RESUMEN
A 6-year-old boy had previously undergone total anomalous pulmonary venous connection repair and postoperative pulmonary vein stenosis release. Magnetic resonance imaging revealed blood stasis caused by a collision between the inflow from the pulmonary veins and the outflow from the left atrial appendage. A surgical specimen revealed evidence of advanced thrombus attachment. Infra-cardiac total anomalous pulmonary venous connection with an antler appearance may be a risk factor for thrombus formation in the left atrial appendage and for postoperative pulmonary venous stenosis due to blood flow collision in the left atrium after total anomalous pulmonary venous connection repair.
Asunto(s)
Venas Pulmonares , Trombosis , Humanos , Masculino , Niño , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/cirugía , Trombosis/fisiopatología , Resultado del Tratamiento , Venas Pulmonares/anomalías , Venas Pulmonares/cirugía , Venas Pulmonares/diagnóstico por imagen , Venas Pulmonares/fisiopatología , Síndrome de Cimitarra/cirugía , Síndrome de Cimitarra/diagnóstico por imagen , Síndrome de Cimitarra/fisiopatología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Imagen por Resonancia Magnética , Cardiopatías/diagnóstico por imagen , Cardiopatías/cirugía , Cardiopatías/etiología , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Atrios Cardíacos/anomalías , Estenosis de Vena Pulmonar/diagnóstico por imagen , Estenosis de Vena Pulmonar/etiología , Estenosis de Vena Pulmonar/cirugía , Estenosis de Vena Pulmonar/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/anomalías , Apéndice Atrial/cirugía , Apéndice Atrial/fisiopatologíaRESUMEN
Double outlet right atrium is a rare congenital cardiac abnormality that has been previously reported in humans and cats, but not in dogs. A double outlet right atrium is typically characterized by the presence of a leftward deviation of the interatrial septum and atrial septal defect. Therefore, the right atrium drains into both ventricles. The unique features consistent with double outlet right atrium were identified by transthoracic echocardiography and computed tomography in a puppy. This case report describes the clinical, echocardiographic, and tomographic findings of a five-month-old Cocker Spaniel diagnosed with this rare congenital abnormality.
Asunto(s)
Enfermedades de los Perros , Ecocardiografía , Atrios Cardíacos , Perros , Animales , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/congénito , Enfermedades de los Perros/diagnóstico , Ecocardiografía/veterinaria , Atrios Cardíacos/anomalías , Atrios Cardíacos/diagnóstico por imagen , Tomografía Computarizada por Rayos X/veterinaria , Masculino , Femenino , Defectos del Tabique Interatrial/veterinaria , Defectos del Tabique Interatrial/diagnóstico por imagenAsunto(s)
Divertículo , Atrios Cardíacos , Humanos , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/anomalías , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiología , Cardiopatías/diagnóstico por imagen , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , ElectrocardiografíaRESUMEN
We describe complex atrial baffling procedures in the setting of left isomerism with right-hand as opposed to left-handed ventricular topology. An appropriate understanding of the connections of the systemic and pulmonary veins, along with the internal atrial anatomy, as revealed using 3D printing, allowed for successful biventricular repair.
Asunto(s)
Atrios Cardíacos , Humanos , Atrios Cardíacos/anomalías , Atrios Cardíacos/cirugía , Impresión Tridimensional , Procedimientos Quirúrgicos Cardíacos/métodos , Síndrome de Heterotaxia/cirugía , Masculino , Femenino , Venas Pulmonares/anomalías , Venas Pulmonares/cirugíaRESUMEN
The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.
Asunto(s)
Atrios Cardíacos , Neoplasias Cardíacas , Humanos , Diagnóstico Diferencial , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/anomalías , Neoplasias Cardíacas/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Ecocardiografía/métodosRESUMEN
An 11-year-old male neutered American bulldog was presented for evaluation of thrombocytopenia, acute onset of ataxia, and vomiting. A new murmur was auscultated on physical examination. Transthoracic echocardiographic examination revealed a bicuspid aortic valve, vegetative lesions on the aortic valve, and continuous shunting from the aortic root to the left atrium through an aorta to left atrial fistula. The dog was euthanized due to its guarded prognosis and critical condition. Pathological examination confirmed presence of a bicuspid aortic valve, aorto-left atrial fistula, and aortic infective endocarditis. Antemortem blood culture revealed two unusual organisms: Achromobacter xylosoxidans and Fusobacterium mortiferum.
