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Heart and Vessels Jan 2022Absent pulmonary valve (APV) syndrome with tricuspid atresia or tricuspid stenosis (TA/TS) is an extremely rare malformation recently reported as a variant of APV with...
Absent pulmonary valve (APV) syndrome with tricuspid atresia or tricuspid stenosis (TA/TS) is an extremely rare malformation recently reported as a variant of APV with intact ventricular septum (VS). The condition, however, has univentricular physiology and unique structural and clinical features. The purpose of this study was to update the current knowledge about this condition by describing long-term outcomes of three new cases and reviewing the available literatures. A systematic literature search was performed to collect clinical and anatomical data of APV with TA/TS. Institutional medical records were retrospectively reviewed to identify APV with TA/TS patients. In a total of 62 (59 reported and 3 new) cases, patent ductus arteriosus was present in 98% of APV patients with TA/TS. A large ventricular septal defect, dilatation of the pulmonary arteries, which is typically found in APV with tetralogy of Fallot, and respiratory distress at birth were rarely reported. Most of the recent cases were successfully managed by the Glenn or Fontan procedure. Coronary artery anomaly and ventricular arrhythmia were more frequently reported as the cause of death or severe neurological sequelae (9/16 and 3/8, respectively). Additional surgical intervention was required in the mid/long-term period in three cases due to left-ventricular outflow obstruction and in two due to aortic dilatation. The Fontan and Glenn procedures improved the survival in the last two decades. In addition to coronary artery anomaly and ventricular arrhythmia, left-ventricular outflow tract obstruction and aortic dilatation should be carefully monitored.
Topics: Constriction, Pathologic; Humans; Pulmonary Atresia; Pulmonary Valve; Retrospective Studies; Tricuspid Atresia
PubMed: 34089363
DOI: 10.1007/s00380-021-01887-y -
Cureus Jan 2023Endobronchial malignancies with significant airway obstruction can lead to multiple complications including pneumonia, and atelectasis over a period of time. Various... (Review)
Review
Endobronchial malignancies with significant airway obstruction can lead to multiple complications including pneumonia, and atelectasis over a period of time. Various intraluminal treatments have proven their value in palliative treatment for advanced malignancies. Nd:YAG (neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12) laser has established its role as a major palliative intervention due to its minimal side effects and improvement in quality of life by relieving local symptoms. The systematic review was conducted with the goal of elucidating the patient characteristics, pre-treatment parameters, clinical outcomes, and possible complications resulting from the use of the Nd:YAG laser. A thorough literature search for relevant studies was conducted on PubMed, Embase, and Cochrane Library from the inception of the idea to November 24, 2022. Our study included all original studies including retrospective studies and prospective trials, but excluded case reports, case series with less than 10 patients, and studies with incomplete or irrelevant data. A total of 11 studies were included in the analysis. The primary outcomes focused on the evaluation of pulmonary functional tests, postprocedural stenosis, blood gas parameters after the procedure, and survival outcomes. Improvement in clinical status, improvement in objective scale for dyspnea, and complications were the secondary outcomes. Our study shows that Nd:YAG laser treatment is an effective form of palliative treatment to provide subjective and objective improvement in patients with advanced and inoperable endobronchial malignancies. Due to the heterogeneous study populations in the studies reviewed and the presence of many limitations, more studies are still warranted to reach a definitive conclusion.
PubMed: 36874755
DOI: 10.7759/cureus.34434 -
Rheumatology International Jun 2023VEXAS (vacuoles, E1 enzyme, X-linked, auto-inflammatory, somatic) syndrome is a newly described auto-inflammatory disease. Many cases feature pulmonary infiltrates or...
BACKGROUND
VEXAS (vacuoles, E1 enzyme, X-linked, auto-inflammatory, somatic) syndrome is a newly described auto-inflammatory disease. Many cases feature pulmonary infiltrates or respiratory failure. This systematic review aimed to summarize respiratory manifestations in VEXAS syndrome described to date.
