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1.
Gac. méd. Méx ; 157(2): 166-173, mar.-abr. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1279097

ABSTRACT

Resumen Introducción: Distintos protocolos de angiotomografía de coherencia óptica evalúan la mácula. Objetivo: R2) entre las densidades vascular y de perfusión de dos protocolos de angiotomografía de coherencia óptica, para determinar si sus mediciones podían intercambiarse. Método: Estudio observacional, comparativo, prospectivo, transversal entre dos protocolos de angiotomografía de coherencia óptica (AngioPlex, Zeiss) en sujetos sanos. Se identificó la R2 entre las densidades vascular y de perfusión central, interna y completa (protocolo de 3 x 3 mm), y central, interna, externa y completa (protocolo de 6 x 6 mm). Resultados: 78 ojos, mediana de edad 23 años. Hubo R2 altas entre las densidades interna y completa del protocolo de 3 x 3 mm (0.96), externa y completa del de 6 x 6 mm (0.96), y centrales vasculares y de perfusión (≥ 0.96); la R2 entre las densidades centrales vascular y de perfusión de distintos protocolos fue ≤ 0.71. Conclusiones: Las densidades vasculares y de perfusión tienen R2 alta dentro de un protocolo, pero no entre protocolos, porque estos miden preferentemente zonas distintas, lo cual limita intercambiar mediciones.


Abstract Introduction: Different optical coherence tomography angiography (OCTA) scanning protocols evaluate the macula. Objective: To compare the determination coefficients (R2) between vessel and perfusion densities of two OCTA scanning protocols, to learn whether their metrics could be interchanged. Method: Non-experimental, comparative, prospective, observational, cross-sectional study, between two OCTA scanning protocols (Angioplex, Zeiss) in healthy subjects. We found the R2 between central, inner, and full densities (3 x 3 mm protocol), and between central, inner, outer and full densities (6 x 6 mm protocol), both for vessel and perfusion densities. Results: 78 eyes, median age 23 years. There were high R2 between inner and full densities in the 3 x 3 mm protocol (0.96), between outer and full densities in the 6 x 6 mm protocol (0.96) and between central vessel and perfusion densities (≥0.96); R2 between central vessel and perfusion densities of different protocols (≤0.71). Conclusions: Vessel and perfusion densities have high determination coefficients within a scanning protocol, but not between protocols, because each preferentially measures different macular areas. The metrics of different protocols should not be interchanged for follow-up.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Angiography/methods , Tomography, Optical Coherence/methods , Macula Lutea/blood supply , Regional Blood Flow/physiology , Blood Vessels/diagnostic imaging , Visual Acuity , Cross-Sectional Studies , Prospective Studies , Statistics, Nonparametric , Healthy Volunteers , Macula Lutea/diagnostic imaging
2.
Rev. bras. oftalmol ; 79(6): 403-405, nov.-dez. 2020. graf
Article in Portuguese | LILACS | ID: biblio-1156169

ABSTRACT

Resumo Retinopatia externa oculta zonal aguda (AZOOR) foi descrita pela primeira vez por Gass em 1993 como uma síndrome com perda rápida de uma ou mais zonas extensas dos segmentos externos da retina. Paciente masculino, 35 anos, portador de doença de Crohn, queixando-se de dor ocular eventual e nictalopia em olho direito desde infância. Em uso regular de azatioprina e mesalazina. melhor acuidade visual 20/20 AO. À fundoscopia, lesões hiperpigmentadas em arcada temporal inferior de olho direito, em treliça, acompanhando vasculatura local. Após exclusão de diagnósticos diferenciais chegou-se ao diagnóstico de Azoor. Azoor é uma síndrome idiopática caracterizada por um quadro agudo início de fotopsia, escotoma ou ambos e é tipicamente associado a uma perda persistente de função visual que envolve uma ou mais zonas da retina externa. Apesar dos sintomas clássicos de fotopsia, o paciente em questão teve uma apresentação clínica atípica. Descrevemos um caso ocorrido em indivíduo do sexo masculino em região periférica apresentando afinamento coroidiano e com doença autoimune associada. Dessa forma, acreditamos que é necessária maior investigação para verificar a etiologia da alteração coroideana e da associação com a doença específica.


