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1.
Medicine (Baltimore) ; 99(6): e18996, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028410

RESUMO

Upper extremity vein thrombosis (UE-VT) are more and more frequent pathologies and yet little studied. The aim is to describe the clinical and ultrasound features, UE-VT-related diseases, and the prevalence of pulmonary embolism (PE) and associated deaths.All UE-VT patients diagnosed by Doppler-ultrasound in Nantes University Hospital, from January 2015 to December 2017, were included retrospectively. UE-VT suspicion patterns, clinical features, UE-VT topography, and prevalence of PE and death were analyzed.Seven hundred and fifty-five UE-VT were analyzed, including 427 deep thrombosis (UE-DVT) and 328 superficial thrombosis (UE-SVT). In 86.2% (n = 651) UE-VT were related to endovascular devices. Among these thrombosis, one third is in connection with a PICC LINE and one quarter with a peripheral venous line. Forty nine percent (n = 370) of the patients had solid neoplasia or hematological malignancies. An inflammatory or systemic infectious context was found in 40.8% (n = 308) of the cases. The most frequently observed clinical sign at the UE-VT diagnosis was edema (28.6%). Among the UE-SVT it was the presence of an indurated cord (33.2%) and among the UE-DVT the indication of the Doppler-ultrasound was mainly a suspicion of infection on endovascular device (35.1%). In 10.6% (n = 80) of the cases the UE-VT were asymptomatic. The most frequently thrombosed veins were brachial basilic veins (16.7% of all thrombosed segments) followed by jugular (13%) and subclavian (12.3%) veins; 61.3% (n = 463) of UE-VT were in the right upper extremity; 63.3% (n = 478) UE-VT were occlusive. The occurrence of PE is 4% and the death rate is 10.2%, mainly related to the severe comorbidities of patients with UE-VT.UE-VT occurs in particular clinical contexts (hematological malignancies, solid cancers, systemic infections) and in the majority of endovascular devices (86.2%). The occurrence of PE is low.


Assuntos
Braço/irrigação sanguínea , Trombose/diagnóstico , Trombose Venosa/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Trombose/complicações , Trombose/diagnóstico por imagem , Trombose/mortalidade , Ultrassonografia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/mortalidade
2.
Life Sci ; 240: 117069, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31751582

RESUMO

AIM: Intraluminal thrombus (ILT) is presented in most abdominal aortic aneurysms (AAAs) and is suggested to promote AAA expansion. D-dimer, a breakdown product in the thrombus remodeling, may have prognostic value for AAA. This study investigated the interrelation between plasma D-dimer level, ILT volume, AAA size and progression. MAIN METHODS: This was a retrospective observational study that involved 181 patients with infra-renal AAA. They were divided into small and large AAA groups according to AAA diameter. 24 of them had repeated abdominal computed tomography angiography (CTA) scan and were divided into slow-growing and fast-growing AAA groups according to the median value of AAA growth rate. Baseline and follow-up plasma D-dimer level, maximum diameter of AAA, total infra-renal aortic volume and ILT volume were analyzed. KEY FINDINGS: Plasma D-dimer level was positively correlated with ILT volume (R = 0.382, P < 0.001) and maximum diameter of AAA (R = 0.442, P < 0.001). Increasing value of plasma D-dimer was positively associated with the accelerated growth rate of AAA (R = 0.720, P < 0.01). ILT volume showed positive correlation with maximum diameter (R = 0.859, P < 0.001) and growth rate of AAA (R = 0.490, P < 0.05). After adjusting the baseline ILT volume, the positive correlations remained to be statistically significant between plasma D-dimer level and AAA size (R = 0.200, P < 0.05), as well as increasing value of plasma D-dimer and growth rate of AAA (R = 0.642, P < 0.05). SIGNIFICANCE: Plasma D-dimer level reflected ILT burden in AAAs. Plasma D-dimer level and ILT volume were positively correlated with AAA size. Increasing value of plasma D-dimer and baseline ILT volume could be predictors of AAA progression.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/etiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Trombose/complicações , Trombose/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/sangue , Efeitos Psicossociais da Doença , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fumar/epidemiologia , Trombose/sangue , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 98(50): e18249, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852092

