- Meaning of "branquio" in the Portuguese dictionary
- Acute coronary syndrome of paradoxical origin | Revista Portuguesa de Cardiologia (English edition)
Selo: Mondo 3 Cat. CD, all inserts, and case are included obi however, is not. Send us your Japanese items wantlist- if we can't find it, it doesn't exist. Never opened. Send us your Japa nese items wantlist- if we can't find it, it doesn't exist. Including bonus 12' and info sheet. Selo: Rise Records 3 Cat. Selo: Song Cycle Records Cat. Selo: Nuclear Blast Cat. Selo: Animate Records Cat. Selo: Metal Blade Records Cat. Selo: High Roller Records Cat. Selo: 4AD Cat. A Coronary angiography showing distal occlusion of the right coronary artery; B final result after thrombus aspiration and stent implantation..
A full transthoracic echocardiogram examination was then performed. A mass consistent with a thrombus was noted in the left atrium, appearing to arise from a redundant interatrial septum, while the right ventricle was moderately dilated with positive McConnell sign and the interventricular septum was displaced into the left ventricle, which was D-shaped in short-axis view Figure 3. The pulmonary artery was dilated and the flow across the pulmonary valve suggested severe pulmonary hypertension with pulmonary artery systolic pressure estimated at 70 mmHg.
Meaning of "branquio" in the Portuguese dictionary
In apical 4-chamber view, color flow imaging of the interatrial septum showed a right-to-left shunt. It was then decided to perform transesophageal echocardiography TEE to better characterize the relationship of the mass with the interatrial septum and its embolic potential, and also to look for masses in the right atrium. TTE showed a long thrombus that appeared to be attached to the atrial septum in the region of the foramen ovale.
Color flow imaging was consistent with a patent foramen ovale PFO and the atrial septum was aneurysmatic. The thrombus had a snake-like movement inside the left atrium and its distal end was freely mobile, prolapsing through the mitral valve Figure 4. No mass was observed in the right atrium or pulmonary arteries.
Thoracic computed tomography angiography revealed bilateral thrombi in the main and lobar branches of the pulmonary artery Figure A parasternal long-axis view; B parasternal short-axis view of the aortic valve; C zoom of short-axis view; D D-shaped left ventricle. Transesophageal echocardiogram showing thrombus crossing the interatrial septum.
Thoracic computed tomography angiography showing bilateral thrombi in the main branches of the pulmonary artery.. According to the criteria suggested by Johnson, 1 the patient had a definitive diagnosis of paradoxical embolism: a thrombus crossing an intracardiac defect was seen during echocardiography in the presence of an arterial embolus. The therapeutic options for paradoxical embolism are still a matter of debate. In our case, cardiothoracic surgeons were consulted and considered the operative risk to be too high, and the patient did not consent to surgical intervention.
Due to her stable clinical condition and the absence of neurological signs, we decided to maintain her on full-dose anticoagulation with enoxaparin and double antiplatelet therapy. Venous Doppler echocardiography of the lower limbs was normal. Five days later the transthoracic echocardiogram was repeated; no reduction was noted in the size of the left atrial thrombus, whereupon the cardiothoracic surgeons were again consulted and it was decided to operate. The same day, she was transferred to a surgical center and surgery was performed: an atrial aspiration system was placed in the right superior pulmonary vein, the right atrium and the interatrial septum were opened and the left atrium was inspected.
No thrombus was seen in any cardiac chamber or vessel and the PFO was sutured. The patient's postoperative course was remarkably stable and the transthoracic echocardiogram before hospital discharge showed no signs of right ventricular overload. She was discharged home anticoagulated with warfarin and advised to discontinue oral contraceptives. Further laboratory testing showed no thrombophilia status.. Although in situ thrombus formation over a ruptured plaque cannot be definitively excluded in our patient, the angiographic appearance of the thrombus was most consistent with coronary embolization.
The patient's increased risk of venous thrombosis can be explained by oral contraceptive use. An interesting point is that when the left atrium was opened during surgery no thrombus was seen, even though the transthoracic echocardiogram on the same day had shown no reduction in the size of the mass.
The most probable explanation is aspiration of the mass by the atrial aspiration system put in place before the left atrium was opened.. Most cases of paradoxical embolism have been associated with PFO. Finally, paradoxical embolism with coronary embolization and visualization of the thrombus crossing a PFO is even rarer, with very few cases described in the literature. TEE is crucial for accurate diagnosis and appropriate management when paradoxical embolism is suspected. TEE is the ideal diagnostic procedure in the setting of suspected myocardial infarction of thromboembolic origin because of its ability to visualize both paradoxical emboli and the proximal portions of the coronary arteries.
Acute treatment options include anticoagulation, fibrinolysis or surgical embolectomy. In the presence of a thrombus with a high embolic potential, fibrinolysis carries a high risk of fragmentation and systemic embolization. Surgery also enables simultaneous closure of the PFO. For this reason, anticoagulation followed by surgical embolectomy has been recommended as the optimal therapy, although recommendations for the management of paradoxical embolism are based on small series and isolated case reports. A medical strategy using thrombolytic therapy or heparin therapy alone may have a role in patients at increased surgical risk.
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Acute coronary syndrome of paradoxical origin | Revista Portuguesa de Cardiologia (English edition)
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