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Can Asthma Cause Pericardial Effusion? Insights Into an Intriguing Association. 哮喘会引起心包积液吗?洞察一个有趣的关联。
IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.14503/THIJ-22-7867
Betul Banu Karasu, Berna Akin

Background: Pericardial effusion (PE) is a commonly encountered condition in clinical practice, but its etiology can be difficult to identify, with many cases remaining classified as idiopathic. This study aimed to investigate whether an association exists between asthma and idiopathic PE (IPE).

Methods: Patients who had been diagnosed with PE in the authors' outpatient cardiology clinics between March 2015 and November 2018 were retrospectively analyzed. The study population was divided into 2 groups-non-IPE (NIPE) and IPE-based on whether a cause had been identified. Demographic, laboratory, and clinical data for the 2 groups were examined statistically.

Results: A total of 714 patients were enrolled in the study after exclusion of 40 cases. Of these 714 patients, 558 were allocated to the NIPE group and 156 to the IPE group (NIPE group median [IQR] age, 50 [41-58] years vs IPE group median [IQR] age, 47 [39-56] years; P = .03). Asthma was significantly more prevalent among patients in the IPE group than among those in the NIPE group (n = 54 [34.6%] vs n = 82 [14.7%]; P < .001). In multivariate logistic regression analysis, asthma (odds ratio, 2.67 [95% CI, 1.53-4.67]; P = .001) was found to be an independent predictor of IPE. In the IPE group, patients with asthma had either mild or moderate PE, with the right atrium being the most common location in these patients.

Conclusion: Asthma was an independent predictor of mild to moderate IPE. The right atrium was the most frequently encountered location for PE in patients with asthma.

背景:心包积液(PE)是临床实践中常见的疾病,但其病因难以确定,许多病例仍被归类为特发性。本研究旨在探讨哮喘与特发性PE (IPE)之间是否存在关联。方法:回顾性分析2015年3月至2018年11月在笔者的门诊心脏科诊所诊断为PE的患者。根据是否确定病因,将研究人群分为两组:非ipe (NIPE)组和ipe组。对两组患者的人口学、实验室和临床资料进行统计学分析。结果:排除40例后,共纳入714例患者。在这714例患者中,558例被分配到NIPE组,156例被分配到IPE组(NIPE组中位年龄为50[41-58]岁,IPE组中位年龄为47[39-56]岁;P = .03)。IPE组患者哮喘患病率明显高于NIPE组(n = 54 [34.6%] vs n = 82 [14.7%]);P < 0.001)。在多因素logistic回归分析中,哮喘(优势比,2.67 [95% CI, 1.53-4.67];P = .001)是IPE的独立预测因子。在IPE组中,哮喘患者有轻度或中度PE,右心房是这些患者中最常见的部位。结论:哮喘是轻中度IPE的独立预测因子。右心房是哮喘患者PE最常见的部位。
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引用次数: 0
Cardiac Surgery for Treatment of COVID-19-Associated Infectious Endocarditis. 心脏手术治疗covid -19相关感染性心内膜炎
IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.14503/THIJ-22-7884
Ali Taghizadeh-Waghefi, Asen Petrov, Manuel Wilbring, Konstantin Alexiou, Utz Kappert, Klaus Matschke, Sems-Malte Tugtekin

Background: Significant uncertainty exists about the optimal timing of surgery for infectious endocarditis (IE) surgery in patients with active SARS-CoV-2 infection. This case series and a systematic review of the literature were carried out to evaluate the timing of surgery and postsurgical outcomes for patients with COVID-19-associated IE.

Methods: The PubMed database was searched for reports published from June 20, 2020, to June 24, 2021, that contained the terms infective endocarditis and COVID-19. A case series of 8 patients from the authors' facility was also added.

