Asunto(s)
Válvula Aórtica/cirugía , Defectos del Tabique Interventricular/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas/métodos , Anciano , Bioprótesis/efectos adversos , Tratamiento Conservador/métodos , Ecocardiografía/métodos , Defectos del Tabique Interventricular/terapia , Humanos , Masculino , Impresión Tridimensional/instrumentación , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagenRESUMEN
Pulmonary embolism (PE) is a frequently encountered clinical condition with a high mortality rate that is affected by various factors such as age, hemodynamics, and other comorbidities. Early diagnosis and risk stratification are crucial to achieving a favorable clinical outcome. New risk stratification algorithms have been proposed in order to identify high-risk patients who will benefit from early thrombolytic treatment. Among the various validated diagnostic methods, the role of echocardiography is increasingly accepted. Recent advances in studying right ventricular function have made echocardiography an attractive tool for establishing or excluding the diagnosis of acute PE in the emergency setting and initiating optimal therapy.
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Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Embolia Pulmonar/diagnóstico por imagen , Enfermedad Aguda , Algoritmos , Técnicas de Apoyo para la Decisión , Humanos , Valor Predictivo de las Pruebas , Pronóstico , Embolia Pulmonar/mortalidad , Embolia Pulmonar/fisiopatología , Embolia Pulmonar/terapia , Medición de Riesgo , Factores de Riesgo , Terapia Trombolítica , Función Ventricular Izquierda , Función Ventricular DerechaRESUMEN
OBJECTIVE: Plasma cortisol in obese subjects does not differ from that in normoweight subjects. Extra-adrenal cortisol production by 11ß-hydroxysteroid dehydrogenase type 1 (11ß-HSD1) can result in local hypercortisolemia. The aim of the present study was to examine the role of visceral hypercortisolemia in the development of metabolic syndrome in severe obesity. METHODS: Eight lean women during hysterectomy (controls) and 19 severely obese women during bariatric surgery were studied, 8 without metabolic syndrome (OM- group) and 11 with it (OM+ group). Biopsies of omental and subcutaneous fat were performed in the severely obese women during surgery, but only omental biopsies in the controls. Expression of 11ß-HSD1, glucocorticoid receptor α (GRα) and glucocorticoid receptor ß (GRß) was evaluated using real-time PCR. RESULTS: Omental 11ß-HSD1 expression was different between groups (one-way ANOVA, p < 0.01). Post-hoc analysis revealed that mean omental 11ß-HSD1 mRNA levels were higher in the OM- group compared to controls, whereas they were similar when comparing the OM+ group with lean controls. Expression of 11ß-HSD1 in subcutaneous fat was not different between OM+ and OM- groups. GRα expression in omental fat did not differ among groups or between omental and subcutaneous fat in severely obese patients. An expression of GRß was not detected. CONCLUSION: Contrary to our original hypothesis, omental 11ß-HSD1 expression is not increased in the OM+ group.
Asunto(s)
11-beta-Hidroxiesteroide Deshidrogenasa de Tipo 1/metabolismo , Hidrocortisona/biosíntesis , Grasa Intraabdominal/metabolismo , Síndrome Metabólico/metabolismo , Obesidad Mórbida/metabolismo , 11-beta-Hidroxiesteroide Deshidrogenasa de Tipo 1/genética , Adulto , Análisis de Varianza , Cirugía Bariátrica , Biopsia , Femenino , Humanos , Histerectomía , Síndrome Metabólico/genética , Persona de Mediana Edad , Obesidad Mórbida/genética , ARN Mensajero/metabolismo , Reacción en Cadena en Tiempo Real de la Polimerasa , Receptores de Glucocorticoides/metabolismo , Grasa Subcutánea/metabolismo , Adulto JovenRESUMEN
Traumatic dissection of the aorta is a well-documented entity with poor prognosis and broad spectrum of clinical presentations. We report a rare case of an asymptomatic late presentation of aortic dissection after a high-speed vehicle accident. This case highlights the importance of high clinical suspicion for the diagnosis of aortic dissection.
