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1.
J Trauma Acute Care Surg ; 90(2): 388-395, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33502150

RESUMO

BACKGROUND: We performed a systematic review (SR) and meta-analysis (MA) to determine the diagnostic accuracy of chest ultrasound (US) compared with a pericardial window (PW) for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. METHODS: A literature search in five databases identified relevant articles for inclusion in this SR and MA. Studies were eligible if they evaluated the diagnostic accuracy of chest US, compared with a PW, for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients presenting with penetrating thoracic trauma. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test accuracy within the bivariate mixed-effects logistic regression modeling framework. RESULTS: We included five studies in our SR and MA. These studies included a total of 556 trauma patients. The MA found that, compared with PW, the US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients. The presence of a concomitant left hemothorax was frequent in patients with false-negative results. CONCLUSION: This SR and MA found that, compared with PW, US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. Caution interpretation of pericardial US results is suggested in the presence of left hemothorax. In these cases, a second diagnostic test should be performed. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis, level II.


Assuntos
Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Torácicos/complicações , Ultrassonografia , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Reprodutibilidade dos Testes , Ultrassonografia/métodos , Ultrassonografia/normas , Ferimentos Penetrantes/complicações
2.
J Intensive Care Med ; 36(4): 500-508, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33349095

RESUMO

BACKGROUND: The available information on the echocardiographic features of cardiac injury related to the novel coronavirus disease 2019 (COVID-19) and their prognostic value are scattered in the different literature. Therefore, the aim of this study was to investigate the echocardiographic features of cardiac injury related to COVID-19 and their prognostic value. METHODS: Published studies were identified through searching PubMed, Embase (Elsevier), and Google scholar databases. The search was performed using the different combinations of the keywords "echocard*," "cardiac ultrasound," "TTE," "TEE," "transtho*," or "transeso*" with "COVID-19," "sars-COV-2," "novel corona, or "2019-nCOV." Two researchers independently screened the titles and abstracts and full texts of articles to identify studies that evaluated the echocardiographic features of cardiac injury related to COVID-19 and/or their prognostic values. RESULTS: Of 783 articles retrieved from the initial search, 11 (8 cohort and 3 cross-sectional studies) met our eligibility criteria. Rates of echocardiographic abnormalities in COVID-19 patients varied across different studies as follow: RV dilatation from 15.0% to 48.9%; RV dysfunction from 3.6% to 40%; and LV dysfunction 5.4% to 40.0%. Overall, the RV abnormalities were more common than LV abnormalities. The majority of the studies showed that there was a significant association between RV abnormalities and the severe forms and death of COVID-19. CONCLUSION: The available evidence suggests that RV dilatation and dysfunction may be the most prominent echocardiographic abnormality in symptomatic patients with COVID-19, especially in those with more severe or deteriorating forms of the disease. Also, RV dysfunction should be considered as a poor prognostic factor in COVID-19 patients.


Assuntos
/diagnóstico por imagem , Ecocardiografia/estatística & dados numéricos , Traumatismos Cardíacos/diagnóstico por imagem , Disfunção Ventricular/diagnóstico por imagem , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Traumatismos Cardíacos/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Disfunção Ventricular/virologia
3.
Comput Biol Med ; 124: 103960, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32919186

RESUMO

Artificial intelligence (AI) has penetrated the field of medicine, particularly the field of radiology. Since its emergence, the highly virulent coronavirus disease 2019 (COVID-19) has infected over 10 million people, leading to over 500,000 deaths as of July 1st, 2020. Since the outbreak began, almost 28,000 articles about COVID-19 have been published (https://pubmed.ncbi.nlm.nih.gov); however, few have explored the role of imaging and artificial intelligence in COVID-19 patients-specifically, those with comorbidities. This paper begins by presenting the four pathways that can lead to heart and brain injuries following a COVID-19 infection. Our survey also offers insights into the role that imaging can play in the treatment of comorbid patients, based on probabilities derived from COVID-19 symptom statistics. Such symptoms include myocardial injury, hypoxia, plaque rupture, arrhythmias, venous thromboembolism, coronary thrombosis, encephalitis, ischemia, inflammation, and lung injury. At its core, this study considers the role of image-based AI, which can be used to characterize the tissues of a COVID-19 patient and classify the severity of their infection. Image-based AI is more important than ever as the pandemic surges and countries worldwide grapple with limited medical resources for detection and diagnosis.


