Aortic valve replacement can produce dramatic benefit in the setting of symptomatic aortic stenosis. The potential for morbidity and mortality associated with thoracotomy, cardiopulmonary bypass, and aortotomy has fostered a search for alternatives. Early experience with transcatheter endovascular aortic valve implantation demonstrated feasibility and efficacy, but the procedure was difficult to reproduce. However, equipment, techniques, and experience have evolved rapidly. Balloon-expandable and self-expanding prostheses and percutaneous femoral artery and open left ventricular apical access have found favor, each with potential advantages and disadvantages. Procedural success rates and clinical outcomes continue to improve. Current studies suggest that morbidity and mortality rates of percutaneous aortic valve implantations are much better in comparison to conventional surgery in selected high-risk patients. On November 11, 2008, in the Gottsegen György Hungarian Institute of Cardiology we performed the first two successful percutaneous aortic valve implantations in Central and Eastern Europe, following a more than one-year preparation period. After seven days the patients were discharged in very good conditions.
A 43-year-old woman with mild hypertension and type-2 diabetes mellitus was presented to the coronary care unit because of ongoing chest pain and associated dyspnea after physical exercise. On arrival, her ECG disclosed ST-segment elevations in the precordial leads. The emergent cardiac catheterization failed to demonstrate coronary artery disease. The prompt performed transthoracic echocardiogram demonstrated systolic dysfunction with apical ballooning. Akinetic segments were irrespective of coronary artery anatomy. Laboratory tests revealed only slightly elevated cardiac enzymes: we observed a significant discrepancy between the extent of akinesis and the minimal increase in cardiac necroenzymes. The patient was medically managed and discharged in stable condition, with follow-up at 4 weeks demonstrating nearly total recovery of cardiac function and total resolution of wall motion disorder. Her clinical presentation is consistent with that of tako-tsubo cardiomyopathy, a syndrome that is characterized by transient apical regional wall motion abnormalities in the absence of epicardial coronary artery disease. Main precipitating factor is thought to be the cathecolamin excess due to emotional or physical stress, subarachnoid hemorrhage, phaeochromocytoma or cocaine use. The authors report the first physical exercise induced tako-tsubo syndrome in the Hungarian medical literature.
Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a thrombotic pulmonary disease associated with pulmonary vasculopathy. Pulmonary endarterectomy (opus, PEA) is the first treatment choice in CTEPH, and specific PAH medication when there is a contraindication for surgery or residual pulmonary arterial hypertension (rPAH) occurs. In the presence of PAH balloon pulmonary angioplasty (BPA) might be also recommended if available. Objective We investigated the long term outcome of our CTEPH patients. Methods CTEPH from our institution retrospectively analyzed (data between 2003 and 2018). Baseline, treatment and outcome data were documented. We compared the outcome, together with mortality in those with and without surgery (PEA vs. non PEA group). NYHA class, 6 minutes walking distance (6MWD) and NT-proBNP were also reported during follow-up. Results Of 29 CTEPH patients (mean age was 62±19 years, 52% male) 16 (55%) were accepted for PEA, and further 12 of them had a long term follow-up post surgery (n=3 periop exit, n=1 waiting for surgery). Half of the PEA patients were cured (n=6) and the other half (n=6) required specific PAH treatment (n=1, in combination with BPA) for rPAH. All patients from the non-PEA group (n=13) were started on specific PAH treatment (n=1 in combination with BPA). Patients with or without PEA did not differ hemodynamically. At the late follow-up there was a significant improvement in PEA group for NYHA class and NT-proBNP (p<0,001, and p=0,046), and in non PEA group for NYHA class and the 6MWD (p=0,012, and 0,006). We found significant difference in mortality at 1,3,5 year (Kaplan-Meier survival analysis) follow-up, for PEA group 100%-100%-100% and non PEA group 100%-85%-78% (p=0,013), respectively. Conclusions 55% of CTEPH patients were suitable for PEA, and those who survived the surgery 50% were cured. Non PEA patients improved functionally on the long term, but had worse survival.
nás keringés, amely hosszú távon a Fontan-/TCPC-keringés elégtelenségéhez (Fontan-failure) vezethet, szívtranszplantáció (HTX) indikációját képezve. TCPC-s populációval. TCPC-s beteget vontunk be, valamint rögzítettük az utánkövetés során észlelt eseményeket. elégtelenség a betegek 16,4%-ban jelentkezett, ez a Fontanosok 22,2%-át, illetve a TCPC-sek 14,5%-át jelenti (p=0,44). A mortalitás 5,4% volt, két betegnél HTX történt; ez utóbbi eseményekben nem volt különbség a Fontan-és a TCPC-betegek arányában. The Fontan surgery is a palliative procedure in patients with univentricular heart performed as the classic right atrial to pulmonary connection (RA-PA), or total cavopulmonary connection (TCPC). The non-pulsatile venosus circulation leads to the inTo evaluate the long-term outcomes of adult patients after Fontan/TCPC procedure, and compare the clinical outcomes of Fontan and TCPC populations. Patients were enrolled who underwent Fontan/TCPC operation between 2001-2017 at our Institute with a follow-up at least 1 year and complications were assessed. Results: 73 Fontan/TCPC patients were enrolled in our study (Fontan: n=18, TCPC: n=55). TCPC was carried out in substantially 16,4% had heart failure, 32.8% had arrhythmias, 15.1% thromboembolic events, 21.9% had liver cirrhosis and 5.4% had protein-losing enteropathy. Compared with TCPC, Fontan patients presented with a higher rate of atrial arrhythmia (p=0.005) and hospitalization for heart failure (p=0.026). Failing Fontan was observed in 16.4% of patients (Fontan: 22.2%, TCPC 14.5%; p=0.44). During Despite of younger age, patients with Fontan/TCPC operation are at high risk for morbidities. The Fontan surgerywhen compared with TCPC seems to carry a higher risk for atrial arrhythmias and heart failure requiring hospitalization. The patient's age at operation was a predictor of Failing Fontan. univentricular heart, Fontan procedure, total cavopulmonary connection (TCPC), Fontan failure
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