METHODS
Databases were searched for articles discussing VEXAS syndrome until May 2022. The research question was: What are the pulmonary manifestations in patients with VEXAS syndrome? The search was restricted to English language and those discussing clinical presentation of disease. Information on basic demographics, type and prevalence of pulmonary manifestations, co-existing disease associations and author conclusions on pulmonary involvement were extracted. The protocol was registered on the PROSPERO register of systematic reviews.
RESULTS
Initially, 219 articles were retrieved with 36 ultimately included (all case reports or series). A total of 269 patients with VEXAS were included, 98.6% male, mean age 66.8 years at disease onset. The most frequently described pulmonary manifestation was infiltrates (43.1%; n = 116), followed by pleural effusion (7.4%; n = 20) and idiopathic interstitial pneumonia (3.3%; n = 9). Other pulmonary manifestations were: nonspecific interstitial pneumonia (n = 1), bronchiolitis obliterans (n = 3), pulmonary vasculitis (n = 6), bronchiectasis (n = 1), alveolar haemorrhage (n = 1), pulmonary embolism (n = 4), bronchial stenosis (n = 1), and alveolitis (n = 1). Several patients had one or more co-existing autoimmune/inflammatory condition. It was not reported which patients had particular pulmonary manifestations.
CONCLUSION
This is the first systematic review undertaken in VEXAS patients. Our results demonstrate that pulmonary involvement is common in this patient group. It is unclear if respiratory manifestations are part of the primary disease or a co-existing condition. Larger epidemiological analyses will aid further characterisation of pulmonary involvement and disease management.
Topics: Aged; Female; Humans; Male; Autoimmune Diseases; Bronchiectasis; Mutation; Pleural Effusion; Vacuoles
PubMed: 36617363
DOI: 10.1007/s00296-022-05266-2 -
Current Problems in Cardiology Oct 2023Twelve CCI patients were studied with confirmed or suspected COVID-19 infection. The majority of these patients were males (83.3%) with a median age of 55 years from... (Review)
Review
Twelve CCI patients were studied with confirmed or suspected COVID-19 infection. The majority of these patients were males (83.3%) with a median age of 55 years from three geographical locations, constituting the Middle East (7), Spain (3), and the USA (1). In 6 patients, IgG/IgM was positive for COVID-19, 4 with high pretest probability and 2 with positive RT-PCR. Type 2 DM, hyperlipidemia, and smoking were the primary risk factors. Right-sided neurological impairments and verbal impairment were the most common symptoms. Our analysis found 8 (66%) synchronous occurrences. In 58.3% of cases, neuroimaging showed left Middle Cerebral Artery (MCA) infarct and 33.3% right. Carotid artery thrombosis (16.6%), tandem occlusion (8.3%), and carotid stenosis (1%) were also reported in imaging. Dual antiplatelet therapy (DAPT) and anticoagulants were conservative therapies (10). Two AMI patients had aspiration thrombectomy, while three AIS patients had intravenous thrombolysis/tissue plasminogen activator (IVT-tPA), 2 had mechanical thrombectomy (MT), and 1 had decompressive craniotomy. Five had COVID-19-positive chest X-rays, whereas 4 were normal. four of 8 STEMI and 3 NSTEMI/UA patients complained chest pain. LV, ICA, and pulmonary embolism were further complications (2). Upon discharge, 7 patients (70%) had residual deficits while 1 patient unfortunately died.
Topics: Female; Humans; Male; Middle Aged; Anticoagulants; COVID-19; Infarction, Middle Cerebral Artery; Stroke; Thrombectomy; Thrombolytic Therapy; Tissue Plasminogen Activator; Treatment Outcome; Case Reports as Topic
PubMed: 37209804
DOI: 10.1016/j.cpcardiol.2023.101814 -
International Journal of Cardiology Oct 2018The 30-day all-cause readmission rate after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) vary substantially. We conducted a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The 30-day all-cause readmission rate after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) vary substantially. We conducted a systematic review and meta-analysis to examine the overall incidence, causes, and risk factors of 30-day all-cause readmission rate after SAVR and TAVR.
METHODS
Eight medical research databases were searched; Cochrane, Medline, Embase, UpToDate, PROSPERO, National Guideline Clearinghouse, SweMed and Oria. We followed The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) for this study.
