BACKGROUND

Venous thromboembolism, encompassing pulmonary embolism (PE) and deep vein thrombosis (DVT), is the third most common acute cardiovascular syndrome. It requires prompt diagnosis and risk-based treatment strategies.

CASE

A 47-year-old male, 30-pack-year smoker who recently underwent open reduction and internal fixation of the right femur presented with dyspnea. There was no hemodynamic instability. Twelve-lead electrocardiogram showed sinus rhythm with incomplete right bundle-branch block, and troponin was elevated. Chest x-ray showed dilated right descending pulmonary artery. Two-dimensional echocardiogram revealed right atrial thrombus with right ventricular dysfunction. Computed tomography of the pulmonary artery confirmed massive PE with infarct on the posterobasal segment of the right lower lobe. Venous duplex scan of the lower extremities showed an acute DVT of the right femoral vein, popliteal vein, and peroneal vein. Anticoagulation was started. With a dilemma of a recent surgery in an intermediate high-risk submassive PE, options other than guideline-recommended systemic thrombolysis were considered. A multidisciplinary consensus recommended the administration of low-dose thrombolysis, which later resulted to clinical improvement.

CONCLUSION

This is the first documented local case of successful resolution of a right atrial thrombus with pulmonary thrombus and DVT using low-dose thrombolysis, without complications of bleeding, in a patient with contraindications to thrombolysis. With more clinical experience and studies of low-dose recombinant tissue plasminogen activator in this special population, it can offer a promising treatment option.

Pulmonary Embolism ; Tissue Plasminogen Activator ; alteplase

BACKGROUND

Thiamine plays a crucial role for normal cardiac function, as severe vitamin B1 (thiamine) deficiency leads to congestive heart failure. Thus, patients undergoing diuretic treatment might have compromised heart function. Several small-scale studies were conducted with conflicting results".

OBJECTIVE

The aim of this study was to determine the effects of thiamine supplementation on cardiac function among patients with heart failure with reduced ejection fraction receiving optimal medical therapy versus optimum medical therapy alone.

DESIGN

This was a meta-analysis of randomized, double-blind, placebo-controlled trials

METHODS

Studies for inclusion were searched using PubMed, Google Scholar, Cochrane, EMBASE, and other databases. Gray literature was also explored. Review Manager version 5.3 was used to analyze data. The mean difference and 95% confidence interval were estimated using random-effects model. χ2 and I 2 were computed to assess heterogeneity.

RESULTS

After the analysis of the combined effects of five studies with 218 subjects, the pooled results showed no significant effect on the left ventricular ejection fraction in heart failure patients when given thiamine supplementation with a P value of 0.04.

CONCLUSION

Based on this limited group of studies, there is insufficient information to suggest that thiamine supplementation has a positive effect on left ventricular ejection fraction in heart failure patients. Further large-scale clinical trials are needed to determine the optimum dose, duration, and route of thiamine in patients with heart failure.

Heart Failure

BACKGROUND

Endovascular technique has replaced open repair as primary treatment for different aortic disease indications and was associated with low perioperative mortality and acceptable short-, mid-, and long-term survival. Locally, thoracic endovascular aortic repair (TEVAR) was not widely practiced until year 2017. This study aims to determine the predictors of in-hospital and short-term outcomes of patients who underwent TEVAR for aortic aneurysm and aortic syndrome in a single center and how it compares with local and international data.

METHODS

This study is a retrospective analysis of 52 adult patients who underwent TEVAR for the treatment of aortic aneurysm and aortic syndrome. Demographic and clinical data, diagnostic imaging, and procedural details were obtained via inpatient charts at the medical records section and hospital system database archiving. Outcomes at 30 days and 1 year postprocedure were obtained through telephone follow-up after attaining verbal consent.

Gathered data were analyzed as to association of different variables with or without the presence of complications. Outcomes reported included in-hospital mortality rate, presence of major adverse events (MAEs), 30-day and 1-year survival rates, and rate of freedom from reintervention.

RESULTS

The overall in-hospital mortality was 7.69% (n = 4/52), and complication rate was 32% (n = 20/52), with a survival rate of 92.31% and 87.76% at 30 days and 1 year, respectively. The rates of overall freedom from reintervention were 83.33% and 100% at 30 days and 1 year, respectively. The independent predictors for in-hospital mortality and development of MAEs were increasing weight (odds ratio [OR], 1.0588; 95% confidence interval [CI], 1.003–1.208), preexisting chronic kidney disease (OR, 10.33; 95% CI, 1.1069–96.462), and TEVAR with debranching done as a single procedure (OR, 3.6667; 95% CI, 1.1154–12.054), whereas an estimated glomerular filtration rate of 49.05 ± 19.25 (OR, 0.9402; 95% CI, 0.9019–0.9801) and TEVAR with debranching done as a staged procedure (OR, 0.1624; 95% CI, 0.0321–0.8225) statistically decrease the risk for development of in-hospital mortality and MAEs (P = 0.001 and P = 0.028, respectively).

CONCLUSION

In this single-center study, indications for TEVAR were fusiform and saccular aneurysm, high-risk intramural hematoma and penetrating aortic ulcer, complicated acute type B dissection, chronic complicated type B dissection with high-risk feature, and aortic rupture. The outcome of this study shows comparable results with other international studies with an acceptable in-hospital mortality rate, complication rate, short-term survival rate, and rate freedom from reintervention at 30 days and 1 year. Increasing weight, preexisting chronic kidney disease, and TEVAR with debranching done as a single setting are independent predictors for developing in-hospital mortality and MAEs, whereas a normal estimated glomerular filtration rate and TEVAR with debranching done as a staged procedure decrease the risk; hence, careful planning and scheduling of procedure among elective and amenable cases could further reduce complication rates of future TEVAR procedures.

Human ; Aortic Aneurysm ; Aortic Diseases ; Endovascular Aneurysm Repair