RESUMEN
BACKGROUND AND AIM OF THE STUDY: The mitral annulus (MA) has a complex dynamic geometry that is difficult to visualize in two dimensions; hence, novel real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) provides insights into its dynamic nature. The study aim was to investigate changes in MA geometry in normal subjects and to explore differences in patients with myxomatous mitral valve disease (MMVD), using 3D quantitation with RT-3D-TEE. METHODS: Thirty-five participants (18 with MMVD, 17 normal subjects as controls) were enrolled into the study. The following geometric measurements were obtained at end-systole (ES) and end-diastole (ED): surface area, circumference, perimeter, height, commissure-to-commissure (C-C) diameter, anterior-to-posterior (A-P) diameter, and the ratio of A-P diameter to C-C diameter (circularization). To detect the effect of the severity of mitral regurgitation (MR) on MA dynamics, patients with MMVD were allocated to two subgroups with mild (n = 7) or moderate/severe (n = 11) MR. RESULTS: Control subjects demonstrated a saddle-shaped, elliptical MA configuration with slightly larger ES parameters. The MA shape was changed during the cardiac cycle, being more circular at ES and flatter at ED (p < 0.05). In MMVD patients, the MA retained a saddle shape but became dilated and circular with larger ED parameters compared to controls (p < 0.05). The degree of MA geometric changes was more prominent in moderate/severe MR patients (p < 0.001), while mild MR patients displayed MA geometry and dynamics similar to those of controls. CONCLUSION: The MA geometry is altered in MMVD patients, with the extent of changes being determined by the severity of the MR. RT-3D-TEE provides high-quality images that permit a precise quantitative analysis of the 3D geometry of the MA.
Asunto(s)
Ecocardiografía Tridimensional/métodos , Ecocardiografía Transesofágica/métodos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Válvula Mitral/diagnóstico por imagen , Mixoma/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Aumento de la Imagen/métodos , Masculino , Persona de Mediana Edad , Válvula Mitral/anatomía & histología , Válvula Mitral/patología , Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/patología , Insuficiencia de la Válvula Mitral/fisiopatología , Mixoma/complicaciones , Mixoma/patología , Mixoma/fisiopatología , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadRESUMEN
Real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) represents a unique perioperative cardiovascular imaging tool which, without any need for off-line reconstruction, has been shown to be highly valuable for evaluating mitral valve and other intracardiac structures. It is highly probable that, in the near future, RT-3D-TEE will have a positive effect on the perioperative assessment of complex 3D mitral valve structures, as it provides important approaches to the pathophysiology of various mitral valve diseases, including prosthetic valves, and will become incorporated into everyday perioperative practice. The clinical applications and therapeutic implications of perioperative RT-3D-TEE in the thorough assessment of the mitral valve are briefly summarized in this review.
Asunto(s)
Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Válvula Mitral/diagnóstico por imagen , Adulto , Anciano , Femenino , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Interpretación de Imagen Asistida por Computador , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Atención Perioperativa , Valor Predictivo de las Pruebas , PronósticoRESUMEN
AIMS: We assessed the hypothesis that global and regional left atrial (LA) function is altered in patients with chronic primary mitral regurgitation (MR) secondary to myxomatous mitral valve disease (MMVD). METHODS AND RESULTS: Velocity vector imaging of the LA was acquired from apical four- and two-chamber views in 41 normal and 43 subjects with chronic MR due to MMVD. All had normal left ventricular systolic function. The LA subendocardium was traced to obtain atrial volumes, ejection fraction, velocities, and strain (ε)/strain rate (SR) measurements. To explore the effects of MR severity on LA function, subjects were divided into two groups: mild vs. moderate/severe MR. Reservoir (expansion and diastolic emptying indices), booster pump (active emptying index) functions, and LA ejection fraction were markedly impaired in subjects with MR (P < 0.001). Mean LA ε was reduced in moderate/severe MR compared with control subjects (P < 0.01). A consistent pattern of differences in atrial regional function was noted with the anterior wall having a lower peak systolic ε/SR, which is more evident in the moderate/severe MR group (P < 0.01) when compared with controls and mild MR groups. CONCLUSION: LA filling during ventricular systole (reservoir function), LA contraction (booster pump function), and ejection fraction were significantly impaired in patients with chronic MR. Regional differences in LA contractility at the anterior wall were noted presumably due to the eccentricity of the systolic anteriorly directed MR jet hitting the anterior wall and altering local wall mechanics.
