Subject(s)
Aortic Valve Prolapse/diagnostic imaging , Diastole , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Outflow Obstruction/diagnostic imaging , Aortic Valve Prolapse/complications , Diagnosis, Differential , Diastole/physiology , Echocardiography, Transesophageal/methods , Humans , Male , Middle Aged , Ventricular Dysfunction, Left/complications , Ventricular Outflow Obstruction/complicationsABSTRACT
Takayasu arteritis which typically affects the aorta and its branches usually presents with obstructive lesions leading to ischemia. We report an unusual case of Takayasu arteritis presenting as an acute Type A intramural hematoma.
Subject(s)
Hematoma/diagnosis , Takayasu Arteritis/diagnosis , Aorta, Thoracic/diagnostic imaging , Diagnosis, Differential , Female , Hematoma/classification , Hematoma/diagnostic imaging , Humans , Middle Aged , Radiography , Takayasu Arteritis/diagnostic imagingABSTRACT
We describe the use of extracorporeal membrane oxygenation to temporize circulatory instability during almost incessant ventricular fibrillation in a patient with Brugada syndrome who had electively discontinued chronic amiodarone therapy. The extracorporeal membrane oxygenation was continued for 3 days after emergent delivery of the neonate, during which time the number of ventricular fibrillation episodes and internal defibrillations markedly decreased concomitant with administration of intravenous amiodarone and verapamil. Oral anti-arrhythmic therapy was subsequently reinstituted, and the remainder of the patient's hospital course was uneventful.
Subject(s)
Atrial Fibrillation/complications , Atrial Fibrillation/surgery , Brugada Syndrome/complications , Brugada Syndrome/surgery , Extracorporeal Membrane Oxygenation/methods , Heart Failure/surgery , Hypoxia/surgery , Pregnancy Complications, Cardiovascular/surgery , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/physiopathology , Brugada Syndrome/physiopathology , Cesarean Section , Combined Modality Therapy , Female , Heart Failure/physiopathology , Hemodynamics/physiology , Humans , Infant, Newborn , Male , Pacemaker, Artificial , Pregnancy , Pregnancy Complications, Cardiovascular/physiopathology , Recurrence , Young AdultABSTRACT
Aortic stenosis due to supravalvular membrane usually presents in children. It may be associated with fusion of the left coronary leaflet and the supravalvular membrane, causing obstruction of the left coronary ostium, and resulting in myocardial ischemia. Despite the immobilization of the left coronary leaflet, these patients present in childhood with aortic stenosis and not regurgitation, with or without accompanying myocardial ischemia. The case is described of an adult patient with supravalvular aortic membrane presenting with severe aortic regurgitation and myocardial infarction due to fusion of the left coronary leaflet with the supravalvular membrane.
Subject(s)
Aortic Stenosis, Supravalvular/diagnosis , Aortic Valve Insufficiency/diagnosis , Aortic Stenosis, Supravalvular/complications , Aortic Stenosis, Supravalvular/surgery , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/surgery , Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Severity of Illness IndexSubject(s)
Aortic Valve/surgery , Extracorporeal Membrane Oxygenation , Heart Valve Prosthesis Implantation/adverse effects , Postoperative Complications/therapy , Pulmonary Edema/etiology , Pulmonary Edema/therapy , Algorithms , Aortic Valve/diagnostic imaging , Echocardiography, Transesophageal , Humans , Male , Middle Aged , Positive-Pressure Respiration , Postoperative Complications/diagnostic imaging , Pulmonary Edema/diagnostic imaging , Radiography, Thoracic , Respiratory Function Tests , RewarmingSubject(s)
Aortic Valve/diagnostic imaging , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Postoperative Complications/diagnostic imaging , Abscess/diagnostic imaging , Abscess/etiology , Aged , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/etiology , Endocarditis/diagnostic imaging , Endocarditis/etiology , Humans , Male , Surgical Wound Dehiscence , Ultrasonography, Doppler, ColorSubject(s)
Angina Pectoris/diagnosis , Chest Pain/diagnosis , Coronary Artery Disease/diagnosis , Dyspnea/diagnosis , Physical Exertion , Aged , Angina Pectoris/diagnostic imaging , Chest Pain/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Diagnosis, Differential , Dyspnea/diagnostic imaging , Humans , Male , Physical Exertion/physiology , Recurrence , Sinus of Valsalva/physiology , UltrasonographySubject(s)
Cardiac Tamponade/etiology , Heart Septal Defects, Atrial/therapy , Prostheses and Implants/adverse effects , Acute Disease , Adult , Cardiac Catheterization/methods , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/therapy , Equipment Failure , Female , Humans , Retreatment/methods , Treatment Outcome , UltrasonographySubject(s)
Aorta/pathology , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Dissection/diagnostic imaging , Cocaine-Related Disorders/complications , Crack Cocaine/toxicity , Echocardiography, Transesophageal , Aortic Dissection/etiology , Aortic Aneurysm, Thoracic/etiology , Cocaine-Related Disorders/pathology , Female , Humans , Middle AgedABSTRACT
BACKGROUND: Treatment of coronary artery disease (CAD) is evolving with better medications, improvements in percutaneous coronary intervention (PCI), and enhanced techniques for coronary artery bypass grafting (CABG). METHODS: In this study, 18,481 patients with significant (>75% stenosis) CAD treated at a single center between 1986 and 2000 were assigned to one of three groups based on initial treatment strategy: medical therapy (MED) (n = 6862), PCI (n = 6292), or CABG (n = 5327). Each group was categorized into 3 groups according to baseline severity of CAD: low-severity (predominantly 1-vessel), intermediate-severity (predominantly 2-vessel), and high-severity (all 3-vessel), and prospectively evaluated in Cox models for all-cause mortality adjusted for cardiac risk, comorbidity, and propensity for selection of a specific treatment. Treatments were compared for the entire period and three eras (1: 1986 to 1990; 2: 1991 to 1995; 3: 1996 to 2000), the last encompassing widespread availability of PCI with stenting. RESULTS: Survival significantly improved in all groups for all degrees of CAD, despite increasing severity of illness. Revascularization strategies provided significant survival over MED with 8.1, 10.6, and 23.6 additional months per 15 years of follow-up for low-severity, intermediate-severity, and high-severity CAD, respectively. Therapeutic improvements led to increased survival of 5.3 additional months per 7 years of follow-up (95% confidence interval, 0.2 to 10.2; p = 0.039) in era 3 for CABG compared with PCI for high-severity CAD. CONCLUSIONS: Initial revascularization strategies result in significant survival advantage over MED for all CAD levels. Patients with high-severity CAD have reduced survival with PCI compared with those initially treated with CABG.
Subject(s)
Angioplasty, Balloon, Coronary , Cardiovascular Agents/therapeutic use , Coronary Artery Bypass , Coronary Stenosis/drug therapy , Coronary Stenosis/surgery , Aged , Coronary Stenosis/mortality , Female , Humans , Male , Prospective Studies , Risk Factors , Survival Analysis , Time Factors , Treatment OutcomeABSTRACT
Off-pump beating heart coronary revascularization is a valuable surgical technique for high-risk patients, particularly those with severe atherosclerotic changes of the aorta, COPD, recent stroke, or for those in whom blood administration is contraindicated. Advances in clampless surgical techniques should further the benefit of OPCAB versus conventional CABG mostly in terms of stroke risk reduction. For now, routine use of OPCAB for all surgical revascularization procedures remains in question.
