dosagem , Dobutamina/administração & dosagem , Comunicação Interatrial/terapia , Hipertrofia Ventricular Direita/fisiopatologia , Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atropina/administração & dosagem , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Humanos , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/etiologia , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/administração & dosagem , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Volume Sistólico , Resultado do Tratamento , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Função Ventricular Esquerda , Remodelação Ventricular , Adulto Jovem
20.
Methodist Debakey Cardiovasc J ; 14(4): 298-300, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30788016

RESUMO

Reversed pulsus paradoxus was first described in 1973 as a rise in peak systolic pressure on inspiration in patients with idiopathic hypertrophic subaortic stenosis or isorhythmic ventricular rhythm and in patients with left ventricular systolic dysfunction on positive pressure ventilation. Positive pressure ventilation, for example, may impel blood from the pulmonary capillaries and venules into the left atrium. This may increase left ventricular preload and accelerate ventricular emptying, which in turn may cause the systolic arterial pressure to rise during inspiration. We observed this phenomenon in a patient with a large pericardial effusion, right ventricular failure, and pulmonary arterial hypertension, and we noted the lack of echocardiographic features of tamponade in the presence of right ventricular hypertrophy and pulmonary hypertension. This case report discusses the subsequent occurrence of acute congestive heart failure after pericardiocentesis.


Assuntos
Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/etiologia , Hipertrofia Ventricular Direita/etiologia , Derrame Pericárdico/etiologia , Escleroderma Sistêmico/complicações , Disfunção Ventricular Direita/etiologia , Função Ventricular Direita , Adulto , Cateterismo Cardíaco , Diuréticos/administração & dosagem , Ecocardiografia Doppler de Pulso , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/fisiopatologia , Hipertrofia Ventricular Direita/terapia , Ventilação não Invasiva/efeitos adversos , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/fisiopatologia , Derrame Pericárdico/terapia , Pericardiocentese/efeitos adversos , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/fisiopatologia , Escleroderma Sistêmico/terapia , Resultado do Tratamento , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia , Disfunção Ventricular Direita/terapia , Função Ventricular Esquerda , Remodelação Ventricular
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