RESUMEN
A two-month-old child having WPW syndrome and orthodromic tachycardia was on treatment with digoxin, flecainide and amiodarone. Despite this, he continued to have severe, very frequent episodes of tachycardia. The left-sided accessory pathway was hence ablated via a patent foramen ovale.
Asunto(s)
Ablación por Catéter , Taquicardia/etiología , Taquicardia/cirugía , Síndrome de Wolff-Parkinson-White/complicaciones , Síndrome de Wolff-Parkinson-White/cirugía , Humanos , Lactante , Masculino , Índice de Severidad de la EnfermedadRESUMEN
Cardiomyopathy is defined as primary myocardial dysfunction which is not due to hypertensive, valvular, congenital, coronary or pulmonary vascular disease. This term usually denotes a dismal prognosis short of cardiac transplantation. However, several organic diseases of the heart can result in right or left ventricular dysfunction resulting in congestive heart failure and prompting the physician to label them as cardiomyopathy; the etiological factor is overlooked as it produces very subtle features. Therefore, before labelling any child as cardiomyopathic, all possible causes of ventricular dysfunction must be excluded by clinical and investigative means. The causes of "treatable cardiomyopathy" include mechanical factors as critical aortic stenosis and pulmonic stenosis, severe coarctation of aorta in an infant and aortaarteritis is an older child. Some of the persistent arrhythmias like atrial tachycardia, fibrillation, paroxysmal junctional re-entrant tachycardia are also known for causing ventricular dysfunction producing tachycardiomyopathy. Treatment of arrhythmia improves the ventricular function. Myocardial ischemia as a result of congenital coronary anomaly (commonest being anomalous origin of left coronary artery from pulmonary artery) can also present with a cardiomyopathy like picture. Early surgical correction is very rewarding. Finally, some of the metabolic conditions like creatinine and thiamine deficiency can also produce ventricular dilatation and dysfunction. In conclusion, the so called cardiomyopathy like picture can be produced because of several reasons and an attempt must be made to identify them.
Asunto(s)
Cardiomiopatía Dilatada/etiología , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/terapia , Arritmias Cardíacas/complicaciones , Cardiomiopatía Dilatada/mortalidad , Cardiomiopatía Dilatada/terapia , Niño , Creatinina/metabolismo , Humanos , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/terapia , Pronóstico , Estenosis de la Válvula Pulmonar/complicaciones , Estenosis de la Válvula Pulmonar/terapia , Deficiencia de Tiamina/complicacionesRESUMEN
Cardiomyopathy is defined as primary myocardial dysfunction which is not due to hypertensive, valvular, congenital, coronary or pulmonary vascular disease. This term usually denotes a dismal prognosis short of cardiac transplantation. However, several organic diseases of the heart can result in right or left ventricular dysfunction resulting in congestive heart failure and prompting the physician to label them as cardiomyopathy; the etiological factor is overlooked as it produces very subtle features. Therefore, before labelling any child as cardiomyopathic, all possible causes of ventricular dysfunction must be excluded by clinical and investigative means. The causes of "treatable cardiomyopathy" include mechanical factors as critical aortic stenosis and pulmonic stenosis, severe coarctation of aorta in an infant and aortaarteritis is an older child. Some of the persistent arrhythmias like atrial tachycardia, fibrillation, paroxysmal junctional re-entrant tachycardia are also known for causing ventricular dysfunction producing tachycardiomyopathy. Treatment of arrhythmia improves the ventricular function. Myocardial ischemia as a result of congenital coronary anomaly (commonest being anomalous origin of left coronary artery from pulmonary artery) can also present with a cardiomyopathy like picture. Early surgical correction is very rewarding. Finally, some of the metabolic conditions like creatinine and thiamine deficiency can also produce ventricular dilatation and dysfunction. In conclusion, the so called cardiomyopathy like picture can be produced because of several reasons and an attempt must be made to identify them.
