scholarly journals Thromboembolic complications in antiphospholipid syndrome and ankylosing spondylitis (two clinical cases)

2021 ◽  
Vol 15 (1) ◽  
pp. 98-104
Author(s):  
K. S. Nurbaeva ◽  
F. A. Cheldieva ◽  
A. A. Shumilova ◽  
A. M. Lila ◽  
T. M. Reshetnyak
Keyword(s):  
Ankylosing Spondylitis ◽  
Aortic Valve ◽  
Antiphospholipid Syndrome ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Valve Prosthesis ◽  
First Case ◽  
Tnfα Inhibitors ◽  
Clinical Cases

We presented two clinical cases with clinical manifestations of antiphospholipid syndrome (APS) and ankylosing spondylitis (AS). The peculiarity of these cases is the onset of diseases in childhood, as well as the presence of not only extra-skeletal manifestations, but also complications or manifestations of other pathology. In the first case, it was thrombosis of the superficial veins of the lower limbs with the development of postthrombotic syndrome. In the second case, aortic valve defect, as a result of aortitis with a dilatation of the ascending aorta, which led to aortic valve replacement and its subsequent dysfunction because of thrombosis of the valve prosthesis. The frequency of detection of antiphospholipid antibodies (aPL), APS and thrombosis in AS is discussed. The role of tumor necrosis factor α (TNFα) inhibitors in the induction of aPL synthesis and the development of APS in patients with AS is considered either. Separately, we discussed the role of TNFα inhibitors, which are the main drugs in the treatment of ankylosing spondylitis, in the induction of aPL synthesis and the development of APS. Data on the occurrence of aPL, the reasons for the development of thrombosis in APS and the role of TNFα inhibitors remains incomplete. Perhaps the combination of APS and AS is an underestimated problem, and the information available in the literature does not reflect the real numbers. It is obvious that further research is needed to improve the treatment of patients with AS with thrombosis.

scholarly journals Impact of the trace element status on the course of ankylosing spondylitis in the Orenburg Region patients

2019 ◽  
Vol 13 (4) ◽  
pp. 66-74
Author(s):  
U. A. Yakubova ◽  
O. V. Bugrova ◽  
S. I. Krasikov ◽  
N. P. Setko ◽  
R. I. Saifutdirov
Keyword(s):  
Ankylosing Spondylitis ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Atomic Absorption Spectrophotometry ◽  
Zn Deficiency ◽  
Orenburg Region ◽  
And Zn Deficiency ◽  
Trace Element Status ◽  
The Impact

The role of trace elements (TEs) and their imbalance in the physiology of bone tissue and in the development of inflammatory diseases of the joints and spine has been discussed in recent years; however, there is no evidence for the TE status of patients with ankylosing spondylitis (AS) and its possible impact on the course of the disease.Objective: to investigate the impact of the TE status of patients with AS on the course, clinical manifestations, and activity of the disease.Patients and methods. Examinations were made in 58 patients (39 men and 19 women), residents of the Orenburg Region, with a reliable diagnosis of AS, the duration of which was 16 [11; 26] years. The patients’ mean age was 38 [31; 48] years. HLA-B27 antigen was detected in 91.4% of cases. In addition to the generally accepted examination, atomic absorption spectrophotometry was used to determine the hair levels of 9 TEs: Cu, Zn, Fe, Mn, Cr, Co, Ni, Pb, and Cd in all the patients.Results and discussion. The AS patients living in the Orenburg Region showed TE imbalance manifested by Cu and Zn deficiency and Ni, Cr, and Mn accumulation in the hair. Multidirectional correlations were found between the values of these TEs and the presence of extra-axial (peripheral arthritis, dactylitis) and extra-skeletal (uveitis) manifestations of AS, its activity, and severity of functional disorders.Conclusion. The preliminary results may suggest that the emerging imbalance of TEs can affect the course of AS, maintaining and increasing its activity.

Possible role of polyclonal Immunoglobulin G (IgG) of patients with different clinical manifestations of the antiphospholipid syndrome on activation of inflammation biomarkers

Placenta ◽  
2019 ◽  
Vol 83 ◽  
pp. e86-e87
Author(s):  
Carlos Mario Rodríguez Colorado ◽  
Manuela Velasquez Berrío ◽  
Diana Carolina Rúa Molina ◽  
Angela María Álvarez Gomez ◽  
Angela Patricia Cadavid Jaramillo
Keyword(s):  
Antiphospholipid Syndrome ◽  
Immunoglobulin G ◽  
Clinical Manifestations ◽  
Polyclonal Immunoglobulin

scholarly journals Post Radiotherapy Lesions of the Heart Valves. Principles of Diagnosis and Results of Treatment

