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1.
Methodist Debakey Cardiovasc J ; 15(2): 138-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384377

RESUMO

Ebstein's anomaly is a malformation of the tricuspid valve with myopathy of the right ventricle (RV) that presents with variable anatomic and pathophysiologic characteristics, leading to equally variable clinical scenarios. Medical management and observation is often recommended for asymptomatic patients and may be successful for many years. Tricuspid valve repair is the goal of operative intervention; repair also typically includes RV plication, right atrial reduction, and atrial septal closure or subtotal closure. Postoperative functional assessments generally demonstrate an improvement or relative stability related to degree of RV enlargement, RV dysfunction, RV fractional area change, and tricuspid valve regurgitation.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fármacos Cardiovasculares/uso terapêutico , Anomalia de Ebstein/terapia , Insuficiência da Valva Tricúspide/terapia , Valva Tricúspide/efeitos dos fármacos , Valva Tricúspide/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Anomalia de Ebstein/complicações , Anomalia de Ebstein/diagnóstico por imagem , Anomalia de Ebstein/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Humanos , Recuperação de Função Fisiológica , Resultado do Tratamento , Valva Tricúspide/anormalidades , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/tratamento farmacológico , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/fisiopatologia , Função Ventricular Direita/efeitos dos fármacos
3.
Pediatr Blood Cancer ; 66(7): e27717, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30907497

RESUMO

Elevated tricuspid valve regurgitation jet velocity (TRV ≥ 2.5 m/s) is associated with mortality among adults with sickle cell disease (SCD), but correlative biomarkers are not studied according to treatment exposure or genotypes. To investigate the associations between biomarkers and TRV elevation, we examined the relationship between TRV and hemolytic, inflammatory, and cardiac biomarkers, stratified by disease-modifying treatments and SCD genotype. In total, 294 participants with SCD (mean age, 11.0 ± 3.7 years) and 49 hereditary spherocytosis (HS; mean age, 22.9 ± 19.75 years) were included for comparison and enrolled. TRV was elevated in 30.7% of children with SCD overall: 18.8% in HbSC/HbSß+ -thalassemia, 28.9% in untreated HbSS/HbSß0 -thalassemia, 34.2% in HbSS/HbSß0 -thalassemia hydroxyurea-treated, and 57% in HbSS/HbSß0 -thalassemia chronic transfusion treated. TRV was elevated in 10.7% and 27.8% in HS children and adults, respectively. In children with SCD, elevated TRV was correlated with hemoglobin (odds ratio [OR] = 0.78, P = 0.004), lactate dehydrogenase (LDH; OR = 2.52, P = 0.005), and N-terminal pro-brain natriuretic peptide (NT-pro BNP; OR = 1.003, P = 0.004). In multivariable logistic regression, adjusting for genotype, sex, hemolytic index, and treatment, hemoglobin concentration remained the only significant variable associated with elevated TRV in untreated HbSS/HbSß0 -thalassemia participants. TRV was not associated with inflammatory markers, other markers of hemolysis, or NT-pro BNP in untreated HbSS/HbSß0 -thalassemia. Neither hemoglobin nor LDH was associated with TRV in HbSC/HbSß+ -thalassemia. These results suggest that elevated TRV is influenced by the degree of anemia, possibly reflecting sickling as part of the disease pathophysiology. Prospective studies should monitor hemoglobin concentration as children with SCD age into adulthood, prompting initiation of TRV screening and monitoring.


Assuntos
Anemia Falciforme , Insuficiência da Valva Tricúspide , Talassemia beta , Adolescente , Anemia Falciforme/complicações , Anemia Falciforme/tratamento farmacológico , Anemia Falciforme/epidemiologia , Anemia Falciforme/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prevalência , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/tratamento farmacológico , Insuficiência da Valva Tricúspide/epidemiologia , Insuficiência da Valva Tricúspide/fisiopatologia , Talassemia beta/complicações , Talassemia beta/tratamento farmacológico , Talassemia beta/epidemiologia , Talassemia beta/fisiopatologia
4.
JACC Cardiovasc Imaging ; 12(3): 389-397, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30660536

