BACKGROUND: Pulmonary embolism (PE) is associated with a risk of consecutive paradoxical embolism with brain infarction through a patent foramen ovale (PFO). The aims of this study were to assess the rate of new ischemic brain lesions (IBLs) using magnetic resonance imaging (MRI) during a 12-month follow-up period with anticoagulation and to evaluate the potential relationship with the presence of PFO on transesophageal echocardiography (TEE). SUBJECTS AND METHODS: Seventy-eight patients with acute PE underwent baseline contrast TEE with brain MRI. After the 12-month follow-up, 58 underwent brain MRI. The rates of MRI documenting new IBLs were measured based on the presence of PFO. RESULTS: PFO was detected in 31 patients (39.7%). At baseline MRI, IBL was present in 39 of 78 patients (50%). The presence of IBL was not significantly higher in patients with PFO than in patients without PFO (20 [64.5% patients with PFO] versus 19 [40.4% without PFO] of 39 patients with baseline IBL, P = .063). At the follow-up MRI, in the group with new IBL (9 of 58 patients, 15.5%), the number of patients with PFO was significantly higher than that without PFO (7 [33.3%] versus 2 [5.4%], P = .008). PFO was identified as an independent predictor of new IBL (odds ratio 4.6 [1.6-47.4], P = .008). CONCLUSIONS: The presence of PFO was associated with new IBL in patients with PE. These patients are at a higher risk of ischemic stroke despite effective anticoagulation therapy.
- MeSH
- antikoagulancia aplikace a dávkování MeSH
- aplikace orální MeSH
- barevná dopplerovská echokardiografie MeSH
- časové faktory MeSH
- cerebrální infarkt diagnostické zobrazování etiologie MeSH
- CT angiografie MeSH
- difuzní magnetická rezonance MeSH
- echokardiografie transezofageální MeSH
- foramen ovale apertum komplikace diagnostické zobrazování MeSH
- lidé MeSH
- logistické modely MeSH
- magnetická rezonanční angiografie MeSH
- odds ratio MeSH
- paradoxní embolie diagnostické zobrazování etiologie MeSH
- plicní embolie komplikace diagnostické zobrazování farmakoterapie MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
OBJECTIVES: The objective of this pilot study was to describe the impact of paced heart rate on left ventricular (LV) mechanical dyssynchrony in synchronous compared to dyssynchronous pacing modes in patients with heart failure. METHODS: Echocardiography was performed in 14 cardiac resynchronization therapy (CRT) patients at paced heart rates of 70 and 90 bpm in synchronous- (CRT), and dyssynchronous (atrial pacing + wide QRS activation) pacing modes. LV dyssynchrony was quantified using the 12-segment standard deviation model (Ts-SD) derived from Tissue Doppler Imaging. In addition, cardiac cycle intervals were assessed using cardiac state diagrams and stroke volume (SV) and filling pressure were estimated. RESULTS: Ts-SD decreased significantly with CRT at 90 bpm (25 ± 12 ms) compared to 70 bpm (35 ± 15 ms, p = .01), but remained unchanged with atrial pacing at different paced heart rates (p = .96). The paced heart rate dependent reduction in Ts-SD was consistent when Ts-SD was indexed to average Ts and systolic time interval. Cardiac state diagram derived analysis of cardiac cycle intervals demonstrated a significant reduction of the pre-ejection interval and an increase in diastole with CRT compared to atrial pacing. SV was maintained at the higher paced heart rate with CRT pacing but decreased with atrial pacing. DISCUSSION: Due to the small sample size in this pilot study general and firm conclusions are difficult to render. However, the data suggest that pacing at higher heart rates acutely reduces remaining LV dyssynchrony during CRT, but not during atrial pacing with dyssynchronous ventricular activation. These results need confirmation in a larger patient cohort.
