PURPOSE: Our aim was to study the association between abnormal findings on chest and brain imaging in patients with coronavirus disease 2019 (COVID-19) and neurologic symptoms. MATERIALS AND METHODS: In this retrospective, international multicenter study, we reviewed the electronic medical records and imaging of hospitalized patients with COVID-19 from March 3, 2020, to June 25, 2020. Our inclusion criteria were patients diagnosed with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection with acute neurologic manifestations and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale of 0-5 (0 corresponded to no involvement and 5 corresponded to .75% involvement). A CT lung severity score was determined as the sum of lung involvement, ranging from 0 (no involvement) to 25 (maximum involvement). RESULTS: A total of 135 patients met the inclusion criteria with 132 brain CT, 36 brain MR imaging, 7 MRA of the head and neck, and 135 chest CT studies. Compared with 86 (64%) patients without acute abnormal findings on neuroimaging, 49 (36%) patients with these findings had a significantly higher mean CT lung severity score (9.9 versus 5.8, P , .001). These patients were more likely to present with ischemic stroke (40 [82%] versus 11 [13%], P , .0001) and were more likely to have either ground-glass opacities or consolidation (46 [94%] versus 73 [84%], P ¼ .01) in the lungs. A threshold of the CT lung severity score of .8 was found to be 74% sensitive and 65% specific for acute abnormal findings on neuroimaging. The neuroimaging hallmarks of these patients were acute ischemic infarct (28%), intracranial hemorrhage (10%) including microhemorrhages (19%), and leukoencephalopathy with and/or without restricted diffusion (11%). The predominant CT chest findings were peripheral ground-glass opacities with or without consolidation. CONCLUSIONS: The CT lung disease severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestations. This can be used as a predictive tool in patient management to improve clinical outcome. ABBREVIATIONS: COVID-19 ¼ coronavirus disease 2019; GGOs ¼ ground-glass opacities; PRES ¼ posterior reversible encephalopathy syndrome; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2; TIPIC ¼ Transient Perivascular Inflammation of the Carotid artery syndrome S evere Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, in December 2019 and has rapidly spread around the world to become a pandemic. 1 Extensive studies have described chest and brain imaging characteristics associated with coronavirus disease 2019 (COVID-19). 2-13 The hallmarks of COVID-19 infection on chest imaging
Balloon expandable stents maintain excellent mechanical characteristics when dilated beyond their manufacturers' recommended nominal expansion diameter. These results support the use of balloon expandable stents in smaller vessels that require future serial redilation.
Background: Total anomalous pulmonary venous connection (TAPVC) comprises 2% of congenital heart disease cases. Obstructed TAPVC typically presents with respiratory distress secondary to pulmonary congestion. We report a case of an infant patient who was electively referred to catheterization for stent placement to relieve vertical vein (VV) stenosis. Our objective was to prevent the emergent need for surgical intervention while allowing additional growth before surgery. Case Presentation: A 7-day-old, late pre-term, small for gestational age male infant was transferred from an outside institution. He was initially placed on nasal cannula due to oxygen saturation around 80% but progressed to continuous positive airway pressure and had a chest X-ray suggestive of pulmonary edema. Echocardiography revealed supracardiac TAPVC, a small apical muscular ventricular septal defect, and a moderate secundum atrial septal defect. On admission, the patient was clinically stable with a baseline oxygen saturation of 72% on 40% oxygen. Echocardiography confirmed supracardiac TAPVC and also showed an obstruction with a mean gradient of 22 mmHg in the VV. The desire to optimize the patient's clinical stability led to the decision to undergo cardiac catheterization for stent implantation in the VV. Immediately following the procedure, the patient's hemodynamics improved, with a pressure gradient between the pulmonary venous confluence and the left innominate vein of 4 mmHg. Conclusions: Over the last decade, surgical outcomes
IntroductionTotal anomalous pulmonary venous connection (TAPVC) is a rare cardiac defect that comprises 2% of congenital heart disease cases [1]. TAPVC encompasses different anatomic subtypes in which pulmonary veins fail to connect directly to the left atrium and drain to the right atrium via an anomalous venous connection [2,3]. Supracardiac TAPVC is the most common type, comprising about 45% of cases [2]. A left-sided vertical vein (VV) accounts for 70% of the connections between the pulmonary confluence and the right atrium, and stenosis occurs in approximately 40% of cases [3].Obstructed TAPVC typically presents with respiratory distress secondary to pulmonary congestion,
A 67-year-old male with Ebstein's anomaly and a dual-chamber pacemaker due to sick sinus syndrome was admitted to our hospital with cardiogenic shock. Echocardiography revealed severe functional mitral valve regurgitation with preserved ejection fraction. He was referred for percutaneous mitral valve repair (PMVR) for refractory shock in the setting of prohibitive surgical risk. Invasive hemodynamics obtained during PMVR revealed worsening mitral regurgitation due to septal dyssynchrony induced by the patient's permanent pacing. He underwent successful PMVR with subsequent clinical recovery. Dyssynchrony from right ventricular apical pacing may exacerbate mitral regurgitation and heart failure. PMVR with MitraClip may be a safe and effective therapeutic option in patients with refractory cariogenic shock and severe mitral regurgitation.
Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for high or intermediate risk patients with symptomatic severe aortic stenosis. Transcatheter mitral valve replacement (TMVR) for native mitral stenosis is still under investigation in clinical trials. Results from a global registry, however, show that TMVR in patients with severe mitral annulus calcification is feasible but associated with significant adverse events. Simultaneous TAVR and TMVR on native valves has only been reported twice. Here, we report the first case of simultaneous TAVR and TMVR for native aortic and mitral stenosis using the Edwards Certitude transapical delivery system.
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