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1.
Coron Artery Dis ; 35(4): 299-308, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38656277

RESUMO

AIM: To investigate the relationship between coronary artery lesion severity determined using the baseline SYNTAX score and sleep problems that might occur after discharge determined using the Pittsburgh Sleep Quality Index (PSQI). METHODS: This prospective study included patients with first acute coronary syndrome (ACS) who underwent percutaneous coronary angiography between February 2019 and August 2019. The severity of coronary artery stenosis was classified according to coronary angiography and SYNTAX scores. Patients were grouped as those with a SYNTAX score of ≤22 and >22. Sleep quality after discharge was classified according to the PSQI. PSQI ≤5 represented good sleep quality, and PSQI >5 represented poor sleep quality. Univariate and multivariate logistic regression was used to investigate the relationship between sleep quality and coronary artery stenosis severity. RESULTS: A total of 424 patients were included in the study. Of these, 294 (69.34%) had a SYNTAX score of ≤22 and 130 (30.66%) had a SYNTAX score of >22. The mean age of all patients was 60.37 ±â€…12.23 years, 59.69 ±â€…11.85 years in the SYNTAX ≤22 groups and 61.90 ±â€…12.98 years in the SYNTAX >22 group (P = 0.086). The majority (78.54%) of the patients were male and there was no significant difference between the SYNTAX ≤22 group and the SYNTAX >22 group in terms of sex distribution (P = 0.383). According to the univariate logistic regression analysis, age (P = 0.014), diabetes (P = 0.027), left ventricular ejection fraction (P = 0.001), estimated glomerular filtration rate (P = 0.039), creatine kinase MB (P = 0.040) and SYNTAX scores (P < 0.001) were significantly associated with high PSQI global scores (>5). However, according to the multivariate logistic regression analysis results, high (>22) SYNTAX scores were the only factor independently associated with the high (>5) PSQI global scores [odds ratio, 3.477; 95% confidence interval (CI), (2.190-5.522); P < 0.001]. Complete revascularization group had significantly higher sleep latency and sleep duration time, sleep efficiency and the percentage of patients with PSQI global score of ≤5 than the incomplete revascularization group (P < 0.001 for all). CONCLUSION: Among patients with ACS, those with high SYNTAX scores should be monitored more carefully for sleep disorders that may occur later.


Assuntos
Síndrome Coronariana Aguda , Angiografia Coronária , Estenose Coronária , Índice de Gravidade de Doença , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/complicações , Estenose Coronária/fisiopatologia , Estenose Coronária/complicações , Angiografia Coronária/métodos , Estudos Prospectivos , Idoso , Qualidade do Sono , Fatores de Risco
2.
Cardiovasc J Afr ; 34: 1-6, 2023 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-37526976

RESUMO

BACKGROUND: Antithrombotic therapy in atrial fibrillation is generally managed with the CHA2DS2-VASc score. Aortic valve sclerosis (AVS) is a focal thickening of the aortic valve without a restriction of motion. AVS is related to several cardiovascular risk factors. Our study was performed to evaluate whether the presence of AVS was associated with the CHA2DS2-VASc score. METHODS: This cross-sectional, observational study comprised 411 patients with AVS grades 1-3 [AVS (+)] and 102 patients with AVS grade 0 [AVS (-)]. We compared CHA2DS2-VASc scores between the AVS (+) and AVS (-) groups. RESULTS: We determined that the AVS (+) group had a higher CHA2DS2-VASc score than the AVS (-) group [3 (0-8) vs 1 (0-4), p < 0.001) ]. CONCLUSIONS: In our study, the CHA2DS2-VASc score was found to be higher in patients with AVS than in those without AVS. AVS may predict cardiovascular risk in the general population.

3.
Kardiol Pol ; 81(7-8): 716-725, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37179463

RESUMO

BACKGROUND: The relationship between the visceral adipose index (VAI), a surrogate marker of visceral adipose tissue dysfunction, and coronary atherosclerotic plaque (CAP) morphology remains unclear. AIMS: This study aimed to investigate the relationships between the VAI and the coronary artery calcification (CAC) score and CAP morphology in asymptomatic patients. METHODS: We retrospectively assessed 782 patients between January 2012 and January 2020. CAC scores were determined at the threshold of 130 Hounsfield units according to the Agatston technique using 64-slice computed tomography. Patients were assigned to groups with no plaque (NP), fatty plaque (FP), calcified plaque (CP), and mixed plaque (MP). RESULTS: The median VAI levels were significantly different in each group (NP: 1.2 vs. FP: 1.7 vs. CP: 2.3 vs. MP: 2.8; P <0.001). An increased VAI level was an independent predictor of the CAC score. The threshold value of the VAI exhibited a gradual increase in predicting CAP morphology. VAI threshold values were >1.6 for the FP group (vs. the NP group), >2.1 for the CP group (vs. the FP group), and >2.6 for the MP group (vs. the CP group). CONCLUSION: High VAI levels independently predict an increased CAC score and CAP morphology. The VAI exhibits superior diagnostic performance in distinguishing the presence and morphology of CAP in asymptomatic patients and offers gradual cut-off values. Therefore, the VAI may be a potential screening tool for risk stratification and diagnosing CAP morphology in patients with suspected coronary artery disease.