Asunto(s)
Cardiomiopatías/terapia , Cardiomiopatías/etiología , Cardiomiopatías/metabolismo , Niño , HumanosAsunto(s)
Procedimientos Quirúrgicos Cardíacos , Conducto Arterioso Permeable/terapia , Embolización Terapéutica/efectos adversos , Cuerpos Extraños/cirugía , Válvula Tricúspide , Niño , Ecocardiografía Doppler , Femenino , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/etiología , Humanos , Radiografía Torácica , Válvula Tricúspide/diagnóstico por imagenRESUMEN
A prospective serial follow-up after coil closure of patent ductus arteriosus in 84 patients showed a cumulative duct closure up to 96% at the end of 2 years. Five patients underwent transient recanalization, and 4 patients required repeat procedure for residual shunt or recanalization.
Asunto(s)
Conducto Arterioso Permeable/terapia , Embolización Terapéutica , Adolescente , Adulto , Velocidad del Flujo Sanguíneo , Cateterismo Cardíaco , Niño , Preescolar , Angiografía Coronaria , Conducto Arterioso Permeable/diagnóstico , Conducto Arterioso Permeable/fisiopatología , Ecocardiografía Doppler en Color , Embolización Terapéutica/instrumentación , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Recurrencia , Estudios RetrospectivosRESUMEN
OBJECTIVES: The present study was performed to determine the outcome of emergent balloon mitral valvotomy (BMV) in patients with cardiac arrest, pulmonary edema or cardiogenic shock. BACKGROUND: In India, many patients with mitral stenosis present in critical condition. They have high mortality despite surgical relief. The role of BMV in such patients is ill-defined. METHODS: Of 558 patients undergoing BMV between January 1993 and December 1994, 40 presented with cardiogenic shock, cardiac arrest or pulmonary edema refractory to medical treatment and underwent emergent BMV (group I). Elective BMV was performed in the remaining 518 patients (group II). RESULTS: Age ([mean +/- SD] 40 +/- 13 vs. 31 +/- 9 years, p < 0.05), incidence of atrial fibrillation (35% vs. 11%, p < 0.05), pulmonary artery systolic pressure (PAsP) (64 +/- 14 vs. 51 +/- 12 mm Hg, p < 0.001) and mitral valve (MV) score (7.4 +/- 1.2 vs. 6.4 +/- 1, p < 0.001) were higher and MV area lower (0.74 +/- 0.17 vs. 0.86 +/- 0.14 cm2, p < 0.001) in group I patients. After emergent BMV in group I, mitral regurgitation occurred in 15%, and the mortality rate was 35%. Stepwise logistic regression analysis identified MV score > or =8 (p = 0.008), PAsP > or =65 mm Hg (p = 0.023) and cardiac output < or =3.151 liters/min (p = 0.001) as significant predictors of a fatal outcome. Follow-up of 1 to 16 months (median 8) was available in 20 of 26 survivors in group I, of whom 15 were asymptomatic. The gain in MV area and the decrease in transmitral gradient and PAsP obtained immediately after BMV persisted during the follow-up period. CONCLUSIONS: Emergent BMV is feasible in critically ill patients. In-hospital survivors have excellent clinical and hemodynamic status at intermediate follow-up.
