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Transplant Renal Artery Stenosis with Varied Clinical Presentations 临床表现各异的移植肾动脉狭窄
Pub Date : 2024-05-23 DOI: 10.4103/jicc.jicc_6_24
Sravani Muske, Kishan Aralapuram, S. Jayaprakash, Sreedhara C. Gurusiddaiah, CM Nagesh, Mythri Shankar
Renal vascular complications constitute a clinically significant cause of morbidity following renal transplantation. Transplant renal artery stenosis (TRAS) is a well-recognized complication accounting for ∼75% of posttransplant vascular complications. Early recognition and prompt correction of TRAS can prevent adverse outcomes, including graft loss. This series is a summary of four renal transplant recipients who developed TRAS at varied time periods and with varied clinical presentations. A 23-year-old male who presented after 1½ months of renal transplantation with accelerated hypertension was diagnosed with TRAS and was treated successfully with percutaneous transluminal angioplasty with stenting. A 26-year-old male with acute allograft dysfunction after 1 month of transplantation without worsening hypertension was diagnosed with TRAS, which was treated successfully with angioplasty and stenting. A 49-year-old male who presented to the emergency with pulmonary edema secondary to accelerated hypertension (Pickering syndrome) after 2 months of transplantation was diagnosed to have TRAS, which was treated successfully with angioplasty with stenting. A 44-year-old male with an incidentally detected TRAS-like clinical picture secondary to kinking in the transplant renal artery in the immediate posttransplant period was successfully treated with re-exploration and repair. All the patients were screened with Doppler ultrasonogram and computed tomogram-angiography supported the diagnosis in three of the cases. None of the cases developed procedure-related complications including contrast-associated nephropathy. All the patients on follow-up after 6 months of the intervention are normotensive with normal renal function. A high index of suspicion is required in the early identification of TRAS, which is a reversible cause of hypertension and graft dysfunction. The risk of contrast-associated nephropathy cannot hinder or delay the diagnosis especially, in emerging transplant centers. The endovascular procedures used today for the treatment of TRAS are safe with high technical success rates.
肾血管并发症是肾移植术后发病率的重要原因之一。移植肾动脉狭窄(TRAS)是一种公认的并发症,占移植后血管并发症的75%。早期识别并及时纠正 TRAS 可避免不良后果,包括移植肾丢失。本系列总结了四名肾移植受者在不同时期出现的 TRAS,他们的临床表现各不相同。一名 23 岁的男性在肾移植 1 个半月后出现加速性高血压,被诊断为 TRAS,并成功接受了经皮腔内血管成形术加支架植入术。一名 26 岁的男性在移植 1 个月后出现急性异体移植功能障碍,但高血压没有恶化,被诊断为 TRAS,并成功接受了血管成形术和支架植入术。一名49岁的男性在移植2个月后因加速高血压(皮克林综合征)继发肺水肿而急诊就医,被诊断为TRAS,并通过血管成形术和支架植入术成功治愈。一名 44 岁的男性患者在移植后不久因移植肾动脉扭结而意外发现了类似 TRAS 的临床表现,经再次探查和修补后成功治愈。所有患者均接受了多普勒超声检查,其中三例患者的计算机断层扫描血管造影支持了诊断。所有病例均未出现与手术相关的并发症,包括造影剂相关肾病。介入治疗 6 个月后的随访结果显示,所有患者血压正常,肾功能正常。TRAS是导致高血压和移植物功能障碍的可逆原因,需要高度怀疑才能早期发现。尤其是在新兴的移植中心,造影剂相关肾病的风险不能妨碍或延误诊断。目前用于治疗 TRAS 的血管内手术安全、技术成功率高。
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引用次数: 0
