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2.
Arq. bras. cardiol ; 116(2): 325-331, fev. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1153019

ABSTRACT

Resumo Fundamentos A fibrilação atrial é a arritmia persistente mais comum e é o principal fator que leva ao tromboembolismo. Objetivo Investigar o valor do diâmetro do átrio esquerdo combinado com o escore CHA2DS2-VASc na predição da trombose atrial esquerda/trombose de apêndice atrial esquerdo na fibrilação atrial não valvar. Métodos Trata-se de estudo retrospectivo. 238 pacientes com fibrilação atrial não valvar foram selecionados e divididos em dois grupos: trombose e não trombose. Determinou-se o escore CHA2DS2-VASc. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados A análise de regressão logística multivariada revelou que histórico de acidente vascular cerebral/ataque isquêmico transitório, doença vascular, escore CHA2DS2-VASc, DAE, DDFVE e FEVE foram fatores de risco independentes para trombose atrial esquerda/trombose de apêndice atrial esquerdo (p<0,05). A análise da curva ROC ( Receiver Operating Characteristic ) revelou que a área sob a curva para o escore CHA2DS2-VASc na predição de trombose atrial esquerda/trombose de apêndice atrial esquerdo foi de 0,593 quando o escore CHA2DS2-VASc foi ≥3 pontos, e a sensibilidade e especificidade foram 86,5% e 32,6%, respectivamente, enquanto a área sob a curva para o DAE na predição de trombose atrial esquerda/trombose de apêndice atrial esquerdo foi 0,786 quando o DAE foi ≥44,17 mm, e a sensibilidade e especificidade foram 89,6% e 60,9%, respectivamente. Entre os diferentes grupos CHA2DS2-VASc, a taxa de incidência de trombose atrial esquerda/trombose de apêndice atrial esquerdo em pacientes com DAE ≥44,17 mm foi maior do que em pacientes com DAE <44,17 mm (p <0,05). Conclusão O escore CHA2DS2-VASc e o DAE estão correlacionados com a trombose atrial esquerda/trombose de apêndice atrial esquerdo na fibrilação atrial não valvar. Para pacientes com escore CHA2DS2-VASc de 0 ou 1, quando o DAE é ≥44,17 mm, o risco de trombose atrial esquerda/trombose de apêndice atrial esquerdo permaneceu alto. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Background Atrial fibrillation is the most common persistent arrhythmia, and is the main factor that leads to thromboembolism. Objective To investigate the value of left atrial diameter combined with CHA2DS2-VASc score in predicting left atrial/left atrial appendage thrombosis in non-valvular atrial fibrillation. Methods This is a retrospective study. 238 patients with non-valvular atrial fibrillation were selected and divided into two groups: thrombosis and non-thrombosis. CHA2DS2-VASc score was determined. P<0.05 was considered statistically significant. Results Multivariate logistic regression analysis revealed that the history of stroke/transient ischemic attack, vascular disease, CHA2DS2-VASc score, left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were independent risk factors for left atrial/left atrial appendage thrombosis (p<0.05). Receiver operating characteristic curve analysis revealed that the area under the curve for the CHA2DS2-VASc score in predicting left atrial/left atrial appendage thrombosis was 0.593 when the CHA2DS2-VASc score was ≥3 points, and sensitivity and specificity were 86.5% and 32.6%, respectively, while the area under the curve for LAD in predicting left atrial/left atrial appendage thrombosis was 0.786 when LAD was ≥44.17 mm, and sensitivity and specificity were 89.6% and 60.9%, respectively. Among the different CHA2DS2-VASc groups, the incidence rate of left atrial/left atrial appendage thrombosis in patients with LAD ≥44.17 mm was higher than patients with LAD <44.17 mm (p<0.05). Conclusion CHA2DS2-VASc score and LAD are correlated with left atrial/left atrial appendage thrombosis in non-valvular atrial fibrillation. For patients with a CHA2DS2-VASc score of 0 or 1, when LAD is ≥44.17 mm, the risk for left atrial/left atrial appendage thrombosis remained high. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Atrial Fibrillation/complications , Atrial Fibrillation/diagnostic imaging , Thrombosis/etiology , Thrombosis/diagnostic imaging , Atrial Appendage/diagnostic imaging , Stroke/etiology , Stroke Volume , Retrospective Studies , Risk Factors , Ventricular Function, Left , Risk Assessment
4.
Rev. bras. cir. cardiovasc ; 35(6): 1010-1012, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143999

