ABSTRACT
An 81-year-old woman was admitted due to acute pulmonary edema. The electrocardiogram showed new Q-waves in anterior leads with ST-elevation in anterolateral leads. Coronary angiogram showed a 100% occluded second diagonal branch with an image of systolic and diastolic compression of the mid-to-distal portion of the left anterior descending coronary artery (LAD) causing a long "bridgelike" effect. Ventriculography revealed a giant aneurysm of the anterolateral wall. A 3-dimensional volume-rendered cardiac computed tomography scan suggested that the aneurysm produced extrinsic compression of the LAD.
Subject(s)
Heart Aneurysm/diagnosis , Heart Ventricles , Myocardial Infarction/diagnosis , Aged, 80 and over , Coronary Angiography , Diagnosis, Differential , Female , Humans , Imaging, Three-Dimensional , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: To assess the incidence of conduction disturbances leading to permanent pacemaker implantation (PPI) following isolated aortic valve replacement (AVR) in a large cohort of elderly patients with severe symptomatic aortic stenosis, and to determine the predictive factors and prognostic value of PPI following AVR in such patients. METHODS: A total of 780 consecutive elderly patients (age 77 ± 4 years, logistic EuroSCORE 10.4 ± 8.5%, STS score 3.5 ± 1.5%) with severe aortic stenosis and no previous pacemaker were analysed. MAIN OUTCOME MEASURES: The incidence, clinical indications, timing and predictive factors of PPI within 30 days after AVR and their prognostic value were evaluated. RESULTS: Baseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalisation due to the occurrence of complete atrioventricular block (2.6%) or severe bradycardia (0.6%). The presence of preprocedural left bundle branch block (OR 4.65, 95% CI 1.62 to 13.36, p = 0.004) or right bundle branch block (OR 4.21, 95% CI 1.47 to 12.03, p = 0.007) predicted the need for PPI after AVR. The need for PPI was associated with a longer hospital stay (p<0.0001). Thirty-day mortality rates were similar between patients with and without PPI (4% vs 3.2%, p = 0.56). Survival rate at 5-year follow-up was 75%, with no differences between patients with and without PPI (p = 0.12). CONCLUSIONS: The need for PPI following isolated AVR in elderly patients with severe symptomatic aortic stenosis was low. Pre-existing bundle branch block predicted the need for PPI. PPI determined a longer hospital stay, but had no effect on acute and long-term mortality.