Zilebesiran: A Breakthrough in Hypertension Management with Biannual Dosing and Favorable Safety Profile 齐莱贝西然:一年两次给药的高血压治疗新突破,安全性良好
Pub Date : 2024-05-14 DOI: 10.4103/jicc.jicc_12_24
Maisam Ali Rajput, Muhammad Momin Khan, Kiran Niaz Hussain, Kundan Kumar Maheshwari
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引用次数: 0
Feasibility of Cardiac Catheterization in an Upcoming Hospital without Onsite Surgical Support 在没有现场外科手术支持的医院进行心导管检查的可行性
Pub Date : 2024-04-09 DOI: 10.4103/jicc.jicc_49_21
R. Barik, Smarak Ranjan Rout, Prafulla Kumar Swain
The study aimed to investigate the feasibility of catheter-based cardiac intervention in an upcoming cardiology center without onsite surgical support. This prospective, cross-sectional study was done from July 2016 to September 2018 in intervention in an upcoming cardiology center without the onsite surgical support. The institutional ethical committee had approved the study. A total of 2000 patients were studied. The age of the study population was above 10 years. The male population constituted 70.1%. A total of 1862 (91.1%) had coronary artery disease. The procedural detail included percutaneous transluminal coronary angioplasty: 269; percutaneous transluminal angioplasty: 22, percutaneous transluminal renal angioplasty: 5; valvuloplasty: 5; pericardiocentesis: 102 and permanent pacemaker implantation (PPI): 39. The access sites were femoral-3 (0.15%), radial-1972 (98.6%), ulnar-1, d-TRA-12, brachial- 4, and switch from radial to other sites was 8 (0.4%). Same-day discharge was possible in 1302 (65.1%). The complications observed were minor bleeding – 23 (1.15%), inhospital death-0, pericardial tamponade-1, and contrast-induced nephropathy-5 (0.25%).
该研究旨在调查即将成立的心脏病学中心在没有现场外科手术支持的情况下进行导管心脏介入治疗的可行性。这项前瞻性横断面研究于 2016 年 7 月至 2018 年 9 月在一家即将成立的心脏病学中心进行,没有现场手术支持。研究获得了机构伦理委员会的批准。共研究了 2000 名患者。研究人群的年龄在 10 岁以上。男性占 70.1%。共有 1862 人(91.1%)患有冠状动脉疾病。手术细节包括经皮腔内冠状动脉血管成形术:269 例;经皮腔内血管成形术:22 例;经皮腔内肾血管成形术:5 例;瓣膜成形术:5 例;心包穿刺术:102 例;永久起搏器植入术(PPI):39 例:39.入路部位为股动脉-3(0.15%)、桡动脉-1972(98.6%)、尺动脉-1、d-TRA-12、肱动脉-4,从桡动脉转至其他部位的有 8 例(0.4%)。1302例(65.1%)患者可以当天出院。观察到的并发症有轻微出血 23 例(1.15%)、院内死亡 0 例、心包填塞 1 例和造影剂诱发肾病 5 例(0.25%)。
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引用次数: 0
Spiked-helmet Sign: A Rare but Alarming Sign on Electrocardiogram 尖盔征:心电图上一种罕见但令人担忧的征兆
Pub Date : 2024-03-27 DOI: 10.4103/jicc.jicc_41_23
Nithin V. Adithiyaa, M. C. Yeriswamy
Spiked Helmet Sign was first described by Littman and Munroe in 2011 in a case series of 8 patients. This novel ECG sign is a predictor of death in critically ill patients. It resembles the German military helmet of the Prussian empire. 27-year-old male came with chief complaints of upper epigastric pain and chest pain for 2 hours. ECG showed ST elevation in the anterior and inferior leads, patient was diagnosed as STEMI and lysed with streptokinase, on further interrogation patient had binge of alcohol last night and had sudden onset of upper abdominal pain and Serum amylase and lipase was elevated and USG abdomen showed acute pancreatitis. SHS is associated with critical non cardiac illness and the association with pancreatitis is very rare.