ABSTRACT

Abstract We report the case of a 60-year-old patient who underwent orthotopic heart transplant 14 years earlier. Routine echocardiography showed giant masses in the left atrium. There were no symptoms or thromboembolic events in the past. Magnetic resonance imaging study revealed very enlarged left atrium (8.7 × 10.6 cm) occupied by irregular smooth mass (7 × 5 × 6.1 cm) with a stalk that was attached to the posterior left atrial wall in the area of graft suture lines. Intraoperative examination revealed a massive thrombus (12 × 10 cm) that filled almost the entire left atrial area.


Subject(s)
Humans , Middle Aged , Thromboembolism , Thrombosis/diagnostic imaging , Heart Transplantation/adverse effects , Heart Diseases/surgery , Heart Diseases/etiology , Heart Diseases/diagnostic imaging , Thrombosis/etiology , Echocardiography , Heart Atria/diagnostic imaging
6.
Rev. Assoc. Med. Bras. (1992) ; 66(10): 1437-1443, Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136138

ABSTRACT

SUMMARY INTRODUCTION: The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke (AIS) patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE). METHODS: In this single-center, retrospective study, we enrolled 149 consecutive AIS patients. All of the patients underwent a TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT. RESULTS: Among all cases, 14 patients (9.3%) had a diagnosis of LAT based on the TEE examination. In a multivariate analysis, elevated mean platelet volume (MPV), low left-ventricle ejection fraction (EF), creatinine, and reduced left-atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area under the receiver operating characteristic curve analysis for MPV was 0.70 (95%CI: 0.57-0.83; p = 0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT. CONCLUSION: AIS patients with low ventricle EF and elevated MPV should undergo further TEE examination to verify the possibility of a cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in such patients without AF.


RESUMO INTRODUÇÃO: O presente estudo teve como objetivo determinar indicadores independentes do trombo auricular esquerdo (LAT) em doentes com acidente vascular cerebral isquêmico agudo (AIS) sem fibrilação auricular (AF) utilizando ecocardiografia transesofágica (TEE). MÉTODOS: Neste único centro, estudo retrospectivo, inscrevemos 149 pacientes consecutivos com AIS. Todos os pacientes foram submetidos a exame de TEE para detectar LAT no prazo de dez dias após a admissão. A análise de regressão logística multivariada foi realizada para avaliar preditores independentes do final. RESULTADO: Entre todos os casos, 14 pacientes (9,3%) tiveram um diagnóstico de exame tardio no TEE. Numa análise multivariada, volume médio de plaquetas (VMP) elevado, fração de ejeção do ventrículo esquerdo baixo (EF), creatinina e uma velocidade de pico de esvaziamento do átrio esquerdo reduzida (LAA) foram indicadores independentes da LAT. A área sob a análise da curva característica de operação do receptor para VMP foi de 0,70 (95% IC: 0, 57-0, 83; p=0,011). Com o valor-limite ideal de 9,45, o VMP teve uma sensibilidade de 71,4% e uma especificidade de 63% para prever mais tarde. CONCLUSÃO: Os doentes AIS com EF ventricular baixa e VMP elevado devem ser submetidos a um exame de TEE adicional para determinar a possibilidade de origem cardioembólica. Além disso, esta investigação pode fornecer novas informações sobre a aplicabilidade do VMP para prever tardiamente os doentes sem AF.


