13 research outputs found

    Timely diagnosis of left ventricular posterior wall rupture by echocardiography: A case report

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    Left ventricular free wall rupture is responsible for up to 10 of in-hospital deaths following myocardial infarction. It is mainly associated with posterolateral myocardial infarction, and its antemortem diagnosis is rarely made. One of the medical complications of myocardial infarction is the rupture of the free wall, which occurs more frequently in the anterolateral wall in hypertensives, women, and those with relatively large transmural myocardial infarction usually 1-4 days after myocardial infarction. We herein present the case of a 66-year-old man suffering inferior wall myocardial infarction with abrupt hemodynamic decompensation 9 days after myocardial infarction. Emergent transthoracic echocardiography revealed massive pericardial effusion with tamponade, containing a large elongated mass measuring 1 x 8cm suggestive of hematoma secondary to cardiac rupture. In urgent cardiac surgery, the posterior wall between the left coronary artery branches was ruptured

    Comparison of two pain assessment tools, �facial expression� and �critical care pain observation tool� in intubated patients after cardiac surgery

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    Background: Critical-care patients are at higher risk of untreated pain, because they are often unable to communicate owing to altered mental status, tracheal intubation and sedation. Objectives: This study compared two pain assessment tools on tracheal intubated critically ill patients in a cardiac post-anesthesia care unit, who were unable to communicate verbally. The studied tools were �critical-care pain observation tool (CPOT)� and �facial expression (FE)�. Patients and Methods: This was a prospective study based on diagnostic test evaluation. A sample of 91 intubated patients was selected from cardiac post-anesthesia care unit. Collected data were demographic characteristics, vital signs, FE and CPOT tools� scale. Pain was assessed with CPOT and FE scores five times. The first assessment was performed in at least 3 hours after admission of patients to ICU. Then, the pain intensity was reassessed every 30 minutes. In addition, blood pressure, heart rate, respiratory rate and oxygen saturation were measured simultaneously. Results: At the first period, the frequency of �severe� pain intensity using the CPOT was 58.2 and with the FE tool was 67 (P = 0.001). Both tools demonstrated reduction in severity of pain on second and third assessment times. Significantly increasing level of pain and blood pressure due to nursing painful procedures (endo-tracheal suctioning, changing patient�s position, etc.), were obtained by CPOT in fourth assessment. FE was not able to detect such important findings (κ = 0.249). In the fifth step, pain intensity was reduced. The most agreement between the two tools was observed when the reported pain was �severe� (κ = 0.787, P < 0.001) and �mild� (κ = 0.851, P < 0.001). Conclusions: The sensitivity of CPOT was higher for detection and evaluation of pain in intubated postoperative patients compared with �Facial Expression�. Best agreement between these tools was observed in two extremes of pain intensity. © 2016, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

    In-hospital and six-month outcomes of elderly patients undergoing primary percutaneous coronary intervention for acute st-elevation myocardial infarction

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    BACKGROUND: Elderly patients constitute a rapidly growing proportion of the population, and hence the increasing rises in the number of patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI), which is now established as the preferred reperfusion strategy in STEMI patients, has been inadequately investigated in this high-risk group. The aim of the present study was to investigate the in- hospital and 6-month outcomes of primary PCI in elderly patients (� 75 years) with STEMI. METHODS: A total of 100 elderly patients with STEMI including those with cardiogenic shock were included. Primary PCI procedures were performed in a tertiary referral center between 2009 and 2014. In-hospital and 6-month outcomes of patients were recorded and analyzed. RESULTS: The average age of the patients was 79.6 ± 3.8 years (range = 75-90 years) and 27.0 were women. Cardiovascular risk factors and prior events were common. Nearly, half of the patients had three-vessel disease and the left anterior descending artery (LAD) was the most common infarct-related artery. The presence of cardiogenic shock but not the other variables was associated with less anatomic and procedural success (P < 0.001). It was also the major independent predictors of 6-month mortality in the patients aged � 75 years, hazard ratio (HR) = 8.02; 95% confidence interval (CI): 1.75-25.97, P < 0.001. In-hospital mortality was 2.4% in the patients without and 83.0% in those with cardiogenic shock. CONCLUSION: Primary PCI in aged patients could be associated with low complication rates and improved survival if performed in high-volume centers with experienced operators. Considering the very high rate of mortality in patients with cardiogenic shock, there should be measures to treat these patients before the onset of hemodynamic instability. © 2016, Isfahan University of Medical Sciences(IUMS). All rights reserved

