RESUMO
This report describes the first use of a new paravalvular leak (PVL) device designed specifically to close paravalvular mitral and paravalvular aortic leaks. The first patient had severe paravalvular mitral leak that was closed using the transapical route with a rectangular designed PVL device that has an oval waist for self-centering and the second patient had moderate paravalvular aortic leak that was closed with a square designed device that has a round waist for self-centering. Both patients had complete closure.
Assuntos
Valva Aórtica/cirurgia , Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/terapia , Valva Mitral/cirurgia , Adulto , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Desenho de Prótese , Radiografia Intervencionista , Resultado do TratamentoRESUMO
BACKGROUND: Structural remodeling is associated with the fibroinflammatory process in the atrial extracellular matrix. In the present study we aimed to investigate whether serum levels of new circulating remodeling markers differ in patients with atrial fibrillation (AF) compared to patients with sinus rhythm. MATERIAL AND METHODS: The study population included 52 patients diagnosed with non-valvular AF and 33 age-matched patients with sinus rhythm. Serum levels of Galectin-3, matrix metalloproteinase-9 (MMP-9), lipocalin-2 (Lcn2/NGAL), N-terminal propeptide of type III procollagen (PIIINP), Hs-Crp, and neutrophil-to-lymphocyte ratio (NLR) were measured. The left atrial volume (LAV) was calculated by echocardiographic method and LAV index was calculated. RESULTS: Galectin-3, MMP-9, and PIIINP levels were significantly higher in AF patients except NGAL levels (1166 pg/ml (1126-1204) and 1204 pg/ml (1166-1362) p=0.001, 104 (81-179) pg/ml and 404 (162-564) pg/ml p<0.0001, and 1101 (500-1960) pg/ml and 6710 (2370-9950) pg/ml p<0.0001, respectively). The NLR and Hs-CRP levels were also higher in AF (2.1 ± 1.0 and 2.7 ± 1.1 p=0.02 and 4.2 ± 1.9 mg/L and 6.0 ± 4.7 mg/L p=0.04, respectively). In correlation analyses, NLR showed a strongly significant correlation with LAVi, but Hs-CRP did not (p=0.007 r=0.247, Pearson test and p=0.808 r=0.025, Pearson test, respectively). Moreover, Galectin-3, MMP-9, and PIIINP had a strong positive correlation with LAVi (p=0.021 r=640, Spearman test and p=0.004 r=0.319 Pearson test, and p=0.004 r=0.325 Pearson test, respectively). CONCLUSIONS: Novel fibrosis and inflammation markers in AF are correlated with atrial remodeling. Several unexplained mechanisms of atrial remodeling remain, but the present study has taken the first step in elucidating the mechanisms involving fibrosis and inflammation markers.
Assuntos
Fibrilação Atrial/sangue , Fibrilação Atrial/fisiopatologia , Remodelamento Atrial , Biomarcadores/sangue , Valvas Cardíacas/fisiopatologia , Inflamação/sangue , Proteínas de Fase Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Proteína C-Reativa/metabolismo , Eletrocardiografia , Feminino , Fibrose , Valvas Cardíacas/patologia , Humanos , Inflamação/complicações , Inflamação/patologia , Lipocalina-2 , Lipocalinas/sangue , Masculino , Metaloproteinase 9 da Matriz/sangue , Pessoa de Meia-Idade , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue , Proteínas Proto-Oncogênicas/sangue , UltrassonografiaRESUMO
BACKGROUND: Levosimendan (LS) is a novel inodilator that improves cardiac performance, central hemodynamics, and symptoms of patients with decompensated chronic heart failure. The aim of this study was to compare the effects of single and repeated LS infusion on left ventricular performance, biomarkers, and neurohormonal activation in patients with acute heart failure. MATERIAL AND METHODS: Twenty-nine consecutive patients with acute exacerbation of advanced heart failure were included in this study. LS was initiated as a bolus of 6 µg/kg followed by a continuous infusion of 0.1 µg/kg/min for 24 hours in both groups who received intravenous single and repeated (baseline and at 1 and 3 months) treatment. Physical examination, echocardiography, and biochemical tests (brain natriuretic peptide, tumour necrosis factor-alpha, interleukin-1beta, 2, and 6) were performed before treatment and on 3 day of the treatment. The last evaluation was performed at 6 month after the baseline treatment. RESULTS: Twenty male and 9 female patients with mean age of 60.2 ± 7.4 years were included in this study. A significant improvement in New York Heart Association functional status and myocardial performance index was detected only in the repeated LS treated patients at 6 month compared to the pretreatment status (p=0.03 and p<0.001; respectively). In addition, a significant decrease in brain natriuretic peptide (p<0.01) and plasma interleukin-6 (p=0.05) levels were also achieved only in patients who were given repeated LS. CONCLUSIONS: Our study showed that repeated LS treatment is more effective compared to the single dose LS treatment in improving clinical status, hemodynamic and laboratory parameters in patients with acute exacerbation of advanced heart failure.
