Pulmonary arteriovenous fistula coexisting with secundum atrial septal defect. An unusual cause of stroke in a young woman.

Pulmonary arteriovenous malformations (PAVM) consist of an abnormal connection between the pulmonary artery and vein bypassing the pulmonary capillary bed. Pulmonary arteriovenous fistulae are characterized by a right-to-left shunt of variable magnitude, and they may be accompanied by other congenital anomalies. We describe a case of pulmonary arteriovenous fistula with a secundum type atrial septal defect (ASD) in a 38-year-old woman, who underwent successful transcatheter closure of both the ASD and PAVM.

Serum high-sensitivity C-reactive protein, amyloid associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia.

AIM: The aim of this study was to detect any relationship between serum high-sensitivity C-reactive protein (hs-CRP), serum amyloid-associated protein (SAA) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and reversible myocardial ischaemia during cardiovascular exercise tests and to determine whether these biomarkers could predict transient myocardial ischaemia. METHODS: Ninety-six patients (36 women, 60 men, mean age 57 ± 8.5 years) were included in the study. Venous blood samples were taken from patients before and 15 minutes after exercise testing. SAA and hs-CRP were analysed using immunonephelometric assays (Dade-Behring, BN II, Marburg, Germany). NT-proBNP (pg/ml) was determined using the immulite 1 000 chemiluminescence immunoassay system (Siemens Medical Solution Diagnostics, Deerfiled, USA). Forty-eight patients (18 women, 30 men) with positive exercise tests were allocated to the exercise-positive group and 48 (18 women, 30 men) with negative exercise tests were put in the exercise-negative group. Coronary angiography was performed on all patients in the exercise-positive group. RESULTS: There was no difference between the levels of hs-CRP, SAA and NT-pro-BNP before and after exercise testing in both of the exercise groups. CONCLUSION: Serum levels of hs-CRP, SAA and NT-proBNP could not predict the occurrence of reversible myocardial ischaemia during exercise. Large-scale clinical studies are needed to clarify the status of hs-CRP, SAA and NT-proBNP with exercise.

Left atriotomy versus right atriotomy trans-septal approach for left atrial myxoma.

The biatrial approach has been the classic means of access for left atrial myxoma resection. Increased surgical experience led cardiac surgeons to favour the uniatrial approach to reduce incisions and achieve adequate exposure. In this study, two unilateral surgical approaches were compared in 18 consecutive left atrial myxoma cases. Patients were divided into two groups according to the surgical approach: left atriotomy (group 1, n = 9) and right atriotomy trans-septal approach (group 2, n = 9). Comparison criteria included pre- and post-operative functional capacity, cardiac rhythm, left ventricular ejection fraction, pulmonary artery pressure, left atrial dimensions, cardiopulmonary bypass time, aortic cross-clamp time, drainage over 48 h post-operatively, units of blood transfused, extubation time and length of stay in the intensive care unit and hospital. No significant between-group difference was observed in any criteria except aortic cross-clamp time, which was significantly longer in group 2 than in group 1. No recurrence of myxoma occurred in either group for the 15 patients followed up. Right atrial trans-septal incision appears to be as safe and effective as the left atriotomy approach for left atrial myxoma resection.

N-acetylcysteine versus N-acetylcysteine + theophylline for the prevention of contrast nephropathy.

BACKGROUND: The use of N-acetylcysteine or theophylline in specific subgroups of patients has been suggested to reduce the incidence of contrast-induced nephropathy (CIN) in patients undergoing angiographic procedures. Our purpose was to compare the use of N-acetylcysteine versus N-acetylcysteine + theophylline for the prevention of CIN. MATERIALS AND METHODS: We randomized 217 patients with estimated glomerular filtration rate (eGFR) (calculated by Modification of Diet in Renal Disease formula) between 30 and 60 mL min(-1) 1.73 m(-2) who were undergoing coronary angiography to three prophylactic treatment groups: Group 1: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast, n = 72). Group 2: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast)+ N-acetylcysteine (600 mg p.o. twice daily the preceding day and the day of angiography, n = 73). Group 3: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast)+ N-acetylcysteine + theophylline (600 mg N-acetylcysteine p.o. and 200 mg theophylline p.o. twice daily for the preceding day and the day of angiography, n = 72). The incidence of CIN (0.5 mg dL(-1) increase in serum creatinine from the baseline value 48 h after intravascular injection of contrast) was compared in three groups. RESULTS: Of the 217 patients, 12 patients (5.5%) experienced CIN. Five patients (6.9%) in group 1, seven patients (9.6%) in group 2 and zero (0%) patients in group 3 experienced CIN (P < 0.033). CONCLUSION: Among patients with eGFR between 30 and 60 mL min(-1) 1.73 m(-2) undergoing coronary angiography, oral administration of N-acetylcysteine + theophylline in addition to saline hydration has a beneficial effect in the prevention of CIN.