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1.
Paediatr Anaesth ; 34(2): 178-181, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-37909841

RESUMO

Endoscopic transsphenoidal resection of craniopharyngioma is a commonly used technique. Cerebral vasospasm may occur in nearly 10% of cases leading to adverse neurological outcomes. Cardiopulmonary dysfunction may be seen in patients with severe vasospasm. The literature describing the occurrence of neurogenic stunned myocardium following craniopharyngioma resection in pediatric patients is very sparse. Here, we describe such a case managed with a combination of milrinone (to relieve vasospasm and improve cardiac pump function), noradrenaline (to obtain target blood pressure), and vasopressin (to control urine output). This case report proposes the treatment plan of neurogenic stunned myocardium following vasospasm in pediatric patients.


Assuntos
Craniofaringioma , Miocárdio Atordoado , Neoplasias Hipofisárias , Humanos , Criança , Craniofaringioma/cirurgia , Craniofaringioma/etiologia , Miocárdio Atordoado/diagnóstico , Miocárdio Atordoado/cirurgia , Procedimentos Neurocirúrgicos , Milrinona , Neoplasias Hipofisárias/cirurgia , Neoplasias Hipofisárias/etiologia
2.
AsiaIntervention ; 9(1): 32-38, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36936103

RESUMO

Background: An anomalous right coronary artery (ARCA) arising from the left sinus of Valsalva is an uncommon congenital anomaly. The unusual location, take-off and intramural courses of ARCA pose a considerable technical challenge during percutaneous coronary intervention (PCI). Aims: We sought to report our experience of PCI of ARCA in 35 cases of atherosclerotic occlusion. Methods: The PCI database of 35 cases of ARCA was retrospectively analysed. The details about demography, clinical presentation, PCI procedure and clinical follow-up were noted. Results: The mean age was 56.7±13.5 years. The clinical presentation included stable angina in 45.7%, unstable angina in 20% and acute myocardial infarction in 34.3% of patients. Vascular access was transradial in 37.1% of cases, transfemoral in 60% of cases, and transbrachial in 1 case (2.9%). Judkins left and Amplatz left were commonly used guide catheters. Two patients with balloon-uncrossable, calcified lesions required rotablation-assisted PCI. Intravascular imaging was performed in 12 patients (34.3%). Optical coherence tomography demonstrated a proximal intramural course in 3 patients, and a slit-like orifice in 4 patients. The mean radiation dose and fluoroscopy time were 877±687.3 mGy and 18.8±11.6 minutes, respectively. Twenty-eight (80%) patients had an asymptomatic median follow-up of 49 (interquartile range: 29.0-97.5) months. Conclusions: We performed successful PCI in a cohort of 35 patients with ARCA, with favourable long-term clinical outcomes. The selection of an appropriate guide catheter and technical skills were important factors in achieving favourable results.

3.
JACC Case Rep ; 4(8): 460-463, 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35493797

RESUMO

A 74-year-old man presented with failure of a bioprosthetic aortic valve implanted 7 years earlier, with a mean gradient of 44 mm Hg across the aortic valve. During valve-in-valve transcatheter aortic valve replacement, we came across an unusual complication of strut inversion at the lower end of the valve. (Level of Difficulty: Advanced.).

4.
Front Pediatr ; 10: 818608, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35359887

RESUMO

Background: Cardiomyopathy is an important cause of morbidity and mortality in boys with Duchenne muscular dystrophy (DMD). Early diagnosis is a prerequisite for timely institution of cardioprotective therapies. Objective: We compared cardiac MRI (CMRI) with transthoracic echocardiography (TTE) including tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) for diagnosis of cardiomyopathy in early ambulatory boys with DMD. Methodology: This cross-sectional study was conducted between June 2018 and December 2020. Consecutive boys between 7 and 15 years of age with DMD were enrolled. Percentage ejection fraction (EF), fractional shortening, wall motion abnormalities, early diastolic mitral annulus velocity (Ea), medial mitral annulus ratio (E/Ea), and global strain were measured with STE. CMRI-derived EF, segmental hypokinesia, and late gadolinium enhancement (LGE) were studied and compared. Results: A total of 38 ambulatory boys with DMD were enrolled. The mean age was 8.8 ± 1.6 years, and none had clinical features suggestive of cardiac dysfunction. In the TTE, EF was ≤55% in 5 (15%), FS was ≤28% in 3 (9%), and one each had left ventricular wall thinning and wall hypokinesia. In TDI, none had diastolic dysfunction, and STE showed reduced global strain of < 18% in 3 (9%) boys. CMRI-derived EF was ≤55% in 20 (53%) boys and CMRI showed the presence of left ventricular wall hypokinesia in 9 (24%) and LGE in 4 (11%) boys. Conclusion: Cardiomyopathy remains clinically asymptomatic among early ambulatory boys with DMD. A significantly higher percentage of boys revealed early features of DMD-related cardiomyopathy in CMRI in comparison with echocardiography.