Asunto(s)
Atrios Cardíacos/patología , Insuficiencia de la Válvula Mitral/patología , Válvula Mitral/patología , Análisis de Varianza , Enfermedad Crónica , Diástole , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Miocardio , Estudios Retrospectivos , Volumen Sistólico , Ultrasonografía Doppler , Función Ventricular IzquierdaRESUMEN
AIMS: Progressive left ventricular (LV) dilatation and irreversible myocardial damage are important causes of morbidity and mortality in patients with chronic primary mitral regurgitation (MR) due to myxomatous mitral valve disease. We assessed the hypothesis that early subclinical LV dysfunction secondary to chronic primary MR could be signalled by abnormal LV rotation mechanics, utilizing velocity vector imaging (VVI). METHODS AND RESULTS: Forty-three with chronic primary MR and 41 normal subjects were evaluated. All had normal LV systolic function. Peak endocardial and epicardial rotations in systole were measured in apical and basal short-axis images. LV twist was defined as the net difference between apical and basal angles of rotation while LV torsion was calculated as LV twist divided by LV diastolic longitudinal length. To explore the effects of MR severity on LV rotation, patients were divided into three groups: mild, moderate, and severe MR. The peak twist and torsion of the LV endocardium displayed significant differences across the study groups (P = 0.005 and 0.015, respectively). Subjects with moderate MR revealed the highest LV rotation profile (2.26 ± 0.66°/cm and 17.83 ± 5.2° for torsion and twist, respectively), implicating hyperdynamic LV function. However, severe MR group showed the lowest LV rotation profile (1.39 ± 0.8°/cm and 11.43 ± 6.09° for torsion and twist, respectively), suggesting incipient LV dysfunction. There were no significant differences in epicardial LV rotations. CONCLUSION: Evaluation of global LV function by VVI is a novel reproducible index for detecting subnormal latent LV dysfunction in chronic MR patients, which may aid in the optimal timing of surgery.
Asunto(s)
Ecocardiografía/métodos , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Análisis de Varianza , Enfermedad Crónica , Diástole/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/fisiopatología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Rotación , Índice de Severidad de la Enfermedad , Procesamiento de Señales Asistido por Computador , Programas Informáticos , Sístole/fisiología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
BACKGROUND: In patients with primary hyperoxaluria (PH), oxalate overproduction can result in recurrent urolithiasis and nephrocalcinosis, which in some cases results in a progressive decline in renal function, oxalate retention, and systemic oxalosis involving bone, retina, arterial media, peripheral nerves, skin, and heart. Oxalosis involving the myocardium or conduction system can potentially lead to heart failure and fatal arrhythmias. METHODS AND RESULTS: A retrospective review of our institution's database was conducted for all patients with a confirmed diagnosis of PH between 1/1948 and 1/2006 (n=103). Electrocardiogram (ECG) and echocardiography were used to identify cardiac abnormalities. Ninety-three patients fulfilled the inclusion criteria, 58% were male. Mean follow-up was 11.9 (median 8.8) years. In 38 patients who received an ECG or echocardiography, 31 were found to have any cardiac abnormalities. Cardiac findings correlated with decline in renal function. CONCLUSIONS: Our data suggests that physicians caring for patients with PH should pay close attention to cardiac status, especially if renal function is impaired.