Asunto(s)
Válvula Aórtica , Enfermedad de la Válvula Aórtica Bicúspide , Enfermedades de los Perros , Endocarditis Bacteriana , Atrios Cardíacos , Perros , Animales , Masculino , Enfermedades de los Perros/microbiología , Enfermedades de los Perros/diagnóstico por imagen , Válvula Aórtica/anomalías , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/patología , Endocarditis Bacteriana/veterinaria , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Atrios Cardíacos/patología , Atrios Cardíacos/anomalías , Enfermedad de la Válvula Aórtica Bicúspide/complicaciones , Fístula Vascular/veterinaria , Fístula Vascular/complicaciones , Fístula Vascular/diagnóstico por imagen , Enfermedades de la Aorta/veterinaria , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/veterinaria , Enfermedades de las Válvulas Cardíacas/complicaciones , Ecocardiografía/veterinaria , Cardiopatías/veterinaria , Cardiopatías/complicaciones , Fístula/veterinaria , Fístula/complicaciones , Enfermedad de la Válvula Aórtica/veterinaria , Enfermedad de la Válvula Aórtica/complicacionesRESUMEN
We describe an unusual example of double-outlet right atrium with separate atrioventricular junctions. The straddling and overriding tricuspid valve had two orifices, and the mitral valve was morphologically normal. An appropriate understanding of the morphology of the atrioventricular junctions, the valves, and the subvalvar apparatus, along with the location of the atrioventricular conduction axis, allowed for successful biventricular repair.
Asunto(s)
Atrios Cardíacos , Humanos , Atrios Cardíacos/anomalías , Atrios Cardíacos/cirugía , Válvula Tricúspide/cirugía , Válvula Tricúspide/anomalías , Válvula Tricúspide/diagnóstico por imagen , Masculino , Recién Nacido , Procedimientos Quirúrgicos Cardíacos/métodos , FemeninoAsunto(s)
Anomalías de los Vasos Coronarios , Atrios Cardíacos , Ultrasonografía Prenatal , Humanos , Atrios Cardíacos/anomalías , Atrios Cardíacos/diagnóstico por imagen , Femenino , Embarazo , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/diagnóstico , Adulto , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/congénito , Fístula/diagnóstico por imagen , Fístula/congénitoRESUMEN
A four-month-old domestic shorthair cat with no clinical signs was referred for further examination of a heart murmur. An echocardiogram revealed marked right atrial dilation, extending into the left hemithorax. Computed tomography angiography was conducted to investigate further, which revealed a balloon-shaped, contrast-filled cavity on the cranial and left side of the chest that connected to the right atrium through a narrow passage. This was diagnosed as a congenital right atrial diverticulum. Treatment included clopidogrel to reduce the risk of thrombus formation. Two months after the initial diagnosis, castration surgery was successfully performed without complications. The cat died suddenly at home 10 months after diagnosis. To the authors' knowledge, this is the first right atrial diverticulum reported in a cat.
Asunto(s)
Enfermedades de los Gatos , Divertículo , Atrios Cardíacos , Animales , Gatos , Divertículo/veterinaria , Divertículo/congénito , Enfermedades de los Gatos/congénito , Enfermedades de los Gatos/diagnóstico por imagen , Enfermedades de los Gatos/diagnóstico , Enfermedades de los Gatos/cirugía , Masculino , Atrios Cardíacos/anomalías , Ecocardiografía/veterinaria , Cardiopatías Congénitas/veterinaria , Angiografía por Tomografía Computarizada/veterinaria , Resultado Fatal , Orquiectomía/veterinariaRESUMEN
RATIONALE: Previous studies have found that the main treatment of sinus arrest is pacemaker treatment. It is rare to have 12 s of sinus arrest after radiofrequency ablation, and whether a permanent pacemaker is implanted immediately in this case is not described in the guidelines. PATIENT CONCERNS: A 76-year-old male patient with persistent atrial fibrillation (AF) developed sinus arrest lasting 12 s in the early morning of the fourth day after using radiofrequency ablation for pulmonary vein isolation. DIAGNOSIS: The patient was diagnosed with AF and sinus arrest. INTERVENTIONS: The patient received cardiopulmonary resuscitation, intravenous injection of atropine 1 mg, and intravenous infusion of isoproterenol 1mg and immediately recovered consciousness thereafter. Approximately, 1.5 h later, the patient underwent surgery to install a temporary pacemaker in the right femoral vein. OUTCOMES: The patient had repeated episodes of sinus arrest after the implantation of a temporary pacemaker. After 3 weeks, the patient stabilized and was discharged. The patient was followed up for 1 year and did not experience any recurrence of sinus arrest or AF. LESSONS: We consider the potential for postoperative myocardial edema, injury to the sinoatrial node during the procedure, propafenone poisoning, and autonomic dysfunction as contributors to the occurrence of sinus arrest after radiofrequency ablation. When sinus arrest occurs after radiofrequency ablation, we can choose the appropriate treatment according to the patient's condition.
