RESUMO
BACKGROUND: The incidence of supraventricular arrhythmia (SVA) is high in patients with mitral valve prolapse (MVP). The purpose of our study was to determine the role of parameters showing atrial conduction heterogeneity such as Pwave dispersion (PWD) and atrial electromechanical delay (AEMD) in predicting the development of SVA in MVP patients. METHODS: A total of 76 patients with MVP (56 female, 20 male) were included in the study. The patients were divided into two groups according to the presence or absence of SVA: 36 patients were allocated to the non-SVA group and 40 patients to the SVA group. Heart rate variability (HRV), PWD, and AEMD values were determined and compared. RESULTS: The PWD was found to be higher in the SVA group. Interatrial EMD was 32.00â¯ms (25.00-35.00) in patients with SVA while it was 18.00 ms in patients without SVA (11.00-23.75); the intra-atrial EMD was 17.0â¯ms (10.00-20.00) in patients with SVA whereas it was 10.00â¯ms (4.00-14.00) in patients without SVA. Lower HRV was found in the SVA group. CONCLUSION: In the SVA group, PWD and AEMD were increased while HRV values were decreased. Noninvasive parameters may help predict the presence and incidence of SVA during the follow-up of this group of patients.
Assuntos
Prolapso da Valva Mitral , Arritmias Cardíacas/diagnóstico , Eletrocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Frequência Cardíaca , Humanos , Masculino , Prolapso da Valva Mitral/diagnóstico por imagemRESUMO
OBJECTIVES: Neurological complications associated with transcatheter aortic valve implantation (TAVI) are important due to its morbidity and mortality risks. The purpose of this study was to investigate the importance of the features of the aortic valve and ascending aorta to predict the neurological complications associated with TAVI. METHODS: The patients for whom the heart team decided to perform TAVI were included in the study. In order to assess possible neurological complications, cerebral diffusionweighted magnetic resonance imaging(MRI) was performed pre- and post-operatively. The diameter of the patients' aortic root and ascending aorta, aortic valve scores, intima media thickness of the ascending aorta were measured from their transesophageal echocardiography records. RESULTS: A total of 108 patients constituted the study population. 31 patients were found to develop a new lesion (MR+) detected on MRI after TAVI, while 76 patients did not have any new lesions (MR-). The groups did not have any significant differences in their aortic valve features and scores. However, AA-IMT was found to be higher in the MR+ group (1.8mm [1.6-2.3] vs 1.4mm [1.2-1.8] interquartile range). The multivariate logistic regression analysis conducted to detect new lesions revealed that AA-IMT led to a significantly increased risk. CONCLUSION: The features of the ascending are more important than the demographic characteristics of patients and features of the native valve in predicting new lesions on MRI scans and thus neurological events after TAVI.
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Aorta/diagnóstico por imagem , Doenças da Aorta/complicações , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Calcinose/cirurgia , Transtornos Cerebrovasculares/etiologia , Ecocardiografia Transesofagiana , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Calcinose/complicações , Calcinose/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Abnormal heart rate recovery (HRR) is predictive of cardiac mortality. Autonomic abnormalities in beta-thalassemia major (TM) patients have been reported in previous studies. However, the importance of low HRR in exercise stress test in TM patients has not yet been ascertained. Therefore, this study will be the first of its kind in the literature. METHODS: Exercise stress test was performed on 56 TM patients who were being treated at the Thalassemia Center of our hospital, along with 46 non-TM iron deficiency anemia (IDA) patients as a control group. Values for HHR were recorded at 1, 2, 3, 4 and 5 min, and HRR was calculated by the difference of heart rate at peak exercise and at a specific time interval following the onset of recovery. RESULTS: All HRR values were found to be lower in TM patients compared to those in the IDA group. Exercise capacity [metabolic equivalents (METs)] was also found to be low in these patients (p < 0.001) as well. Total exercise time was significantly lower in the TM group compared to the IDA group (8.40 ± 1.7 min vs. 11.17 ± 1.51 min, p < 0.001). Exercise capacity (METs) was also lower in the TM group compared to the IDA group. Mean T2* value was 28.3 ± 13.7 ms in TM patients on magnetic resonance imaging (MRI). In addition, there are 18 TM patients with T2* value was < 20 ms. CONCLUSIONS: This study found that TM was independently associated with low HRR. Such a condition is an indicator of autonomic dysfunction in TM patients, since abnormal HRR is related to impaired autonomic response. In addition, impaired HRR may be a marker of early cardiac involvement in patients, whose T2* value is high on MRI. Modifying HRR with a cardiac rehabilitation program in TM patients with impaired HRR is a field open for further investigation.