Assuntos
Doença da Artéria Coronariana , Placa Aterosclerótica , Calcificação Vascular , Humanos , Doença da Artéria Coronariana/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Adiposidade , Estudos Retrospectivos , Vasos Coronários , Obesidade Abdominal , Calcificação Vascular/diagnóstico por imagem , Angiografia Coronária , Fatores de Risco
4.
Biomark Med ; 17(1): 5-16, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36942625

RESUMO

Aim: This study aimed to evaluate the prognostic role of the left ventricular (LV) global function index (LVGFI) in predicting major adverse cardiovascular events in patients with acute coronary syndrome after long-term follow-up. Methods: This retrospective study included 718 patients with ST-elevated myocardial infarction (STEMI) and 781 patients with non-ST-elevated myocardial infarction (NSTEMI). The LVGFI was calculated on echocardiography with the following formula: (LV stroke volume/[LV cavity volume + LV myocardial volume]) × 100. Results: Mean LVGFI was higher in the NSTEMI group than in the STEMI group. Decreased LVGFI levels were independent predictors of major adverse cardiovascular events in both the STEMI and the NSTEMI group. Conclusion: Echocardiographic LVGFI may be a useful prognostic screening tool for acute coronary syndrome cohorts.


After a heart attack, poor heart performance is an important cause of major adverse cardiovascular events (MACEs). The left ventricular global function index (LVGFI) is a new index that evaluates cardiac performance. Early identification of patients with poor heart performance following a heart attack could prevent the occurrence of major adverse cardiovascular events and improve survival. This study aimed to explore whether the LVGFI is associated with the risk of MACEs in heart attack patients. We found that a decrease in LVGFI levels was independently associated with MACEs at 3-year follow-up in patients after a heart attack. Accordingly, we showed that an assessment of LVGFI using echocardiography offers a good distinction in identifying patients at risk for MACE after a heart attack. These findings indicate that the LVGFI may be helpful in identifying high-risk patients and optimizing treatment strategies in clinical practice.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio sem Supradesnível do Segmento ST , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Prognóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Estudos Retrospectivos , Função Ventricular Esquerda , Intervenção Coronária Percutânea/efeitos adversos
5.
Medicine (Baltimore) ; 100(22): e26171, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087879

RESUMO

ABSTRACT: Abdominal aortic aneurysm is a life threatening disease. Most of the patients diagnosed incidentally because of the asymptomatic nature of this disease. This study aimed to determine the frequency of abdominal aortic aneurysm and evaluate the value of opportunistic screening during transthoracic echocardiography.A total of 5138 patients referred for echocardiographic evaluation for any reason were screened for abdominal aortic aneurysm between November 2014 to July 2019. The aneurysm was defined as an abdominal aorta with a diameter greater than 30 mm, or segmental dilatation of more than 50% of its size in non-dilated parts.The overall frequency of abdominal aortic aneurysm was 2.2% (n = 109) in the study population. Male sex (P < .001), older age (P < .001), presence of diastolic dysfunction (P = .036), hypertension (P < .001), coronary artery disease (P < .001), and hyperlipidemia (P < .001) were associated with abdominal aortic aneurysm. Patients with aneurysm had significantly increased diameters of the aortic trunk (P < .001) and ascending aorta (P < .001), significantly thicker interventricular septum (P < .001) and posterior wall (P < .001), significantly increased end-diastolic diameter (P < .001) and enlarged left atrium (P < .001), and significantly decreased ejection fraction (P < .001). The mostly met criteria for screening abdominal aortic aneurysm in international guidelines was the age of the patients.Based on the results of this study, screening patients over 60 years of age who undergo a transthoracic echocardiography for any reason would be beneficial to detect an asymptomatic abdominal aortic aneurysm in Turkish population.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico , Ecocardiografia/métodos , Programas de Rastreamento/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/epidemiologia , Dilatação Patológica/fisiopatologia , Ecocardiografia/estatística & dados numéricos , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Prevalência , Turquia/epidemiologia
8.
Clin Appl Thromb Hemost ; 26: 1076029619900544, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31941359

