[Show abstract][Hide abstract] ABSTRACT: Introduction:
Left Main Compression Syndrome (LMCS) represents an entity described as the extrinsic compression of the left main coronary artery (LMCA) by a dilated pulmonary artery (PA) trunk. We examined the presence of LMCS in patients with pulmonary hypertension (PH) using dual-source computed tomography (DSCT), as a non-invasive diagnostic tool.
The following parameters were measured: PA trunk diameter (PAD), the distance between PAD and LMCA (LMPA) and the distance between PA and aorta (AoPA). These measurements were related with demographic, echocardiographic, hemodynamic and clinical parameters. Angiography was performed in two patients with LMCS suspected by cardiac computed tomographic angiography. Patients without PH but with angina were examined as controls, using DSCT cardiac angiography to assess the same measurements and to detect the prevalence of coronary artery disease.
PA diameter value over 40.00 mm has been associated with PH and LMCS. Furthermore, LMCS did not occur at a distance smaller than 0.50 mm between the PA and the LMCA, and did not correlate with the distance between the PA and the aorta or with cardiac index and NT-proBNP.
DSCT may represent the initial testing modality in PH patients with dilated PA trunk to exclude LMCS. A periodical rule-out of this rare entity, as assessed by DSCT, in patients with a severely dilated PA seems to be mandatory for PH patients contributing to survival improvement.
[Show abstract][Hide abstract] ABSTRACT: Left Main Compression Syndrome (LMCS) refers to extrinsic compression of the left main coronary artery due to a dilated pulmonary artery trunk. The condition represents an unusual cause of angina, left ventricular dysfunction and sudden cardiac death in patients with pulmonary hypertension. We present two patients with the syndrome followed-up with serial assessments of coronary flow reserve by transthoracic echocardiography to screen for LMCS-related ischemia.
The Canadian journal of cardiology 04/2015; 31(4):p548.e9-p548.e11. DOI:10.1016/j.cjca.2014.09.012 · 3.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Left ventricular wall rupture (LVWR) comprises a complication of acute myocardial infarction (AMI). Acute LVWR is a fatal condition, unless the formation of a pseudoaneurysm occurs. Several risk factors have been described, predisposing to LVWR. High index of suspicion and imaging techniques, namely echocardiography and computed tomography, are the cornerstones of timely diagnosis of the condition. As LVWR usually leads to death, emergency surgery is the treatment of choice, resulting in significant reduction in mortality and providing favorable short-term outcomes and adequate prognosis during late follow-up. Herein, we present two patients who were diagnosed with LVWR following AMI, and subsequent pseudoaneurysm formation. In parallel, we review the aforementioned condition.
[Show abstract][Hide abstract] ABSTRACT: Availability of normative reference values for cardiac chamber quantitation is a prerequisite for accurate clinical application of echocardiography. In this study, we report normal reference ranges for cardiac chambers size obtained in a large group of healthy volunteers accounting for gender and age. Echocardiographic data were acquired using state-of-the-art cardiac ultrasound equipment following chamber quantitation protocols approved by the European Association of Cardiovascular Imaging.
A total of 734 (mean age: 45.8 ± 13.3 years) healthy volunteers (320 men and 414 women) were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. A comprehensive echocardiographic examination was performed on all subjects following pre-defined protocols. There were no gender differences in age or cholesterol levels. Compared with men, women had significantly smaller body surface areas, and lower blood pressure. Quality of echocardiographic data sets was good to excellent in the majority of patients. Upper and lower reference limits were higher in men than in women. The reference values varied with age. These age-related changes persisted for most parameters after normalization for the body surface area.
The NORRE study provides useful two-dimensional echocardiographic reference ranges for cardiac chamber quantification. These data highlight the need for body size normalization that should be performed together with age-and gender-specific assessment for the most echocardiographic parameters.
[Show abstract][Hide abstract] ABSTRACT: Pulmonary Arterial Hypertension (PAH) is a disease of small pulmonary arteries, characterized by vascular proliferation and remodeling. Progressive increase in pulmonary vascular resistance ultimately leads to right ventricular heart failure and death. PAH-specific drug therapy led to improvement in clinical outcomes, and survival. While the survival is better, progression of pulmonary vasculopathy contributes to pulmonary artery dilatation.Left Main Compression Syndrome, Pulmonary Artery Dissection, Pulmonary Artery Rupture and severe Hemoptysis are reported as complications leading to Sudden Cardiac Death (SCD), entity encountered more often in PAH patients.The advent of PAH-targeted drug therapy has reduced referral for lung transplantation programs, however identification of severe complications need appropriate diagnostic management, rapid decision making and successful therapeutic approach, and once recognized, they might be indications for rapid registration on lung transplantation waiting lists. Multidisciplinary approach in PAH referral centers provide emergency care and specific therapeutic management, contributing to improved quality of life and survival for PAH patients.The aim of the present manuscript is to review the complications leading to sudden death in PAH.
