RESUMEN
Uncontrolled arterial hypertension is a major global health issue. Catheter-based renal denervation has shown to lower blood pressure in sham-controlled trials and represents a device-based, complementary treatment option for hypertension. In this situation assessment, the authors, who are practicing experts in hypertension, nephrology, general practice and cardiology in the Republic of Ireland, discuss the current evidence base for the BP-lowering efficacy and safety of catheter-based renal denervation with different modalities. Although important questions remain regarding the identification of responders, and long-term efficacy and safety of the intervention, renal denervation has the potential to provide much-needed help to address hypertension and its adverse consequences. The therapeutic approach needs to be multidisciplinary and personalised to take into account the perspective of patients and healthcare professionals in a shared decision-making process.
Asunto(s)
Insuficiencia de la Válvula Tricúspide/complicaciones , Insuficiencia de la Válvula Tricúspide/diagnóstico , Obstrucción del Flujo Ventricular Externo/diagnóstico , Obstrucción del Flujo Ventricular Externo/etiología , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/diagnóstico , Femenino , HumanosRESUMEN
Paravalvular leaks are an uncommon but serious complication of prosthetic valves. Transthoracic echocardiography is used in the assessment of prosthetic valves but can be limited by acoustic shadowing from the prosthesis and poor acoustic windowing. Small case series have previously shown cardiac CT to have promising results in detecting paravalvular leaks. We assessed 32 valves in our institution on cardiac CT using echocardiography results as standard and developed methods for improved evaluation of prosthetic valves. These include optimizing prescan drug therapy for heart rate control, optimum window and center adjustments, and carefully selected image planes to best demonstrate the valve ring and valve annulus. Recognition of surgical material is also important to recognize. In this review, we provide a detailed description of these techniques with imaging examples of prosthetic valve evaluation using cardiac CT.
Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Tomografía Computarizada Multidetector , Adulto , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/etiología , Artefactos , Ecocardiografía Doppler en Color , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Valor Predictivo de las Pruebas , Diseño de Prótesis , Falla de Prótesis , Interpretación de Imagen Radiográfica Asistida por ComputadorRESUMEN
A 40-year-old man with no cardiac history was admitted for evaluation of atypical chest pain of 1-month duration. On investigation he was found to have hypertrophic cardiomyopathy and an anomalous right coronary artery arising from the left sinus of Valsalva. This is of great clinical significance as both these conditions are independently associated with sudden cardiac death. Following extensive risk assessment and detailed discussion with the patient, he was discharged on medical therapy, comprising bisoprolol, aspirin and rosuvastatin. He has remained free of symptoms for 1 year. This report describes the rare coexistence of these two distinct clinical entities, examines the various treatment options and provides support for medical management as an acceptable treatment strategy in appropriately selected cases.
Asunto(s)
Cardiomiopatía Hipertrófica/complicaciones , Anomalías de los Vasos Coronarios/complicaciones , Adulto , Cardiomiopatía Hipertrófica/diagnóstico , Dolor en el Pecho/etiología , Anomalías de los Vasos Coronarios/diagnóstico , Humanos , MasculinoAsunto(s)
Pericarditis/diagnóstico por imagen , Uremia/complicaciones , Adulto , Resultado Fatal , Glomerulonefritis/complicaciones , Hepacivirus/aislamiento & purificación , Humanos , Masculino , Pericarditis/etiología , Staphylococcus aureus/aislamiento & purificación , Abuso de Sustancias por Vía Intravenosa/complicaciones , UltrasonografíaRESUMEN
Ebstein's anomaly (EA) is a rare cardiac congenital malformation with displacement of septal and posterior tricuspid leaflets, resulting in atrialization of the right ventricle. We report a case of EA in which the etiology of a malfunctioning prosthetic tricuspid valve is depicted on cardiac computed tomography to be as a result of thrombus lodged in the valve.
RESUMEN
Valvular cardiomyopathy can present a diagnostic challenge in the absence of overt cardiac symptoms. This report describes the case of a 46-year-old woman who presented with acute peritonitis associated with vomiting and abdominal distension. Subsequent abdominal computed tomography and ultrasound revealed bibasal pleural effusions, ascites, and normal ovaries. An echocardiogram revealed that all cardiac chambers were dilated with a global decrease in contractility and severe mitral, tricuspid, and aortic regurgitation. A diagnosis of cardiomyopathy with acute heart failure, secondary to valvular heart disease, was secured. Acute peritonitis as the presenting feature of valvular cardiomyopathy is a rare clinical entity.
Asunto(s)
Enfermedades de las Válvulas Cardíacas/complicaciones , Peritonitis/etiología , Dolor Abdominal/etiología , Enfermedad Aguda , Cardiomiopatías/etiología , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico , Humanos , Persona de Mediana Edad , Derrame Pleural/etiología , Vómitos/etiologíaRESUMEN
We report the radiographic, echocardiographic and cardiac CT appearances of 'porcelain heart' in an 85-year-old woman who presented with progressive heart failure. The extensive myocardial calcification was secondary to hyperparathyroidism with renal failure.
Asunto(s)
Cardiomiopatías , Ecocardiografía , Hiperparatiroidismo/complicaciones , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/etiología , Femenino , Humanos , Radiografía TorácicaAsunto(s)
Aneurisma de la Aorta/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Implantación de Prótesis Vascular/instrumentación , Vasos Coronarios/lesiones , Descompresión Quirúrgica/instrumentación , Anastomosis Quirúrgica/métodos , Disección Aórtica/etiología , Disección Aórtica/cirugía , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/cirugía , Prótesis Vascular , Angiografía Coronaria/métodos , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Stents/efectos adversos , Tomografía Computarizada por Rayos X/métodosRESUMEN
During the decade of the IDNDR, significant progress has been made towards more effectively mitigating the tsunami hazard, much of it though the activities of the OIC International Coordination Group of Tsunami Warning System in the Pacific (ITSU) and its Member State. Worldwide historical tsunami data have been compiled in computer databases with graphical interfaces for more widespread access and to better assess the tsunami hazard in each coastal region. Numerical modelling of tsunamis has matured, and this technology has been transferred to many countries at risk for producing realistic tsunami run - up maps to guide coastal development and emergency planning. Warning systems have better and faster access to high quality seismic and water level data, better techniques for evaluating tsunamis, and more effective methods for disseminating warnings. Educational materials for both children and adults have been produced in many languages. But with ever - increasing coastal development and population growth, significant challenges remain. Eleven destructive tsunamis have occurred since 1990, causing over 4000 casualties and significant property damage. When these events are examined, it is possible to identify ways that mitigation efforts have helped, but more often how those efforts need to be expanded and improved in the future. (AU)