1,721,000 research outputs found
Free-floating right heart thrombi in pulmonary embolism: therapeutic options and differential diagnosis
No full textBackground: There is little published evidence on the treatment of mobile masses in the right heart. We report the clinical courses of three consecutive patients presenting with acute pulmonary embolism and mobile masses in the right heart. History and admission findings: Three women, aged 75, 72 and 52 years, were hospitalized within three months because of dyspnea and suspected pulmonary embolism. Investigations: Transthoracic echocardiography revealed right ventricular dysfunction and highly mobile masses, which were considered as in-transit right heart thrombi in all cases. Treatment and course: All patients received immediate thrombolytic therapy (alteplase). No bleeding complications occurred. Thrombolysis was successful in the first two cases. However, the mass in the right ventricle did not disappear after thrombolysis in the third case and was removed surgically later on. The definite histological diagnosis was a myxoma of the right ventricle. Conclusion: According to literature, in-transit right heart thrombi are a potentially life-threatening complication of pulmonary embolism even in stable patients. Immediate thrombolysis is a valid therapeutic option and was successfully performed in 2 of our 3 patients. However, as case 3 suggests, differential diagnoses concerning mobile masses in the right heart, i.e. cardiac myxoma, should be taken into account and excluded by thoracic computed tomography
Effects of the NO donor sodium nitroprusside on oxygen consumption and energetics in rabbit myocardium
No full textNitric oxide (NO) has influence on various cellular functions. Little is known of the influence of NO on myocardial energetics. In the present study oxygen consumption and mechanical parameters of isometrically contracting rabbit papillary muscles (1 Hz stimulation frequency) were investigated at varying interventions while maintaining physiological conditions (37A degrees C; 2.5 mM Ca(2+)) to study the effects of NO on energetics. The NO donor sodium nitroprusside (SNP) showed a negative inotropic effect. SNP decreased the maximal force in normal rabbit muscle strips by 30%, the force time integral (FTI) by 40% and the relaxation time by 20%. In addition the oxygen consumption decreased by 60%, a notably disproportional decrease compared to the mechanical parameters. Consequently, the economy as a ratio of FTI and oxygen consumption is significantly increased by SNP. In contrast the negative inotropic effect due to a reduction in extracellular Calcium (Ca(2+)) from 2.5 to 1.25 mM reduced FTI and oxygen consumption proportionally by 40% and did not change economy. The effect of NO on force and oxygen consumption could be reproduced by the application of the cyclic guanosine monophosphate (cGMP) analogue 8-bromo-cGMP. In summary, NO increased the economy of isometrically contracting papillary muscles. The improvement in contraction economy under NO seems to be mediated by cGMP as the secondary messenger and maybe due to alterations of the crossbridge cycle
Uncommon delayed and late complications after percutaneous left atrial appendage closure with Amplatzer(A (R)) Cardiac Plug
No full textAims Percutaneous left atrial appendage closure with Amplatzer(A (R)) Cardiac Plug (St. Jude Medical Inc.) for the prevention of stroke in patients with atrial fibrillation is rapidly propagating. We sought to provide additional safety data. We have screened our database of patients having been treated with Amplatzer(A (R)) Cardiac Plug and found 3 cases with uncommon complications that have not been reported previously. One patient experienced an embolisation of the occluder about 12 months after implantation that potentially resulted from mismatch of occluder size and landing zone. Another patient developed cardiac tamponade 9 days after implantation. This case of delayed effusion was probably not a result of interventional trauma, but might have been provoked by scratching of the inner pericardial membrane. A third patient developed a large thrombus in the left atrium which was considered to be caused by injury of the endothelial wall during implantation. The first two cases could be treated by a percutaneous procedure, the last case by cardiac surgery without any sequelae. Complications after left atrial appendage closure not related to a device-related thrombus can occur later after implantation. With appropriate percutaneous or surgical management these complications can be handled without sequelae
Successful ablation of a bioresorbable polymeric vascular scaffold by rotational atherectomy
No full textOutcome of interventional treatment for access site complications in transfemoral aortic valve implantation
No full textOutcome of interventional treatment for access site complications in transfemoral aortic valve implantation
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Determinants for survival and hospitalisation because of congestive heart failure after percutaneous mitral valve repair
No full textDeterminants for survival and hospitalisation because of congestive heart failure after percutaneous mitral valve repair
No full textMitraClip (R) and Amplatzer (R) cardiac plug implantation in a single procedure: A reasonable approach?
No full textBackground: Percutaneous mitral valve repair using MitraClip (R) (MC) is a well-established method for a subset of patients with severe mitral regurgitation (MR) and high risk for surgical intervention. Amplatzer (R) Cardiac Plug (ACP) occludes left atrial appendage and allows the discontinuation of oral anticoagulation and prevention of thromboembolic stroke. Due to the need for femoral and transseptal access in both procedures, a single approach could lead to minor risk of further complications and shorter cumulative intervention time. Methods: We systematically analysed all four patients who underwent a combined procedure with MC and ACP in our heart-centre. All procedures were performed under fluoroscopic as well as echocardiographic guidance, and follow-up controls in a midterm period were carried out. Results: In all patients (2 male/female; age 73-88 years), MC (1-2 Clips) and ACP (size 18-28mm) were successfully implanted in one procedure (mean total time: 114 +/- 17 min). At least moderate MR was achieved and two patients had no complications and therefore were discharged early. In a third patient, a dislocation of ACP occurred 2 h after the implantation. The oldest patient developed a respiratory insufficiency due to cardiac decompensation and further complications. Conclusion: A combination of MC and ACP in a single procedure was feasible in this first case series of patients without a significant extension of procedure time. However, it might be important to select patients carefully. The location of optimal transseptal puncture may be challenging in regard to ACP placement, even in experienced hands and subsequent complications can occur. (C) 2016 Elsevier Ireland Ltd. All rights reserved
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