Asunto(s)
Aneurisma de la Aorta/etiología , Disección Aórtica/etiología , Traumatismos Torácicos/complicaciones , Heridas no Penetrantes/complicaciones , Accidentes de Tránsito , Disección Aórtica/diagnóstico , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Traumatismos Torácicos/diagnóstico , Heridas no Penetrantes/diagnósticoRESUMEN
Little information exists regarding the prevalence of aberrant or ectopic aortic arch vessels in patients with different cardiovascular anomalies. We present a young patient with an aberrant right subclavian artery associated with an ectopic left vertebral artery and a bicuspid aortic valve.
Asunto(s)
Anomalías Múltiples/diagnóstico , Aorta Torácica/anomalías , Válvula Aórtica/anomalías , Aneurisma/diagnóstico , Anomalías Cardiovasculares/diagnóstico , Trastornos de Deglución/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Arteria Subclavia/anomalías , Arteria Vertebral/anomalías , Adulto JovenRESUMEN
Various electrocardiography (ECG) abnormalities have been reported in patients who present with pulmonary embolism (PE). Severe sepsis is also associated with ECG changes that may mimic ST elevation myocardial infarction. We report a case of an elderly patient with PE and septic shock associated with striking ECG changes.
RESUMEN
Although Brevibacterium species used to be considered as nonpathogenic microorganisms until recently, it seems that they can cause a wide variety of clinical diseases by acting mostly as opportunistic pathogens. The present case is the second reported case of infective endocarditis by Brevibacterium species; however, it is the first reported infected native aortic valve in an immunocompetent patient.
Asunto(s)
Infecciones por Actinomycetales/diagnóstico , Válvula Aórtica , Brevibacterium , Endocarditis Bacteriana/diagnóstico , Enfermedades de las Válvulas Cardíacas/diagnóstico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Válvula Aórtica/microbiología , Quimioterapia Combinada , Endocarditis Bacteriana/microbiología , Gentamicinas/administración & dosificación , Gentamicinas/uso terapéutico , Enfermedades de las Válvulas Cardíacas/microbiología , Humanos , Inmunocompetencia , Masculino , Persona de Mediana Edad , Vancomicina/administración & dosificación , Vancomicina/uso terapéuticoRESUMEN
INTRODUCTION: The ratio of early diastolic transmitral velocity to early mitral annular diastolic velocity (E/Ea) can be used to group patients according to filling pressures. However this relationship has not been validated in the intermediate group (E/Ea = 8-15). The time difference between the onset of E and Ea also correlates with left ventricular (LV) filling pressures. The purpose of our study was to evaluate the correlation between the time interval difference of isovolumic relaxation (T[IVRT-IVRTa]) and N-terminal pro-brain natriuretic peptide (NTpro-BNP) in patients with an intermediate E/Ea ratio. METHODS: Echocardiography was performed simultaneously with NTpro-BNP measurement in 60 consecutive patients who had an intermediate E/Ea and were in sinus rhythm. Ea and the isovolumic relaxation time (IVRTa) at the septal and lateral sites of the mitral annulus were measured using pulsed tissue Doppler and the average was utilised. Pulsed Doppler was used to measure E and IVRT. E/Ea and IVRT-IVRTa (T[IVRT-IVRTa]) were calculated. RESULTS: We demonstrated significant correlations between T[IVRT-IVRTa] and NTpro-BNP (r = -0.72, p<0.001), maximal systolic velocity of the mitral annulus (Sa: r = -0.50, p < 0.001), pulmonary artery systolic pressure (r = 0.42, p = 0.002), IVRTa (r = -0.27, p = 0.03), LV ejection fraction (LVEF: r = -0.26, p = 0.04), IVRT (r = -0.24, p = 0.04). We were unable to demonstrate significant relationships between NTpro-BNP and E deceleration time, left atrial diameter/area/volume, Ea or E. By a multiple linear regression analysis, including T[IVRT-IVRTa], IVRT, IVRTa, E/Ea, LVEF, pulmonary artery systolic pressure and Sa as potential determinants, TIVRT-IVRTa (= -0.57, p < 0.001) was shown to be the best independent predictor of NTpro-BNP (r 2 = 0.68, p < 0.001). CONCLUSIONS: T[IVRT-IVRTa] correlates strongly with NTpro-BNP levels in patients with intermediate E/Ea, and could be used as a simple echocardiographic index, with reasonable accuracy.