尖盔征由 Littman 和 Munroe 于 2011 年在一组 8 名患者的病例中首次描述。这种新颖的心电图征象可预测危重病人的死亡。它类似于普鲁士帝国的德军头盔。27 岁男性,主诉上腹痛和胸痛 2 小时。心电图显示前导联和下导联ST段抬高,患者被诊断为STEMI,并用链激酶溶解。进一步询问得知,患者昨晚酗酒,突然出现上腹部疼痛,血清淀粉酶和脂肪酶升高,腹部USG显示为急性胰腺炎。SHS 与危重的非心脏病有关,而与胰腺炎有关的情况非常罕见。
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引用次数: 0
How Did I Manage a Case of Pulseless Electrical Activity During Transcatheter Aortic Valve Implantation in a Patient with Severe Aortic Valve Stenosis with Left Ventricular Dysfunction? 我是如何处理一名严重主动脉瓣狭窄伴左心室功能障碍患者在经导管主动脉瓣植入术中出现的无脉搏电活动病例的?
Pub Date : 2024-02-14 DOI: 10.4103/jicc.jicc_1_22
Abhisekh Mohanty
Cardiac arrest during transcatheter aortic valve implantation (TAVI) is rare but is generally associated with dramatic consequences including mortality and severe neurological damage. Our patient is an 89-year-old male with symptomatic severe aortic valve stenosis and left ventricular dysfunction. He had a prolonged cardiac arrest in the form of pulseless electrical activity (PEA) during TAVI. After ruling out cardiac tamponade and bleeding, we decided to do the TAVI while doing cardiopulmonary resuscitation. The hemodynamics of the patient improved immediately after TAVI and we could avoid the use of a mechanical circulatory support. We have also discussed in detail the cause, diagnosis, and management of PEA during TAVI.
经导管主动脉瓣植入术(TAVI)期间发生心脏骤停的情况非常罕见,但通常会造成严重后果,包括死亡率和严重的神经损伤。我们的患者是一名 89 岁的男性,患有无症状的重度主动脉瓣狭窄和左心室功能障碍。他在 TAVI 过程中出现了长时间的心脏停搏,表现为无脉电活动(PEA)。在排除心脏填塞和出血的可能性后,我们决定在进行心肺复苏的同时进行 TAVI 手术。TAVI 术后,患者的血流动力学状况立即得到改善,我们可以避免使用机械循环支持。我们还详细讨论了 TAVI 期间 PEA 的原因、诊断和处理。
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引用次数: 0
How Did I Manage a Case of Pulseless Electrical Activity During Transcatheter Aortic Valve Implantation in a Patient with Severe Aortic Valve Stenosis with Left Ventricular Dysfunction? 我是如何处理一名严重主动脉瓣狭窄伴左心室功能障碍患者在经导管主动脉瓣植入术中出现的无脉搏电活动病例的?
Pub Date : 2024-02-14 DOI: 10.4103/jicc.jicc_1_22
Abhisekh Mohanty
Cardiac arrest during transcatheter aortic valve implantation (TAVI) is rare but is generally associated with dramatic consequences including mortality and severe neurological damage. Our patient is an 89-year-old male with symptomatic severe aortic valve stenosis and left ventricular dysfunction. He had a prolonged cardiac arrest in the form of pulseless electrical activity (PEA) during TAVI. After ruling out cardiac tamponade and bleeding, we decided to do the TAVI while doing cardiopulmonary resuscitation. The hemodynamics of the patient improved immediately after TAVI and we could avoid the use of a mechanical circulatory support. We have also discussed in detail the cause, diagnosis, and management of PEA during TAVI.
