[Show abstract][Hide abstract]ABSTRACT: We report a case of a 37-year-old woman with arrhythmogenic right ventricular cardiomyopathy (ARVC), after implantation of a cardioverter-defibrillator (ICD), who was admitted to our hospital because of focal infarctions in the right kidney and in the spleen. Echocardiography showed thrombi on the ICD electrode and the presence of patent foramen ovale. Patent foramen ovale was successfully closed by septal occluder. To our knowledge it is the first ever case report of paradoxical thromboembolism in a patient with ARVC.
Full-text · Article · Mar 2015 · Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology
[Show abstract][Hide abstract]ABSTRACT: Patent foramen ovale (PFO) is associated with cryptogenic strokes, recurrent transient neurologic deficits, sleep apnea, decompression illness and migraines with aura.
We verify cryptogenic embolism recurrence after transcatheter PFO closure in patients younger than 55 years old, and determine the prevalence of migraine with aura before and after PFO closure.
We sent a questionnaire concerning the recurrence of stroke or transient ischemic attack (TIA) and the presence of migraine symptoms before and after PFO closure to 224 consecutive patients (mean age 40.9 ±9 years; 103 men; 108 patients < 40 years old, 116 patients 40-55 years old) after successful PFO transcatheter closure as secondary prevention of cryptogenic embolism.
The mean follow-up period was 37.8 ±32.5 (median 27) months. Stroke or TIA recurred in 6 patients (2.6%), all of whom were over 40 years old at the time of closure. The median time of recurrence was 24 months. Two patients (0.89%) died, but the deaths were not related to the device nor to thromboembolism. Migraine occurred in the study group before closure in 68 (30.4%) patients. After the procedure 55 (80.9%) reported improvement or disappearance of migraine symptoms.
Recurrent strokes after PFO closure are rare, and they occur more often in patients over 40 years old at the time of closure. The PFO closure results in migraine subsiding or symptoms noticeably ameliorating.
Full-text · Article · Sep 2014 · Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology
[Show abstract][Hide abstract]ABSTRACT: A particularly dangerous condition in pregnant women is already dilated left ventricle with severe functional impairment. Taking as an example the case of woman with dilated cardiomyopathy (DCM) first diagnosed in 17th week of pregnancy, the paper discusses diagnostic, therapeutic challenges and management of heart failure during pregnancy. Repeat measurements of brain natiuretic peptide levels should be helpful in diagnosing heart failure. To distinguish DCM from peripartum cardiomyopathy the time of manifestation should be considered. The risk of serious events is associated with NYHA class and impairment of left ventricular ejection fraction. Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin-II receptor blockers are contraindicated in pregnancy because of fetal toxicity. The incidence of sight effects is associated with time of administration of ACE-I and duration of treatment. Possible sight effects of drugs in fetus should be monitored (mainly ultrasonographically). ICD can be implanted during pregnancy if indicated. To assess the time and mode of delivery, a multidisciplinary team of different specialists is required. Subsequent pregnancy is contraindicated in a patient with DCM and low ejection fraction of left ventricle.
Full-text · Article · Jun 2012 · Medical science monitor: international medical journal of experimental and clinical research
[Show abstract][Hide abstract]ABSTRACT: Therapeutic management in pregnant patients with heart failure still remains a challenge, even though in most pregnant women with cardiac diseases an outcome is good. A 32-year-old woman, 17 weeks pregnant, was admitted to hospital with heart failure (HF) NYHA class III/IV. Echocardiography revealed enlarged LV, LVEF 13%, significant mitral insufficiency and pulmonary hypertension. The patient wished to continue the pregnancy. In a life-threatening condition, metoprolol, enalapril, spironolactone (for 5 days), furosemide, and digitalis were administered. Enalapril was continued for 42 days. Then the patient was switched to a dihydralazine and isosorbide mononitrate regimen. The fetus was controlled ultrasonographically. In the 19th week of pregnancy, the patient's condition improved (NYHA class II, LVEF 23%). The patient experienced 2 more episodes of HF exacerbation. In the 26th week of pregnancy, in a primary prevention of sudden cardiac death and because of 2nd-degree AV block, an ICD was implanted. In the 32nd week of pregnancy a cesarean section was performed. A male infant was delivered. The patient made a good recovery and was discharged on the 7th postoperative day. The newborn was discharged after 4 weeks, in good general condition. At 1-year follow-up the patient presented NYHA class II.
Full-text · Article · Apr 2012 · Medical science monitor: international medical journal of experimental and clinical research
[Show abstract][Hide abstract]ABSTRACT: Patent foramen ovale (PFO) is the most common cause of right-to-left shunt which carries a significant risk for stroke when associated with venous thrombosis, coagulation abnormalities or other conditions. We present a young male in whom diving was associated with stroke in a subject with otherwise clinically silent PFO.
