Ostra niewydolność serca po embolizacji guza nerki. Opis przypadku

Renal cell carcinoma (RCC) is the most common primary malignant renal tumor. The classic triad of symptoms includes palpable abdominal mass, hematuria and flank pain. However, some of the patients diagnosed with RCC first present with paraneoplastic symptoms occurring as a consequence of secretion of various substances from the tumor. We present a case of a woman diagnosed with large kidney tumor, who developed acute heart failure soon after being treated with percutaneous embolization. We discuss toxic myocarditis as one of the possible causes for the acute hemodynamic compromise and the fatal outcome of the patient. Our case report highlights the complexity of this pathology and the importance of awareness of the various possible life-threatening complications.Rak nerkowo-komórkowy jest najczęstszym pierwotnym nowotworem złośliwym nerki. Klasyczna triada objawów z nim związanych obejmuje guz w jamie brzusznej, krwiomocz i ból w okolicy lędźwiowej. Jednak niektórzy pacjenci z rakiem nerkowo-komórkowym najpierw mają objawy paraneoplastyczne wywoływane przez substancje produkowane przez guz. W pracy przedstawiono przypadek kobiety, u której zdiagnozowano duży guz nerki i u której bezpośrednio po jego embolizacji rozwinęły się objawy ostrej niewydolności serca. Jako jedną z możliwych przyczyn ostrych zaburzeń hemodynamicznych i zgonu pacjenta rozważono toksyczne zapalenie mięśnia sercowego. Przedstawiony opis przypadku podkreśla złożoność patologii, jak również potrzebę świadomości różnych możliwych zagrażających życiu powikłań związanych z jego leczeniem

Elliptical stretch as a cause of side branch ostial compromise after main vessel stenting in coronary bifurcations: New insights from numerical analysis

Background: The side branch (SB) compromise after main vessel (MV) stenting remains a significant problem in coronary bifurcation treatment. Currently the two major hypotheses for the mechanism of SB compromise are carina shift from MV into the SB and plaque shift into the ostium of side vessel. It is proposed herein, SB ostial deformation leading to reshaping of the ostium from circle to ellipse is a third possible mechanism. In the current study, the theoretical effects and correlation of ostial deformation with fractional flow reserve (FFR) is explored.Methods: Based on angiographic measurements and theoretical analysis formulas, three different SB ostial areas using circular ostial shape assumption and elliptical ostial shape assumption were calculated. Three different types of ostial areas with FFR values after MV stenting in 49 patients from the FIESTA registry were compared and analyzed.Results: It was found that there is significant overestimation of stenosis severity when estimated by the circle formula, than with the ellipse formula — ASc vs. ASds with 25% ± 13%, p < 0.001, ASc vs. ASmld with 9% ± 10%, p < 0.001. The elliptical shape assumptions provide more accurate ostial area stenosis, which correlates better with FFR. This finding is more significant in less severe stenosis (< 70% area stenosis) than in a more severe one.Conclusions: A third possible mechanism of SB compromise after MV stenting of coronary bifurcation stenosis is elliptical ostial deformation at the ostium of SBs. The ostial area, calculated based on elliptical assumption correlates better with FFR, than area stenosis calculated with the traditional circular formula

Intravascular ultrasound imaging in evaluation of aortic stiffness: A proof-of-concept study

Background: Aortic stiffness is a well-known cardio-vascular risk factor. For years, different methods have been studied in the assessment of aortic elastic properties and large arterial stiffness for risk stratification. Herein is an assessment of the role of intravascular ultrasound (IVUS) imaging for the evaluation of aortic elastic properties. Methods: Intravascular ultrasound imaging of the aorta was performed in 12 patients with transthoracic echocardiography (TTE) and computed tomography (CT) evidence for enlargement of the ascending aorta — diameter ≥ 40.0 mm. Mechanical properties of the aorta were derived from the measured diameters and intra-aortic pressure. Paired samples T-test analyses were performed to determine differences between measurements derived by TTE, CT and IVUS. Results: Mean values of the calculated elastic properties via IVUS of the ascending aorta were as follows: compliance 0.021 ± 0.02; strain 205 ± 4.3; aortic stiffness index 4.3 ± 0.75; elastic modulus 0.31 ± 0.05. On paired T-test analysis maximum ascending aortic diameter measured by CT aortography and IVUS did not differ significantly (t = –0.19, p = 0.985), but a significant difference between IVUS measurements and TTE derived diameters was found (t = 13.118, p = 0.034). On average, IVUS diameters were 2.3 mm larger than the results acquired by TTE (95% confidence interval: 14.21–17.13). Conclusions: Intravascular ultrasound examination of the ascending aorta provided larger diameters than the ones collected by means of TTE. However, IVUS measurements did not differ significantly from diameters derived by CT aortography