Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia sob Estresse/normas , Protocolos Clínicos , Meios de Contraste , Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico , Estenose Coronária/diagnóstico por imagem , Dipiridamol , Ecocardiografia sob Estresse/métodos , Pessoal de Saúde , Humanos , Prontuários Médicos , Isquemia Miocárdica/diagnóstico por imagem , Fatores de Risco , VasodilatadoresRESUMO
Candida endocarditis of native valves is difficult to diagnose and treat. The majority of cases require valve replacement and long term amphotericin treatment. We describe a case of Candida endocarditis which was successfully managed with fluconazole without valve replacement. The patient has now been reviewed for 4.5 years from the time of diagnosis and 39 months since treatment was discontinued.
Assuntos
Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Endocardite/tratamento farmacológico , Fluconazol/uso terapêutico , Doenças das Valvas Cardíacas/tratamento farmacológico , Feminino , Seguimentos , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Valva Mitral/microbiologia , Recidiva , Fatores de Tempo , Valva Tricúspide/microbiologiaRESUMO
DNA markers were used to assess the segregation of genes encoding the collagen types that predominate in the mitral valve (types I, III, and V) in two family pedigrees that are phenotypically different but showed dominantly inherited mitral valve prolapse. The inheritance of these markers was compared with the segregation of the phenotype for mitral valve prolapse in both families. In one family it was shown that the COL1A1, COL1A2, COL3A1, and COL5A2 genes segregated independently of the phenotype; in the other family the results for COL1A1, COL1A2, and COL5A2 were similar but analysis at the COL3A1 locus was not possible. These data indicate that in these families mitral valve prolapse does not arise from a defect in one of these collagen genes.
Assuntos
Colágeno/genética , Genes Dominantes , Prolapso da Valva Mitral/genética , Feminino , Marcadores Genéticos/análise , Humanos , Escore Lod , Masculino , Mutação , Linhagem , FenótipoRESUMO
Seventy two consecutive patients with severe isolated aortic regurgitation were evaluated by preoperative echocardiographic and angiographic assessment of the aortic root. Biopsy specimens of the aortic wall were taken at operation. Two major groups of patients were found: those with cusp derangement but normal aortic roots and those with normal cusps but dilated aortic roots. Of the 42 cases of abnormal cusps, 20 were rheumatic, 15 were infective, and six were bicuspid. One patient had a tear in an otherwise normal cusp. Of the 30 cases of abnormal roots but normal cusps, six had inflammatory changes (syphilis, Reiter's disease, giant cell aortitis) and 24 had root dilatation caused by non-inflammatory destruction of elastic laminae. Echocardiographic measurement of the aorta at the level of the top of the commissures predicted the findings at pathology. In 37 of 39 patients with cusp disease the measurement was less than 37 mm. In 27 of 33 patients with root disease the measurement was greater than or equal to 37 mm. This difference was statistically significant. There was no difference in the sizes of the prosthesis used in each group, suggesting that it was the diameter of the junction of the aorta with the sinuses rather than the junction of the sinuses with the ventricle that was important in aortic regurgitation. Clinical progression in patients with non-inflammatory aortic root disease is slower than in patients with infective disease but faster than in those with rheumatic cusp disease.
