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1.
Med Ultrason ; 21(3): 279-287, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31476208

RESUMO

AIM: To establish reference range values for peak myocardial tissue Doppler velocity (MTD) and myocardial performance index (MPI) of the left ventricle (LV), the right ventricle (RV), and the interventricular septum (IVS) at 20 to 36+6 weeks of gestation using spectral tissue Doppler. MATERIAL AND METHODS: This cross-sectional study was conducted among 360 lowrisk singleton pregnancies. MTD during systole (S'), and early (E') and late diastole (A'), and MPI' were assessed by placing sample volume at the basal segment of the LV free wall, the RV free wall, and the IVS, respectively. Polynomial regression was used to obtain the best-fit curves for MTD and MPI' measurements as a function of gestational age (GA), and adjustments were made using the determination coefficient (R2). Intra- and inter-observer reproducibility was evaluated using the concordance correlation coefficient (CCC). RESULTS: All MTD velocities (cm/s) progressively increased with advancing GA (p<0.0001). Mean LV MTD values were 4.19 to 6.86 for S', 3.52 to 7.22 for E', and 6.85 to 9.19 for A'; mean RV MTD were 4.85 to 7.97 for S', 4.49 to 8.66 for E', and 8.44 to 11.20 for A'; and mean IVS MTD values were 3.75 to 5.78 for S', 3.34 to 5.79 for E', and 5.88 to 7.98 for A'. LV MPI', RV MPI', and IVS MPI' did not significantly change with advancing GA. The CCC values for MTD were predominantly greater than 0.70, while those for MPI' were <0.70. CONCLUSIONS: Reference values for the fetal MTD and MPI' of RV, LV and IVS using tissue Doppler between 20 and 36+6 weeks of gestation were described.


Assuntos
Ecocardiografia Doppler/métodos , Coração Fetal/fisiologia , Septos Cardíacos/fisiologia , Ultrassonografia Pré-Natal/métodos , Função Ventricular/fisiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Coração Fetal/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Ventrículos do Coração , Humanos , Variações Dependentes do Observador , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
2.
BMJ Case Rep ; 12(6)2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31248896

RESUMO

Atrial septal aneurysms have two mechanisms for cardioembolic events. One is the aneurysm itself can act as a nidus for thrombus formation in the left atrium. The aneurysm creates an area of low turbulence leading to haemostasis allowing fibrin-platelet adhesions to form. If the clot is on the left atrial wall, it may be dislodged by oscillations of the septum and travel into the systemic circulation. The second mechanism is via, an often comorbid, interatrial shunt such as a Patent Foramen Ovale or Atrial Septal Defect. We report a unique case where the associated right to left shunt leading to the cryptogenic stroke is a pulmonary arteriovenous malformation.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Evolução Fatal , Feminino , Septos Cardíacos/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Veias Pulmonares/diagnóstico por imagem
3.
Med Ultrason ; 21(2): 183-190, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31063523

RESUMO

The key to a successful catheterization of the left heart chambers is the safe transseptal puncture. Intracardiac echocardiography (ICE) is an attractive tool used in cardiac catheterization and electrophysiology labs to provide detailed images thatcan facilitate transseptal puncture. ICE permits a direct visualization of the endocardium and precisely locates the needle and the sheath against the interatrial septum. Two different ICE catheters are available: a phased array and a mechanical transducer, both being currently used in clinical practice. This paper describes the technique used for guiding transseptal puncture with ICE. Due to its advantages, ICE has currently become an important tool used to maximize the safety of the transseptal puncture and increase efficacy of interventional cardiology procedures.


