RESUMO
Se presenta un caso poco frecuente de hemoptisis en un paciente adolescente con cirugía de Fontan, causada por el sangrado de una malformación arteriovenosa pulmonar (MAVP), tras la práctica de un instrumento de viento (saxofón). El paciente se estudió con angiografía y se realizó cierre percutáneo, consiguiendo posteriormente mejoría clínica y evitando la aparición de nuevos episodios de hemoptisis. Actualmente existe escasa literatura que reporte casos de hemoptisis en pacientes con cirugía de Fontan y ningún caso publicado en relación a gatillantes relacionados a las maniobras de valsalva; como la generada al practicar instrumentos de viento. Por esta razón, se decide publicar este caso clínico en pro de generar mayores conocimientos en este grupo de pacientes con cardiopatías congénitas operadas con procedimientos paliativos como es la cirugía de Fontan.
A rare case of hemoptysis is presented in an adolescent patient with Fontan surgery, caused by bleeding from a pulmonary arteriovenous malformation (PAVM), after playing a wind instrument (saxophone). The patient was studied with angiography and percutaneous closure was performed, subsequently achieving clinical improvement and preventing the appearance of new episodes of hemoptysis. Currently, there is little literature on hemoptysis in patients with Fontan surgery and no case published in relation to triggers related to valsalva maneuvers; like that generated when practicing wind instruments. For this reason, it was decided to publish this clinical case in order to generate greater knowledge in this group of patients with congenital heart disease operated on with palliative procedures such as Fontan surgery.
Assuntos
Malformações Arteriovenosas/complicações , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Técnica de Fontan/efeitos adversos , Hemoptise/etiologia , Hemoptise/terapia , Malformações Arteriovenosas/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Angiografia , Radiografia Torácica , Manobra de Valsalva , Embolização TerapêuticaRESUMO
Los pseudoaneurismas arteriales viscerales son patologías infrecuentes y raras veces son de hallazgo casual, ya que normalmente debutan con un sangrado. Las lesiones vasculares de la gastroduodenal y de la omental derecha son bastante infrecuentes dentro de este grupo de patologías y debido a su ubicación por frecuencia son asociadas a la pancreatitis y durante el curso de esta enfermedad se las podría hallar de manera casual. Los sangrados de estos aneurismas tienen un índice de mortalidad alto, debido a la inespecificidad de sus síntomas no son de primera línea de diagnóstico y por lo tanto se retrasan en su tratamiento. Idealmente y si son accesibles deben de ser tratados de manera endovascular siempre que la hemodinamia del paciente lo permita, pero un enfoque quirúrgico ya sea abierto o laparoscópica puede resolver la mayoría de los aneurismas complicados de nuestros pacientes
Visceral arterial pseudoaneurysms are rare pathologies and are rarely found by chance, since they normally begin with bleeding. Vascular lesions of the gastroduodenal and right omental are quite uncommon within this group of pathologies and due to their frequent location, they are associated with pancreatitis and during the course of this disease they could be found by chance. Bleeding from these aneurysms has a high mortality rate, due to the non-specificity of their symptoms, they are not first line of diagnosis and therefore their treatment is delayed. Ideally, if they are accessible, they should be treated endovascularly as long as the patient's hemodynamics allow it, but an open or laparoscopic surgical approach can resolve the majority of complicated aneurysms in our patients.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Angiografia , Falso Aneurisma , Artéria Gastroepiploica/patologiaRESUMO
BACKGROUND: The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies. OBJECTIVE: In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used. METHODS: Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated. RESULTS: Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS ≤ 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis. CONCLUSION: mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.