Subject(s)
Humans , Atrial Fibrillation/complications , Atrial Fibrillation/diagnostic imaging , Thrombosis/etiology , Thrombosis/diagnostic imaging , Brain Ischemia/complications , Brain Ischemia/diagnostic imaging , Atrial Appendage , Stroke/diagnostic imaging , Cross-Sectional Studies , Retrospective Studies , Risk Factors
7.
Rev. bras. cir. cardiovasc ; 35(4): 471-476, July-Aug. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137315

ABSTRACT

Abstract Objective: To examine the relationship between the left atrial (LA) thrombus presence and the epicardial adipose tissue (EAT) thickness. Methods: Three hundred and twelve consecutive rheumatic mitral valve stenosis (RMVS) patients with mitral valve area (MVA) < 2 cm2 were included in this cross-sectional study. Patients were divided into two groups, those with and those without LA thrombus. Routine biochemical analysis and electrocardiographic examinations were carried out. EAT was measured using transthoracic echocardiography. Results: LA thrombus was determined in 84 (26.9%) RMVS patients. In echocardiographic examinations, higher mean gradient and LA diameter as well as lower MVA were found in the group with LA thrombus (P<0.001). In this group, higher C-reactive protein (CRP) and EAT values were also determined (P<0.001). There was significant correlation between EAT and MVA, CRP, LA appendage peak flow velocity, LA anteroposterior diameter, and mean gradient (P<0.001). Higher EAT values were identified as independently associated with the presence of LA thrombus (odds ratio 59.5; 95% confidence interval 12.1-290.10; P<0.001). Conclusion: Transthoracic echocardiography, routinely used in patients with RMVS, can measure EAT to determine patients who are under risk for thrombus.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Thrombosis/complications , Thrombosis/diagnostic imaging , Mitral Valve Stenosis/etiology , Mitral Valve Stenosis/diagnostic imaging , Adipose Tissue/diagnostic imaging , Cross-Sectional Studies , Echocardiography, Transesophageal , Heart Atria/diagnostic imaging
8.
Rev. bras. cir. cardiovasc ; 35(3): 387-391, May-June 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137251

ABSTRACT

Abstract Total arch replacement and stent trunk were performed for two patients. One of these underwent a total bilateral carotid artery replacement in anatomical position while the other underwent partial carotid artery dissection. The first patient demonstrated no neurological complication after surgery and a postoperative computed tomography angiography (CTA) showed bilateral common carotid artery patency. However, the second patient had neurological dysfunction after surgery, while a postoperative CTA showed occlusion of the left common carotid artery. Anatomical replacement for a common carotid artery dissection with thrombus has the potential to significantly improve cerebral perfusion and reduce postoperative neurological complications.


Subject(s)
Humans , Thrombosis/etiology , Thrombosis/diagnostic imaging , Aneurysm, Dissecting/surgery , Aneurysm, Dissecting/complications , Aneurysm, Dissecting/diagnostic imaging , Stents , Treatment Outcome , Carotid Artery, Common/surgery , Carotid Artery, Common/diagnostic imaging , Dissection
10.
Rev. bras. anestesiol ; 70(1): 55-58, Jan.-Feb. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137135

ABSTRACT

Abstract Background: Veno-venous extracorporeal membrane oxygenation is an established therapy for patients with refractory acute respiratory distress syndrome (ARDS). One complication related to the use of veno-venous extracorporeal membrane oxygenation is thrombosis despite proper anticoagulation. We report the diagnosis and management of a clot-obstruction in a single site cannula placed through the internal jugular vein, guided by transesophageal echocardiography. Case report: A 39 year-old male developed acute respiratory distress syndrome and hemodynamic instability after an episode of pulmonary aspiration in the ICU. Eight hours after placement of a single site veno-venous extracorporeal membrane oxygenation, suddenly the perfusionist noticed a reduction in flow. TEE showed a thrombus-like mass obstructing the inflow port in SVC and inflow at IVC was intact. After unsuccessful attempts to reposition the cannula, the team decided to insert additional femoral inflow cannula through the IVC. The single site catheter was then pulled out until its tip was positioned in the right atrium and all three ports of the catheter were switched to the infusion ports. After this, flows and oxygenation improved significantly. Unfortunately, despite all of the efforts, the patient died 2 days later. Discussion: The diagnosis of veno-venous extracorporeal membrane oxygenation cannula obstruction is based on reduced inflow rates, hemodynamic instability and poor oxygenation of blood. TEE allows evaluation of the flows inside the cannula and in this case, an obstruction was found. The management presented points to the fact that in a situation of catheter obstruction caused by a clot, there is a feasible alternative to assure minimal interruption of the hemodynamic support offered by the veno-venous extracorporeal membrane oxygenation.