经导管主动脉瓣植入术(TAVI)期间发生心脏骤停的情况非常罕见,但通常会造成严重后果,包括死亡率和严重的神经损伤。我们的患者是一名 89 岁的男性,患有无症状的重度主动脉瓣狭窄和左心室功能障碍。他在 TAVI 过程中出现了长时间的心脏停搏,表现为无脉电活动(PEA)。在排除心脏填塞和出血的可能性后,我们决定在进行心肺复苏的同时进行 TAVI 手术。TAVI 术后,患者的血流动力学状况立即得到改善,我们可以避免使用机械循环支持。我们还详细讨论了 TAVI 期间 PEA 的原因、诊断和处理。
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引用次数: 0
An Insight on Prehospital Delay and Ambulance Usage in Acute Myocardial Infarction 洞察急性心肌梗死的院前延误和救护车使用情况
Pub Date : 2024-02-07 DOI: 10.4103/jicc.jicc_26_23
Raghunatha Reddy Bana, Manabendra Nayak, Kranthi Chaitanya
In acute myocardial infarction (AMI), the time elapsed between the onset of symptoms and definitive care plays a crucial role in the mortality and morbidity of a victim. The symptom onset to reperfusion therapy comprises prehospital time and hospital time. There are evidence-based international guidelines to minimize hospital time. However, reducing prehospital time and developing strategies to prevent the delay necessitate a thorough understanding of the underlying causes. In the event of an emergency, calling an ambulance can assist cut down on transportation delays, which cuts down on prehospital time and its effects. Aim of this review is to analyze the relationship between ambulance service utilization and prehospital delay in AMI patients. Studies that reported prehospital delay and ambulance usage were collected with a search on the expression “prehospital delay in AMI” in combination with “ambulance usage.” These studies were from around 15 countries on six continents and were analyzed and summarized in this review. The extracted data expressed under six headings: emergency medical service (EMS) as a first medical contact, ambulance disuse, shorter prehospital delay, no or poor EMS system, predictors of ambulance use in AMI, and efforts to reduce prehospital delay. In AMI, using an ambulance is advisable for early diagnosis and swift transport to a definitive care center. However, ambulance services are frequently unavailable or underutilized.
在急性心肌梗死(AMI)中,从症状出现到最终治疗之间的时间对患者的死亡率和发病率起着至关重要的作用。从症状出现到再灌注治疗包括院前时间和住院时间。国际上有循证指南来尽量缩短住院时间。然而,要缩短入院前时间并制定防止延误的策略,就必须彻底了解延误的根本原因。在发生紧急情况时,呼叫救护车可以帮助减少运输延误,从而减少院前时间及其影响。本综述旨在分析急性心肌梗死患者使用救护车服务与院前延误之间的关系。通过搜索 "急性心肌梗死院前延误 "和 "救护车使用",收集了报告院前延误和救护车使用的研究。这些研究来自六大洲约 15 个国家,本综述对其进行了分析和总结。提取的数据分为六个标题:作为首次医疗接触的急救医疗服务(EMS)、救护车的废弃、院前延误的缩短、无EMS系统或EMS系统不完善、AMI中使用救护车的预测因素以及为减少院前延误所做的努力。急性心肌梗死患者最好使用救护车,以便及早诊断并迅速送往最终治疗中心。然而,救护车服务经常无法使用或使用不足。
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引用次数: 0
An Insight on Prehospital Delay and Ambulance Usage in Acute Myocardial Infarction 洞察急性心肌梗死的院前延误和救护车使用情况
Pub Date : 2024-02-07 DOI: 10.4103/jicc.jicc_26_23
Raghunatha Reddy Bana, Manabendra Nayak, Kranthi Chaitanya
In acute myocardial infarction (AMI), the time elapsed between the onset of symptoms and definitive care plays a crucial role in the mortality and morbidity of a victim. The symptom onset to reperfusion therapy comprises prehospital time and hospital time. There are evidence-based international guidelines to minimize hospital time. However, reducing prehospital time and developing strategies to prevent the delay necessitate a thorough understanding of the underlying causes. In the event of an emergency, calling an ambulance can assist cut down on transportation delays, which cuts down on prehospital time and its effects. Aim of this review is to analyze the relationship between ambulance service utilization and prehospital delay in AMI patients. Studies that reported prehospital delay and ambulance usage were collected with a search on the expression “prehospital delay in AMI” in combination with “ambulance usage.” These studies were from around 15 countries on six continents and were analyzed and summarized in this review. The extracted data expressed under six headings: emergency medical service (EMS) as a first medical contact, ambulance disuse, shorter prehospital delay, no or poor EMS system, predictors of ambulance use in AMI, and efforts to reduce prehospital delay. In AMI, using an ambulance is advisable for early diagnosis and swift transport to a definitive care center. However, ambulance services are frequently unavailable or underutilized.
