Primary stenting in a young adult with aortic coarctation

A young male adult with significant aortic coarctation was initially referred to our clinics due to uncontrolled blood pressures. On evaluation the diagnosis of aortic coarctation was evident and confirmed with Magnetic Resonance Angiography (MRA). After discussing treatment options with the patient and his parents they opted for the least invasive procedure possible. Primary stenting of a simple discrete aortic coarctation was performed successfully. The following is a report on the methods used and immediate results.

Diagnosis and management of pericardial effusions

Pericardial effusions are a relatively common phenomenon, largely in part due to its many possible etiologies. Although a considerable amount of cases are idiopathic, careful history and physical examination will reveal the etiology in a vast majority of patients. The most effective tools, echocardiography and right heart catheterization, should be aimed not only at the diagnosis of the pericardial effusion, but also to the assessment of the severity of the pericardial effusion, since this will determine that individual patient's management. A small, asymptomatic pleural effusion of known etiology can be treated conservatively, mostly by treating the underlying cause and with careful observation for signs or symptoms of deterioration. Large effusions can be treated with closed pericardiocentesis after routine evaluation for possible etiologies. For patients presenting actual or impending tamponade, the definitive treatment is either closed or open pericardiocentesis, depending on fluid accumulation characteristics, and it should not be delayed for the administration of medical treatment (inotropes, intravenous fluids). Routine evaluation of pericardial fluid is warranted in those cases in which a clear etiology was not established prior to pericardiocentesis.

Percutaneous coronary intervention versus thrombolysis: the definite management of st elevation myocardial infarction

The management of an ST elevation myocardial infarction has undergone significant changes in the past few years. Fibrinolytic agents have become more and more clot specific increasing their efficacy. However, percutaneous coronary intervention, along with its adjuvant therapy (glycoprotein IIB/IIIA receptor inhibitors and clopidrogel), have come to challenge fibrinolytic use. Many studies have demonstrated the benefits of percutaneous coronary intervention as compared to fibrinolysis in the management of acute myocardial infarction by decreasing infarct size, myocardial function loss, and mortality