Kardiologiia ◽  
2019 ◽  
Vol 59 (3) ◽  
pp. 36-42
Author(s):  
R. M. Muratov ◽  
S. I. Babenko ◽  
A. S. Sachkov ◽  
N. N. Soboleva ◽  
E. A. Andrianova
Keyword(s):  
Radiation Therapy ◽  
Heart Disease ◽  
Aortic Valve ◽  
Coronary Arteries ◽  
Heart Valves ◽  
Severe Heart Failure ◽  
Clinical Manifestations ◽  
Cardiac Complications ◽  
Valve Prosthesis ◽  
Thoracic Irradiation

Background. The use of radiation therapy for the treatment of tumors of the chest сan lead to the development of cardiac pathology, including that of the valves and coronary arteries. Study aim: to analyze the specifics of post-radiation lesions of the valvular apparatus and coronary arteries, and to assess the immediate results and risks of surgical correction of detected defects. Materials and  methods. In the Emergency department of surgery of acquired heart disease of A. N. Bakulev National Medical Research Center of Cardiovascular Surgery in the period from 2004 to 2017 were examined and operated 46 patients aged 35–81 years (mean age 56±12.4 years, 80 % women). The period from primary irradiation of the chest to surgical treatment of valvular pathology ranged from 4 to 40 years. Indications for thoracic radiotherapy were Hodgkin’s lymphoma in 23 patients (50 %), breast cancer – in 20 (43 %). Results. Stenosis of the aortic valve was the leading defect in 42 patients (91 %). According to coronary angiography, coronary artery disease was diagnosed in 31 patients (67 %). Isolated aortic valve prosthesis was performed in 14 (30 %) patients, other operations were combined. Hospital mortality was 11 % (5 patients). There were no deaths among patients who underwent radiation therapy after mastectomy. Main nonlethal complications were: pericardial effusion in 6 patients (13 %), hydrothorax requiring repeated pleural punctures in 5 patients (11 %). Conclusion. The variety of clinical manifestations of radiation heart disease and its progressive nature emphasize the need for long-term dynamic observation of patients after thoracic irradiation in order to timely identify the pathology and eliminate the risk of sudden cardiac complications and the development of severe heart failure decompensation.

scholarly journals Spontaneous regression of severe aortic stenosis after massive embolization in a patient with antiphospholipid syndrome

2019 ◽  
Vol 25 (1) ◽  
pp. 4-8
Author(s):  
Ali Youssef ◽  
Mustafa Alrefae ◽  
Sayed Abouelsoud
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Antiphospholipid Syndrome ◽  
Severe Aortic Stenosis ◽  
Valve Surgery ◽  
Lower Limbs ◽  
Acute Ischemia ◽  
Primary Antiphospholipid Syndrome ◽  
Aortic Valve Surgery ◽  
History Of

Summary We present a case of probably unreported aortic stenosis evolution in a patient with primary antiphospholipid syndrome (APS). A female patient, 54 years old, with a history of recurrent deep venous thrombosis, an episode of pulmonary embolism and was positive for APS antibodies. She was kept on warfarin and aspirin. The patient was admitted with acute pulmonary edema and severe aortic stenosis. While preparing for aortic valve surgery, the patient developed acute stroke, and a week later developed concurrent acute ischemia of both lower limbs. Emergency surgery salvaged the lower limbs and follow up transthoracic echocardiography showed marked regression of the thickening of the aortic valve leaflets, only mild aortic stenosis and moderate aortic regurgitation. Aortic valve surgery was cancelled, and the patient was kept on warfarin and aspirin. Conclusion Development of severe aortic stenosis is uncommon in primary APS, and this scenario of spontaneous improvement from a severe to a mild aortic stenosis, is probably unreported before.

scholarly journals Magnetic resonance imaging of the heart in the diagnosis of sarcoidosis

2018 ◽  
Vol 90 (12) ◽  
pp. 101-106
Author(s):  
O V Stukalova ◽  
N V Meladze ◽  
D A Ivanova ◽  
T M Shvecz ◽  
S A Gaman ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Contrast Enhancement ◽  
Cardiac Sarcoidosis ◽  
Clinical Manifestations ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Clinical Cases

Heart sarcoidosis diagnosis presents great difficulties due to the absence of specific clinical manifestations. Most often, the diagnosis is established during autopsy. Magnetic resonance imaging (MRI) of the heart with contrast enhancement is one of the most informative methods of intravital diagnosis of cardiac sarcoidosis. In this article, two clinical cases, shows the role of MRI of the heart with contrast enhancement in the diagnosis of cardiac sarcoidosis.