ANTECEDENTES: A relação entre circulação colateral e prognóstico após tratamento endovascular em acidentes vasculares cerebrais de circulação anterior tem sido relatada em muitos estudos. OBJETIVO: Neste estudo, nosso objetivo foi comparar o poder preditivo do desfecho clínico comparando cinco escores colaterais diferentes que são frequentemente utilizados. MéTODOS: Entre os pacientes submetidos a tratamento endovascular em nossa clínica entre novembro de 2019 e dezembro de 2021, foram incluídos no estudo pacientes com mRS pré-mórbido < 3, oclusão intracraniana de ICA e/ou MCA M1 e exame de CTA multifásico pré-procedimento. Foram registradas informações demográficas, técnicas e de duração sobre o procedimento, eventos importantes após o procedimento e resultados clínicos em três meses. Foram avaliados os escores colaterais mCTA, Tan, Maas, Miteff e rLMC dos pacientes. RESULTADOS: Os resultados clínicos aos três meses foram bons em 37 dos 68 pacientes incluídos no estudo (mRS ≤ 2). Apenas os escores colaterais mCTA e rLMC foram estatisticamente significativamente maiores naqueles com boa evolução clínica. Correlação significativa com mRS de três meses foi detectada apenas nos escores mCTA e rLMC. Embora os escores colaterais de rLMC e mCTA tenham mostrado uma associação estatisticamente significativa com o prognóstico, eles não foram suficientes para serem um preditor independente de prognóstico. CONCLUSãO: Verificou-se que mCTA e rLMC têm o maior poder preditivo do resultado clínico e a maior correlação com o resultado clínico de três meses. Nosso estudo sugere que seria benéfico desenvolver um novo sistema de pontuação em vez de CTA multifásico, que combinasse avaliação regional e temporal, que são os pontos fortes de ambas as pontuações colaterais.
Assuntos
Angiografia por Tomografia Computadorizada , Acidente Vascular Cerebral , Humanos , Angiografia , Tomografia Computadorizada por Raios X , Instituições de Assistência Ambulatorial , Acidente Vascular Cerebral/diagnóstico por imagemRESUMO
OBJECTIVE: Catheter ablation procedure may cause retinal complications associated with the risk of thromboembolism. We aimed to evaluate retina and optic disc microvascularity with optical coherence tomography angiography before and after the catheter ablation process in patients with ventricular arrhythmia. METHODS: A total of 40 eyes of 21 ventricular arrhythmia patients were included in this cross-sectional study. Demographic characteristics and ophthalmic examination findings of patients were recorded. optical coherence tomography angiography measurements were evaluated before (group 1) and after (group 2) catheter ablation. Optical coherence tomography angiography was applied to all eyes with 6×6 mm sections for the macula and 4.5×4.5 mm sections for the optic nerve head. Foveal retinal thickness, peripapillary retinal nerve fiber layer thickness, vessel density in different parts of the retina, and optic disc were analyzed. RESULTS: The mean age of ventricular arrhythmia patients was 53.48±13.02 years. In all, 13 (61.9%) of the patients were males and 8 (38.1%) were females. There was no significant difference between the groups in terms of average, inferior, superior, and temporal retinal nerve fiber layer thicknesses, foveal avascular area, flow areas, superficial and deep vessel densities, and optic disc capillary densities of the optic disc. However, when compared with group 1, significantly lower values in foveal retinal thickness and higher values in nasal retinal nerve fiber layer thickness were observed in group 2 (248.42±20.50 vs. 247.20±20.44, p<0.001 and 94.22±18.43 vs. 96.12±20.18, p=0.044, respectively). CONCLUSION: Although foveal retinal thickness and nasal retinal nerve fiber layer thickness are affected in patients undergoing catheter ablation for ventricular arrhythmia, the stable retinal and optic disc vessel densities can be explained by the administration of effective anticoagulants during the procedure.