Abstract Acute zonal occult external retinopathy (AZOOR) was first described by Gass in 1993 as a syndrome with rapid loss of one or more large areas of the external retinal segments. Male, 35 years, with Crohn's disease complaining of occasional eye pain and right eye nictalopia since childhood. In regular use of azathioprine and mesalazine. better visual acuity 20/20 OU. At fundoscopy, hyperpigmented lesions in the right temporal arcade of the right eye, in trellis, accompanying local vasculature. After exclusion of differential diagnoses, Azoor's diagnosis was reached. Azoor is an idiopathic syndrome characterized by an acute onset of photopsy, scotoma or both and is typically associated with a persistent loss of visual function involving one or more areas of the external retina. Despite classic photopsy symptoms, the patient in question had an atypical clinical presentation. We describe a case of a peripheral male with choroidal thinning and associated autoimmune disease. Thus, we believe that further investigation is necessary to verify the etiology of choroidal alteration and its association with the specific disease.


Subject(s)
Humans , Male , Adult , Retinal Diseases/diagnostic imaging , Autoimmune Diseases/complications , Angiography/methods , Crohn Disease/diagnosis , Tomography, Optical Coherence/methods
3.
Rev. cuba. angiol. cir. vasc ; 21(2): e120, mayo.-ago. 2020. tab, fig
Article in Spanish | LILACS, CUMED | ID: biblio-1126378

ABSTRACT

Introducción: Los aneurismas de aorta abdominal resultan dilataciones arteriales a dicho nivel. Su ruptura constituye uno de los principales riesgos y provoca la muerte del paciente, de ahí la importancia de tratarlos a tiempo. Las opciones actuales de tratamiento son la cirugía abierta y la reparación aneurismática endovascular; esta última representa la primera línea de tratamiento, por constituir una técnica mínimamente invasiva con bajas tasas de morbilidad y mortalidad. Objetivo: Evaluar el tratamiento endovascular del aneurisma de la aorta abdominal con endoprótesis percutáneas en pacientes cubanos. Métodos: Entre enero y abril de 2018 se realizó un estudio prospectivo, descriptivo y cualitativo en 6 pacientes del sexo masculino con aneurisma de aorta abdominal, seleccionados aleatoriamente, que cumplieron los criterios de uso de endoprótesis vasculares y estuvieron de acuerdo con realizar el proceder. Se colocaron 6 dispositivos en una sala de angiografía, y se utilizó en los pacientes anestesia general y guía fluoroscópica. Resultados: De forma satisfactoria fue posible el tratamiento endovascular por vía percutánea de los 6 pacientes seleccionados; solo 1 presentó una complicación menor y fue dado de alta a las 72 horas y el resto fue egresado en menos de 24 horas. Se logró implementar por vez primera en el país el sistema de cierre percutáneo Proglide sin complicaciones. Conclusiones: El tratamiento endovascular por vía percutánea de aneurismas de aorta abdominal con endoprótesis vasculares es una alternativa eficaz para la cirugía convencional en pacientes que cumplen los criterios de uso del dispositivo(AU)


Introduction: Abdominal aortic aneurysms are arterial dilations in that level. Their rupture is one of the main risks and it causes death in patients; that is why the importance of treating them early. Among the current treatment options are open surgery and endovascular aneurismal reparation, being the last one in the first line of treatment since it is a minimal invasive technique with low rates of morbidity and mortality. Objective: To evaluate the endovascular treatment of abdominal aortic aneurysm with percutaneous endoprosthesis in Cuban patients. Methods: It was conducted from January to April 2018 a retrospective, descriptive and qualitative study in 6 male patients with aneurysm of the abdominal aorta, selected randomly and who met the criteria of vascular endoprosthesis use and agreed with the performance of the procedure. Six devices were placed in an angiography room and it was used general anaesthetic and fluoroscopic guidance. Results: It was possible in a satisfactory way the endovascular treatment by percutaneous way in the six patients selected; just one presented a minor complication and he was discharged after 72 hours; and the rest were discharged in less than 24 hours. It was implemented for the first time in the country without complications the system of percutaneous closure called Proglide. Conclusions: Endovascular treatment by percutaneous way of abdominal aortic aneurysms with vascular endoprosthesis is an efficient alternative for conventional surgery in patients that met the criteria of use of the device(AU)


Subject(s)
Humans , Male , Middle Aged , Aged , Angiography/methods , Prospective Studies , Aortic Aneurysm, Abdominal/diagnosis , Epidemiology, Descriptive
5.
Rev. argent. radiol ; 84(2): 61-67, abr. 2020. tab, graf, il.
Article in Spanish | LILACS | ID: biblio-1125857

ABSTRACT

Resumen La inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infecciosa (pseudoaneurisma micótico, sífilis) y no infecciosa (arteritis, aortitis idiopática, espondilitis anquilosante, entre otras) de difícil diagnóstico clínico y variable pronóstico. Por esa razón, la utilización de diversos métodos por imágenes, tales como la tomografía computada multidetector (TCMD), la tomografía computada por emisión de positrones (PET-TC), la resonancia magnética (RM) y ultrasonido (US) facilitan la identificación, seguimiento y tratamiento de esa entidad. El siguiente trabajo tiene como objetivo realizar una revisión y actualización bibliográfica acerca de la aortitis y sus diversas etiologías, ejemplificando con casos de nuestra institución.


