RESUMEN
Bioprosthetic valve thrombosis (BPVT) is a rare but potentially life-threatening complication. Human menopausal gonadotropin (hMG) is commonly used for ovulation induction and has been associated with arterial and venous thrombosis. We reported a case of BPVT related to in vitro fertilization in a 39-year-old female, who underwent redo mitral valve replacement. To the best of our knowledge, this is the first case of hMG-induced BPVT in a young female patient.
RESUMEN
INTRODUCTION: The aim of this study is to compare three different echocardiographic methods commonly used in the assessment of left ventricle (LV) ejection fraction (EF). METHODS: All patients underwent full echocardiography including LVEF assessed using M-mode, automated EF (Auto-EF), and visual estimation by two readers. RESULTS: We enrolled 268 patients. Auto-EF measurement was feasible in 240 (89.5%) patients. The averaged LVEF was (52% ± 12) with the visual assessment, (51% ± 11) with Auto-EF and (57% ± 13) with M-mode. Using Bland-Altman analysis, we found that the difference between the mean visual and the Auto-EF was not significant (-0.3% [-0.5803-0.0053], P = 0.054). However, the mean EF was significantly different when comparing visual versus M-mode and Auto-EF versus M-mode with the mean differences: (-2.4365 [-2.9946--1.8783], P < 0.0001) and (-2.1490 [-2.7348--1.5631], P < 0.0001) respectively. Inter-observer variability analysis of the visual EF assessment between the two readers showed that intraclass correlation coefficient was 0.953, (95% confidence interval: 0.939-0.965, P < 0.0001), with excellent correlation between the two readers: R = 0.911, P < 0.0001). CONCLUSION: The two-dimensional echocardiographic methods using Biplane Auto-EF or visual assessment were significantly comparable, whereas M-mode results in an overestimation of the LVEF.
RESUMEN
Coronary artery fistulas (CAFs): Are anomalous connections of the coronary arteries (CA) with major vascular structures or heart chambers. Most of CAFs are incidental findings during invasive coronary angiography (ICA) or computed tomography angiography (CTA). Many patients with CAFs are asymptomatic; only a minority has been associated with various clinical features and outcomes. We have reported a rare CAF complicated with acute myocardial infarction (AMI) in 43 years old female Patient who was admitted to our institution with a Diagnosis of Acute Infero-Posterior Myocardial Infarction (AMI). ICA and CTA showed a thrombosed CAF between left main coronary artery and right atrium with totally occluded left circumflex artery by a thrombus extended from the fistula. As there was a high risk associated with immediate intervention, the patient was kept on conservative management with a future plan of catheter-assisted or surgical closure. We have shown a rare case of CAF presenting with AMI that is unusual for such an anomaly, and have highlighted the role of CTA in the diagnosis and management of such rare disorder.