Assuntos
Ablação por Cateter , Tomografia de Coerência Óptica , Feminino , Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Transversais , Angiografia , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/cirurgia , Ablação por Cateter/efeitos adversosRESUMO
INTRODUCTION: Cerebral venous sinus thrombosis (CVST) is a well-known, although underestimated, cause of stroke in childhood. Its diagnosis requires a high index of suspicion, a correct interpretation of neuroimaging studies and an interrelation between clinicians and radiologists. The clinical features, risk factors and neuroimaging of children under 15 years of age with CVST were analyzed. METHODS: multicenter, retrospective, descriptive, study of a consecutive series of cases of children under 15 years of age, who were admitted due to CVST between January 1st, 2010, and March 1st, 2022. RESULTS: The study included 51 patients: 39% with acute symptoms and 59% with subacute symptoms. Newborns predominantly presented encephalopathic symptoms and seizures, while children exhibited signs of intracranial hypertension (ICH). Risk factors were identified in 90% of the cases. Magnetic resonance with angiography in venous time confirmed the diagnosis in 80% of the patients, with the straight sinus being the most affected in newborns and the lateral sinus in children. Hemorrhagic complications were found in 30.5%, being more frequent in newborns. Anticoagulation was initiated in 82% without complications. Sequelae were present in 44.4% of newborns and 37.9% of children, being more frequent and severe in newborns. CONCLUSIONS: To make an early diagnosis, it is essential to consider CVST in newborns with encephalopathic symptoms and/or seizures, and in children with signs of ICH in the presence of predisposing or triggering conditions.
Introducción: La trombosis de venas y senos venosos cerebrales (TVSC) constituye una causa conocida, aunque subestimada de ictus en la infancia. Su diagnóstico requiere un alto índice de sospecha, una correcta interpretación de la neuroimagen e interrelación entre el clínico y el radiólogo. OBJETIVO: Analizar las manifestaciones clínicas, factores de riesgo y neuroimagen de recién nacidos (RN) y niños menores de 15 años con TVSC. Métodos: Estudio descriptivo, retrospectivo, multicéntrico, de una serie consecutiva de casos de menores de 15 años que ingresaron por TVSC entre el 1 de enero del 2010 y el 1 de marzo de 2022. RESULTADOS: El estudio incluyó 51 pacientes: 39% con síntomas agudos y 59% subagudos. En los RN predominaron síntomas encefalopáticos y convulsiones, mientras en los niños elementos de hipertensión endocraneana (HTEC). Se identificaron factores de riesgo en el 90% de los casos. La resonancia magnética con angiografía en tiempo venoso confirmó el diagnóstico en el 80%, siendo el seno recto el más afectado en RN y el seno lateral en niños. Se encontraron complicaciones hemorrágicas en 30.5%, siendo más frecuentes en los RN. Se inició anticoagulación en el 82% sin complicaciones. Las secuelas estuvieron presentes en 44.4% de RN y 37.9% de niños, siendo más frecuentes y graves en los RN. CONCLUSIONES: Para realizar un diagnóstico precoz es fundamental pensar en TVSC en RN con síntomas encefalopáticos y/o convulsiones y en mayores con clínica de HTEC en presencia de enfermedades predisponentes o desencadenantes.
Assuntos
Encefalopatias , Trombose dos Seios Intracranianos , Recém-Nascido , Humanos , Criança , Estudos Retrospectivos , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/etiologia , Convulsões/etiologia , AngiografiaRESUMO
INTRODUÇÃO: A nefropatia induzida por contraste (NIC) é uma complicação dos procedimentos angiográficos que requerem a administração de meios de contraste. Grandes volumes estão associados à NIC. Não está claro se o tipo de contraste interfere nessa diferença. OBJETIVO: Avaliar se o volume de contraste utilizado nos procedimentos percutâneos tem interação com o tipo de contraste (baixa ou isosmolar) no desenvolvimento de NIC. MÉTODOS: A NIC é definida como uma elevação de creatinina sérica de mais de 25% ou ≥0,5 mg/dl da basal após 48 h. Subanálise de estudo randomizado, centro único, incluindo 2268 pacientes consecutivos submetidos a procedimentos coronários diagnósticos e terapêuticos entre 2016 a 2018. Todos os procedimentos foram realizados com contraste de baixa osmolaridade ou iso-osmolar. A amostra foi dividida em 2 grupos em relação ao volume de 150ml de contraste. Análise estatística: para avaliar o efeito do contrate e do volume no NIC, utilizou-se um modelo de regressão logística com efeito de interação. Este modelo foi avaliado também ajustado para síndrome coronária aguda, disfunção ventricular, creatinina basal, sexo e idade. Os dados foram analisados com uso do software R versão 4.1.2. RESULTADOS: População predominantemente masculina, HAS (85%), DM (52%), DRC (31%). Modelo de regressão logística com efeito de interação entre contraste e volume (p>0,999). Modelos aditivos para NIC apresentado sem diferença entre os grupos (p= 0.974 e p= 0.202) ajustado para sexo, idade, creatinina basal, IC, SCA. CONCLUSÃO: Nesse estudo, mesmos nos casos em que maior quantidade de contraste foi utilizada, o tipo de contraste (iso-osmolar ou de baixa osmolaridade) não foi associado à ocorrência de NIC.