Resumo Justificativa: A oxigenação por membrana extracorpórea veno-venosa é terapia estabelecida para pacientes com a síndrome do desconforto respiratório agudo. Uma complicação relacionada ao uso da oxigenação por membrana extracorpórea veno-venosa é trombose apesar de anti-coagulação adequada. Relatamos o diagnóstico e conduta em obstrução por coágulo em cânula de acesso único inserida pela veia jugular interna, guiada por ecocardiografia transesofageana. Relato de caso: Paciente do sexo masculino de 39 anos desenvolveu síndrome do desconforto respiratório agudo e instabilidade hemodinâmica após episódio de aspiração pulmonar na UTI. Oito horas após a instalação de oxigenação por membrana extracorpórea veno-venosa de acesso único, o perfusionista notou repentina redução no fluxo. A ETE revelou massa semelhante a um trombo obstruindo o portal de fluxo de entrada na VCS e o fluxo de saída na VCI estava intacto. Após tentativas sem sucesso para reposicionar a cânula, a equipe decidiu inserir cânula de entrada de fluxo adicional pela VCI. O catéter de acesso único foi, então, puxado até que sua ponta se posicionasse no átrio direito e todos os três portais do catéter fossem transferidos para os portais de infusão. A seguir, os fluxos e oxigenação melhoraram significativamente. Infelizmente, apesar dos esforços, o paciente foi a óbito 2 dias depois. Discussão: O diagnóstico de obstrução de cânula da oxigenação por membrana extracorpórea veno-venosa se baseia em velocidades reduzidas de entrada de fluxo, instabilidade hemodinâmica e oxigenação pobre do sangue. A ETE permite a avaliação dos fluxos dentro da cânula, e nesse caso foi encontrada obstrução. A técnica apresentada aponta para o fato de que em situação de obstrução de catéter causada por coágulo, existe alternativa factível para garantir interrrupção mínima do suporte hemodinâmico oferecido pela oxigenação por membrana extracorpórea veno-venosa.


Subject(s)
Humans , Male , Adult , Respiratory Distress Syndrome, Newborn/therapy , Thrombosis/etiology , Extracorporeal Membrane Oxygenation/instrumentation , Cannula/adverse effects , Thrombosis/therapy , Thrombosis/diagnostic imaging , Venae Cavae , Echocardiography, Transesophageal
11.
Rev. Assoc. Med. Bras. (1992) ; 66(1): 31-35, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1091903

ABSTRACT

SUMMARY Homozygous familial hypercholesterolemia is a rarely agentic disorder of the lipoprotein metabolism intimately related to premature atherosclerotic cardiovascular disease that can lead to high disability and mortality. Homozygous familial hypercholesterolemia typically affects not only the aortic root, compromising the coronary ostia, but also affects other territories such as the carotid, descending aorta, and renal arteries. Multi-contrast high-resolution magnetic resonance imaging (MRI) provides a validated and useful method to characterize carotid artery atherosclerotic plaques quantitatively. However, very few studies have been done on assessing plaque composition in patients with Homozygous familial hypercholesterolemia using high-resolution MRI. This report is to evaluate the value of MRI in accessing carotid artery disease in patients with Homozygous familial hypercholesterolemia. We describe a 28-year-old patient from Beijing, China, who presented to the Neurology Clinic with intermittent blurred vision of the right eye, headache, nausea, and vomiting for eight years without obvious causes. Familial hypercholesterolemia was suspected based on medical history and laboratory examination. Carotid Doppler ultrasound showed bilateral common carotid artery, internal carotid artery, and external carotid artery wall thickening with hyperechoic signals. Subsequently, high-resolution multi-contrast MRI of the carotid showed calcification with hypo-intense areas located at the middle layer of the plaque, with moderate stenosis. The plaque located at the right bifurcation of the common carotid artery extended to the internal carotid artery, causing lumen stenosis close to occlusion. The patient was treated with right carotid artery endarterectomy. At a 6-month follow-up, there had been no recurrence of the patient's symptoms.