Assuntos
Biomarcadores/metabolismo , Insuficiência Cardíaca/tratamento farmacológico , Ventrículos do Coração/efeitos dos fármacos , Hidrazonas/farmacologia , Piridazinas/farmacologia , Vasodilatadores/farmacologia , Idoso , Relação Dose-Resposta a Droga , Ecocardiografia , Feminino , Humanos , Hidrazonas/administração & dosagem , Hidrazonas/uso terapêutico , Infusões Intravenosas , Interleucina-1beta/metabolismo , Interleucina-2/metabolismo , Interleucina-6/metabolismo , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/metabolismo , Piridazinas/administração & dosagem , Piridazinas/uso terapêutico , Simendana , Fator de Necrose Tumoral alfa/metabolismo , Turquia , Vasodilatadores/administração & dosagem , Vasodilatadores/uso terapêuticoRESUMO
BACKGROUND: Cardiac involvement in sarcoidosis has been associated with poor prognosis. We evaluated myocardial contractility quantitatively in a cohort of pulmonary sarcoidosis (PS) patients with and without cardiac involvement. We also studied markers of fibrosis (tenascin-C [Tn-C] and galectin-3 [Gl-3]) as diagnostic tools for PS and cardiac sarcoidosis (CS). METHODS: Forty ambulatory patients with PS of grades 1-2 and 26 healthy subjects were prospectively enrolled. All patients with PS underwent cardiac magnetic resonance (CMR) to explore the presence of CS. The study population was divided into three groups: controls (n = 26), non-CS patients (n = 34), and CS patients (n = 6). Speckle-tracking strain echocardiography (STE) was performed on all patients, and Gl-3 and Tn-C values were measured in all patients and controls. RESULTS: PS patients had higher levels of Gl-3 and Tn-C than did controls, and the STE parameters of PS patients, including global longitudinal strain (GLS) and global circumferential strain (GCS), were lower than those of controls (p < 0.001 for all comparisons). GLS values were lower in CS patients than in the other groups (p = 0.05). CONCLUSIONS: PS patients demonstrate reduced cardiac contractility, independent of CMR-proven structural cardiac lesions, while patients with structural lesions have a more pronounced drop in strain parameters. Tn-C and Gl-3 are promising markers for the diagnosis of PS, but they are not specific for cardiac involvement.