No preview · Article · Jan 2012 · Kardiologia polska
[Show abstract][Hide abstract]ABSTRACT: We describe 2 patients with arrhythmogenic right ventricular cardiomyopathy (ARVD): 58 year-old female and 48 year-old man. Both patients presented with echocardiographic features typical for ARVD and impaired systolic left ventricular function. Both patients had symptoms resembling acute coronary syndrome and received cardioverter-defibrillator due to recurrent sustained ventricular tachycardia.
No preview · Article · May 2011 · Kardiologia polska
[Show abstract][Hide abstract]ABSTRACT: Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) has long been considered a disease with the risk of sudden cardiac death (SCD) [1, 2]. Life-threatening arrhythmias have been emphasized as the main clinical feature and major therapeutic problem. In long-term follow-up studies, high rates of SCD have been reported, particularly in the young. Enormous progress has been made in recent years in the treatment of arrhythmias, changing the clinical outcome of ARVC/D. Implantable cardioverter- defibrillator (ICD) implantation, radiofrequency (RF) ablation or hybrid therapy for high-risk patients have significantly decreased the incidence of SCD in this group of patients.Worldwide awareness of the disease, advances in diagnostic procedures, preparticipation screening tests of young athletes, and family examinations have identified affected people early and enabled proper management, decreasing the incidence of SCD as the first symptom of the disease. Success in the fight against SCD unmasked the problem of heart failure in patients with a longer disease history.
[Show abstract][Hide abstract]ABSTRACT: Aim: To report the periprocedural and long-term results of using the Amplatzer septal occluder for primary closure of post myocardial infarction ventricular septal defects.Methods and results: Transcatheter closure was considered in patients with significant left-to-right shunting and defect anatomy and location thought to be suitable for closure with such a device. From December 1999 until February 2005 eleven patients (9 males) aged 52-81 years (mean 67,9) underwent an attempted closure. The time from the onset of infarction to the procedure ranged between 2 days and 58 weeks (mean 15,4 weeks). There were three patients in an acute phase of infarction (three weeks or less). They were in critical condition and required inotropic and ventilatory support. Eight patients (all in a chronic infarction phase) were hemodynamically stable and in NYHA class III-IV (6 patients) or class II (2 patients). A successful device implantation occurred in all but one patient, in whom a 26 mm occluder pulled through a 16 mm defect on day 8 of infarction. An infarct exclusion surgery was successfully performed in this patient. In the remaining 10 patients, the defect size ranged 8-21 mm (mean 14,3), and the devices 11-30 mm (mean 19,3) were implanted. The procedure and screening time ranged 134-286 (mean 187,2) and 23-90 minutes (mean 43,6) respectively. The successful implantation did not clinically succeed in both patients with the acute septal rupture - they died 2 and 15 days after the procedure. In the eight patients in whom the procedure was performed late (3,5-56 weeks) after the infarction onset, the defect was either completely closed or the shunt was insignificant, and they improved dramatically. In the most recent follow-up from 1 to 62 months (mean 25,5), the patients have been alive and feeling well, and in NYHA I or II class.Conclusion: Primary transcatheter closure of postinfarction ventricular septal defects may be an alternative to surgery in patients with suitable anatomy and completed necrosis. In our experience, primary transcatheter closure of ventricular septal defects in patients who are in the acute phase of infarction does not improve their survival.
Preview · Article · May 2005 · EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
[Show abstract][Hide abstract]ABSTRACT: Introduction: The aim of the study was to evaluate incidence of arrhythmia and conduction abnormalities one year after transcatheter closure of atrial septal defect (ASD) or patent foramen ovale (PFO) with Amplatzer septal occluder. Material and Methods: We analysed and compared 24 hour ECG monitoring early and one year after the procedure in 34 patients (30 patients had ASD and 4 had PFO closure). Results: Mean and minimal heart rate values did not differ significantly. Maximal heart rates were significantly higher after one year. In two Patients we found significant increase of number of supraventricular ectopic beats up to 2 weeks after the procedure. One was treated successfully with radiofrequency ablation and the other one with β-blocker. In 3 patients with atrial fibrillation we registered pauses 2-3.9 s long in both recordings. One patient with sinus rhythm had benign sinus pauses after ectopic beats. One episode of wandering pacemaker occurred one year after the closure. Conclusions: Transcatheter closure of ASD or PFO with Amplatzer septal occluder is connected with low risk of early increase of supraventricular arrhythmia. They can be associated with heeling processes on the edge of the device. During one-year follow-up there were neither clinically significant new arrhythmia, changes in conducting rhythm, heart rate nor conduction disturbances. The further follow-up is necessary.
No preview · Article · Jan 2002 · Folia cardiologica