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1.
Sci Rep ; 11(1): 4828, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33649391

RESUMO

Novel coronavirus disease (COVID-19) has led to a major public health crisis globally. Currently, myocardial damage is speculated to be associated with COVID-19, which can be seen as one of the main causes of death of patients with COVID-19. We therefore, aim to investigate the effects of COVID-19 disease on myocardial injury in hospitalized patients who have been tested positive for COVID-19 pneumonia in this study. A prospective study was conducted among 201 patients with COVID-19 in the Pakistan Military Hospital from April 1 to August 31, 2020, including non-critical cases and critical cases. COVID-19 patients were stratified as critical and non-critical according to the signs and symptoms severity; with those requiring intensive care and invasive mechanical ventilation as critical, and those did not requiring invasive mechanical ventilation as non-critical. A total of 201 COVID-19 patients with critical and non-critical categories presented with myocardial injury. All patients with myocardial injury had an elevation in CKMB and Troponin-I levels. Of these patients, 43.7% presented with new electrocardiography (ECG) changes, and ST depression was typically observed in 36.3% patients. In addition, 18.7% patients presented with abnormal echocardiography findings, with right ventricular dilatation and dysfunction commonly seen among critical group patients. Results analyzed by a logistic regression model showing COVID-19 direct contribution to myocardial injury in these patients. COVID-19 disease directly leads to cardiovascular damage among critical and non-critical patients. Myocardial injury is associated not only with abnormal ECG changes but also with myocardial dysfunction on echocardiography and more commonly observed among critical patients.


Assuntos
Ecocardiografia , Eletrocardiografia , Traumatismos Cardíacos , /metabolismo , Adulto , /complicações , /terapia , Cuidados Críticos , Feminino , Traumatismos Cardíacos/sangue , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Traumatismos Cardíacos/terapia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/metabolismo , Estudos Prospectivos , Índice de Gravidade de Doença
2.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431448

RESUMO

Embolised needles causing injury to the right heart and cardiac tamponade has been reported before in intravenous drug users, but to our knowledge, this is the first reported case of a needle migrating via the pulmonary arterial system to cause perforation of the left ventricle. Appropriate utilisation of imaging modalities such as plain X-ray and point-of-care focused cardiac ultrasound can be vital and life-saving in the emergency setting, and the value of gated multidetector CT as a powerful tool for imaging moving structures is highlighted.


Assuntos
Migração de Corpo Estranho/diagnóstico , Traumatismos Cardíacos/diagnóstico , Ventrículos do Coração/lesões , Agulhas/efeitos adversos , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Ponte Cardiopulmonar , Ecocardiografia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Pericardiocentese , Artéria Pulmonar/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento
3.
Methods Mol Biol ; 2158: 23-32, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32857362

RESUMO

Neonatal mouse hearts have a regenerative capacity similar to adult zebrafish. Different cardiac injury models have been established to investigate the regenerative capacity of neonatal mouse hearts, including ventricular amputation, cryoinjury, and ligation of a major coronary artery. While the ventricular resection model can be utilized to study how tissue forms and regenerates de novo, cryoinjury and coronary artery ligation are methods that might better mimic myocardial infarction by creating tissue damage and necrosis as opposed to the removal of healthy tissue in the ventricular amputation model. Here we describe methods of creating ventricular resection and cardiac cryoinjury in newborn mice.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criocirurgia/efeitos adversos , Traumatismos Cardíacos/patologia , Coração/fisiologia , Regeneração , Remodelação Ventricular , Animais , Animais Recém-Nascidos , Proliferação de Células , Feminino , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/reabilitação , Masculino , Camundongos
4.
Methods Mol Biol ; 2158: 51-61, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32857365

RESUMO

Zebrafish have the capacity to regenerate most of its organs upon injury, including the heart. Due to its amenability for genetic manipulation, the zebrafish is an excellent model organism to study the cellular and molecular mechanisms promoting heart regeneration. Several cardiac injury models have been developed in zebrafish, including ventricular resection, genetic ablation, and ventricular cryoinjury. This chapter provides a detailed protocol of zebrafish ventricular cryoinjury and highlights factors and critical steps to be considered when performing this method.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criocirurgia/efeitos adversos , Modelos Animais de Doenças , Traumatismos Cardíacos/patologia , Coração/fisiologia , Regeneração , Remodelação Ventricular , Animais , Proliferação de Células , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/reabilitação , Peixe-Zebra
5.
Methods Mol Biol ; 2158: 63-69, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32857366