Assuntos
Cateterismo Cardíaco/métodos , Eletrofisiologia Cardíaca/métodos , Ecocardiografia/métodos , Septos Cardíacos/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Humanos
4.
J Invasive Cardiol ; 31(8): 223-228, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30982777

RESUMO

BACKGROUND: Transcatheter closure of mitral paravalvular leaks (PVLs) can be a lengthy and cumbersome procedure that may not guarantee satisfying results. We used steerable sheaths in order to perform these procedures in a faster and more controllable manner. METHODS: FlexCath and Occlutech steerable sheaths were used. After transseptal puncture, the sheath was introduced into the left atrium and positioned co-axially above the PVL channel. A 5 Fr Judkins catheter was used to cross the PVL channel. A distance wire was placed in most cases through the sheath in the left atrium. A delivery set with a closure device was introduced. The device was positioned under echocardiographic and fluoroscopic guidance and deployed. Technical success rate (TSR) and implantation time (IT) were compared with a control group of mitral PVLs closed without a steerable sheath. RESULTS: TSR was higher for the steerable sheath group (93.5% vs 72.7%; P<.05). There were no adverse events during index hospitalization. Median IT was shorter for cases performed with steerable sheaths vs cases performed without a steerable sheath (28.5 min [range, 15-58 min] vs 64 min [range, 35-180 min], respectively; P<.05). CONCLUSIONS: Steerable sheaths are safe and effective devices that support mitral PVL closure, particularly in cases with challenging PVL locations.


Assuntos
Cateterismo Cardíaco/métodos , Septos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Sistema de Registros , Dispositivo para Oclusão Septal , Idoso , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Septos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico , Estudos Prospectivos , Falha de Prótese , Resultado do Tratamento
5.
Heart Vessels ; 34(10): 1703-1709, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30953137

RESUMO

Cavo-tricuspid isthmus (CTI) anatomies are highly variable, and specific anatomies lead to a difficult CTI ablation. This study aimed to compare the clinical utility of angiography and intracardiac echocardiography (ICE) in evaluating CTI anatomies, and to investigate the impact of the CTI anatomy on the procedure when the ablation tactic was adjusted to the anatomy. This study included 92 consecutive patients who underwent a CTI ablation. The CTI morphology was assessed with both right atrial angiography and ICE before the ablation, and the ablation tactic was adjusted to the anatomy. The mean CTI length was 34 ± 9 mm. On ICE imaging, 21 (23%) patients had a flat CTI, while 41 (45%) had a concave CTI with a mean depth of 5.6 ± 2.7 mm. The remaining 30 (32%) had a distinct pouch with a mean depth of 6.4 ± 2.3 mm, located at the posterior, middle, and anterior isthmus in 15, 14, and 1 patients, respectively. The Eustachian ridge (ER) was visualized in 46 (50%) patients. On angiography, a pouch and ER were detected in 22 and 15 patients, but not in the remaining 8 and 31, respectively. A complete CTI block line was created in all patients without any complications. The CTI anatomy did not significantly impact any procedural parameters. ICE was superior to angiography in evaluating the detailed CTI anatomy, especially pouches and the ER. An adjustment of the ablation tactic to the anatomy could overcome the procedural difficulties of the CTI ablation in cases with specific anatomies.


Assuntos
Angiografia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Ecocardiografia , Sistema de Condução Cardíaco/anatomia & histologia , Sistema de Condução Cardíaco/diagnóstico por imagem , Idoso , Artérias/anatomia & histologia , Artérias/diagnóstico por imagem , Artérias/patologia , Feminino , Átrios do Coração/anatomia & histologia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Sistema de Condução Cardíaco/patologia , Septos Cardíacos/anatomia & histologia , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/patologia , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Cuidados Intraoperatórios , Japão , Masculino , Pessoa de Meia-Idade , Pericárdio/fisiopatologia , Resultado do Tratamento , Valva Tricúspide/anatomia & histologia , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/patologia
6.
J Med Case Rep ; 13(1): 75, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30894202

