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1.
J Innov Card Rhythm Manag ; 15(1): 5704-5708, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38304091
5.
J Hypertens ; 36(6): 1423-1424, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29697482
6.
Echocardiography ; 35(3): 410-412, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29346704

RESUMO

The development of an aorto-right ventricular fistula is a rare complication of cardiac surgery. The most common treatment is surgical closure of the fistula, but percutaneous closure of the fistula has become an attractive alternative option. We present a case of successful utilization of live/real time three/four-dimensional transoesophageal echocardiography (3/4DTEE) to select the correct device size for percutaneous closure of an adult patient presenting with an aorto-right ventricular (AO-RV) fistula following aortic valve replacement. To the best of our knowledge, this is the first case in which 3/4DTEE was used to select the device size and guide percutaneous closure of an iatrogenic AO-RV fistula.


Assuntos
Valva Aórtica/cirurgia , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Ventrículos do Coração/cirurgia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia , Valva Aórtica/diagnóstico por imagem , Ecocardiografia Quadridimensional/métodos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade
8.
Eur Heart J Qual Care Clin Outcomes ; 4(2): 132-141, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29121222

RESUMO

Aims: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors considerably alter the lipid profile. We sought to examine the rates of ischaemic stroke and neurocognitive deficits in patients treated with and without PCSK9 inhibitors. Methods and results: Randomized controlled trials (RCTs) reporting rates of ischaemic stroke and neurocognitive deficits in patients using PCSK9 inhibitors were identified. Standard meta-analysis techniques were used to compare these outcomes among patients treated with and without PCSK9 inhibitors and the two US Food and Drug Administration-approved PCSK9 inhibitors, evolocumab and alirocumab. The results were presented in terms of risk ratio (RR) with 95% confidence intervals (CIs). Sixteen RCTs with 39 104 patients were included. Evolocumab was used in six RCTs with 33 450 patients, whereas alirocumab was used in 10 RCTs with 5654 patients. We observed a significantly lower risk of ischaemic stroke among those treated with PCSK9 inhibitors (RR 0.77, 95% CI 0.64-0.93) when compared with those without. We did not observe any difference in the risk of neurocognitive deficits between the aforementioned groups (RR 1.11, 95% CI 0.93-1.32). The lower stroke risk in the PCSK9 inhibitors group was driven by evolocumab studies. We observed no difference in the risk of neurocognitive deficits among evolocumab and alirocumab when compared with no PCSK9 inhibitors group. Conclusion: Treatment with PCSK9 inhibitors significantly lowers the risk of ischaemic stroke, without any increased risk of neurocognitive deficits. PCSK9 inhibitors are neuroprotective due to the decrease in ischaemic-mediated neurovascular events and should be considered cognitively innocuous medications.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Isquemia Encefálica , Inibidores de PCSK9 , Anticorpos Monoclonais Humanizados , Anticolesterolemiantes/uso terapêutico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/metabolismo , Isquemia Encefálica/prevenção & controle , Saúde Global , Humanos , Hipercolesterolemia , Incidência , Resultado do Tratamento
10.
Echocardiography ; 34(11): 1680-1686, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29086433

RESUMO

Ventricular septal rupture is a serious complication following acute myocardial infarctions and is associated with a significant mortality rate. Classically, two-dimensional transthoracic echocardiography has been used to diagnose this complication and visualize its location. Two-dimensional transesophageal echocardiography has supplemented the transthoracic approach by providing more accurate assessment of the defect size and in guiding closure both percutaneously and intraoperatively. This modality, however, is limited to two-dimensional views only, and a greater breadth of information is instead available through the use of three-dimensional transesophageal echocardiography. We present a series of 11 patients in which live/real time three-dimensional transesophageal echocardiography offered incremental benefits over two-dimensional imaging alone.


Assuntos
Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/diagnóstico por imagem , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Reprodutibilidade dos Testes , Ruptura do Septo Ventricular/etiologia , Septo Interventricular/diagnóstico por imagem , Septo Interventricular/lesões
11.
Echocardiography ; 34(7): 1057-1061, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28664669

RESUMO

Ascending aortic pseudoaneurysms (AO PSAs), if left untreated, are complicated by a high rate of rupture resulting in significant morbidity and mortality. New transcatheter modalities have emerged as acceptable surgical alternatives for their management. We present a case of an ascending aortic PSA in which intraoperative two- and three-dimensional transesophageal echocardiography (2DTEE and 3DTEE) provided a comprehensive assessment of the PSA in pre- and postclosure settings.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aorta/diagnóstico por imagem , Aorta/cirurgia , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Idoso , Humanos , Masculino , Resultado do Tratamento
12.
Echocardiography ; 34(7): 1050-1056, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28600838

RESUMO

Loeffler endocarditis is a complication of hypereosinophilic syndrome resulting from eosinophilic infiltration of heart tissue. We report a case of Loeffler endocarditis in which three-dimensional transthoracic and transesophageal echocardiography provided additional information to what was found by two-dimensional transthoracic echocardiography alone. Our case illustrates the usefulness of combined two- and three-dimensional echocardiography in the assessment of Loeffler endocarditis. In addition, a summary of the features of hypereosinophilic syndrome and Loeffler endocarditis is provided in tabular form.


