Triple leaflet perforation due to endocarditis in aortic valve complicated by pneumonia and exacerbation of chronic obstructive pulmonary disease

AbstractValve perforation complicating infective endocarditis has been for decades a bad sign leading to severe valve destruction, intractable heart failure and even death if surgical therapy is not administered in time. Here we present a 57years old male patient inadvertently diagnosed with pneumonia and chronic obstructive pulmonary disease exacerbation in another hospital. After 20days of broad spectrum antibiotics and bronchodilator therapy no improvement was achieved. During examination a severe aortic regurgitation was recognized. Immediately after, patient was transferred to our hospital for aortic valve surgery evaluation. Transthorasic echocardiography (TTE) showed a severe aortic regurgitation and vegetation like echogenicity over the noncoronary leaflet. An aortic valve replacement surgical therapy was decided. During the aortic valve excision underneath the vegetations, multiple small perforations in all the three leaflets were noticed. The destructed valve was excised and a mechanical aortic prosthesis (St Jude No: 23, MN, USA) was successfully replaced. After 14days of treatment patient was healthily discharged

Koroner arter hastalığında magnezyum/fosfat oranı ile endotel fonksiyonları arasındaki ilişki: Bir prospektif çalışma

Amaç: Aterosklerotik değişikliklerin ve endotel disfonksiyonunun patogenezi karmaşık ve çok faktörlüdür. Kandaki elektrolitlerden magnezyum ve fosfat mineralleri aterogenez ve endotel fonksiyon bozukluğunun patofizyolojisinde yer alan önemli minerallerdir. Endotel fonksiyonu değerlendirmede en çok kabul görmüş akım aracılı vazodilatasyon testidir. Çalışmamızda, koroner arter hastalığı olan hastalarda magnezyum/fosfat oranı ile endotel fonksiyonları arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Koroner anjiyografi ile belgelenmiş koroner arter hastalığı olan ardışık 61 hasta çalışmaya dahil edildi. Radial arterden akım aracılı vazodilatasyon testi ile endotel fonksiyonları poliklinik kontrolünde incelendi. Magnezyum/fosfat oranı ile akım aracılı vazodilatasyon yüzdelik değişimi arasındaki korelasyonu değerlendirmek için Spearman korelasyon analizi kullanıldı. Bulgular: Hastaların ortalama yaşı 61,2±10,1 yıl olup hastaların %72’si erkek ve ortalama vücut kitle indeksi 27,8±5,4 kg/m2’dir. AAD testinde ortalama radial arter bazal çapı 0,25±0,03 cm, test sonrası ortalama radial arter çapı 0,28±0,03 cm olarak saptandı. Magnezyum/fosfat oranları ile endotel fonksiyonlarını gösteren arter çapındaki yüzdelik değişim arasında pozitif yönde bir ilişki saptandı (r = 0,268, p = 0,037). Sonuç: Koroner arter hastalığı olan hastalarda, magnezyum/fosfat oranı endotel fonksiyonlarının bir göstergesi olarak kullanılabilir

Preservation of Radial Vasomotor Functions Through the Anatomic Snuffbox: A Prospective Comparison with other Radial Accesses during Coronary Angiography

Kis, Mehmet/0000-0003-0775-8992WOS:000592262900002PubMed: 33222725Objective: To compare radial vasomotor functions at three different access sites namely right, left main radial artery, and left distal radial (LDR) artery. Study Design: Observational study. Place and Duration of Study: Department of Cardiology, EGE University, Turkey, from September 2017 to February 2018. Methodology: Forty-one patients scheduled for transradial elective coronary angiography and intervention were consecutively enrolled. Access site decision was left free to operators being blind of the study. Main radial vasomotor function measured through flow mediated vasodilation test was compared between other radial access sites on admission, 1 day and 2 months post-catheterisation. Results: Five patients were intervened through the left main radial, whereas the LDR and the right main radial access were used in 17 and 19 patients respectively. in contrast to other radial access sites, LDR approach showed significantly less influenced vasomotor functions the day after the procedure. This feature continued to be preserved for two months of followup. Conclusion: Left distal radial branch in the anatomic snuffbox is a reliable access in terms of vasomotor function preservation compared to conventional left and right radial artery accesses

Coronary angiography using the left distal radial approach - An alternative site to conventional radial coronary angiography

WOS: 000429628000005PubMed ID: 29578203Objective: To share our experience with the left distal radial approach for transradial coronary angiography and interventions. By performing the radial puncture in the fossa radialis or the so called anatomical "Snuffbox" we aimed to present the feasibility and complications of this new technique. Methods: Left distal radial artery was used as an access site in 54 patients admitted to our clinic for coronary angiography and intervention between May 25th and October 20th 2017. All of them had pulse in their left distal radial artery. In the laboratory, they had their left arm gently flexed at the shoulder so that the hand was placed over their right groin. The operator stood on the right side of the patient and performed coronary angiography and interventions. During the hospital stay, demographic features and complications were recorded. Results: Mean age of patients was 59.3 years and 80% were male. We used Judkins 6 French catheters for the procedures. Seventeen patients admitted with acute coronary syndrome. They all underwent successful left distal transradial coronary angiography and intervention. Primary angioplasty was performed in 10 patients. In total, 20 patients had coronary intervention. Left anterior descending artery was the artery requiring most intervention (11 patients). Two patients experienced brachial spasm requiring crossover to right femoral artery. There were no cases of radial artery occlusion, hematoma, or hand numbness. The radial sheath was removed at procedure termination. Hemostasis was achieved with manual compression. Conclusion: Left distal radial approach is safe and feasible as a new technique for coronary angiography and interventions

In response to: Radial Artery Cannulation at the Anatomical Snuffbox: Hype or Hope in Interventional Cardiology?

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