RESUMO

BACKGROUND: Hypertrophic cardiomyopathy is one of the most common causes of sudden cardiac death in young athletes. Performing, comparing, and monitoring serial electrocardiograms over time can help to detect potential cardiovascular diseases and to prevent malignant cardiac events in these populations. CASE PRESENTATION: A young Han Chinese male football player had abnormal electrocardiograms for 8 years without any subjective discomfort. Electrocardiograms revealed that T-wave inversions increased from 1 mm to a maximum of 5 mm on lead I and fluctuated around 5 mm on lead avL. Q-wave duration ranged from 40 ms to 60 ms, its depth increased to a maximum of 8 mm and was much greater than 40% of the R waves in depth in II, III, and avF leads. Echocardiography showed increasingly thickened interventricular septum from 10 mm to 13 mm, enlarged left atrium and ventricle, and reduced left ventricular ejection fraction. Coronary angiography showed no distinct stenosis. Emission computed tomography revealed mild myocardial ischemia of the left ventricular inferior wall. These unusual electrocardiogram manifestations were initially regarded as benign alterations of a highly trained athlete. Upon reviewing the clinical information and the newest criteria for electrocardiographic interpretation in athletes, hypertrophic cardiomyopathy was identified. The misreading of electrocardiograms is not uncommon, thus predisposing such patients to high susceptibility to exercise-induced sudden cardiac death. CONCLUSIONS: We propose that abnormal electrocardiogram findings reveal the initial expression of underlying cardiac diseases such as hypertrophic cardiomyopathy, preceding the symptoms and signs by many years. Accordingly, early detection and continuous surveillance are important for athletes with such electrocardiogram patterns, and improvement of physicians' expertise is crucial.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico , Adulto , Atletas , Ecocardiografia , Eletrocardiografia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/patologia , Humanos , Masculino , Cooperação do Paciente , Função Ventricular Esquerda
7.
J Invasive Cardiol ; 31(3): E47-E48, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30819978

RESUMO

The uptake of CTO-PCI and the use of the hybrid approach have increased widely; this has resulted in a new set of complications, some of which are unusual, particularly with the retrograde approach. We present a case of a rare complication of septal collateral perforation resulting in the formation of septal hematoma that fortunately on this occasion did not result in any significant clinical deterioration, and was managed conservatively with a successful outcome. However, on other occasions, the outcome can be more serious.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/terapia , Septos Cardíacos/lesões , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Adulto , Angioplastia Coronária com Balão/métodos , Angiografia Coronária/métodos , Ecocardiografia , Eletrocardiografia/métodos , Seguimentos , Septos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Doenças Raras , Remissão Espontânea , Medição de Risco , Índice de Gravidade de Doença
8.
Circulation ; 139(16): 1876-1888, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30704273

RESUMO

BACKGROUND: Septal activation in patients with left bundle-branch block (LBBB) patterns has not been described previously. We performed detailed intracardiac mapping of left septal conduction to assess for the presence and level of complete conduction block (CCB) in the His-Purkinje system. Response to His bundle pacing was assessed in patients with and without CCB in the left bundle. METHODS: Left septal mapping was performed with a linear multielectrode catheter in consecutive patients with LBBB pattern referred for device implantation (n=38) or substrate mapping (n=47). QRS width, His duration, His-ventricular (HV) intervals, and septal conduction patterns were analyzed. The site of CCB was localized to the level of the left-sided His fibers (left intrahisian) or left bundle branch. Patients with ventricular activation preceded by Purkinje potentials were categorized as having intact Purkinje activation. RESULTS: A total of 88 left septal conduction recordings were analyzed in 85 patients: 72 LBBB block pattern and 16 controls (narrow QRS, n=11; right bundle-branch block, n=5). Among patients with LBB block pattern, CCB within the proximal left conduction system was observed in 64% (n=46) and intact Purkinje activation in the remaining 36% (n=26). Intact Purkinje activation was observed in all controls. The site of block in patients with CCB was at the level of the left His bundle in 72% and in the proximal left bundle branch in 28%. His bundle pacing corrected wide QRS in 54% of all patients with LBBB pattern and 85% of those with CCB (94% left intrahisian, 62% proximal left bundle-branch). No patients with intact Purkinje activation demonstrated correction of QRS with His bundle pacing. CCB showed better predictive value (positive predictive value 85%, negative predictive value 100%, sensitivity 100%) than surface ECG criteria for correction with His bundle pacing. CONCLUSIONS: Heterogeneous septal conduction was observed in patients with surface LBBB pattern, ranging from no discrete block to CCB. When block was present, we observed pathology localized within the left-sided His fibers (left intrahisian block), which was most amenable to corrective His bundle pacing by recruitment of latent Purkinje fibers. ECG criteria for LBBB incompletely predicted CCB, and intracardiac data might be useful in refining patient selection for resynchronization therapy.