Abstract Aortic inflammation (aortitis) is a rare pathology, with infectious (fungal pseudoaneurysm, syphilis) and noninfectious etiology (arteritis, idiopathic aortitis, ankylosing spondylitis, among others), it has a difficult clinical diagnosis and a variable prognosis. The use of various imaging methods such as multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) and ultrasound (US) facilitate the identification, monitoring and treatment of this entity. The following paper aims to perform a literature review and update about aortitis and its various etiologies, exemplifying cases of our institution.


Subject(s)
Aortitis/etiology , Aortitis/diagnostic imaging , Spondylitis, Ankylosing/diagnostic imaging , Giant Cell Arteritis/diagnostic imaging , Angiography/methods , Takayasu Arteritis/etiology , Takayasu Arteritis/diagnostic imaging , Multidetector Computed Tomography/methods
6.
Rev. bras. ortop ; 55(1): 70-74, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092675

ABSTRACT

Abstract Objective The aim of the present study is to evaluate the artery of Adamkiewicz by multidetector computed tomography angiography (MCTA) in a Brazilian population. Methods Two independent observers evaluated 86 coronary MCTA examinations. The variables studied included the identification of the artery of Adamkiewicz at its origin level, and its entry side in the spine. Results The artery of Adamkiewicz was detected in 71 (82.5%) examinations. The origin level was identified between the 9th and 11th thoracic vertebrae (T9 and T11) in 56 (79.2%) patients. In 65 (91.5%) patients, the artery was on the left side. The identification of the artery of Adamkiewicz using MCTA showed high reproducibility. Conclusions Our results were consistent with the literature regarding the identification of the artery of Adamkiewicz using MCTA, suggesting that this technique should be considered as an option to recognize this structure. In addition, we found that the distribution of the artery of Adamkiewicz in the Brazilian population is similar to that of other populations, that is, its most common origin is at the left side, between the 8th and 12th thoracic vertebrae (T8-T12).


Resumo Objetivo Avaliar a artéria de Adamkiewicz por angiotomografia computadorizada por multidetectores (ATCM) em uma população brasileira. Métodos Dois observadores independentes avaliaram 86 exames de ACTM. As variáveis estudadas incluíram a identificação da artéria de Adamkiewicz no nível de origem e o lado de entrada da artéria na coluna vertebral. Resultados A artéria de Adamkiewicz foi identificada em 71 (82,5%) exames. O nível de origem foi identificado entre a 9a e a 11a vértebras torácicas (T9 e T11) em 56 (79,2%) pacientes. Em 65 (91,5%) pacientes, a artéria foi identificada no lado esquerdo. A identificação da artéria de Adamkiewicz usando ACTM mostrou elevada reprodutibilidade. Conclusões Obtivemos resultados consistentes com os da literatura prévia quanto à identificação da artéria de Adamkiewicz utilizando angiotomografia computadorizada por multidetectores. Nossos resultados sugerem que a ATCM pode ser considerada como uma opção para identificar a artéria de Adamkiewicz. Além disso, encontramos uma distribuição da artéria de Adamkiewicz na população brasileira semelhante à de outras populações, com a artéria de Adamkiewicz originando-se mais comumente no lado esquerdo, entre a 8a e a 12a vértebras torácicas (T8-T12).


Subject(s)
Humans , Male , Female , Paraplegia , Arteries/pathology , Spinal Cord , Angiography/methods , Multidetector Computed Tomography
7.
Clinics ; 75: e1373, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055875