Results: A total of 12 cases were included, including 4 case reports that met inclusion criteria in addition to a case series of 8 patients from the authors' facility. Mean (SD) patient age was 61.9 (17.1) years, and patients were predominantly male (91.7%). Being overweight was the main comorbidity among patients studied (7/8 [87.5%]). Among all patients evaluated in this study, dyspnea (n = 8 [66.7%]) was the leading symptom, followed by fever (n = 7 [58.3%]). Enterococcus faecalis and Staphylococcus aureus caused 75.0% of COVID-19-associated IE. The mean (SD) time to surgery was 14.5 (15.6) days (median, 13 days). In-hospital and 30-day mortality for all evaluated patients was 16.7% (n = 2).

Conclusion: Clinicians must carefully assess patients diagnosed with COVID-19 to prevent missing underlying diseases such as IE. If IE is suspected, clinicians should avoid postponement of crucial diagnostic and treatment steps.

背景:SARS-CoV-2活动性感染患者感染性心内膜炎(IE)手术的最佳手术时机存在显著的不确定性。本病例系列和文献系统综述旨在评估covid -19相关IE患者的手术时机和术后结果。方法:检索PubMed数据库中发表于2020年6月20日至2021年6月24日的包含感染性心内膜炎和COVID-19术语的报告。还增加了来自作者机构的8例患者的病例系列。结果:共纳入12例病例,包括4例符合纳入标准的病例报告,以及来自作者机构的8例患者的病例系列。患者平均(SD)年龄为61.9(17.1)岁,患者以男性为主(91.7%)。超重是研究患者的主要合并症(7/8[87.5%])。在本研究评估的所有患者中,呼吸困难(n = 8[66.7%])是主要症状,其次是发热(n = 7[58.3%])。粪肠球菌和金黄色葡萄球菌导致75.0%的新冠肺炎相关IE。到手术的平均(SD)时间为14.5(15.6)天(中位数,13天)。所有评估患者的住院死亡率和30天死亡率为16.7% (n = 2)。结论:临床医生必须仔细评估被诊断为COVID-19的患者,以防止遗漏IE等基础疾病。如果怀疑IE,临床医生应避免推迟关键的诊断和治疗步骤。
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引用次数: 1
Establishment and Verification of a Nomogram for Predicting the Probability of New-Onset Atrial Fibrillation After Dual-Chamber Pacemaker Implantation. 预测双室起搏器植入后新发房颤概率的Nomogram建立与验证。
IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.14503/THIJ-21-7796
Ying Yang, Jiangting Lu, Cui Xiong, Zhida Shen, Chao Shen, Jinshan Tong, Jiangfen Jiang, Guosheng Fu, Fen Xu

Background: This study aims to establish and validate a nomogram as a predictive model in patients with new-onset atrial fibrillation (AF) after dual-chamber cardiac implantable electronic device (pacemaker) implantation.

Methods: A total of 1120 Chinese patients with new-onset AF after pacemaker implantation were included in this retrospective study. Patients had AF of at least 180/minute lasting 5 minutes or longer, detected by atrial lead and recorded at least 3 months after implantation. Patients with previous atrial tachyarrhythmias before device implantation were excluded. A total of 276 patients were ultimately enrolled, with 51 patients in the AF group and 225 patients in the non-AF group. Least absolute shrinkage and selection operator (LASSO) method was used to determine the best predictors. Through multivariate logistic regression analysis, a nomogram was drawn as a predictive model. Concordance index, calibration plot, and decision curve analyses were applied to evaluate model discrimination, calibration, and clinical applicability. Internal verification was performed using a bootstrap method.

Results: The LASSO method regression analysis found that variables including peripheral arterial disease, atrial pacing-ventricular pacing of at least 50%, atrial sense-ventricular sense of at least 50%, increased left atrium diameter, and age were important predictors of developing AF. In multivariate logistic regression, peripheral arterial disease, atrial pacing-ventricular pacing of at least 50%, and age were found to be independent predictors of new-onset AF.

Conclusion: This nomogram may help physicians identify patients at high risk of new-onset AF after pacemaker implantation at an early stage in a Chinese population.