RESUMO A hipercolesterolemia familiar homozigótica, uma doença patogênica rara do metabolismo da lipoproteína intimamente relacionada com a doença cardiovascular aterosclerótica prematura, pode conduzir a uma elevada deficiência e mortalidade. A hipercolesterolemia familiar homozigótica afeta tipicamente não só a raiz aórtica, comprometendo os óstios coronários, mas também outros territórios, como a carótida, a aorta descendente e as artérias renais. Imagens de ressonância magnética multicontraste de alta resolução (RM) fornecem um método validado e útil para caracterizar quantitativamente as placas de aterosclerose da artéria carótida. No entanto, muito poucos estudos foram feitos sobre a avaliação da composição da placa em doentes com hipercolesterolemia familiar homozigótica utilizando ressonância magnética de alta resolução. Este trabalho deve avaliar o valor da ressonância magnética no acesso à doença da artéria carótida em doentes com hipercolesterolemia familiar homozigótica. Descrevemos um paciente de 28 anos de Pequim, China, que se apresentou à clínica neurológica com visão turva intermitente do olho direito, dor de cabeça, náuseas e vômitos por oito anos sem causas aparentes. Suspeitava-se de hipercolesterolemia familiar com base no histórico médico e no exame laboratorial. O ultrassom Doppler carotídeo mostrou uma artéria carótida bilateral comum, artéria carótida interna e parede da carótida externa espessando-se com sinais hiperecoicos. Posteriormente, a ressonância multicontraste de alta resolução da carótida mostrou calcificação com áreas hipointensas localizadas na camada média da placa, com estenose moderada. A placa localizada na bifurcação direita da artéria carótida comum estendia-se até a artéria carótida interna, causando estenose do lúmen próxima à oclusão. O paciente foi tratado com endarterectomia da artéria carótida direita. Em seis meses de acompanhamento, não houve recorrência dos sintomas do paciente.


Subject(s)
Humans , Female , Adult , Thrombosis/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Magnetic Resonance Imaging/methods , Carotid Stenosis/diagnostic imaging , Plaque, Atherosclerotic/diagnostic imaging , Hyperlipoproteinemia Type II/diagnostic imaging , Carotid Artery, External/pathology , Carotid Artery, External/diagnostic imaging , Carotid Artery, Internal/pathology , Carotid Artery, Internal/diagnostic imaging , Ultrasonography, Doppler, Color/methods , Plaque, Atherosclerotic/pathology , Carotid Intima-Media Thickness , Computed Tomography Angiography/methods
13.
Arch. cardiol. Méx ; 89(3): 248-253, jul.-sep. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1149074

ABSTRACT

Resumen Los aneurismas de las arterias coronarias se definen como una dilatación localizada que excede el diámetro normal en 1.5 veces. Esta es una condición poco frecuente, su incidencia varía del 0.3 hasta el 5.3% de las angiografías coronarias. Los aneurismas que exceden cuatro veces el diámetro del vaso normal se consideran gigantes. Estos son aún más raros y se presentan en el 0.02 a 0.2% de todos los casos. Existe controversia en cuanto a su fisiopatología, sin embargo, hasta el 50% de los casos se relacionan con la aterosclerosis. Se diagnostican más frecuentemente entre la sexta y séptima décadas de vida. Las principales manifestaciones clínicas están relacionadas con la cardiopatía isquémica. Respecto a su tratamiento, no existe un consenso del manejo en los pacientes adultos, las opciones son: médico, quirúrgico o intervencionismo. Reportamos la presencia de un aneurisma gigante de la coronaria derecha y ectasia gigante del sistema izquierdo con trombosis activa en un hombre con antecedentes de un aneurisma en la aorta abdominal, tratado por vía endovascular, e infarto agudo al miocardio sin elevación del segmento ST no reperfundido. Requirió de estudio de angiotomografía coronaria, el cual permitió la identificación de las características anatómicas de esta enfermedad.