5.
J Invasive Cardiol ; 34(4): E346, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35366231

RESUMO

Ortner's syndrome is hoarseness of the voice caused by enlarged cardiac structures compressing the left recurrent laryngeal nerve (LRLN). The LRLN is vulnerable for impingement by cardiac structures due to its anatomical course. LRLN is longer and it hooks below the arch of the aorta, posterior to the ligamentum arteriosum before ascending toward the tracheo- esophageal groove. Ortner's syndrome has been commonly described with left atrial enlargement due to mitral stenosis; however, other causes like aortic aneurysm, pulmonary artery aneurysm, and aortic dissection have been described. Although rare, hoarseness of the voice could be the only presenting complaint in aortic aneurysms as in the case described herein.


Assuntos
Aneurisma da Aorta Torácica , Aneurisma Aórtico , Dissecção Aórtica , Paralisia das Pregas Vocais , Dissecção Aórtica/complicações , Aneurisma Aórtico/complicações , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Rouquidão/complicações , Rouquidão/etiologia , Humanos , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologia
6.
BMJ Case Rep ; 15(3)2022 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-35321914

RESUMO

A middle-aged woman with hypertension presented with atypical chest pain of 1 month duration and had a positive exercise stress test. She underwent diagnostic coronary angiography which demonstrated an anomalous branch arising from the proximal part of the left circumflex artery supplying the right lung. She had atherosclerotic plaques in the right coronary artery and left anterior descending artery. Stress myocardial perfusion imaging did not reveal any inducible ischaemia in the left circumflex artery territory. She was started on medical therapy for coronary artery disease and is doing well on follow-up.


Assuntos
Anomalias dos Vasos Coronários , Imagem de Perfusão do Miocárdio , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade
7.
Egypt Heart J ; 73(1): 106, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34928466

RESUMO

BACKGROUND: Kounis syndrome, also known as "allergic myocardial infarction," is a rare co-occurrence of acute coronary syndrome (ACS) in the setting of hypersensitivity reaction to any agent. Non-steroidal anti-inflammatory drugs (NSAIDs) like are often implicated in causing allergic reactions. Here, we present a case of anterior wall myocardial infarction (AWMI) occurred following angioedema secondary to intake of Nimesulide, not described earlier in literature. CASE PRESENTATION: A 45-year-old female developed generalized pruritic, erythematous maculopapular rash, facial puffiness, oral ulcers and hoarseness of voice within few hours following consumption of Nimesulide for fever and body-ache. Due to development of hypotension, electrocardiogram (ECG) was done, which revealed ST elevation in V2-V6, with marked elevation of troponin (TnI) and creatine kinase (CK-MB). He had no chest pain or shortness of breath. Echocardiography showed regional wall motion (RWMA) abnormality in left anterior descending artery (LAD) territory with an ejection fraction of 25%. Coronary angiography showed a complete thrombotic cutoff of LAD, for which Tirofiban infusion was started to decrease thrombus burden. Repeat angiography on next day showed 80% lesion in proximal LAD for which she underwent revascularization with a drug-eluting stent. The patient later showed improvement in cardiac function at 8 months of follow-up. CONCLUSIONS: The occurrence of ACS requiring percutaneous coronary intervention (PCI) in the setting of allergic reactions is rarely reported in the literature. One should be aware of the rare possibility of Kounis syndrome in the setting of hypersensitivity reaction when accompanying features of symptoms suggestive of coronary artery disease co-exists. When indicated, ECG monitoring and cardiac biomarkers in patients with allergic responses help to identify this rare and treatable condition.

