RESUMEN
BACKGROUND: Tissue acceleration utilizing the tissue Doppler imaging (TDI) technique is a new marker of ventricular contraction. We evaluated whether the left atrial appendage (LAA) wall acceleration was associated with thrombosis in patients with nonvalvular atrial fibrillation (NVAF). METHODS: Seven NVAF patients with thromboembolism (TE), eight without TE, and eight with normal sinus rhythm (NSR) were studied using transesophageal echocardiography. TDI was used to evaluate the LAA wall acceleration. RESULTS: There was a decrease in the peak flow velocity in the TE group compared with the other two groups. There was greater LAA expansion in NVAF with TE groups (with TE [8.9 +/- 2.1 cm(2)] compared with the group without TE [7.3 +/- 2.8 cm(2)]), but the difference was not statistically significant; the difference was statistically significant compared with the NSR group (5.3 +/- 1.2 cm(2); P = 0.0035). The average of the continuous 40-frames area where tissue Doppler acceleration (TDA) was >0.024 cm/sec(2) was significantly lower in the TE group (0.12 +/- 0.05 cm(2)) compared to the group without TE (0.33 +/- 0.17 cm(2); P = 0.0017) and NSR group (0.30 +/- 0.13 cm(2); P = 0.0042), although wall velocity was not significantly different comparing the two NVAF groups. Furthermore, peak flow velocity of LAA was well correlated with LAA wall acceleration (r = 0.864, P < 0.0001). CONCLUSIONS: LAA wall acceleration obtained utilizing the TDI technique may be a new predictor of thrombogenesis in patients with NVAF.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial/complicaciones , Tromboembolia/diagnóstico por imagen , Tromboembolia/etiología , Aceleración , Anciano , Análisis de Varianza , Fibrilación Atrial/diagnóstico por imagen , Ecocardiografía Doppler , Ecocardiografía Transesofágica , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
Because temporary caval filters have not been associated with any long-term complications, their use seems practical as long as indications are accurately assessed. However, problems about further dealing with the emboli trapped in a temporary filter remain. This case report describes a new approach to managing a thrombus captured by a temporary filter during the exchange for a permanent filter. We applied the Anthéor temporary filter (Boston Scientific, Natick, MA, USA) as the device for thrombus capturing, then successfully placed the permanent filter with no clinical evidence of pulmonary embolism. Intravascular ultrasound was also useful for monitoring the entire procedure.
Asunto(s)
Embolia Pulmonar/prevención & control , Filtros de Vena Cava , Vena Cava Inferior , Remoción de Dispositivos , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico por imagen , Radiografía Intervencional , Ultrasonografía IntervencionalRESUMEN
A 56-year-old man who complained of quadrantic hemianopsia was admitted to determine its etiology. Cerebral angiography revealed no organic stenosis. Echocardiography showed clear direct continuity between a hypertrophied anterolateral papillary muscle and the anterior mitral leaflet, and the left ventricular (LV) outflow tract (LVOT) was narrowed by the presence of an accessory papillary muscle. The LVOT obstruction caused an intra-LV pressure overload that resulted in LV concentric hypertrophy. Arrhythmia, such as paroxysmal atrial fibrillation (PAF), was thought to have caused a cerebral embolism. Mitral valve replacement (MVR), septal myectomy, and myectomy of the abnormal papillary muscle were performed, and complete release of the LVOT obstruction was accomplished. Anomalous insertion of papillary muscle is a rare cause of LVOT obstruction. Echocardiography was useful in identifying the papillary muscle malformation, and surgery was completely curative.
Asunto(s)
Músculos Papilares/anomalías , Músculos Papilares/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/complicaciones , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Infarto Cerebral/etiología , Ecocardiografía , Prótesis Valvulares Cardíacas , Hemianopsia/etiología , Humanos , Hipertensión/etiología , Hipertrofia Ventricular Izquierda/etiología , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Músculos Papilares/patología , Músculos Papilares/cirugía , Resultado del Tratamiento , Obstrucción del Flujo Ventricular Externo/patología , Obstrucción del Flujo Ventricular Externo/cirugíaRESUMEN
Transthoracic echocardiography is useful for evaluation of the coronary arteries in infants and children with Kawasaki disease. In adults, however, transthoracic echocardiography often cannot detect or accurately estimate coronary artery lesions. We describe two young adults admitted for a diagnosis of acute myocardial infarction ascribed to Kawasaki disease and treated by angioplasty. Coronary aneurysms were not evident in either patient at the time of angioplasty. However, follow-up transthoracic echocardiography revealed coronary aneurysms at the culprit lesions. On follow-up angiograms, we identified a new coronary aneurysm in the first patient, and a regressed coronary aneurysm in the second, confirmed by intravascular ultrasound imaging. These cases suggest that transthoracic echocardiography plays an important role in the diagnosis and treatment of young adults with acute myocardial infarction due to Kawasaki disease.
Asunto(s)
Aneurisma Coronario/diagnóstico por imagen , Ecocardiografía/métodos , Síndrome Mucocutáneo Linfonodular/complicaciones , Infarto del Miocardio/complicaciones , Enfermedad Aguda , Adulto , Angioplastia Coronaria con Balón , Cateterismo Cardíaco , Aneurisma Coronario/complicaciones , Angiografía Coronaria , Estenosis Coronaria/complicaciones , Estenosis Coronaria/terapia , Humanos , Masculino , Infarto del Miocardio/terapia , Reproducibilidad de los Resultados , Ultrasonografía IntervencionalRESUMEN
Vascular endothelial cells play important roles in atherogenesis, and bradykinin is associated with atherosclerosis. The effect of bradykinin on apoptosis in human umbilical vein endothelial cells (HUVECs) was investigated, with a focus on Ca2+ kinetics and nitric oxide production. In serum-free conditions, the number of apoptotic cells increased in a time-dependent manner, but this increase was inhibited by bradykinin in a dose-dependent manner. The apoptosis inhibited by bradykinin was reduced by nitric oxide inhibitor N(G)-monomethyl-L-arginine (L-NMMA) and consequently restored by combined treatment with L-NMMA and L-arginine. Bradykinin increased influx of extracellular Ca2+, generation of inositol 1,4,5-trisphosphate, and release of Ca2+ from intracellular storage sites, thus increasing the total intracellular Ca2+ concentration ([Ca2+]i). Bradykinin increased nitric oxide production, which was inhibited by L-NMMA and restored by combined treatment with L-NMMA and L-arginine. Sodium nitroprusside (SNP) dose-dependently increased nitric oxide production and inhibited apoptosis; however, 10(-5) M SNP did not inhibit apoptosis. Caspase-3 inhibitor, acetyl-Asp-Met-Gln-Asp-aldehyde, enhanced bradykinin-induced inhibition of apoptosis but did not effect bradykinin-induced nitric oxide production. These findings suggest that bradykinin inhibits serum-depletion-induced apoptosis in HUVECs by enhancing nitric oxide production via an increase in [Ca2+]i.