RESUMO

RATIONALE: Cancer and chemotherapy individually confer hypercoagulability and increased risks of thrombosis. Most thromboembolic complication after breast cancer chemotherapy was venous thrombosis after multiagent chemotherapy. Arterial thrombosis is extremely rare in early breast cancer patients receiving adjuvant chemotherapy. PRESENTING CONCERNS: A 55-year-old woman with right breast cancer presented to the emergency department with sudden pain, numbness, and swelling in her left hand. She underwent breast conserving surgery and sentinel lymph node biopsy 2 months before the visit. She received the second cycle of adjuvant Adriamycin-cyclophosphamide chemotherapy 5 days before. INTERVENTIONS: Computed tomography angiography revealed acute arterial thrombosis in the left brachial, radial, and ulnar arteries. Unfractionated heparin was initiated immediately, followed by brachial and radial-ulnar thrombectomy, restoring perfusion to the extremity. The postoperative course was uncomplicated; she was discharged on warfarin at a daily dose of 4 mg. OUTCOMES: Chemotherapy was discontinued. Anticoagulation with warfarin was continued. She subsequently received adjuvant endocrine therapy with an aromatase inhibitor and adjuvant radiotherapy. MAIN LESSONS: Despite the low risks of arterial thrombosis in breast cancer, it is a devastating complication with significant morbidity and mortality. Thromboprophylaxis should be considered in those at risk. Immediate anticoagulant therapy and surgical intervention should be considered in affected cases.


Assuntos
Artéria Braquial , Neoplasias da Mama/tratamento farmacológico , Ciclofosfamida/efeitos adversos , Doxorrubicina/efeitos adversos , Artéria Radial , Trombose/induzido quimicamente , Artéria Ulnar , Doença Aguda , Neoplasias da Mama/diagnóstico , Quimioterapia Adjuvante/efeitos adversos , Angiografia por Tomografia Computadorizada , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Quimioterapia Combinada/efeitos adversos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Trombectomia/métodos , Trombose/diagnóstico , Trombose/cirurgia , Ultrassonografia Doppler
4.
Tex Heart Inst J ; 46(3): 219-221, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708708

RESUMO

Bioprosthetic valve thrombosis was previously considered to be a relatively rare complication of surgical or transcatheter bioprosthetic valve replacement. Although echocardiograms can reliably show the characteristic findings of prosthetic valve stenosis, differentiating between thrombus formation and pannus overgrowth as the underlying cause of prosthetic valve dysfunction can be challenging. We present the case of a 75-year-old man who underwent transthoracic Doppler echocardiography in the presence of an elevated valvular gradient 2 years after his aortic valve had been surgically replaced with a bioprosthesis. The echocardiographic findings suggested prosthetic valve stenosis. Cardiac computed tomography, performed to distinguish between thrombus formation and pannus overgrowth, revealed hypoattenuated leaflet thickening and reduced leaflet mobility, which suggested thrombus. After the patient took oral anticoagulants for 3 months, images showed complete resolution of the previous abnormalities, thus confirming the diagnosis of bioprosthetic valve thrombosis. We found cardiac computed tomography valuable when evaluating our patient who had an elevated prosthetic valve gradient.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Bioprótese/efeitos adversos , Cardiopatias/diagnóstico , Trombose/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Diagnóstico Diferencial , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Cardiopatias/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Desenho de Prótese
5.
Medicine (Baltimore) ; 98(48): e18170, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31770267

