RESUMO
Percutaneous balloon mitral valvuloplasty (PBMV) has recently become the treatment of choice for many patients suffering from mitral stenosis. In the current report, we introduce a 26-year-old woman who presented to us with palpitation and exertional dyspnea but without any remarkable medical history. ECG illustrated the sinus rhythm, transthoracic echocardiography (TTE) showed severe rheumatic mitral stenosis and (2+) mitral regurgitation, and transesophageal echocardiography (TEE) demonstrated severe mitral stenosis and no thrombus. Accordingly, the patient underwent percutaneous transvenous mitral commissurotomy (PTMC). On the following day, TTE showed a fresh mobile thrombus in the right atrium attached to the atrial septum, which was confirmed by TEE. As a result, the patient received 1 mg/kg (60 mg) of enoxaparin subcutaneously twice daily plus 5 mg of warfarin daily. Subsequent TTE revealed no mass 4 days after the treatment. Evidence suggests that endocardial surface injury and trans-septal puncture during PTMC may be associated with clot formation, which is aggravated by low blood flow in the right atrium and the catheter as a foreign body. This case report emphasizes the importance of post-PTMC anticoagulant therapy.
RESUMO
BACKGROUND: The phospholipid fatty acid content of high-density lipoprotein (HDL) partially reflects that of the diet and has been reported to be associated with several important biological functions that might serve as risk markers for coronary heart disease. OBJECTIVE: To investigate whether fatty acid composition of HDL phospholipids correlates with angiographically documented coronary artery disease (CAD). METHODS: The population included 212 patients who underwent clinically indicated coronary angiography. The patients were classified with significantly diseased arteries (SDA) if one or more coronary arteries had a stenosis >50% and with minimally diseased arteries (MDA) if there was no significant stenosis (<40%) in any artery. The severity of CAD was expressed by the number of affected vessels. The fatty acid composition of HDL phospholipids was determined by gas liquid chromatography. Multivariate analyses were used to test the independence of associations between the presence and severity of CAD as outcome variables and fatty acid composition of HDL phospholipids. RESULTS: Patients with SDA showed significantly lower levels of linoleic acid (P = .041), eicosapentaenoic acid (EPA) (P = .027), and docosahexaenoic acid (DHA) (P = .026) than patients with MDA in univariate analyses. The association of linoleic acid (odds ratio [OR] .90, P < .05), EPA (OR, 0.41, P < .02), and DHA (OR, 0.48, P < .02) remained statistically significant in the multivariate analyses. The content of EPA (ß = -0.23, P < .01) and DHA (ß = -0.17, P < .05) remained inversely significantly associated with the severity of CAD. CONCLUSIONS: This study shows that polyunsaturated fatty acids, including EPA and DHA content of HDL particles, are independently associated with the presence and severity of angiographically documented CAD.