Assuntos
Cardiomiopatias/diagnóstico , Ecocardiografia Doppler , Ecocardiografia Tridimensional , Galectina 3/sangue , Contração Miocárdica , Sarcoidose Pulmonar/diagnóstico , Sarcoidose/diagnóstico , Tenascina/sangue , Adulto , Biomarcadores/sangue , Proteínas Sanguíneas , Cardiomiopatias/sangue , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Estudos de Casos e Controles , Estudos de Viabilidade , Feminino , Fibrose , Galectinas , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sarcoidose/sangue , Sarcoidose/diagnóstico por imagem , Sarcoidose/fisiopatologia , Sarcoidose Pulmonar/sangue , Sarcoidose Pulmonar/diagnóstico por imagem , Sarcoidose Pulmonar/fisiopatologiaRESUMO
OBJECTIVES: Little is known about whether estimated glomerular filtration rates (eGFR) affect left ventricular (LV) function and gain benefit with antiremodeling treatment in patients with ST-elevation myocardial infarction (STEMI). We investigated the effect of eGFR on LV function using tissue Doppler imaging (TDI) parameters. In addition, we sought to evaluate the antiremodeling effect of standard treatment at follow-up in patients with renal insufficiency (RI) after STEMI. METHODS AND RESULTS: A retrospective analysis of 579 patients with STEMI was performed. Patients were divided into 3 groups according to eGFR (Group 1: eGFR > 90 mL/min per 1.73 m(2); Group 2: eGFR = 60-89 mL/min per 1.73 m(2); Group 3: eGFR < 60 mL/min per 1.73 m(2)). Conventional echocardiography and TDI were performed within 48-72 hours after STEMI and at 6-month follow-up. The mean left ventricular ejection fraction (LVEF) was significantly lower in Group 3 than in Group 1 (P = 0.021). The mean peak systolic velocity (Sm) was significantly lower in Group 3 than in Group 1 and Group 2 (P = 0.002 and 0.006, respectively). The estimated GFR had a linear association with Sm and LVEF (P = 0.001, r = 0.161; P = 0.005, r = 0.132, respectively). Multivariate analysis showed that an eGFR < 60 mL/min per 1.73 m(2) was an independent predictor of lower Sm and in-hospital mortality. In addition, an antiremodeling effect of standard treatment was seen in all groups at 6-month follow-up. CONCLUSIONS: Estimated glomerular filtration rate of <60 mL/min per 1.73 m(2) was associated with lower LV function after STEMI, and may gain an antiremodeling effect with standard treatment at follow-up.
Assuntos
Ecocardiografia Doppler de Pulso/métodos , Eletrocardiografia , Taxa de Filtração Glomerular/fisiologia , Infarto do Miocárdio/terapia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Angioplastia Coronária com Balão/métodos , Estudos de Coortes , Intervalos de Confiança , Angiografia Coronária , Ecocardiografia/métodos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/diagnóstico por imagem , Razão de Chances , Valor Preditivo dos Testes , Estudos Retrospectivos , Volume Sistólico/fisiologia , Remodelação Ventricular/fisiologiaRESUMO
OBJECTIVES: Psoriasis vulgaris is one of the most common skin disorders. Patients with psoriasis carry an excessive risk of coronary artery disease. Visceral adipose tissue around the heart affects the heart and coronaries by secreting proatherogenic mediators. It can be evaluated easily by measurement of epicardial fat thickness (EFT). The aim of this study was to investigate EFT in patients with psoriasis vulgaris. STUDY DESIGN: One hundred and fifteen adult patients (62 male; mean age 33.6±6.0 years) with psoriasis vulgaris (Group 1) and 60 age- and sex-matched healthy individuals (28 male; mean age, 32.5±8.3 years) (Group 2) were included in this study. EFT was obtained by transthoracic echocardiography. Disease-specific characteristics of the patients were recorded. Serum glucose, lipid profile and high-sensitive C-reactive protein (hs-CRP) levels were measured. RESULTS: EFT and hs-CRP were significantly higher in Group 1 than in Group 2 (5.7±1.2 vs. 4.1±1.0 mm, p<0.001 and 0.52±0.45 mg/dl vs. 0.19±0.17 mg/dl, p<0.001, respectively). The psoriasis disease activity score and hs-CRP were found to be independent predictors of EFT in patients with psoriasis vulgaris (ß=0.21, t=2.67, p=0.01 and ß=0.62, t=7.72, p=0.001, respectively). CONCLUSION: Our findings indicate that EFT was significantly higher in patients with psoriasis vulgaris compared with the controls. It was more prominent in patients with severe disease.
