RESUMO
Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality that is responsible for over 300,000 deaths in the United States each year. Underlying cardiac etiologies remain the most common culprit. Despite medical advances in the treatment of coronary artery disease, the mortality following OHCA remains dismal. Additionally, of those who survive the initial event, many are left with debilitating and irreversible anoxic brain injuries. Therefore, improving survival as well as neurologic outcome is of primary importance in this group. Our goal was to evaluate the underlying etiologies, neurologic outcomes, and cardiac interventions being performed in patients with OHCA presenting to our large tertiary care center. We retrospectively reviewed 181 charts of patients presenting to our emergency department over a 1-year time period with a diagnosis of OHCA. Following exclusion criteria, 130 patients remained, with 17 of those surviving to hospital admission. Of the 17 initial survivors, only 9 survived to hospital discharge and only 6 of those obtained good neurologic outcomes. Additionally, there was no mortality benefit in the 4 patients who had coronary angiography or percutaneous intervention.
RESUMO
We describe a man with the Marfan syndrome and a prior ascending aortic aneurysm resection who presented with knee pain and concern of endocarditis. Transesophageal echocardiogram showed no vegetations, and computed tomography angiogram of the heart showed a possible pseudoaneurysm. Cardiac catheterization and aortogram revealed the diagnosis of an aorto-right atrial fistula, which was then operatively repaired. This case highlights the role that cardiac catheterization with aortogram can play in the detection of aorto-atrial fistula.