Assuntos
Betacoronavirus , Lesões Encefálicas/epidemiologia , Infecções por Coronavirus/epidemiologia , Traumatismos Cardíacos/epidemiologia , Pneumonia Viral/epidemiologia , Inteligência Artificial , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Lesões Encefálicas/classificação , Lesões Encefálicas/diagnóstico por imagem , Técnicas de Laboratório Clínico/métodos , Comorbidade , Biologia Computacional , Infecções por Coronavirus/classificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/diagnóstico por imagem , Aprendizado Profundo , Traumatismos Cardíacos/classificação , Traumatismos Cardíacos/diagnóstico por imagem , Humanos , Aprendizado de Máquina , Pandemias/classificação , Pneumonia Viral/classificação , Pneumonia Viral/diagnóstico por imagem , Fatores de Risco , Índice de Gravidade de Doença
5.
Asian Cardiovasc Thorac Ann ; 28(9): 598-600, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32762246

RESUMO

Iatrogenic atrial septal defect is an issue after percutaneous interventions for structural heart disease. A 63-year-old man, who had previously received 5 catheter ablations for paroxysmal atrial fibrillation, was found to have an iatrogenic atrial septal defect that persisted after the fourth intervention. Approximately 4 years later, he suffered exertional dyspnea. Pulmonary hypertension was caused by a left-to-right shunt via a large iatrogenic atrial septal defect. We performed surgical closure and the symptom improved. The timing of treatment for persistent iatrogenic atrial septal defect is difficult to determine, but preferable before the appearance of right ventricular dysfunction or embolism.


Assuntos
Fibrilação Atrial/cirurgia , Septo Interatrial/lesões , Cateterismo Cardíaco/efeitos adversos , Ablação por Cateter/efeitos adversos , Traumatismos Cardíacos/etiologia , Doença Iatrogênica , Septo Interatrial/diagnóstico por imagem , Septo Interatrial/cirurgia , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Reoperação , Resultado do Tratamento
7.
Cardiovasc J Afr ; 31(4): 217-220, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32490507

RESUMO

The use of peripherally inserted central catheters (PICCs) has expanded substantially for drug delivery in clinical practice in recent years. However, PICC lines expose patients to potential complications associated with an increasing incidence of infective endocarditis. We herein report a case of a 57-year-old woman who was diagnosed with tricuspid valve endocarditis by echocardiography. The most probable cause was direct injury to the tricuspid valve by the tip of a PICC line with excessive length in the right heart. The vegetation disappeared with conservative treatment after removal of the PICC line. Clinicians must maintain vigilance against any suspected PICC-related infection in febrile patients with a PICC line. For echocardiographers, precise evaluation of the position of the PICC tip and the detection of endocarditis is important to devise the optimal clinical strategy.


Assuntos
Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Cateteres de Demora/efeitos adversos , Endocardite/etiologia , Traumatismos Cardíacos/etiologia , Valva Tricúspide/lesões , Antibacterianos/uso terapêutico , Tratamento Conservador , Remoção de Dispositivo , Endocardite/diagnóstico por imagem , Endocardite/terapia , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/terapia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem
8.
Circ Cardiovasc Interv ; 13(1): e008383, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32525410

RESUMO

BACKGROUND: We investigated whether optical coherence tomography (OCT) guidance would reduce nonoptimal bioresorbable vascular scaffold (BVS) deployment. METHODS: This was a randomized controlled trial. Patients who required percutaneous coronary intervention for ischemic heart disease were recruited from 2 centers in Korea. The enrolled patients were randomly assigned to receive either OCT-guided BVS (Absorb; Abbott Vascular) implantation or angiography-guided BVS implantation using an optimized technique. The primary outcome was nonoptimal deployment, which was a composite outcome of the following parameters assessed by OCT: a minimal scaffold area <5 mm2, residual area stenosis >20%, incomplete apposition of the scaffold struts >5%, major edge dissection, or scaffold disruption. The secondary outcome was a procedural complication defined by the occurrence of no reflow, coronary perforation, or flow-limiting dissection. RESULTS: Between September 2016 and January 2018, 88 patients (90 lesions) were assigned to OCT guidance, while 88 patients (89 lesions) were assigned to angiography guidance. The recruitment was prematurely terminated in March 2018 because the manufacturer stopped supplying BVS. Postprocedural OCT data were available for 88 lesions with OCT guidance and for 88 lesions with angiography guidance. There was nonoptimal BVS deployment postprocedurally in 35.2% of patients in the OCT-guidance group and in 38.6% in the angiography-guidance group (absolute difference, -3.7% [95% CI, -19.0% to 11.6%]; P=0.64). There were no procedural complications in either group. CONCLUSIONS: OCT-guided BVS implantation did not reduce the incidence of nonoptimal deployment compared to that of angiography-guided BVS implantation (using optimized techniques). CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02894697.