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Ventrículos Cardíacos/fisiopatología , Contracción Miocárdica/fisiología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Disfunción Ventricular Izquierda/fisiopatología , Anciano , Diástole/fisiología , Ecocardiografía Doppler de Pulso , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Factores de Tiempo , Disfunción Ventricular Izquierda/sangre , Disfunción Ventricular Izquierda/diagnóstico por imagenAsunto(s)
Aorta Torácica/diagnóstico por imagen , Aorta Torácica/lesiones , Ecocardiografía , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/diagnóstico por imagen , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico por imagen , Femenino , Humanos , Rotura/diagnóstico por imagen , Rotura/etiología , Adulto JovenRESUMEN
We report a case of a 40-year-old primipara Caucasian woman with Turner syndrome (TS) and Hashimoto thyroiditis who had underwent a successful IVF-ET cycle with oocyte donation and single embryo transfer. All pregnancies in women with TS are considered as high risk, with cardiovascular complications being the most dangerous. Our case represents a typical case of fetal growth restriction with gradual slowing down of fetal growth after 28 weeks. At 37 + 3 gestational weeks, a healthy male newborn weighing 2240 g, with artery pH of 7.32 was delivered by cesarean section. The neonate was small for gestational age. Women with TS who become pregnant need close surveillance from a multidisciplinary team of cardiologists, obstetricians and endocrinologists. The primary goal is to prevent maternal complications and to improve perinatal outcome. In doing so, a thorough evaluation of fetal growth and uteroplacental and fetal circulation should by no means be omitted, after 26-28 weeks of gestation. The examinations should be at monthly or even shorter intervals to find early signs of growth restriction and act accordingly.
Asunto(s)
Retardo del Crecimiento Fetal , Síndrome de Turner , Adulto , Femenino , Enfermedad de Hashimoto , Humanos , Recién Nacido , Masculino , Donación de Oocito , Embarazo , Factores de RiesgoRESUMEN
We report three cases of patients with blunt thoracic trauma, who underwent transesophageal echocardiography (TEE) because of high index of clinical suspicion for acute traumatic aortic syndrome. TEE revealed three different locations of aortic injury one of which was not diagnosed with aortography.
Asunto(s)
Aorta Torácica/lesiones , Rotura de la Aorta/diagnóstico por imagen , Traumatismos Torácicos/diagnóstico por imagen , Heridas no Penetrantes/diagnóstico por imagen , Accidentes de Tránsito , Adulto , Aorta Torácica/diagnóstico por imagen , Rotura de la Aorta/etiología , Ecocardiografía Transesofágica , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Traumatismos Torácicos/complicaciones , Heridas no Penetrantes/complicacionesRESUMEN
We present the case of a patient with acute pulmonary embolism and a large right atrial and a smaller pulmonary artery thrombus. Thrombi were successfully treated with intravenous heparin. Echocardiography was used to document the morphological evolution of thrombi and to evaluate the medical treatment.
RESUMEN
We report the case of a patient who was admitted to the hospital with acute pulmonary embolism 2 weeks after a complicated pelvis fracture. Echocardiography revealed a large, long, and mobile thrombus in the right atrium. The patient was scheduled to undergo urgent surgical thrombectomy. Preoperative echocardiography did not detect any thrombi in the right heart and pulmonary artery. The obvious embolism of this large thrombus in the pulmonary circulation was silent as the patient remained asymptomatic and hemodynamically stable. We discuss the contribution of echocardiography to the appropriate therapeutic management of right atrial thrombi and particularly to the cancellation of urgent operative thrombectomy.