Abstract Coronary artery aneurysms are described as a localized dilatation that exceeds the normal diameter by 1.5 times. This is a rare condition; its incidence varies from 0.3% up to 5.3% of all coronary angiographies. Those aneurysms that exceed 4 times the diameter of a normal artery are considered giant aneurysms, which are even more uncommon, presenting between 0.02% and 0.2% of all cases. There is controversy regarding its pathophysiology, however, up to 50% of the cases are related to atherosclerosis. They are diagnosed more frequently between the sixth and seventh decade of life. The main clinical manifestations are related to ischemic heart disease. Regarding their treatment, there is no general consensus towards its management in adult patients. The options are medical, surgical or percutaneous treatment. We report the presence of a giant aneurysm of the right coronary artery and giant ectasia of the left coronary system with active thrombosis in a man with history of an abdominal aortic aneurysm, with endovascular treatment and a non-ST segment elevation myocardial infarction with no reperfusion strategy, who required a coronary computed tomography, identifying the anatomical characteristics of this disease.


Subject(s)
Humans , Male , Aged , Thrombosis/diagnostic imaging , Coronary Aneurysm/diagnostic imaging , Tomography, X-Ray Computed , Aortic Aneurysm, Abdominal/therapy , Dilatation, Pathologic/diagnostic imaging , Non-ST Elevated Myocardial Infarction/physiopathology
15.
Rev. bras. anestesiol ; 69(1): 82-86, Jan.-Feb. 2019. graf
Article in English | LILACS | ID: biblio-977417

ABSTRACT

Abstract Background and objective: Atrial fibrillation is the most common cardiac arrhythmia, which may occur during the perioperative period and lead to hemodynamic instability due to loss of atrial systolic function. During atrial fibrillation management, electrical cardioversion is one of the therapeutic options in the presence of hemodynamic instability; however, it exposes the patient to thromboembolic event risks. Transesophageal echocardiography is a diagnostic tool for thrombi in the left atrium and left atrial appendage with high sensitivity and specificity, allowing early and safe cardioversion. The present case describes the use of transesophageal echocardiography to exclude the presence of thrombi in the left atrium and left atrial appendage in a patient undergoing non-cardiac surgery with atrial fibrillation of unknown duration and hemodynamic instability. Case report: Male patient, 74 years old, hypertensive, with scheduled abdominal surgery, who upon cardiac monitoring in the operating room showed atrial fibrillation undiagnosed in preoperative electrocardiogram, but hemodynamic stable. During surgery, the patient showed hemodynamic instability requiring norepinephrine at increasing doses, with no response to heart rate control. After the end of the surgery, transesophageal echocardiography was performed with a thorough evaluation of the left atrium and left atrial appendage and pulsed Doppler analysis of the left atrial appendage with mean velocity of 45 cm.s-1. Thrombus in the left atrium and left atrial appendage and other cardiac causes for hemodynamic instability were excluded. Therefore, electrical cardioversion was performed safely. After returning to sinus rhythm, the patient showed improvement in blood pressure levels, with noradrenaline discontinuation, extubation in the operating room, and admission to the intensive care unit. Conclusion: In addition to a tool for non-invasive hemodynamic monitoring, perioperative transesophageal echocardiography may be valuable in clinical decision making. In this report, transesophageal echocardiography allowed the performance of early and safely cardioversion, with reversal of hemodynamic instability, and without thromboembolic sequelae.


