ABSTRACT
Patent foramen ovale is increasingly diagnosed in patients who are undergoing clinical study for cryptogenic stroke or migraine. In addition, patent foramen ovale is often suspected as a cause of paradoxical embolism in patients who present with arterial thromboembolism. The femoral venous approach to closure has been the mainstay. When the femoral approach is not feasible, septal occluder devices have been deployed via a transjugular approach.Herein, we describe 2 cases of patent foramen ovale in which the transhepatic approach was used for closure. To our knowledge, this is the 1st report of a transhepatic approach to patent foramen ovale closure in an adult patient. Moreover, no previous case of patent foramen ovale closure has been reported in a patient with interrupted inferior vena cava.
Subject(s)
Cardiac Catheterization/methods , Foramen Ovale, Patent/therapy , Hepatic Veins , Vena Cava Filters , Vena Cava, Inferior/abnormalities , Aged , Cardiac Catheterization/instrumentation , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Female , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/diagnostic imaging , Hepatic Veins/diagnostic imaging , Humans , Male , Radiography , Septal Occluder Device , Treatment Outcome , Vena Cava, Inferior/diagnostic imagingABSTRACT
Myocardial infarction in the absence of significant atherosclerotic coronary artery disease is not uncommonly encountered in clinical practice. This has been more often seen with the current sensitive biomarker assays for myocardial necrosis. Acute illnesses, spontaneous coronary dissection, sepsis, pulmonary embolism and coagulation disorders are some of the common clinical situation where elevated cardiac markers are noted. We describe two brothers presenting with acute myocardial infarction due to thrombus without any obvious cause.
Subject(s)
Coronary Thrombosis/complications , Coronary Thrombosis/diagnosis , Myocardial Infarction/etiology , Adult , Angioplasty, Balloon , Cardiac Catheterization , Coronary Angiography , Coronary Thrombosis/therapy , Electrocardiography , Humans , Male , Myocardial Infarction/therapy , Siblings , Stents , Thrombectomy , Ultrasonography, InterventionalABSTRACT
BACKGROUND: Chronic kidney disease (CKD) has been linked to serious arrhythmias. We studied the impact of CKD upon implantable cardioverter-defibrillator (ICD) recipients. METHODS AND RESULTS: Baseline estimated glomerular filtration rate (eGFR) was calculated from variables at the time of ICD implantation in 95 patients. Patients with eGFR below 60 ml/min and those with end-stage renal disease (ESRD) were considered to have significant CKD. Among 95 patients who underwent ICD implantation for VT/VF, the mean age was 66.5+/-12.2 years, 27 (29.0%) were women and 20 (21.5%) were African American. The CKD groups (eGFR < 60 ml/min and ESRD) and control group (eGFR > or = 60 ml/min) were similar with respect to background histories and medications. A significant difference in all-cause mortality in those with eGFR >or = 60 ml/min, 3 patients (8.6%), compared to either those with eGFR < 60 ml/min, 28 (60.9%), or ESRD 7 patients (58.3%), p < 0.0001, was noted. Proportionately more patients died from arrhythmic deaths in those with eGFR < 60 ml/min, 8 patients (17.39%) and ESRD 3 patients (25%), than those with eGFR > or = 60 ml/min, no patient. P < or = 0.0001. There was progressive increase in DFT's with worsening renal failure. The Cox proportional hazards model for time until death, found independent predictors to be: age, OR = 1.04 (per year), 95% CI 1.00-1.08, p = 0.04; CKD group, OR 2.59, 95% CI 1.27-5.30, p = 0.009; and use of beta-blockers, OR 0.25, 95% CI 0.10-0.61, p = 0.002. CONCLUSIONS: Significant CKD was related to overall poor survival, arrhythmic death and high DFTs.