Assuntos
Fascículo Atrioventricular/fisiologia , Bloqueio de Ramo/diagnóstico , Técnicas de Imagem Cardíaca/métodos , Eletrocardiografia/métodos , Septos Cardíacos/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico , Ramos Subendocárdicos/fisiologia , Idoso , Fascículo Atrioventricular/diagnóstico por imagem , Cateteres Cardíacos , Terapia de Ressincronização Cardíaca , Estudos de Coortes , Feminino , Frequência Cardíaca , Septos Cardíacos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Prognóstico
9.
Cardiovasc Interv Ther ; 34(4): 364-372, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30725361

RESUMO

Preprocedural computed tomography (CT) imaging appears to provide an advantage in localization of the appropriate septal branch targeted for alcohol septal ablation (ASA). The objective of this study was to compare the clinical backgrounds, procedural characteristics, and outcomes of patients who underwent ASA with preprocedural CT assessment against those without CT assessment. Thirty consecutive patients with obstructive hypertrophic cardiomyopathy who underwent ASA were retrospectively included. Patients who underwent preprocedural CT (CT-guided ASA group, n = 11) were compared with patients who underwent ASA without CT (traditional ASA group, n = 19). The CT-guided ASA group had a significantly lower number of approached target vessels (1 [interquartile range {IQR}, 1-2] vs. 2 [IQR, 2-3], P = 0.036) and non-ablated target vessels (0 [IQR, 0-1] vs. 1 [IQR, 0-2], P = 0.031) than the traditional ASA group. There were no differences between the two groups in total fluoroscopy time, the amount of delivered radiation dose, and the volume of contrast medium used during the procedures. There were also no differences between the two groups in procedural success rate and improvement of left ventricular outflow tract gradient and New York Heart Association functional class at 1 month follow-up. CT had a significant impact on the ASA procedure diminishing the number of target vessels, and could be a reliable assessment modality to build its procedural strategy.


Assuntos
Técnicas de Ablação/métodos , Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/cirurgia , Tomografia Computadorizada Multidetectores , Idoso , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Etanol , Feminino , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Estudos Retrospectivos
10.
Echocardiography ; 36(4): 809-812, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30801807

RESUMO

Transthoracic echocardiography is the principal imaging modality for assessment of patients with atrioventricular septal defects. Three-dimensional echocardiography streamlines and simplifies data acquisition offering a unique realistic en-face display of heart valves and septal defects and enables accurate evaluation of the cardiac anatomy, dynamic, and function. We demonstrated an added value of three-dimensional echocardiography in assessment of an adult patient with atrioventricular septal defect and its advantages over conventional echocardiography.


