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1.
J Clin Med ; 13(11)2024 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-38892916

RESUMO

Current guidelines for the care of heart transplantation recipients recommend routine endomyocardial biopsy and invasive coronary angiography as the cornerstones in the surveillance for acute rejection (AR) and coronary allograft vasculopathy (CAV). Non-invasive tools, including coronary computed tomography angiography and cardiac magnetic resonance, have been introduced into guidelines without roles of their own as gold standards. These techniques also carry the risk of contrast-related kidney injury. There is a need to explore non-invasive approaches providing valuable information while minimizing risks and allowing their application independently of patient comorbidities. Echocardiographic examination can be performed at bedside, serially repeated, and does not carry the burden of contrast-related kidney injury and procedure-related risk. It provides comprehensive assessment of cardiac morphology and function. Advanced echocardiography techniques, including Doppler tissue imaging and strain imaging, may be sensitive tools for the detection of minor myocardial dysfunction, thus providing insight into early detection of AR and CAV. Stress echocardiography may offer a valuable tool in the detection of CAV, while the assessment of coronary flow reserve can unravel coronary microvascular impairment and add prognostic value to conventional stress echocardiography. The review highlights the role of Doppler echocardiography in heart transplantation follow-up, weighting advantages and limitations of the different techniques.

2.
J Artif Organs ; 23(2): 98-104, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31463532

RESUMO

Left ventricular assist device (LVAD) implantation is an important treatment option for patients with advanced heart failure. The presence of a patent foramen ovale (PFO) may elicit undesired consequences in LVAD patients: hypoxemia and paradoxical embolization. The variable physiological status of the patient with heart failure can make pre-LVAD implant identification of a PFO elusive. When identified pre- or intraoperatively, PFO is closed at time of LVAD implantation. In the case of delayed diagnosis, percutaneous PFO closure has proven to be a feasible and safe solution. As mechanical circulatory support gains prevalence, it is important to raise awareness of physiological implications of right-to-left shunt during mechanical circulatory support. We reviewed the diagnostic and therapeutic management of PFO in LVAD patients.


Assuntos
Forame Oval Patente/complicações , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/cirurgia , Hipóxia/etiologia , Coração Auxiliar/efeitos adversos , Humanos , Resultado do Tratamento
3.
Heart Fail Rev ; 25(6): 965-972, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-31691065

RESUMO

Mechanical ventricular support with left ventricular assist device (LVAD) has emerged as a durable and safe therapy, both as bridge-to-transplant (BTT) or destination therapy (DT), in patients with advanced heart failure (HF). However, the occurrence of pump thrombosis (PT) still represents a serious complication, especially when LVADs of first or second generation are implanted. During the latest years, some investigations have recognized the occurrence of cavitation, evidenced through transthoracic echocardiography (TTE), as a potential early and indirect sign of PT. In the present manuscript, we reviewed the available data on the occurrence of cavitation in LVAD patients as an early potential marker of PT, also presenting the hemodynamic mechanisms involved.


Assuntos
Insuficiência Cardíaca/terapia , Ventrículos do Coração/fisiopatologia , Coração Auxiliar/efeitos adversos , Trombose/etiologia , Saúde Global , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração , Humanos , Incidência , Falha de Prótese , Trombose/epidemiologia
4.
Aorta (Stamford) ; 7(4): 121-124, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31770774

RESUMO

In selected cases, the utilization of branched endografts for the treatment of aortic arch aneurysms could be a safe and advantageous alternative to high-risk procedures such as open total aortic arch replacement or hybrid arch repair. We present the case of a 70-year-old man with saccular aneurysm of a bovine aortic arch which was endovascularly treated using a double-branched custom-made aortic endoprosthesis based on the Relay NBS (Non-Bare Stent) Plus platform intended for zone 0 deployment. The postoperative clinical course was uneventful. The postoperative computed tomography scan showed a good result of the implant. The patient was discharged 6 days after the procedure.