8.
Eur Heart J Case Rep ; 5(2): ytab066, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33738423

RESUMO

BACKGROUND: Submitral aneurysm is a rare disease initially described in the African population. It is usually considered congenital in origin, due to a defect in the posterior portion of the mitral annulus. However, it can be seen in other diseases like ischaemic heart disease, rheumatic heart disease, infective endocarditis, tuberculosis, and syphilis. CASE PRESENTATION: Case 1 was a 29-year-old female, hypertensive undergoing maintenance haemodialysis for chronic kidney disease and on anti-tubercular therapy. She was found to have a large submitral aneurysm with severe mitral regurgitation, moderate left ventricular dysfunction, and pericardial effusion on echocardiogram. Case 2 was a 58-year-old gentleman presented with inferior wall ST-elevation myocardial infarction and was thrombolyzed with streptokinase for the same. Echocardiogram done 6 months later for evaluation of dyspnoea showed a large inferobasal aneurysm. Case 3 was a 56-year-old hypertensive presented with dyspnoea on exertion and echocardiogram showed a large posterolateral region with transmural late gadolinium enhancement. Case 4 was a 13-year-old boy presented with fever and cerebrovascular accident. Echocardiogram revealed vegetation in the mitral valve and a small submitral aneurysm with vegetation inside it. DISCUSSION: Submitral aneurysm is usually considered congenital in origin. However, it can be due to ischaemic heart disease, rheumatic heart disease, Takayasu arteritis, and tuberculosis. Top dimensional echocardiogram is the investigation of choice. Cardiac magentic resonance imaging helps in identifying the underlying aetiology and delineating the surrounding structures.

9.
Indian Heart J ; 72(4): 293-295, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32861386

RESUMO

In this case series, we share our experience of total percutaneous closure of large arteriotomies using combination of vascular closure devices (VCD). A total of six patients with seven sites for endovascular repair were taken for total percutaneous endovascular aortic repair. Ten femoral arteriotomies (26 French (F) = 2, 24 F = 1, 22 F = 3, 20 F = 1, 18 F = 1 &16 F = 2) were successfully closed with 26 Perclose™ and 07 Angio-seal™ devices. There were no local site complications or VCD failure in any of our patients.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Técnicas Hemostáticas/instrumentação , Dispositivos de Oclusão Vascular/efeitos adversos , Idoso , Angiografia , Feminino , Artéria Femoral , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento
10.
Egypt Heart J ; 72(1): 19, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32266513

RESUMO

BACKGROUND: Subclavian artery injury during internal jugular vein catheterization is a rare yet potentially life-threatening complication leading to hemothorax and exsanguination. The percutaneous endovascular approach offers a less invasive and effective alternative to the high-risk surgical repair in emergent situations. CASE PRESENTATION: We present a case of a 6-year-old child suffering from hemolytic uremic syndrome requiring urgent hemodialysis, for which IJV (internal jugular vein) cannulation was attempted. This procedure led to iatrogenic subclavian arterial perforation causing massive hemothorax with hemodynamic compromise. CT angiogram showed a through and through perforation in the first part of right subclavian artery between common carotid and vertebral artery. A definitive assessment of the extent of ongoing leak was made through an invasive angiogram in the catheterization laboratory. The perforation was successfully closed percutaneously with a covered stent without compromising any branch vessels. CONCLUSION: Arterial injury although rare is a potentially life-threatening complication of IJV cannulation which warrants immediate attention and corrective measures. Ultrasound guidance can reduce the risk of such life-threatening complications. Percutaneous management offers a less invasive, less time consuming, and effective alternative in critically ill patients in emergency situations.

11.
Int J Appl Basic Med Res ; 9(4): 251-252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31681554

RESUMO

Primary cardiac tumors are relatively rare, and myxoma, the most common variety, is found predominantly in the left atrium. Clinical presentation varies from asymptomatic incidental masses to serious life-threatening cardiovascular complications. Some cases are difficult to diagnose, as symptoms can be nonspecific. We present a case of a young female with 4 months of history of dyspnea, weight loss, and night sweats, eventually diagnosed as a case of large left atrial myxoma arising from the anterior mitral valve through transthoracic echocardiography.