在急性心肌梗死(AMI)中,从症状出现到最终治疗之间的时间对患者的死亡率和发病率起着至关重要的作用。从症状出现到再灌注治疗包括院前时间和住院时间。国际上有循证指南来尽量缩短住院时间。然而,要缩短入院前时间并制定防止延误的策略,就必须彻底了解延误的根本原因。在发生紧急情况时,呼叫救护车可以帮助减少运输延误,从而减少院前时间及其影响。本综述旨在分析急性心肌梗死患者使用救护车服务与院前延误之间的关系。通过搜索 "急性心肌梗死院前延误 "和 "救护车使用",收集了报告院前延误和救护车使用的研究。这些研究来自六大洲约 15 个国家,本综述对其进行了分析和总结。所提取的数据按六个标题进行表述:急救医疗服务(EMS)作为首次医疗接触、救护车的废弃、较短的院前延误、无EMS系统或EMS系统不完善、AMI中使用救护车的预测因素以及减少院前延误的努力。急性心肌梗死患者最好使用救护车,以便及早诊断并迅速送往最终治疗中心。然而,救护车服务经常无法使用或使用不足。
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引用次数: 0
Pacemaker Implantation in a Patient with a Persistent Left Superior Vena Cava 为一名左上腔静脉阻塞的患者植入起搏器
Pub Date : 2024-02-06 DOI: 10.4103/jicc.jicc_28_23
Dibyasundar Mahanta, R. C. Barik, Debasish Das, D. Acharya
Persistent left-sided superior vena cava (PLSVC) is rare and is the most common systemic vein anomaly. It is mostly asymptomatic and often an incidental finding. It may pose a challenge in performing intervention through it due to its complex anatomy. We report a case of degenerative symptomatic complete atrioventricular node block in whom PLSVC was found incidentally during permanent pacemaker implantation. We also discussed the technical challenges and how to overcome these difficulties.
持续性左侧上腔静脉(PLSVC)很罕见,是最常见的全身静脉异常。它多无症状,通常是偶然发现。由于其解剖结构复杂,通过它进行介入治疗可能是一项挑战。我们报告了一例退行性症状性完全性房室结阻滞患者,在植入永久起搏器时意外发现了 PLSVC。我们还讨论了技术挑战以及如何克服这些困难。
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引用次数: 0
Pacemaker Implantation in a Patient with a Persistent Left Superior Vena Cava 为一名左上腔静脉阻塞的患者植入起搏器
Pub Date : 2024-02-06 DOI: 10.4103/jicc.jicc_28_23
Dibyasundar Mahanta, R. C. Barik, Debasish Das, D. Acharya
Persistent left-sided superior vena cava (PLSVC) is rare and is the most common systemic vein anomaly. It is mostly asymptomatic and often an incidental finding. It may pose a challenge in performing intervention through it due to its complex anatomy. We report a case of degenerative symptomatic complete atrioventricular node block in whom PLSVC was found incidentally during permanent pacemaker implantation. We also discussed the technical challenges and how to overcome these difficulties.
持续性左侧上腔静脉(PLSVC)很罕见,是最常见的全身静脉异常。它多无症状,通常是偶然发现。由于其解剖结构复杂,通过它进行介入治疗可能是一项挑战。我们报告了一例退行性症状性完全性房室结阻滞患者,在植入永久起搏器时意外发现了 PLSVC。我们还讨论了技术挑战以及如何克服这些困难。
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引用次数: 0
期刊
Journal of Indian College of Cardiology
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