RESUMO

Blood group types are associated with coronary artery disease. However, data are scarce about the impact of blood group types on coronary collateral circulation. In this study, we aimed to investigate the relationship between the blood group types and coronary collateral circulation. Two hundred and twelve patients who underwent coronary angiography in our department and had a stenosis of ≥ 90% in at least one major epicardial vessel were included in our study. Collateral degree was graded according to Rentrop-Cohen classification. After grading, patients were divided into poor coronary collateral circulation (Rentrop grade 0 and 1) and good coronary collateral circulation (Rentrop 2 and 3) groups. The ABO blood type of all participants was determined. The incidence rates of O blood group type were significantly higher in the good coronary collateral group compared to the poor collateral group (37.9% vs 17.1%, P < .001). The O type blood group was an independent predictor of good coronary collateral circulation (odds ratio = 1.83, 95% confidence interval = 1.56-6.18, P = .015). Coronary collateral circulation is associated with blood group types. The O blood group predicts good coronary collateral development among patients with coronary artery disease.


Assuntos
Antígenos de Grupos Sanguíneos/análise , Circulação Colateral , Circulação Coronária , Sistema ABO de Grupos Sanguíneos/fisiologia , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Estenose Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Arq. bras. cardiol ; 113(6): 1129-1137, Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1055060

RESUMO

Abstract Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. Results: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. Conclusions: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.


Resumo Fundamento: O aneurisma do ventrículo esquerdo (AVE) é uma importante complicação do infarto agudo do miocárdio (IAM). Objetivo: Investigar o papel da porção N-terminal do pró-hormônio do peptídeo natriurético do tipo B (NT-proBNP) para predizer o desenvolvimento de AVE após infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST). Métodos: Incluímos prospectivamente 1519 pacientes consecutivos com IAMCST. Os pacientes foram divididos em dois grupos de acordo com o desenvolvimento de AVE nos seis meses após o infarto do miocárdio. Os pacientes com ou sem AVE foram examinados para determinar se existia uma relação significativa entre os valores basais do NT-proBNP e as características clínicas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: O AVE foi detectado em 157 pacientes (10,3%). O nível basal do NT-proBNP foi significativamente maior em pacientes que desenvolveram AVE após IAM (523,5 ± 231,1 pg/mL vs. 192,3 ± 176,6 pg/mL, respectivamente, p < 0,001). Os preditores independentes da formação de AVE após IAM foram idade > 65 anos, tabagismo, classe Killip > 2, cirurgia de revascularização miocárdica anterior, insuficiência cardíaca pós-infarto do miocárdio, fração de ejeção do ventrículo esquerdo < 50%, falha de reperfusão, fenômeno de no-reflow, pico de troponina I e CK-MB e NT-proBNP > 400 pg/mL na internação. Conclusões: Nossos achados indicam que o nível plasmático do fragmento N-terminal do peptídeo natriurético tipo B na admissão, entre outras variáveis, fornece informações preditivas valiosas sobre o desenvolvimento de AVE após o IAMCST agudo.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Fragmentos de Peptídeos/sangue , Disfunção Ventricular Esquerda/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Aneurisma Cardíaco/diagnóstico , Índice de Gravidade de Doença , Biomarcadores/sangue , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Angiografia Coronária , Disfunção Ventricular Esquerda/etiologia , Aneurisma Cardíaco/etiologia
12.
Arq Bras Cardiol ; 113(6): 1129-1137, 2019 12.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664316

RESUMO

BACKGROUND: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). METHODS: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. RESULTS: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. CONCLUSIONS: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.


Assuntos
Aneurisma Cardíaco/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Disfunção Ventricular Esquerda/diagnóstico , Adulto , Idoso , Biomarcadores/sangue , Angiografia Coronária , Feminino , Aneurisma Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/etiologia , Adulto Jovem
15.
Interact Cardiovasc Thorac Surg ; 28(2): 318-320, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30053112

RESUMO

Extrinsic compression of coronary arteries causing angina pectoris is very unusual. No data regarding the optimal treatment for coronary artery compression due to dilated cardiac chambers have been reported. In this case report, we describe a man with severe mitral valve stenosis and the dilated left atrium, which resulted in coronary artery compression, and the successful management of his condition by surgical reconstruction.


Assuntos
Angina Pectoris/etiologia , Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Dilatada/complicações , Estenose Coronária/etiologia , Estenose da Valva Mitral/complicações , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/cirurgia , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/cirurgia , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Dilatação Patológica/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/cirurgia
16.
Int J Angiol ; 25(5): e70-e72, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28031659

RESUMO

Dextrocardia is a rare cardiac anomaly in which the heart is located in the right chest along with the cardiac long axis directing to the right and inferiorly. Although, it is a rare clinical phenomenon, coronary artery disease with dextrocardia is presumed to be of similar frequency as in the general population. Percutaneous coronary intervention has some technical difficulties in these patients. We hereby report a male patient with dextrocardia who was previously treated with coronary artery bypass graft surgery.

