ABSTRACT
Abstract The cardiac involvement of hydatid cyst, which is rarely seen, with the location of asymptomatic huge cyst in the interventricular septum (IVS) is an extraordinary condition. We report an isolated cardiac hydatid cyst located in the IVS in an 18-year-old man diagnosed incidentally by transthoracic echocardiography. Cardiac magnetic resonance imaging confirmed a mass lesion of 47×74 mm in diameter located at the base of IVS. The cystic content and its germinative membrane were resected and the cavity was applicated under cardiopulmonary bypass. Postoperative course was uneventful and the patient was discharged on the 6th postoperative day, with oral albendazole therapy.
Subject(s)
Humans , Male , Adolescent , Echinococcosis , Ventricular Septum , Magnetic Resonance Imaging , Echocardiography , AlbendazoleABSTRACT
Abstract Background: A subset of patients who take antiplatelet therapy continues to have recurrent cardiovascular events which may be due to antiplatelet resistance. The effect of low response to aspirin or clopidogrel on prognosis was examined in different patient populations. Objective: We aimed to investigate the prevalence of poor response to dual antiplatelet therapy and its relationship with major adverse cardiovascular events (MACE) in young patients with ST-elevation myocardial infarction (STEMI). Methods: In our study, we included 123 patients under the age of 45 with STEMI who underwent primary percutaneous intervention. A screening procedure to determine both aspirin and clopidogrel responsiveness was performed on the fifth day of admission. We followed a 2x2 factorial design and patients were allocated to one of four groups, according to the presence of aspirin and/or clopidogrel resistance. Patients were followed for a three-year period. A p-value less than 0.05 was considered statistically significant. Results: We identified 48% of resistance against one or more antiplatelet in young patients with STEMI. More MACE was observed in patients with poor response to dual platelet therapy or to clopidogrel compared those with adequate response to the dual therapy (OR: 1.875, 1.144-3.073, p < 0.001; OR: 1.198, 0.957-1.499, p = 0.036, respectively). After adjustment for potential confounders, we found that poor responders to dual therapy had 3.3 times increased odds for three-year MACE than those with adequate response to the dual therapy. Conclusion: Attention should be paid to dual antiplatelet therapy in terms of increased risk for cardiovascular adverse events especially in young patients with STEMI.
Resumo Fundamento: Um subgrupo de pacientes que recebem terapia antiplaquetária continua a apresentar eventos cardiovasculares recorrentes, possivelmente por resistência aos medicamentos. O efeito da baixa resposta à aspirina ou ao clopidogrel sobre o prognóstico foi avaliado em diferentes populações. Objetivo: Investigar a prevalência de baixa resposta à terapia antiplaquetária e sua relação com eventos adversos cardiovasculares em pacientes jovens com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCST). Métodos: Em nosso estudo, incluímos 123 pacientes com IAMCST e idade inferior a 45 anos, submetidos à intervenção percutânea primária. No quinto dia após admissão hospitalar, os pacientes foram rastreados quanto à capacidade de resposta à aspirina e ao clopidogrel. Seguimos um delineamento fatorial 2x2 e os pacientes foram alocados a um dos quatro grupos formados segundo presença de resistência à aspirina e/ou ao clopidogrel. Os pacientes foram acompanhados por um período de três anos. Um valor de P inferior a 0,05 foi considerado estatisticamente significativo. Resultados: Nós identificamos 48% de resistência a um ou mais agentes antiplaquetários em pacientes jovens com IAMCST. Houve maior ocorrência de MACE em pacientes com baixa resposta à terapia antiplaquetária dupla ou ao clopidogrel em comparação àqueles com resposta adequada à terapia dupla (OR: 1,875; 1,144-3,073; p < 0,001; OR: 1,198; 0,957-1,499; p = 0.036, respectivamente). Após ajuste quanto a possíveis fatores de confusão, pacientes com baixa resposta à terapia dupla apresentaram risco 3,3 vezes maior para MACE em três anos em comparação àqueles com resposta adequada a essa terapia. Conclusão: Atenção deve ser dada à resistência à terapia antiplaquetária dupla quanto ao risco aumentado de eventos adversos cardiovasculares, especialmente em pacientes jovens com IAMCST.