背景:本研究旨在建立并验证心电图图作为双室心脏植入式电子装置(起搏器)植入术后新发心房颤动(AF)患者的预测模型。方法:对1120例中国起搏器植入后新发房颤患者进行回顾性研究。患者房颤至少180次/分钟,持续5分钟或更长时间,经心房导联检测并在植入后至少3个月记录。排除植入器械前有房性心动过速的患者。最终共有276例患者入组,其中51例为房颤组,225例为非房颤组。采用最小绝对收缩和选择算子(LASSO)方法确定最佳预测因子。通过多变量logistic回归分析,绘制出nomogram作为预测模型。采用一致性指数、校正图和决策曲线分析评价模型判别、校正和临床适用性。使用bootstrap方法执行内部验证。结果:LASSO回归分析发现外周动脉疾病、心房起搏-室性起搏≥50%、心房感觉-室性起搏≥50%、左心房直径增大、年龄是房颤发生的重要预测因素。多因素logistic回归分析发现外周动脉疾病、心房起搏-室性起搏≥50%、年龄是新发房颤的独立预测因素。这种图可以帮助医生在中国人群中早期识别起搏器植入后新发房颤的高风险患者。
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引用次数: 0
Managing False Lumen Patency in Chronic Thoracic Aortic Dissecting Aneurysms With Coil Embolization. 螺旋栓塞治疗慢性胸主动脉夹层动脉瘤假腔通畅。
IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.14503/THIJ-22-7938
Yash Pradeep Vaidya, Naveed Abdul Rahman, Manu Kannan Arul, Anthony Feghali, Palma M Shaw, Michael James Costanza

Thoracic endovascular aortic repair has become the preferred modality of treatment of complicated type B aortic dissections. However, persistent pressurization of the false lumen can lead to negative aortic remodeling with aneurysmal dilation. Described herein is the coil embolization technique that can be used to manage this complication and a review of the literature on the recent development of management options.

胸主动脉血管内修复已成为治疗复杂B型主动脉夹层的首选方式。然而,假腔持续加压可导致负性主动脉重构伴动脉瘤扩张。本文描述的是线圈栓塞技术,可用于管理这种并发症,并回顾了最近发展的管理方案的文献。
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引用次数: 0
The Evolution of Durable, Implantable Axial-Flow Rotary Blood Pumps. 耐用、可植入轴流旋转血泵的发展。
IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.14503/THIJ-22-7908
P Alex Smith, Yaxin Wang, O H Frazier

Left ventricular assist devices (LVADs) are increasingly used to treat patients with end-stage heart failure. Implantable LVADs were initially developed in the 1960s and 1970s. Because of technological constraints, early LVADs had limited durability (eg, membrane or valve failure) and poor biocompatibility (eg, driveline infections and high rates of hemolysis caused by high shear rates). As the technology has improved over the past 50 years, contemporary rotary LVADs have become smaller, more durable, and less likely to result in infection. A better understanding of hemodynamics and end-organ perfusion also has driven research into the enhanced functionality of rotary LVADs. This paper reviews from a historical perspective some of the most influential axial-flow rotary blood pumps to date, from benchtop conception to clinical implementation. The history of mechanical circulatory support devices includes improvements related to the mechanical, anatomical, and physiologic aspects of these devices. In addition, areas for further improvement are discussed, as are important future directions-such as the development of miniature and partial-support LVADs, which are less invasive because of their compact size. The ongoing development and optimization of these pumps may increase long-term LVAD use and promote early intervention in the treatment of patients with heart failure.