Assuntos
Gordura Intra-Abdominal/fisiologia , Pericárdio/fisiologia , Psoríase/epidemiologia , Psoríase/fisiopatologia , Adulto , Índice de Massa Corporal , Peso Corporal , Proteína C-Reativa/análise , Estudos de Casos e Controles , Feminino , Humanos , Lipídeos/sangue , Masculino , Adulto JovemRESUMO
BACKGROUND: Postdilatation (PD) with noncompliant balloon during elective percutaneous coronary intervention (PCI) is performed usually in clinical practice in order to optimize stent expansion. However, current knowledge about its use in patients undergoing primary PCI is controversial. This study aims to evaluate the angiographical and clinical results of PD in patients who underwent primary PCI with drug eluting stents (DESs). METHODS: A total of 405 consecutive patients (mean age 56.9 ± 12.3 years; 302 male) with ST elevation myocardial infarction were evaluated retrospectively. Patients received DES with or without predilatation according to physician's discretion. Eligible patients were divided into 2 groups based on PD procedure. The clinical end-points were death, target vessel revascularization (TVR) and stent thrombosis at 6 months after PCI. The angiographic end-points were postprocedural correct Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC), final TIMI flow, and myocardial blush grade (MBG). RESULTS: PD was performed in 214 patients (52.8%). Angiographical parameters such as TIMI flow, cTFC, and MBG did not differ after PD (P>0.05). During 6-month follow-up, TVR and stent thrombosis rates were lower in the PD group (6 vs. 16, P=0.03; and 3 vs. 10, P=0.04, respectively). PD and diabetes were detected as independent predictors of MACE (ß=0.52, P=0.01, and ß=-0.47, P=0.02; respectively). CONCLUSION: Our study revealed that PD does not yield adverse effects on final angiographic parameters when performed during primary PCI. Besides PD seems to decrease probability of stent thrombosis and TVR.
Assuntos
Angioplastia Coronária com Balão , Stents Farmacológicos , Infarto do Miocárdio/terapia , Adulto , Idoso , Angiografia Coronária , Trombose Coronária/prevenção & controle , Angiopatias Diabéticas/terapia , Dilatação , Stents Farmacológicos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
INTRODUCTION: Red cell distribution width (RDW) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of RDW in prediction of new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG). We aimed to investigate the relation between the RDW and postoperative AF in patients undergoing CABG. METHODS: A total of 132 patients undergoing nonemergency CABG were included in the study. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. We retrospectively analyzed 132 consecutive patients (mean age, 60.55 ± 9.5 years; 99 male and 33 female). The RDW level was determined preoperatively and on postoperative Day 1. RESULTS: Preoperative RDW levels were significantly higher in patients who developed AF than in those who did not (13.9 ± 1.4 vs. 13.3 ± 1.2, p = 0.03). There was not any correlation between postoperative RDW levels and AF. Using a cutpoint of 13.45, the preoperative level correlated with the incidence of AF with a sensitivity of 61% and specificity of 60%. CONCLUSION: Preoperative RDW level predicts new-onset AF after CABG in patients without histories of AF.
Assuntos
Fibrilação Atrial/etiologia , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Índices de Eritrócitos , Idoso , Área Sob a Curva , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Distribuição de Qui-Quadrado , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis have excess risk of essential hypertension. Masked hypertension (MH), defined as normal office blood pressure (BP) with elevated ambulatory BP (ABPM), has been drawing attention recently due to its association with increased risk of developing sustained hypertension, cardiovascular morbidity, and mortality. The aim of this study was to investigate the prevalence of MH in psoriatic patients. MATERIAL AND METHODS: On hundred and ten middle-aged, normotensive, non-obese patients with psoriasis vulgaris and 110 age- and sex-matched normotensive controls were included in the study. ABPM was performed in all participants over a 24-h period. The clinical severity of the disease was determined according to current indexes. RESULTS: The prevalence of MH among subjects with psoriasis vulgaris was 31.8% and increased compared to control subjects (p<0.01). Predictors of MH in patients with psoriasis vulgaris were detected as male sex, smoking, obesity-related anthropometric measures, and disease activity. Male sex, waist circumference, and diffuse psoriatic involvement were detected as independent predictors of MH. CONCLUSIONS: MH is prevalent in patients with psoriasis vulgaris. Assessment with ABPM and close follow-up for development of hypertension is reasonable.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão Mascarada/complicações , Hipertensão Mascarada/fisiopatologia , Psoríase/complicações , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Modelos Logísticos , Masculino , Hipertensão Mascarada/epidemiologia , Prevalência , Psoríase/epidemiologia , Turquia/epidemiologia , Adulto JovemRESUMO
