Different vascular abnormalities have been reported under the denomination of "persistence of the fifth aortic arch." Detailed studies on experimental embryology raised the discussion about the existence of the fifth aortic arch as an embryological structure, both in humans and mammals. In 1969 the Van Praaghs described the occurrence of double left aortic arch, denominating such anomaly as persistence of the fifth arch. We describe here a female patient showing the presence of an anomalous vessel in parallel with the aortic arch. The finding was occasional, during a preoperative evaluation for cholecystectomy.
Thus far, little has been written concerning echocardiographic identification of the oblique vein of the left atrium, or Marshall's vein. There is much discussion, nonetheless, on the potential significance of the vein, or its ligamentous remnant, as an arrhythmic substrate. We describe here four patients in whom transthoracic echocardiography revealed a venous structure protruding within the cavity of the left atrium. We discuss the possibility that these structures represent Marshall's vein, albeit probably as part of a persistent left superior caval vein.
Background: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case.Objective: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction.Methods: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml), meperidine 1 mg (1 ml) and distilled water (7.5 ml). Four age groups were analyzed: G1: ≤ 24 years; G2: 25 to 44 years; G3: 45 to 64 years; and G4: ≥ 65 years. Body surface area was calculated using the formula {[(height x 100) 0.725 ] x (weight 0.425 ) x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: < 55%; and GB: ≥ 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area.Results: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01). The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01). The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null). Conclusion Effective Dose of Sedation in Transesophageal EchocardiographyRelation to Age, Body Surface Area and Left Ventricle FunctionGuilherme Moreira José, Carlos Eduardo Suaide Silva, Luiz Darcy Cortez Ferreira, Yara Prosdossini Soares de Novaes, Claudia Gianini Monaco, Manuel Adán Gil, Renata Rejane Linhares, Marcelo Sgrott Rodrigues, Antônio S. S. de Moraes, Juarez Ortiz. OMNI-CCNI Medicina Diagnóstica de São Paulo, São Paulo, SP -Brazil IntroductionTransesophageal echocardiography is performed via esophageal intubation, using a probe with one or more transducers at its tip. An approximately 5-hour fast is required for all patients undergoing the procedure whether using anesthesia or sedation 1 .The use of a local anesthetic agent (lidocaine hydrochloride 10% spray) and peripheral venipuncture are also recommended; usually, sedatives and analgesic agents are preferably administered intravenously 1 . The tolerance to the procedure, which is almost always uncomfortable, is increased with the use of sedation and analgesia by blocking the response to stress (quite useful in patients with heart diseases), and by reducing the laryngeal activity (very useful in patients with asthma, chronic bronchitis and heart diseases), discomfort and pain. It is also very useful for excessively anxious patients and those with neurological diseases or psychiatric disorders who are unable to cooperate. It can also be performed as per patient . Today, the drugs most frequently used for sedation in transesophageal echocardiography are the benzodiazepines (diazepam and midazolam), and for analgesia, the opioids (meperidine and fentanyl) and propofo...
Background: In atrial fibrillation (AF), the CHA 2 DS 2-VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique. Objective: To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA 2 DS 2 VASc score. Method: A total of 247 patients were divided into three groups considering the CHA 2 DS 2-VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted. Results: The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p < 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p < 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA < 0.4 m/s in 22.7% (p < 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005). Conclusions: The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA 2 DS 2 VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables.
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