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1.
Mayo Clin Proc ; 76(1): 79-83, 2001 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11155418

RESUMO

Dynamic left ventricular outflow tract (LVOT) obstruction is typically observed in the setting of hypertrophic cardiomyopathy. It has also been reported with concentric LV hypertrophy, excessive sympathetic stimulation, and acute myocardial infarction. We describe 3 patients with chest discomfort after emotional stress, who had pronounced abnormalities on electrocardiograms, insignificant obstructive coronary disease and hemodynamic instability with LVOT obstruction, and regional wall motion abnormalities. Suppression of contractility with beta-blockers resulted in resolution of the gradient and in clinical improvement. On follow-up, functional recovery was excellent, and ventricular function had normalized. The conditions and mechanisms that may produce this sequence of events are discussed. The most probable scenario is that an acute ischemic insult secondary to vasospasm, LV stunning, and acute geometric remodeling produced a substrate for LVOT obstruction that was exacerbated by basal LV hypercontractility. The importance of this observation is that routine treatment of cardiogenic shock cannot be used and that conservative management results in excellent prognosis.


Assuntos
Miocárdio Atordoado/complicações , Obstrução do Fluxo Ventricular Externo/etiologia , Idoso , Cardiomiopatia Hipertrófica/complicações , Vasoespasmo Coronário/complicações , Ecocardiografia Transesofagiana , Feminino , Humanos , Hipertrofia Ventricular Esquerda/complicações , Miocárdio Atordoado/diagnóstico , Miocárdio Atordoado/etiologia , Obstrução do Fluxo Ventricular Externo/diagnóstico , Remodelação Ventricular
2.
South Med J ; 92(8): 812-4, 1999 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10456723

RESUMO

Coagulase-negative staphylococci are uncommon causes of native valve endocarditis, and the clinical course after valvular infection with these organisms is variable. In clinical practice, species identification is frequently not done, and possible differences in the pathogenicity of various species may be unrecognized. We report a case of Staphylococcus lugdunensis native valve endocarditis associated with valve leaflet perforation and cerebral embolization. This recently described species appears to be more virulent when infecting native cardiac valves than other species of coagulase-negative staphylococci. We review S lugdunensis native valve endocarditis.


Assuntos
Endocardite Bacteriana/microbiologia , Doenças das Valvas Cardíacas/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus/classificação , Adulto , Antibacterianos/uso terapêutico , Valva Aórtica/microbiologia , Coagulase , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Embolia e Trombose Intracraniana/complicações , Masculino , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus/patogenicidade
3.
J Am Soc Echocardiogr ; 12(5): 319-23, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10231618

RESUMO

Although an acquired subaortic membrane has been reported as a cause of left ventricular outflow tract (LVOT) obstruction in various clinical settings, it previously has not been reported after mitral valve surgery. We describe 3 cases of acquired LVOT obstruction that resulted from development of a subaortic membrane after mitral valve replacement. This report emphasizes the role of an acquired subaortic membrane in LVOT obstruction after mitral valve replacement, the use of echocardiography in diagnosing this condition, and the importance of early intervention.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Ecocardiografia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Mitral/cirurgia , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Adulto , Estenose da Valva Aórtica/etiologia , Feminino , Humanos , Membranas , Pessoa de Meia-Idade , Obstrução do Fluxo Ventricular Externo/etiologia
4.
J Am Soc Echocardiogr ; 12(5): 324-5, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10231619

RESUMO

Aortic stenosis in pregnancy can be a life-threatening condition, but fortunately it is rare. In the modern era, careful obstetric and cardiologic monitoring, particularly through echocardiography, have improved fetal and maternal outcomes. However, a test that could predict outcome has not been available for patients with aortic stenosis who seek prepregnancy counseling. We report a case in which exercise Doppler echocardiography was used to predict cardiac function and maximal gradients in a woman with a bicuspid aortic valve who wished to become pregnant.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Ecocardiografia Doppler , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Adulto , Estenose da Valva Aórtica/fisiopatologia , Teste de Esforço , Feminino , Hemodinâmica , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez
5.
Am J Cardiol ; 83(7): 1127-9, A9, 1999 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-10190533

RESUMO

Although the long-term prognosis for patients with a normal dobutamine stress echocardiographic result is good, most studies have focused on men. We assessed the long-term cardiac prognosis for women by reviewing the cases of 100 women who underwent dobutamine stress echocardiography for suspected coronary artery disease and found that women with a normal result have an excellent long-term cardiac prognosis.


Assuntos
Doença das Coronárias/diagnóstico por imagem , Dobutamina , Ecocardiografia , Doença das Coronárias/terapia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico
6.
Circulation ; 99(4): 511-7, 1999 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-9927397

RESUMO

BACKGROUND: Little information is available about changes in left ventricular diastolic function during pregnancy. We used mitral inflow and pulmonary venous flow profiles to evaluate left ventricular diastolic function in 37 healthy pregnant women 26 to 41 years old (mean, 32 years). METHODS AND RESULTS: Echocardiographic studies were performed at the end of each trimester. Eight subjects (control group) underwent similar testing 1 to 3.5 months (mean, 1.7 months) postpartum. During pregnancy, the cardiac output increased significantly as a result of an increased heart rate and, to a lesser degree, stroke volume. Significantly decreased systemic vascular resistance and increased left ventricular mass were also noted. Peak mitral flow velocity in early diastole (E) increased 13. 3% during the first trimester and remained at the high end of normal throughout pregnancy. Peak A-wave velocity (A) increased maximally in the third trimester. Compared with control subjects, first-trimester subjects had a significantly increased E/A ratio. The ratio subsequently decreased, reflecting the augmented A-wave velocity. Pulmonary venous peak systolic forward flow velocity increased, peaking in the second trimester (nonsignificant), but returned to baseline levels postpartum. The pulmonary venous diastolic time-velocity integral decreased significantly from the first to the third trimester. Peak pulmonary venous reverse flow velocity at atrial contraction increased significantly, without being markedly changed in duration. CONCLUSIONS: Pregnancy, a chronic, natural volume-overload state, has important effects on hemodynamic and echocardiographic variables. Based on pulmonary venous flow and left ventricular inflow velocities, our results provide a standard reference concerning diastolic filling dynamics by trimester.


Assuntos
Gravidez/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Velocidade do Fluxo Sanguíneo , Diástole , Ecocardiografia Doppler , Feminino , Hemodinâmica , Humanos , Valva Mitral , Estudos Prospectivos , Veias Pulmonares , Valores de Referência
8.
J Heart Valve Dis ; 7(3): 355-7, 1998 May.
Artigo em Inglês | MEDLINE | ID: mdl-9651852

RESUMO

Hypertrophic cardiomyopathy (HCM) in pregnancy can result in a high incidence of maternal complications. Although echocardiography is frequently performed in pregnant women with HCM in order to confirm their hemodynamic classification, this modality has not been applied during labor and delivery in these patients. This case report documents the application of two-dimensional and Doppler echocardiography during labor and delivery in a 35-year-old woman with HCM.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia Doppler , Ecocardiografia , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Adulto , Parto Obstétrico , Feminino , Humanos , Trabalho de Parto , Gravidez
12.
J Thorac Cardiovasc Surg ; 111(4): 791-7; discussion 797-9, 1996 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-8614139

RESUMO

We are investigating a new technique for myocardial revascularization in which an 800 W carbon dioxide laser is used to drill 1 mm diameter channels into a beating heart after left thoracotomy. Clotting occludes the channels on the subepicardium, and in the long-term setting, blood from the left ventricular cavity flows through these channels to perfuse the ischemic subendocardium. To test the efficacy of this technique in a preliminary clinical trial, we used it as sole therapy for 21 consecutive patients. All patients had hibernating myocardium, reduced coronary flow reserve, or both, had distal diffuse coronary artery disease, and had angina refractory to normal therapy. Eight patients were excluded from follow-up because of death (n=5), rerevascularization (n=2), or diaphragmatic paralysis resulting in postoperative respiratory incapacity (n=1). In the remaining 13 patients available for follow-up, the mean angina class (Canadian Cardiovascular Society) was 3.7 +/- 0.4 before operation and 1.8 +/- 0.6 12 months after operation (p < 0.01). Mean resting left ventricular ejection fraction was 48% +/- 10% before operation and 50% +/- 8% at 12-month follow-up. At 12 months, resting mean subendocardial/subepicardial perfusion ratio had increased by 20% +/- 9% in septal regions treated by laser but decreased by 2% +/- 5% in untreated regions (n=11, p <.001). These results suggest that revascularization by this laser technique positively affects subregional myocardial perfusion and may result in clinical benefits for patients with reversible myocardial ischemia. Studies to date have not demonstrated significant changes in global and regional ventricular contractile function.


Assuntos
Doença das Coronárias/cirurgia , Terapia a Laser , Revascularização Miocárdica/métodos , Idoso , Doença das Coronárias/fisiopatologia , Seguimentos , Humanos , Pessoa de Meia-Idade , Contração Miocárdica , Volume Sistólico , Resultado do Tratamento , Função Ventricular Direita
14.
Tex Heart Inst J ; 23(2): 98-107, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8792540

RESUMO

Despite recent diagnostic and therapeutic advances, infective endocarditis continues to be a very serious illness, with high patient morbidity and mortality rates. The diagnosis of infective endocarditis has been based primarily on clinical signs and positive blood cultures. Echocardiography is currently recognized as the technique of choice for the detection of valvular vegetations, which are the hallmark of endocarditis. We briefly review the use of echocardiography in the diagnosis of suspected infective endocarditis, with emphasis on transesophageal echocardiography. High-resolution imaging of the cardiac valves with transesophageal echocardiography has proved to be invaluable in the management of infective endocarditis.


Assuntos
Ecocardiografia Transesofagiana/métodos , Endocardite Bacteriana/diagnóstico por imagem , Endocardite/diagnóstico por imagem , Micoses/diagnóstico por imagem , Abscesso/complicações , Contraindicações , Endocardite/microbiologia , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Próteses Valvulares Cardíacas/microbiologia , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico
15.
J Heart Valve Dis ; 5(1): 16-9, 1996 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8834719

RESUMO

Severe mitral stenosis is a challenging complication in pregnancy. A case is described in which mitral valve replacement was undertaken immediately following caesarean section at 34 weeks' gestation. A review of the literature discusses the evolution of treatment approaches for mitral stenosis in pregnancy, including open mitral commissurotomy and percutaneous mitral commissurotomy with the use of balloon catheters. With balloon procedures, potential risks to the fetus are minimized because the abdomen and pelvis are shielded. In addition, the use of adjunct transesophageal echocardiography shortens fluoroscopic time. In the case described, neither open nor percutaneous mitral commissurotomy were viable options because of moderate-to-severe mitral regurgitation and a heavily calcified valve. This is one of few such cases reported in the literature to date.


Assuntos
Cesárea , Próteses Valvulares Cardíacas , Estenose da Valva Mitral/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Calcinose/cirurgia , Ecocardiografia Doppler , Feminino , Insuficiência Cardíaca/cirurgia , Hemodinâmica/fisiologia , Humanos , Recém-Nascido , Insuficiência da Valva Mitral/cirurgia , Gravidez , Cardiopatia Reumática/cirurgia
16.
Circulation ; 92(9 Suppl): II58-65, 1995 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-7586462

RESUMO

BACKGROUND: We assessed the transmyocardial laser revascularization (TMLR) as sole therapy in patients with symptomatic coronary artery disease refractory to interventional or medical treatment. METHODS AND RESULTS: Thirty-one patients were evaluated with positron emission tomography (PET), dobutamine echocardiography, 201Tl single-photon emission computed tomography (201Tl-SPECT), and multigated acquisition radionuclide ventriculography (MUGA). TMLR was performed in 21 patients who had demonstrable ischemia in viable myocardium. The mean Canadian Cardiovascular Society (CCS) angina class was 3.70 +/- 0.7 (4 patients with unstable angina). Untreated septal segments were used as controls. At 3 months, (n = 15 patients), the mean CCS angina class was to 2.43 +/- 0.9 (P < .05). On dobutamine echocardiography, the mean resting wall motion score index was improved by 16% in lased segments (P < .03 vs control), and mean LVEF at peak stress increased by 19% (P = NS vs baseline). On 201Tl-SPECT, perfusion of lased and nonlased segments did not change. On PET, the mean ratio of subendocardial to subepicardial perfusion (SEn/SEp) increased 14% over baseline (P < .001 vs control). At 6 months (n = 15 patients), the mean CCS angina class was 1.7 +/- 0.8 (P < .05). The mean resting wall motion score index was up by 13% in lased segments (P < .05 vs control). Resting LVEF was unchanged. Stress LVEF increased 21% (P = NS vs baseline). Myocardial perfusion remained unchanged by 201Tl-SPECT. On PET, 36% of the lased segments were better, and 25% were worse compared with baseline. The resting SEn/SEp by PET was up 21% (P < .001 vs control). All deaths (two perioperative and three late) occurred in patients with preoperative congestive heart failure. Two patients required repeat revascularization of new coronary lesions. CONCLUSIONS: These results suggest that TMLR improves anginal status, relative endocardial perfusion, and cardiac function in patients who do not have preoperative congestive heart failure.