Asunto(s)
Cateterismo , Urgencias Médicas , Paro Cardíaco/terapia , Estenosis de la Válvula Mitral/terapia , Edema Pulmonar/terapia , Choque Cardiogénico/terapia , Causas de Muerte , Paro Cardíaco/mortalidad , Hemodinámica/fisiología , Humanos , India/epidemiología , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/mortalidad , Edema Pulmonar/mortalidad , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/mortalidad , Cardiopatía Reumática/terapia , Factores de Riesgo , Choque Cardiogénico/mortalidad , Tasa de SupervivenciaAsunto(s)
Tronco Braquiocefálico/anomalías , Conducto Arterioso Permeable/complicaciones , Arteria Pulmonar/anomalías , Adulto , Angiografía , Tronco Braquiocefálico/diagnóstico por imagen , Tronco Braquiocefálico/cirugía , Cateterismo Cardíaco , Cateterismo , Constricción Patológica/complicaciones , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/cirugía , Conducto Arterioso Permeable/diagnóstico por imagen , Conducto Arterioso Permeable/cirugía , Estudios de Seguimiento , Humanos , Masculino , Cuidados Paliativos , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , StentsRESUMEN
OBJECTIVE: Radiofrequency catheter ablation of atrial tachycardias and flutter is an established technique. The same modality in the microbipolar mode is effective in producing full thickness coagulation injury. Cox's maze procedure is highly successful in curing atrial fibrillation (AF) surgically. However, it consumes relatively long cross clamp time and cardiopulmonary bypass time. In this study, radiofrequency microbipolar coagulation was used as an adjunct to corrective valve surgery, as an intraoperative ablative modality to replace Cox's maze III incisions, thus remarkably shortening the procedure. The results of this procedure are compared historically with those of 26 patients who underwent corrective valve surgery alone. METHODS: Radiofrequency microbipolar coagulation was used to produce conduction blocks along the Cox's maze III incision lines as an adjunct to valve surgery in 18 patients in atrial fibrillation undergoing surgery for rheumatic valvular disease. A bayonet type bipolar forceps with an active tip length of 7 mm drawing current from a microbipolar port of Valleylab Force 4 electrosurgical unit (Valleylab, Boulder, CO) was used for microbipolar coagulation. A 3-mm retinal handheld cryoprobe working on nitrous oxide gas was used for cryoablation. RESULTS: A total of 15 survivors in the coagulation maze group were followed from 43 to 224 days (149.7 +/- 73.1 mean +/- S.D.). Twelve of the 15 survivors (80%) converted to normal sinus rhythm (70% confidence limit: 64.7-90.6%). Atrial transport function studies with pulsed wave doppler, showed presence of a wave in all the 12 (100%) patients in tricuspid valve flow and in nine (75%) patients in mitral valve flow. The procedure took 11.62 +/- 3.86 min of elective cardioplegic arrest time for the left atrial portion and 18.71 +/- 4.25 min of cardiopulmonary bypass time during reperfusion for the right atrial portion. Of the 23 survivors out of 26 patients who underwent the valve procedure alone, only one patient (4.3%) converted to normal sinus rhythm (70% confidence limit: 0.6-14%). CONCLUSION: Thus, our modification considerably shortened the time taken for creating the maze in comparison to the Cox's maze procedure and was effective in restoring normal sinus rhythm in 80% of the patients.
Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter , Válvula Mitral/cirugía , Cardiopatía Reumática/cirugía , Adulto , Fibrilación Atrial/etiología , Fibrilación Atrial/mortalidad , Estudios de Casos y Controles , Ablación por Catéter/métodos , Femenino , Estudios de Seguimiento , Atrios Cardíacos/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/mortalidad , Factores de TiempoAsunto(s)
Angioplastia de Balón/instrumentación , Arteriopatías Oclusivas/terapia , Arteria Pulmonar/anomalías , Stents , Adulto , Arteriopatías Oclusivas/diagnóstico por imagen , Diseño de Equipo , Femenino , Hemodinámica/fisiología , Humanos , Persona de Mediana Edad , Arteria Pulmonar/diagnóstico por imagen , RadiografíaRESUMEN
An unusual tear in an Inoue balloon during dilatation of calcific mitral stenosis is presented and its mechanisms discussed. An abnormal sequence of inflation indicates a possible tear.
Asunto(s)
Cateterismo/instrumentación , Estenosis de la Válvula Mitral/terapia , Adulto , Calcinosis/diagnóstico por imagen , Calcinosis/terapia , Falla de Equipo , Humanos , Masculino , Estenosis de la Válvula Mitral/diagnóstico por imagen , RadiografíaRESUMEN
Several mechanisms have been suggested for the development of hypoxemia in cirrhosis. A few patients of portal hypertension due to non cirrhotic liver disease with cyanosis have also been reported earlier. We report probably the first documented case of portal hypertension with portal cavernoma and a normal liver, who had intrapulmonary vascular dilatations leading to hypoxemia and cyanosis. Our case suggests that changes leading to hypoxemia can occur due to portal hypertension alone, in the presence of a normal liver.