RESUMO
OBJECTIVE: In our study, we aimed to evaluate the effect of weight loss on left and right ventricular functions in obese patients. METHODS: Thirty patients with a BMI greater than 30 kg/m(2) and without any exclusion criteria were included in the study. Left ventricular systolic and diastolic functions were assessed with conventional and tissue Doppler echocardiography (TDE). At the end of 3 months, echocardiographic examination was repeated in patients with weight loss for cardiac function evaluation and it was compared to the baseline echocardiographic parameters. RESULTS: At the end of 3 months of weight loss period, conventional Doppler echocardiography revealed an improvement in diastolic functions with an increase in mitral E-wave, a decrease in mitral A-wave and an increase in E/A ratio. Deceleration time and isovolumetric relaxation time were ascertained shortened and Tei index decreased. TDE showed an increase in left ventricular lateral wall systolic wave (Sm) and E-wave velocity (Em). Mitral septal annular isovolumetric acceleration time (IVA), Sm and Em, were found to be increased, whereas Tei index was ascertained reduced. Right ventricular tissue Doppler examination following weight loss revealed an increase in RV- IVA, RV-Sm, and RV-Em, and a decrease in Tei index. CONCLUSION: We disclosed that left ventricular structural changes and diastolic dysfunction occur in obese patients, and by weight loss, these abnormalities may be reversible which we demonstrated both by conventional and TDE. In addition, obesity might impair RV function as well, and we observed an enhancement in right ventricular functions by weight loss.
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Ecocardiografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Obesidade/diagnóstico por imagem , Obesidade/prevenção & controle , Disfunção Ventricular/diagnóstico por imagem , Disfunção Ventricular/prevenção & controle , Adulto , Feminino , Humanos , Masculino , Obesidade/complicações , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Volume Sistólico , Resultado do Tratamento , Disfunção Ventricular/etiologia , Função Ventricular , Programas de Redução de PesoRESUMO
OBJECTIVE: An increased neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical prognosis in patients with cardiovascular disease. In this study, we aimed to investigate if there was a correlation between NLR and the risk of stroke in patients with intermediate carotid artery stenosis. METHODS: A total of 254 patients with a 50%-70% stenosis in the carotid artery, 115 of whom were symptomatic and 139 of whom were asymptomatic, were included in the study. Patients with a history of ischemic cerebrovascular event with or without sequelae, transient ischemic attack, and amaurosis fugax in the last 1-6 months were included in the symptomatic group of the study. The symptomatic and asymptomatic groups were compared in terms of total neutrophil count, lymphocyte count, and NLR. RESULTS: The total white blood cell count (WBC), neutrophil count, and NLR were found to be higher and the lymphocyte count was found to be lower in the symptomatic patients than those in the asymptomatic patients (symptomatic/asymptomatic, respectively, WBC [10(3)/mm(3)]: 9.0/8.2, neutrophil count [10(3)/mm(3)]: 6.1/5.0, NLR: 3.08/2.2, lymphocyte count [10(3)/mm(3)]: 1.9/2.2) (P < .001). The cutoff value for NLR was found to be 2.6 or higher. In the multivariate regression analysis, an NLR value of 2.6 or higher was shown to be an independent variable for carotid artery stenosis to become symptomatic. CONCLUSIONS: NLR is increased in symptomatic intermediate carotid artery stenosis. An increased NLR value is an independent variable for carotid artery plaques to become symptomatic.