BACKGROUND: QT dispersion (QTd), which is a measure of inhomogeneity of myocardial repolarization, increases following impaired myocardial perfusion. Its prolongation may provide a suitable substrate for life-threatening ventricular arrhythmias. We investigated the changes in QTd and heart rate variability (HRV) parameters after successful coronary artery revascularization in a patient with chronic total occlusions (CTO). MATERIAL/METHODS: This study included 139 successfully revascularized CTO patients (118 men, 21 women, mean age 58.3±9.6 years). QTd was measured from a 12-lead electrocardiogram and was defined as the difference between maximum and minimum QT interval. HRV analyses of all subjects were obtained. Frequency domain (LF: HF) and time domain (SDNN, pNN50, and rMSSD) parameters were analyzed. QT intervals were also corrected for heart rate using Bazett's formula, and the corrected QT interval dispersion (QTcd) was then calculated. All measurements were made before and after percutaneous coronary intervention (PCI). RESULTS: Both QTd and QTcd showed significant improvement following successful revascularization of CTO (55.83±14.79 to 38.87±11.69; p<0.001 and 61.02±16.28 to 42.92±13.41; p<0.001). The revascularization of LAD (n=38), Cx (n=28) and RCA (n=73) resulted in decrease in HRV indices, including SDDN, rMSSD, and pNN50, but none of the variables reached statistical significance. CONCLUSIONS: Successful revascularization of CTO may result in improvement in regional heterogeneity of myocardial repolarization, evidenced as decreased QTcd after the PCI. The revascularization in CTO lesions does not seem to have a significant impact on HRV.
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Transtornos Cerebrovasculares/terapia , Frequência Cardíaca/fisiologia , Revascularização Miocárdica/métodos , Sístole/fisiologia , Idoso , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Estudos ProspectivosRESUMO
BACKGROUND: The polycystic ovary syndrome (PCOS) is associated with various cardiac manifestations including cardiac arrhythmias. P-wave dispersion (Pdis) is an appealing marker for predicting the risk of developing atrial arrhythmias. The purpose of this study was to evaluate P-wave durations and Pdis in patients with PCOS. METHODS: Forty adult patients with PCOS and 46 age- and sex-matched healthy individuals were included in this study. P-wave maximum duration (Pmax) and P-wave minimum duration (Pmin) were calculated on the 12-lead electrocardiogram, and the difference between the Pmax and the Pmin was defined as Pdis. All individuals also underwent transthoracic echocardiographic evaluation. RESULTS: Pmax and Pdis were significantly higher in patients with PCOS compared with controls (p = 0.007, p < 0.001, respectively). There was no difference in Pmin duration between both the groups (p = 0.2). Waist-to-hip ratio, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were higher in the PCOS group. Early mitral inflow deceleration time (DT) (p < 0.001) and isovolumetric relaxation time (p = 0.003) were longer in PCOS group. Waist-to-hip ratio, DT, E/A ratio and diastolic blood pressure correlated with Pdis. CONCLUSIONS: Patients with PCOS have prolonged Pmax and Pdis. The increase in those parameters may be an indicator for identification of patients at increased risk of atrial fibrillation.
Assuntos
Arritmias Cardíacas/etiologia , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/fisiopatologia , Adulto , Arritmias Cardíacas/epidemiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Síndrome do Ovário Policístico/epidemiologia , Fatores de Risco , Circunferência da Cintura , Relação Cintura-Quadril , Adulto JovemRESUMO
BACKGROUNDS: Little is known about the effect of the estimated glomerular filtration rate (eGFR) on the periprocedural myocardial infarction (PMI). The aim of this study was to determine an eGFR value that is related with PMI development in patients with stable angina undergoing elective percutaneous coronary intervention (PCI). METHOD: A retrospective analysis was conducted of 257 consecutive PCI patients with stable angina pectoris. The patients were divided into three groups according to eGFR: Group 1: eGFR > 90 mL/min/1.73 m(2), Group 2: eGFR = 60-89 mL/min/1.73 m(2), and Group 3: eGFR = 30-59 mL/min/1.73 m(2). Cardiac biomarkers were measured before, at 8, and at 24 h after the procedure. RESULTS: Periprocedural myocardial infarction occurred in 19% of the study patients. The frequency of PMI was 13.8% in group 1, 15.2% in group 2, and 35% in group 3 (p = 0.002). There was an inverse relationship with increasing cardiac biomarkers and decreasing eGFR values. Multiple regression analysis showed that an eGFR value between 30 and 59 mL/min/1.73 m(2) was an independent variable that significantly affected PMI development after PCI. CONCLUSIONS: An estimated glomerular filtration rate between 30 and 59 mL/min/1.73 m(2) is a predictor of developing PMI after elective PCI in patients with stable angina pectoris.