    Relationship between maximum clot firmness in ROTEM® and postoperative bleeding after coronary artery bypass graft surgery in patients using clopidogrel

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    Background: The aim of the present study was to investigate the relationship between maximum clot firmness (MCF) in rotational thromboelastometry (ROTEM®) and postoperative bleeding in patients on clopidogrel after emergency coronary artery bypass graft surgery (CABG). Methods: This observational study recruited 60 patients posted for emergency CABG following unsuccessful primary percutaneous coronary intervention (PCI) while on 600 mg of clopidogrel. The study population was divided into 2 groups on the basis of their MCF in the extrinsically activated thromboelastometric (EXTEM) component of the (preoperative) ROTEM® test: patients with MCF &lt;50 mm (n = 16) and those with MCF �50 mm (n = 44). Postoperative chest tube drainage amount, need for blood product transfusion, postoperative complications, and duration of mechanical ventilation after CABG were recorded. Results: No significant differences were observed between the two groups regarding duration of surgery, cardiopulmonary bypass, and aortic cross-clamp time. Chest tube drainage at 6, 12, and 24 h after Intensive Care Unit admission were significantly higher in the patients with MCF below 50 mm. The need for blood product transfusion was higher in the group with MCF &lt;50 mm. In patients who experienced postoperative bleeding of 1000 mL or more, the ROTEM® parameters of INTEM (Intrinsically activated thromboelastomery) and MCF, EXTEM and MCF, and HEPTEM (INTEM assay performed in the presence of heparinase) MCF (but not FIBTEM (Thromboelastometric assay for the fibrin part of the clot) values) were significantly lower than those with postoperative bleeding &lt;1000 mL (P � 0.05). Conclusions: When platelet aggregometry is not available, the ROTEM® test could be useful for the prediction of increased risk bleeding after emergency CABG in patients who have received a loading dose of clopidogrel. © 2018 Annals of Cardiac Anaesthesia | Published by Wolters Kluwer - Medknow

    Comparison of diagnostic accuracy between coronary CT angiography and conventional coronary angiography

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    Background: Coronary computed tomography angiography (CCTA) is a noninvasive imaging method with a high diagnostic value and minimal complications for evaluating coronary arteries. Therefore, in cases with low and moderate probabilities of coronary artery disease, CCTA can be a good alternative to conventional coronary angiography (CCA). Previous studies with 64- slice CTA have tried to determine its diagnostic accuracy compared with CCA as the gold standard. In this survey, we compared the results of 256-slice CCTA with CTA. Method: The present cross-sectional descriptive study evaluated 53 patients (36 men) undergoing CCTA and then CCA (except for 4 patients with pervious CCAs). Our primary goal was to compare the 2 imaging methods for the evaluation of coronary lesions and their runoff. Results: In the coronary artery bypass graft group, the diagnostic accuracy of CCTA for the arterial graft lesions (left internal mammary artery to left anterior descending) had 72.73 sensitivity, 100 specificity, 100 positive predictive value, and 84.2 negative predictive value and its diagnostic accuracy for the venous graft lesions had 100 sensitivity, 80 to 100 specificity, 80 to 100 positive predictive value, and 66.4 to 100 negative predictive value. Apropos runoff (adequacy of perfusion), CCTA had 100 sensitivity, 63.64 specificity, 80 positive predictive value, and 100 negative predictive value in the arterial grafts and 54 to 100 sensitivity and 100 specificity in the venous grafts. In the percutaneous coronary intervention group, CCTA had 90 specificity, and 75 positive predictive value, and 0 negative predictive value in the differentiation of significant from nonsignificant in-stent restenoses. Conclusions: The diagnostic accuracy of CCTA in determining the severity of arterial graft stenoses and their runoff was similar to that reported in previous studies with 64-slice CTA. Strikingly, CCTA had low sensitivity for significant in-stent restenosis. © 2018, Iranian Heart Association. All rights reserved

    Comparison of diagnostic accuracy between coronary CT angiography and conventional coronary angiography