Assuntos
Ecocardiografia Tridimensional/métodos , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Adulto , Septos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Reprodutibilidade dos Testes
11.
Semin Thorac Cardiovasc Surg ; 31(3): 424-431, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641129

RESUMO

Surgical septal myectomy is a standard treatment option for patients with hypertrophic obstructive cardiomyopathy. Subvalvular abnormalities of the mitral valve might play an important role in residual left ventricular outflow tract obstruction. This randomized study aimed to compare the surgical outcomes of septal myectomy with vs without subvalvular interventions. Between July 2015 and December 2016, 80 eligible patients were randomly assigned to undergo septal myectomy with vs without subvalvular intervention. The peak gradient was 92.3 ± 16.9 and 88.1 ± 15.4 mm Hg, respectively (P = 0.281). The mean septum thickness was 26.8 ± 4.5 and 26.1 ± 4.2 mm, respectively (P = 0.504). Moderate or severe systolic anterior motion syndrome-mediated mitral regurgitation was observed in all patients. There was no residual mitral regurgitation in the group with subvalvular intervention, while 15% of patients in the control group had regurgitation (P = 0.013). Residual systolic anterior motion syndrome was observed in 5% and 27.5% of patients, respectively (P = 0.007). The median postoperative gradient was 13 (interquartile range 9-16) mm Hg and 8 (interquartile range 4-12) mm Hg, respectively (P = 0. 0.019). At the 12-month follow-up, all patients were alive. There were 87.5% vs 77.5%, and 12.5% vs 22.5% of patients categorized as having New York Heart Association functional classes I and II, respectively (P = 0.378). The prevalence rate of residual mitral regurgitation was 10% and 32.5%, respectively (P = 0.010). Concomitant subvalvular intervention during septal myectomy more effectively eliminates left ventricular outflow tract obstruction, providing better freedom from residual mitral regurgitation without clinical benefit 1 year after surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Feminino , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Federação Russa , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/fisiopatologia
12.
Cardiol Young ; 29(3): 454, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30688192

RESUMO

A shorter umbilical venous approach provides an opportunity for balloon atrial septostomy in the younger neonate as opposed to those who present at the end of first week of life. However, the ideal choice of access for a bedside balloon atrial septostomy is not well established. Wouldn't prostaglandin infusion be a safer option for transport of babies with dextro-transposition in the neonatal period, when the arterial duct can be kept open? A prenatal diagnosis of dextro-transposition facilitates monitoring and planning of septostomy in the early neonatal period explaining why babies underwent bedside procedures more often.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Septos Cardíacos/cirurgia , Unidades de Terapia Intensiva Neonatal , Transposição dos Grandes Vasos/cirurgia , Ecocardiografia , Septos Cardíacos/diagnóstico por imagem , Humanos , Recém-Nascido , Transposição dos Grandes Vasos/diagnóstico
13.
Mayo Clin Proc ; 94(1): 66-73, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30611455

RESUMO

OBJECTIVES: To assess the frequency and implications of mitral valve (MV) surgery at the time of septal myectomy (SM) for hypertrophic cardiomyopathy (HCM) in a national cohort. PATIENTS AND METHODS: The National Inpatient Sample (NIS) was used to analyze surgical outcomes in patients with HCM undergoing SM from January 1, 2003, through December 31, 2014. Univariate analyses were used to compare patients undergoing SM with vs without concomitant procedures, and logistic regression was used to determine factors associated with prolonged length of stay (LOS) and in-hospital mortality. Numeric values of 10 or less were not reported per NIS data use agreements. RESULTS: The national cohort included 1174 adults with a primary diagnosis of HCM undergoing SM. Overall mean ± SD age was 54.4±14.5 years, and 45% of patients (n=529) were male. Isolated SM was performed in 67% (n=786), and the remainder had concomitant cardiac procedures, most frequently MV repair/replacement (22%, n=257). Median LOS was increased in those with concomitant MV surgery, 7 days, compared with isolated SM, 6 days (P<.001). Overall hospital mortality was 2.9% (n=34) and was lowest in those undergoing isolated SM (<1%; P<.001). In otherwise isolated SM, MV replacement increased likelihood of in-hospital death (odds ratio, 12.0; 95% CI, 3.9-36.5; P<.001) on a univariate basis. CONCLUSION: Intervention on the MV is more common nationally than in specialized centers, and the addition of MV replacement and other concomitant cardiac procedures was associated with increased rates of hospital mortality and LOS compared with patients undergoing isolated SM. These results suggest that concomitant MV intervention is associated with increased risk.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adolescente , Adulto , Idoso , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Septos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
16.
ESC Heart Fail ; 6(1): 122-130, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30284755