Asunto(s)
Fibrilación Atrial , Cardiomiopatías , Ablación por Catéter , Enfermedades Genéticas Congénitas , Paro Cardíaco , Atrios Cardíacos/anomalías , Bloqueo Cardíaco , Ablación por Radiofrecuencia , Masculino , Humanos , Anciano , Resultado del Tratamiento , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Fibrilación Atrial/diagnóstico , Paro Cardíaco/cirugíaRESUMEN
We report an uncommon case report of total anomalous pulmonary venous returns into the right atrium at the base of the superior caval vein's ostium without a sinus venosus defect, in situs solitus, without vertical vein or a posterior pulmonary venous confluence.
Asunto(s)
Defectos del Tabique Interatrial , Venas Pulmonares , Síndrome de Cimitarra , Humanos , Síndrome de Cimitarra/diagnóstico por imagen , Vena Cava Superior/diagnóstico por imagen , Vena Cava Superior/anomalías , Venas Pulmonares/diagnóstico por imagen , Venas Pulmonares/anomalías , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/anomalíasRESUMEN
INTRODUCTION: Severe transitory episodes of bradycardia with subsequent syncope in children are common, and generally portend a benign prognosis. Rarely, patients may experience prolonged asystolic episodes secondary to significant sinus pauses (SP) or paroxysmal atrioventricular block (AVB). Cardioneuroablation (CNA) is a catheter-based intervention, used to identify and ablate the epicardial ganglionated plexi (GP), which results in disruption of the vagal-mediated parasympathetic input to the sinus and atrioventricular node. OBJECTIVE: Describe the methodology and role of CNA for treatment of pediatric patients with functional AVB or SP. METHODS: This is a single-center, case series study. Patients with SP or AVB, 21 years of age or younger, who underwent CNA between 2015 and 2021 were included. CNA was performed via anatomically guided and high-frequency stimulation methods. RESULTS: Six patients were included. The median age was 18.9 years (range 12.3-20.9 years), 33% female. Two patients had prolonged SP, two had paroxysmal AVB, and two had both SP and AVB. Four patients had prior syncope. The median longest pause was 8.9 s (range 3.9-16.8) with 11 total documented pauses (range 2-231) during the 6 months pre-CNA. Post-CNA, the median longest pause was 1.3 s (range 0.8-2.2) with one documented SP after termination of atrial tachycardia at the 3-month follow-up. At 6 months, the median longest pause was 1.1 s (0.8-1.3) with 0 documented pauses. No patients had syncope post-CNA. CONCLUSION: CNA may be an effective alternative to pacemaker implantation in pediatric patients with syncope or significant symptoms secondary to functional SP or AVB.