Asunto(s)
Cardiopatías/etiología , Hiperoxaluria Primaria/complicaciones , Adolescente , Adulto , Anciano , Biopsia , Niño , Preescolar , Ecocardiografía , Electrocardiografía , Femenino , Pruebas Genéticas , Cardiopatías/diagnóstico , Humanos , Hiperoxaluria Primaria/diagnóstico , Lactante , Recién Nacido , Enfermedades Renales/etiología , Masculino , Persona de Mediana Edad , Minnesota , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
Cardiovascular risk factors have utility in risk prediction but have limitations in predicting individual risk. Identifying an individual's risk remains a challenge. Emerging technologies such as carotid artery ultrasonography and measures of carotid intima-media thickness (CIMT) may be useful in identifying the susceptible patient who may benefit from more aggressive preventive therapy. This screening test is noninvasive, reproducible, inexpensive, and radiation-free. Recent data have improved our understanding of the application of CIMT as a screening tool for cardiovascular disease. CIMT measurement may place an individual into a higher- or lower-risk category, allowing for appropriate institution of preventive strategies.
Asunto(s)
Arterias Carótidas/patología , Enfermedades de las Arterias Carótidas/patología , Túnica Íntima/patología , Túnica Media/patología , Anticolesterolemiantes/uso terapéutico , Antihipertensivos/uso terapéutico , Azetidinas/uso terapéutico , Enfermedades de las Arterias Carótidas/diagnóstico , Enfermedades de las Arterias Carótidas/tratamiento farmacológico , Progresión de la Enfermedad , Ezetimiba , Humanos , Pronóstico , Factores de RiesgoRESUMEN
Echocardiography-guided pericardiocentesis is relatively safe with minimal risk in experienced hands. However, complications can occur because of the procedure. This report describes a unique case of an 84-year-old man with unanticipated fatal pulmonary thromboembolism following a successful pericardiocentesis.
Asunto(s)
Pericardiocentesis/efectos adversos , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/etiología , Anciano de 80 o más Años , Resultado Fatal , Humanos , Masculino , Embolia Pulmonar/prevención & control , UltrasonografíaRESUMEN
BACKGROUND AND AIM OF THE STUDY: Right-sided valve abnormalities are less common than their left-sided counterparts. Furthermore, whilst organic rheumatic involvement of the tricuspid valve is not uncommon, it receives less attention than left-sided heart valves. An evidence-based systematic overview was carried out to assess the epidemiology, diagnosis and management of organic rheumatic tricuspid valve disease (RTVD) over the past half century. METHODS: A computed search spanning more than four decades was conducted to identify articles on various aspects of RTVD. The bibliographies of all relevant articles were also searched. RESULTS: A total of 2,497 rheumatic heart disease patients (mean age 25.5 years; female:male ratio 1.3:1) was included. RTVD was detected in 193 patients (7.7%). Echocardiography was used to detect tricuspid valve involvement in all patients. Associated mitral valve disease was present in 99.3% of the patients with RTVD. A total of 1,092 patients (mean age 45.4 years) was included from six studies on surgical correction of the tricuspid valve. Of these patients, 278 (25.4%) underwent tricuspid valve replacement, while 814 (74.5%) had tricuspid valve repair. The in-hospital mortality was 9.9%, and late mortality 33.2% CONCLUSION: RTVD is not uncommon among patients with rheumatic heart disease, but attracts less attention and might, therefore, be overlooked. Echocardiography is the most common diagnostic tool. Although indications for surgical intervention are not well defined, valve repair may have a better outcome than replacement.