Assuntos
Angina Estável/cirurgia , Taxa de Filtração Glomerular , Infarto do Miocárdio , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Biomarcadores/sangue , Creatina Quinase Forma MB/sangue , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Avaliação de Processos e Resultados em Cuidados de Saúde , Intervenção Coronária Percutânea/métodos , Período Perioperatório/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Turquia/epidemiologiaRESUMO
Ortner's syndrome results in hoarseness caused by compression of the left laryngeal recurrent as a result of cardiovascular pathology. A wide range of cardiovascular such as valvular heart disease, thoracic aortic aneurysm and congenital heart disease may result in Ortner's syndrome. We present a case of Ortner's syndrome caused by a large diameter (120 mm) aneurysm, previously unreported in the literature. A male patient aged 71 years was admitted to our clinic for exertional dyspnea, asthenia and hoarseness. In the indirect laryngoscopic examination, left vocal cord paralysis of the patient was observed and his chest X-ray revealed a mass with a diameter of 120 mm that filled the left upper zone. A dissected aortic aneurysm 120 mm in diameter in arcus level at thorax was seen in CT imaging. Surgical treatment was suggested; however, the patient refused treatment and died at the 4th month of the follow up period.
Assuntos
Aneurisma Aórtico/complicações , Dissecção Aórtica/complicações , Rouquidão/etiologia , Paralisia das Pregas Vocais/etiologia , Idoso , Dissecção Aórtica/diagnóstico , Aneurisma Aórtico/diagnóstico , Astenia/etiologia , Dispneia/etiologia , Evolução Fatal , Humanos , Masculino , Síndrome , Recusa do Paciente ao TratamentoRESUMO
OBJECTIVES: We report our initial experience with thrombectomy devices in patients with acute ischemic stroke. STUDY DESIGN: Demographic, clinical, and angiographic findings of 19 consecutive patients (7 females and 12 males; mean age 61.4±12.5 years) with acute ischemic stroke were evaluated retrospectively. RESULTS: The mean initial National Institutes of Health Stroke Scale (NIHSS) score was 19.5±5.6. Middle cerebral artery was the occluded artery in all of the patients (proximal occlusion in 11, distal in 8 and tandem occlusions in 7 patients). Successful revascularization was achieved in 16 patients (84%). The mean NIHSS score was 8.4±8.2 at 24 hours after the procedure, and 60% of patients showed a modified Rankin scale score of ≤2 at 90 days. New occlusion by migrated emboli was observed in 2 (11%) cases. None of the patients had experienced post-procedural symptomatic intracerebral hemorrhage; 3 patients died during the three-month follow-up. In all patients, thrombectomy was performed with retrievable Solitaire AB stent system. CONCLUSION: This single-center experience with mechanical thrombectomy devices demonstrated that high success rates can be achieved by experienced interventional cardiologists in equipped cath labs throughout the country.
Assuntos
Procedimentos Endovasculares/instrumentação , Acidente Vascular Cerebral/cirurgia , Trombectomia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/métodos , Feminino , Humanos , Infarto da Artéria Cerebral Média/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Stents , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/métodosRESUMO
A 33-year-old woman was referred to our echocardiography laboratory because of loud murmur at the apex. Transthoracic and transesophageal echocardiography (TTE and TEE) showed a mass involving the anterior leaflet of the mitral valve. Real time three-dimensional TEE (RT3D TEE) images clearly showed the nodular, irregular and large size of the mass. Based on her laboratory findings and the echocardiographic appearance of the mass, Libman-Sacks endocarditis was prediagnosed. In intraoperative inspection, a large nodular tumor was shown on the atrial side of the anterior mitral valve leaflet. In this case, RT3D TEE is better than all echocardiographic imaging modalities in evaulating vegetation of Libman-Sacks endocarditis.