scholarly journals Netosis in the pathogenesis of antiphospholipid syndrome and systemic lupus erythematosus

2021 ◽  
Vol 15 (5) ◽  
pp. 96-102
Author(s):  
K. S. Nurbaeva ◽  
T. M. Reshetnyak ◽  
A. M. Lila
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Space Form ◽  
Clinical Manifestations ◽  
Immunosuppressive Drugs ◽  
Systemic Lupus ◽  
Extracellular Traps ◽  
Activated Neutrophils

Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are autoimmune diseases. In recent years, APS has been considered as an autoimmune thrombo-inflammatory disease. It has been established that clinical manifestations of APS can persist, progress over time, or debut during an adequate anticoagulant therapy and, in some cases, require administration of immunosuppressive drugs, which indicates the role of autoimmune inflammation in their development. The formation of extracellular neutrophil traps (neutrophil extracellular traps, NETs) is one of the connecting links of inflammation and thrombosis. Netosis is the process by which activated neutrophils in the extracellular space form netlike structures (NETs). This review examines the role of neutrophils and netosis in the pathogenesis of APS and SLE.

scholarly journals 234 The role of preprocedural assessment of aortic valve calcium volume for the optimization of percutaneous aortic bioprosthesis implantation (TAVI)

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N52-N63
Author(s):  
Tiziana Attisano ◽  
Mario Ferraioli ◽  
Angelo Silverio ◽  
Michele Bellino ◽  
Luca Esposito ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pacemaker Implantation ◽  
Added Value ◽  
Valve Prosthesis ◽  
Axial Tomography ◽  
Composite Event ◽  
Valvular Stenosis ◽  
Group A ◽  
Group B

Abstract Aims Paravalvular leaks (PVL) and conduction disorders requiring permanent pacemaker implantation (PPI) in patients with severe Aortic Valvular Stenosis (SA) undergoing percutaneous aortic valve prosthesis (TAVI) still have a significant and unacceptable incidence for patients at medium and low surgical risk, who represent, with increasing scientific evidence, the prevalent population. The appearance of these complications seems to be related to clinical, anatomical and procedural factors, which influence the decision-making process of the type and size of bioprosthesis to be implanted. Particular attention has been paid to the role of the volume of calcium present at the native aortic valve (VCA) as a predictor of these complications, in order to optimize the percutaneous procedure. The VCA can be quantified using algorithms derived from Multilayer Computed Computed Axial Tomography (MSCT), an examination that has become a pivotal element in the evaluation of the patient's eligibility for TAVI.The aim of our study was to document the pre-procedural added value of VCA in terms of possible containment of adverse events and how much it may affect the choice of the type of bioprosthesis to be implanted. Methods and results 111 patients underwent TAVIs at the Interventional Cardiology Unit of the AOU S. Giovanni di Dio and Ruggi D'Aragona, between 2017 and 2020, subsequently divided into 2 groups: group A (self-expandable bioprosthesis, Medtronic Evolut R or Evolut Pro) and group B (balloon expandable bioprosthesis, Edward Sapien 3).The clinical, electrocardiographic, echocardiographic and anatomical parameters of the enrolled patients were analyzed, and the VCA in the preprocedural phase was quantified for each of them, using an algorithm extracted from the MSCT reading software, OsiriX (OsiriX-MD v.2.8.2 64-bit). A univariate logistic regression analysis was performed for the risk of developing the composite event of significant PVL and IPP.In Group B, no significant variables were found, while in Group A, the VCA (OR: 1.001; 95% CI, 1.000-1.002; p < 0.043) and incomplete left branch block (OR: 5.781; 95% CI, 0.013-32.988; p < 0.048) were significant. Subsequently, these two variables were tested in a multivariate regression model according to which only the VCA emerged as an independent predictor for the composite event (OR: 1.001; 95% CI, 1.000-1.002; p < 0.039). Conclusion VCA is significantly associated with the risk of moderate to severe PVL and rhythm disturbances requiring PPI, in the group of patients in whom a self-expandable bioprosthesis was implanted, unlike patients who received a balloon-expandable bioprosthesis where this association is not significant.

scholarly journals P1301 Opposite outcomes of two equally destructive forms of infective endocarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Carvalho ◽  
S Fernandes ◽  
L Santos ◽  
F Montenegro Sa ◽  
J Guardado ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Troponin I ◽  
Clinical Manifestations ◽  
Systolic Murmur ◽  
Hypoxemic Respiratory Failure ◽  
Blood Tests ◽  
First Case