Assuntos
Doença das Coronárias/cirurgia , Terapia a Laser , Revascularização Miocárdica/métodos , Idoso , Idoso de 80 Anos ou mais , Doença das Coronárias/diagnóstico , Doença das Coronárias/mortalidade , Dobutamina , Ecocardiografia , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Angiografia Cintilográfica , Radioisótopos de Tálio , Fatores de Tempo , Tomografia Computadorizada de Emissão , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
17.
Tex Heart Inst J ; 22(2): 134-7, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-7647596

RESUMO

Transesophageal echocardiography and 2-dimensional transthoracic echocardiography have proved to be extremely valuable in the diagnosis of cardiac masses. In this report, we review the echocardiographic findings, clinical history, and histopathologic findings in 21 patients with intracardiac masses who underwent transthoracic echocardiography, transesophageal echocardiography, or both, at our institution. Of these patients, 14 had benign masses and 7 had malignant tumors. The potential role of transesophageal echocardiography in the diagnosis and treatment of patients with intracardiac masses is discussed. We believe that transesophageal echocardiography offers the cardiologist and cardiovascular surgeon the capability of more accurate preoperative and intraoperative assessment of cardiac masses.


Assuntos
Ecocardiografia Transesofagiana , Neoplasias Cardíacas/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Diagnóstico Diferencial , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/cirurgia , Mixoma/diagnóstico por imagem , Mixoma/patologia , Mixoma/cirurgia , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Sarcoma/cirurgia , Trombose/diagnóstico por imagem , Trombose/patologia , Trombose/cirurgia
18.
Tex Heart Inst J ; 22(2): 197-9, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-7647607

RESUMO

Thrombosis is a serious complication of prosthetic heart valve operations. In recent years, systemic thrombolysis has emerged as a suitable alternative to surgery. Experience with thrombosis of pulmonary prosthetic valves is very limited. We report a case of successful administration of intravenous streptokinase for thrombosis of a St. Jude Medical prosthetic valve 3 weeks after pulmonary valve replacement.


Assuntos
Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/tratamento farmacológico , Insuficiência da Valva Pulmonar/cirurgia , Estreptoquinase/uso terapêutico , Terapia Trombolítica , Trombose/tratamento farmacológico , Adulto , Seguimentos , Humanos , Masculino , Desenho de Prótese
19.
J Am Soc Echocardiogr ; 7(5): 547-9, 1994.
Artigo em Inglês | MEDLINE | ID: mdl-7986554

RESUMO

This is the second reported case of a patient with hepatocellular carcinoma in whom the presence of a solitary, left atrial metastatic tumor was confirmed with the aid of transesophageal echocardiography. The tumor was discovered during computed tomography scanning at a follow-up examination after a 3-month regimen of chemotherapy. The patient had exhibited no signs of cardiac involvement, which may have been the result of the relatively small size of the tumor. Surgical excision of the tumor was successfully undertaken, and the patient's postoperative course was uneventful. In this case, transesophageal echocardiography was valuable in providing information regarding the exact location of the tumor and its relation to surrounding anatomical structures.


Assuntos
Carcinoma Hepatocelular/secundário , Neoplasias Cardíacas/secundário , Neoplasias Hepáticas/patologia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Ecocardiografia Transesofagiana , Feminino , Átrios do Coração , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Pessoa de Meia-Idade
20.
Ann Thorac Surg ; 58(3): 876-7; discussion 877-8, 1994 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-7944721

RESUMO

We report a case of mitral valve repair with a Duran ring that was complicated by left ventricular outflow tract obstruction, mitral regurgitation, and hemolytic anemia. A 59-year-old man with severe mitral valve regurgitation underwent mitral valve repair, including a Duran ring annuloplasty. Postoperatively, left ventricular outflow tract obstruction developed and echocardiography revealed severe systolic anterior motion of the mitral valve. The patient then underwent mitral valve replacement with a 29-mm St. Jude valve.


Assuntos
Anemia Hemolítica/etiologia , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/etiologia , Próteses e Implantes , Obstrução do Fluxo Ventricular Externo/etiologia , Adulto , Ecocardiografia Doppler , Humanos , Masculino , Valva Mitral , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Falha de Prótese , Reoperação , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/cirurgia
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