RESUMO

OBJECTIVES: This study sought to define the relationship between functional tricuspid regurgitation (TR) and mortality in patients with heart failure with reduced ejection fraction (HFrEF); and to establish the prognostic value of quantitative measures of TR severity (i.e., effective regurgitant orifice area [EROA] and regurgitant volume). BACKGROUND: The significance of TR in chronic heart failure is controversial. Earlier studies have shown an independent impact of TR on mortality, whereas more recent evidence suggests myocardial impairment to be the driving force of mortality rather than TR itself. Earlier studies have used qualitative measures of TR severity, hence the prognostic value of more quantitative measures of TR severity (i.e., EROA and regurgitant volumes) remains unclear. METHODS: We enrolled 382 patients with HFrEF on guideline-directed medical therapy and assessed TR EROA and regurgitant volume by Doppler/2-dimensional echocardiography. All-cause mortality was defined as the primary study endpoint. RESULTS: TR severity was associated with the HFrEF phenotype with more symptoms (p = 0.004), higher neurohumoral activation (p < 0.001), progressive right-ventricular dilatation (p < 0.001), and impaired function (p < 0.001). Cox regression showed a strong association between quantitative measures of TR with mortality (all p < 0.001). Quantitative metrics of TR severity were consistently associated with mortality with a hazard ratio of 1.009 (95% confidence interval: 1.004 to 1.013; p < 0.001) per 0.01 cm2 increase of the EROA and of 1.013 (95% confidence interval: 1.007 to 1.020; p < 0.001) per 1-ml increase in regurgitant volume. Results remained unchanged after bootstrap- or clinical confounder-based adjustment. A spline curve pattern illustrates the association with mortality with thresholds for the EROA ≥0.2 cm2, and the regurgitant volume ≥20 ml with sustained excess mortality thereafter. CONCLUSIONS: This large-scale outcome study demonstrates the prognostic value of quantitative Doppler-echocardiographic measures of TR severity in HFrEF. The thresholds for EROA and TR regurgitant volume associated with mortality in our study fall within current ranges defining nonsevere TR. This may potentially impact therapeutic decision making, particularly timing of intervention.


Assuntos
Ecocardiografia Doppler , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Idoso , Fármacos Cardiovasculares/uso terapêutico , Causas de Morte , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico , Fatores de Tempo , Valva Tricúspide/efeitos dos fármacos , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/tratamento farmacológico , Insuficiência da Valva Tricúspide/mortalidade , Insuficiência da Valva Tricúspide/fisiopatologia , Função Ventricular Esquerda
5.
Am J Cardiovasc Drugs ; 19(2): 211-218, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30255476

RESUMO

OBJECTIVES: Our objective was to explore the effects of tolvaptan as a new therapeutic approach in patients with right heart failure with tricuspid insufficiency (TI). METHODS: This prospective, multicenter, non-randomized controlled pilot study enrolled patients (N = 40) with TI from the Shanghai Chest Hospital and Shanghai Tongren Hospital who fulfilled inclusion criteria between March 2015 and June 2016. Participants were assigned to receive either tolvaptan combined with torasemide (n = 20) or torasemide monotherapy (n = 20; control group). The primary endpoints were changes in patient weight and in tricuspid annular plane systolic excursion (TAPSE) after 10 days of treatment. The secondary endpoints included net fluid balance and cardiac functions before and after medication from the first to the tenth day of treatment. Safety was evaluated by monitoring adverse and serious adverse events. RESULTS: TAPSE significantly increased in the tolvaptan group compared with the control group after 10 days of medication (P = 0.029). Daily weight losses in the tolvaptan group significantly increased as the time of treatment increased (time × group, P = 0.022). Recovery to New York Heart Association (NYHA) grade I occurred 4 days earlier in the tolvaptan group. In addition, the net fluid balance and median net fluid balance were significantly higher in the tolvaptan group. Eight adverse events and one serious adverse event were recorded in the tolvaptan group and 15 adverse events were recorded in the control group. CONCLUSIONS: Our results indicate that tolvaptan might be a useful and safe drug to improve heart function in patients with right heart failure with TI after left heart valve replacement. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier no. NCT02644616.