- MeSH
- barevná dopplerovská echokardiografie MeSH
- časové faktory MeSH
- dysfunkce levé srdeční komory diagnostické zobrazování patofyziologie terapie MeSH
- funkce levé komory srdeční * MeSH
- komorový tlak (srdce) MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- pulzní dopplerovská echokardiografie MeSH
- senioři MeSH
- srdeční frekvence * MeSH
- srdeční resynchronizační terapie škodlivé účinky metody MeSH
- srdeční selhání diagnostické zobrazování patofyziologie terapie MeSH
- tepový objem MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Although the remodeling technique provides the most dynamic valve-sparing root replacement, a dilated annulus (>25 mm) is a risk factor for failure. Aortic annuloplasty aims to reduce the annulus diameter, thus increasing coaptation height to protect the repair. The results of 177 patients with remodeling and external aortic ring annuloplasty were studied. METHODS: Data were collected from the Aortic Valve repair InternATiOnal Registry. Preoperative aortic insufficiency grade 3 or greater was present in 79 patients (44.7%). The valve was bicuspid in 59 patients (33.3%). External annuloplasty was performed through a homemade Dacron ring (56) or a dedicated expansible aortic ring (121). RESULTS: Thirty-day mortality was 2.9% (5). Mean follow-up was 41.1 ± 36.4 months. For the whole series, freedom from valve-related reoperation, aortic insufficiency grade 3 or greater, aortic insufficiency grade 2 or greater, and major adverse valve-related events were 89.5%, 90.5%, 77.4%, and 86.6% at 7 years, respectively, with similar results for tricuspid and bicuspid valves. Since 2007, systematic use of calibrated expansible ring annuloplasty, followed 1 year later by systematic cusp effective height assessment, significantly increased 7-year freedom from valve-related reoperation, aortic insufficiency grade 3 or greater, and major adverse valve-related events up to 99.1% ± 0.9% (P = .017), 100% (P = .026), and 96.3% ± 1.8% (P = .035), respectively, whereas freedom from aortic insufficiency grade 2 or greater remained unaffected (78.1% ± 7.6%). Calibrated annuloplasty and effective height assessment were identified as protective factors from reoperation: hazard ratio, 0.13; 95% confidence interval, 0.02-1.06; P = .057 and hazard ratio, 0.11; 95% confidence interval, 0.01-0.95; P = .044, respectively. CONCLUSIONS: The standardization of remodeling root repair with calibrated expansible aortic ring annuloplasty and cusp effective height assessment improves valve repair outcomes.
- MeSH
- anuloplastika srdeční chlopně škodlivé účinky přístrojové vybavení mortalita MeSH
- aorta diagnostické zobrazování patofyziologie chirurgie MeSH
- aortální aneurysma diagnostické zobrazování mortalita patofyziologie chirurgie MeSH
- aortální chlopeň abnormality diagnostické zobrazování patofyziologie chirurgie MeSH
- aortální insuficience diagnostické zobrazování mortalita patofyziologie chirurgie MeSH
- barevná dopplerovská echokardiografie MeSH
- časové faktory MeSH
- cévní protézy * MeSH
- cévy - implantace protéz škodlivé účinky přístrojové vybavení mortalita MeSH
- chirurgická náhrada chlopně škodlivé účinky přístrojové vybavení mortalita MeSH
- doba přežití bez progrese choroby MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nemoci srdečních chlopní diagnostické zobrazování mortalita patofyziologie chirurgie MeSH
- obnova funkce MeSH
- polyethylentereftaláty MeSH
- pooperační komplikace etiologie MeSH
- protézy - design MeSH
- registrace MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční chlopně umělé * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- audiovizuální média MeSH
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- Geografické názvy
- Francie MeSH
Nemoci mitrální chlopně hrají důležitou roli v etiologii kardiálního selhání a mohou se projevit jako závažné, život ohrožující stavy vyžadující intenzivní péči. Echokardiografie je jedním z nejdůležitějších diagnostických nástrojů, který v posledních letech stále častěji používají, kromě kardiologů, i anesteziologové a intenzivisté. Autoři seznamují čtenáře se základními metodami echokardiografického vyšetření u pacientů s onemocněním mitrální chlopně.
Mitral valve disease plays an important role in the aetiology of cardiac failure. It may present as a serious, life-threatening condition necessitating intensive care. Echocardiography is one of the most important diagnostic tools, nowadays widely used not only by cardiologists but also by anaesthetists and intensivists. The authors present basic echocardiographic methods used in patients with mitral valve disease.
