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Immens MHM, van den Hoeven V, van Lith TJ, Duijnhouwer TD, ten Cate TJF, de Leeuw FE. Heart-Stroke Team: A multidisciplinary assessment of patent foramen ovale-associated stroke. Eur Stroke J 2024; 9:219-225. [PMID: 37978872 PMCID: PMC10916814 DOI: 10.1177/23969873231214862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Patent foramen ovale (PFO) closure prevents recurrent ischemic stroke in selected patients with a cryptogenic stroke. Trial results tend to be generalized to daily practice, often extending original trial inclusion criteria. This may result in unnecessary closure without benefit, but with risk of complications. We therefore introduced a standardized and structured evaluation by an interdisciplinary Heart-Stroke Team (HST). Our aim was to investigate the proportion of actual PFO closure of all referred patients with a cryptogenic stroke, after evaluation by the HST. PATIENTS AND METHODS We conducted a single-center, retrospective cohort study. Patients with an assumed cryptogenic ischemic stroke or transient ischemic attack (TIA) and a PFO who were referred for PFO closure were analyzed. As part of the HST approach, all patients underwent a standardized work-up, first to demonstrate the ischemic event on neuroimaging, second to evaluate all potential causes of stroke and finally, to assess the possible relation between the PFO and stroke. Outcome was the proportion of patients treated with PFO closure after referral. RESULTS A total of 195 patients were included. In 124 patients (64%) PFO closure was advised. Fourty-two (22%) patients had a clear alternative cause of stroke and in 13 (7%) patients the initial stroke diagnosis could not be confirmed. CONCLUSION After careful analysis of patients referred for PFO closure a relationship between the PFO and stroke could not be demonstrated in 32% of referrals, and 3% preferred best medical treatment over percutaneous closure. This stresses the need for a complete neurovascular work-up and multidisciplinary assessment.
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Affiliation(s)
- Maikel HM Immens
- Department of Neurology, Radboud University Medical Centre, Donders institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Vincent van den Hoeven
- Department of Neurology, Radboud University Medical Centre, Donders institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Theresa J van Lith
- Department of Neurology, Radboud University Medical Centre, Donders institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Toon D Duijnhouwer
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tim JF ten Cate
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Centre, Donders institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Yetkin E, Atmaca H, Cuglan B, Yalta K. Ignored Role of Paroxysmal Atrial Fibrillation in the Pathophysiology of Cryptogenic Stroke in Patients with Patent Foramen Ovale and Atrial Septal Aneurysm. Curr Cardiol Rev 2024; 20:14-19. [PMID: 38367262 PMCID: PMC11107473 DOI: 10.2174/011573403x267669240125041203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 02/19/2024] Open
Abstract
The association between cryptogenic stroke (CS) and patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) has been a debate for decades in terms of pathophysiologic processes and clinical courses. This issue has become more interesting and complex, because of the concerns associating the CS with so-called normal variant pathologies of interatrial septum, namely ASA and PFO. While there is an anatomical pathology in the interatrial septum, namely PFO and ASA, the embolic source of stroke is not clearly defined. Moreover, in patients with PFO and CS, the risk of recurrent stroke has also been associated with other PFOunrelated factors, such as hyperlipidemia, body mass index, diabetes mellitus, and hypertension, leading to the difficulty in understanding the pathophysiologic mechanism of CS in patients with PFO and/or ASA. Theoretically, the embolic source of cryptogenic stroke in which PFO and/or ASA has been involved can be categorized into three different anatomical locations, namely PFO tissue and/or ASA tissue itself, right or left atrial chambers, and venous vascular territory distal to the right atrium, i.e., inferior vena cava and lower extremity venous system. However, the possible role of paroxysmal atrial fibrillation associated with PFO and/or ASA as a source of cryptogenic stroke has never been mentioned clearly in the literature. This review aims to explain the association of cryptogenic stroke with PFO and/or ASA in a comprehensive manner, including anatomical, clinical, and mechanistic aspects. The potential role of paroxysmal atrial fibrillation and its contribution to clinical course have been also discussed in a hypothetical manner to elucidate the pathophysiology of CS and support further treatment modalities.
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Affiliation(s)
- Ertan Yetkin
- Division of Cardiology, Türkiye Hospital, Istanbul, Turkey
| | - Hasan Atmaca
- Division of Cardiology, Türkiye Hospital, Istanbul, Turkey
| | - Bilal Cuglan
- Department of Cardiology, Kanuni Sultan Suleiman Training and Research Hospital, Istanbul, Turkey
| | - Kenan Yalta
- Department of Cardiology, Faculty of Medicine Edirne, Trakya University, Trakya, Turkey
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Rodrigues R, Leitão K, Sousa C, Carvalho P, Marques D, Alves F. Interatrial septal aneurysm associated with patent foramen ovale in a dog - case report. ARQ BRAS MED VET ZOO 2023. [DOI: 10.1590/1678-4162-12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
ABSTRACT Atrial septal aneurysm (ASA) is a rare congenital deformity of variable clinical relevance, often reported in association with patent foramen ovale (PFO). Transthoracic Doppler echocardiography (TTE) is the first choice for diagnosis, but complementary techniques, such as microbubble contrast, should be used. Despite its importance, in Veterinary Medicine, there is little information related to the subject, and the present study is the second report of this condition in dogs. The objective was to report a case of ASA type IV LR associated with PFO in a Shar Pei bitch, diagnosed by a combined approach of transthoracic echocardiography backed by agitated saline solution (microbubbles). During clinical care, the owners reported episodes of seizures as their main complaint. Echocardiographic examination revealed a type 4 LR atrial septal aneurysm and left ventricular systolic dysfunction. The use of microbubble contrast showed right-to-left shunt, confirming PFO. The recommended treatment was medication. It was concluded that the rarity of ASA in dogs may be due to incomplete diagnoses and the transthoracic echocardiographic examination allows its analysis and classification. Furthermore, ASA can be found in animals with or without evidence of heart disease and it should be investigated in patients with neurological alterations.
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Cho K, Feneley M, Holloway C. Atrial Septal Aneurysms - A Clinically Relevant Enigma? Heart Lung Circ 2021; 31:17-24. [PMID: 34507890 DOI: 10.1016/j.hlc.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022]
Abstract
Atrial septal aneurysms (ASAs) are often seen during routine cardiac imaging, though their clinical relevance has been poorly defined. The aneurysmal, and often mobile, inter-atrial septum is frequently associated with other clinically relevant structural cardiac abnormalities, particularly patent foramen ovale (PFO). Whilst ASAs have previously been considered an incidental finding, a well-endowed atrial septum provides more than visual interest, including insights into atrial function and intra-atrial pressures, and has important clinical implications in PFO-associated stroke, migraines, and arrhythmias. This review outlines diagnostic challenges when assessing ASAs using all imaging modalities and the clinical implications of this common anatomical variant.
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Affiliation(s)
- Kenneth Cho
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; Western Sydney University, Sydney, NSW, Australia
| | - Michael Feneley
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Cameron Holloway
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.
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Sun H, Zhou C, Xu L, Xu T. A meta-analysis of the association of atrial septal abnormalities and atrial vulnerability. Medicine (Baltimore) 2021; 100:e27165. [PMID: 34477173 PMCID: PMC8416013 DOI: 10.1097/md.0000000000027165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/19/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The mechanism of cryptogenic stroke (CS) in patients with atrial septal abnormalities remains unclear, and the increased incidence of atrial vulnerability may be one of the reasons. We performed this meta-analysis to clarify the association between atrial septal abnormalities and atrial vulnerability, and to provide evidence-based basis for the prevention and mechanism of CS. METHODS We systematically searched for studies on the association between atrial septal abnormalities and atrial vulnerability, and pooled available data on types of atrial septal abnormalities, types of atrial vulnerability, and methods of atrial vulnerability detection. The primary endpoints were the occurrence of atrial arrhythmias or P wave abnormalities. Random-effects models were used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Twelve case-control studies were eligible. Compared with the control group, patients with atrial septal abnormalities had a higher risk of atrial vulnerability (OR: 1.93; 95% CI: 1.13-3.30, P = .02). Data based on stroke patients showed that the group with atrial septal abnormalities had a higher risk of atrial vulnerability than the control group (OR: 2.00; 95% CI: 1.13-3.53, P = .02). However, there was no significant difference in the incidence of atrial vulnerability between the 2 groups of nonstroke patients. Subgroup analysis showed that although atrial septal abnormality increased the risk of atrial vulnerability in the subgroup of atrial septal aneurysm (OR: 1.68; 95% CI: 0.47-5.95, P = .42), the subgroup of atrial fibrillation (AF)/atrial fluster (OR: 1.81; 95% CI: 0.94-3.46, P = .07) and the subgroup of subcutaneous recording system (OR: 1.33; 95% CI: 0.68-2.61, P = .41), the difference was not statistically significant. CONCLUSIONS Atrial septal abnormalities can increase the risk of atrial vulnerability, and atrial arrhythmia caused by atrial septal abnormalities may be one of the mechanisms of CS.
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Mol D, Houterman S, Balt JC, Bhagwandien RE, Blaauw Y, Delnoy PPH, van Driel VJ, Driessen AH, Folkeringa RJ, Hassink RJ, van Huysduynen BH, Luermans JG, Ouss AJ, Stevenhagen YJ, van Veghel D, Westra SW, de Jong JS, de Groot JR. Complications in pulmonary vein isolation in the Netherlands Heart Registration differ with sex and ablation technique. Europace 2020; 23:216-225. [DOI: 10.1093/europace/euaa255] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/27/2020] [Indexed: 12/31/2022] Open
Abstract
Abstract
Aims
Pulmonary vein isolation (PVI) has become a cornerstone of the invasive treatment of atrial fibrillation. Severe complications are reported in 1–3% of patients. This study aims to compare complications and follow-up outcome of PVI in patients with atrial fibrillation.
Methods and results
The data were extracted from the Netherlands Heart Registration. Procedural and follow-up outcomes in patients treated with conventional radiofrequency (C-RF), multielectrode phased RF (Ph-RF), or cryoballoon (CB) ablation from 2012 to 2017 were compared. Subgroup analysis was performed to identify variables associated with complications and repeat ablations. In total, 13 823 patients (69% male) were included. The reported complication incidence was 3.6%. Patients treated with C-RF developed more cardiac tamponades (C-RF 0.8% vs. Ph-RF 0.3% vs. CB 0.3%, P ≤ 0.001) and vascular complications (C-RF 1.7% vs. Ph-RF 1.2% vs. CB 1.3%, P ≤ 0.001). Ph-RF was associated with fewer bleeding complications (C-RF: 1.0% vs. Ph-RF: 0.4% vs. CB: 0.7%, P = 0.020). Phrenic nerve palsy mainly occurred in patients treated with CB (C-RF: 0.1% vs. Ph-RF: 0.2% vs. CB: 1.5%, P ≤ 0.001). In total, 18.4% of patients were referred for repeat ablation within 1 year. Female sex, age, and CHA2DS2-VASc were independent risk factors for cardiac tamponade and bleeding complications, with an adjusted OR for female patients of 2.97 (95% CI 1.98–4.45) and 2.02 (95% CI 1.03–4.00) respectively.
Conclusion
The reported complication rate during PVI was low. Patients treated with C-RF ablation were more likely to develop cardiac tamponades and vascular complications. Female sex was associated with more cardiac tamponade and bleeding complications.
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Affiliation(s)
- Daniel Mol
- Department of Cardiology, OLVG, Oosterpark 9 1091 AC Amsterdam, The Netherlands
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jippe C Balt
- Department of Cardiology, St. Antonius, Nieuwegein, The Netherlands
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - Antoine H Driessen
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard J Folkeringa
- Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Justin G Luermans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexandre J Ouss
- Department of Cardiology and Cardiac Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Sjoerd W Westra
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jonas S de Jong
- Department of Cardiology, OLVG, Oosterpark 9 1091 AC Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
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Lin S, Li Y, Xu L, Lin L, Yang Y, Xie M. A giant atrial septal aneurysm causing tricuspid valvular obstruction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:503-505. [PMID: 31930731 DOI: 10.1002/jcu.22813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/29/2019] [Accepted: 01/02/2020] [Indexed: 06/10/2023]
Abstract
Atrial septal aneurysm (ASA) is a rare congenital malformation consisting of redundant atrial septal tissue that bulges into either the right or the left atrium. Here, we report the case of a 45-year-old man with a giant ASA prolapsing into the tricuspid orifice and leading to tricuspid valvular obstruction. He was treated successfully by resection of the ASA and repair of the resulting atrial septal defect. Our case indicates the utility of transthoracic, contrast, and transesophageal echocardiography to characterize a huge ASA causing tricuspid valvular obstruction.
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Affiliation(s)
- Shan Lin
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lingling Xu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ling Lin
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yali Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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8
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Role of transthoracic echocardiography in the detection of atrial septal aneurysm and intracardial shunts of PFO type in ambulatory practice. COR ET VASA 2020. [DOI: 10.33678/cor.2020.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Chen CB, Sandhu HS, Keane MG, Dass C, Whitman IR. Dramatic Aneurysmal Atrial Septum Identified with Intracardiac Echo Complicating Transseptal Puncture. CASE 2020; 4:115-118. [PMID: 32577588 PMCID: PMC7303242 DOI: 10.1016/j.case.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Atrial septal aneurysm is a largely underdiagnosed phenomenon. Septal anatomy is best delineated using intracardiac echocardiography. Septal anatomy is clinically relevant with procedures involving transseptal puncture. Atrial septal aneurysms may be associated with supraventricular tachycardias.
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10
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Abstract
Objective. This study aimed to assess the association of atrial septal aneurysm (ASA) with cardiac arrhythmias by comparing patients with ASA with a control group with non-ASA, matched for age and gender. Methods. 641 patients with ASA who fulfilled the inclusion criteria were enrolled into the study. The control group consisted of 641 patients without ASA. Patients underwent physical, electrocardiographic and transthoracic echocardiographic examinations. Additional examinations such as transesophageal echocardiography, 24-h rhythm Holter monitoring, and electrophysiological study were performed when clinically needed. Results. There were no differences between the groups in respect to baseline demographic, clinical parameters and echocardiographic parameters except ischemic stroke and smoking status. Percentages of patients suffering from atrial premature complex (APC), ventricular premature complex (VPC), supraventricular tachycardia (SVT) and paroxysmal atrial fibrillation (AF) were higher in ASA patients compared to non-ASA patients. In addition, these parameters were independently associated with the presence of ASA in logistic regression analysis. Conclusions. Certain types of arrhythmias such as APC, VPC, SVT and paroxysmal AF have been shown to be independently associated with the presence of ASA.
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Affiliation(s)
- Ertan Yetkin
- Department of Cardiology, Istinye University Liv Hospital, Istanbul, Turkey
| | - Mehmet Ileri
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Ahmet Korkmaz
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Selcuk Ozturk
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
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Savenkov MP, Ivanov SN, Mikhaylusova MP, Borschevskaya MV, Savenkova AM, Kozachenko NY, Sherifova ES. The Study of the Fixed Dose Combination of Lisinopril with Prolonged Indopamide (FIXLINDA) with Daily Blood Pressure Monitoring and Diuresis in Hypertensive Patients. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-4-510-517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Аim. To study the efficacy, tolerability and safety of using a fixed dose combination of an ACE inhibitor lisinopril with a prolonged-action diuretic indapamide in patients with degree 1-2 hypertension.Material and methods. Patients (n = 32) with uncontrolled 1-2 degrees hypertension, moderate or high cardiovascular risk, without severe comorbid diseases, who were prescribed a fixed dose combination of lisinopril (5, 10 or 20 mg) and indapamide (1.5 mg) were included in the observational study. All patients had home monitoring of blood pressure and diuresis, as well as assessment of subjective tolerance of treatment and registration of adverse events within 3 months of observation. Assessment of changes in circadian fluctuations in blood pressure and diuresis, the frequency of achieving the target blood pressure at the outpatient stage, as well as the subjective tolerance of treatment and adverse events during a three-month follow-up.Results. Target blood pressure was achieved in 44.5% of patients taking the fixed dose combination of lisinopril 5 mg + prolonged-acting indapamide1.5 mg; 76.9% – in patients taking the combination of lisinopril 10 mg + indapamide 1.5 mg; 78,6% – in patients taking the combination of lisinopril 20 mg + indapamide 1.5 mg. The achieved antihypertensive effect was characterized by daily circadian stability, accompanied by an improvement in the initially impaired day and night diuretic profile (increase in the share of daytime diuresis by 29.6% and 22.3% with a decrease in the share of nighttime diuresis by 35% and 49% when using a combination with lisinopril 5 and 10 mg, respectively). The treatment was well tolerated by patients and did not cause the development of serious adverse events. Reported adverse events (non-intense dry cough, headache, general weakness) were transient and did not require correction or withdrawal of treatment.Conclusion. The fixed dose combination of the ACE inhibitor lisinopril (5, 10 or 20 mg) and the long-acting thiazide-like diuretic indapamide (1.5 mg) had good antihypertensive efficacy with improved circadian blood pressure and diuresis profiles, acceptable tolerance and safety of treatment, as well as a simple choice of doses of the drug components.
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Affiliation(s)
| | - S. N. Ivanov
- War Veterans Hospital No.2 of the Moscow Health Department
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Ryazantseva OV, Lenkova NI, Ostroumova OD, Shikh EV, Rykova SM. Atrial Septal Aneurysm in Adult Patients of Therapeutic Hospital. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-4-518-523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To study detection of atrial septal aneurysm (ASA) by transthoracic echocardiography in patients of the older age group of the therapeutic hospital, as well as combinations with other structural disorders of the heart and blood vessels, as well as other signs of congenital connective tissue dysplasia (CCTD) of other localization.Material and methods. Identification of ASA as well as other signs of CCTD was performed in patients ≥40 years hospitalized due to exacerbation of therapeutic diseases (n=1119), which had transthoracic echocardiography.Results. ASA was found in 1.34% of patients (n=15). Undifferentiated connective tissue dysplasia was diagnosed in 14 (93.3%) ASA patients. Prolapse of mitral (60%), tricuspid (33.3%) or both atrio-ventricular valves of the heart (6.7%), patent foramen ovale (33.3%), rudimentary Eustachian valve (6.7%), additional ventricle chords (13.3%), Valsalva sinus dilation (6.7%) was found in ASA patients. 14 (93.3%) patients had electrocardiography signs of cardiac rhythm and conduction disorders. Chronic venous insufficiency (100%), disorders of the musculoskeletal system (100%), hiatal hernia (40%), anterior abdominal wall hernia (46.7%), nephroptosis (46.7%), kidney cysts (33.3%) intestinal diverticula and dolichosigma (26.7%), bronchiectasis (6.7%) were also found.Conclusion. ASA was found in 1.34% of patients in a therapeutic hospital ≥40 years. Clinically significant and prognostically unfavorable CCTDs were not found in ASA patients in this study. However, physicians should consider the possibility of the presence of other abnormalities of the heart and large vessels, as well as other systems and organs that can lead to fatal events, in these patients.
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Affiliation(s)
- O. V. Ryazantseva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. I. Lenkova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - O. D. Ostroumova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. V. Shikh
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - S. M. Rykova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Bell K, Abu-Heija A, Smith A, Nnodim I. Atrial septal aneurysm with rare comorbid pulmonary arteriovenous malformation as aetiology for cryptogenic stroke. BMJ Case Rep 2019; 12:12/6/e229282. [PMID: 31248896 DOI: 10.1136/bcr-2019-229282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Atrial septal aneurysms have two mechanisms for cardioembolic events. One is the aneurysm itself can act as a nidus for thrombus formation in the left atrium. The aneurysm creates an area of low turbulence leading to haemostasis allowing fibrin-platelet adhesions to form. If the clot is on the left atrial wall, it may be dislodged by oscillations of the septum and travel into the systemic circulation. The second mechanism is via, an often comorbid, interatrial shunt such as a Patent Foramen Ovale or Atrial Septal Defect. We report a unique case where the associated right to left shunt leading to the cryptogenic stroke is a pulmonary arteriovenous malformation.
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Affiliation(s)
- Kendall Bell
- Internal Medicine, Wayne State University Physician Group, Detroit, Michigan, USA
| | - Ahmad Abu-Heija
- Internal Medicine, Wayne State University Physician Group, Detroit, Michigan, USA
| | - Antonio Smith
- Internal Medicine, Wayne State University Physician Group, Detroit, Michigan, USA
| | - Ijeoma Nnodim
- Internal Medicine and Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, USA
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Echocardiographic Findings in Patients with Atrial Septal Aneurysm: A Prospective Case-Control Study. Cardiol Res Pract 2019; 2019:3215765. [PMID: 31061729 PMCID: PMC6466951 DOI: 10.1155/2019/3215765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/12/2019] [Accepted: 02/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background Atrial septal aneurysm (ASA) is a congenital deformity of the interatrial septum with a prevalence of 1-2% in the adult population. Although ASA has been supposed to be an incidental finding in echocardiographic examination, its structural and clinical associations have gained an increasing interest. Aim To investigate and compare the clinical features and echocardiographic parameters between ASA patients and age- and gender-matched control group patients. Methods 410 patients with ASA were enrolled in the study, prospectively. After the exclusion of 33 patients, the remaining 377 patients comprised the study group. The control group consisted of 377 age- and gender-matched patients without ASA. Results Aortic valve regurgitation and mitral valve regurgitation were more often observed in patients with ASA, and percentages of patients with ascending aortic aneurysm (AAA), patent foramen ovale (PFO), and atrial septal defect (ASD) were higher in ASA patients compared to control group patients. Aortic root diameter was larger in ASA patients compared to control group patients (29.2 ± 3.9, 28.6 ± 3.1, p=0.05, respectively). Ascending aorta diameter was higher in ASA patients compared to patients without ASA (44 ± 0.3, 41.5 ± 0.2, p=0.02). Logistic regression analysis revealed that mitral valve regurgitation (OR: 2.05, 95% CI : 1.44–2.92, p < 0.001) and PFO (OR: 11.62, 95% CI : 2.64–51.02, p=0.001) were positively and independently associated with the presence of ASA. AAA tended to be statistically and independently associated with ASA (OR: 2.69, 95% CI : 0.97–7.47, p=0.05). Conclusions We have demonstrated a higher incidence of mitral/aortic valvular regurgitations, AAA, PFO, and ASD in ASA patients compared to age- and gender-matched control group patients. In addition, we have shown that ASA is significantly and positively associated with mild mitral regurgitation and PFO.
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15
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Yetkin E, Ozturk S. Cardiac Complications in Behçet's Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2165-2166. [PMID: 30054022 DOI: 10.1016/j.ultrasmedbio.2018.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 02/10/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Ertan Yetkin
- Department of Cardiology, Yenisehir Hospital, Mersin, Turkey
| | - Selcuk Ozturk
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
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16
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Dilating Vascular Diseases: Pathophysiology and Clinical Aspects. Int J Vasc Med 2018; 2018:9024278. [PMID: 30225143 PMCID: PMC6129317 DOI: 10.1155/2018/9024278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/29/2018] [Indexed: 01/22/2023] Open
Abstract
Atherosclerotic disease of the vessels is a significant problem affecting mortality and morbidity all over the world. However, dilatation of the vessels either in the arterial system or in the venous territory is another vessel disease. Varicocele, pelvic, and peripheral varicose veins and hemorrhoids are aneurysms of the venous vascular regions and have been defined as dilating venous disease, recently. Coronary artery ectasia, intracranial aneurysm, and abdominal aortic aneurysm are examples of arterial dilating vascular diseases. Mostly, they have been defined as variants of atherosclerosis. Although there are some similarities in terms of pathogenesis, they are distinct from atherosclerotic disease of the vessels. In addition, pathophysiological and histological similarities and clinical coexistence of these diseases have been demonstrated both in the arterial and in the venous system. This situation underlies the thought that dilatation of the vessels in any vascular territory should be considered as a systemic vessel wall disease rather than being a local disease of any vessel. These patients should be evaluated for other dilating vascular diseases in a systematic manner.
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17
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Sun F, Fan M, Li Y, Ren W, Chen Y. Multiperforated atrial septal "aneurysm in aneurysm": Percutaneous closure guided by real-time three-dimensional transesophageal echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:421-423. [PMID: 29080307 DOI: 10.1002/jcu.22549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/24/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
Abstract
Atrial septal aneurysm (ASA) is a localized deformity of the interatrial septum, which protrudes into the right and/or left atrium. ASA with defects is a source of cardiac embolism. Although transcatheter closure is now a common procedure, it is still challenging in patients with complicated ASA. We describe a case of giant atypical multiperforated ASA with irregular mobility, which showed a rare "aneurysm in aneurysm" structure. Real-time three-dimensional transesophageal echocardiography showed vivid images, which clearly demonstrated these irregular shaped defects mimicking the atriotomy view, and played a crucial role in guiding the transcatheter closure.
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Affiliation(s)
- Feifei Sun
- Department of Ultrasonography, Shengjing Hospital, China Medical University, Shenyang, China
| | - Miao Fan
- Department of Ultrasonography, Shengjing Hospital, China Medical University, Shenyang, China
| | - Ying Li
- Department of Ultrasonography, Shengjing Hospital, China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasonography, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yanli Chen
- Department of Cardiology, Shengjing Hospital, China Medical University, Shenyang, China
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18
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Güvenç TS, Güzelburç Ö, Asarcikli LD, Can F, Çetin Güvenç R, Eren M. An unusual "mass" within the left atrium: Localized aneurysm of a patent foramen ovale tunnel. Echocardiography 2018; 35:755-756. [PMID: 29577427 DOI: 10.1111/echo.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Masses on the interatrial septum are usually caused by myxomas or thrombi within a patent foramen ovale. We report a 53-year-old male patient with a hollow mass within the left atrium that was incidentally found during a routine transthoracic echocardiography. Further investigation of the mass with transesophageal two- and three-dimensional echocardiography has revealed that the mass was a localized aneurysm of a patent foramen ovale tunnel. While aneurysms of interatrial septum are relatively common in normal population, to the best of our knowledge, present case is the first report of a localized aneursym of a patent foramen ovale tunnel.
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Affiliation(s)
- Tolga S Güvenç
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Özge Güzelburç
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Lale Dinç Asarcikli
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Fatma Can
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Rengin Çetin Güvenç
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Eren
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
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