RESUMO

RATIONALE: The umbilical cord is the way to exchange gas, supply nutrients, excrete metabolized. Thrombosis of the umbilical cord leads to fetal hypoxia, which jeopardizes fetal health and can cause fetal death. Umbilical vessel thrombosis, which is rarely reported, is difficult to detect prenatally. PATIENT CONCERNS: Both pregnant women had an unremarkable pregnancy course until a routine ultrasound scan in the third trimester showed a single umbilical artery. However, one umbilical vein and 2 umbilical arteries were seen during an ultrasound examination at 32 weeks. Case 2 had a better pregnancy outcome because of the timely discovery of this complication. DIAGNOSIS: Both cases were diagnosed as umbilical artery thrombosis. INTERVENTIONS: The first patient received no interventions until they reported decreased fetal movements and gradually disappear. The second patient underwent an emergency cesarean section. OUTCOMES: In Case 1, an emergency ultrasound examination showed intrauterine fetal death, and the patient vaginally delivered a stillborn child weighing 3300 g in a day. In Case 2, a female neonate weighing 2860 g was delivered by cesarean section, and exhibited Apgar scores of 10 and 10 at 1 and 5 minutes. CONCLUSION: In the late-term abortions, obstetricians should be vigilant if ultrasound imaging shows suspected umbilical vascular thrombosis or shows 1 umbilical artery when there had previously been 2. The fetus should be closely monitored and interventions implemented as early as possible to improve the prenatal detection rate of umbilical vessel thrombosis and avoid adverse pregnancy outcomes.


Assuntos
Cesárea/métodos , Intervenção Médica Precoce/métodos , Morte Fetal , Complicações Cardiovasculares na Gravidez , Trombose , Artérias Umbilicais , Adulto , Serviços Médicos de Emergência/métodos , Feminino , Morte Fetal/etiologia , Morte Fetal/prevenção & controle , Monitorização Fetal/métodos , Humanos , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Natimorto , Trombose/complicações , Trombose/diagnóstico , Trombose/fisiopatologia , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/patologia
6.
Wiad Lek ; 72(9 cz 2): 1727-1731, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622255

RESUMO

OBJECTIVE: Introduction: The anticipation of the development of thrombotic complications in coronary angioplasty patients helps to prevent this dangerous complication. Development of the available informative scales on the basis of mathematical methods taking into account the main clinical and biochemical parameters significantly simplifies the classification of patients in terms of thrombotic risk. The aim of the paper is to concentrate information on the state of hemostasis in the studied category of patients using the method of the main components and to obtain a matrix with minimal loss of information, which is convenient for analysis and the creation of a grade-ranking scale. PATIENTS AND METHODS: Materials and methods: Data of 70 patients with coronary heart disease and percutaneous coronary angioplasty were analyzed. The level of soluble fibrin, fibrinogen, D-dimer, protein C, and ratios rf/dd×100 were determined, and also the presence of diabetes mellitus and restenosis in the history was considered. RESULTS: Results: As a result of a stepwise study using the method of the main components, in the first stage two most singular matrices were obtained that describe 70% of the entire data variance (one of them is the component rf+dd, and the second one is fg+pc), which led to the first indicator of the level of thrombotic risk. At the second stage, the level of thrombotic risk was clarified, taking into consideration the presence of diabetes and history of restenosis, and it is recommended to use a second indicator for its determination (rf/dd×100). CONCLUSION: Conclusions: The presented grade-ranking scale scale allows the anticipation of the development of thrombotic complications in the studied category of patients with high probability.


Assuntos
Angioplastia Coronária com Balão , Doença das Coronárias/terapia , Trombose/diagnóstico , Doença das Coronárias/complicações , Diabetes Mellitus , Humanos , Recidiva , Medição de Risco , Fatores de Risco
7.
Anticancer Res ; 39(9): 4619-4625, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519559

RESUMO

Cancer patients are at risk for both venous and arterial thrombotic events. Accumulating evidence suggests a link between cancer and arterial thrombosis events. The pathophysiology of arterial thrombosis in cancer is complex and multifactorial. The risk of arterial thrombosis in cancer patients relies on individual risk factors, on cancer-related hypercoagulability, on anticancer drugs and radiotherapy often via a common underlying mechanism of endothelial dysfunction. This review describes the mechanisms involved in the development of arterial thrombotic events and their clinical manifestations. Furthermore, it provides an overview on therapeutic agents associated with arterial thrombosis.