- MeSH
- Aspirin aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- barevná dopplerovská echokardiografie metody využití MeSH
- cévní mozková příhoda * diagnóza etiologie terapie MeSH
- defekty septa síní diagnóza etiologie terapie MeSH
- diagnostické zobrazování * metody trendy využití MeSH
- dospělí MeSH
- echokardiografie transezofageální metody využití MeSH
- elektrokardiografie metody využití MeSH
- klinický obraz nemoci MeSH
- lidé MeSH
- magnetická rezonanční angiografie metody využití MeSH
- magnetická rezonanční tomografie metody využití MeSH
- recidiva * MeSH
- tiklopidin analogy a deriváty aplikace a dávkování terapeutické užití MeSH
- ultrasonografie dopplerovská pulzní metody využití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
BACKGROUND: A significant proportion of patients with exertional dyspnea require exercise to diagnose heart failure with normal ejection fraction (HFNEF). METHODS AND RESULTS: In this review article, we evaluate current data on the prevalence, clinical significance and specifically the establishment of a diagnosis of isolated, exercise-induced HFNEF. Despite the unquestioned clinical importance and high prevalence of exercise-induced HFNEF, there are limited and conflicting data on making a diagnosis of exercise-induced HFNEF. This mostly relies on the evidence of exercise-induced elevation in left ventricular filling pressure (LVFP). At present, there is no agreement on the ability of exercise echocardiographic parameteres to predict exercise-induced LVFP elevation. In addition, even invasively measured exercise LVFP faces the problem of defining normal exercise LVFP values. More data and probably new diagnostic approaches are necessary to reliably diagnose exercise HFNEF. CONCLUSIONS: There are conflicting results and significant problems associated with the diagnosis of exercise HFNEF. This review hopefully will encourage further research in this difficult but clinically important area of heart failure.
- MeSH
- barevná dopplerovská echokardiografie MeSH
- cvičení fyziologie MeSH
- dysfunkce levé srdeční komory diagnóza patofyziologie MeSH
- dyspnoe etiologie MeSH
- krevní tlak fyziologie MeSH
- lidé MeSH
- srdeční selhání diagnóza patofyziologie MeSH
- tepový objem fyziologie MeSH
- zátěžová echokardiografie MeSH
- zátěžový test MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
OBJECTIVES: A geometric annuloplasty ring could improve efficacy and stability of aortic valve repair. Toward this goal, a 1-piece 3-dimensional titanium annuloplasty ring with Dacron covering was developed and tested successfully in animals. The purpose of this study was to define hemodynamic outcomes with this device used as the annuloplasty component of human aortic valve repair. METHODS: In a 4-center pilot trial with informed consent, 16 patients underwent aortic valve repair for aortic insufficiency, with the annuloplasty device sutured into the annulus beneath the leaflets. Preoperative annular diameter averaged 26.5 ± 2.0 (mean ± standard deviation) mm, and average ring size was 22.3 ± 1.2 mm. After annuloplasty, leaflet defects were easy to identify, and 14 of 16 patients (88%) required leaflet plication and/or autologous pericardial reconstruction for leaflet defects. Three patients had ascending aortic replacement, and 2 had remodeling root replacement. One had ultrasonic leaflet decalcification and another tricuspid valve annuloplasty. Follow-up data were from site-specific studies at the 6-month postoperative time point. RESULTS: There were no in-hospital mortalities or major complications. Preoperative aortic insufficiency grade (0-4 scale) was 3.6 ± 1.0 and fell to 1.0 ± 0.8 at 6 months (P < .0001). New York Heart Association class fell from 2.5 ± 0.5 to 1.1 ± 0.3 (P < .0001). Postrepair valve area was 2.7 ± 0.2 cm(2), and 6-month mean systolic gradient was 11.3 ± 3.3 mm Hg. Left ventricular end-diastolic diameter and ejection fraction both normalized (both P < .0001). CONCLUSIONS: Geometric ring annuloplasty facilitated aortic valve repair, allowing more precise reconstruction of leaflet defects. Aortic insufficiency reduction and systolic gradients were excellent, and expansion of valve reconstruction into broader categories of aortic valve disease seems indicated.