ABSTRACT

OBJECTIVES: Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension (PH) that arises from obstruction of the pulmonary vessels by recanalized thromboembolic material. CTEPH has a wide range of radiologic presentations. Commonly, it presents as main pulmonary artery enlargement, peripheral vascular obstructions, bronchial artery dilations, and mosaic attenuation patterns. Nevertheless, other uncommon presentations have been described, such as lung cavities. These lesions may be solely related to chronic lung parenchyma ischemia but may also be a consequence of concomitant chronic infectious conditions. The objective of this study was to evaluate the different etiologies that cause lung cavities in CTEPH patients. METHODS: A retrospective data analysis of the medical records of CTEPH patients in a single reference PH center that contained or mentioned lung cavities was conducted between 2013 and 2016. RESULTS: Seven CTEPH patients with lung cavities were identified. The cavities had different sizes, locations, and wall thicknesses. In two patients, the cavities were attributed to pulmonary infarction; in 5 patients, an infectious etiology was identified. CONCLUSION: Despite the possibility of being solely associated with chronic lung parenchyma ischemia, most cases of lung cavities in CTEPH patients were associated with chronic granulomatous diseases, reinforcing the need for active investigation of infectious agents in this setting.


Subject(s)
Humans , Male , Female , Pulmonary Embolism/diagnosis , Thromboembolism/etiology , Granulomatous Disease, Chronic/pathology , Hypertension, Pulmonary/diagnosis , Pulmonary Embolism/complications , Pulmonary Embolism/therapy , Angiography/methods , Tomography, X-Ray Computed/methods , Chronic Disease , Retrospective Studies , Treatment Outcome , Perfusion Imaging , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/therapy , Lung/blood supply , Anticoagulants/therapeutic use
8.
Einstein (Säo Paulo) ; 18: eRC4934, 2020. graf
Article in English | LILACS | ID: biblio-1056036

ABSTRACT

ABSTRACT Varicose gastrointestinal bleeding is one of the major causes of morbidity and mortality in patients with chronic liver disease. Endoscopic treatment is the first therapeutic line for these patients, however, for those whom this therapeutic modality fail, a broad knowledge of alternative treatment options may improve the prognosis. We describe a case of a patient who were successfully embolized from gastroesophageal varices via transsplenic access.


RESUMO O sangramento gastrointestinal varicoso está entre as maiores causas de morbimortalidade nos paciente com doença hepática crônica. O tratamento endoscópico é a primeira linha terapêutica neste pacientes, porém naqueles que apresentam falha nesta modalidade terapêutica, o amplo conhecimento de opções alternativas de tratamento pode melhorar o prognóstico. Descrevemos um caso de paciente submetido à embolização com sucesso de varizes gastresofágicas por acesso transesplênico.


Subject(s)
Humans , Female , Adult , Splenic Vein/surgery , Esophageal and Gastric Varices/surgery , Embolization, Therapeutic/methods , Gastrointestinal Hemorrhage/surgery , Portal Vein/surgery , Splenic Vein/diagnostic imaging , Angiography/methods , Esophageal and Gastric Varices/diagnostic imaging , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography, Doppler/methods , Venous Thrombosis/surgery , Gastrointestinal Hemorrhage/diagnostic imaging
9.
Revista Digital de Postgrado ; 9(1): e194, 2020. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1095043

ABSTRACT

El implante valvular aórtico transcatéter, es un procedimiento cardiovascular de mínima invasión y una alternativa frente a la intervención convencional, en insuficiencia aórtica severa. En este trabajo se realiza una revisión de las complicaciones y la sobrevida, en pacientes sometidos a TAVI, frente a remplazo aórtico tradicional. Para ello se realizó una investigación documental con información entre los años 2010-2018. El implante valvular aórtico transcatéter debe efectuarse vía transfemoral o transapical, con una válvula Core o Sapien XT, según la necesidad del individuo, para evitar la regurgitación para valvular. Con este implante disminuyen las complicaciones y se remodela el ventrículo izquierdo; reduciendo la disnea y mejorando el pronóstico vida y la tasa de mortalidad en comparación con otros métodos(AU)


The transcatheter aortic valve implant is a minimally invasive cardiovascular procedure and, an alternative to conventional intervention in severe aortic insufficiency. In this work, a review of complications and survival is performed in patients undergoing TAVI, compared to traditional aortic replacement. For this, a documentary investigation was carried out with information between the years 2010-2018. The transcatheter aortic valve implant should be performed transfemorally or transapically, with a Core or Sapien XT valve, depending on the individual's need, to avoid regurgitation to valvulate. With this implant the complications decrease and the left ventricle is remodeled; reducing breathlessness and improving the life prognosis and mortality rate compared to other methods(AU)


Subject(s)
Humans , Aortic Valve Insufficiency/diagnosis , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/complications , Radiography, Thoracic/methods , Transcatheter Aortic Valve Replacement/methods , Surgical Clearance , Angiography/methods , Cardiac Catheterization , Survival Rate , Retrospective Studies
10.
Rev. méd. Chile ; 147(10): 1350-1354, oct. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058605

ABSTRACT

We report a 65-years old woman with a history of permanent atrial fibrillation with high risk for ischemic and bleeding events. She developed a heart failure with severely impaired left ventricular ejection fraction and severe secondary mitral regurgitation. Given her high surgical risk, using transesophageal echocardiography guidance, a concomitant deployment of two MitraClip devices using a high-posterior septal puncture and a left atrial appendage closure with an Amplatzer Amulet occluder were performed through the same access.


Subject(s)
Humans , Female , Aged , Atrial Fibrillation/surgery , Heart Valve Prosthesis Implantation/methods , Atrial Appendage/surgery , Septal Occluder Device , Mitral Valve Insufficiency/surgery , Severity of Illness Index , Angiography/methods , Risk Factors , Treatment Outcome , Echocardiography, Transesophageal
11.
Int. braz. j. urol ; 45(5): 925-931, Sept.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1040066

ABSTRACT

ABSTRACT Objective To evaluate the effectiveness and outcomes of endovascular treatment of TRAS with PTA. Materials and Methods We searched our prospectively collected database looking at cases of TRAS between January 2005-December 2011. CCT was the gold-standart for diagnosis of TRAS. Parameters analysed comprised technical aspects, arterial blood pressure variation, and renal function. A minimum follow-up of 24 months was considered. Results Of the 2221 renal transplants performed in the selected period, 22 (0.9%) patients were identified with TRAS. Fourteen (63.6%) were male and mean age was 377±14.8years (12-69). Kidney graft was from deceased donnors in 20 (80%) cases. On doppler evaluation, mean blood flow speed after transplantation, at TRAS diagnosis and after TAP was 210.6±99.5, 417±122.7 and 182.5±81.6mL/sec, respectively (p<0.001). For SBP and DBP, there was a significant difference between between pre-intervention and all post-treatment time points (p<0.001). After 1 month of the procedure, there was stabilization of the Cr level with a significant difference between mean Cr levels along time (p<0.001). After a mean follow-up of 16±4.2 (3-24) months, overall success rate was 100%. Conclusions Endovascular treatment with PTA/stenting is a safe and effective option for managing TRAS, ensuring the functionality of the graft and normalization of blood pressure and renal function.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Aged , Young Adult , Renal Artery Obstruction/surgery , Renal Artery Obstruction/etiology , Kidney Transplantation/adverse effects , Angioplasty/methods , Renal Artery Obstruction/diagnostic imaging , Time Factors , Blood Pressure/physiology , Angiography/methods , Reproducibility of Results , Retrospective Studies , Analysis of Variance , Follow-Up Studies , Treatment Outcome , Creatinine/blood , Middle Aged
12.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3 Supl): 291-296, jul.-set. 2019. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1023081

ABSTRACT

Avaliar a eficácia diagnóstica da angiotomografia coronariana (AC) comparada com a cineangiocoronariografia (CAT). Material e Métodos: Foram avaliados retrospectivamente 146 pacientes submetidos a AC e CAT com angiografia coronariana quantitativa (ACQ), com intervalo médio de um mês entre os exames. O estudo foi realizado no Hospital Cardiológico Costantini. Foram avaliados os fatores de risco da amostra, a localização das lesões e o grau de severidade da obstrução coronariana nos grandes vasos (TCE, DA, CX e CD). Os resultados dos métodos diagnósticos foram comparados pelo coeficiente de correlação de Pearson. A partir dos achados positivos foi realizada a avaliação de correlação entre os métodos perante a severidade das lesões. Resultados: A amostra foi composta predominantemente por homens (73,97%), sendo a hipertensão arterial (HAS) (71,91%) o fator de risco mais frequente. A artéria mais acometida foi a DA. Quanto ao grau de severidade das lesões, os resultados foram os seguintes na comparação entre AC e CAT: lesões discretas com correlação r = 0,23; moderadas com r = 0,53 e severas com r = 0,70. Na comparação entre AC e ACQ: lesões discretas com correlação r = 0,45; moderadas com r = 0,70 e severas com r = 0,67. Conclusão: A AC apresentou moderada com ACQ e CAT em lesões moderadas e severas, e forte correlação na ausência de lesões quando comparada com ACQ


To evaluate the diagnostic efficacy of multislice CT coronary angiotomography compared with coronary cineangiography. Material and Methods: We retrospectively evaluated 146 patients submitted to MSCT and CA with quantitative coronary angiography (QCA), with a mean interval of one month between the exams. The study was carried out at the Costantini Cardiology Hospital. The risk factors for the sample, the location of the lesions and the degree of severity of the coronary obstruction in the large vessels (LCT, AD, CX and RC).The results of the diagnostic methods were compared using Pearson correlation coefficient. From the positive findings, a correlation evaluation was performed between the methods for the severity of the lesions. Results: The sample consisted predominantly of men (73.97%), and hypertension (SAH) (71.91%) was the most frequent risk factor. The most affected artery was AD. Regarding the degree of severity of the lesions, the results were as follows in the comparison between MSCT and CA: mild lesions with correlation r = 0.23, moderate with r = 0.53 and severe with r = 0.70. In the comparison between MSCT and QCA: mild lesions with correlation r = 0.45, moderate with r = 0.70 and severe with r = 0.67. Conclusion: MSCT showed moderate correlation with QCA and CA in moderate and severe lesions, and a strong correlation in the absence of lesions when compared with QCA


Subject(s)
Humans , Male , Female , Coronary Artery Disease/diagnostic imaging , Angiography/methods , Angiography, Digital Subtraction/methods , Coronary Angiography/methods , Diagnostic Imaging/methods , Cardiovascular Diseases/mortality , Retrospective Studies , Risk Factors , Magnetic Resonance Angiography/methods , Computed Tomography Angiography/methods , Hypertension
13.
Rev. bras. cir. cardiovasc ; 34(3): 344-351, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013473

ABSTRACT

Abstract Objectives: To compare the advantages and disadvantages of perventricular and percutaneous procedures for treating isolated ventricular septal defect (VSD). Methods: A total of 572 patients with isolated VSD were selected in our hospital between January 2015 and December 2016. The patients' median age and weight were five years (1-26 years) and 29 kg (9-55 kg), respectively. The median diameter of VSD was 6.0 mm (5-10 mm). Patients were divided into two groups. In group A, perventricular device closure was performed in 427 patients; in group B, 145 patients underwent percutaneous device closure. Results: Four hundred twelve patients in group A and 135 patients in group B underwent successful closure. The total occlusion rate was 98.5% (immediately) and 99.5% (3-month follow-up) in group A, which were not significantly different from those in group B (97.7% and 100%, respectively). Patients in group A had longer intensive care unit (ICU) stay than those in group B, but patients in group B experienced significantly longer operative times than those in group A. The follow-up period ranged from 8 months to 1.5 year (median, 1 year). During the follow-up period, late-onset complete atrioventricular block occurred in two patients. No other serious complications were noted in the remaining patients. Conclusion: Both procedures are safe and effective treatments for isolated VSD. The percutaneous procedure has obvious advantages of shorter ICU stay and less trauma than the perventricular procedure. However, the perventricular procedure is simpler to execute, results in a shorter operative time, and avoids X-ray exposure.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Septal Occluder Device/standards , Heart Septal Defects, Ventricular/surgery , Aortic Valve Insufficiency/surgery , Time Factors , Angiography/methods , Echocardiography/methods , Retrospective Studies , Treatment Outcome , Statistics, Nonparametric , Equipment Design , Atrioventricular Block/surgery , Operative Time , Heart Septal Defects, Ventricular/diagnostic imaging , Cardiac Surgical Procedures/instrumentation , Cardiac Surgical Procedures/methods , Length of Stay
14.
Rev. méd. Chile ; 147(4): 426-436, abr. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1014243

ABSTRACT

Background: Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Aim: To report the initial experience with the "refined BPA technique" with the use of intravascular images. Patients and Methods: Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. Results: We performed 16 BPA in eight patients aged 61 ± 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 ± 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/ patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 ± 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 ± 377,0 at baseline to 516,6 ± 323,3 Dynes/sec/cm−5 (p<0.01) and the cardiac index increased from 2.4±0.6 at baseline to 2.8±0.3 L/min/m2 (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3±0.5 to 2.5±0.5 (p<0,01) and six minutes walking distance from 331±92 to 451±149 m (p=0.01). Conclusions: BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pulmonary Embolism/therapy , Angioplasty, Balloon/methods , Hypertension, Pulmonary/therapy , Pulmonary Embolism/physiopathology , Pulmonary Embolism/diagnostic imaging , Time Factors , Angiography/methods , Chronic Disease , Reproducibility of Results , Treatment Outcome , Tomography, Optical Coherence/methods , Hemodynamics , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/diagnostic imaging
18.
Arq. bras. oftalmol ; 82(1): 72-77, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-973866

ABSTRACT

ABSTRACT A 33-year-old male presented to our clinic with low vision in both eyes that started during the previous week. Visual acuity was 20/63 in the right eye and 20/50 in the left eye. Fundus examination revealed signs of hypertensive retinopathy; thus, a multidisciplinary approach was adopted for the diagnosis and treatment of this patient. We consulted the nephrology and cardiology departments on this case. Upon diagnosing malignant hypertension and renal failure, the patient was put on hemodialysis. His visual acuity was 20/20 at 6 months, whereas foveal assessment on optical coherence tomography angiography revealed neither marked superficial and deep capillary density loss and foveal avascular zone enlargement nor a decrease in disc flow and radial peripapillary capillary density. Early diagnosis and treatment of malignant hypertension are critical in preventing progression of end-organ damage including the eyes. Optical coherence tomography angiography may be useful in cases when fundus fluorescein angiography is relatively contraindicated (e.g., renal failure).


RESUMO Um homem de 33 anos apresentou-se à nossa clínica com baixa visão em ambos os olhos que começou uma semana antes. A acuidade visual foi de 20/63 no olho direito e 20/50 no olho esquerdo. O exame de fundo de olho revelou sinais de retinopatia hipertensiva; então, adotou-se uma abordagem multidisciplinar para o diagnóstico e tratamento desse paciente. Consultamos os departamentos de nefrologia e cardiologia neste caso. Ao diagnosticar hipertensão maligna e insuficiência renal, o paciente foi colocado em hemodiálise. Sua acuidade visual era 20/20 aos 6 meses, enquanto a avaliação foveal com angiotomografia de coerência óptica não revelou perda de densidade capilar superficial e profunda acentuada e aumento da zona avascular foveal nem uma diminuição no fluxo de disco e na densidade capilar peripapilar radial. O diagnóstico precoce e o tratamento da hipertensão maligna são fundamentais na preveção da progressão de danos nos órgãos-alvo, incluindo os olhos. A Angiografia por tomografia de coerência óptica pode ser útil nos casos em que a angiografia com fluoresceína do fundo de olho é relativamente contraindicada (por exemplo, insuficiência renal).


Subject(s)
Humans , Male , Adult , Angiography/methods , Tomography, Optical Coherence/methods , Hypertensive Retinopathy/diagnostic imaging , Hypertension, Malignant/diagnostic imaging , Retinal Vessels/pathology , Retinal Vessels/diagnostic imaging , Time Factors , Capillaries/pathology , Capillaries/diagnostic imaging , Disease Progression , Renal Insufficiency, Chronic , Hypertensive Retinopathy/pathology , Hypertension, Malignant/pathology
19.
J. bras. pneumol ; 45(4): e20180137, 2019. tab, graf
Article in English | LILACS | ID: biblio-1012569

ABSTRACT

ABSTRACT Objective: To present a case series of pulmonary arteriovenous malformations (PAVMs), describing the main clinical findings, the number/location of pulmonary vascular abnormalities, the clinical complications, and the treatment administered. Methods: This was a retrospective observational study evaluating patients with PAVM divided into two groups: hereditary hemorrhagic telangiectasia (HHT); and idiopathic PAVM (iPAVM). Results: A total of 41 patients were selected for inclusion, but only 33 had PAVMs. After clinical evaluation, 27 and 6 were diagnosed with HHT and iPAVM, respectively. In the HHT group, the mean age was 49.6 years and 88.9% were female. In that group, 4 patients had an SpO2 of < 90% and the most common clinical finding was epistaxis. In the iPAVM group, the mean age was 48.1 years and 83.3% were female. In that group, 3 patients had an SpO2 of < 90%. Computed tomographic pulmonary angiography showed that most of the PAVMs were in the lower lobes: 56.4% in the HHT group and 85.7% in the iPAVM group. Embolization was performed in 23 patients (in both groups). At this writing, 10 patients are scheduled to undergo the procedure. One of the patients who underwent embolization was subsequently referred for pulmonary resection. Conclusions: In both of the PAVM groups, there was a predominance of women and of fistulas located in the lower lobes. Few of the patients had respiratory symptoms, and most had an SpO2 > 90%. The treatment chosen for all patients was percutaneous transcatheter embolization.