Assuntos
Implantes Absorvíveis , Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea/instrumentação , Tomografia de Coerência Óptica , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/lesões , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Humanos , Masculino , Fenômeno de não Refluxo/diagnóstico por imagem , Fenômeno de não Refluxo/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Desenho de Prótese , Falha de Prótese , Fatores de Risco , Seul , Fatores de Tempo , Resultado do Tratamento
9.
Asian Cardiovasc Thorac Ann ; 28(5): 276-278, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32479110

RESUMO

An 86-year-old female with severe aortic valve stenosis underwent transcatheter aortic valve replacement. A balloon-expandable valve was used, guided by a double-stiff guidewire that successfully straightened the aorta. During valve placement, the balloon shifted. After placement of the prosthetic valve, intraoperative transesophageal echocardiography revealed severe mitral regurgitation from the anterior mitral leaflet. Open conversion was performed immediately. A 5-mm hole was identified in the anterior leaflet, and direct closure was chosen for mitral valve repair. While transcatheter aortic valve replacement has gained popularity for patients with severe aortic stenosis and high operative risk, reports of mitral valve perforation are rare.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valvuloplastia com Balão/efeitos adversos , Traumatismos Cardíacos/etiologia , Insuficiência da Valva Mitral/etiologia , Valva Mitral/lesões , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento
13.
Asian Cardiovasc Thorac Ann ; 28(4): 205-212, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32276539

RESUMO

BACKGROUND: Mechanical complications of percutaneous coronary interventions are treated percutaneously in most cases. If the rescue intervention is unsuccessful, bailout bypass surgery is necessary to restore the coronary flow. The surgical risk in these cases is higher than that of patients operated on for other indications. The aim of our study was to characterize patients who underwent surgical treatment at our institution and to compare their long-term outcomes with patients who underwent emergency bypass surgery for other indications. METHODS: We analyzed 707 consecutive patients who underwent isolated emergency bypass surgery at our institution from 2007 to 2015. In 44 of these cases, the surgery was necessitated by mechanical complications of percutaneous coronary interventions. There were 31 coronary dissections, 5 entrapped guidewires, and 8 coronary perforations. We compared patients in these three groups with one another. Follow-up was performed to assess long-term outcomes. RESULTS: The median age of the cohort was 68 years (range 59-75 years), and 36 (81.8%) patients presented in cardiogenic shock. Thirty-seven (84.1%) patients had history of a percutaneous coronary intervention. The courses were typical for bypass patients. The long-term survival was similar in all three subgroups (p = 0.16). The survival profiles within our sample did not differ significantly from that in patients who underwent emergency bypass surgery for other indications. CONCLUSIONS: Surgical risk and short- and long-term outcomes of patients undergoing emergency bypass surgery due to mechanical complications of percutaneous coronary interventions are similar to those of patients receiving the same surgery for other indications.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/terapia , Vasos Coronários/cirurgia , Traumatismos Cardíacos/cirurgia , Doença Iatrogênica , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/lesões , Emergências , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
Can Assoc Radiol J ; 71(3): 301-312, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32066272

RESUMO

Traumatic cardiovascular injuries are only second to the central nervous system injuries as a cause of death in young adult population. Multidetector computed tomography is the gold standard diagnostic modality in patients with blunt or penetrating chest trauma and clinical suspicion of cardiac injury. The imaging spectrum of cardiac injuries includes but not limits to pericardial rupture, myocardial contusions, valve rupture, coronary artery injuries, cardiac herniations, and cardiac tamponade. In this review article, we discuss clinical presentation, types, and mechanism of cardiac trauma with emphasis on the imaging findings and illustrations in blunt, penetrating traumatic, and iatrogenic cardiac injuries.


Assuntos
Traumatismos Cardíacos/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Meios de Contraste , Angiografia Coronária , Humanos , Doença Iatrogênica , Tomografia Computadorizada Multidetectores
19.
Intern Med ; 59(4): 541-544, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31645534

RESUMO

A 71-year-old woman with cardiac sarcoidosis underwent an implantable cardioverter-defibrillator implantation in the left precordium to prevent fatal arrhythmias. Two weeks later, she presented with dyspnea. Chest X-ray revealed right pneumothorax due to the active atrial lead perforation. Subsequently, air was detected surrounding the heart. Although it was difficult to differentiate pneumopericardium from pneumomediastinum, postural conversion computed tomography (CT) in the supine and prone positions documented air migration in the pericardial cavity and diagnosed pneumopericardium. This rare case of pneumopericardium combined with pneumothorax contralateral to the venous access site highlights the utility of postural conversion CT for diagnosis of pneumopericardium.


Assuntos
Fibrilação Atrial/cirurgia , Desfibriladores Implantáveis/efeitos adversos , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Pneumopericárdio/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Postura , Idoso , Feminino , Humanos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
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