左心室辅助装置(lvad)越来越多地用于治疗终末期心力衰竭患者。植入式左心室辅助装置最初是在20世纪60年代和70年代开发的。由于技术限制,早期lvad的耐久性有限(如膜或瓣膜失效),生物相容性差(如传动系统感染和高剪切率引起的高溶血率)。在过去的50年里,随着技术的进步,现代旋转lvad变得更小,更耐用,更不容易导致感染。对血流动力学和终末器官灌注的更好理解也推动了对旋转式左心室辅助器增强功能的研究。本文从历史的角度回顾了迄今为止一些最具影响力的轴流式旋转血泵,从台式概念到临床应用。机械循环支持装置的历史包括与这些装置的机械、解剖和生理方面有关的改进。此外,还讨论了进一步改进的领域,以及重要的未来方向,例如微型和部分支持型lvad的发展,由于其紧凑的尺寸,其侵入性较小。这些泵的持续发展和优化可能会增加LVAD的长期使用,并促进心力衰竭患者的早期干预治疗。
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引用次数: 0
Randomized Noninferiority Trial of Radiation Exposure During Coronary Angiography: the Transradial and Transfemoral Approach by EXPERienced Operators in Daily rouTine (EXPERT) Trial. 冠状动脉造影期间辐射暴露的随机非效性试验:由经验丰富的操作员在日常(专家)试验中经桡动脉和经股骨入路。
IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.14503/THIJ-22-7930
Cristiano de Oliveira Cardoso, Cláudio Vasques de Moraes, Julio Vinícius Teixeira, Carlos Roberto Cardoso, Felipe Baldissera, Eduardo Ilha de Mattos, Marcio José Siqueira, Leandro Fischer, Juliana Cañedo Sebben, Bruna Santos Silva, Gabriel Broetto, Carlos Antônio Mascia Gottschall, Rogério Sarmento-Leite

Background: The transradial approach (TRA) to coronary angiography reduces vascular complications but is associated with greater radiation exposure than the transfemoral approach (TFA). It is unknown whether exposure remains higher when TRA is performed by experienced operators.

Methods: Patients were randomly, prospectively assigned to TRA or TFA. The primary end point was patient radiation dose; secondary end points were the physician radiation dose and 30-day major adverse cardiac event rate. Coronary angiography was performed by experienced operators using a standardized protocol.

Results: Clinical and procedural characteristics were similar between the TRA (n = 150) and TFA (n = 149) groups, and they had comparable mean (SD) radiation doses for patients (616.51 [252] vs 585.57 [225] mGy; P = .13) and physicians (0.49 [0.3] vs 0.46 [0.29] mSv; P = .32). The mean (SD) fluoroscopy time (3.52 [2.02] vs 3.13 [2.46] min; P = .14) and the mean (SD) dose area product (35,496.5 [15,670] vs 38,313.4 [17,764.9] mGy·cm2; P = .2) did not differ. None of the following factors predicted higher radiation doses: female sex (hazard ratio [HR], 0.69 [95% CI, 0.38-1.3]; P = .34), body mass index >25 (HR, 0.84 [95% CI, 0.43-1.6]; P = .76), age >65 years (HR, 1.67 [95% CI, 0.89-3.1]; P = .11), severe valve disease (HR, 1.37 [95% CI, 0.52-3.5]; P = .68), or previous coronary artery bypass graft (HR, 0.6; 95% CI, 0.2-1.8; P = .38).

Conclusion: TRA for elective coronary angiography is noninferior to TFA when performed by experienced operators.

