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1.
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
5.
BMJ Case Rep ; 20162016 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-27389729

RESUMO

Trans-septal puncture is associated with risks of serious complications. We report a case of an obese 52-year-old man with hypertrophic cardiomyopathy who underwent preoperative coronary angiography and cardiac catheterisation complicated by left atrial perforation. We describe a direct transatrial pericardiocentesis approach to treating cardiac tamponade.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Cardiomiopatia Hipertrófica/complicações , Septos Cardíacos/lesões , Pericardiocentese/métodos , Tamponamento Cardíaco/diagnóstico por imagem , Ecocardiografia Transesofagiana , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/lesões , Septos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Punções
7.
Clin Exp Pharmacol Physiol ; 43(1): 75-80, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26473435

RESUMO

Alcohol septal ablation (ASA) has been used widely to treat patients with hypertrophic obstructive cardiomyopathy (HOCM). During the routine ASA procedure, it is difficult to detect the septal injury in real-time. The aim of the present study is to assess myocardial injury during ASA by recording intracoronary electrocardiogram (IC-ECG). From 2012 to 2015, 31 HOCM patients were treated with ASA, and IC-ECG was recorded in 21 patients successfully before and after ethanol injection. The elevation of ST-segment on IC-ECG after ethanol injection was expressed as its ratio to the level before injection or the absolute increasing value. Blood samples were collected before and after ASA for measuring changes in cardiac biomarkers. The ratio value of ST-segment elevation was positively correlated with both the amount of ethanol injected (r = 0.645, P = 0.001) and the myocardial injury size (creatine kinase-MB area under the curve (AUC) of CK-MB) (r = 0.466, P = 0.017). The absolute increment of ST-segment was also positively associated with both the amount of ethanol (r = 0.665, P = 0.001) and AUC of CK-MB (0.685, P = 0.001). However, there was no statistical correlation between the reduction of left ventricular outflow tract gradient and ST-segment elevation. Additionally no severe ASA procedure-related complications were observed in our patients. In conclusion, myocardial injury induced by ethanol injection can be assessed immediately by ST-segment elevation on IC-ECG. This study is the first to show that IC-ECG is a useful method for predicting myocardial injury during ASA in real-time.


Assuntos
Técnicas de Ablação/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Cardiomiopatia Hipertrófica/terapia , Eletrocardiografia , Etanol/efeitos adversos , Septos Cardíacos/lesões , Idoso , Cardiomiopatia Hipertrófica/diagnóstico , Etanol/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Catheter Cardiovasc Interv ; 86(7): 1264-70, 2015 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-26033272

RESUMO

OBJECTIVES: To determine event-free survival after transcatheter closure of ventricular septal defect (VSD), and to identify predictors of adverse events (AE) in post myocardial infarction VSD (post-MI VSD) subgroup. BACKGROUND: There are limited data on mid-term follow-up after transcatheter VSD closure. METHODS: Retrospective review of 27 cases of transcatheter VSD closure (post-MI = 18 and non-ischemic = 9) performed from 1999 to 2013. We defined AE as death, device embolization, hemolysis requiring blood transfusion, heart block and reintervention. RESULTS: In the post-MI VSD subgroup, mean age and follow-up was 69 ± 11 and 7.3 ± 7 years, respectively. AE occurred in 8 (44%) patients (death-3, device embolization-1, hemolysis-1, surgical VSD closure-2, reintervention-1). Event-free survival was 56% at 1 month and 5 years, and all AE occurred in the periprocedural period. Cardiogenic shock (HR: 3.21, CI: 1.82-5.41, P = 0.002), and VSD closure in acute phase (HR: 2.14, CI: 1.12-4.31, P = 0.004) were independent predictors of AE. In the non-ischemic VSD subgroup, mean age and follow-up was 49 ± 15 and 8.7 ± 8 years, respectively. AE occurred in 3 (33%) patients (late death-1, surgical VSD closure-2). For the entire cohort, freedom from death was 89% and 85% at 1 month and 5 years, and event-free survival was 70% and 61% at 1 month and 5 years. CONCLUSIONS: Transcatheter closure of post-MI VSD carries a moderate risk of periprocedural complications but low event rates afterwards. By comparison, device closure of non-ischemic VSD has lower periprocedural morbidity but some patients continued to experience AE during follow-up.