Assuntos
Linfócitos/patologia , Neutrófilos/patologia , Acidente Vascular Cerebral/patologia , Idoso , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Tomógrafos Computadorizados , Ultrassonografia DopplerRESUMO
BACKGROUND: It is generally well-understood that iron-mediated cardiomyopathy is the major complication that can arise from beta thalassemia major (TM). Therefore, early diagnosis, risk stratification, and the effective treatment of beta TM patients are clinically important to optimize long-term positive outcomes. METHODS: This study included 57 beta TM patients with a mean age of 25 ± 7 years. We determined the serum ferritin level, echocardiography, heart rate recovery (HRR), and cardiac magnetic resonance (CMR) T2* in all patients. CMR T2* findings were categorized as normal myocardium (T2* > 20 ms), and myocardial involvement (T2* ≤ 20 ms). HRR values at 1-5 min (HRR1-5) were recorded; Subsequently. HRR was calculated by subtracting the heart rate at each time point from the heart rate at peak exercise. RESULTS: There was a significant negative correlation between the serum ferritin level and the cardiac T2* MRI findings (r = -0.34, p = 0.009). A similar result was found in the negative correlation between serum ferritin and all heart rate recovery values. There was a significant positive correlation between HRR1, HRR2, and HRR3 values, and CMR T2* (T2* heart rate recovery (HRR)1: r = 0.51, p < 0.001; T2* HRR2: r = 0.48, p < 0.001; T2* HRR3: r = 0.47, p < 0.001, respectively). CONCLUSIONS: The serum ferritin level and echocardiography can be used to predict the presence of myocardial iron load in beta TM patients. Therefore, HRR can be used to screen beta TM patients, and the clinical use of HRR can be a predictive marker for autonomic dysfunction in beta TM patients. KEY WORDS: Beta thalassemia major ⢠Cardiac magnetic resonance T2* ⢠Heart rate recovery ⢠Iron overload ⢠Serum ferritin level ⢠Tissue Doppler imaging.
RESUMO
BACKGROUND: The aim of this study was to assess the short and long-term effects of carotid artery stenting (CAS) procedure on blood pressure (BP) through ambulatory BP monitoring. METHODS: One hundred fifty three patients who underwent CAS for primary or secondary protection from December 2010 to September 2013 were enrolled to our study. The BP levels of total of 123 patients were monitored for 1 year. Thereafter, the pre-procedure levels of BP were compared with BP levels at the 24-hour and the first year intervals after the procedure. RESULTS: Systolic and diastolic BP levels at the 24-hour and the first year intervals after CAS were significantly lower than the pre-procedure BP levels. The mean 24-hour systolic BP was 113 ± 13 mmHg and diastolic BP was 63 ± 8 mmHg, both of which were significantly lower (p < 0.001 and p < 0.001 respectively), while the pre-procedure mean systolic BP was 133 ± 10 mmHg and the mean diastolic BP was 75 ± 9 mmHg. Moreover, the mean first-year systolic BP was 125 ± 10 mmHg with a decline of 8 ± 8 mmHg and mean diastolic BP was 71 ± 8 mmHg with a decline of 4 ± 7 mmHg, both of which were again significantly lower compared to the pre-procedure levels (p < 0.001 and p < 0.001 respectively). CONCLUSIONS: The results of our study suggested that systolic and diastolic BP levels diminished after CAS. Additionally, BP reduction continued even 1 year after the CAS.
RESUMO
Transcatheter aortic valve implantation (TAVI) is considered an alternative therapy in high-risk patients with severe aortic stenosis (AS). However, this minimally invasive procedure carries potential complications, such as valve embolization at time of TAVI. We present a case of balloon-expandable aortic valve embolization which was managed nonsurgically. Valve embolization was managed conservatively, as the patient refused open heart surgery for definitive treatment. The patient was transferred to the intensive care unit in stable hemodynamic condition and discharged 1 week following the procedure.
