Assuntos
Reestenose Coronária/diagnóstico , Dor no Peito/etiologia , Angiografia Coronária , Reestenose Coronária/sangue , Reestenose Coronária/complicações , Reestenose Coronária/terapia , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Troponina I/sangueRESUMO
Pulmonary embolism (PE) is a major cause of cardiovascular death. Thrombolytic therapy was shown to reduce mortality, especially in high risk patients. In elderly patients (>65 years old) with PE, thrombolytic therapy may be underused due to risk of hemorrhagic complications. In this study, we aimed to assess the effectiveness and safety of thrombolytic therapy among elderly patients with PE. 363 patients (205 subjects in study group, 158 subjects in control group) who were admitted to our hospital with PE were enrolled to the study. The patients were divided into subgroups according to their age and treatment strategy. Mortality rates and bleeding complications according to TIMI bleeding criteria in 30 days and 1-year were analyzed. In elderly patients, total mortality (7.8 vs. 20.1 %, p = 0.05) and mortality at 1-year follow-up (1.9 vs. 12.9 %, p = 0.03) was significantly lower in patients who received thrombolytic treatment. Difference in total bleeding (9.8 vs. 4.5 %, p = 0.18) and major bleeding (3.9 vs. 0.6 %, p = 0.10) in thrombolytic and non-thrombolytic groups was non-significant. Thrombolytic therapy is associated with lower mortality and acceptable bleeding complication rates in PE patients older than 65 years old.
Assuntos
Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Seguimentos , Hemorragia/induzido quimicamente , Hemorragia/mortalidade , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Fatores de Risco , Segurança , Taxa de Sobrevida , Terapia Trombolítica/efeitos adversosRESUMO
We present an adult patient in whom live/real time three-dimensional transesophageal echocardiography (3DTEE) provided incremental value in the assessment of the spinal cord as compared to two-dimensional transesophageal echocardiographic (2DTEE) findings published in the literature. It improved accurate identification and assessment of the anterior radiculomedullary spinal arteries which may have an important clinical application in monitoring for spinal cord ischemia during thoracic aortic surgery. Because the spinal cord and spinal canal could be examined using not only transverse but also coronal (frontal), sagittal, and oblique planes, 3DTEE further allowed for three-dimensional measurements of the dimensions and volumetric analysis of the visualized spinal cord and spinal canal. These may have implications in the assessment of spinal cord edema due to trauma and other conditions which result in increase in the size and volume of the spinal cord.
Assuntos
Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Monitorização Intraoperatória/métodos , Medula Espinal/diagnóstico por imagem , Aorta Torácica/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Medula Espinal/irrigação sanguínea , Isquemia do Cordão Espinal/prevenção & controleRESUMO
We describe the incremental value of live/real time three-dimensional (3D) echocardiography over the 2D technique in the assessment of ruptured right sinus of Valsalva into the right ventricle associated with an adjacent perimembranous ventricular septal defect in an elderly patient.
Assuntos
Ruptura Aórtica/complicações , Ruptura Aórtica/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Seio Aórtico/diagnóstico por imagem , Idoso , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
A 2.5-year-old boy presented with frequent hospitalizations due to recurrent respiratory tract infections with dyspnea. A fibromuscular membrane dividing the left atrium with obstruction of left atrial inflow to the left ventricle was documented by two-dimensional transthoracic echocardiography (2DTTE). Live/real time three-dimensional transthoracic echocardiography (3DTTE) provided incremental value over 2DTTE by providing en face views of the 2 obstructing orifices in the membrane enabling accurate assessment of their position, shape and size. 3DTTE also showed clearly the location of the membrane superior and proximal to the left atrial appendage which was not well delineated by 2DTTE. In addition, 3DTTE demonstrated the full extent of the left atrial appendage and careful sequential cropping of the 3D dataset showed it to have 2 distinct lobes and no thrombus. These findings provided comprehensive assessment of the lesion and were helpful in surgical decision making and planning.