NT-proBNP Indicates Left Ventricular Impairment and Adverse Clinical Outcome in Patients With Tetralogy of Fallot and Pulmonary Regurgitation.

BACKGROUND: The goal of this study was to interrelate N-terminal B-type natriuretic peptide (NT-proBNP) levels and cardiac magnetic resonance imaging-derived ventricular function, mass, and volumes in adults with pulmonary regurgitation after Fallot repair and to evaluate the prognostic relevance of these parameters regarding adverse clinical outcome. METHODS: Eighty-one patients (aged 26.3 ± 7.4 years; male sex, 45.7%; New York Heart Association class I, 72.8%; pulmonary valve velocity, < 3 m/s) were included. At baseline cardiac magnetic resonance imaging and NT-proBNP measurements were performed. RESULTS: During a mean observation time of 6.9 ± 2.6 years, 13 patients (16.1%) had sustained supraventricular arrhythmias or heart failure (2.4 per 100 patient-years). Multivariate Cox analysis identified NT-proBNP, left ventricular (LV) end-systolic volume index and LV ejection fraction, right ventricular (RV) end-diastolic volume index, and tricuspid regurgitation as independent predictors of adverse events. NT-proBNP correlated with LV but not with RV parameters. In receiver operating characteristic curve analysis using significant variables of the multivariate analysis, NT-proBNP was superior to all other parameters to detect patients at risk (area under the curve [AUC], 0.873; 95% confidence interval, 0.772-0.974). LV end-systolic volume index (AUC, 0.734), RV end-diastolic volume index (AUC, 0.645) und tricuspid regurgitation (AUC, 0.747) showed lower diagnostic accuracy. CONCLUSIONS: Even in mildly symptomatic patients with pulmonary regurgitation after Fallot repair NT-proBNP is a strong predictor of adverse outcome. It is rather associated with LV but not with RV impairment. In severe pulmonary regurgitation an increase in the level of NT-proBNP and LV impairment seem to provide additional useful information for the timing of pulmonary valve replacement.

[Pseudoaneuryma after transradial puncture in systemic lysis of basilar artery thrombosis]. / Pseudoaneurysma nach transradialer Punktion bei systemischer Lyse einer Basilaristhrombose.

HISTORY: Because of neurological symptoms as a result of thrombotic occlusion of the basilar artery, a successful revascularization after systemic Actilyse application was performed in a 78 year old patient. Later, it came to the formation of a pseudoaneurysm at the radial artery, punctured for invasive blood pressure measurement. TREATMENT AND COURSE: After oscillographic respectively ultrasound detection of a 2 cm wide pseudoaneurysm from the radial artery, the surgical resection of the aneurysm sac was performed. An ultrasound-guided manual compression due to the localization of a thrombus close to the aneurysm neck could not be conducted. The further clinical course was unremarkable. CONCLUSION: With an increasing number of pseudoaneurysms as a complication of transradial puncture occuring more frequently in the context of intensive care supply and rising outpatient cardiac catheterization (coronary angiography and PCI), the knowledge of care options of vascular complications are of particular importance before practical application.

Dynamic obstruction of the left main coronary artery ostium by a papillary fibroelastoma.

BACKGROUND: Benign tumours of the heart are usually detected as incidental findings during echocardiography. Most cases are intracardiac tumours, with myxoma being the most frequent entity. We present images of a patient with acute myocardial infarction and a concomitant extracardiac benign tumour in the aortic root. METHODS: Transesophageal echocardiography, coronary computed tomography angiography, cardiac surgery and histology of the excised tumour were performed. RESULTS: A mobile mass was found in the aortic root obstructing the left main coronary artery ostium during diastole. Coronary CT angiography indicated severe coronary artery disease and the patient underwent bypass surgery and excision of the tumour. The excised tumour was identified as papillary fibroelastoma. CONCLUSIONS: Papillary fibroelastoma is the second most benign tumour of the heart. More than other tumours it is prone to embolization. Extracardiac location as in our case is very rare but dangerous since embolization may occur spontaneously or associated with catheterization.