International journal of cardiology
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Iatrogenic causes constitute increasingly frequent sources of pseudoaneurysms due to endovascular interventions. However, till now, all analyses focused on evaluating different risk factors contributing to the development of pseudoaneurysm, overlooking the issue of localization of femoral puncture. The aim of this study was to assess the influence of position of femoral artery puncture on the risk of pseudoaneurysm formation. 116 patients were evaluated for the site of catheter insertion into femoral arteries. ⋯ Upon further analysis, we concluded that the likelihood of the development of pseudoaneurysm depends on the artery punctured in the groin. This risk increases dramatically for external iliac artery, superficial and deep femoral arteries. A simple means of prevention of this dangerous complication of femoral artery puncture is duplex ultrasound mapping of the groin arteries.
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To assess cardiovascular magnetic resonance (CMR) findings in Takotsubo cardiomyopathy (TTC), 17 consecutive patients (15 women) with TTC who underwent left heart catheterization and gadolinium-enhanced CMR were evaluated. All patients had an abnormal electrocardiogram consisting of ST-segment elevation (n=8) and/or ST-segment depression (n=4) and/or T-wave inversion (n=14). One patient presented with left-bundle branch block. ⋯ However, upon follow up ejection fraction by CMR was not different between classical and variant TTC (49+/-9% vs. 56+/-11%, p=0.23). Delayed hyperenhancement was absent in all but one patient. This finding may help differentiate TTC from entities with similar clinical presentations such as myocarditis and myocardial infarction, as the latter typically exhibits a subendocardial pattern of delayed hyperenhancement while the former usually displays a patchy subepicardial pattern.
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Multicenter Study
Pulmonary arterial hypertension in congenital heart disease: an epidemiologic perspective from a Dutch registry.
Pulmonary arterial hypertension (PAH) associated with congenital heart disease is usually the result of a large systemic-to-pulmonary shunt, and often leads to right ventricular failure and early death. The purpose of this study was to determine the prevalence of PAH among adult patients included in a national registry of congenital heart disease and to assess the relation between patient characteristics and PAH. ⋯ PAH is common in adult patients with congenital heart disease. In our registry the prevalence of PAH in septal defects is around 6%. More than half of these patients have the Eisenmenger syndrome, which accounts for 1% of the total population in the CONCOR registry. Whether the prevalence of PAH will decrease in the future as a result of early detection and intervention remains to be awaited.
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Letter Case Reports
Takotsubo cardiomyopathy--a new variant and widening disease spectrum.
Classic takotsubo cardiomyopathy had left ventricular apical ballooning. Variants with mid-ventricular ballooning without involvement of the apex have been described. We describe a new variant of takotsubo cardiomyopathy where apical contraction was preserved while the rest of the ventricle was dyskinetic.
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Aortic valve stenosis is known to be associated with loss of high molecular von Willebrand multimers. This can lead to gastrointestinal bleeding in patients with gastrointestinal angiodysplasia, the Heyde syndrome. Here we present a case of anaemia and severe epistaxis associated with acquired von Willebrand syndrome. ⋯ Calcifying aortic stenosis was confirmed by echocardiography. Loss of high molecular weight multimers of von Willebrand factor in our patient was shown by immunoblot analysis. If severe epistaxis occurs in the context of symptomatic aortic valve stenosis, it might be an additional reason to recommend valve replacement surgery to the patient.