Asunto(s)
Bloqueo Atrioventricular , Cardiomiopatías , Enfermedades Genéticas Congénitas , Atrios Cardíacos/anomalías , Bloqueo Cardíaco , Humanos , Femenino , Niño , Adolescente , Adulto Joven , Adulto , Masculino , Bloqueo Atrioventricular/diagnóstico , Bloqueo Atrioventricular/etiología , Bloqueo Atrioventricular/terapia , Síndrome del Seno Enfermo/diagnóstico , Síndrome del Seno Enfermo/cirugía , Nodo Atrioventricular/cirugía , Síncope/diagnóstico , Síncope/etiología , Síncope/cirugíaRESUMEN
OBJECTIVES: To investigate the clinical and echocardiographic presentation of dogs with persistent atrial standstill (PAS), identify variables measured at first presentation that could predict their survival, and document the progression of the disease after pacing. MATERIALS AND METHODS: Retrospective study of medical records of dogs diagnosed with PAS at three referral hospitals of the United Kingdom over seven years. RESULTS: Twenty-six dogs were diagnosed with PAS during the study period. Median age of the population was three years (range: seven months-12.5 years). The most common clinical sign was syncope (14/26). Twenty-four dogs received artificial pacemakers (PM). Major complications after PM implantation were observed in four dogs (four/24). Serial echocardiographic examinations showed that cardiac dimensions of PAS dogs with left atrial or left ventricular dilation at first presentation did not return to reference range after pacing. Further dilation of the cardiac chambers, recurrence of congestive heart failure (CHF), or development of new episodes of CHF were documented in seven, four, and 10 PAS dogs, respectively, despite pacing. Median survival time for cardiac-related deaths after PM implantation was 1512 days (18-3207). Neither CHF nor echocardiographic variables at presentation predicted survival after PM implantation in PAS dogs. CONCLUSIONS: Persistent atrial standstill (PAS) is an uncommon bradyarrhythmia, occurring in young adult dogs. Affected dogs were often presented with syncope. Whilst syncope resolved, cardiac remodeling persisted after PM implantation. Long-term survival was favorable after PM implantation and was not predicted by congestive status or cardiac chamber size at first presentation.
Asunto(s)
Cardiomiopatías , Enfermedades de los Perros , Enfermedades Genéticas Congénitas , Atrios Cardíacos/anomalías , Insuficiencia Cardíaca , Perros , Animales , Estudios Retrospectivos , Atrios Cardíacos/diagnóstico por imagen , Bloqueo Cardíaco/veterinaria , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/veterinaria , Síncope/veterinaria , Estimulación Cardíaca Artificial/veterinaria , Estimulación Cardíaca Artificial/métodos , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/terapiaRESUMEN
Coronary arterial fistulae are rare, but it is one of the most common coronary artery anomalies. Most of the cases are asymptomatic in younger patients unless it is large and of haemodynamic significance. The incidence of thromboembolic complications usually increases with age. We report a case of a young male in his early 20s presenting with central chest pain. Coronary computed tomographic angiography revealed acute coronary syndrome due to a fistula between right coronary artery and right atrium occluded by thrombus. After discussion with coronary and congenital heart multidisciplinary team, a consensus was agreed that we should manage him conservatively with anticoagulant and antiplatelet therapy and a 3-month follow-up strategy that included repeating cardiac imaging. After a year, his anticoagulation and antiplatelet medication was discontinued.
Asunto(s)
Síndrome Coronario Agudo , Enfermedad de la Arteria Coronaria , Anomalías de los Vasos Coronarios , Fístula , Trombosis , Humanos , Masculino , Síndrome Coronario Agudo/complicaciones , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Fístula/complicaciones , Fístula/diagnóstico por imagen , Fístula/congénito , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/anomalías , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológico , Adulto JovenRESUMEN
Idiopathic dilatation of the right atrium is a rare malformation characterized by disproportionate growth of the right atrium in the absence of a cause that justifies it. We present the case of a patient with idiopathic dilatation of the right atrium diagnosed since fetal life.
La dilatación idiopática de la aurícula derecha (DIAD) es una malformación poco frecuente caracterizada por un crecimiento desproporcionado de la aurícula derecha en ausencia de una causa estructural o funcional que la justifique. Presentamos el caso de una paciente con DIAD con diagnóstico desde la etapa prenatal.
Asunto(s)
Atrios Cardíacos , Humanos , Dilatación , Atrios Cardíacos/anomalías , Dilatación PatológicaRESUMEN
An idiopathic enlargement of the right atrium is an extremely rare cardiac malformation. There are no established guidelines for the management of this disease, especially concerning medical versus surgical therapeutic approach and the timing for an operation. We report in this case about a neonate that first was treated conservatively until the age of 5 month and finally got an operative resection of the aneurysm. After surgery, unexpected complications occurred. A second aneurysm in the left atrium was demasked. Furthermore, a progressive dilatation of both atrial chambers after resection required regular follow-up and ongoing evaluation of treatment.