Assuntos
Embolia , Próteses Valvulares Cardíacas/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Ecocardiografia Transesofagiana , Embolia/etiologia , Embolia/patologia , Embolia/terapia , Fluoroscopia , Humanos , MasculinoRESUMO
BACKGROUND: There is some evidence suggesting increased risk of atrial fibrillation (AF) in patients with celiac disease (CD). Impaired left atrial function plays a significant role in the development of AF. This study aimed at assessing the electrical and mechanical functions of the left atrium in patients with CD. METHODS: A total of 71 patients with biopsy-proven, antibody-positive CD and 52 age-matched healthy controls were included in this prospective study. P-wave dispersion (PWD) was measured to assess the electrical functions of the left atrium through the use of surface electrocardiography. A tissue Doppler echocardiography was performed to determine the atrial conduction and electromechanical delay (EMD) time. To evaluate the mechanical functions of the left atrium, maximum, minimum, and presystolic atrial volumes were estimated to calculate the contractile, conduit, and reservoir functions. RESULTS: In terms of transthoracic echocardiographic parameters, CD and control subjects were not significantly different. However, as compared to controls, patients with CD had significantly increased PWD (median 52 ms [interquartile range 46-58 ms] vs. 38 [36-40], P < 0.001). Also, significantly higher interatrial (49 ms [32-60] vs. 26 ms [22-28], P < 0.001), intra-left atrial (26 ms [17-44] vs. 14 ms [12-18], P < 0.001), and intra-right atrial (15 ms [8-22] vs. 10 ms [8-14], P < 0.001) EMD was found among CD subjects than controls. Despite an increase in the left atrial volume in patients with CD, conduit and reservoir functions were comparable. CONCLUSIONS: Although atrial mechanical functions are preserved in patients with CD, a slower electrical conduction was found, suggesting an increased risk of AF in this group of patients.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Doença Celíaca/diagnóstico por imagem , Doença Celíaca/fisiopatologia , Adulto , Fibrilação Atrial/etiologia , Doença Celíaca/complicações , Ecocardiografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The relationship between arterial stiffness (AS) and atrial fibrillation (AF) incidence is well-known. In this study we aimed to investigate the relationship between AS parameters and AF occurence as well as AF recurrence post catheter ablation (CA) in patients with paroxysmal AF (PAF). METHODS: We enrolled 103 patients with PAF diagnosis and 103 control subjects with similar demographic characteristics. We measured AS parameters and central aortic pressure (CAP) parameters by an oscillometric device in both groups. In the patient group 51 patients underwent CA for AF and recurrence rates at 3 and 6 months postprocedurally were recorded. AS parameters were compared between patients with and without AF recurrence. RESULTS: In the PAF patient group central systolic pressure, central diastolic pressure, central pulse pressure, augmentation pressure, augmentation index, and pulse wave velocity were significantly higher than in the control group (for each listed parameter P<0.05). AS parameters were not associated with AF recurrence post CA. Left atrial size (LAS) was found as an independent predictor for recurrence in multivariate analysis (0: 2.30; P = 0.02; OR: 9.97; 95% CI [1.28-77.48]). CONCLUSION: Increased AS is associated with PAF occurence. Nevertheless, LAS, a traditional risk factor, was the most powerful predictor for recurrence post CA; whereas AS or CAP were not associated with recurrence.
Assuntos
Pressão Arterial , Fibrilação Atrial , Ablação por Cateter , Átrios do Coração/patologia , Rigidez Vascular , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Prognóstico , Análise de Onda de Pulso/métodos , Recidiva , Fatores de Risco , Turquia/epidemiologiaRESUMO
The most serious complication of carotid artery stenting (CAS) is acute carotid artery stent thrombosis (ACAST). ACAST is a very rare complication, but it may lead to dramatic and catastrophic consequences. The most important cause is inadequate or ineffective antiaggregant therapy. It is very important to identify, before CAS, those patients who might be candidates for ACAST and to start antiplatelet therapy for them. Testing patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may prevent this complication.
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Aspirina/uso terapêutico , Trombose das Artérias Carótidas/etiologia , Trombose das Artérias Carótidas/prevenção & controle , Inibidores da Agregação Plaquetária/uso terapêutico , Stents/efeitos adversos , Ticlopidina/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Trombose das Artérias Carótidas/complicações , Angiografia Cerebral , Clopidogrel , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ticlopidina/uso terapêuticoRESUMO
BACKGROUND: The frequency of patent foramen ovale (PFO) is greater in patients who have had a stroke and transient ischemic attack (TIA) than that in the general population. However, it is not well defined, which PFO would cause stroke or TIA. In this trial, we aimed to evaluate whether there was a difference regarding morphologic features of PFO in patients who were symptomatic (cryptogenic stroke or history of TIA) or asymptomatic according to the neurologic findings. METHODS: Symptomatic patients with PFO and cryptogenic stroke or TIA and asymptomatic patients with PFO who were symptomatic in terms of neurologic findings as well as patients without any neurologic symptoms in whom PFO was diagnosed incidentally by transesophageal echocardiography were enrolled to this retrospective study on the condition that they were aged younger than 55 years. Not only the clinical and demographic characteristics of 2 groups were compared but also their morphological features were assessed. The morphologic features of PFO that were assessed included the length and height of tunnel, atrial septal excursion distance, thickness of septum primum, and thickness of septum secundum. RESULTS: One hundred fifty-six patients, 64 of whom were symptomatic, were enrolled to this study. The height of PFO (median, 3.0 [interquartile range, 2.0-3.8]mm versus 2.0 [2.0-2.0]mm, P < .001), thickness of septum secundum (5.0 [5.0-7.0] versus 3.0 [2.0-3.0], P < .001), and septal excursion distance (7.0 [6.0-10.5] versus 4.0 [4.0-5.0], P < .001) were found to be greater in the symptomatic group than those in the asymptomatic group. There was no significant difference regarding the length of tunnel and thickness of septum primum. The ratio of length to height of PFO tunnel was less in the symptomatic group (3.0 [3.0-3.23] versus 5.0 [4.0-6.25], P < .001). CONCLUSIONS: Our findings appear to indicate that a higher PFO tunnel, relatively greater interatrial septal mobility, thicker septum pellucidum, and the presence of an atrial septal aneurysm may help identifying the subjects at the age of or younger than 55 years with PFO who are at greater risk for cryptogenic stroke or TIA.