背景:经桡动脉入路(TRA)进行冠状动脉造影可减少血管并发症,但与经股入路(TFA)相比,其辐射暴露更大。尚不清楚当有经验的操作员进行TRA时,暴露量是否会更高。方法:患者随机,前瞻性分配到TRA或TFA。主要终点为患者的辐射剂量;次要终点是医师放射剂量和30天主要心脏不良事件发生率。冠状动脉造影由经验丰富的操作人员使用标准化方案进行。结果:TRA组(n = 150)和TFA组(n = 149)的临床和程序特征相似,患者的平均(SD)辐射剂量相似(616.51[252]对585.57 [225]mGy;P = .13)和医生(0.49 [0.3]vs 0.46 [0.29] mSv;P = .32)。平均(SD)透视时间(3.52 [2.02]vs 3.13 [2.46] min;P = .14)和平均(SD)剂量面积积(35,496.5 [15,670]vs 38,313.4 [17,764.9] mGy·cm2);P = 2)无差异。以下因素均不能预测较高的辐射剂量:女性(危险比[HR], 0.69 [95% CI, 0.38-1.3];P = .34),体重指数>25 (HR, 0.84 [95% CI, 0.43-1.6];P = 0.76),年龄>65岁(HR, 1.67 [95% CI, 0.89-3.1];P = 0.11),严重瓣膜疾病(HR, 1.37 [95% CI, 0.52-3.5];P = 0.68),或既往冠状动脉搭桥术(HR, 0.6;95% ci, 0.2-1.8;P = .38)。结论:由经验丰富的手术人员进行选择性冠状动脉造影时,TRA的效果不逊于TFA。
{"title":"Randomized Noninferiority Trial of Radiation Exposure During Coronary Angiography: the Transradial and Transfemoral Approach by EXPERienced Operators in Daily rouTine (EXPERT) Trial.","authors":"Cristiano de Oliveira Cardoso,&nbsp;Cláudio Vasques de Moraes,&nbsp;Julio Vinícius Teixeira,&nbsp;Carlos Roberto Cardoso,&nbsp;Felipe Baldissera,&nbsp;Eduardo Ilha de Mattos,&nbsp;Marcio José Siqueira,&nbsp;Leandro Fischer,&nbsp;Juliana Cañedo Sebben,&nbsp;Bruna Santos Silva,&nbsp;Gabriel Broetto,&nbsp;Carlos Antônio Mascia Gottschall,&nbsp;Rogério Sarmento-Leite","doi":"10.14503/THIJ-22-7930","DOIUrl":"https://doi.org/10.14503/THIJ-22-7930","url":null,"abstract":"<p><strong>Background: </strong>The transradial approach (TRA) to coronary angiography reduces vascular complications but is associated with greater radiation exposure than the transfemoral approach (TFA). It is unknown whether exposure remains higher when TRA is performed by experienced operators.</p><p><strong>Methods: </strong>Patients were randomly, prospectively assigned to TRA or TFA. The primary end point was patient radiation dose; secondary end points were the physician radiation dose and 30-day major adverse cardiac event rate. Coronary angiography was performed by experienced operators using a standardized protocol.</p><p><strong>Results: </strong>Clinical and procedural characteristics were similar between the TRA (n = 150) and TFA (n = 149) groups, and they had comparable mean (SD) radiation doses for patients (616.51 [252] vs 585.57 [225] mGy; P = .13) and physicians (0.49 [0.3] vs 0.46 [0.29] mSv; P = .32). The mean (SD) fluoroscopy time (3.52 [2.02] vs 3.13 [2.46] min; P = .14) and the mean (SD) dose area product (35,496.5 [15,670] vs 38,313.4 [17,764.9] mGy·cm2; P = .2) did not differ. None of the following factors predicted higher radiation doses: female sex (hazard ratio [HR], 0.69 [95% CI, 0.38-1.3]; P = .34), body mass index >25 (HR, 0.84 [95% CI, 0.43-1.6]; P = .76), age >65 years (HR, 1.67 [95% CI, 0.89-3.1]; P = .11), severe valve disease (HR, 1.37 [95% CI, 0.52-3.5]; P = .68), or previous coronary artery bypass graft (HR, 0.6; 95% CI, 0.2-1.8; P = .38).</p><p><strong>Conclusion: </strong>TRA for elective coronary angiography is noninferior to TFA when performed by experienced operators.</p>","PeriodicalId":22352,"journal":{"name":"Texas Heart Institute journal","volume":"50 2","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10178642/pdf/i1526-6702-50-2-e227930.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9506624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Enhanced Left Ventricular Recovery in Treatment of Mitral Regurgitation With Severe Left Ventricular Dysfunction. 加强左心室恢复治疗二尖瓣返流伴严重左心室功能不全。
IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.14503/THIJ-22-7912
Robert Devich, Balakrishnan Mahesh, Geetha Bhat, Mark Kozak, Esther Choi, Nathaniel Melton, Robert Dowling