6.
Artif Organs ; 43(3): 229-233, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30159914

RESUMO

Few studies evaluated the effect of cardiac rehabilitation programs on perceived emotional and health status of left ventricular assist device (LVAD) patients, and none explored their effect on caregivers' strain. We enrolled 119 adult LVAD patients, together with their caregivers (n = 91), in two Rehabilitation Institutes that provided inpatient multidisciplinary activities. At admittance and prior to discharge they completed questionnaires evaluating patient emotional state and subjective perception of health status, caregiver strain, and patient and caregiver perception of the VAD. Six months after discharge, patients and caregivers were contacted again and asked specific questions about their quality of life. Patients' state anxiety and depression symptoms significantly diminished at discharge (0.000), whereas their perception of general health status rose (0.000). Caregivers' perceived strain also significantly decreased (0.001) and the perceived device management skill grew both for patients and caregivers (0.000). A substantial amount (36%) of psychologically frail patients and caregivers, although improving their emotional condition, never reached that of the less frail subjects. At the 6-month follow-up, both patients and caregivers appeared stable in evaluating respectively their general health and their caregiving-related strain, compared to discharge. Our data show that a comprehensive inpatient rehabilitation program improves the emotional state of LVAD patients and of their caregivers, even in psychologically frailer subjects. Team approach makes patients and caregivers self-confident about device management, increasing their knowledge, clarifying their doubts, and encouraging them to handle the difficulties met during the rehabilitation period, suggesting strategies to cope with daily life at home.


Assuntos
Cuidadores/psicologia , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/psicologia , Qualidade de Vida , Estresse Psicológico/reabilitação , Adaptação Psicológica , Adulto , Idoso , Feminino , Nível de Saúde , Insuficiência Cardíaca/psicologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
7.
Echocardiography ; 34(6): 949-950, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28386957

RESUMO

Hypoplasia of the posterior mitral valve leaflet (PMVL) is a rare congenital heart disease, usually presenting in infancy and childhood with severe mitral regurgitation, either in isolation or associated with other cardiac lesions. We report a case of a 69-year-old woman with recent-onset exertional dyspnea and severe mitral regurgitation. Two- and three-dimensional transesophageal echocardiography showed severe hypoplasia of the PMVL, confirmed by surgical inspection.


Assuntos
Ecocardiografia Transesofagiana/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Valva Mitral/anormalidades , Valva Mitral/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Ecocardiografia Tridimensional/métodos , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia
8.
G Ital Cardiol (Rome) ; 14(1): 79-82, 2013 Jan.
Artigo em Italiano | MEDLINE | ID: mdl-23258208

RESUMO

Isolated left ventricular noncompaction in adults is uncommon. The most frequent clinical manifestations are heart failure due to left ventricular systolic dysfunction and supraventricular and ventricular arrhythmias, which may be sustained and associated with sudden death. Thromboembolic complications are also possible. We report the case of an adult patient with isolated left ventricular noncompaction who came to our observation because of acute cerebral ischemia, an initial presentation of the disease only rarely described.


Assuntos
Isquemia Encefálica/etiologia , Miocárdio Ventricular não Compactado Isolado/complicações , Doença Aguda , Humanos , Miocárdio Ventricular não Compactado Isolado/diagnóstico , Masculino , Pessoa de Meia-Idade
9.
J Card Surg ; 26(4): 378-80, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21793925

RESUMO

A 68-year-old female with hypertrophic obstructive cardiomyopathy (HOCM), fibrous subaortic stenosis, mitro-aortic valve insufficiencies, and congenital left ventricular diverticulum (CLVD) at apical level was diagnosed after syncope. Although the association between HOCM and CLVD has been previously reported, no case has ever been disclosed in advanced adulthood.


Assuntos
Cardiomiopatia Hipertrófica/complicações , Divertículo/complicações , Cardiopatias/complicações , Idoso , Divertículo/congênito , Divertículo/cirurgia , Feminino , Cardiopatias/congênito , Cardiopatias/cirurgia , Ventrículos do Coração , Humanos
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