Assuntos
Artérias/patologia , Neoplasias/complicações , Trombose/etiologia , Animais , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gerenciamento Clínico , Humanos , Neoplasias/epidemiologia , Neoplasias/patologia , Neoplasias/terapia , Neovascularização Patológica , Radioterapia/efeitos adversos , Radioterapia/métodos , Avaliação de Sintomas , Trombose/diagnóstico , Trombose/epidemiologia
9.
Adv Gerontol ; 32(3): 415-421, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31512429

RESUMO

Aged patients with atrial fibrillation (AF) are at high risk of both thromboembolic and haemorrhagic complications of disease and of its treatment. A study was provided to assess the role of D-dimer plasma level as a marker of thrombosis in aged patients with AF having no clinical signs of active thrombosis depending on used treatment strategy and quantitative thrombotic and haemorrhagic risk of AF. The results show that D-dimer plasma levels correlate with scores of thromboembolic and haemorrhagic risks in group on antiplatelet agents but not anticoagulants, with the difference in D-dimer level driven by subgroup on CHA2DS2-VASc score ≥5. High D-dimer level was associated with in-hospital mortality and rhythm of AF at the moment of blood sample collection. Therefore, an accuracy of risk prognosis of fatal complications of AF for elderly patients may be increased by using the laboratory markers of thrombus formation such as D-dimer and by using the obtained results to guide an antithrombotic therapy.


Assuntos
Fibrilação Atrial , Biomarcadores , Produtos de Degradação da Fibrina e do Fibrinogênio , Trombose , Idoso , Fibrilação Atrial/complicações , Biomarcadores/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Fatores de Risco , Trombose/diagnóstico , Trombose/etiologia
10.
Rev Port Cardiol ; 38(7): 511-514, 2019 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31522938

RESUMO

An 83-year-old woman with a 10-year history of rheumatoid arthritis was admitted for urinary tract infection with exacerbation of chronic kidney disease and decompensated heart failure of unknown etiology. Transesophageal echocardiography (TEE) showed a vegetation involving the posterior mitral valve leaflet, and a hypothesis of infective endocarditis was proposed. Empirical antibiotic therapy was initiated. TEE was repeated after antibiotic therapy, and showed persistence of the original vegetation and revealed the presence of another, smaller vegetation. Clinical investigation revealed no infectious process, and so a diagnosis of nonbacterial thrombotic endocarditis (NBTE) was established. Anticoagulant therapy was started immediately. The NBTE lesion had disappeared on the follow-up echocardiogram two months after anticoagulant therapy.


Assuntos
Endocardite não Infecciosa/complicações , Ventrículos do Coração , Trombose/etiologia , Idoso de 80 Anos ou mais , Ecocardiografia Transesofagiana , Endocardite não Infecciosa/diagnóstico , Feminino , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Humanos , Trombose/diagnóstico
11.
J Cardiothorac Surg ; 14(1): 157, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484541

RESUMO

BACKGROUND: A floating thrombus in the ascending aorta is occasionally found in clinical practice. The treatment for such lesions is poorly defined and mainly depends on the clinical experience of the surgeons. CASE PRESENTATION: We herein report a case involving a 22- × 22- × 45-mm space-occupying lesion in the ascending aorta. The patient was successfully treated with surgical intervention. Thrombectomy and ascending aorta replacement were performed to prevent systemic embolization. Histopathological examination revealed that the lesion was a thrombus. CONCLUSIONS: Aortic computed tomography angiography is a useful examination technique for patients with aortic thrombi. Resection of the thrombus can effectively reduce the risk of recurrent embolism.


Assuntos
Aorta , Doenças da Aorta/diagnóstico , Trombectomia/métodos , Trombose/diagnóstico , Doenças da Aorta/cirurgia , Angiografia por Tomografia Computadorizada , Ecocardiografia Transesofagiana , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/cirurgia
13.
Rev Cardiovasc Med ; 20(2): 53-58, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31344997

RESUMO

Peripartum cardiomyopathy is a type of non-ischemic cardiomyopathy with a high rate of thromboembolic events. Guiding strategies for anticoagulation in patients with peripartum cardiomyopathy and thromboembolic events are limited. Literature for all cases of peripartum cardiomyopathy with intracardiac thrombi were reviewed and summarized from twelve case reports. Based on the available literature, we conclude that patients with peripartum cardiomyopathy with ejection fraction of less than 30% should strongly consider anticoagulation therapy to avoid thromboembolic events. Future studies may be able to further elucidate the optimal indication and duration of anticoagulation.


