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- 저자 : Raja Shariff Raja Ezman Faridz (검색결과 3 건)
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Raja Ezman Faridz Raja Shariff,Khairul Shafiq Ibrahim,Hafisyatul Aiza Zainal Abidin,Sazzli Kasim 아시아심장혈관영상의학회 2021 Cardiovascular Imaging Asia Vol.5 No.4
Objective: Little is known regarding the levels of knowledge and attitudes amongst non-cardiology clinicians in managing valvular heart diseasel (VHD). Materials and Methods: To determine the knowledge and attitudes towards management of VHD patients amongst internal medicine clinicians in Malaysia. We conducted a 20-item survey study, distributed amongst internal medicine clinicians. Results: A total of 75 responses was obtained. Respondents included medical officers (50.7%), consultants (32.0%), and pre-consultant specialist (17.3%). Respondents were comfortable using online resources from both formal (94.7%) and informal (74.7%) sources. A large proportion felt that they had ‘insufficient’ or ‘very insufficient’ knowledge and experience managing VHD patients (36.0%), and less than half felt that management of VHD patients within their institutions was ‘adequate’ or ‘very adequate’ (49.4%). Although many were felt to be overzealous with echocardiography monitoring in mild VHD (55.9% felt that it was required within 2 years), nevertheless attitudes regarding referrals to cardiology services for consult and intervention were felt to be appropriate. Conclusion: The survey highlights the need for education amongst internal medicine clinician to tackle both the overzealous attitude in monitoring patients with mild valvular disease on one extreme and in improving early referrals for VHD indicated for intervention on the other.
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An Unexpected Mass in a Patient With a Left Ventricular Assist Device
Raja Shariff Raja Ezman Faridz,Beng Koh Hui,Ting Yuen Beh,Yee Sin Tey,Mohd Ghazi Azmee 아시아심장혈관영상의학회 2022 Cardiovascular Imaging Asia Vol.6 No.4
Left ventricular assist devices (LVAD) have helped improve survival, functional status, and quality of life for end-stage heart-failure patients, worldwide. Unfortunately, the risk of complications associated with such devices, including infections, has increased with improved survival. We report a unique case of pump pocket infections (PPI) and collection, diagnosed using multi-modality cardiovascular imaging in a young male patient implanted with a HeartWare LVAD. He had multiple admissions in the past for driveline infections (DLI). Transthoracic echocardiography revealed a 1.4×4.6-cm hyperechoic mass. An 18F-FDG PET-CT scan was performed revealing multiple foci of hypermetabolism seen along the driveline and pump, as well as from a lesion with high radiotracer uptake anterior to the right ventricle, suggesting collection. The patient underwent extensive wound debridement and prolonged intravenous antibiotics, followed by life-long oral antibiotics. Although uncommon, following the current trend in preferential use of centrifugal pumps, PPI remains a possibility, especially in the presence of chronic DLI. Our case highlights the value of multi-modality imaging, including PET-CT imaging, in managing LVAD-related infections, as it may alter the course of subsequent management.
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Raja Ezman Faridz Raja Shariff,Lim Chiao Wen,Rizmy Najme Khir,Khairul Shafiq Ibrahim,Sazzli Kasim 아시아심장혈관영상의학회 2021 Cardiovascular Imaging Asia Vol.5 No.3
We report a rare case of delayed cardiac perforation that progressed to cardiac tamponade and initially presented as loss of pacemaker lead capture. A 50-year-old female with a singlelead permanent pacemaker for third-degree atrioventricular dissociation presented with lethargy, dyspnea, and reduced effort tolerance. Home monitoring by her cardiac device and an electrocardiogram performed on arrival showed loss of capture. Transthoracic echocardiogram revealed cardiac tamponade requiring urgent pericardiocentesis, revealing hemorrhagic effusion. Delayed perforation of her device leads was suspected, even though neither CT nor cardiac MRI revealed contrast leakage or displaced lead position. Cardiac perforation following device implantation is rare. This case is unique as it highlights an extreme presentation in which delayed perforation led to gradual accumulation progressing to tamponade and loss of device capture, both of which resolved following emergency pericardiocentesis. The main treatment of suspected lead perforation remains revision of leads, although evidence to support either a percutaneous or surgical approach remain debatable.
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