Assuntos
Forame Oval Patente/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ataque Isquêmico Transitório/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: It is well known that nondipper blood pressure (BP) pattern is associated with an increased cardiovascular risk in hypertensive patients. The aim of this study is to observe whether carotid artery stent (CAS) procedure returns nondipper BP pattern to dipper pattern in hypertensive patients. METHODS: Ambulatory BP monitorization (ABPM) was performed in 152 hypertensive patients who underwent CAS procedure 1 day before, and 1 day and 1 year after the procedure. BP monitorization of patients was classified as dipper and nondipper. BP parameters 1 year after CAS procedure were compared with preprocedure parameters. RESULTS: According to baseline ambulatory BP follow-ups, a total of 152 hypertensive patients with 122 (80%) nondippers and 30 (20%) dippers were enrolled in this study. According to ABPM results 1 year after CAS procedure, 78 patients (64%) who had nondipper pattern at first transformed into dipper pattern and 44 patients (36%) remained to be nondippers. Moreover, 1 year after CAS procedure, 18 patients (60%) who had dipper pattern at first transformed into nondipper pattern and 12 patients (40%) remained as dippers. When BP follow-up values at 1 year after CAS procedure were compared with BP readings before the procedure, 78 patients (51%) who were nondipper before the procedure transformed into dipper pattern (P ≤ .01), whereas 44 patients (29%) with nondipper pattern remained to be nondippers (P = .01). Twelve patients (7.9%) who had dipper pattern remained to have dipper pattern (P = .768). Eighteen patients who had dipper pattern (12%) transformed into nondipper pattern after the procedure (P < .01). The total number of nondipper pattern patients before CAS procedure was 80.3% (122 patients), whereas this percentage dropped to 40.8% (62 patients) after the CAS procedure (P < .01). CONCLUSIONS: During 1-year follow-up after CAS procedure, nondipper BP pattern transforms into dipper pattern. This result might be attributed to the contributory effect of CAS procedure to long-term cardiovascular protection.
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Angioplastia/métodos , Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Hipertensão/cirurgia , Stents , Rigidez Vascular , Idoso , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estatísticas não ParamétricasRESUMO
Pregnancy is among the risk factors for mechanical valve thrombosis, and even though thrombolytic therapy is contraindicated during pregnancy, it may be used in the treatment of this life-threatening complication. This case report describes a pregnant patient, whose echocardiogram showed evident gradient increase on her mechanical prosthetic mitral valve, and who was treated successfully with tissue plasminogen activator for mechanical valve thrombosis.
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Próteses Valvulares Cardíacas , Valva Mitral/patologia , Complicações Cardiovasculares na Gravidez/diagnóstico , Trombose/diagnóstico , Adulto , Diagnóstico Diferencial , Dispneia/etiologia , Ecocardiografia Transesofagiana , Feminino , Humanos , Valva Mitral/diagnóstico por imagem , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Diagnóstico Pré-Natal , Terapia Trombolítica , Trombose/complicações , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológicoRESUMO
Electrocardiography alterations and cardiac enzyme elevation have been reported in patients with cerebrovascular events in various articles. This case reports a case of syncope with an electrocardiography of atrioventricular complete block and extensive ST segment elevation. However, it was finally diagnosed as subarachnoid hemorrhage. To the best of our knowledge, this patient is the first case of subarachnoid hemorrhage mimicking ST elevation myocardial infarction with atrioventricular complete block.
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Síndrome Coronariana Aguda/diagnóstico por imagem , Hemorragia Subaracnóidea , Diagnóstico Diferencial , Eletrocardiografia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/cirurgia , UltrassonografiaRESUMO
Vascular complications in transfemoral transcatheter aortic valve implantation are relatively frequent and there is increased morbidity and mortality risk in the procedure. This report presents successful surgical repair of a femoral artery thrombosis case following an implantation procedure.