RESUMO

AIMS: Mutant transthyretin (ATTRm) amyloidosis is a systemic disease caused by the deposition of amyloid fibrils derived from mutated transthyretin. Although cardiac involvement impacts the prognosis of patients with ATTRm amyloidosis, the incidence of cardiac events, such as bradyarrhythmia, ventricular tachycardia, and heart failure, has not been fully elucidated. The aim of this study was to evaluate the prognosis and predictors of clinical outcomes, including cardiac events, in patients with ATTRm amyloidosis in Japan. METHODS AND RESULTS: We evaluated 90 consecutive patients with ATTRm amyloidosis at Kumamoto University. ATTRm amyloidosis was diagnosed by the observation of both amyloid fibril deposition on tissue biopsy and a transthyretin mutation on sequential analysis. Sympathetic nerve activity was evaluated in 59 patients using 123-iodine metaiodobenzylguanidine (123 I-MIBG) imaging. The endpoint was a composite of all-cause death, hospitalization for heart failure, and implantation of a pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization therapy defibrillator. Sixty-seven patients had the Val30Met mutation (74%). The composite endpoint occurred in 23 patients (26%): all-cause death (n = 6), hospitalization for worsening heart failure (n = 1), and implantation of an implantable cardioverter defibrillator (n = 6), cardiac resynchronization therapy defibrillator (n = 3), or pacemaker (n = 7). The 5-year incident rate for clinical outcomes was 19%. In a multivariate Cox hazard analysis, age [hazard ratio (HR): 1.07, 95% confidence interval (95% CI): 1.01-1.12, P = 0.015], PQ interval (HR: 1.01, 95% CI: 1.00-1.02, P = 0.042), interventricular septum thickness in diastole (HR: 1.25, 95% CI: 1.09-1.42, P = 0.001), and non-Val30Met mutation (HR: 4.31, 95% CI: 1.53-12.16, P = 0.006) were independent predictive factors of clinical outcomes. Kaplan-Meier analysis demonstrated a significantly higher probability of the composite endpoint in the non-Val30Met group than in the Val30Met group (log-rank test: P = 0.002) and in patients with left ventricular hypertrophy than in patients without left ventricular hypertrophy (log-rank test: P < 0.001). In patients who underwent 123 I-MIBG imaging, a delayed heart-to-mediastinum (HM) ratio <1.6 was a significant predictive factor of the composite endpoint (HR: 4.98, 95% CI: 1.73-14.37, P = 0.003) in the univariate Cox hazard analyses. Kaplan-Meier curve analysis showed that a delayed HM ratio <1.6 was associated with a poor prognosis (log-rank test: P = 0.001). CONCLUSIONS: Non-Val30Met mutation, septal hypertrophy, and a delayed HM ratio are useful predictors of clinical outcomes in patients with ATTRm amyloidosis in Japan. These results suggest that it is important to evaluate cardiac involvement in terms of morphological (left ventricular hypertrophy) and functional (cardiac denervation) perspectives using echocardiography and 123 I-MIBG imaging, respectively.


Assuntos
Neuropatias Amiloides Familiares/genética , Cardiomiopatia Hipertrófica/genética , DNA/genética , Septos Cardíacos/diagnóstico por imagem , Mutação , Pré-Albumina/genética , Simpatectomia/métodos , Idoso , Neuropatias Amiloides Familiares/terapia , Terapia de Ressincronização Cardíaca/métodos , Cardiomiopatia Hipertrófica/etiologia , Cardiomiopatia Hipertrófica/terapia , Análise Mutacional de DNA , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pré-Albumina/metabolismo , Estudos Retrospectivos
17.
Clin Exp Hypertens ; 41(7): 607-614, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30285504