RESUMO

The zebrafish (Danio rerio) possesses a spectacular capacity for cardiac regeneration. Zebrafish have been used in cardiac regeneration research for nearly two decades, contributing to the identification of signals and cellular mechanisms as potential targets for human heart repair. Investigations into cardiac regeneration in zebrafish have been facilitated by multiple methods of inducing cardiac tissue damage. Among the established methods, cardiac resection injury is a relatively simple, yet robust approach traditionally used to induce cardiac tissue damage in a reproducible manner. Here, we describe a detailed protocol to perform a cardiac resection injury in adult zebrafish and discuss potential complications for researchers who are new to this technique.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Modelos Animais de Doenças , Traumatismos Cardíacos/patologia , Coração/fisiologia , Remodelação Ventricular , Animais , Proliferação de Células , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Peixe-Zebra
6.
Methods Mol Biol ; 2158: 71-80, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32857367

RESUMO

Adult zebrafish possess an elevated cardiac regenerative capacity as compared with adult mammals. In the past two decades, zebrafish have provided a key model system for studying the cellular and molecular mechanisms of innate heart regeneration. The ease of genetic manipulation in zebrafish has enabled the establishment of a genetic ablation injury model in which over 60% of cardiomyocytes can be depleted, eliciting signs of heart failure. After this severe injury, adult zebrafish efficiently regenerate lost cardiomyocytes and reverse heart failure. In this chapter, we describe the methods for inducing genetic cardiomyocyte ablation in adult zebrafish, assessing cardiomyocyte proliferation, and histologically analyzing regeneration after injury.


Assuntos
Ablação por Cateter/efeitos adversos , Modelos Animais de Doenças , Traumatismos Cardíacos/patologia , Miócitos Cardíacos/citologia , Regeneração , Remodelação Ventricular , Proteínas de Peixe-Zebra/genética , Animais , Proliferação de Células , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/reabilitação , Miócitos Cardíacos/fisiologia , Peixe-Zebra
7.
Anesth Analg ; 131(5): 1491-1499, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079872

RESUMO

BACKGROUND: Increased pulse pressure has been associated with adverse cardiovascular events, cardiac and all-cause mortality in surgical and nonsurgical patients. Whether increased pulse pressure worsens myocardial injury and dysfunction after cardiac surgery, however, has not been fully characterized. We examined whether cardiac surgical patients with elevated pulse pressure are more susceptible to myocardial injury, dysfunction, cardiac-related complications, and mortality. Secondarily, we examined whether pulse pressure was a stronger predictor of the outcomes than systolic blood pressure. METHODS: This retrospective observational study included adult cardiac surgical patients having elective isolated on-pump coronary artery bypass grafting (CABG) between 2010 and 2017 at the Cleveland Clinic. The association between elevated pulse pressure and (1) perioperative myocardial injury, measured by postoperative troponin-T concentrations, (2) perioperative myocardial dysfunction, assessed by the requirement for perioperative inotropic support using the modified inotropic score (MIS), and (3) cardiovascular complications assessed by the composite outcome of postoperative mechanical circulatory assistance or in-hospital mortality were assessed using multivariable linear regression models. Secondarily, the association between pulse pressure versus systolic blood pressure and the outcomes were compared. RESULTS: Of 2704 patients who met the inclusion/exclusion criteria, complete data were available for 2003 patients. Increased pulse pressure over 40 mm Hg was associated with elevated postoperative troponin-T level, estimated to be 1.05 (97.5% confidence interval [CI], 1.02-1.09; P < .001) times higher per 10 mm Hg increase in pulse pressure. The association between pulse pressure and myocardial dysfunction and the composite outcome of cardiovascular complications and death were not significant. There was no difference in the association with pulse pressure versus systolic blood pressure and troponin-T concentrations. CONCLUSIONS: Elevated preoperative pulse pressure was associated with a modest increase in postoperative troponin-T concentrations, but not postoperative cardiovascular complications or in-hospital mortality in patients having CABG. Pulse pressure was not a better predictor than systolic blood pressure.


Assuntos
Pressão Sanguínea , Ponte de Artéria Coronária/efeitos adversos , Traumatismos Cardíacos/epidemiologia , Traumatismos Cardíacos/etiologia , Hipertensão/complicações , Complicações Pós-Operatórias/epidemiologia , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Troponina T/sangue
8.
Pan Afr Med J ; 36: 170, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32952814

RESUMO

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8thDecember 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic.