A 73-year-old male patient presented with shortness of breath at rest resulting from new-onset severe primary mitral regurgitation with a flail posterior leaflet, left ventricular dysfunction, and cardiogenic shock. After initial stabilization in the intensive care unit, multiple treatment options were considered for this patient, all associated with significant mortality. Ultimately, operative mitral valve repair with Impella 5.5 placement was performed for postoperative hemodynamic support. Surgical repair provided elimination of mitral regurgitation. Impella support was maintained for 7 days to provide unloading of the left ventricle. After device removal, the patient had sustained left ventricular recovery with significantly improved ejection fraction. Full left ventricular support and unloading may decrease operative risk and promote left ventricular recovery in patients with severe mitral regurgitation and left ventricular dysfunction. This case emphasizes the value of ventricular unloading to facilitate the recovery of left ventricular function as a treatment option for patients with challenging cases of severe mitral regurgitation and left ventricular dysfunction.

一例73岁男性患者,因新发严重二尖瓣返流伴连枷状后小叶、左心室功能障碍和心源性休克,静息时呼吸短促。在重症监护室初步稳定后,考虑了该患者的多种治疗方案,所有治疗方案均与显著死亡率相关。最终,手术二尖瓣修复与Impella 5.5放置进行术后血流动力学支持。手术修复消除了二尖瓣返流。Impella支架维持7天以提供左心室卸荷。移除装置后,患者持续左心室恢复,射血分数显著提高。对于严重二尖瓣反流和左心室功能不全的患者,充分的左心室支持和卸载可降低手术风险,促进左心室恢复。本病例强调了心室卸荷的价值,以促进左心室功能的恢复,作为严重二尖瓣反流和左心室功能障碍患者的治疗选择。
{"title":"Enhanced Left Ventricular Recovery in Treatment of Mitral Regurgitation With Severe Left Ventricular Dysfunction.","authors":"Robert Devich,&nbsp;Balakrishnan Mahesh,&nbsp;Geetha Bhat,&nbsp;Mark Kozak,&nbsp;Esther Choi,&nbsp;Nathaniel Melton,&nbsp;Robert Dowling","doi":"10.14503/THIJ-22-7912","DOIUrl":"https://doi.org/10.14503/THIJ-22-7912","url":null,"abstract":"<p><p>A 73-year-old male patient presented with shortness of breath at rest resulting from new-onset severe primary mitral regurgitation with a flail posterior leaflet, left ventricular dysfunction, and cardiogenic shock. After initial stabilization in the intensive care unit, multiple treatment options were considered for this patient, all associated with significant mortality. Ultimately, operative mitral valve repair with Impella 5.5 placement was performed for postoperative hemodynamic support. Surgical repair provided elimination of mitral regurgitation. Impella support was maintained for 7 days to provide unloading of the left ventricle. After device removal, the patient had sustained left ventricular recovery with significantly improved ejection fraction. Full left ventricular support and unloading may decrease operative risk and promote left ventricular recovery in patients with severe mitral regurgitation and left ventricular dysfunction. This case emphasizes the value of ventricular unloading to facilitate the recovery of left ventricular function as a treatment option for patients with challenging cases of severe mitral regurgitation and left ventricular dysfunction.</p>","PeriodicalId":22352,"journal":{"name":"Texas Heart Institute journal","volume":"50 2","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10178643/pdf/i1526-6702-50-2-e227912.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9506627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endovascular Aortic Repair for Thoracic Aortic Compression Resulting From Chance Fracture of the Thoracic Spine. 胸椎偶然骨折所致胸主动脉压迫的血管内修复。
IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.14503/THIJ-22-7891
Akinobu Matsuo, Sho Matsuyama, Kazuhiro Kurisu, Yasutaka Ueno, Yasuhisa Oishi, Akira Shiose

Blunt aortic injury is a serious condition with a high mortality rate. Although rare, blunt aortic injury associated with spinal fracture has also been reported, and appropriate management of aortic disease is key to a good outcome. This report is a case of a 78-year-old man who was found to have a transverse fracture (Chance fracture) in the ninth thoracic vertebra, with a sharp bone fragment compressing the thoracic aorta. Early spinal surgery was needed; however, there was concern about the possibility of bleeding from the aorta and surrounding small arteries associated with the bone fragment during spinal surgery. Therefore, thoracic endovascular aortic repair was performed before spinal surgery. The next day after thoracic endovascular aortic repair, posterior spinal instrumentation was performed, and the postoperative course was uneventful. Because aortic injury associated with vertebral fracture can lead to massive bleeding and spinal cord injury, endovascular repair before spinal surgery is reasonable.

