Segundo dispositivo para el cierre de un foramen oval permeable / No disponible

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Management of residual shunts after initial percutaneous patent foramen ovale closure: a single center experience with immediate and long-term follow-up.

BACKGROUND: Moderate-to-large residual shunts following percutaneous patent foramen ovale (PFO) closure are clinically important and associated with recurrent neuroembolic events. However, their management has not been clearly established in clinical practice. We report our experience in patients of these patients with a prior history of cryptogenic stroke and/or transient ischemic attack (TIA). METHODS: All patients undergoing percutaneous PFO closure were routinely screened at six-months for residual shunts using transthoracic 2D echocardiography with antecubital administration of agitated saline contrast and color flow Doppler. Patients with evidence of moderate-to-large residual shunts were selected to undergo reintervention with shunt closure. Post-reintervention follow-up was performed at 24-hr, 30 days, and every six months thereafter. Clinical predictors of the moderate-to-large residual shunts, and the feasibility, safety and long-term efficacy of percutaneous residual shunt closure using a second device implant were examined. RESULTS: Between 1995 and 2007, a total of 424 patients underwent PFO closure. Of these, 5% (21/424) had moderate-to-large residual shunts. Baseline characteristics among patients with moderate-to-large residual shunts and those with only none or small defects (n = 403) were similar. Multivariate analysis identified the 24-hr postprocedure shunt as the only independent predictor of residual shunting at six months. Of the 21 study patients with moderate-to-large residual shunt (mean age, 47 +/- 14), one underwent successful elective surgical repair, while the remaining 20 underwent transcatheter closure using a second device. The technique was successful in 95% (19/20), and all but one patient had complete shunt closure at six months of their percutaneous reintervention. We report no deaths, recurrent strokes or TIAs during the long-term mean follow-up period of 2.9 years. CONCLUSIONS: Our study suggests that in patients with moderate-to-large residual PFO shunts, percutaneous reintervention using a second device implant is safe and effective.

Prevalence, clinical correlates, and prognosis of discrete upper septal thickening on echocardiography: the Framingham Heart Study.

The upper interventricular septum may be prominent in elderly individuals, a finding referred to as discrete upper septal thickening (DUST). We examined the prevalence, clinical and echocardiographic correlates, and prognostic significance of DUST in a community-based sample. We evaluated Framingham Study participants who underwent routine echocardiography. In 3562 Framingham Study participants (mean age 58 years, 57% women), DUST was observed in 52 participants. The clinical correlates of DUST were increasing age (odds ratio [OR] per 10 year increment 2.59, 95% confidence intervals [CI] 1.64-4.08) and systolic blood pressure (OR per SD increment 1.55, 95% CI 1.15-2.09). DUST was positively associated with left ventricular (LV) fractional shortening and mitral annular calcification but inversely with LV diastolic dimensions (P < 0.02 for all). On follow-up (mean 15 years), 732 individuals died (33 with DUST) and 560 experienced a cardiovascular disease (CVD) event (18 with DUST). Adjusting for cardiovascular risk factors, DUST was not associated with CVD or mortality risk (P > 0.30 for both). The follow-up component of our study suggests that DUST is not independently associated with adverse prognosis.

Probing the arterial baroreflex: is there a 'spontaneous' baroreflex?

The arterial baroreflex is important for beat-to-beat arterial pressure control and its sensitivity has predictive value for clinical outcomes in a myriad of cardiovascular conditions. Given this, researchers have sought approaches for baroreflex assessment that are not invasive and easily obtained. These techniques have exploited the beat-by-beat parallel changes in arterial pressure and heart period to produce estimates that have been termed 'spontaneous' baroreflex indices. The two most commonly used analyses--frequency domain or spectral analyses and sequence analysis have been evaluated in both animals and humans. The animal data suggests an important baroreflex role in linking spontaneous heart period and pressure variabilities, but do not resolve the extent to which these fluctuations reflect baroreflex gain. The human data suggest a high correlation between spontaneous indices and pharmacologically derived baroreflex gain, but also indicate a poor correspondence between them. This may be due to the fact that short-term fluctuations in RR interval are not intimately and always linked to those in pressure via the baroreflex and thus simple observation of arterial pressure and heart period alone may not reveal the extent of arterial baroreflex involvement. If baroreflex function is to be assessed with the fewest and safest assumptions, the input to the system should be driven externally to create large and apparent responses. Nonetheless, spontaneous baroreflex indices may have predictive power; although it remains unknown whether spontaneous indices provide predictive power beyond that provided by heart rate variability indices alone.

Nesiritide for the treatment of diastolic dysfunction.

Despite advances in the treatment of left ventricular diastolic dysfunction, therapy is still primarily empiric and readmission rates remain high, with up to half of patients discharged with the diagnosis of congestive heart failure being rehospitalized within 6 months due to recurrent decompensation. Even with this high economic burden, no effective, long-term therapies have been developed. The authors present a patient with recurrent hospitalizations for decompensated congestive heart failure due to left ventricular diastolic dysfunction becoming refractory to parenteral diuretic therapy. The patient exhibited a dramatic response to a 96-hour intravenous infusion of nesiritide and experienced prolonged clinical benefit, remaining in New York Heart Association functional class I for more than 6 months after the infusion.

Valoración de la eficacia y tolerancia del secnidazol a dosis única en niños con amibiasis intestinal sintomática(AU) / Evaluation of the efficacy and tolerability of a single dose secnidazole in children with symptomatic intestinal amoebiasis

A 52 niños con amibiasis intestinal sintomática no complicada se trataron con dosis única de Secnidazol en suspensión a la dosis de 30 mg/Kg de peso. Se obtiene una recuperación clínica y curación parasitológica del 90.4%. Los efectos secundarios fueron leves y no requirieron administración de otros fármacos ni retirar el paciente del estudio. Se concluye que el Secnidazol a esta dosis es efectivo y seguro para el tratamiento de la amibiasis intestinal sintomática no complicada en niños.