A rare cause of intracardiac mass Caldentey, Guillem, MD; Flores, Eduardo, MD; Antonio, Rodolfo San, MD ...
International journal of cardiology,
11/2016, Letnik:
223
Journal Article
Giant Left Atrium as a Rare Cause of Dysphagia Flores Umanzor, Eduardo Josué, MD; Mimbrero, Maria, MD; San Antonio, Rodolfo, MD ...
The American journal of medicine,
12/2016, Letnik:
129, Številka:
12
Journal Article
Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is an infrequent finding. Revascularization is recommended in the presence of demonstrated viability or ischemia. Coronary artery ...bypass grafting (CABG) has long been considered the preferred option. Patients with previous CABG due to LMCA disease with occlusion of one graft and progression of the LMCA to CTO constitute a special population, as just one ischemic artery remains. For these patients, there is no other option for revascularization other than cardiac surgery (requiring resternotomy) or percutaneous coronary intervention (PCI) of the LMCA.
Out of 620 patients with CTO diagnosed in our center, we identified five with previous CABG due to LMCA disease for a retrospective case series. They had occlusion of one graft and progression of the LMCA to CTO. All five underwent PCI. Each patient received a functional classification for angina, myocardial ischemic tests, and a follow-up coronary angiogram during a median follow-up of 63 months. Coronary angiogram showed CTO of the semi-protected LMCA lesions with two CABGs previously performed in all patients, one occluded and the other patent. Three patients had occluded saphenous vein grafts to the circumflex coronary artery, and the rest had left internal mammary artery-left anterior descending artery CABG failure. Ischemia and viability were demonstrated. Surgery was ruled out due to high surgical risk. PCI due to CTO of the LMCA with drug-eluting stents was performed. In a five-year follow-up period, four patients remained asymptomatic and event free. One post-PCI death occurred from non-cardiovascular cause.
PCI due to CTO of the LMCA following CABG can be successful and safe and can provide sustained clinical improvements in selected cases.
A oclusão crónica total (OCT) do tronco comum (TC) coronário é um achado pouco frequente. A revascularização é recomendada na presença de viabilidade ou de isquemia comprovada. A coronary artery bypass grafting (CABG) tem sido durante muito tempo a opção preferencial. Os doentes com CABG prévia devida a doença do TC com oclusão de um enxerto e progressão para oclusão crónica total do tronco comum constituem uma população especial, uma vez que fica apenas uma artéria com isquemia. Para esses doentes não existe outra opção de revascularização além da cirurgia cardíaca – com necessidade de reesternotomia – ou a intervenção coronária percutânea do tronco comum.
Dos 620 doentes com oclusões coronárias totais diagnosticadas no nosso centro, identificamos como séries de casos retrospetivos, cinco com CABG prévia devida a doença do TC, que tinham uma oclusão de um enxerto e progressão da doença do TC para oclusão crónica total. Os cinco foram submetidos a intervenção coornária percutânea (ICP). Cada doente recebeu a classificação funcional de angina, de testes de isquemia do miocárdio e o seguimento com angiografía coronária durante o tempo médio de 63 meses de seguimento. O angiograma coronário mostrou oclusão coronária total das lesões semiprotegidas do TC com duas pontagens previamente feitas em todos os doentes, uma ocluída e a outra permeável. Três doentes tinham enxertos de veia safena para a artéria coronária circunflexa (Safena-CX) ocluídos e os restantes tinham insuficiência da pontagem com mamária interna esquerda para a artéria coronária descendente anterior (MIE-DA). Foi demonstrada isquemia ou viabilidade. A opção cirúrgica foi recusada devido ao elevado risco cirúrgico. Foi feita a ICP da oclusão coronária total do TC com stents revestidos de fármaco. Em cinco anos de seguimento, quatro doentes permaneceram assintomáticos e livres de eventos. Ocorreu uma morte após ICP devido a causa não cardiovascular.
A ICP de oclusão crónica total do TC após CABG pode ser bem-sucedida, segura, e pode fornecer melhorias clínicas mantidas em casos selecionados.
Objectives This study sought to assess the prognostic value of physical examination in a modern treated heart failure population. Background The physical examination is the cornerstone of the ...evaluation and monitoring of patients with heart failure. Yet, the prognostic value of congestive signs (i.e., peripheral edema, jugular venous distension, a third heart sound, and pulmonary rales) has not been assessed in the current era. Methods A post-hoc analysis was conducted on all 1,376 patients, 81% male, mean age 67 ± 11 years, with symptomatic left ventricular systolic dysfunction enrolled in the AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial. The prognostic value of baseline physical examination findings was assessed in univariate and multivariate Cox regression analyses. Results Peripheral edema was observed in 425 (30.9%), jugular venous distension in 297 (21.6%), a third heart sound in 207 (15.0%), and pulmonary rales in 178 (12.9%) patients. Death from cardiovascular causes occurred in 357 (25.9%) patients over a mean follow-up of 37 ± 19 months. All 4 physical examination findings were associated with cardiovascular mortality in univariate analyses (all p values <0.01). In multivariate analyses, taking all 4 signs as potential covariates, only rales (hazard ratio 1.41; 95% confidence interval: 1.07 to 1.86; p = 0.013) and peripheral edema (hazard ratio: 1.25; 95% confidence interval: 1.00 to 1.57; p = 0.048) were associated with cardiovascular mortality, independent of other variables. Conclusions In the modern era, congestive signs on the physical examination (i.e., peripheral edema, jugular venous distension, a third heart sound, and pulmonary rales) continue to provide important prognostic information in patients with congestive heart failure.
Therapeutic hypothermia has been associated with an increase in thrombotic events, but this point has not been fully clarified. Most patients undergoing therapeutic hypothermia in a cardiac ICU ...receive antithrombotic treatment, usually in the context of ischemic heart disease. But, what should we do if our patient does not need antithrombotic treatment for any reason? After this case, doubts arise on the need to use an anti-thrombotic treatment on all patients subjected to therapeutic hypothermia in the context of aborted cardiac arrest
In the era of primary percutaneous coronary intervention, mechanical complications after acute myocardial infarction are extremely rare, with an incidence of less than 0.5%. Rupture of the ...ventricular septum is the least frequent occurrence. Nevertheless, current mortality remains high and a prompt diagnosis and treatment are imperative to increase survival. Despite early surgical repair, mortality still remains high.
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