Resumo Justificativa e objetivos: A fibrilação atrial é a arritmia cardíaca mais comum, pode ocorrer durante todo período perioperatório e gerar instabilidade hemodinâmica devido à perda da função sistólica atrial. No manejo da fibrilação atrial, a cardioversão elétrica é uma das opções terapêuticas quando há instabilidade hemodinâmica, entretanto expõe o paciente a risco de eventos tromboembólicos. A ecocardiografia transesofágica é uma ferramenta que diagnostica trombos no átrio esquerdo e apêndice atrial esquerdo com alta sensibilidade e especificidade e permite a cardioversão precoce e segura. O presente caso descreve o uso da ecocardiografia transesofágica para excluir a presença de trombos no átrio esquerdo e apêndice atrial esquerdo em um paciente submetido à cirurgia não cardíaca com fibrilação atrial de duração desconhecida e instabilidade hemodinâmica. Relato de caso: Paciente, masculino, 74 anos, hipertenso, com cirurgia abdominal programada, que à monitoração cardíaca em sala operatória apresentava ritmo de fibrilação atrial não documentada em eletrocardiograma pré-operatório, porém estável hemodinamicamente. Durante a cirurgia, apresentou instabilidade hemodinâmica com necessidade de noradrenalina em doses crescentes, sem resposta ao controle de frequência cardíaca. Após o término da cirurgia, a ecocardiografia transesofágica foi feita com uma avaliação minuciosa do átrio esquerdo e apêndice atrial esquerdo e análise Doppler pulsado do apêndice atrial esquerdo com velocidade média de 45 cm.s-1. Foram excluídos trombo em átrio esquerdo e apêndice atrial esquerdo e outras causas cardíacas para instabilidade hemodinâmica. Dessa forma, foi feita cardioversão elétrica com segurança. Após retorno ao ritmo sinusal, o paciente apresentou melhoria dos níveis pressóricos com retirada da noradrenalina, extubação em sala operatória e transferência para unidade de terapia intensiva. Conclusão: Além de ferramenta para monitoração hemodinâmica pouco invasiva, a ecocardiografia transesofágica no perioperatório pode ser valiosa na tomada de decisões clínicas. Nesse relato, a ecocardiografia transesofágica permitiu que a cardioversão fosse feita precocemente e com segurança, revertendo o quadro de instabilidade hemodinâmica sem sequelas tromboembólicas.


Subject(s)
Humans , Male , Aged , Atrial Fibrillation/physiopathology , Surgical Procedures, Operative , Thrombosis/diagnostic imaging , Echocardiography, Transesophageal , Clinical Decision-Making , Heart Diseases/diagnostic imaging , Hemodynamics , Intraoperative Complications/physiopathology , Atrial Fibrillation/complications , Atrial Fibrillation/therapy , Thrombosis/etiology , Electric Countershock , Intraoperative Care/methods , Intraoperative Complications/therapy
16.
J. vasc. bras ; 18: e20180026, 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1002493

ABSTRACT

Hemangioma é um tumor frequente, geralmente diagnosticado em crianças, constituindo quase 10% das neoplasias benignas. Um hemangioma com crescimento na parede de um vaso é extremamente raro, e deve ser diferenciado de outras malformações vasculares de mesma origem. Apresentamos um caso raro de hemangioma de veia jugular externa e discutimos sua propedêutica e manejo


Hemangioma is a common tumor, normally diagnosed in children, and accounting for almost 10% of benign neoplasms. A hemangioma arising from the wall of a vessel is rare, and must be differentiated from other vascular malformations of the same origin. We report a rare case of a hemangioma arising from the wall of an external jugular vein and discuss diagnostic work-up and management


Subject(s)
Humans , Female , Adult , Head and Neck Neoplasms/diagnostic imaging , Hemangioma/therapy , Jugular Veins , Surgical Procedures, Operative/methods , Thrombosis/diagnostic imaging , Diagnostic Imaging/methods , Echocardiography/methods , Rivaroxaban/therapeutic use
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