Abstract Introduction Infective Endocarditis is a complex entity with great variability of clinical manifestations and a broad spectrum of complications. The prognosis depends not only on the baseline characteristics of the patient, but also on the agent and the complications, both local and systemic, with clinical repercussion. Two clinical cases are presented. A 67-year-old woman with history of uncharacterized aortic valve disease, presented in the emergency department with a 3-month evolution of asthenia and anorexia, and ocasional fever. She presented pallor, with a systolic murmur II/VI audible throughout the precordium and no other abnormalities in physical examination. Blood tests showed Hb 9g/dL with normal MCV and MCH, no leucocytosis, CRP 132mg/L, mild elevation of troponin I (0.32ng/ml; N <0.04ng / ml) and erythrocyturia. Transthoracic and transesophageal echocardiograms (TTE and TEE) showed a mass on the aortic valve suggestive of vegetation, conditioning a moderate aortic regurgitation (AoR) and mitroaortic pseudoaneurysm. Another 49-year-old female patient, submitted during childhood to a subaortic aneurysm, intraventricular comunication, AoR and aortic coarctation repair, presented with deterioration of functional and neurological status, associated with fever and lower limb edema. At examination she had tachypnea, tachycardia, pallor, aortic systolic murmur and signs of pulmonary congestion. Blood tests had leukocytosis and neutrophilia, CRP 174mg/L, Hb 9.6g/dL, elevation of liver enzymes, spontaneous INR 1.4 and no renal damage. TTE and TEE showed a mobile vegetation attached to the ventricular face of the aortic valve with major AoR and perivalvular abscess fistulized to the left ventricle. Both patients were treated with empirical therapy with gentamicin, ampicillin, and flucloxacillin. The first case evolved with hemodynamic stability, without heart failure or distant embolization. It was isolated a multisensitive Strept. gordonii and antibiotic therapy was de-escalated to ampicillin alone. In the second case, the patient showed rapidly progressive clinical deterioration with hypoxemic respiratory failure and cardiogenic shock requiring vasopressor support, and was urgently presented to a surgical center. No microorganism was isolated and broad-spectrum antibiotic therapy was maintained. She eventually died before she underwent valve surgery. On the other hand, in the first case, 6 weeks of antibiotic therapy were completed and aortic valve replacement surgery was performed without complications. She was discharged without cardiovascular symptoms and has an unremarkable follow-up of 6 months. With these cases it was possible to demonstrate the variability of presentations and prognosis of the same entity, even if ab initio with equally severe local complications. The initial stratification of the prognosis, the initiation of early treatment and the adequacy of the surgical time for intervention are of importance. Abstract P1301 Figure. Imaging study of endocarditis

scholarly journals Antiphospholipid Syndrome (APS) - An Update on Clinical Features and Treatment Options

2015 ◽  
Vol 8 (1) ◽  
pp. 27-38 ◽  
Author(s):  
Mamatha Katikaneni ◽  
Meera Gangam ◽  
Seth Mark Berney ◽  
Sarwat Umer
Keyword(s):  
Clinical Features ◽  
Antiphospholipid Syndrome ◽  
Treatment Options ◽  
Anticoagulation Therapy ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Thrombin Inhibitors ◽  
Direct Thrombin Inhibitors ◽  
Thrombotic Risk

Antiphospholipid syndrome (APS) is an autoantibody disorder characterized by the presence of antiphospholipid (APL) antibodies and heterogeneous clinical manifestations. Patients may present with recurrent thrombosis, obstetric morbidity, cardiac valvular lesions, thrombocytopenia, skin lesions, renal or neurologic abnormalities. We provide a comprehensive review of these diverse clinical features except renal and obstetric complications. Treatment of APS can be challenging as one tries to balance the benefit of anticoagulation therapy in this hypercoagulable state while minimizing the risk of bleeding. We discuss the various therapeutic options including the role of aspirin, warfarin, low molecular weight heparin, new direct thrombin inhibitors, hydroxychloroquine, intravenous gamma globulin, rituximab and others. Lower risk APS patients (i.e. first venous thrombosis) should receive warfarin with a target INR of 2.0-3.0. Higher risk patients (i.e. arterial thrombosis or recurrent venous events) have a target INR of >3.0. Currently, warfarin remains the mainstay in treatment of APS. Because of lack of adequate data, the newer oral direct inhibitors should be considered only when there is a known allergy/ intolerance or poor control with warfarin. Additional vascular and thrombotic risk factors should be aggressively reduced. Further studies involving large number of APS patients, diagnosed according to accepted criteria, are needed to better define the role of newer anticoagulants and other novel therapies.

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