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    Background: Coronary computed tomography angiography (CCTA) is a noninvasive imaging method with a high diagnostic value and minimal complications for evaluating coronary arteries. Therefore, in cases with low and moderate probabilities of coronary artery disease, CCTA can be a good alternative to conventional coronary angiography (CCA). Previous studies with 64- slice CTA have tried to determine its diagnostic accuracy compared with CCA as the gold standard. In this survey, we compared the results of 256-slice CCTA with CTA. Method: The present cross-sectional descriptive study evaluated 53 patients (36 men) undergoing CCTA and then CCA (except for 4 patients with pervious CCAs). Our primary goal was to compare the 2 imaging methods for the evaluation of coronary lesions and their runoff. Results: In the coronary artery bypass graft group, the diagnostic accuracy of CCTA for the arterial graft lesions (left internal mammary artery to left anterior descending) had 72.73 sensitivity, 100 specificity, 100 positive predictive value, and 84.2 negative predictive value and its diagnostic accuracy for the venous graft lesions had 100 sensitivity, 80 to 100 specificity, 80 to 100 positive predictive value, and 66.4 to 100 negative predictive value. Apropos runoff (adequacy of perfusion), CCTA had 100 sensitivity, 63.64 specificity, 80 positive predictive value, and 100 negative predictive value in the arterial grafts and 54 to 100 sensitivity and 100 specificity in the venous grafts. In the percutaneous coronary intervention group, CCTA had 90 specificity, and 75 positive predictive value, and 0 negative predictive value in the differentiation of significant from nonsignificant in-stent restenoses. Conclusions: The diagnostic accuracy of CCTA in determining the severity of arterial graft stenoses and their runoff was similar to that reported in previous studies with 64-slice CTA. Strikingly, CCTA had low sensitivity for significant in-stent restenosis. © 2018, Iranian Heart Association. All rights reserved

    Cyclotron production and parameters calculation of V-48 Nitinol stent for renal arteries in brachytherapy

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    Tenreiro, C (Tenreiro, Claudio). Talca Univ, Fac Engn, Talca, ChileThe Nitinol stent was bombarded in a cyclotron at a flux rate of 4 mu A/cm(2) to produce V-48 via Ti-48 (p, n) V-48 reaction. In this study dose distribution of V-48 radioactive stent was investigated for renal arteries. Version X-2.6 of the MCNP Monte Carlo radiation transport system code was employed to calculate dose distribution around the stent. As V-48 is a mixed gamma and beta particle emitter, two separate runs of MCNP for both beta and gamma particles were performed and the total deposited dose was acquired by adding the two mentioned values. In order to verify the simulation, the calculated results have been compared with previous published data for the source. Calculated results show high dose gradient near the stent and the maximum amount of dose deposits at the vessel wall. According to (AAPM) TG-60/149 protocol, the dosimetric parameters, including geometry function, G(rho,z), radial dose function, g (L) (rho), and anisotropy function, F(rho,z), were also determined

    Doppler echocardiographic assessment of pulmonary prostheses: A comprehensive assessment including velocity time integral ratio and prosthesis effective orifice area

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    Objective. Few reports have been published on the Doppler-derived echocardiographic data for pulmonary valve prostheses (PVPs). The aim of this study was to provide a comprehensive Doppler echocardiographic assessment of PVPs. Methods. We studied 40 patients (mean age 24.2) with PVPs: 13 (32.5) mechanical and 27 (67.5) bioprosthetic valves. After clinical evaluation, all patients underwent complete, two-dimensional and Doppler studies. Results. In 30 patients with normally functioning PVPs, the mean (SD) peak velocity was 2.33 (0.36)m/s with an average peak pressure gradient of 22.69 (6.7)mmHg and an average mean pressure gradient of 12.5 (4.1)mmHg. The mean PVPs velocity time integral (VTI) was 47.49 (12.78)cm with mean right ventricle outflow tract/peak velocity (PV) VTI ratio 0.43 (0.14), mean PVPs effective orifice area was 1.63 (0.36) cm2. Metallic PVPs had significantly better hemodynamic Doppler study compared with biologic PVPs. In 9 patients with PVP malfunction, average peak PVPs velocity, average peak pressure gradient, mean pressure gradient, PV VTI, PV/left ventricle outflow tract VTI ratio was significantly increased (P &lt; 0.05). Conclusion. This study contributes to establishing the normal range for Doppler hemodynamics in various PVPs. © 2008 Copyright the Authors Journal compilation © 2008 Blackwell Publishing
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