Assuntos
Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Endocardite/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Adulto , Sistemas Computacionais , Feminino , HumanosRESUMO
Warfarin sodium is an antithrombin agent used in patients with prosthetic valve and atrial fibrillation. However, there are many factors that can change the effectiveness of the drug. Today, herbal mixtures promoted through targeted print and visual media can lead to sudden activity changes in patients using warfarin. In this case report we will present two cases with a sudden rise in INR due to using combination of Tribulus terrestris, Avena sativa and Panax ginseng (Panax Clavis). Two patients who used warfarin due to a history of aortic valve replacement (case 1) and atrial fibrillation (case 2) were admitted to the hospital due very high levels of INR detected during routine follow-up. Both patients had used an herbal medicine called ''Panax'' during the last month. The patients gave no indication regarding a change in diet or the use of another agent that might interact with warfarin. In cases where active bleeding could not be determinated, we terminated the use of the drug and re-evaluated dosage of warfarin before finally discharging the patient.
Assuntos
Anticoagulantes/uso terapêutico , Avena/efeitos adversos , Interações Ervas-Drogas , Panax/efeitos adversos , Tribulus/efeitos adversos , Varfarina/uso terapêutico , Idoso , Valva Aórtica , Fibrilação Atrial/tratamento farmacológico , Avena/química , Próteses Valvulares Cardíacas , Hemorragia/etiologia , Humanos , Coeficiente Internacional Normatizado , Masculino , Panax/química , Tribulus/químicaRESUMO
Nowadays, herbal combinations are commonly used in Turkey and around the world. In particular, an herbal combination including Tribulus terrestris (TT), Avena sativa (AS), and Panax Ginseng (PG), which may be effective in treatment of atherosclerosis and thrombosis, is used by patients with coronary artery disease. In this paper, we will report three cases with coronary stents who were diagnosed with acute coronary syndrome while using this herbal combination of TT, AS and PG together with anti-aggregant medications. A 45-year-old man presented with chest pain and coronary angiography confirmed a total occluded stent in left anterior descending artery which was implanted a year ago. Balloon dialation was performed to dilate the stent, resulting in full opening of the vessel. The second case, a 53-year-old woman, was admitted to the hospital with chest pain. Coronary angiography confirmed a total occluded stent, which had been implanted three months ago. A balloon was performed to dilate the stent and it was fully opened. The third case, a 62-year-old man, presented with chest pain. Coronary angiography was performed and there was a 98% stenosis of the circumflex stent, which was implanted three months ago. A balloon was performed to dilate the stent and it was fully opened. It was learnt that all three patients had used the same herbal combination (TT, AS and PG) with dual anti-aggregant therapy for three months ago to presentation in the clinic. Patients were discharged with the suggestion not to use this herbal combination with dual anti-aggregant therapy. There were no problems during the four month follow-up period. Stent thrombosis may be caused by interactions between herbal combination (TT, AS and PG) and clopidogrel in these patients under dual antiaggregant therapy.
Assuntos
Síndrome Coronariana Aguda/etiologia , Avena/efeitos adversos , Panax/efeitos adversos , Stents , Trombose/etiologia , Tribulus/efeitos adversos , Angioplastia Coronária com Balão , Aspirina/uso terapêutico , Dor no Peito , Clopidogrel , Angiografia Coronária , Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêuticoRESUMO
We report on a 43-year-old woman who presented with shortness of breath and syncope due to massive pulmonary embolism. Transthoracic echocardiography showed signs of right ventricular overload, and contrast-enhanced chest computed tomography demonstrated filling defects in both main pulmonary arteries consistent with obstructing thrombi. Initially, thrombolytic therapy with recombinant tissue plasminogen activator was given, but shock was not resolved. Thrombolytic therapy was repeated with streptokinase and infusion was extended to 48 hours, which yielded a successful result without any hemorrhagic complication. Repeated prolonged thrombolytic therapy after initial unsuccessful thrombolysis can be considered an alternative option in massive pulmonary embolism.