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Estenose da Valva Aórtica/cirurgia , Artéria Femoral/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Trombose/diagnóstico , Angiografia , Estenose da Valva Aórtica/diagnóstico por imagem , Diagnóstico Diferencial , Falha de Equipamento , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/patologia , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Trombose/diagnóstico por imagem , Trombose/patologia , Trombose/cirurgia , UltrassonografiaRESUMO
Haemophilia is a congenital coagulation defect brought about by the deficiency or lack of coagulation factor IX. The prevalence of coronary artery disease and acute coronary syndrome (ACS) is lower among haemophiliacs than in the normal population. However, with the administration of factor concentrate, average life expectancy can now extend to as long as 70 years in patients with haemophilia, and this in turn is leading to an increase in the prevalence of cardiac diseases among this population. Data regarding a treatment protocol for ACS and percutaneous coronary intervention (PCI) in patients with congenital coagulation defects is limited. We report a 41-year-old male patient with haemophilia B who presented with a non-ST elevation myocardial infarction, and on whom PCI was performed following monitoring of factor IX levels. The patient had no cardiovascular risk factor except smoking.
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Síndrome Coronariana Aguda , Hemofilia B/complicações , Intervenção Coronária Percutânea/métodos , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/cirurgia , Adulto , Angiografia Coronária , Humanos , MasculinoRESUMO
OBJECTIVE: The aim of this trial was to investigate the impact of corrected balloon occlusive diameter (cBOD) on successful performance of percutaneous atrial septal defect (ASD) closure. METHODS: The trial comprised 86 patients (60 female, 26 male; mean age 36.5±14.3) on whom percutaneous ASD closure was performed. Patients were evaluated using transesophageal echocardiography (TEE). Relation of the defect to surrounding tissues and size of rims was also investigated. Balloon sizing was performed intraoperatively on all patients. Size of device was ascertained according to both durability of rims and whether or not they formed significant indentation, both of which determine cBOD. RESULTS: The ASD closure device was successfully implanted in 84 (97.5%) patients. Mean maximum defect size was 17.4±5.9 mm, and mean color flow diameter was 16.8±5.4 mm. Mean maximum defect size at the moment of loss of shunt flow was 18.4±5.9 mm with TEE, and 18.8±6.1 mm with fluoroscopy. Mean size of Amplatzer occluder device was 20.0±6.5 mm. Device embolization was observed in 2 patients. However, no death occurred during or after the procedure. CONCLUSION: Percutaneous secundum ASD closure is a safe and effective treatment modality in experienced centers. Utilizing corrected balloon occlusive diameter may be of benefit in deciding the size of ASD occluder device.
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Oclusão com Balão/instrumentação , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Adulto , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dispositivo para Oclusão Septal/efeitos adversos , Dispositivo para Oclusão Septal/estatística & dados numéricosRESUMO
OBJECTIVES: The effectiveness of carotid artery stenting (CAS) for primary and secondary prevention of ischemic stroke has been demonstrated. The aim of our study was the clinical and radiological evaluation of the reliability of the CAS procedure over a two-year follow-up period. STUDY DESIGN: This study included 120 patients (mean age, 68 (48-86) years) admitted to our hospital between December 2010 and March 2013 for whom CAS was decided in the neurology, cardiovascular surgery and cardiology council. Symptomatic cases with more than 50% stenosis by angiography and asymptomatic patients with stenosis of more than 70% were included in the study. 80% of the asymptomatic patients were those detected during the screening before the coronary bypass surgery. RESULTS: The success rate of the procedure was found as 97.5%. No mortality or myocardial infarction was observed in any of the patients in whom CAS was applied successfully. In 1 symptomatic patient (0.8%), ischemic cerebrovascular event with sequelae was observed 24 hours after the procedure. In total, transient ischemic attack was observed in 2 patients (1.7%) 6 and 11 months after the procedure. Asymptomatic restenosis was detected in 3 patients (2.5% of the total, with 2 in the asymptomatic and 1 in the symptomatic group). Symptomatic restenosis was not observed. None of the patients experienced hyperperfusion syndrome. CONCLUSION: We believe the CAS procedure can be performed safely in symptomatic and asymptomatic patients with low complication and high success rates.