Assuntos
Cateterismo Cardíaco , Septos Cardíacos/lesões , Doença Iatrogênica , Infarto do Miocárdio/complicações , Complicações Pós-Operatórias/terapia , Ruptura do Septo Ventricular/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Intervalo Livre de Doença , Feminino , Septos Cardíacos/diagnóstico por imagem , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Minnesota , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Modelos de Riscos Proporcionais , Radiografia , Estudos Retrospectivos , Fatores de Risco , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/mortalidade , Ruptura do Septo Ventricular/terapia
13.
Rev. chil. cardiol ; 33(3): 228-233, dic. 2014. ilus
Artigo em Espanhol | LILACS | ID: lil-743827

RESUMO

Introducción: El balón intraaórtico de contrapulsación (BIAC) puede utilizarse como soporte circulatorio en pacientes cuyo tratamiento definitivo no está en el hospital de ingreso y es necesario hacer un traslado pensando en el mejor resultado final para el paciente. No existen reportes nacionales de este tipo de traslado Presentación del caso: Paciente mujer de 62 años con múltiples antecedentes mórbidos fue trasladada desde Tocopilla al Hospital Regional de Antofagasta (HRA), consultando por cuadro de disnea progresiva y dolor en hemiabdomen superior de 72 horas de evolución. Se planteó un síndrome coronario agudo y se solicitó co-ronariografía que reveló una estenosis de la arteria descendente anterior en su 1/3 medio en un 80%. Se realizó una angioplastía con Stent DES. Al llegar a UCI destaca soplo pansistólico en foco mitral solicitándose ecocar-diograma Doppler Color que mostró una comunicación interventricular (CIV) (Figura 1). Se instaló un balón de contrapulsación intra aórtico (Figura 2) y se planificó el traslado aéreo al Hospital Gustavo Fricke (HGF) que se efectuó sin incidentes (Figura 3). Tres días después se cerró la CIV manteniendo el balón de contrapulsación intra aórtico. Un ecocardiograma de control mostró una CIV residual de 0,7 mm y la evolución clínica posterior fue satisfactoria. Al 13er día post operación se constató una infección de la herida operatoria. Se trató con an-tibióticoterapia y aseo quirúrgico en 4 oportunidades, evolucionando satisfactoriamente. Se trasladó de regreso al Hospital de Antofagasta sin complicaciones y finalmente se dio de alta.


Introduction: Intra-aortic balloon counterpulsation (IABC) has been used for many years. IABC serves as circulatory support in patients where definitive care is not in the admission hospital. There are not reports of air transport with IABC in our national reality. Case report: A 62 year old patient with multiple morbid history was derived from Tocopilla to Antofagasta's Regional Hospital (ARH), she consulted for progressive dyspnea and abdominal pain 72 hours ago. We diagnosed acute coronary syndrome and the coronariography informs coronary stenosis of the anterior descending artery in the middle third about 80%. Angioplasty with stent is performed. The patient arrived to UCI, in the physical examination stands mitral pansystolic murmur. Color doppler echocardiography was requested: highlight interventricular comunication (IVC). Counterpulsation balloon is positioned and we planned the air transport to Gustavo Fricke Hospital (HGF). Transfer HRA-HGF was performed uneventfully with stable patient. 3 days after, IVC is closed and maintains IABC. Control echocardiography reports 0.7 mm residual IVC with satisfactory clinical course. At the 13th post-surgical day, the wound becomes infected and she is treated with antibiotic therapy and surgical toilet in 4 opportunities to evolve successfully. The HGF-HRA transfer is done without complications, his recuperation is satisfactory and she is discharged from the ARH. Discussion: There is evidence that the air tranfers with BIAC are safe, always considering factors such as the expansion of gases and electronic failures.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Resgate Aéreo , Balão Intra-Aórtico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/terapia , Transporte de Pacientes/métodos , Constrição Patológica/etiologia , Serviços Médicos de Emergência , Infarto do Miocárdio/complicações , Septos Cardíacos/lesões , Transferência de Pacientes/métodos
15.
J Heart Valve Dis ; 23(2): 216-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25076553

RESUMO

Transcatheter aortic valve implantation (TAVI) is sometimes associated with severe complications due to the unpredictability of such closed-chest procedures. Reported complications include atrioventricular blocks, vascular complications, aortic root rupture, aorto-right ventricular fistulas, and aortic dissections. Herein is presented the case of an 88-year-old female with a late atrioventricular septal defect that developed after TAVI.