Assuntos
Infecções por Coronavirus/complicações , Traumatismos Cardíacos/fisiopatologia , Pneumonia Viral/complicações , Complicações Pós-Operatórias/fisiopatologia , Cálculos Ureterais/cirurgia , Doenças Assintomáticas , Infecções por Coronavirus/diagnóstico , Evolução Fatal , Traumatismos Cardíacos/etiologia , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Fatores de Risco
9.
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
10.
J Card Surg ; 35(10): 2860-2862, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32827157

RESUMO

Left atrial perforation is a known complication following pulmonary vein catheter ablation. Our case of a 62-year-old female underwent urgent surgery for repair of left atrium perforation with left pleural effusion as a late complication after multiple transcatheter radiofrequency pulmonary vein ablations for persistent atrial fibrillation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Lesão Pulmonar/etiologia , Veias Pulmonares , Procedimentos Cirúrgicos Cardíacos/métodos , Emergências , Feminino , Átrios do Coração/lesões , Átrios do Coração/cirurgia , Humanos , Lesão Pulmonar/cirurgia , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Derrame Pleural/cirurgia , Resultado do Tratamento
11.
Artigo em Inglês | MEDLINE | ID: mdl-32859020

RESUMO

Marathons continue to grow in popularity among amateurs. However, the impact of intensive exercise on the amateur's cardiovascular system has not yet been studied. Analysis of the influence of the marathon on kinetics of biomarkers reflecting cardiac injury and overload may bring new insights into this issue. We investigated the effect of running a marathon on the concentrations of high sensitivity cardiac troponin I (hs-cTnI), heart-type fatty acid binding protein (H-FABP), N-terminal proatrial natriuretic peptide (NT-proANP), B-type natriuretic peptide (BNP), growth differentiation factor 15 (GDF-15) and galectin 3 (Gal-3) in the population of male amateur runners. The study included 35 amateur marathoners and followed 3 stages: S1-two weeks prior to the marathon, S2-at the finish line and S3-two weeks after. Blood samples were collected at each stage and analyzed for biomarkers and laboratory parameters. Concentrations of all studied biomarkers were significantly higher at S2, whereas at S3 did not differ significantly compared to S1. Running a marathon by an amateur causes an acute rise in biomarkers of cardiac injury and stress. Whether repetitive bouts of intensive exercise elicit long-term adverse cardiovascular effects in amateur marathoners needs further research.


Assuntos
Atletas , Biomarcadores/sangue , Exercício Físico/fisiologia , Coração/fisiologia , Peptídeo Natriurético Encefálico/sangue , Corrida/fisiologia , Troponina I/sangue , Adulto , Desempenho Atlético/fisiologia , Fenômenos Fisiológicos Cardiovasculares , Sistema Cardiovascular , Feminino , Traumatismos Cardíacos/sangue , Traumatismos Cardíacos/etiologia , Humanos , Masculino , Miocárdio/metabolismo , Resistência Física/fisiologia
12.
Crit Care ; 24(1): 468, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32723362

RESUMO

BACKGROUND: Cardiac injury is now a common complication of coronavirus disease (COVID-19), but it remains unclear whether cardiac injury-related biomarkers can be independent predictors of mortality and severe disease development or intensive care unit (ICU) admission. METHODS: Two investigators searched the PubMed, EMBASE, Cochrane Library, MEDLINE, Chinese National Knowledge Infrastructure (CNKI), Wanfang, MedRxiv, and ChinaXiv databases for articles published through March 30, 2020. Retrospective studies assessing the relationship between the prognosis of COVID-19 patients and levels of troponin I (TnI) and other cardiac injury biomarkers (creatine kinase [CK], CK myocardial band [CK-MB], lactate dehydrogenase [LDH], and interleukin-6 [IL-6]) were included. The data were extracted independently by two investigators. RESULTS: The analysis included 23 studies with 4631 total individuals. The proportions of severe disease, ICU admission, or death among patients with non-elevated TnI (or troponin T [TnT]), and those with elevated TnI (or TnT) were 12.0% and 64.5%, 11.8% and 56.0%, and 8.2% and. 59.3%, respectively. Patients with elevated TnI levels had significantly higher risks of severe disease, ICU admission, and death (RR 5.57, 95% CI 3.04 to 10.22, P < 0.001; RR 6.20, 95% CI 2.52 to 15.29, P < 0.001; RR 5.64, 95% CI 2.69 to 11.83, P < 0.001). Patients with an elevated CK level were at significantly increased risk of severe disease or ICU admission (RR 1.98, 95% CI 1.50 to 2.61, P < 0.001). Patients with elevated CK-MB levels were at a higher risk of developing severe disease or requiring ICU admission (RR 3.24, 95% CI 1.66 to 6.34, P = 0.001). Patients with newly occurring arrhythmias were at higher risk of developing severe disease or requiring ICU admission (RR 13.09, 95% CI 7.00 to 24.47, P < 0.001). An elevated IL-6 level was associated with a higher risk of developing severe disease, requiring ICU admission, or death. CONCLUSIONS: COVID-19 patients with elevated TnI levels are at significantly higher risk of severe disease, ICU admission, and death. Elevated CK, CK-MB, LDH, and IL-6 levels and emerging arrhythmia are associated with the development of severe disease and need for ICU admission, and the mortality is significantly higher in patients with elevated LDH and IL-6 levels.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Traumatismos Cardíacos/etiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Biomarcadores/sangue , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Traumatismos Cardíacos/sangue , Hospitalização/estatística & dados numéricos , Humanos , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Valor Preditivo dos Testes , Medição de Risco , Índice de Gravidade de Doença , Troponina I/sangue
13.
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
14.
Zhonghua Zhong Liu Za Zhi ; 42(6): 456-462, 2020 Jun 23.
Artigo em Chinês | MEDLINE | ID: mdl-32575940

