ABSTRACT
Contrast induced nephropathy (CIN) is the third leading cause of hospital acquired renal failure and is associated with significant morbidity and mortality. Chronic kidney disease is the primary predisposing factor for CIN. As estimated glomerular filtration rate<60 ml/1.73 m2 represents significant renal dysfunction and defines patients at high risk. Modifiable risk factors for CIN include hydration status, the type and amount of contrast, use of concomitant nephrotoxic agents and recent contrast administration. The cornerstone of CIN prevention, in both the high and low risk patients, is adequate parenteral volume repletion. In the patient at increased risk for CIN it is often appropriate to withhold potentially nephrotoxic medications, and consider the use of n-acetylcysteine. In patients at increased risk for CIN the use of low or iso-osomolar contrast agents should be utilized and strategies employed to minimize contrast volume. In these patients serum creatinine should be obtained forty-eight hours post procedure and it is often appropriate to continue withholding medications such as metformin or non steroidal anti-inflammatories until renal function returns to normal.
Subject(s)
Contrast Media/adverse effects , Coronary Angiography , Kidney Diseases/chemically induced , Kidney Diseases/prevention & control , Radiography, Interventional , Fluid Therapy , Glomerular Filtration Rate/drug effects , Humans , Premedication , Risk FactorsSubject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Cardiac Catheterization/methods , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis , Aortic Valve Insufficiency/mortality , Aortic Valve Stenosis/mortality , Calcinosis/mortality , Calcinosis/surgery , Clinical Trials as Topic , Coronary Angiography , Humans , Prosthesis DesignABSTRACT
Percutaneous closure of a secundum atrial septal defect was performed successfully via the jugular approach in a 77-year-old patient with heparin-induced thrombocytopenia and total occlusion of the inferior vena cava using the Amplatzer septal occluder after an unsuccessful attempt using the CardioSEAL septal occluder. This case demonstrates the advantages of the jugular approach in the patient with difficult anatomy and the advantage of the Amplatzer over the CardioSEAL device in this situation.
Subject(s)
Angioplasty, Balloon, Coronary , Embolization, Therapeutic/instrumentation , Heart Septal Defects, Atrial/therapy , Jugular Veins/surgery , Aged , Cardiac Catheterization , Combined Modality Therapy , Device Removal , Echocardiography, Transesophageal , Equipment Design , Heart Failure/diagnostic imaging , Heart Failure/therapy , Heart Septal Defects, Atrial/diagnostic imaging , Humans , Jugular Veins/diagnostic imaging , Male , Thrombocytopenia/diagnostic imaging , Thrombocytopenia/therapy , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/pathology , Vena Cava, Inferior/surgery , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/therapyABSTRACT
Setenta e sete valvotomias foram realizadas nas primeiras 80 tentativas de tratamento da estenose mitral por valvuloplastia percutânea por duplo baläo (BMV). No grupo de 80 pacientes, 16 eram homens, a média de idade era de 44 ñ 17 anos, 12 tinham sido submetidos anteriormente a comissurotomia mitral cirúrgica, 26 apresentavam pequena insuficiência mitral. Havia importante alteraçäo valvar (imobilidade, espessamento ou calcificaçäo) ou do aparelho subvalvar em 29 pacientes. A média da pressäo "capilar" pulmonar variou de 22 ñ 6 a 12 ñ 5 mmHg (p < 0,001), o gradiente transvalvar mitral médio de 15 ñ 6 a 5 ñ 4 mmHg (p < 0,001). O índice cardíaco näo variou, a área valvar mitral (Gorlin) aumentou de 1,09 ñ 0,29 a 2,19 ñ 0,72 cm**2 (p < 0,001). Variaçöes similares foram medidas pela ecodopplercardiografia. Houve 3 tamponamentos: o primeiro num paciente no qual a BMV näo foi concluída; nos outros casos, as pressöes intracavitárias foram medidas depois da drenagem cirúrgica do pericárdio. A BMV näo foi eficaz num dos pacientes, que faleceu 3 dias após a toracotomia. Os três tamponamentos ocorreram por perfuraçäo do ventrículo esquerdo por baläo terminando em ponta. Näo houve mais tamponamento depois que foram adotados balöes terminando em "pigtail". Näo houve aumento de insuficiência mitral de mais de 1 +. Foi constatada comunicaçäo interatrial com relaçäo de fluxos pulmonar/sistêmico >= 1,5 e < 2 em 5 pacientes, e nenhum deles necessitou correçäo cirúrgica. A BMV é alternativa ao...