Assuntos
Estenose da Valva Aórtica/terapia , Valva Aórtica/patologia , Valvuloplastia com Balão/efeitos adversos , Calcinose/terapia , Cateterismo Cardíaco/efeitos adversos , Traumatismos Cardíacos/etiologia , Septos Cardíacos/lesões , Implante de Prótese de Valva Cardíaca/efeitos adversos , Doença Iatrogênica , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/diagnóstico , Calcinose/diagnóstico , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Evolução Fatal , Feminino , Traumatismos Cardíacos/diagnóstico , Septos Cardíacos/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Fatores de Tempo , Tomografia Computadorizada por Raios X
16.
Ann Saudi Med ; 34(2): 171-4, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24894788

RESUMO

Ventricular septal defect (VSD) is a life-threatening complication of transmural myocardial infarction. Urgent surgical repair and concomitant revascularization are the standard of care. Percutaneous catheter-based closure techniques have been reserved for patients with a high-risk surgery or a failed surgical procedure with residual shunting. This case report demonstrates the successful transcatheter closure of residual VSD using the Amplatzer muscular VSD device (Amplatzer, Minnesota, USA) after surgical patch dehiscence for postinfarction VSD and 3-and-a-half years' post-intervention follow-up.


Assuntos
Cateterismo Cardíaco/métodos , Ruptura Cardíaca Pós-Infarto/cirurgia , Septos Cardíacos/lesões , Infarto Miocárdico de Parede Inferior/complicações , Infarto do Miocárdio/complicações , Deiscência da Ferida Operatória/cirurgia , Feminino , Ruptura Cardíaca Pós-Infarto/etiologia , Humanos , Pessoa de Meia-Idade , Dispositivo para Oclusão Septal , Resultado do Tratamento
17.
J Card Surg ; 29(4): 478-81, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24861676

RESUMO

Transcatheter aortic valve implantation (TAVI) is associated with various complications, usually related to valve positioning or prosthesis delivery. We report the rare complication of an iatrogenic ventricular septal defect, secondary to aortic annulus disruption after TAVI-transfemoral procedure, generating a significant left-to-right shunt and cardiac failure. Open surgical procedures under cardiopulmonary bypass remain the best option for this lethal complication.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Septos Cardíacos/lesões , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Doença Iatrogênica , Assistência Perioperatória , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Ecocardiografia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Complicações Pós-Operatórias/etiologia , Ruptura/etiologia , Índice de Gravidade de Doença
19.
Int J Cardiol ; 168(6): 5352-4, 2013 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-24012276

RESUMO

BACKGROUND: Cardiac tamponade is the main complication of transseptal catheterization that is necessary for a variety of cardiac interventions and electrophysiology procedures. METHODS: A retrospective assessment of all consecutive procedures that required transseptal puncture by the same experienced operator (with already >100 previous trans-septal procedures) during the period 2000-2012 was performed. We recorded any puncture-related complications of pericardial effusion and cardiac tamponade (acute or delayed). RESULTS: A total of 393 procedures were retrieved: Group 1 [ablation of left-sided accessory pathways (n = 77), atrioventricular nodal reentry tachycardia-left septal access (AVNRT) (n = 12), and Inoue balloon mitral valvuloplasty (n = 27)], and Group 2 [atrial fibrillation (AF) ablation procedures: ostial pulmonary vein isolation (PVI) (including RF (n = 76) and cryo-balloon (n = 30)), circumferential PVI (n = 51), and combined procedures (n = 120)]. In total, 5 cases of tamponade were recorded, four of them were acute and one delayed (occurring 1h after the procedure). All tamponade cases occurred only during or after AF ablation procedures (cryo-balloon ablation = 1, circumferential PVI = 2, and combined procedures = 2). In one case emergency atrial repair following median sternotomy was necessary, and in another a surgical drainage through a limited thoracotomy was performed. The other three cases were treated with pericardiocentesis and drainage for 12h. No patient was on uninterrupted oral anticoagulation during the procedure. CONCLUSIONS: AF ablation is associated with a higher incidence of tamponade compared to other procedures that require transseptal access. Such procedures should only be performed in hospitals with access to emergency surgical support.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Tamponamento Cardíaco/etiologia , Ablação por Cateter/efeitos adversos , Septos Cardíacos/lesões , Septos Cardíacos/cirurgia , Adulto , Idoso , Fibrilação Atrial/cirurgia , Valvuloplastia com Balão , Eletrofisiologia Cardíaca/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Derrame Pericárdico/etiologia , Veias Pulmonares/cirurgia , Estudos Retrospectivos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia
20.
Turk J Pediatr ; 55(6): 662-4, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24577991

RESUMO

We report a rare case of interventricular septal hematoma after patch closure of a perimembranous ventricular septal defect in a 10-month-old infant. Intraoperative transesophageal echocardiography was not performed. Routine transthoracic echocardiography at the 1st postoperative hour showed a huge intramural hematoma causing severe thickening of the ventricular septum. The patient's hemodynamics were stable and surgical revision was not required. The patient recovered well without complication.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Comunicação Interventricular/cirurgia , Septos Cardíacos/lesões , Hematoma/etiologia , Complicações Intraoperatórias , Ecocardiografia , Comunicação Interventricular/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Humanos , Lactente
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