Assuntos
Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Cardiomiopatias/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Trombose/tratamento farmacológico , Adulto , Anticoagulantes/efeitos adversos , Cardiomiopatias/sangue , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Feminino , Humanos , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/sangue , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Trombose/sangue , Trombose/diagnóstico , Trombose/fisiopatologia , Resultado do Tratamento , Adulto Jovem
14.
Rev Port Cardiol ; 38(6): 457.e1-457.e3, 2019 06.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31303466

RESUMO

A 24-year-old woman who was 11 weeks pregnant and had a mechanical mitral valve presented at the emergency department with ischemic stroke. Although treatment with aspirin and unfractionated heparin was initially successful, subsequent management was almost impossible, as she eventually suffered a right hemispheric stroke, requiring percutaneous intervention and an emergency cesarian; prosthetic valve thrombosis with hemodynamic instability; and multiple bleeding complications. This case demonstrates how difficult it can be to select the appropriate treatment strategy for prosthetic valve thrombosis.


Assuntos
Isquemia Encefálica/etiologia , Cardiopatias/complicações , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/cirurgia , Complicações Cardiovasculares na Gravidez , Trombose/complicações , Isquemia Encefálica/diagnóstico , Ecocardiografia Transesofagiana , Feminino , Cardiopatias/diagnóstico , Humanos , Gravidez , Falha de Prótese , Trombose/diagnóstico , Adulto Jovem
15.
Cancer Treat Res ; 179: 117-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317484

RESUMO

Central venous access devices are a critical instrument in the treatment and supportive care delivery for oncology patients. Catheter-related thrombosis (CRT) is a common complication of central venous access devices in oncology patients. Risk factors for CRT include patient-, device-, and treatment-related risk factors. Treatment of CRT is indicated to reduce symptoms, prevent catheter malfunction, prevent recurrent DVT or thromboembolic pulmonary embolism, and minimize the risk of post-thrombotic syndrome. Minimal prospective data exist on the prevention and treatment of catheter-related thromboses in cancer patients. As such recommendations largely are derived from data in the lower-extremity DVT and PE studies in cancer and non-cancer patients. Based on the available literature, primary pharmacologic prophylaxis against CRT is not recommended in cancer patients. Treatment options for CRT include catheter removal, anticoagulation, catheter-directed thrombolysis, or surgical thrombectomy. Current evidence-based guidelines recommend LMWH as the anticoagulant of choice. However, recent data showing efficacy and safety of DOACs in cancer-related VTE may be extrapolated to treatment of CRT in cancer patients. In patients with CRT, catheter removal should be pursued if continued vascular access is no longer needed, the catheter is dysfunctional, a catheter-associated infection is present, or if CRT symptoms do not resolve with anticoagulation alone. Catheter-directed thrombolysis is reserved for rare severe cases of CRT. Herein we discuss the pathophysiology, clinical presentation, diagnosis, and general management of CRT in cancer patients.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Neoplasias/complicações , Trombose/terapia , Humanos , Trombose/diagnóstico , Trombose/etiologia
16.
Cancer Treat Res ; 179: 159-178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317487

RESUMO

The myeloproliferative neoplasms (MPNs) are clonal stem cell-derived diseases. This chapter focuses on the subcategory of Philadelphia (Ph) chromosome-negative classical MPNs, polycythemia vera (PV), essential thrombocythemia (ET), primary myelofibrosis (PMF). These MPNs are associated with both microvascular and macrovascular thrombosis, which may occur in the venous and arterial circulation. Erythrocytosis, leukocytosis, and increased JAK2V617F allele burden are known to be risk factors. In this chapter, we review the thrombotic and hemostatic manifestations of the Philadelphia (Ph) chromosome-negative classical MPNs, including the clinical manifestations, the pathophysiology, as well as management.