RESULTS
Thirty-three articles were included in the systematic review, 32 of which were appropriate for the meta-analysis. Overall, 17% (95% CI: 16-18%) of patients in the SAVR group, and 16% (95% CI: 15-18%) in the TAVR groups were readmitted within 30 days. Heart failure, arrhythmia, infection, and respiratory problems were the most frequent causes of all-cause readmission after SAVR and TAVR. Most frequent reported prior risk factors for all-cause readmission following TAVR were diabetes, chronic lung disease/chronic obstructive pulmonary disease, atrial fibrillation, kidney problems, and transapical approach/nonfemoral access. For SAVR, no risk factors for 30-day all-cause readmission were reported in the literature to date.
CONCLUSION
In conclusion, the overall proportion of 30-day all-cause readmission after SAVR and TAVR are high. Interventions to prevent avoidable readmissions ought to be developed and implemented.
Topics: Cohort Studies; Humans; Patient Readmission; Postoperative Complications; Prospective Studies; Time Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 29779575
DOI: 10.1016/j.ijcard.2018.05.026 -
Annals of Internal Medicine Nov 2016Atherosclerotic renal artery stenosis (ARAS) is associated with high blood pressure (BP), decreased kidney function, renal replacement therapy (RRT), and death. (Review)
Review
BACKGROUND
Atherosclerotic renal artery stenosis (ARAS) is associated with high blood pressure (BP), decreased kidney function, renal replacement therapy (RRT), and death.
PURPOSE
To compare benefits and harms of percutaneous transluminal renal angioplasty with stent placement (PTRAS) versus medical therapy alone in adults with ARAS.
DATA SOURCES
MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1993 to 16 March 2016; gray literature; and prior systematic reviews.
STUDY SELECTION
Randomized, controlled trials (RCTs); nonrandomized, comparative studies (NRCSs); single-group studies; and selected case reports that reported all-cause and cardiovascular mortality, RRT, kidney function, BP, and adverse events.
DATA EXTRACTION
Six researchers extracted data on design, interventions, outcomes, and study quality into a Web-based database.
DATA SYNTHESIS
Eighty-three studies met eligibility criteria. In 5 of 7 RCTs, PTRAS and medical therapy led to similar BP control in patients with ARAS, and no RCTs showed statistically significant differences in kidney function, mortality, RRT, cardiovascular events, or pulmonary edema. Eight NRCSs had more variable results, finding mostly no significant differences in mortality, RRT, or cardiovascular events but heterogeneous effects on kidney function and BP. Procedure-related adverse events were rare, and medication-related adverse events were not reported. Two RCTs found no patient characteristics that were associated with outcomes with either PTRAS or medical therapy. Single-group studies found various but inconsistent factors that predict outcomes. Case reports provided examples of clinical improvement after PTRAS in patients with acute decompensation.
LIMITATION
Limited clinical applicability and power in RCTs, and possible publication bias and lack of adjusted analyses in NRCSs.
CONCLUSION
The strength of evidence regarding the relative benefits and harms of PTRAS versus medical therapy alone for patients with ARAS is low. Studies have generally focused on patients with less severe ARAS.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Adult; Angioplasty; Antihypertensive Agents; Comparative Effectiveness Research; Humans; Hypertension; Renal Artery Obstruction; Renal Insufficiency; Stents
PubMed: 27536808
DOI: 10.7326/M16-1053 -
Annals of Surgery Mar 2024Ischemia at the anastomotic site plays a critical role determinant in the development of anastomosis-related complications after esophagectomy. Gastric ischemic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ischemia at the anastomotic site plays a critical role determinant in the development of anastomosis-related complications after esophagectomy. Gastric ischemic conditioning (GIC) before esophagectomy has been described to improve the vascular perfusion at the tip of the gastric conduit with a potential effect on anastomotic leak (AL) and stenosis (AS) risk minimization. Laparoscopic (LapGIC) and angioembolization (AngioGIC) techniques have been reported.
PURPOSE
Compare short-term outcomes among different GIC techniques.