Respiratory care 12/2012; 58(7). DOI:10.4187/respcare.02252 · 1.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present two clinical cases of pulmonary arterial hypertension (PAH) diagnosed after pregnancy. Both patients experienced exertional breathlessness during the third month after their uncomplicated delivery, and idiopathic PAH was diagnosed after an integrated assessment. Our first patient, a 30-year-old woman, was vasoreactive, treated with optimally tolerated doses of calcium channel blockers with adequate response, and she has remained in a stable and satisfactory condition for the last seven years. The second patient, a 34-year-old woman, was non-vasoreactive and had an inadequate response to combination therapy, including prostanoids. Balloon atrial septostomy was performed as a bridge to lung transplantation, however she expired five months after her delivery.
[Show abstract][Hide abstract] ABSTRACT: Pulmonary Arterial Hypertension is a rare and devastating disease characterized by vascular proliferation and remodeling. Epoprostenol, the drug counterpart of the eicosanoid prostacyclin produced by the vascular endothelial cells, is the drug of choice for this disease. Its capacity to act rapidly and significantly improve survival prospects in severe Pulmonary Hypertension patients has been supported by a wealth of evidence. Intravenous Epoprostenol was believed to require therapy of indefinite duration. Since 2001, oral drugs have been approved for specific treatment. The availability of newer and less invasive drug therapies for Pulmonary Arterial Hypertension led physicians to withdraw epoprostenol in carefully selected patients. We report a case of successful intravenous epoprostenol interruption in a patient with idiopathic disease. Literature review on epoprostenol withdrawal in pulmonary hypertension in adult patients is also provided.
Respiratory care 06/2012; DOI:10.4187/respcare.01752 · 1.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Embolism of cardiac origin accounts for around 15-30% of ischaemic strokes. Strokes due to cardioembolism are generally severe and early and long-term recurrence and mortality are high. The diagnosis of a cardioembolic source of stroke is frequently uncertain and relies on the identification of a potential cardiac source of embolism in the absence of significant autochthone cerebrovascular occlusive disease. In this respect, echocardiography (both transthoracic and/or transoesophageal) serves as a cornerstone in the evaluation, diagnosis, and management of these patients. A clear understanding of the various types of cardiac conditions associated with cardioembolic stroke and their intrinsic risk is therefore very important. This article reviews potential cardiac sources of embolism and discusses the role of echocardiography in clinical practice. Recommendations for the use of echocardiography in the diagnosis of cardiac sources of embolism are given including major and minor conditions associated with the risk of embolism.
[Show abstract][Hide abstract] ABSTRACT: Plasma levels of brain natriuretic peptide (BNP) have been shown to correlate to aortic stenosis severity and are predictive of symptom development and survival. They also predict postoperative outcomes after valve replacement in patients with aortic stenosis. The early evolution of N-terminal-pro-BNP (NT-pro-BNP) levels after 50 aortic balloon valvuloplasty procedures performed in 45 patients was investigated. The mean NT-pro-BNP concentration decreased from 7,048 +/- 7,636 pg/ml at baseline to 5,309 +/- 6,150 pg/ml at 1 to 3 days after the procedure (mean difference 1,739 pg/ml, 95% confidence interval 804 to 2,675, p = 0.001). The absolute reduction in NT-pro-BNP levels correlated to the reductions in the maximum and mean transvalvular pressure gradients (on echocardiography: c = 0.57, p = 0.004, and c = 0.54, p = 0.012, respectively; invasively: c = 0.54, p = 0.025, and c = 0.39, p = 0.019). In conclusion, NT-pro-BNP levels decrease early after aortic balloon valvuloplasty in patients with severe aortic stenosis at high surgical risk.
The American journal of cardiology 10/2009; 104(6):846-9. DOI:10.1016/j.amjcard.2009.05.013 · 3.43 Impact Factor