Asunto(s)
Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Cardiopatía Reumática/cirugía , Válvula Tricúspide/cirugía , Adulto , Ecocardiografía Doppler , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/epidemiología , Humanos , Masculino , Cardiopatía Reumática/diagnóstico por imagen , Cardiopatía Reumática/epidemiologíaRESUMEN
The development of heart failure in patients with aortic valve disease is associated with increased mortality, unless aortic valve replacement is performed. There is an especially high risk of death among patients with low ejection fraction. The heart failure must be treated and the patient's condition stabilized before surgery is performed. A delay in surgery, on the other hand, may lead to irreversible cardiac dysfunction and culminate in heart failure. Initial management must include an evaluation of the severity of the lesion and the functional state of the left ventricle. It is possible to achieve both of these goals simultaneously with echocardiography and pharmacologic challenge.
Asunto(s)
Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/terapia , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/terapia , Válvula Aórtica/cirugía , Disfunción Ventricular Izquierda/complicaciones , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/fisiopatología , Diagnóstico Diferencial , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Prótesis Valvulares Cardíacas , Ventrículos Cardíacos/fisiopatología , Humanos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Ultrasonografía , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/mortalidad , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Valvular endocarditis due to Mycobacterium tuberculosis is a rare clinical entity. It is usually manifest in the context of disseminated tuberculosis in immunocompromised patients. This report describes a unique case of a 30-year-old immunocompetent man with an incidental finding of tuberculous valvular endocarditis. The patient had a large mass on the anterior mitral leaflet and severe mitral regurgitation. He underwent mitral valve replacement and Mycobacterium tuberculosis was cultured from the valve vegetation and the right atrial masses. Post-operative recovery has been uneventful without relapse for 24 months.
Asunto(s)
Endocarditis Bacteriana/microbiología , Atrios Cardíacos/microbiología , Insuficiencia de la Válvula Mitral/microbiología , Válvula Mitral/microbiología , Mycobacterium tuberculosis , Tuberculosis Cardiovascular/microbiología , Adulto , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Inmunocompetencia , Masculino , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Tuberculosis Cardiovascular/cirugíaRESUMEN
Cardiac remodeling remains an important primary therapeutic target in patients with myocardial infarction (MI) and chronic heart failure. It also has utility as a reliable surrogate for clinical outcomes. The past three decades of research have demonstrated the importance of cardiac remodeling as a basic mechanism in the progression of heart failure. Novel therapeutic advances have allowed more patients to survive acute MI. Strategies to prevent or halt adverse left ventricular remodeling have included pharmacotherapy, percutaneous interventions, device-based therapies, and surgical procedures. More recently, experimental research has added opportunities for novel approaches to prevent and reverse cardiac remodeling. This review summarizes the effects of current and future therapeutic strategies on left ventricular remodeling and dysfunction after MI.
Asunto(s)
Cardiotónicos/uso terapéutico , Cardioversión Eléctrica/métodos , Insuficiencia Cardíaca/prevención & control , Infarto del Miocardio/complicaciones , Disfunción Ventricular Izquierda/prevención & control , Remodelación Ventricular/fisiología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Infarto del Miocardio/fisiopatología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
BACKGROUND: Although recent literature suggests a changing spectrum for infectious pericarditis (IP), this view has not been proven. In this report, we aim to review the features of IP in cases from a large tertiary centre. METHODS: A retrospective review of our institution's database was conducted to identify cases with IP between January 1994 and December 2004. All pericardial biopsy tissue results from the same period were also reviewed. RESULTS: One hundred and thirty-eight cases were identified, of which 14 cases were identified by pathology. The mean age was 53 +/- 18 years, and 74% were men. The most frequently identified causative organisms were Propionibacterium acnes (P. acnes), staphylococci and streptococci. A common predisposing factor was an immune-compromised state, followed by cardiac surgery. Fifty-five patients were treated with antibiotics (medical group) while 63 cases (surgical group) underwent surgical drainage (pericardial window) and/or pericardiectomy. In comparison to the medical group, the surgical group was more critically ill and immunocompromised (40% versus 24%, respectively). There were 52 late deaths during follow-up. Mortality in the medical group was 67% while in the surgical group it was 24% (P < 0.0001). CONCLUSIONS: In contradistinction to the literature reports, the most prevalent organism for IP was P. acnes. Patients managed aggressively with both antibiotics and surgery, demonstrated lower mortality rates. Therefore, clinicians should maintain a high index of suspicion for IP so that timely and appropriate mortality-reducing strategies can be offered.