MATERIALS AND METHODS
Systematic review and network meta-analysis. One-step esophagectomy (noGIC), LapGIC, and AngioGIC were compared. Primary outcomes were AL, AS, and gastric conduit necrosis (GCN). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrIs) were used to assess relative inference.
RESULTS
Overall, 1760 patients (14 studies) were included. Of those, 1028 patients (58.4%) underwent noGIC, 593 (33.6%) LapGIC, and 139 (8%) AngioGIC. AL was reduced for LapGIC versus noGIC (RR=0.68; 95% CrI 0.47-0.98) and AngioGIC versus noGIC (RR=0.52; 95% CrI 0.31-0.93). Similarly, AS was reduced for LapGIC versus noGIC (RR=0.32; 95% CrI 0.12-0.68) and AngioGIC versus noGIC (RR=1.30; 95% CrI 0.65-2.46). The indirect comparison, assessed with the network methodology, did not show any differences for LapGIC versus AngioGIC in terms of postoperative AL and AS risk. No differences were found for GCN, pulmonary complications, overall complications, hospital length of stay, and 30-day mortality among different treatments.
CONCLUSIONS
Compared to noGIC, both LapGIC and AngioGIC before esophagectomy seem equivalent and associated with a reduced risk for postoperative AL and AS.
Topics: Humans; Esophagectomy; Network Meta-Analysis; Stomach; Ischemic Preconditioning; Anastomotic Leak; Anastomosis, Surgical; Ischemia; Esophageal Neoplasms
PubMed: 37830253
DOI: 10.1097/SLA.0000000000006124 -
International Journal of Surgery... Jun 2022Totally laparoscopic total gastrectomy for gastric cancer is limited to few expert surgeons, and a reason for this is the technical difficulty of performing... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Totally laparoscopic total gastrectomy for gastric cancer is limited to few expert surgeons, and a reason for this is the technical difficulty of performing esophagojejunostomy laparoscopically. Overlap has acted as a more popular reconstruction method in recent years; however, its clinical outcomes are inconclusive. Thus, this meta-analysis aimed to provide a higher level of evidence to demonstrate the safety and effectiveness of overlap esophagojejunostomy in totally laparoscopic total gastrectomy.
MATERIALS AND METHODS
PubMed, Embase, Cochrane Library, and Web of Science databases were searched up to November 2021 for published English literature on retrospective research, prospective research, and randomized controlled trials of overlap anastomosis versus other anastomoses. Basic information and observation indicators of the included articles were extracted. The Cochrane Risk of Bias tool was used by the same researchers to independently assess the risk of bias in the included randomized controlled trials and evaluate the quality of cohort studies using the Newcastle-Ottawa scale. Review Manager 5.3 was used to produce forest plots for meta-analysis, funnel plots were used to assess publication bias, and sensitivity analysis was performed to evaluate result stability.
RESULTS
Overall, 1534 patients from 12 studies were included in this study (738 in and 796 in the overlap and non-overlap groups, respectively). Meta-analysis of the inclusion indicators showed a lower incidence of anastomotic stenosis (OR = 0.19, 95% confidence interval [CI]: 0.09 to 0.41, P < 0.0001) compared with other anastomosis methods, with significant differences in both groups. However, no significal differences were noted between the two groups with respect to operative time (WMD = 13.79, 95% CI: -5.41 to 32.98, P = 0.16), anastomotic time (WMD = 7.18,95% CI: -5.34 to 19.69, P = 0.26), intraoperative blood loss (WMD = 19.96, 95% CI: -17.80 to 57.72, P = 0.30), number of retrieved lymph nodes (WMD = -1.33, 95% CI: -6.24 to 3.57, P = 0.59), time to first flatus (WMD = -0.11, 95% CI: -0.25 to 0.04, P = 0.14), postoperative hospital stay (WMD = -0.09, 95% CI: -1.59 to 1.41, P = 0.90), anastomotic leak (OR = 1.23, 95% CI: 0.67 to 2.27, P = 0.50), anastomotic bleeding (OR = 0.87, 95% CI: 0.28 to 2.67, P = 0.80), postoperative pulmonary infection (OR = 0.94, 95% CI: 0.34 to 2.57, P = 0.90), and mortality (OR = 1.33, 95% CI: 0.27 to 6.48, P = 0.72).