Assuntos
Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Tolvaptan/uso terapêutico , Insuficiência da Valva Tricúspide/tratamento farmacológico , Idoso , Antagonistas dos Receptores de Hormônios Antidiuréticos/efeitos adversos , Diuréticos/efeitos adversos , Diuréticos/uso terapêutico , Feminino , Doenças das Valvas Cardíacas/etiologia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Tolvaptan/efeitos adversos , Torasemida/efeitos adversos , Torasemida/uso terapêutico , Resultado do Tratamento , Valva Tricúspide/efeitos dos fármacos , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/fisiopatologia , Equilíbrio Hidroeletrolítico/efeitos dos fármacos
8.
Herz ; 42(7): 634-643, 2017 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-28835976

RESUMO

The vast majority of tricuspid valve regurgitations are of low degree without prognostic relevance in healthy individuals; however, morbidity and mortality increase with the degree of regurgitation, which can be secondary to either primary (structural) or secondary (functional) alterations of the valve. Due to the frequent lack of symptoms, echocardiographic examinations should be annually performed in patients with higher degree (at least moderate) tricuspid valve regurgitation, in particular in the presence of risk factors. Individual therapeutic management strategies should consider the etiology of the tricuspid valve regurgitation, the degree of regurgitation, the valve pathology and the risk-to-benefit ratio of the envisaged therapeutic procedure. Medicinal treatment options for tricuspid valve regurgitation are limited and generalized recommendations cannot be provided due to the lack of conclusive clinical trials. Symptomatic therapeutic measures encompass especially (loop) diuretics for the reduction of preload and afterload of the right ventricle. Pharmaceutical reduction of the heart rate should be avoided in patients with right heart insufficiency. While symptomatic therapeutic measures are often associated with only moderate effects, the most effective therapy of tricuspid valve regurgitation consists in the treatment of underlying illnesses, in most cases pulmonary hypertension due to pulmonary arterial hypertension (PAH), left heart disease or acute pulmonary embolism. Based on a number of published clinical studies and licensing of new drugs, treatment options for patients with PAH and heart failure with reduced ejection fraction (HFrEF) have substantially improved during the past years allowing for a differentiated, individualized management.


Assuntos
Insuficiência Cardíaca/diagnóstico por imagem , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Insuficiência da Valva Tricúspide/tratamento farmacológico , Ecocardiografia , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/tratamento farmacológico , Medicina de Precisão , Prognóstico , Fatores de Risco , Volume Sistólico/efeitos dos fármacos , Insuficiência da Valva Tricúspide/diagnóstico por imagem
9.
J Med Ultrason (2001) ; 43(4): 533-6, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27577563

RESUMO

Pericardiocentesis is performed to treat cardiac tamponade or diagnose the cause of pericardial effusion. Cardiogenic shock with right ventricular (RV) dysfunction is a rare complication after pericardiocentesis. We report a case of an 82-year-old man who suddenly suffered cardiopulmonary arrest 12 h after pericardiocentesis. A transthoracic echocardiogram showed remarkable RV dysfunction and tricuspid valve dysfunction. Tricuspid valve closure was severely impaired, and the tricuspid regurgitation signal showed laminar flow with an early peak. However, after treatment with high-dose inotropic drugs, hemodynamic parameters gradually recovered. A transthoracic echocardiogram performed 24 h later showed improved motion of the RV and the tricuspid valve, resulting in a reduction in tricuspid regurgitation. RV and tricuspid valve dysfunction after pericardiocentesis needs to be recognized as a critical complication. Physicians also need to pay attention to not only the amount of drainage but also underlying RV dysfunction.


Assuntos
Parada Cardíaca/etiologia , Pericardiocentese/efeitos adversos , Insuficiência da Valva Tricúspide/etiologia , Disfunção Ventricular Direita/etiologia , Idoso de 80 Anos ou mais , Dispneia/diagnóstico por imagem , Dispneia/terapia , Ecocardiografia , Parada Cardíaca/diagnóstico por imagem , Parada Cardíaca/tratamento farmacológico , Parada Cardíaca/fisiopatologia , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/terapia , Masculino , Pericardite/diagnóstico por imagem , Pericardite/terapia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/tratamento farmacológico , Insuficiência da Valva Tricúspide/fisiopatologia , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/tratamento farmacológico , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Esquerda
11.
Cardiovasc J Afr ; 26(2): e6-8, 2015 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-25938498

RESUMO

Tricuspid infective endocarditis is rare and represents five to 10% of all cases of infective endocarditis. It occurs predominantly in intravenous drug users, and patients with central venous catheters or intracardiac probes. We report on the case of subacute tricuspid infective endocarditis in a girl of 17 years. She had no particular cardiovascular history. She was admitted for a persistent fever with cachexy, cough and thoracic pains, and right heart failure that appeared one month after a clandestine abortion. Transthoracic echocardiography found several vegetations on the tricuspid valve with massive tricuspid regurgitation. The chest X-ray showed bilateral excavated lung abscesses and condensation areas. Blood culture was not done and broad-spectrum antibiotic therapy was given. She was apyretic after 10 days. However, the massive tricuspid regurgitation with right heart failure persisted. She was discharged from hospital after 40 days of treatment. Although rare, infective endocarditis is one of the more serious complications of gynaecological procedures, particularly clandestine abortion. Therefore any young girl with persistent fever must be suspected of clandestine abortion.


Assuntos
Endocardite/diagnóstico , Insuficiência da Valva Tricúspide/diagnóstico , Valva Tricúspide/patologia , Aborto Induzido/efeitos adversos , Adolescente , Ceftizoxima/administração & dosagem , Ceftizoxima/análogos & derivados , Ciprofloxacino/administração & dosagem , Ecocardiografia , Endocardite/tratamento farmacológico , Endocardite/etiologia , Feminino , Humanos , Metronidazol/administração & dosagem , Radiografia Torácica , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/tratamento farmacológico , Insuficiência da Valva Tricúspide/etiologia
12.
Pediatr Cardiol ; 36(6): 1255-60, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25824807

RESUMO

Sildenafil, a phosphodiesterase-5 inhibitor, is a controversial treatment option for pulmonary arterial hypertension (PAH), a significant complication of bronchopulmonary dysplasia (BPD). The objective of this study was to evaluate the use of sildenafil in infants with PAH secondary to BPD. This was a retrospective review of medical records of all premature infants with PAH associated with BPD treated with sildenafil between January 2009 and May 2013 in a level 3 neonatal intensive care unit. The primary outcomes were clinical response (20 % decreases in respiratory support score or oxygen requirements) and echocardiographic response (20 % decrease in tricuspid regurgitation gradient or change of at least 1° of septal flattening). Twenty-three infants were included in the study. Significant echocardiographic and clinical responses were, respectively, observed in 71 and 35 % of cases. Most clinical responses were observed in the first 48 h of treatment, and the median time to an echocardiographic response was of 19 days. The median dose of sildenafil used was 4.4 mg/kg/day, with a median time to reach the maximum dose of 9 days. Transient hypotension was the primary reported side effect, and it was observed in 44 % of our study population. Sildenafil treatment in patients with PAH secondary to BPD was associated with an echocardiographic improvement in the majority of patients, whereas clinical improvement was observed in a minority of patients. Many infants presented with transient hypotension during the course of the treatment. Further prospective studies are required to better assess safety and efficacy of this treatment in this population.


Assuntos
Displasia Broncopulmonar/complicações , Ecocardiografia , Hipertensão Pulmonar/tratamento farmacológico , Inibidores da Fosfodiesterase 5/uso terapêutico , Citrato de Sildenafila/uso terapêutico , Displasia Broncopulmonar/diagnóstico por imagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Hipotensão/induzido quimicamente , Hipotensão/epidemiologia , Lactente , Recém-Nascido , Terapia Intensiva Neonatal , Masculino , Oxigênio/metabolismo , Taxa Respiratória/efeitos dos fármacos , Estudos Retrospectivos , Citrato de Sildenafila/administração & dosagem , Citrato de Sildenafila/efeitos adversos , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/tratamento farmacológico , Insuficiência da Valva Tricúspide/epidemiologia
14.
Eur Heart J ; 36(10): 623-32, 2015 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-24566799

RESUMO

AIMS: Imatinib mesylate, as add-on therapy in patients with pulmonary arterial hypertension (PAH) who remain inadequately treated despite receiving at least two PAH-specific drugs, improves exercise capacity and haemodynamics. We evaluated whether 24 weeks of add-on therapy with imatinib compared with placebo also improves right ventricular (RV) function assessed by echocardiography. METHODS AND RESULTS: Echocardiograms were obtained at baseline, 12 weeks, and 24 weeks in 74 patients randomized to imatinib or placebo in the Imatinib in Pulmonary arterial hypertension, a Randomized Efficacy Study (IMPRES) trial. Right ventricular function was assessed by tissue Doppler tricuspid annular peak systolic velocity (TA S'), tricuspid annular plane systolic excursion (TAPSE), RV Tei index, and RV fractional area change. Between-treatment-group differences in the changes from baseline to week-24 were assessed using an ANCOVA with the last observation carried forward. At week-24 patients randomized to imatinib demonstrated greater improvements in TA S' (1.6 ± 2.3 imatinib vs. 0.5 ± 2.4 cm/s placebo, P = 0.007) and RV Tei index (-0.11 ± 0.18 imatinib vs. 0.05 ± 0.18 placebo, P = 0.005) compared with placebo, but not in TAPSE (0.07 ± 0.44 imatinib vs. 0.03 ± 0.32 cm placebo, P = 0.08). Imatinib therapy was also associated with significant reduction in peak tricuspid regurgitation velocity, increase in LV size, and improvement in LV early diastolic relaxation velocity. CONCLUSIONS: Among patients with advanced PAH who remain symptomatic on at least two PAH-specific drugs, treatment with imatinib compared with placebo is associated with significant improvements in echocardiographic measures of RV function, in addition to LV size and LV early diastolic relaxation. CLINICAL TRIAL REGISTRATION: NCT00902174 (Clinicaltrials.gov).


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão Pulmonar/tratamento farmacológico , Mesilato de Imatinib/uso terapêutico , Análise de Variância , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Ecocardiografia Doppler , Tolerância ao Exercício/efeitos dos fármacos , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/tratamento farmacológico , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Volume Sistólico/efeitos dos fármacos , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/tratamento farmacológico , Insuficiência da Valva Tricúspide/fisiopatologia , Resistência Vascular/efeitos dos fármacos , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/tratamento farmacológico , Disfunção Ventricular Direita/fisiopatologia
15.
S Afr Med J ; 104(12): 853-5, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26042266

RESUMO

We report three cases of tricuspid valve infective endocarditis associated with intravenous nyoape use. Nyoape is a variable drug combination of an antiretroviral (efavirenz or ritonavir), heroin, metamphetamines and cannabis. Its use is becoming increasingly common among poor communities in South Africa. All our patients were young HIV-positive men from disadvantaged backgrounds. They all presented with tricuspid regurgitation and septic pulmonary emboli. They were treated with prolonged intravenous antibiotic courses, and one required referral for surgery.


Assuntos
Endocardite/etiologia , Infecções por HIV/virologia , Insuficiência da Valva Tricúspide/etiologia , Adulto , Antibacterianos/uso terapêutico , Benzoxazinas/administração & dosagem , Benzoxazinas/efeitos adversos , Cannabis/efeitos adversos , Cannabis/química , Endocardite/tratamento farmacológico , Heroína/administração & dosagem , Heroína/efeitos adversos , Humanos , Masculino , Metanfetamina/administração & dosagem , Metanfetamina/efeitos adversos , Embolia Pulmonar/etiologia , Embolia Pulmonar/patologia , Ritonavir/administração & dosagem , Ritonavir/efeitos adversos , África do Sul , Transtornos Relacionados ao Uso de Substâncias/complicações , Valva Tricúspide/patologia , Insuficiência da Valva Tricúspide/tratamento farmacológico , Adulto Jovem
16.
Ann Cardiol Angeiol (Paris) ; 62(1): 60-3, 2013 Feb.
Artigo em Francês | MEDLINE | ID: mdl-21292235

RESUMO

Pulmonary arteries aneurysms are rare and the rarely described bilateral aneurysms. A 45-year-old patient carrier of mitral stenosis was admitted for dyspnoea class III of the NYHA, chest pain and a not infectious cough. The clinical examination found semiology of mitral stenosis, tricuspid incapacity and pulmonary arterial hypertension. The electrocardiogram showed atrial fibrillation and right ventricle hypertrophy. Chest X-ray found a cardiomegaly, an aspect of double outline of the inferior right bow, a prominent aspect of the left average bow reminding an aneurysm of the left pulmonary artery. The echocardiography Doppler found a pure tight mitral stenosis (mitral surface=0.6 cm(2)), a dilation of the trunk of the pulmonary artery (diameter=74 mm) and of its branches (diameter of the right pulmonary artery=28 mm, diameter of the left pulmonary artery=36 mm) seat of a spontaneous contrast. The left atrium and right cardiac cavities were also dilated. There was an important tricuspid incapacity with a major pulmonary hypertension (systolic pulmonary arterial=109 mmHg). The thoracic angioscan showed a pseudoaneurysm of the trunk of pulmonary artery and its branches to their distal parts. Under diuretic, anticoagulating and analgesic treatment the clinical signs improved however the spontaneous contrast persisted. The patient was rejected by the surgery for exceeded clinical board. She is at present followed in our service for 5 months.


Assuntos
Falso Aneurisma/diagnóstico , Países em Desenvolvimento , Estenose da Valva Mitral/diagnóstico , Artéria Pulmonar , Analgésicos/uso terapêutico , Falso Aneurisma/tratamento farmacológico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Diuréticos/uso terapêutico , Ecocardiografia Doppler , Eletrocardiografia , Feminino , Seguimentos , Acesso aos Serviços de Saúde , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/tratamento farmacológico , Hipertrofia Ventricular Direita/diagnóstico , Hipertrofia Ventricular Direita/tratamento farmacológico , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Estenose da Valva Mitral/tratamento farmacológico , Áreas de Pobreza , Senegal , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/tratamento farmacológico
17.
BMJ Case Rep ; 20122012 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-22922931

RESUMO

A 78-year-old man admitted with complaints of breathlessness of 1 year and typical chest pain of 2 months duration. He had a blunt chest trauma 7 years back. Transthoracic echocardiography revealed severe tricuspid regurgitation due to a flail anterior leaflet of the tricuspid valve. It also revealed global left ventricular dysfunction. Flail tricuspid valve causing severe regurgitation is usually due to mechanical trauma. Since it is well tolerated for years, the diagnosis may be delayed or missed entirely. Echocardiography has allowed easier diagnosis of this condition resulting in earlier and, hence, more effective treatment.


Assuntos
Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia , Valva Tricúspide/lesões , Ferimentos não Penetrantes/complicações , Idoso , Ecocardiografia Doppler em Cores , Humanos , Masculino , Fatores de Tempo , Insuficiência da Valva Tricúspide/tratamento farmacológico
19.
Ann Acad Med Stetin ; 58(1): 33-9; discussion 39, 2012.
Artigo em Polonês | MEDLINE | ID: mdl-23547392

RESUMO

INTRODUCTION: Systemic sclerosis (SSc) is an autoimmune disease characterized by multisystem involvement. Heart involvement occurs in 80-100% of cases and represents one of the more common risk factors of death. Myocardial fibrosis and vascular microangiopathy lead to arrhythmias and impaired contractility with secondary left and right heart failure. Pulmonary arterial hypertension in some patients with systemic sclerosis results in right heart failure and low output syndrome during the end-stage of the disease. The aim of the present study was to analyze four cases of systemic sclerosis with severe cardiovascular complications and a fatal outcome. CASE DESCRIPTIONS: Case 1: A 68-year-old female who probably suffered from limited SSc (lcSSc) and pulmonary arterial hypertension for more than 10 years was unsuccessfully treated with vasodilatators (sildenafil, iloprost). Case 2: A 52-year-old female with a 5-year history of diffuse cutaneous SSc (dcSSc), interstitial lung disease, and pulmonary arterial hypertension underwent aggressive therapy with immunosuppressive and antiproliferative (treprostinil) agents but without effect on the progression of the disease. Case 3: A 50-year-old male with dcSSc and coexistent cardiomyopathy with dominating symptoms of right heart failure was placed on high doses of immunosuppressants (i.v. cyclophosphamide) and had a cardioverter-defibrillator implanted as part of primary prevention. The patient died with symptoms of severe, therapy-resistant, two-sided heart failure. Case 4: A 58-year-old female with a 6-year history of dcSSc, interstitial lung disease, and heart involvement with severe ventricular arrhythmias and significant mitral and tricuspid insufficiency received intensive immunosuppressive therapy (i.v. cyclophosphamide) and underwent arrhythmia ablation. Sudden cardiac arrest in this patient was attributed to arrhythmia due to cardiomyopathy associated with systemic sclerosis. CONCLUSIONS: Lung and heart involvement is the most common reason for poor prognosis in systemic sclerosis. Arrhythmias, usually latent clinically, and right heart failure associated with cardiomyopathy or pulmonary hypertension are the main reasons of cardiac death in SSc patients. Severe and fatal cardiovascular complications occur more often in dcSSc, particularly during the first few years after diagnosis. Early detection of cardiovascular manifestations should be a priority in systemic sclerosis.


Assuntos
Cardiomiopatias/etiologia , Insuficiência Cardíaca/etiologia , Escleroderma Sistêmico/complicações , Idoso , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Cardiomiopatias/terapia , Ciclofosfamida/uso terapêutico , Desfibriladores Implantáveis , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Hipertensão/complicações , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/tratamento farmacológico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Tricúspide/tratamento farmacológico , Insuficiência da Valva Tricúspide/etiologia
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