Asunto(s)
Infecciones por Bacterias Grampositivas/mortalidad , Pericarditis/microbiología , Pericarditis/mortalidad , Propionibacterium acnes/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Niño , Preescolar , Femenino , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pericardiectomía , Pericardiocentesis , Pericarditis/tratamiento farmacológico , Pericarditis/cirugía , Estudios Retrospectivos , Factores de Riesgo , Staphylococcus/aislamiento & purificación , Streptococcus/aislamiento & purificación , Succión , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Left internal mammary artery to pulmonary vasculature fistulas are rare complications following coronary artery bypass grafting surgery. In symptomatic cases, management may either be conservative, or involve coil embolisation or surgical ligation of the fistula. We describe a 52-year-old male patient who suffered from an acute coronary syndrome due to significant stenosis of the right coronary artery 12 years after coronary artery bypass grafting surgery. Coronary angiography accidentally revealed a fistulous connection between the left internal mammary artery and the left pulmonary vasculature. The patient underwent percutaneous coronary intervention for his right coronary artery and was managed conservatively for his fistula.
Asunto(s)
Angioplastia de Balón , Fístula Arteriovenosa/etiología , Fístula Arteriovenosa/terapia , Puente de Arteria Coronaria , Reestenosis Coronaria/terapia , Arterias Mamarias/anomalías , Venas Pulmonares/anomalías , Síndrome Coronario Agudo/cirugía , Fístula Arteriovenosa/diagnóstico por imagen , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/etiología , Humanos , Masculino , Arterias Mamarias/diagnóstico por imagen , Persona de Mediana Edad , Venas Pulmonares/diagnóstico por imagen , Radiografía , Factores de TiempoRESUMEN
An isolated single coronary artery is a rare congenital anomaly and an uncommon finding in patients undergoing coronary angiography. In this report, we describe a rare case of a patient who had an anomaly of the left and right coronary arteries with a single coronary ostium in the right sinus of Valsalva, in which percutaneous coronary intervention was successfully performed in the right coronary artery.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/terapia , Anomalías de los Vasos Coronarios/complicaciones , Seno Aórtico/anomalías , Anciano de 80 o más Años , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Femenino , Humanos , Infarto del Miocardio/complicacionesRESUMEN
Shone's anomaly, a congenital cardiac malformation complex, consists of multiple levels of left heart obstruction. A rare case of an incomplete form of this anomaly discovered incidentally during cardiac catheterization for an unrelated event is described.
RESUMEN
Cardiac metastases of thyroid carcinomas are rarely diagnosed ante mortem and infrequently reported in the literature. A 68-year-old man with known papillary thyroid carcinoma presented to the hospital with progressive shortness of breath. A transthoracic echocardiogram revealed a right ventricular mass. Contrast echocardiography perfusion imaging was used to evaluate the vascularity of the mass.
