The international journal of cardiovascular imaging
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Int J Cardiovasc Imaging · Mar 2013
Relationship between routine multi-detector cardiac computed tomographic angiography prior to reoperative cardiac surgery, length of stay, and hospital charges.
While multi-detector cardiac computed tomography angiography (MDCCTA) prior to reoperative cardiac surgery (RCS) has been associated with improved clinical outcomes, its impact on hospital charges and length of stay remains unclear. We studied 364 patients undergoing RCS at Washington Hospital Center between 2004 and 2008, including 137 clinically referred for MDCCTA. Baseline demographics, procedural data, and perioperative outcomes were recorded at the time of the procedure. ⋯ Median total charges [$127,000 (95,000-188,000) vs. $123,000 (86,800-226,000) p = 0.77] and length of stay [9 days (6-19) vs. 11 days (7-19), p = 0.21] were similar. Means analysis demonstrated a strong trend towards lower mean total hospital charges [$163,000 (108,426) vs. $192,000 (181,706), p = 0.06] in the MDCCTA group. In conclusion, preoperative MDCCTA is associated with a number of improved perioperative outcomes and does not significantly effect the length of stay or total hospital charges during the index hospitalization.
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Int J Cardiovasc Imaging · Mar 2013
Case ReportsSalmonella mycotic aneurysm: a rare cause of fever and back pain in elderly.
An 85-year-old man with history of hypertension presented with fever, cough and abdominal pain. Unfortunately fever and leukocytosis persisted despite treatment. Blood cultures obtained on admission grew Salmonella enteritidis. ⋯ The diagnosis of S. aortitis can be challenging, because the clinical course may be indolent and the symptoms are nonspecific. A high index of suspicion is required to make the diagnosis of S. aortitis, especially in patients with Salmonella bacteraemia, fever, back pain and/or abdominal pain. This case highlights the usefulness of TOE in the evaluation of diseases involving the thoracic aorta, leading to a successful intervention.
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Int J Cardiovasc Imaging · Mar 2013
Comparative StudyRight ventricular regional and global systolic function is diminished in patients with pulmonary arterial hypertension: a 2-dimensional ultrasound speckle tracking echocardiography study.
The purpose of the study is to evaluate right ventricular (RV) regional and global systolic function in patients with pulmonary arterial hypertension (PAH) by 2-dimensional ultrasound speckle tracking echocardiography (STE) and explore the impact of pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) on RV systolic function. 42 patients with PAH and 31 healthy controls were included in this study. RV longitudinal peak systolic strain (LS) and strain rate (LSRs) were measured at the basal, mid and apical segments of the RV free wall and septum by STE. RV global longitudinal peak systolic strain (GLS) and strain rate (GLSRs) were also measured by STE. ⋯ GLS and GLSRs were correlated with CMR-derived RVEF. (r₁ = 0.693; r₂ = 0.560, respectively, P < 0.05). STE can identify impaired RV regional and global systolic function in patients with PAH. STE-derived strain and strain rate can be used as novel indices for RV function assessment from 2-dimensional echocardiographic images.
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Int J Cardiovasc Imaging · Mar 2013
Case ReportsPapillary muscle rupture: small life-threatening myocardial infarction.
We report the case of a 70 years old man admitted to our coronary care unit because of atrial fibrillation, non-ST-elevation myocardial infarction and cardiogenic shock. Emergency coronary angiography showed a 99 % stenosis of the circumflex coronary that was successfully treated with a bare metal stent. Atrial fibrillation was cardioverted to sinus rhythm. ⋯ The postoperative course was uneventful and the patient recovered fully. This case highlights that even small myocardial infarction may have dramatic clinical presentations such as PM rupture with cardiogenic shock. Clinical suspicion and rapid confirmation of the diagnosis by TEE are essential requirements for successful treatment.