CONCLUSIONS
Overlap esophagojejunostomy is a safe and effective procedure during totally laparoscopic total gastrectomy. It is superior to other types of anastomosis in reducing anastomotic stenosis rates.
Topics: Anastomosis, Surgical; Constriction, Pathologic; Gastrectomy; Humans; Laparoscopy; Postoperative Complications; Prospective Studies; Retrospective Studies; Stomach Neoplasms; Treatment Outcome
PubMed: 35598735
DOI: 10.1016/j.ijsu.2022.106684 -
Journal of Cardiology Aug 2024Assessment of right ventricular (RV) function in aortic stenosis (AS) may improve risk stratification. However, whether the prognostic value of RV free-wall longitudinal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Assessment of right ventricular (RV) function in aortic stenosis (AS) may improve risk stratification. However, whether the prognostic value of RV free-wall longitudinal strain (RVfwLS) is better than that of other right heart or pulmonary circulation parameters remains uncertain. This study assessed and compared the prognostic value of RVfwLS with traditional parameters in the AS population using a systematic review and meta-analysis.
METHODS
We selected studies reporting the hazard ratio (HR) of RVfwLS in patients with AS. We also collected data regarding the HR of systolic pulmonary arterial pressure (SPAP), fractional area change (FAC), and tricuspid annulus plane systolic excursion (TAPSE). To ensure comparability, we standardized the HR using within-study standard deviations. The comparison between the prognostic value of RVfwLS and other parameters was conducted as a ratio of HR.
RESULTS
This meta-analysis included 9 studies comprising a total of 2547 patients, with 679 events. The pooled HR of RVfwLS was 1.56 (95 % CI: 1.39-1.75, p < 0.001). When examining the ratio of HR between RVfwLS and conventional parameters, all comparisons were statistically non-significant [RVfwLS/SPAP: 1.28 (95 % CI: 0.99-1.65, p = 0.06); RVfwLS/FAC: 1.24 (95 % CI: 0.90-1.72, p = 0.14); and RVfwLS/TAPSE:1.07 (95 % CI: 0.75-1.52, p = 0.60)].
CONCLUSIONS
This meta-analysis establishes a substantial association between RVfwLS and adverse outcomes in the AS population. However, comparative analysis between RVfwLS and SPAP, FAC, or TAPSE did not support the prognostic superiority of RVfwLS.
Topics: Humans; Aortic Valve Stenosis; Prognosis; Ventricular Function, Right; Heart Ventricles; Ventricular Dysfunction, Right; Echocardiography
PubMed: 38043709
DOI: 10.1016/j.jjcc.2023.11.008 -
Journal of the Saudi Heart Association Oct 2010Patients referred for aortic valve replacement are often elderly and may have increased surgical risk associated with ascending aortic calcification, left ventricular...
Patients referred for aortic valve replacement are often elderly and may have increased surgical risk associated with ascending aortic calcification, left ventricular dysfunction, presence of coronary artery disease, previous surgery, and/or presence of several co-morbidities. Some of these patients may not be considered candidates for conventional surgery because of their high risk profile. While transcatheter aortic valve replacement constitutes a widely accepted alternative, some patients may not be eligible for this modality due to anatomic factors. Apico-Aortic Conduit (AAC) insertion (aortic valve bypass surgery) constitutes a possible option in those patients. Apico-Aortic Conduit is not a new technique, as it has been used for decades in both pediatric and adult populations. However, there is a resurging interest in this technique due to the expanding scope of elderly patients being considered for the treatment of aortic stenosis. Herein, we describe our surgical technique and provide a systematic review of recent publications on AAC insertion, reporting that there is continued use and several modifications of this technique, such as performing it through a small thoracotomy without the use of the cardiopulmonary bypass.
PubMed: 23960619
DOI: 10.1016/j.jsha.2010.06.003