Asunto(s)
Ecocardiografía , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/secundario , Ventrículos Cardíacos/patología , Neoplasias de la Tiroides/patología , Anciano , Medios de Contraste , Resultado Fatal , Fluorocarburos , Humanos , MasculinoRESUMEN
BACKGROUND: Isolated anomalous left main coronary artery (ALMCA) from the right aortic sinus of Valsalva (RASV) with an interarterial course between the pulmonary trunk and aorta is a rare congenital abnormality. We performed an evidence based systematic overview spanning 4 decades to assess the prevalence, clinical features and management of this anomaly. METHODS: A computerized search spanning 40 years was conducted to identify articles describing cases of ALMCA arising from the RASV with an interarterial course. The bibliographies of all relevant articles were also searched. RESULTS: The search identified 264 cases. Age ranged from 3.5 months to 87 years. Male/female ratio was 2.9/1. Forty-nine percent of the cases were diagnosed postmortem. Cardiac catheterization was the most common diagnostic tool (41.7%) followed by echocardiography, magnetic resonance imaging (MRI) and computerized assisted tomography. Fifty-seven (21.6%) cases underwent surgical procedures with no mortality and low morbidity. CONCLUSIONS: ALMCA from the RASV is associated with increased risk of sudden death, notably in young patients. Unfortunately the majority are diagnosed postmortem. More than a third present with sudden cardiac death. Echocardiography, computerized assisted tomography and cardiac MRI are valuable non-invasive diagnostic tools. Cardiac catheterization provides a definitive diagnosis in the majority. Surgical correction is the mainstay of treatment with low risk and good anatomic and functional results.
Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico , Medicina Basada en la Evidencia/métodos , Procedimientos Quirúrgicos Cardiovasculares/métodos , Procedimientos Quirúrgicos Cardiovasculares/tendencias , Anomalías de los Vasos Coronarios/epidemiología , Anomalías de los Vasos Coronarios/cirugía , Humanos , Prevalencia , Arteria Pulmonar/anomalías , Seno Aórtico/anomalíasRESUMEN
An 89-year-old woman presented to the hospital with an exacerbation of chronic obstructive airway disease and congestive heart failure symptoms. A transthoracic echocardiogram revealed an incidental inferior vena cava aneurysm.
Asunto(s)
Aneurisma/diagnóstico por imagen , Vena Cava Inferior/diagnóstico por imagen , Anciano de 80 o más Años , Femenino , Humanos , Hallazgos Incidentales , UltrasonografíaRESUMEN
Congenital anomalies of the coronary arteries occur in 0.2% to 1.2% of the general population. Most coronary artery anomalies are found incidentally during angiographic evaluation for other cardiac diseases. We describe the case of a young woman presenting with chest discomfort and fatigue where echocardiography identified a coronary artery fistula. Successful embolization of the coronary artery fistula was performed. To our knowledge, this is a unique case of an anomalous coronary artery and a fistulous anomaly in the same patient. This report describes the echocardiographic diagnosis, and the feasibility of a transcatheter management decision to avoid cardiopulmonary bypass in a patient in whom blood products are contraindicated.
Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Fístula/diagnóstico por imagen , Adulto , Femenino , Humanos , UltrasonografíaRESUMEN
OBJECTIVES: To analyze the cardiac findings that necessitate surgery in patients with relapsing polychondritis (RP) and to compare our results to cases in the literature. MATERIAL AND METHODS: A systematic overview of the literature was completed with the addition of cases of RP from the Mayo patient population that necessitated cardiac surgery. RESULTS: Thirty-three patients were identified (25 from the literature and 8 from the Mayo patient population). Nine patients (27%) were female, 22 (67%) were male, and sex was not stated for 2 patients (6%). The patient age ranged from 17 to 69 years (mean +/- SD, 42.5 +/- 15.7 years). At operation, 30 patients (91%) had aortic regurgitation, 21 (64%) had aortic root disease, and 13 (39%) had mitral regurgitation. The most common surgical procedure performed was aortic valve replacement in 12 patients (36%). The most common complications were death in 12 patients (36%) and prosthetic valve dehiscence in 4 patients (12%). CONCLUSIONS: Cardiac involvement is more prominent in the male population and requires more invasive procedures. Aortic valve replacement with composite graft replacement of the ascending aorta along with coronary artery ostial reimplantation should be considered in these patients. Postsurgical valvular complications include prosthetic dehiscence, paravalvular leakage, mediastinitis, and heart failure, and these complications are associated with postoperative corticosteroid therapy. Initiation of second-line immunosuppressive therapy should be substituted for corticosteroids after cardiac surgery.