RESUMEN
Haemodynamically significant systemic-to-pulmonary artery collaterals may present as a cause of cardiorespiratory compromise in tetralogy of Fallot (TOF) with pulmonary atresia. We present here a case of TOF with pulmonary atresia with aneurysmally dilated aorto-pulmonary collateral causing compression over trachea, presenting as dry irritating cough who died suddenly with haemoptysis probably due to rupture of hypertrophied bronchial collaterals or direct erosion of large major aorto-pulmonary collateral arteries (MAPCA) into the respiratory tract.
Asunto(s)
Aorta Torácica/anomalías , Circulación Colateral/fisiología , Pulmón/irrigación sanguínea , Circulación Pulmonar/fisiología , Tetralogía de Fallot/patología , Adolescente , Aneurisma/complicaciones , Aorta Torácica/patología , Dilatación Patológica , Resultado Fatal , Femenino , Cardiopatías Congénitas , Hemoptisis/etiología , Humanos , Tetralogía de Fallot/complicacionesRESUMEN
AIMS: To assess the immediate and mid-term outcome of transcatheter closure (TCC) using the first-generation Amplatzer duct occluder (ADO) in patients with ruptured sinus of Valsalva aneurysm (SOVA). Ruptured SOVA is a rare cardiac shunt lesion, with scant data about its TCC. METHODS AND RESULTS: Twenty patients (8 females and 12 males) aged 17-52 years (median 27 years) with ruptured SOVA were selected for TCC. Most (13/20) were in symptomatic NYHA class III or IV. Three had previous cardiac surgeries. Associated defects were bicuspid aortic valve in one, trivial pre-existing aortic regurgitation (AR) in five, coarctation of the aorta in one, and secundum atrial septal defect in one. Patients with co-existing ventricular septal defect or significant AR requiring surgery were excluded. Echocardiography revealed ruptured SOVA from right coronary sinus to right atrium (RA) in 4 and right ventricular (RV) outflow in 5, whereas non-coronary sinus ruptured into RA in 10 and RV inflow in 1. At cardiac catheterization, the defect was 4-11 mm (median 9 mm) at its aortic end as measured by online transoesophageal echocardiography or angiography. The Q(p)/Q(s) ratio ranged from 1.5 to 3.2 (mean 2.32 ± 0.53). In all patients, the defect was closed from the venous side, using ADOs 2-4 mm larger than the aortic end of the defect. The ADO sizes ranged from 8/6 to 16/14 mm (median 13/11 mm). The procedure was successful in 18 out of 20 patients (90%). Of these 18, 13 had a complete closure at discharge. Five had a residual shunt (four small and one moderate with self-abating haemolysis). Trivial AR occurred in four. On a median follow-up of 24 months (range 1-60 months), 15 patients were in NYHA class I and 3 in class II. The residual shunt disappeared in three and was small in two; procedure-related AR vanished in two of four. There was no AR progression, recurrence, infective endocarditis, or device embolization. CONCLUSION: In appropriately selected patients with ruptured SOVA, TCC is an attractive alternative to surgery with encouraging short- and mid-term outcomes.
Asunto(s)
Aneurisma de la Aorta/terapia , Rotura de la Aorta/terapia , Oclusión con Balón/instrumentación , Dispositivo Oclusor Septal , Seno Aórtico , Adolescente , Adulto , Ecocardiografía Transesofágica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Ultrasonografía Intervencional , Adulto JovenRESUMEN
Ruptured sinus of Valsalva aneurysm (SOVA) is a rare albeit well-described entity and coexisting defects like ventricular septal defect, aortic regurgitation and, infrequently, atrial septal defect (ASD) have been reported. Until recently, open surgical closure with cardiopulmonary bypass was the mainstay of treatment. However, transcatheter closure of isolated ruptured SOVA defects has been encouraging. We report percutaneous closure of ruptured noncoronary SOVA to the right atrium and a coexisting secundum ASD with deficient aortic margin. Our experience suggests that successful percutaneous closure of ruptured SOVA and coexisting ASD is a safe alternative to open surgery with satisfactory mid-term follow up.
Asunto(s)
Aneurisma de la Aorta/cirugía , Rotura de la Aorta/cirugía , Cateterismo Cardíaco , Defectos del Tabique Interatrial/cirugía , Seno Aórtico/patología , Adulto , Aneurisma de la Aorta/diagnóstico por imagen , Rotura de la Aorta/diagnóstico por imagen , Ecocardiografía , Femenino , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Seno Aórtico/diagnóstico por imagen , Ultrasonografía IntervencionalRESUMEN
Cardiovascular diseases have emerged as major health burden worldwide in recent times. Low density lipoprotein cholesterol (LDL-C) serves as the primary marker for cardiovascular diseases. Reports suggest that rice bran oil has antihyperlipidaemic properties. However, current evidence suggests that no single oil can provide the recommended dietary fat ratio. Hence the present study was undertaken in patients with hyperlipidaemia to study effects of substitution of the cooking oil with a blend of 80% rice bran oil and 20% safflower oil on LDL-C levels. The selected patients (n = 73) were randomly assigned either to the study oil group (blend under study) or control oil group (the oil which the patient was using before). The lipid profile was monitored monthly in these patients for 3 months during which they consumed the oil as per the randomisation. At each follow up, LDL-C levels showed a significant reduction from baseline in the study oil group and reduction was more than that observed in the control group. It was also observed that the percentage of the respondents was higher in the study oil group. At the end of the study period, 82% patients from this group had LDL levels less than 150 mg% as against 57% in the control group. Thus, the substitution of usual cooking oil with a blend of rice bran oil and safflower oil (8:2) was found to exert beneficial effects on the LDL-C levels shifting them to low-risk lipid category.