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Biomedical subjects

Tomas G Neilan

Publications and source records attributed to Tomas G Neilan.

25 records · Page 2Linked to original sources
PubMed2006

A case report of a round cystic tumor in the left ventricular outflow tract.

We report a case of a patient who was admitted to our hospital complaining of angina pectoris. On auscultation, a systolic ejection murmur was heard at the right upper sternal border. Transthoracic echocardiography displayed regional wall motion abnormalities and detected a mobile mass in the left ventricular outflow tract, causing mild obstruction during systole. The mass appeared as an unilocular cystic tumor. Coronary angiography showed a significant lesion in the left anterior descending artery. Surgical treatment was indicated for coronary artery disease and for the unpredictable behaviour of the neoplasm. The mass was identified as arising from the top of the anterior papillary muscle. Histopathological examination revealed that the tumor was a cavernous hemangioma. Cardiac hemangiomas are rare, benign vascular tumors of the heart. This is an unusual case of left ventricular hemangioma incidentally discovered, which raised an interesting differential diagnosis.

Aged↗
PubMed2006

Delayed enhancement cardiac MR imaging in noncompaction of left ventricular myocardium.

A 49-year-old female with a history of paroxysmal atrial fibrillation, presented with worsening dyspnea on minimal exertion. During the follow-up period, transthoracic echocardiography and cardiac magnetic resonance imaging (CMR) were consistent with the diagnosis of noncompaction of the left ventricle. Delayed-enhancement CMR demonstrated hyperenhancement of the prominent trabeculations located at the mid and apical portions of the left ventricle, suggesting areas of fibrosis. Although previous cases of left ventricular noncompaction diagnosed with CMR have been described in the literature, this is the first case to describe the utility of delayed-enhancement imaging in the pathohistological confirmation of myocardial fibrosis and scarring in the hypertrabeculated myocardium.

Contrast Media↗
PubMed2006

A continuous murmur.

A 61-year-old male with a history of a mechanical Bjork-Shiley aortic valve replacement in 1977 and repair of an ascending aortic root dissection in 1993, presented with a 2-week history of fatigue and exertional dyspnea. Echocardiography confirmed the presence of an aortic pseudoaneurysm with a fistulous connection between the aorta and right atrium, which subsequently underwent successful repair. Although there have been several cases describing the development of an aortic pseudoaneurysm after aortic dissection repair, our case is the first to describe an aorta-atrial fistula as a long-term complication of a previous aortic dissection repair.

Aortic Dissection↗
PubMed2006

Elevation of myeloperoxidase in conjunction with cardiac-specific markers after marathon running.

Cardiac-related death has been reported following strenuous exercise, and biochemical markers predicting adverse outcomes would be useful. Despite the fact the myeloperoxidase (MPO) release may precede myocardial injury and identify at-risk patients earlier than traditional markers, information on the effects of marathon running on MPO levels is lacking. We measured MPO in conjunction with the creatine kinase MB fraction (CK-MB), myoglobin, troponin T (TnT), and N-terminal B-type natriuretic peptide (NT-proBNP) in 24 athletes before and after a marathon race. Of the 24 athletes, 22 (92%) had an increased MPO level, and the mean MPO level increased from 281.44 pmol/L to 785.21 pmol/L (P < .0001). Results for 14 (58%) of the athletes reached or exceeded the manufacturer's recommended clinical threshold. The increases in CK-MB, myoglobin, TnT, and NT-proBNP also reached statistical significance. Although the elevation in MPO most likely represents a systemic inflammatory response, the concurrent elevations in TnT and NT-proBNP suggest that myocardial injury cannot be excluded.

Biomarkers↗
PubMed2006

Measurement of a plasma stroke biomarker panel and cardiac troponin T in marathon runners before and after the 2005 Boston marathon.

We report changes in cardiac troponin-T (TnT) and a new plasma stroke biomarker panel (D-dimer, B-natriuretic peptide [BNP], matrix metalloproteinase-9 [MMP-9], S-100 b, Biosite Diagnostics, San Diego, CA) in 30 nonprofessional marathon runners before and immediately after the 2005 Boston Marathon. Following competition, there was a statistically significant increase in MMP-9 (P < .001) and D dimer (P < .001). Nonsignificant changes in S-100 b and BNP were observed. Premarathon and postmarathon values for a multimarker stroke index increased from 0.97 (normal) to 3.5 (low risk or more; P < .001). Two subjects had index values more than the high-risk cutoff value. Mean TnT premarathon and postmarathon levels increased (from <0.01 to 0.03 ng/mL; P < .0001). After the marathon, with a cutoff value of 0.05 ng/mL, 7 runners (23%) had values above the manufacturer's recommended cutoff for myocardial damage. Although biochemical evidence of myocardial damage following strenuous exercise may reflect myocardial stunning or subclinical ischemia, the changes in the stroke index and values for individual stroke markers may reflect a systemic inflammatory response to exertional rhabdomyolysis which is common, but the possibility of subclinical central nervous system damage cannot be excluded.

Biomarkers↗
PubMed2006

Surgical management of infective endocarditis.

BACKGROUND AND AIM OF THE STUDY: Although retrospective reviews evaluating the surgical management of infective endocarditis (IE) have been conducted in Europe and in the USA, few data exist regarding management of the condition in Canada. The study aim was to evaluate the surgical management of individuals with culture-positive active IE at a Canadian tertiary care university hospital. METHODS: A retrospective analysis was performed of 74 patients (53 males, 21 females; mean age 56 +/- 14 years) with a preoperative diagnosis of acute IE between 1995 and 2003 at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia. Preoperative clinical variables evaluated included the Duke criteria for endocarditis, correlation between preoperative echocardiographic imaging and intraoperative findings, and postoperative morbidity and mortality. RESULTS: Native valve endocarditis (NVE) was present in 60 patients, and prosthetic valve endocarditis (PVE) in 14. All patients met the Duke criteria for endocarditis. Correlation between preoperative transesophageal echocardiography (TEE) and surgical findings (vegetations 63%, abscesses 96%, leaflet perforation 100%) was superior when compared with preoperative transthoracic echocardiography (vegetations 43%, abscesses 75%, leaflet perforation 89%). There were low rates of postoperative morbidity (reoperation 8%, stroke 5%). Overall in-hospital mortality was 14% (seven NVE, 12%; three PVE, 21%). CONCLUSION: Herein is presented the largest and most current case series of patients treated surgically for active IE. The results demonstrate excellent agreement between preoperative TEE and intraoperative surgical findings in the current era of surgical management of this condition.

Adult↗