ABSTRACT
Resumen: Los aneurismas de seno de Valsalva son una malformación rara de observar en la práctica clínica. Se presentan a cualquier edad y pueden ser de origen congénito o adquirido. La importancia de su estudio radica en que potencialmente pueden complicarse con rotura y fistulización a otra estructura cardíaca o extracardíaca, con una alta mortalidad asociada. El diagnóstico muchas veces puede ser complejo, pero existen algunos elementos clínicos inespecíficos que pueden orientarnos en su detección y rápido manejo, lo que puede marcar una diferencia en el pronóstico del paciente. Se presenta el caso de un paciente de 49 años con un aneurisma de seno de Valsalva complicado y a continuación una breve revisión del tema.
Abstract: Aneurysms of the sinus of Valsalva are. They occur at any age, either as a congenital or an acquired malformation. They may rupture and form a fístula to other cardiac structures, with a high mortality rate. The clinical case of a 49 year-old patient with a ruptured sinus of Valsalva an a fístula to the right atrium is presented. A brief review of the subject is included.
Subject(s)
Humans , Male , Middle Aged , Aortic Aneurysm/complications , Aortic Aneurysm/diagnostic imaging , Aortic Rupture/complications , Aortic Rupture/diagnostic imaging , Aortic Aneurysm/surgery , Aortic Rupture/surgery , Sinus of Valsalva/surgery , Sinus of Valsalva/diagnostic imaging , Tomography, X-Ray Computed , Echocardiography, TransesophagealABSTRACT
BACKGROUND: Patients with a cardiovascular (CV) history may be at greater risk of becoming ill and die due to SARS-CoV-2. AIM: To assess the incidence of CV complications in COVID-19 patients, the type of complication, and their association with CV history. MATERIAL AND METHODS: The clinical course of 1,314 patients with COVID-19 admitted consecutively to critical care units of 10 Chilean hospitals was registered between April and August of 2020. RESULTS: The median age of patients was 59 years and 66% were men. One hundred-four (8%) had a CV history, namely heart failure (HF) in 53 (4.1%), coronary heart disease in 50 (3.8 %), and atrial fibrillation in 36 (2.7 %). There were CV complications in 359 patients (27.3%). The most common were venous thrombosis in 10.7% and arrhythmias in 10.5%, HF in 7.2%, type 2 acute myocardial infarction in 4.2%, arterial thrombosis in 2.0% and acute coronary syndrome (ACS) in 1.6%. When adjusted by age, sex and risk factors, only HF (Odds ratio (OR) = 7.16; 95% confidence intervals (CI), 3.96-12.92) and ACS (OR = 5.44; 95% CI, 1.50-19.82) were significantly associated with CV history. There was no association with arrhythmias, type 2 acute myocardial infarction, arterial or venous thrombosis. CONCLUSIONS: Patients with a history of CV disease are at greater risk of suffering HF and ACS when hospitalized due to COVID-19. Arrhythmias, type 2 AMI, and arterial or venous thrombosis occur with the same frequency in patients with or without CV history, suggesting that these complications depend on inflammatory phenomena related to the infection.
Subject(s)
Humans , Male , Female , Middle Aged , Venous Thrombosis/etiology , Venous Thrombosis/epidemiology , Acute Coronary Syndrome , COVID-19/complications , COVID-19/epidemiology , Heart Failure/etiology , Heart Failure/epidemiology , Myocardial Infarction , Chile/epidemiology , SARS-CoV-2 , Hospitals , Intensive Care UnitsABSTRACT
BACKGROUND: Patients with a cardiovascular (CV) history may be at greater risk of becoming ill and die due to SARS-CoV-2. AIM: To assess the incidence of CV complications in COVID-19 patients, the type of complication, and their association with CV history. MATERIAL AND METHODS: The clinical course of 1,314 patients with COVID-19 admitted consecutively to critical care units of 10 Chilean hospitals was registered between April and August of 2020. RESULTS: The median age of patients was 59 years and 66% were men. One hundred-four (8%) had a CV history, namely heart failure (HF) in 53 (4.1%), coronary heart disease in 50 (3.8 %), and atrial fibrillation in 36 (2.7 %). There were CV complications in 359 patients (27.3%). The most common were venous thrombosis in 10.7% and arrhythmias in 10.5%, HF in 7.2%, type 2 acute myocardial infarction in 4.2%, arterial thrombosis in 2.0% and acute coronary syndrome (ACS) in 1.6%. When adjusted by age, sex and risk factors, only HF (Odds ratio (OR) = 7.16; 95% confidence intervals (CI), 3.96-12.92) and ACS (OR = 5.44; 95% CI, 1.50-19.82) were significantly associated with CV history. There was no association with arrhythmias, type 2 acute myocardial infarction, arterial or venous thrombosis. CONCLUSIONS: Patients with a history of CV disease are at greater risk of suffering HF and ACS when hospitalized due to COVID-19. Arrhythmias, type 2 AMI, and arterial or venous thrombosis occur with the same frequency in patients with or without CV history, suggesting that these complications depend on inflammatory phenomena related to the infection.