- MeSH
- anuloplastika srdeční chlopně přístrojové vybavení MeSH
- aortální chlopeň patofyziologie chirurgie ultrasonografie MeSH
- aortální insuficience diagnóza patofyziologie chirurgie MeSH
- barevná dopplerovská echokardiografie MeSH
- časové faktory MeSH
- chirurgická náhrada chlopně přístrojové vybavení MeSH
- echokardiografie transezofageální MeSH
- hemodynamika * MeSH
- lidé středního věku MeSH
- lidé MeSH
- obnova funkce MeSH
- pilotní projekty MeSH
- polyethylentereftaláty MeSH
- protézy - design MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční chlopně umělé * MeSH
- stupeň závažnosti nemoci MeSH
- titan MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
Background Patent ductus arteriosus (PDA) is common in very premature infants. Pharmacological closure of PDA with indomethacin, a prostaglandin inhibitor, has remained the mainstay of treatment in premature infants over the last three decades. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reaction in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route. This study was designed to assess the efficacy and safety of oral ibuprofen and intravenous ibuprofen for the early pharmacological treatment of PDA in LBW preterm infants with respiratory distress syndrome. Methods A randomized, single-blinded, controlled study was performed on premature neonates at the neonatal care unit of the University Hospital for Obstetrics and Gynecology”Koco Gliozheni”, Tirana, Albania, from January 2010 to December 2012. The study enrolled 68 preterm infants with gestational age between 28-32 weeks, birth weight ≤ 2000 g, postnatal age 48-96 h, and had echocardiographically confirmed significant PDA. The preterm infants received either intravenous or oral ibuprofen randomly as an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 h. After the first dose of treatment in both groups, echocardiographic evaluation was performed, to determine the need for a second or third dose. The rate of ductal closure, adverse effects, complications, and the patient’s clinical course were recorded. Results All patients were born after 28 until 32 weeks’ gestation. 36 patients were treated with oral ibuprofen and 32 with intravenous ibuprofen in this period. After the first course of the treatment, the PDA closed in 30 (83.3%) of the patients assigned to the oral ibuprofen group versus 23 (71.8%) of those enrolled in the intravenous ibuprofen group (p = 0.355). There was no difference between treatment groups in demographics or baseline renal function. In the evaluation of renal tolerance, none of the patients had oliguria. There were no significant differences with respect to complications during the stay. Conclusions In low birth weight infants, the rate of early ductal closure with oral ibuprofen is at least as good as with the intravenous route. Oral ibuprofen is associated with fewer adverse effects
- MeSH
- aplikace orální * MeSH
- barevná dopplerovská echokardiografie MeSH
- dusík močoviny v krvi MeSH
- gestační stáří MeSH
- ibuprofen * aplikace a dávkování škodlivé účinky MeSH
- intravenózní podání * statistika a číselné údaje MeSH
- kreatinin krev MeSH
- lidé MeSH
- nemoci nedonošenců farmakoterapie MeSH
- novorozenec nedonošený MeSH
- novorozenec s nízkou porodní hmotností * MeSH
- novorozenec MeSH
- oligurie chemicky indukované MeSH
- otevřená tepenná dučej * farmakoterapie MeSH
- porodní hmotnost MeSH
- prospektivní studie MeSH
- statistika jako téma MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
Aneuryzma Valsalvova sinu je vzácné postižení aortálního sinu, které může probíhat asymptomaticky až po známky těžké kardiální dekompenzace při významném levo-pravém zkratu v případě jeho ruptury. V kazuistice popisujeme neobvyklý případ pravostranného srdečního selhání u devatenáctiletého muže, který byl v dětství operovaný pro koarktaci aorty a perzistující Botalovu dučej. U pacienta jsme diagnostikovali defekt nekoronárního Valsalvova sinu s významným levo-pravým zkratem řešený následně uzávěrem pomocí perikardu.
Aneurysm of Valsalva sinus is a rare disease of the coronary sinus, course of which may range from asymptomatic to severe heart failure with significant left-to-right shunt in the case of its rupture. In this case, we describe an unusual case of right heart failure of a 19-year old man, who underwent surgery for aortic coarctation and patent ductus arteriosus as a child. We diagnosed the defect of noncoronary Valsalva sinus with significant left-to-right shunt, which was closed by pericardium.
- MeSH
- aneurysma * etiologie MeSH
- barevná dopplerovská echokardiografie MeSH
- kardiochirurgické výkony * MeSH
- klinický obraz nemoci MeSH
- lidé MeSH
- mladý dospělý MeSH
- perikard * MeSH
- příznaky a symptomy MeSH
- srdeční selhání * etiologie MeSH
- srdeční tamponáda MeSH
- Valsalvův sinus * patofyziologie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
There are various complications of prosthetic valvular surgeries. Among them, leaflet perforation should be emphasized and brought to mind when there have been eccentric valvular regurgitation. In this report, we presented 2 cases of iatrogenic aortic and mitral valve leaflet perforation after prosthetic valve surgeries.
- MeSH
- aortální chlopeň zranění MeSH
- aortální insuficience chirurgie MeSH
- barevná dopplerovská echokardiografie MeSH
- dospělí MeSH
- echokardiografie transezofageální MeSH
- lidé středního věku MeSH
- lidé MeSH
- mitrální chlopeň zranění MeSH
- mitrální insuficience chirurgie MeSH
- následné studie MeSH
- ruptura srdce diagnóza etiologie MeSH
- srdeční chlopně umělé škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH