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Alexandre A, Sá-Couto D, Campinas A, Santos M, Baggen-Santos R, Brochado B, Silveira J, Torres S, Luz A. Concomitant high-risk pulmonary embolism and paradoxical ischemic stroke: aspiration thrombectomy as a treatment option. Kardiol Pol 2023:VM/OJS/J/94493. [PMID: 36999726 DOI: 10.33963/kp.a2023.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 04/01/2023]
Affiliation(s)
- André Alexandre
- Department of Cardiology, Porto University Hospital Center, Portugal.
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
| | - David Sá-Couto
- Department of Cardiology, Porto University Hospital Center, Portugal
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Andreia Campinas
- Department of Cardiology, Porto University Hospital Center, Portugal
| | - Mariana Santos
- Department of Cardiology, Porto University Hospital Center, Portugal
| | - Raquel Baggen-Santos
- Department of Cardiology, Porto University Hospital Center, Portugal
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Bruno Brochado
- Department of Cardiology, Porto University Hospital Center, Portugal
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - João Silveira
- Department of Cardiology, Porto University Hospital Center, Portugal
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Severo Torres
- Department of Cardiology, Porto University Hospital Center, Portugal
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - André Luz
- Department of Cardiology, Porto University Hospital Center, Portugal
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- Cardiovascular Research Group, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
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Dias-Frias A, Costa R, Campinas A, Alexandre A, Sá-Couto D, Sousa MJ, Roque C, Vieira P, Lagarto V, Reis H, Torres S. Right Ventricular Septal Versus Apical Pacing: Long-Term Incidence of Heart Failure and Survival. J Cardiovasc Dev Dis 2022; 9:jcdd9120444. [PMID: 36547441 PMCID: PMC9786931 DOI: 10.3390/jcdd9120444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
The clinical benefits of right ventricular septal (RVS) pacing compared to those of right ventricular apical (RVA) pacing are still in debate. We aimed to compare the incidence of heart failure (HF) and all-cause mortality in patients submitted to RVS and RVA pacing during a longer follow-up. This a single-center, retrospective study analysis of consecutive patients submitted to pacemaker implantation. The primary outcome was defined as the occurrence of HF during follow-up. The secondary outcome was all-cause death. A total of 251 patients were included, 47 (18.7%) with RVS pacing. RVS pacing was associated to younger age, male gender, lower body mass index, ischemic heart disease, and atrial fibrillation. During a follow-up period of 5.2 years, the primary outcome occurred in 89 (37.1%) patients. RVS pacing was independently associated with a 3-fold lower risk of HF, after adjustment. The secondary outcome occurred in 83 (34.2%) patients, and pacemaker lead position was not a predictor. Fluoroscopy time and rate of complications (rarely life-threatening) were similar in both groups. Our study points to a potential clinical benefit of RVS positioning, with a 3.3-fold lower risk of HF, without accompanying increase in procedure complexity nor complication rate.
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Alexandre A, Vieira P, Dias-Frias A, Pereira A, Campinas A, Sá-Couto D, Brochado B, Sá I, Silveira J, Torres S. Myocardial Bridging Leading to Cardiac Collapse in a Marathon Runner. J Cardiovasc Dev Dis 2022; 9:jcdd9070200. [PMID: 35877561 PMCID: PMC9317123 DOI: 10.3390/jcdd9070200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 02/01/2023] Open
Abstract
Myocardial bridging (MB) is a congenital coronary anomaly, which is defined as cardiac muscle overlying a portion of a coronary artery. Although traditionally considered benign in nature, increasing attention is being given to specific subsets of MB. Sports medicine recognizes MB as a cause of sudden death among young athletes. We present a case of a 30-year-old man who suddenly collapsed during a marathon running. Diagnostic workup with coronary computed tomography angiography revealed the presence of three simultaneous myocardial bridges in this patient, possibly explaining the exercise-induced syncope. The other diagnostic tests excluded seizures, cranioencephalic lesions, ionic or metabolic disturbances, acute coronary syndromes, cardiomyopathies, myocarditis, or conduction disturbances. Exertional syncope is a high-risk complaint in the marathon runner. In the context of intense physical activity, the increased sympathetic tone leading to tachycardia and increased myocardial contractility facilitates MB ischemia. In this illustrative case, the patient’s syncope might probably be associated with an ischemia-induced arrhythmia secondary to MB and potentiated by dehydration in the context of prolonged stress (marathon running). In conclusion, this case highlights that MB may be associated with dangerous complications (myocardial ischemia and life-threatening ventricular arrhythmias), particularly during intense physical activity and in the presence of a long myocardial bridge.
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Affiliation(s)
- André Alexandre
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
- Correspondence: or
| | - Pinheiro Vieira
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - André Dias-Frias
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
| | - Anaisa Pereira
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
| | - Andreia Campinas
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - David Sá-Couto
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - Bruno Brochado
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - Isabel Sá
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
| | - João Silveira
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - Severo Torres
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
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