Rodriguezegeberg6374

Chronic mesenteric ischemia is an uncommon disorder in the USA. Frequently, a percutaneous approach is the first therapeutic choice to reduce its symptoms and improve outcomes. After an initial treatment with stents, further interventions might be necessary to address in-stent restenosis and re-establish a better visceral flow. Using laser atherectomy in a similar fashion as used in the peripheral arteries, has proven to be safe helping to achieve a desired final result. We present a case of chronic mesenteric ischemia in a 53-year-old man caused by severe in-stent restenosis who had abdominal pain and weight loss. We used a 0.9 mm laser catheter with low energy and pulse rate as an adjunct to balloon therapy. After revascularization, the patient's symptoms improved dramatically. To the best of our knowledge, this is the first published case in which atherectomy with laser was used to treat severe in-stent restenosis of a mesenteric vessel in chronic mesenteric ischemia. Learning Objective The treatment of severe in-stent restenosis of the superior mesenteric artery using laser atherectomy is safe and can give excellent results when traditional percutaneous therapies fail. © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.A 58-year-old male with gangrene in his left 1st digit due to critical limb ischemia had undergone endovascular therapy for chronic total occlusion of the left superficial femoral artery using bare-metal stents (BMSs). Angiography revealed in-stent occlusion of the BMS site when he was referred to our hospital with a recurrent ulcer at 7 years after stent implantation. As catheter-directed thrombolysis with urokinase was not effective, surgical thrombectomy was performed. His ankle-brachial index improved, and the ulcer was completely healed after thrombectomy. Pathological evaluation of the retrieved thrombi showed that it consisted of a massive erythrocyte, abundant fibrin precipitation, and fragments of atherosclerotic plaques, such as foamy macrophages and ghost images thought to be cholesterol crystals. These findings suggested that the neoatherosclerotic changes in the neointima gradually occurred in the stented segment, and neointimal disruption potentially caused the intrastent thrombotic occlusion. . © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Isolated unilateral absence of the pulmonary artery (UAPA) is a congenital anomaly where involution of the extrapulmonary PA is insufficient and the intrapulmonary PA is only fed by the ductus arteriosus. Affected lung disorder causes complications years after ductus closure; thus, early diagnosis is of importance to avoid these complications. Here, we present the case of a male infant who was admitted to the neonatal intensive care unit because of transient tachypnea of the newborn and absence of the left PA (LPA) was indicated. Intensive echocardiography could detect neither the LPA nor the aortopulmonary collateral arteries to the left lung. Although the ductus was orthotopic with the right aortic arch, use of prostaglandin (PG) E1 unmasked the diagnosis of UAPA with bilateral ductus arteriosus. After ductal closure, delineation of the anatomy is not necessarily easy even with catheterization, whereas early use of PGE1 facilitates anatomical understanding by echocardiography, particularly early after birth. . © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Fungal endocarditis is a relatively rare condition which mostly complicates those with intra-cardiac devices and those whose immune system is compromised. Here we present a 63-year-old diabetic man with two-weeks history of weakness and fatigue plus low-grade fever. Transesophageal echocardiography showed a mobile mass attached to the left coronary cusp of the aortic valve which protruded into the left ventricular (LV) outflow tract. Cardiac magnetic resonance further confirmed the presence of a large broad base 18 × 20 × 18 mm mass without gadolinium enhancement suggestive for fungal infection. Voriconazole was administered on the same day after which distal embolization of the mass to distal abdominal aorta ensued shortly. Echocardiography documented the disappearance of the mass from LV outflow tract. Vascular surgeon removed the mass from abdominal aorta immediately and pathology revealed the aspergilloma which was later confirmed by culture. After embolization the patient had become unstable and signs of septic shock occurred which ultimately led to his death in 72 h. Presence of Aspergillus infection in apparently normal cardiac chambers without presence of any intra-cardiac device is extremely rare and the presented case study reports such a scenario. Rapid initiation of anti-fungal agents and early surgery are of paramount importance in patient survival. . © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Rationale Chest computed tomography (CT) has been used for the coronavirus disease 2019 (COVID-19) monitoring. However, the imaging risk factors for poor clinical outcomes remain unclear. In this study, we aimed to assess the imaging characteristics and risk factors associated with adverse composite endpoints in patients with COVID-19 pneumonia. Methods This retrospective cohort study enrolled patients with laboratory-confirmed COVID-19 from 24 designated hospitals in Jiangsu province, China, between 10 January and 18 February 2020. buy H3B-6527 Clinical and initial CT findings at admission were extracted from medical records. Patients aged less then 18 years or without available clinical or CT records were excluded. The composite endpoints were admission to ICU, acute respiratory failure occurrence, or shock during hospitalization. The volume, density, and location of lesions, including ground-glass opacity (GGO) and consolidation, were quantitatively analyzed in each patient. Multivariable logistic regression models were used to identify the risk factors among age and CT parameters associated with the composite endpoints. Results In this study, 625 laboratory-confirmed COVID-19 patients were enrolled; among them, 179 patients without an initial CT at admission and 25 patients aged less then 18 years old were excluded and 421 patients were included in analysis. The median age was 48.0 years and the male proportion was 53% (224/421). During the follow-up period, 64 (15%) patients had a composite endpoint. There was an association of older age (odds ratio [OR], 1.04; 95% confidence interval [CI] 1.01-1.06; P = 0.003), larger consolidation lesions in the upper lung (Right OR, 1.13; 95%CI 1.03-1.25, P =0.01; Left OR,1.15; 95%CI 1.01-1.32; P = 0.04) with increased odds of adverse endpoints. Conclusion There was an association of older age and larger consolidation in upper lungs on admission with higher odds of poor outcomes in patients with COVID-19. © The author(s).