17.
Postepy Kardiol Interwencyjnej ; 11(4): 318-22, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26677382

RESUMO

INTRODUCTION: Coronary artery fistula consists of abnormal congenital connections between a coronary artery and cardiac chambers, a coronary vessel or an intrathoracic vessel that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, or coronary aneurysms. Recent reports have emphasized the efficacy of percutaneous transcatheter techniques as an alternative to surgical closure, but the reported experience is relatively limited. AIM: To assess angiographic outcomes in a series of 20 patients who underwent transcatheter closure of coronary artery fistula. MATERIAL AND METHODS: We evaluated all patients presenting with significant coronary artery fistula and undergoing transcatheter closure with coils and a vascular plug between March 2008 and June 2012. RESULTS: There were 20 patients (14 men; mean age: 53 ±8 years) with coronary artery fistula. Fistula diameter ranged from 4 to 12 mm; an average of three coils were used in the percutaneous procedure. Post-deployment angiograms demonstrated complete occlusion in all patients. The patients were followed up for 4 ±1.6 years. The control coronary computed tomographic angiography was performed in the sixth month and no patients had recanalization of the embolized vessel. CONCLUSIONS: Percutaneous closure of coronary artery fistula is a safe and effective treatment modality.

18.
Acta Cardiol ; 70(4): 473-8, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26455251

RESUMO

OBJECTIVE: Serum procalcitonin levels are associated with congestive heart failure, but are not established biomarkers of the disease. We evaluated the predictive value of serum procalcitonin levels for diagnosing heart failure and assessing its severity. METHODS AND RESULTS: This retrospective, case-control study involved 59 subjects (mean age 59.7-10.1 years; 38 males), including 21 outpa- tients and 19 inpatients with heart failure and left ventricular ejection fractions <45%, and 19 healthy controls. Serum procalcitonin levels were measured and compared among the 3 groups. Procalcitonin levels were significantly higher among inpatients (median [interquartile range], 1.45 [0.25-5.801 ng/mL) than among the outpatients (0.35 [0.001.-1.70] ng/mL; P< 0.001) or controls (0.05 [0.02-0.08] ng/mL; P< 0.0011. Using a procalcitonin cut-off level of 0.09 ng/mL, 35 (87.5%) of the 40 inpatients and outpatients were procalcitonin-positive; all control individuals were procalcitonin-negative. Serum procalcitonin levels differentiated between heart failure patients and healthy controls (sensitivity, 88.9% [95% confidence interval, 75.9-96.2%]; specificity, 100% [82.2-100.0%]; positive predictive value, 100% [91.1-100.0%]; negative predictive value, 79.2% [57.8-92.8%]). Pro calcitonin levels were >0.53 ng/mL in 4/21 (19%) outpatients and in 16/19 (84.2%) inpatients. The sensitivity and specificity of serum procalcitonin levels for differentiating between inpatients and outpatients were 84.2% and 81.0%, respectively (positive predictive value 80% [95% confidence interval, 67.6-92.4%] and 85.0% [73.9-96.1%], respectively). CONCLUSION: Serum procalcitonin levels, showing high sensitivity and specificity for diagnosing and assessing the severity of heart failure in this small study, might be considered ootential heart failure biomarkers.


Assuntos
Calcitonina/sangue , Insuficiência Cardíaca , Precursores de Proteínas/sangue , Função Ventricular Esquerda , Idoso , Biomarcadores/sangue , Peptídeo Relacionado com Gene de Calcitonina , Estudos de Casos e Controles , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Volume Sistólico , Turquia
19.
Case Rep Vasc Med ; 2014: 865490, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24744954

RESUMO

Single coronary artery anomaly associated with coronary fistula is a rare entity. Transcatheter coil embolization is the treatment of choice for coronary artery fistulas. In this case report, we describe a patient with both single coronary artery anomaly and coronary fistula who was successfully treated with coil embolization.

20.
Turk Kardiyol Dern Ars ; 42(8): 759-62, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25620339

RESUMO

In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treated by percutaneous closure of the rupture using the retrograde approach. The procedure was performed successfully within 26 minutes. We think this approach may be used in future instead of the antegrade approach.


Assuntos
Ruptura Aórtica/terapia , Seio Aórtico , Adulto , Ruptura Aórtica/diagnóstico por imagem , Cateterismo Cardíaco , Dor no Peito , Diagnóstico Diferencial , Dispneia , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Humanos , Masculino , Dispositivo para Oclusão Septal
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