RESUMO

Objective: To evaluate the incidence of early cardiac injury in patients with left-sided breast cancer receiving hypofractionated radiotherapy after breast conserving surgery, and to investigate the correlation between cardiac injury and hypofractionated radiotherapy dose. Methods: We prospectively enrolled 103 breast cancer patients who received whole breast with or without regional nodal irradiation after breast conserving surgery using either deep inspiration breath-hold (DIBH) or free breathing (FB) radiotherapy technique. Cardiac examinations that included N-terminal pro-B-type natriuretic peptide (NT-proBNP), electrocardiogram, and myocardial perfusion imaging were performed routinely before and after radiotherapy. The effects of heart dose, systemic therapy and individual factors (Framingham score) on the incidence of cardiac events were analyzed. Results: The median age was 48 years. The mean dose (Dmean) of the heart, left anterior descending coronary artery (LAD), left ventricular (LV), and right ventricular (RV) were 4.0, 16.9, 6.3, and 4.4 Gy, respectively. With a median follow-up of 13.4 months, no patient had clinical cardiac abnormalities. The incidence rates of subclinical cardiac events at 1- 6- and 12-month were 23.5%, 31.6%, and 41.3%, respectively. The DIBH group had a lower mean dose, maximum dose, and V5-V40 in the heart, LAD, LV, and RV than the FB group (P<0.001). Univariate analysis showed an increased incidence of subclinical cardiac events with heart Dmean >4 Gy, LAD V40 > 20%, LV Dmean >6 Gy, RV Dmean >7 Gy, or cumulative doses of anthracycline or taxane > 300 mg/m(2) (All P<0.05). Anti-HER2 targeted therapy, endocrine therapy and Framingham score were not associated with the incidence of subclinical cardiac events (all P>0.05). Multivariate analysis demonstrated that Dmean of LV and RV were independently associated with the increased incidence of subclinical cardiac events. Conclusions: Early subclinical heart injury are found in patients with left-sided breast cancer after hypofractionated radiotherapy. The increased incidence of subclinical cardiac events after radiotherapy is positively associated with the cardiac radiation doses.


Assuntos
Neoplasias da Mama/radioterapia , Traumatismos Cardíacos/etiologia , Coração/efeitos da radiação , Mastectomia Segmentar , Neoplasias Unilaterais da Mama/radioterapia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Suspensão da Respiração , Coração/diagnóstico por imagem , Ventrículos do Coração/efeitos da radiação , Humanos , Mastectomia Segmentar/efeitos adversos , Pessoa de Meia-Idade , Estudos Prospectivos , Hipofracionamento da Dose de Radiação , Lesões por Radiação , Resultado do Tratamento , Neoplasias Unilaterais da Mama/patologia
15.
Biomed Res Int ; 2020: 7413673, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32596365

RESUMO

Some patients with coronavirus disease 2019 (COVID-19) show abnormal changes in laboratory myocardial injury markers, suggesting that patients with myocardial injury have a higher mortality rate than those without myocardial injury. This article reviews the possible mechanism of myocardial injury in patients with COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects the patients with COVID-19 in aspects of direct infection of myocardial injury, specific binding to functional receptors on cardiomyocytes, and immune-mediated myocardial injury. During hospitalization, the monitoring of laboratory myocardial injury markers in patients of COVID-19 should be strengthened.