Assuntos
Transtornos Mieloproliferativos/complicações , Trombose , Neoplasias da Medula Óssea/complicações , Neoplasias da Medula Óssea/genética , Hemostasia/fisiologia , Humanos , Mutação , Transtornos Mieloproliferativos/genética , Transtornos Mieloproliferativos/fisiopatologia , Cromossomo Filadélfia , Policitemia Vera/complicações , Mielofibrose Primária/complicações , Trombocitemia Essencial/complicações , Trombose/diagnóstico , Trombose/etiologia , Trombose/fisiopatologia , Trombose/terapia
17.
Int Heart J ; 60(4): 849-853, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308325

RESUMO

The diagnostic performance of 320-detector cardiac computed tomography (CCT) for the detection of thrombi in the left atrial appendage (LAA), relative to transesophageal echocardiography (TEE) as the gold standard, has not yet been evaluated. A total of 91 consecutive patients who were scheduled to undergo pulmonary vein isolation and underwent TEE and CCT were enrolled in this study. Delayed scanning on CCT was performed following early scanning, at 60 seconds after the start of the contrast injection. The radiation dose was estimated for both scans. The early scans showed a contrast medium filling defect (FD) in the LAA in 27 patients, whereas the delayed scans showed an FD in the LAA in six patients. Of these, five patients were confirmed to have a thrombus in the LAA by TEE. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100, 74.4, 18.5, 100, and 75.8% for early scanning and 100, 98.8, 83.3, 100, and 98.9% for delayed scanning, respectively. The area under the curve for the detection of a thrombus in the LAA on the delayed scans was significantly larger than that for the detection on the early scans (0.99 versus 0.87, P < 0.001). The estimated median radiation doses for the early and delayed scans were 2.86 and 0.42 mSv, respectively. Addition of delayed scanning to early scanning improved the diagnostic performance for the detection of a thrombus in the LAA and may obviate unnecessary TEE, with minimal additional radiation exposure.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Cardiopatias/diagnóstico , Tomografia Computadorizada Multidetectores/métodos , Trombose/diagnóstico , Idoso , Fibrilação Atrial/complicações , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Trombose/etiologia
18.
Biosens Bioelectron ; 141: 111437, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31279177

RESUMO

Thrombus formation is quantitatively measured and evaluated by the electrical impedance spectroscopy method in this study, which confirms the possibility for the application of a promising non-invasive thrombus detection method. The impedance parameter Z*(t) of blood from the electrical impedance spectroscopy is utilized to elaborate the impedance performance of blood during thrombus formation process. Experimental results indicate that the impedance Z*(t) of blood has regular variations under the formation of thrombus, which could be divided into three stages. Modified Hanai equation is proposed to quantitatively expound the three stages of impedance Z*(t) variation. The amount of fibrin and thrombus clot is founded to be accounted for the impedance variation of blood, which confirms the feasibility and theoretical basis of the non-invasive and on-line thrombus bio-detection technology for patients with serious cardiovascular disease.


Assuntos
Técnicas Biossensoriais/instrumentação , Espectroscopia Dielétrica/instrumentação , Fibrina/análise , Trombose/sangue , Animais , Coagulação Sanguínea , Impedância Elétrica , Desenho de Equipamento , Humanos , Suínos , Trombose/diagnóstico
19.
Int Heart J ; 60(4): 994-997, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257336

RESUMO

Pump thrombosis (PT) is a serious complication after continuous-flow left ventricular assist device (LVAD) implantation. To detect PT, echocardiographic ramp test using left ventricular end-diastolic diameter (LVEDD) is known to be useful. However, this method has several limitations. In this study, we propose an alternative novel ramp test using the flow velocity of outflow graft (OG). A 46-year-old man underwent continuous-flow LVAD (HeartMate II, Abbott Laboratories, Lake Forest, IL, USA) implantation for advanced heart failure due to idiopathic dilated cardiomyopathy. About 2 years after implantation, he suffered from hemolysis and symptoms of heart failure, and PT was strongly suspected. The change in LVEDD was minimal with increase in pump speed (-0.06 cm/400 rotations per minute (rpm)), suggesting PT. The systolic to diastolic velocity (S/D) ratio of OG flow, which we proposed as a new indicator of PT, also showed minimal change (-0.07/400 rpm). His clinical symptoms improved with anticoagulation therapy, and the changing slope of the S/D ratio dramatically improved to -0.92/400 rpm. Although its consistency should be verified in many other cases, this novel method can be useful for detecting PT and evaluating its clinical course.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Fluxo Sanguíneo Regional/fisiologia , Trombose/etiologia , Função Ventricular Esquerda/fisiologia , Ecocardiografia , Falha de Equipamento , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/diagnóstico , Trombose/fisiopatologia
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