12.
Indian Heart J ; 71(6): 492-495, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32248924

RESUMO

Severe acute malnutrition (SAM) may affect cardiac structure and function. Cardiac changes in sick children with SAM have received little attention in the literature. Children aged 6-60 months with SAM were cases, and age and sex matched children were controls. Cardiac biomarker levels were measured by the quantitative the Enzyme- linked immunosorbent assay (ELISA) method, and echocardiography was used to assess cardiac changes in all children. The study included 76 children in each group. Children with SAM had less left ventricular mass and increased myocardial performance index as compared with controls (p < 0.0001). Cardiac biomarker levels were increased in children with SAM (p < 0.0001). Cardiac changes and biomarker levels were comparable in children with edema and children without edema except creatine kinase-MB (p = 0.01).


Assuntos
Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Desnutrição Aguda Grave/epidemiologia , Biomarcadores/sangue , Estudos de Casos e Controles , Pré-Escolar , Creatina Quinase Forma MB/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Peptídeo Natriurético Encefálico/sangue , Estudos Prospectivos , Centros de Atenção Terciária , Troponina I/sangue
13.
BMJ Case Rep ; 20182018 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-30413449

RESUMO

Renovascular hypertension is a common clinical presentation in Takayasu arteritis (TA), when the renal arteries are involved. Although most of the patients respond to optimal antihypertensive drug therapy, certain patients with TA require percutaneous or surgical renal artery revascularisation to manage renovascular hypertension. We, hereby, present a 45-year-old woman, who had resistant hypertension secondary to in-stent restenosis (ISR) of renal artery stent in a single functioning kidney. She had successful renal autotransplantation following a failed endovascular attempt to treat ISR. Endovascular and surgical interventions related to renal artery stenosis in TA are discussed in the article.


Assuntos
Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/cirurgia , Artéria Renal/cirurgia , Stents , Arterite de Takayasu/complicações , Transplante Autólogo/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
14.
J Invasive Cardiol ; 30(5): E44-E45, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29715171

RESUMO

This letter addresses an article regarding coronary-cameral fistula after septal myomectomy published in the December 2017 issue of the Journal of Invasive Cardiology and authored by Walters D, et al.


Assuntos
Seio Coronário , Fístula Vascular , Angiografia Coronária , Humanos
15.
Indian Heart J ; 70 Suppl 3: S204-S207, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30595259

RESUMO

OBJECTIVES: During the attacks of acute severe bronchial asthma there are marked cardiopulmonary changes leading to hypoxia. The study aims to find the incidence of myocardial dysfunction in patients of acute severe bronchial asthma based on cardiac enzyme levels at admission and see whether the myocardial damage is transient or persistent even after stabilization of the patient based on enzyme levels at discharge. MATERIALS AND METHODS: This prospective, case control study was done at Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University between October 2016 to May 2018. Sixty pediatric patients of acute severe bronchial asthma were taken as cases and 15 age and sex matched children served as controls. Blood samples were collected in Ethylene diamine tetra acetic acid vials before the start of treatment, for measurement of cardiac biomarkers Troponin I (TnI), Brain natriuretic peptide (BNP) and Creatine Kinase-muscle/brain (CK-MB) and repeat samples were taken before discharge. RESULTS: Fifty percent of the cases had abnormal TnI levels, 15% had abnormal CK-MB levels and 8.3% had abnormal BNP levels at admission. At discharge, only 1 (1.7%) case had abnormal levels of CK-MB, whereas the levels of TnI and BNP normalized in all. The level of cardiac biomarkers were significantly raised at admission when compared to discharge values (p value < 0.001). CONCLUSIONS: The raised cardiac biomarkers suggest myocardial stress during acute exacerbation of bronchial asthma. Though, the present study showed that the changes are of transient nature, larger follow up studies are required to document any permanent damage to myocardium.


Assuntos
Asma/sangue , Creatina Quinase Forma MB/sangue , Infarto do Miocárdio/sangue , Peptídeo Natriurético Encefálico/sangue , Troponina I/sangue , Troponina T/sangue , Adolescente , Asma/complicações , Asma/epidemiologia , Biomarcadores/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Índia/epidemiologia , Masculino , Infarto do Miocárdio/complicações , Prevalência , Estudos Prospectivos , Índice de Gravidade de Doença
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