Assuntos
Valva Aórtica/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Síndrome Hipereosinofílica/diagnóstico por imagem , Adulto , Anticoagulantes/uso terapêutico , Valva Aórtica/fisiopatologia , Ecocardiografia/métodos , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Síndrome Hipereosinofílica/tratamento farmacológico , Síndrome Hipereosinofílica/fisiopatologia
14.
Echocardiography ; 34(6): 915-918, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28512744

RESUMO

Ostial lesions represent a challenging clinical scenario and percutaneous intervention (PCI) of left main coronary artery ostial lesions has been associated with postintervention complications, including protrusion of deployed stents into a sinus of Valsalva or aortic root. We report a case of stent protrusion into the aortic root following aorto-ostial left main coronary artery PCI, in which three-dimensional transesophageal echocardiography (3DTEE) provided incremental benefit over standard two-dimensional images. Specifically, 3DTEE confirmed the presence of stent protrusion by allowing clear visualization of the stent scaffold, in addition to characterizing the relationship between the stent and surrounding structures.


Assuntos
Ponte de Artéria Coronária , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Migração de Corpo Estranho/diagnóstico por imagem , Stents , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
South Med J ; 110(2): 97-100, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28158878

RESUMO

Psoriasis is an idiopathic chronic immune-mediated skin condition in which the body's immune system undergoes several derangements, including increased antigen presentation by T cells and increased T-helper cell type 1 cytokines, resulting in skin lesions as well as arthritis. Despite that cardiovascular involvement in psoriasis is common and reported in up to 47% of cases, this association is not well recognized by physicians, dermatologists, and cardiologists. Psoriasis is considered the most prevalent autoimmune disease in the United States and affects approximately 7.4 million people. Although its exact etiology is unclear, inflammatory response to infectious agents has been proposed as one of the mechanisms. We present a concise review of the literature associating psoriasis with dilated cardiomyopathy and the proposed pathophysiologic processes for the main goal of increased awareness.


Assuntos
Cardiomiopatia Dilatada , Psoríase , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/imunologia , Cardiomiopatia Dilatada/fisiopatologia , Citocinas/imunologia , Humanos , Psoríase/complicações , Psoríase/imunologia , Psoríase/fisiopatologia
16.
Echocardiography ; 34(2): 264-266, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28240431

RESUMO

Paraprosthetic aortic valve abscess represents a rare, but lethal complication of infective endocarditis. We report a case of proximal left coronary system compression by a paraprosthetic aortic valve abscess whose detection was augmented using live/real time three-dimensional transesophageal echocardiography. Our case illustrates the usefulness of combined two- and three-dimensional transesophageal echocardiography in detecting this finding.


Assuntos
Abscesso/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Próteses Valvulares Cardíacas/microbiologia , Abscesso/complicações , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/microbiologia , Vasos Coronários/fisiopatologia , Diagnóstico Diferencial , Endocardite/complicações , Evolução Fatal , Feminino , Doenças das Valvas Cardíacas/complicações , Humanos , Pessoa de Meia-Idade
17.
J Gen Intern Med ; 32(5): 585-588, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28210918

RESUMO

We describe the case of a 27-year-old woman with a history of sickle cell trait (SCT) who presented with several months of hematuria and was found to have nutcracker syndrome (NCS). While SCT is a common cause of hematuria resulting from renal papillary necrosis, our patient had concomitant abdominal pain and anemia, prompting further evaluation and the subsequent diagnosis of NCS. Interestingly, the anoxia in the left renal vein from NCS predisposes patients with SCT to sickling. Our case highlights key clinical features of both NCS and SCT and the relationship between the two disease processes.


Assuntos
Hematúria/diagnóstico por imagem , Hematúria/etiologia , Síndrome do Quebra-Nozes/complicações , Síndrome do Quebra-Nozes/diagnóstico por imagem , Traço Falciforme/complicações , Traço Falciforme/diagnóstico por imagem , Adulto , Feminino , Seguimentos , Humanos
19.
Am J Ophthalmol Case Rep ; 4: 14-17, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29503915

RESUMO

PURPOSE: To report a case of regained corneal sensation and function in a patient with neurotrophic keratopathy due to direct damage to the long ciliary nerves by performing a corneal neurotization procedure using ipsilateral supraorbital nerve. Surgical technique is described in detail as well as a review of the literature on corneal neurotization. OBSERVATIONS: A patient with devastating corneal anesthesia and poor visual acuity refractory to other treatments underwent a new surgical technique involving an ipsilateral supraorbital nerve transfer to the surrounding limbus to restore corneal sensation. At 8 months follow up, there was resolution of corneal stromal opacification documented with photographs and greatly improved corneal sensation by testing with a wisp of cotton in all 4 quadrants. Her visual acuity had improved, and at two years she was stable with even more improvement in visual acuity and ocular surface health. CONCLUSIONS AND IMPORTANCE: We present the first successful case of corneal neurotization with ipsilateral supraorbital nerve in a patient with corneal anesthesia from a local injury to the long ciliary nerves. Our case demonstrates that the described method of corneal neurotization is a viable option for patients with recalcitrant neurotrophic keratopathy and an intact ipsilateral frontal nerve.

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