钝性主动脉损伤是一种严重的疾病,死亡率很高。钝性主动脉损伤合并脊柱骨折虽然罕见,但也有报道,主动脉疾病的适当处理是获得良好结果的关键。这是一个78岁的男性病例,他被发现在第9胸椎有横向骨折(Chance骨折),有一个锋利的骨碎片压迫胸主动脉。需要早期脊柱手术;然而,人们担心脊柱手术中与骨碎片相关的主动脉和周围小动脉出血的可能性。因此,在脊柱手术前进行胸椎血管内主动脉修复。胸腔血管内主动脉修复后第二天,行后路脊柱内固定术,术后过程顺利。由于主动脉损伤合并椎体骨折可导致大出血和脊髓损伤,因此脊柱手术前血管内修复是合理的。
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引用次数: 0
The Impact of Bicuspid Aortic Valve Leaflet Fusion Morphology on the Ascending Aorta and on Outcomes of Aortic Valve Replacement. 二尖瓣瓣叶融合形态对升主动脉及主动脉瓣置换术疗效的影响。
IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.14503/THIJ-21-7831
Steve Bibevski, Mark Ruzmetov, Juan F Plate, Frank G Scholl

Background: Patients with bicuspid aortic valves (BAVs) tend to develop dilation of the ascending aorta. The aim of this study was to analyze the impact of leaflet fusion pattern on aortic root diameter and outcomes in patients undergoing surgery for BAV vs tricuspid aortic valve (TAV) disease.

Methods: This is a retrospective review of 90 patients with aortic valve disease (mean [SD] age, 51.5 [8.2] years) who underwent aortic valve replacement for BAV (n = 60) and TAV (n = 30). Fusion of right-left (R/L) coronary cusps was identified in 45 patients, whereas the remaining 15 patients had right-noncoronary (R/N) cusp fusion. Aortic diameter was measured at 4 levels, and Z values were computed.

Results: There were no significant differences between the BAV and TAV groups for age, weight, aortic insufficiency grade, or size of implanted prostheses. However, a higher preoperative peak gradient at the aortic valve was significantly associated with R/L fusion (P = .02). Preoperative Z values of ascending aorta and sinotubular junction diameter were significantly higher in patients with R/N fusion than with the R/L (P < .001 and P = .04, respectively) and TAV (P < .001 and P < .05, respectively) subgroups. During the follow-up period (mean [SD], 2.7 [1.8] years), 3 patients underwent a redo procedure. At the last follow-up, the sizes of ascending aorta were similar among all 3 patient groups.

Conclusion: This study suggests that preoperative dilation of the ascending aorta is more common in patients with R/N fusion than in patients with R/L and TAV but is not significantly different between all groups in the early follow-up period. R/L fusion was associated with an increased risk of preoperative presence of aortic stenosis.

背景:患有二尖瓣主动脉瓣的患者容易出现升主动脉扩张。本研究的目的是分析小叶融合模式对BAV与三尖瓣主动脉瓣(TAV)疾病手术患者主动脉根直径和预后的影响。方法:回顾性分析90例因BAV (n = 60)和TAV (n = 30)行主动脉瓣置换术的主动脉瓣病变患者(平均[SD]年龄51.5[8.2]岁)。45例患者发现右-左(R/L)冠状动脉尖融合,其余15例患者发现右-非冠状动脉(R/N)尖融合。测量4个水平的主动脉直径,计算Z值。结果:BAV组和TAV组在年龄、体重、主动脉功能不全程度、植入假体大小等方面无显著差异。然而,较高的主动脉瓣术前峰值梯度与R/L融合显著相关(P = 0.02)。R/N融合患者术前升主动脉Z值和窦小管结直径均显著高于R/L亚组(P < 0.001和P = 0.04)和TAV亚组(P < 0.001和P < 0.05)。在随访期间(平均[SD], 2.7[1.8]年),3例患者接受了重做手术。最后一次随访时,3组患者升主动脉大小相似。结论:本研究提示术前升主动脉扩张在R/N融合患者中较R/L合并TAV患者更为常见,但在早期随访中各组间差异无统计学意义。R/L融合与术前存在主动脉狭窄的风险增加相关。
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引用次数: 0
Sustained Lumen Area by Paclitaxel-Coated Balloon Following Rotational Atherectomy for Napkin-Ring Left Main Trunk Ostial Lesion. 用紫杉醇涂层球囊治疗左主干直肠病变后的持续管腔面积。
IF 0.8 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.14503/THIJ-22-7883
Takumi Osawa, Tomomi Koizumi, Yuta Ito