RESUMO

Background: To the best our knowledge there is no data in the literature related to changes in renal resistive index (RRI) values in children who have hypertension (HT). In this study, we aimed to investigate the changes of RRI values and it is usability in children with HT. Methods: A total of 75 children; 48 with newly diagnosed HT and 27 healthy controls were included in the study. Routine history, physical examination, and laboratory examinations were performed. Left ventricular (LV) dimensions and systolic-diastolic functions, septum and posterior wall thickness (IVSd and PWd) and LV mass index (LVMI) were calculated by echocardiography. In addition to routine renal ultrasonography (US), renal pulsatility indexes (RPI), accelerated time and RRI were measured. Increased RRI was accepted as >0.70. Results: Increased RRI was detected in 25 (52%) of HT patients. Systolic and diastolic blood pressure (SBP and DBP), and pulse pressure (PP), low-density lipoprotein cholesterol and triglyceride levels, RRI, RPI, kidney length, IVSd, PWd, and LVMI were significantly higher in patients with HT (both p < 0.05). SBP and PP, PWd, LV ejection fraction, LV fractional shortening, and LVMI were positively correlated with the RRI. High-density lipoprotein cholesterol was negatively correlated with the RRI. Of these measurements, RRI values were found to be independently associated with PP and LVMI (p < 0.05). Conclusions: In hypertensive children, RRI was significantly higher than healthy controls and it is also related with LVMI and PP.


Assuntos
Pressão Sanguínea , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Artéria Renal/fisiopatologia , Resistência Vascular , Adolescente , Criança , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Diástole , Ecocardiografia , Feminino , Septos Cardíacos/diagnóstico por imagem , Humanos , Hipertensão/sangue , Rim/diagnóstico por imagem , Masculino , Sístole , Triglicerídeos/sangue , Ultrassonografia Doppler em Cores
20.
Heart Lung Circ ; 28(3): 477-485, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29602755

RESUMO

BACKGROUND: To assess the role of the mitral valve apparatus (leaflets, chordae and papillary muscles, (PM)) in left ventricle outflow tract (LVOT) obstruction, and results of the surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM). METHODS: Twenty-eight consecutive patients (58±11years, 53% female) undergoing HOCM surgery from 2007 to 2016 at our institute were retrospectively reviewed. Endpoints included the involvement of the mitral valve in LVOT obstruction, mortality, and changes in clinical and echocardiographic characteristics after HOCM surgery. RESULTS: Secondary chordae tendineae tractioning the anterior mitral leaflet to the interventricular septum, and systolic anterior motion were detected in 78% of the patients. Anomalous, hypertrophied, and fused PM with muscularis trabeculae hypertrophy were found in 50%, 25%, and 35% of the patients, respectively. Four patients had posterior leaflet redundancy. Secondary chordae (92%), PM, and muscularis trabeculae resection (71%), and PM splitting and elongation (28%) were added variably to septal myectomy (100%). Nine procedures (32%) on mitral valve leaflets were performed, involving six posterior and three anterior mitral leaflets. Long-term follow-up was 4±2.8years. There was no hospital mortality, and NYHA was reduced from 3±0.5 to 1±0.7 (p<0.0001), the LVOT gradient from 88±35 to 20±18mmHg (p<0.0001), mitral valve regurgitation from grade 3±1 to 1±0.7 (p<0.0001), and septum thickness from 18±3 to 14±2mm (p<0.0001). CONCLUSIONS: The mitral valve apparatus contributes with all its components variably to LVOT dynamic obstruction thus surgical correction in addition to extended myectomy is recommended to achieve the best outcome.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/diagnóstico , Septos Cardíacos/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Músculos Papilares/diagnóstico por imagem , Adulto , Idoso , Cardiomiopatia Hipertrófica/cirurgia , Ecocardiografia , Feminino , Septos Cardíacos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Músculos Papilares/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
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