Subject(s)
Acute Coronary Syndrome , COVID-19 , Heart Failure , Myocardial Infarction , Venous Thrombosis , Male , Humans , Middle Aged , Female , COVID-19/complications , COVID-19/epidemiology , Chile/epidemiology , SARS-CoV-2 , Heart Failure/epidemiology , Heart Failure/etiology , Hospitals , Intensive Care Units , Venous Thrombosis/epidemiology , Venous Thrombosis/etiologyABSTRACT
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is taking a leading role in the management of patients with severe aortic stenosis. Valve replacement surgery prolongs survival and is the technique of choice considering its historical background and long experience worldwide. Recently however, TAVI has positioned itself as the only standard therapy for symptomatic patients who are not candidates for surgery. AIM: To report the experience with this new technique comparing our results with those reported in the literature. MATERIAL AND METHODS: Between May 2010 and December 2011,17 patients aged 81 ± 7.3 years (58.8% men with an Euro SCORE 29 ± 22.4%) underwent a TAVI. RESULTS: The median transvalvular gradient was 54 ± 15.7 mmHg. All patients received a CoreValve™. Technical success was 100%, with a post implant gradient of 6.29 ± 3.3 mmHg. Residual aortic regurgitation was observed in 94%, none greater than grade II. There were no complications at the vascular access site. One patient developed cardiac tamponade during the procedure. Permanent pacemaker implantation was required in 35.2%. Hospital mortality rate was 5.8%, a figure that remained unchanged at 30 days of follow-up. CONCLUSIONS: In high-risk patients with aortic stenosis, TAVI has a high success rate and a low rate of complications. Besides an appropriate patient selection, a trained multidisciplinary team and technical conditions to solve possible complications of the procedure are required.
Subject(s)
Aortic Valve Stenosis/surgery , Cardiac Catheterization/methods , Heart Valve Prosthesis Implantation/methods , Aged, 80 and over , Cardiac Catheterization/standards , Female , Heart Valve Prosthesis Implantation/mortality , Heart Valve Prosthesis Implantation/standards , Hospital Mortality , Humans , Male , Treatment OutcomeABSTRACT
Background: Transcatheter aortic valve implantation (TAVI) is taking a leading role in the management of patients with severe aortic stenosis. Valve replacement surgery prolongs survival and is the technique of choice considering its historical background and long experience worldwide. Recently however, TAVI has positioned itself as the only standard therapy for symptomatic patients who are not candidates for surgery. Aim: To report the experience with this new technique comparing our results with those reported in the literature. Material and Methods: Between May 2010 and December 2011,17patients aged 81 ± 7.3 years (58.8% men with an Euro SCORE 29 ± 22.4%) underwent a TAVI. Results: The median transvalvular gradient was 54 ± 15.7 mmHg. All patients received a CoreValveTM. Technical success was 100%, with a post implant gradient of 6.29 ± 3.3 mmHg. Residual aortic regurgita-tion was observed in 94%, none greater than grade II. There were no complications at the vascular access site. One patient developed cardiac tamponade during the procedure. Permanent pacemaker implantation was required in 35.2%. Hospital mortality rate was 5.8%, a figure that remained unchanged at 30 days offollow-up. Conclusions: In high-risk patients with aortic stenosis, TAVI has a high success rate and a low rate of complications. Besides an appropriate patient selection, a trained multidisciplinary team and technical conditions to solve possible complications of the procedure are required.
Subject(s)
Aged, 80 and over , Female , Humans , Male , Aortic Valve Stenosis/surgery , Cardiac Catheterization/methods , Heart Valve Prosthesis Implantation/methods , Cardiac Catheterization/standards , Heart Valve Prosthesis Implantation/mortality , Heart Valve Prosthesis Implantation/standards , Hospital Mortality , Treatment OutcomeABSTRACT
Hyperkalemia is a complications of the use of angiotensin converting enzyme inhibitors, angiotensin receptor antagonists and aldosterone antagonists. These drugs are commonly used for the treatment of hypertension and cardiac failure. We report a 84 year-old female treated with losartan 50 mg/day and spironolactone 25 mg/day that presented with a hyperkalemia of 8.4 mEq/l and bradicardia, drowsiness and respiratory depression. She required hemodialysis and ventilatory assistance. She was discharged in good conditions five days after admission.