Assuntos
Angiografia , Meios de Contraste , Intervenção Coronária PercutâneaRESUMO
Pulmonary embolism has a high incidence and mortality, especially if undiagnosed. The examination of choice for diagnosing the disease is computed tomography pulmonary angiography. As many factors can lead to misinterpretations and diagnostic errors, different groups are utilizing deep learning methods to help improve this process. The diagnostic accuracy of these methods tends to increase by augmenting the training dataset. Deep learning methods can potentially benefit from the use of images acquired with devices from different vendors. To the best of our knowledge, we have developed the first public dataset annotated at the pixel and image levels and the first pixel-level annotated dataset to contain examinations performed with equipment from Toshiba and GE. This dataset includes 40 examinations, half performed with each piece of equipment, representing samples from two medical services. We also included measurements related to the cardiac and circulatory consequences of pulmonary embolism. We encourage the use of this dataset to develop, evaluate and compare the performance of new AI algorithms designed to diagnose PE.
Assuntos
Angiografia por Tomografia Computadorizada , Embolia Pulmonar , Humanos , Doença Aguda , Algoritmos , Angiografia/métodos , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
INTRODUCTION: The transfemoral TAVR is a safe and effective treatment for severe and symptomatic aortic stenosis, regardless of the surgical risk profile. The vascular access and hemostasis are fundamental steps of the procedure and have impact on the prognosis. Traditionally, the arterial hemostasis has been obtained through the use of 2 or more vascular closure devices (ProGlide, Perclose) or the association of vascular closure devices (suture + collagen). Nevertheless, the reduction of sheet size and routinary use of ultrasound guided puncture, the use of one vascular closure device could be effective in obtaining hemostasis in such patients. METHODS: Observational, prospective study, including patients submitted to transfemoral TAVR through March/2020 to April/2022. The arterial access was obtained with ultrasound assistance on all cases. From September/2021 we initiated the institutional protocol with the use of one Perclose after obtaining the femoral access (pre-closure technique). We evaluated the need for additional vascular closure devices, the presence of femoral stenosis of > 50% (according to femoral angiography at the end of the procedure) and the occurrence of bleeding (according to the VARC-III criteria). RESULTS: In the period, a total of 75 patients were submitted to transfemoral TAVR on our institution. We used 1 Perclose in 31 patients (Group A) and 2 Perclose devices on 44 patients (Group B). The characteristics of the patients at baseline; mean age of 77 7.32 years, 39% were female, and mean STS score of 3.6%. There were no significant differences between Group A and B. Balloon expandable TAVR was used in 97.3% of the patients, and in 96% of the patients the introducer sheet used was 14F. At the post-procedure femoral angiography, residual stenosis was present in only 1 (4.1%) patient on Group A and on 9 (25%) patients on Group B (p=0.034). there was no difference in major or minor bleeding with manual prolonged compression in both groups. two patients in Group A required additional vascular closure devices and no in group B. CONCLUSION: On this initial series, the ultrasound guided femoral access and the use of one vascular closure device, proved to be feasible and effective on vascular hemostasis, while reducing residual stenosis of the femoral artery when compared to the use of two vascular closure devices.