Assuntos
Betacoronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Traumatismos Cardíacos/sangue , Traumatismos Cardíacos/etiologia , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Biomarcadores/sangue , Biomarcadores/metabolismo , Infecções por Coronavirus/metabolismo , Citocinas/sangue , Citocinas/imunologia , Traumatismos Cardíacos/metabolismo , Humanos , Mediadores da Inflamação/sangue , Mediadores da Inflamação/imunologia , Modelos Cardiovasculares , Modelos Imunológicos , Miócitos Cardíacos/imunologia , Miócitos Cardíacos/metabolismo , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/metabolismo
16.
Am J Physiol Lung Cell Mol Physiol ; 319(2): L277-L288, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32551862

RESUMO

In the last few months, the number of cases of a new coronavirus-related disease (COVID-19) rose exponentially, reaching the status of a pandemic. Interestingly, early imaging studies documented that pulmonary vascular thickening was specifically associated with COVID-19 pneumonia, implying a potential tropism of the virus for the pulmonary vasculature. Moreover, SARS-CoV-2 infection is associated with inflammation, hypoxia, oxidative stress, mitochondrial dysfunction, DNA damage, and lung coagulopathy promoting endothelial dysfunction and microthrombosis. These features are strikingly similar to what is seen in pulmonary vascular diseases. Although the consequences of COVID-19 on the pulmonary circulation remain to be explored, several viruses have been previously thought to be involved in the development of pulmonary vascular diseases. Patients with preexisting pulmonary vascular diseases also appear at increased risk of morbidity and mortality. The present article reviews the molecular factors shared by coronavirus infection and pulmonary vasculature defects, and the clinical relevance of pulmonary vascular alterations in the context of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumopatias/etiologia , Pulmão/irrigação sanguínea , Pulmão/fisiopatologia , Pneumonia Viral/complicações , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Citocinas/sangue , Dano ao DNA , Traumatismos Cardíacos/etiologia , Interações entre Hospedeiro e Microrganismos/fisiologia , Humanos , Hipóxia/etiologia , Mediadores da Inflamação/sangue , Pulmão/virologia , Pneumopatias/fisiopatologia , Pneumopatias/virologia , Mitocôndrias/fisiologia , Miocárdio , Estresse Oxidativo , Pandemias , Peptidil Dipeptidase A/fisiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Circulação Pulmonar , Embolia Pulmonar/etiologia , Receptores Virais/fisiologia , Fatores de Risco , Vasculite/etiologia
17.
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
18.
Circ Cardiovasc Interv ; 13(6): e008962, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32527193

RESUMO

Complications of percutaneous coronary intervention (PCI) may have significant impact on patient survival and healthcare costs. PCI procedural complexity and patient risk are increasing, and operators must be prepared to recognize and treat complications, such as perforations, dissections, hemodynamic collapse, no-reflow, and entrapped equipment. Unfortunately, few resources exist to train operators in PCI complication management. Uncertainty regarding complication management could contribute to the undertreatment of patients with high-complexity coronary disease. We, therefore, coordinated the Learning From Complications: How to Be a Better Interventionalist courses to disseminate the collective experience of high-volume PCI operators with extensive experience in chronic total occlusion and high-risk PCI. From these conferences in 2018 and 2019, we developed algorithms that emphasize early recognition, effective treatment, and team-based care of PCI complications. We think that an algorithmic approach will result in a logical and systematic response to life-threatening complications. This construct may be useful for operators who plan to perform complex PCI procedures.


Assuntos
Algoritmos , Procedimentos Clínicos , Corpos Estranhos/terapia , Traumatismos Cardíacos/terapia , Isquemia Miocárdica/terapia , Fenômeno de não Refluxo/terapia , Intervenção Coronária Percutânea/efeitos adversos , Choque/terapia , Tomada de Decisão Clínica , Congressos como Assunto , Corpos Estranhos/etiologia , Corpos Estranhos/mortalidade , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/mortalidade , Humanos , Isquemia Miocárdica/mortalidade , Fenômeno de não Refluxo/etiologia , Fenômeno de não Refluxo/mortalidade , Intervenção Coronária Percutânea/mortalidade , Medição de Risco , Fatores de Risco , Choque/etiologia , Choque/mortalidade , Resultado do Tratamento
19.
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
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