4 research outputs found
Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction
Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS) are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI) centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure
Double orifice mitral valve: A case report
Introduction. Double orifice mitrol valve (DOMV) is a very rare congenital
heart defect. Case report. We reported 20-year-old male referred to our
center due to evaluation of his cardiologic status. He was operated on
shortly after birth for a tracheoesophageal fistula. Accidentally,
echocardiography examination at the age of 4 years revealed double orifice
mitral valve (DOMV) without the presence of mitral regurgitation, as well as
mitral stenosis, with normal dimensions of all cardiac chambers. The patient
was asymptomatic, even more he was a kick boxer. His physical finding was
normal. Electrocardiography showed regular sinus rhythm, incomplete right
bundle branch block. Transthoracic echocardiography (TTE) examination
revealed the normal size of the left atrial, mitral leaflets were slightly
more redundant. The left and right heart chambers, aorta, tricuspid valve and
pulmonary artery valve were normal. During TTE examination on a short axis
view two asymmetric mitral orifices were seen as a double mitral orifice
through which we registered normal flow, without regurgitation and mitral
stenosis. Transesophageal echocardiography (TEE) examination from the
transgastric view at the level of mitral valve, showed 2 single asymmetric
mitral orifices separated by fibrous tissue, mitral leaflet with a separate
insertion of hordes for each orifice. Conclusion. The presented patient with
DOMV is the only one recognized in our country. The case is interesting
because during 16-year a follow-up period there were no functional changes
despite the fact that he performed very demanded sport activities. This is
very important because there is no information in the literature about that
Survival Benefit of the Late Percutaneous Coronary Intervention in the Patients after Acute Myocardial Infarction Who Are Or Who Are Not Treated with Thrombolysis
The impact of late percutaneous coronary intervention (PCI) in the patients after acute myocardial infarction (AMI) on long term mortality remains to be established. At currently, thrombolysis is accepted as standard therapy when PCI is not immediately available. However, PCI is often performed in stable patients with AMI who are/are not received thrombolysis .
We performed the trial that enrolled myocardial infarction patients treated with thrombolysis, late PCI and medically to assess the potential benefits of delayed PCI.
We follow up 164 consecutive patients after AMI one year. The patients are divided in two groups; first group-66 patients who received reperfusion (37 patients received only thrombolysis, 10 patients received thrombolysis and PCI 7-9 days after thrombolysis and 19 patients underwent only PCI after 7-9 days) and second group-98 patients medically treated. One year mortality was 3% in the reperfusion group (2/66) and 14,3% in the medical group (14/98) (p=0,016). There were not significant differences between groups about other end points-reinfarctus, coronary artery bypass surgery and PCI performed later after discharge. The major predictors of one year mortality were ages (p<0,001) and ejection fraction (p=0,003). Also, therapy with beta-blockers (p=0,002), statins (p=0,001) and ACE-inhibitors (p=0,024) was associated with better survival.
Delayed PCI performed 7-9 days after AMI in the patients who underwent thrombolysis or those did not improves outcome at long-term follow-u
Survival Benefit of the Late Percutaneous Coronary Intervention in the Patients after Acute Myocardial Infarction Who Are Or Who Are Not Treated with Thrombolysis
The impact of late percutaneous coronary intervention (PCI) in the patients after acute myocardial infarction (AMI) on long term mortality remains to be established. At currently, thrombolysis is accepted as standard therapy when PCI is not immediately available. However, PCI is often performed in stable patients with AMI who are/are not received thrombolysis .
We performed the trial that enrolled myocardial infarction patients treated with thrombolysis, late PCI and medically to assess the potential benefits of delayed PCI.
We follow up 164 consecutive patients after AMI one year. The patients are divided in two groups; first group-66 patients who received reperfusion (37 patients received only thrombolysis, 10 patients received thrombolysis and PCI 7-9 days after thrombolysis and 19 patients underwent only PCI after 7-9 days) and second group-98 patients medically treated. One year mortality was 3% in the reperfusion group (2/66) and 14,3% in the medical group (14/98) (p=0,016). There were not significant differences between groups about other end points-reinfarctus, coronary artery bypass surgery and PCI performed later after discharge. The major predictors of one year mortality were ages (p<0,001) and ejection fraction (p=0,003). Also, therapy with beta-blockers (p=0,002), statins (p=0,001) and ACE-inhibitors (p=0,024) was associated with better survival.
Delayed PCI performed 7-9 days after AMI in the patients who underwent thrombolysis or those did not improves outcome at long-term follow-u