RESUMEN
A 42-year-old man was involved in a motor vehicle collision. Imaging studies revealed the presence of a post-traumatic aortic pseudo-aneurysm (about 34x26 cm) arising from the descending thoracic aorta at the level of the left subclavian artery (LSA), prone to rupture. Thoracic endovascular aneurysm repair (TEVAR) was the only feasible option due to his poor overall medical status. In this case, LSA needed to be covered in order to extend the proximal landing zone. Eventually, modified TEVAR was successfully performed by means of the chimney technique to preserve flow to the LSA and to prevent flow into the pseudoaneurysmal sac.
Asunto(s)
Adulto , Humanos , Masculino , Accidentes de Tránsito , Aneurisma Falso , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Procedimientos Endovasculares/métodos , Arteria Subclavia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Heridas no Penetrantes/diagnóstico por imagenRESUMEN
A 73-year-old woman with a history of chronic hypertension and severe chronic obstructive pulmonary disease, presented to a district general hospital with thoracic pain in a profound state of shock. She was diagnosed with cardiac tamponade, severe mitral regurgitation, and Stanford type A (Debakey type I) intramural hematoma. Her ascending aorta was of a significant size and therefore emergent repair was done to replace the ascending aorta and mitral valve. After 6 months, an increased aneurysmal size of 6.0 cm was observed in a follow up contrast-enhanced computed tomography angiography. The patient was successfully treated by a staged hybrid procedure involving initial supra-aortic reconstruction.
Asunto(s)
Anciano , Femenino , Humanos , Aneurisma , Angiografía , Aorta , Aorta Torácica , Aneurisma de la Aorta Torácica , Taponamiento Cardíaco , Quimera , Procedimientos Endovasculares , Estudios de Seguimiento , Hematoma , Hospitales Generales , Hipertensión , Válvula Mitral , Insuficiencia de la Válvula Mitral , Enfermedad Pulmonar Obstructiva Crónica , Choque , Injerto VascularRESUMEN
BACKGROUND AND OBJECTIVES: The current guidelines recommend an early invasive strategy for patients suffering with non-ST segment elevation myocardial infarction (NSTEMI). However, there is still debate about the timing of revascularization in patients with NSTEMI. To analyze the clinical efficacy of the timing of revascularization, we compared the in-hospital clinical outcome of NSTEMI patients from the Korea Acute Myocardial Infarction Registry (KAMIR) between the early and selective invasive therapeutic groups. SUBJECTS AND METHODS: Between Nov. 2005 and Apr. 2007, 2762 acute NSTEMI patients (mean age=64.6+/-12.8 years, 1847 males) were enrolled in the KAMIR. The therapeutic strategy of NSTEMI was categorized into early invasive treatment (within 48 hours, Group I mean age: 63.1+/-13.1 years, 1085 males) and selective invasive treatment (Group II mean age: 66.5+/-12.1 years, 762 males). The initial clinical status and the in-hospital mortality and morbidity rate were compared between these two groups. The in-hospital outcomes were also compared between the two groups according to each level of the Thrombolysis In Myocardial Infarction (TIMI) risk score. RESULTS: There were significant differences in the mortality and morbidity rate between the groups (6.5% vs. 10.3%, respectively, p<0.001). According to TIMI risk score, there were no significant differences of mortality and morbidity for the low to moderate risk patients (5.3% vs. 7.8%, respectively, p=0.123 for the risk score 0-2, 6.4% vs. 8.7%, p=0.139 for the risk score 3-4). CONCLUSION: Early invasive treatment improves the hospital outcome for the high-risk NSTEMI patients. The use of abciximab, a low ejection fraction, a high Killip class, a high TIMI risk score and old age are the predictive factors of in-hospital mortality and morbidity.
Asunto(s)
Humanos , Angioplastia , Mortalidad Hospitalaria , Corea (Geográfico) , Mortalidad , Infarto del Miocardio , Pronóstico , Terapia TrombolíticaRESUMEN
We report a case of multicentric, biatrial cardiac myxoma in a 29-year-old female who complained of exertional dyspnea, abdominal distension and peripheral edema. Any other associated skin lesions, breast mass or endocrine disorder presenting complex form were not seen on her. Also, there was no contributory medical history, hypertension and diabetes mellitus. By using transthoracic echocardiography, we identified a biatrial myxoma attached to the interatrial septum. During surgical excision, we found a large right atrial myxoma with extension through the fossa ovalis into the left atrium and small myxoma attached to the right atrial free wall. After successful resection of interatrial septum and free wall, atrial septal defect was created during the resection and safely repaired by bovine pericardial patch.