RESUMO Objetivo: Apresentar uma série de casos de malformações arteriovenosas pulmonares (MAVP) e descrever os principais achados clínicos, a quantidade e localização das MAVP, as complicações clínicas e os tratamentos realizados. Métodos: Estudo retrospectivo observacional que avaliou pacientes com MAVP divididos em dois grupos: telangiectasia hemorrágica hereditária (THH) e MAVP idiopática (MAVPi). Resultados: Foram avaliados 41 pacientes, sendo 33 pacientes portadores de MAVP. Após a avaliação clínica, 27 e 6 foram diagnosticados com THH e MAVPi, respectivamente. No grupo THH a média de idade foi de 49,6 anos e 88,9% eram do sexo feminino. Desses pacientes, 4 tinham SpO2 < 90% e o achado clínico mais frequente era epistaxe. No grupo MAVPi a média de idade foi de 48,1 anos, sendo que 83,3% eram do sexo feminino. Desses, 3 tinham SpO2 < 90%. Após a realização de angiotomografia de tórax observou-se que a maior parte das MAVP se situava nos lobos inferiores, totalizando 56,4% e 85,7% nos grupos THH e MAVPi, respectivamente. O tratamento por embolização foi realizado em 23 pacientes nos dois grupos, enquanto 10 aguardavam o procedimento até o momento da escrita deste estudo. Um paciente submetido à embolização foi encaminhado para ressecção pulmonar. Conclusões: Em ambos os grupos de pacientes com MAVP observou-se uma predominância de mulheres e de fístulas localizadas nos lobos inferiores. A maioria era assintomático respiratório com SpO2 > 90%. O tratamento de escolha para todos foi a embolização percutânea por cateter.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Arteriovenous Malformations/etiology , Arteriovenous Malformations/therapy , Arteriovenous Malformations/diagnostic imaging , Pulmonary Artery/abnormalities , Pulmonary Artery/diagnostic imaging , Telangiectasia, Hereditary Hemorrhagic/complications , Catheterization/methods , Angiography/methods , Echocardiography , Radiography, Thoracic/methods , Retrospective Studies , Treatment Outcome , Embolization, Therapeutic/methods , Septal Occluder Device , Computed Tomography Angiography
20.
J. vasc. bras ; 18: e20180122, 2019. ilus
Article in Portuguese | LILACS | ID: biblio-984685

ABSTRACT

O tumor glômico é uma neoplasia benigna rara originada de células paraganglionares da crista neural que se desenvolve na camada adventícia do vaso. São tumores não encapsulados e altamente vascularizados. Paciente feminina, 64 anos, foi diagnosticada com tumor glômico hipervascularizado com 5 cm posteriormente à bifurcação carotídea esquerda e oclusão de carótida contralateral. Optou-se por realizar embolização através de acesso endovascular seguida de punção percutânea direta, guiada por angiografia, para preenchimento da área remanescente. Após embolização, realizou-se a exérese cirúrgica do tumor com menor sangramento e maior facilidade para encontrar o plano de clivagem das estruturas adjacentes. Em acompanhamento tardio, a paciente apresenta-se sem recidiva tumoral. O tumor foi classificado como pertencente ao grupo Shamblin II, o qual inclui tumores apresentando de 4 a 6 cm com inserção arterial moderada. Através dessa dupla abordagem, foi possível notar uma redução relativa do sangramento intraoperatório e facilitação de identificação do plano de clivagem, colaborando para sua exérese e evitando o pinçamento cirúrgico


Glomus tumors are rare benign neoplasms originating from paraganglionic cells of the neural crest developing in the adventitious layer of the vessel. They are nonencapsulated and highly vascularized. A 64-year-old female patient was identified with a hypervascularized glomus tumor measuring 5 cm, posterior to the left carotid bifurcation and contralateral carotid occlusion. We performed preoperative embolization via endovascular access followed by direct percutaneous puncture, guided by angiography, to fill the remaining area. After embolization, surgical excision of the tumor was performed with reduced bleeding and it was easier to find the cleavage planes to adjacent structures. At late follow-up, the patient is free from tumor recurrence. The tumor was classified as Shamblin II, measuring 4 to 6 cm with moderate arterial insertion. Through this double approach we observed a relative reduction in intraoperative bleeding and improved identification of the cleavage plane, facilitating excision and avoiding surgical clamping


Subject(s)
Humans , Female , Middle Aged , Carotid Body Tumor/diagnosis , Glomus Jugulare/surgery , Glomus Jugulare/diagnostic imaging , Neoplasms/surgery , Paraganglioma , Diagnostic Imaging/methods , Angiography/methods , Echocardiography, Doppler/methods , Carotid Artery Diseases , Carotid Artery, External , Embolization, Therapeutic/methods
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