RESUMEN
AIMS AND OBJECTIVES: To evaluate left ventricular (LV) function by assessment of LV global longitudinal strain (GLS) in ST-segment elevation myocardial infarction (STEMI) patients who underwent delayed fibrinolysis and coronary intervention (extended pharmaco-invasive strategy), since LV function is one of the determinants of both immediate and long-term outcomes. METHODS: Prospective study of consecutive STEMI patients who underwent extended pharmaco-invasive strategy. The LV function was estimated using LV GLS at baseline and at 6 months. RESULTS: The study included eighty-seven STEMI patients who received delayed pharmaco-invasive therapy and coronary intervention. The primary aim of the study was to evaluate a change in LV function by assessment of GLS at 6 months as compared to baseline. Prior to PCI, LV ejection fraction was 48.08 ± 6.23% and GLS was -11.11 ± 2.99%. Procedural success was achieved in all patients. LV ejection fraction after 6 months of follow-up increased to 53.12 ± 5.61% and the GLS improved to -13.03 ± 3.06% In comparison to baseline, there was a significant improvement in both LV ejection fraction and GLS at 6 months of follow-up (P < .001).The cardiac mortality was 1.1% at 6 months. CONCLUSION: There is a significant improvement of LV function as assessed by GLS and ejection fraction at short-term follow-up. In a stable cohort of STEMI patients, extended pharmaco-invasive strategy is also a reasonable option if PCI cannot be performed within the first 24 hours, due to logistic and infrastructural constraints.
Asunto(s)
Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Estudios de Seguimiento , Humanos , Estudios Prospectivos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Función Ventricular IzquierdaRESUMEN
BACKGROUND: Hemopericardium is a major complication of balloon mitral valvotomy (BMV). Only a few studies are available to address this issue following transseptal access. In addition, the management strategy regarding completion of BMV is uncertain. OBJECTIVE: We sought to determine the incidence of hemopericardium complicating transseptal puncture during BMV. In addition, the management strategy adopted and outcomes are highlighted. METHODS: This prospective study included 29 consecutive patients who developed hemopericardium following transseptal access during BMV. RESULTS: Out of 1424 patients who underwent BMV, hemopericardium developed in 29 patients following transseptal access (2.0%). The mean age of the study cohort was 36.9 ± 13.7 years and 82.8% were women. A second transseptal puncture was done and BMV was completed in 26 patients (89.6%). An acceptable hemodynamic result was obtained in 22 patients (84.6%). Six patients (20.7%) underwent emergency surgery for hemopericardium. The sites of perforation were inferior vena cava-right atrial junction in 4 cases, left atrial posterior wall in 1 case, and left atrial appendage in 1 case. In addition to repair of the perforation, a total of 2 patients underwent mitral valve replacement and 1 patient underwent open mitral commissurotomy. The in-hospital mortality rate was 6.9%. CONCLUSIONS: The incidence of hemopericardium complicating transseptal access during BMV was 2.0%, and was associated with a mortality rate of 6.9%. BMV can be safely performed in the same sitting with a second transseptal puncture, in patients with a favorable valve morphology. Surgical intervention can be reserved for a subset of patients with persistent pericardial collection.
Asunto(s)
Valvuloplastia con Balón/efectos adversos , Tabiques Cardíacos/lesiones , Complicaciones Intraoperatorias , Estenosis de la Válvula Mitral/cirugía , Punciones , Reoperación , Adulto , Valvuloplastia con Balón/métodos , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Incidencia , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Masculino , Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/diagnóstico , Evaluación de Procesos y Resultados en Atención de Salud , Derrame Pericárdico/etiología , Derrame Pericárdico/mortalidad , Derrame Pericárdico/cirugía , Estudios Prospectivos , Punciones/efectos adversos , Punciones/métodos , Reoperación/métodos , Reoperación/estadística & datos numéricosRESUMEN
Prosthetic Valve Thrombosis (PVT), in spite of the advances in the valve design and the material used, remains a serious complication of mechanical cardiac valve replacement. The factors influencing the development of PVT are: thrombogenicity of the valve, hemodynamics of the transprosthetic blood flow and ineffective anticoagulation. Genetic polymorphism of the genes VKORC1 (-1639 Gâ>âA and 1173 Câ>âT), CYP2C9 (*2 & *3 alleles) and CYP4F2 (1347 Gâ>âA) are known to influence the anticoagulant dose-effect response. Since there has not been any earlier study on the direct influence of gene polymorphism on the development of PVT, we investigated into this association.Genotyping for the genes VKORC1, CYP2C9 and CYP4F2 was carried out by conventional PCR-RFLP method for 91 consecutive PVT patients. Subjects of our earlier study served as controls (nâ=â136).Female patients and patients with smaller prosthetic valve size were more prone to developing PVT (68%, nâ=â62). Patients bearing A allele of CYP4F2 1347 Gâ>âA polymorphism exhibited a fivefold increased risk of PVT (ORâ=â5.022 (1.39-18.04), Pâ=â.013). G allele of VKORC1 when analyzed in combination of genotypes showed a fourteen fold increased risk for developing PVT (ORâ=â14.25 (5.52-36.77), Pâ=â0.001). CYP2C9 (*2&*3) gene polymorphism did not show any significant association with PVT (ORâ=â1.54 (0.128 - 18.82), Pâ=â.731).Patients bearing A allele of CYP4F2 showed an increased risk of developing PVT in our case - control study.
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Citocromo P-450 CYP2C9/genética , Familia 4 del Citocromo P450/genética , Prótesis Valvulares Cardíacas/efectos adversos , Trombosis/genética , Vitamina K Epóxido Reductasas/genética , Adolescente , Adulto , Anciano , Alelos , Anticuerpos Antifosfolípidos/sangre , Estudios de Casos y Controles , Femenino , Genotipo , Humanos , India , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Estudios Prospectivos , Factores Sexuales , Adulto JovenRESUMEN
Intermittent dysfunction of mechanical mitral valve prosthesis is an uncommon condition. It carries serious clinical implications if unrecognized. Here, we present a case of a 28-year-old female with a history of rheumatic multivalvular disease, for which she had undergone double valve replacement and tricuspid annuloplasty. Six months later, she presented with heart failure. Clinical examination revealed intermittent loss of closing clicks followed by a pansystolic murmur at the apex, suggestive of mitral prosthetic valve dysfunction. We highlight the echocardiographic findings of paroxysmal mitral valvular regurgitation secondary to prosthetic valve malfunction secondary to prosthetic valve thrombosis.
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Trombosis Coronaria/complicaciones , Trombosis Coronaria/diagnóstico por imagen , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Falla de Prótesis/efectos adversos , Adulto , Trombosis Coronaria/cirugía , Ecocardiografía/métodos , Femenino , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/cirugía , ReoperaciónRESUMEN
Discrete subaortic stenosis (DSS) is a progressive obstruction of left ventricular outflow tract (LVOT) resulting in the development of aortic regurgitation in its natural course. Hence, early intervention is recommended. Percutaneous balloon dilation of DSS has been reported and can substantially reduce LVOT pressure gradient. The response to balloon dilation of DSS is transient and may complicate with chordal or papillary muscle rupture. Hence, balloon dilation of DSS should be discouraged.