Late lumen enlargement after percutaneous coronary intervention (PCI) with drug-coated balloon has contributed to good clinical results. However, late lumen enlargement with drug-coated balloon following rotational atherectomy has not been well reported. This report describes a case of calcified napkin-ring ostial lesion at the left main trunk that showed a sustained lumen area after PCI with drug-coated balloon following rotational atherectomy. An 85-year-old female patient was admitted to the hospital with dyspnea. Echocardiography showed hypokinesis in the anteroseptal and inferior walls. Electrocardiograph-gated cardiac computed tomography showed a calcified ostial lesion in the left main trunk. Invasive angiography of the coronary artery showed severe stenosis in the left main trunk ostium. Percutaneous coronary intervention was performed with a drug-coated balloon after rotational atherectomy. The minimal lumen area measured by intravascular ultrasound grew mildly from 4.09 to 4.17 mm2 immediately after PCI. Follow-up angiography and intravascular ultrasound performed after 6 months showed that the minimal lumen area in the left main trunk ostium was further enlarged from 4.17 to 4.69 mm2. The presence of sustained lumen area after PCI with drug-coated balloon following rotational atherectomy for a napkin-ring left main trunk ostial lesion was confirmed. This case demonstrates sustained lumen area after drug-coated balloon following rotational atherectomy in the left main trunk ostium, improving the patient's chest symptom. Hence, drug-coated balloon after rotational atherectomy may be an option for complex stent sites, such as the left main trunk ostium in geriatric patients and sites with highly calcified lesions.

使用药物涂层球囊进行经皮冠状动脉介入治疗(PCI)后的晚期管腔扩大有助于获得良好的临床效果。然而,旋转动脉粥样硬化切除术后使用药物涂层球囊的晚期管腔扩大尚未得到充分报道。本报告描述了一例左主干钙化餐巾纸环状骨膜病变病例,该病例在使用药物涂层球囊进行PCI治疗后出现了持续的管腔面积扩大。一名 85 岁的女性患者因呼吸困难入院。超声心动图显示前隔壁和下壁运动减弱。心电图门控心脏计算机断层扫描显示左主干有钙化的骨膜病变。冠状动脉有创血管造影显示左主干骨膜严重狭窄。在旋转动脉粥样硬化切除术后,使用药物涂层球囊进行了经皮冠状动脉介入治疗。PCI术后,血管内超声测量的最小管腔面积从4.09平方毫米轻微增加到4.17平方毫米。6个月后进行的随访血管造影和血管内超声检查显示,左主干管腔的最小管腔面积从4.17平方毫米进一步扩大到4.69平方毫米。在对餐巾纸环状左主干动脉口病变进行旋转粥样斑块切除术后,使用药物涂层球囊进行 PCI 治疗,证实了持续管腔面积的存在。本病例显示,在左主干动脉瘤旋转粥样硬化切除术后使用药物涂层球囊进行 PCI 治疗后,管腔面积得以持续扩大,患者的胸部症状得到了改善。因此,旋转动脉粥样硬化切除术后药物涂层球囊可能是复杂支架部位的一种选择,如老年患者的左主干骨干和高钙化病变部位。
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