Asunto(s)
Hipertensión Portal/complicaciones , Hipoxia/etiología , Dilatación Patológica , Hemangioma Cavernoso/complicaciones , Humanos , Pulmón/irrigación sanguínea , Masculino , Persona de Mediana Edad , Sistema PortaRESUMEN
The successful use of streptokinase therapy in a child with chronic thrombosis of a prosthetic valve (Carbomedics) in the tricuspid position is presented.
Asunto(s)
Prótesis Valvulares Cardíacas/efectos adversos , Estreptoquinasa/administración & dosificación , Trombosis/tratamiento farmacológico , Válvula Tricúspide , Niño , Enfermedad Crónica , Electrocardiografía , Femenino , Humanos , Infusiones Intravenosas , Terapia Trombolítica , Trombosis/diagnóstico , Trombosis/etiologíaRESUMEN
Symptoms of a heart murmur in a 48-year-old male schizophrenic patient with self-injurious behaviour were investigated. Immediately noticeable were multiple scars on his hands. Clinical evidence of subcutaneous needles and aortic regurgitation was found. Echocardiography revealed a linear metallic foreign body across the interventricular septum. He underwent surgery and via a right atriotomy, a needle from the same location was removed.
Asunto(s)
Cuerpos Extraños/etiología , Soplos Cardíacos/etiología , Corazón , Conducta Autodestructiva/complicaciones , Ecocardiografía , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/cirugía , Humanos , Masculino , Persona de Mediana Edad , AgujasRESUMEN
From May 1987 to August 1990, eighteen patients underwent balloon angioplasty for native aortic coarctation. The age of the patients ranged from four to fifty six years (mean age 17.5 years). The procedure was successful in all cases with a reduction in the peak gradient across the coarctation from 61 +/- 19 mm Hg to 11.7 +/- 8.1 mmHg (p < 0.05). The coarcted segment increased from 4.5 +/- 1.9 mm to 10.7 +/- 3.9 mm (p < 0.05). Peak gradient at six to twelve months follow up, obtained in ten patients, was 19.8 +/- 10.1 mmHg (p = NS). There were no life threatening complications, although seven patients had local vascular problems after the procedure. In two patients, there was persistence of hypertension necessitating drug therapy. On haemodynamic and angiographic restudy in 10 patients, one patient had restenosis and none had aneurysm formation. We conclude that balloon angioplasty is a safe, and less invasive alternative to surgery for native aortic coarctation with gratifying immediate and short term results.
Asunto(s)
Angioplastia de Balón , Coartación Aórtica/terapia , Adolescente , Adulto , Coartación Aórtica/fisiopatología , Niño , Preescolar , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Recurrencia , Resultado del TratamientoRESUMEN
Dysfunction of a mechanical prosthetic valve caused by thrombus formation is usually treated surgically. A patient with a thrombosed Björk-Shiley valve in the aortic position was treated successfully with intravenous streptokinase. The considerable improvement in the patient's clinical condition and the phonocardiographic, echocardiographic, and cinefluoroscopic evidence of normalisation of prosthetic valve function established the efficacy of thrombolytic therapy of a thrombosed prosthetic valve in this patient.
Asunto(s)
Prótesis Valvulares Cardíacas/efectos adversos , Estreptoquinasa/uso terapéutico , Trombosis/tratamiento farmacológico , Adulto , Válvula Aórtica , Humanos , Masculino , Fonocardiografía , Trombosis/etiologíaRESUMEN
Direct extention of bronchogenic carcinoma via pulmonary veins into the left atrium is rare. We describe two such cases, one which presented as a left atrial mass with pulmonary edema, and another which was detected at autopsy.