RESUMO
Cardiac myxomas are rare tumors. They usually appear as a sporadic isolated condition in the left atrium of middle-aged women with no other coincidental pathology. Carney and others have described in young people a special complex group of cardiac myxomas associated to a distinctive complex pathology, giving identity to the "Syndrome Myxoma" or "Carney's Syndrome". Four additional cases of this syndrome, treated from 1977 to 1999 at the Hospital Clínico de la Universidad de Chile are presented here with a comprehensive review of the literature, accumulating 100 cases. The main features of our cases include the presence of malignant non cardiac tumors, a familial trend, follow-up of 23 years and an iterative recurrence in the elder case. To date all patients are tumor free. Reviewing the literature, patients with Carney's Syndrome were younger, with a mean age of 26 years and female predominance (62%). Cardiac myxomas affected the four chambers of the heart: 64% the left atrium; 44% the right atrium; 14% the left ventricle and 12% the right ventricle. They were multiple tumors in 41% and involved more than one chamber in 31%, being synchronous or metachronous. There was a marked familial trend (52%), a high incidence of recurrence (20%), with more than one occurring in half the cases. Extra-cardiac involvement consisted of: 68% pigmented skin lesions, 40% cutaneous myxomas, 37% adrenal cortical disease, 27% myxoid mammary fibroadenoma and 34% male patients with testes tumors. A low percentage had pituitary adenoma, melanotic schwannomas and thyroid disease. The diagnosis is made when two or more of these criteria are present. In agreement with these findings the four chambers of the heart should be examined at surgery for atypical myxoma locations, right atriotomy and combined superior-transseptal approach improve exposure of the cavities, careful screening of the first degree family members should be conducted, and closed short and long term follow up controls are important. Complex myxoma appears as a multi-systemic disorder, occasionally having an ominous prognosis and malignant potentiality, and is still undergoing investigation for better understanding and identification.
Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Mioma/diagnóstico por imagem , Mioma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adolescente , Adulto , Criança , Ecocardiografia Transesofagiana , Feminino , Predisposição Genética para Doença , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/genética , Humanos , Masculino , Pessoa de Meia-Idade , Mioma/diagnóstico , Mioma/genética , Resultado do TratamentoRESUMO
We studied left ventricular perfusion and motility in 37 patients with coronary artery disease and disturbances of parietal motility, aged 57 +/- 9 years old, before and after revascularization. Perfusion was assessed with dipyridamole-tc99m MIBI SPECT and motility was assessed with two dimensional echocardiography with amrinone. Myocardial segments were defined as normal, viable or necrotic in both studies. Eighteen subjects were subjected to angioplasty and 19 to coronary bypass surgery. Submitted SPECT and echocardiography were repeated 64 +/- 15 and 69 +/- 23 days after revascularization respectively. The concordance between SPECT and echocardiographic pre-revascularization diagnosis was 60.1% Eighty one percent of segments considered viable with SPECT and 71% thus considered with echocardiography improved after revascularization. Likewise, 50% of segments considered necrotic with SPECT and 68% of segment thus considered with echocardiography did not improve. It is concluded that although there is a good concordance between both methods, they have limitations on the study of myocardial viability and should be considered as second choice.
Assuntos
Amrinona , Doença das Coronárias/diagnóstico por imagem , Dipiridamol , Revascularização Miocárdica , Tecnécio Tc 99m Sestamibi , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tomografia Computadorizada de Emissão de Fóton Único , UltrassonografiaRESUMO
We report two male patients aged 50 and 55 years old with coronary artery disease who were treated with surgical revascularization and angioplasty respectively. To assess viable and ischemic myocardial territories, they were studied before and after revascularization with radionuclide perfusion SPECT with Tc99m-Sestamibi under Dipyridamole and with 2-D echocardiography at baseline and after the use of amrinone. Improvement in relative perfusion on SPECT and wall motion on 2-D echocardiography indicated tissue recovery.
Assuntos
Amrinona , Doença das Coronárias/diagnóstico por imagem , Dipiridamol , Ecocardiografia/métodos , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único , Angiografia Coronária , Doença das Coronárias/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Revascularização Miocárdica , Função Ventricular EsquerdaRESUMO
We analyzed the clinical and echocardiographic features of 24 patients with infective endocarditis followed for a mean of 20.2 month (range 3-84) after discharge. Mean age was 38 years, male to female ratio was 2:1 and 87% of cases had a subacute clinical course; 17% of patients had late prosthetic endocarditis. Positive blood cultures were obtained in only 50% of patients. Vegetations were detected by echocardiography in 88%, 66% of them located at the aortic valve. Heart failure (62%) was the main complication, leading to valve replacement in 4 patients. Four patients died during follow up, 3 males due to heart failure and a female from systemic emboli. Twenty patients survive at the end of follow up (84%), 50% of them in FC I or II, 40% in FC III or IV (2 lost to follow up). Eleven patients had a late echocardiogram at a mean of 12 months after discharge: 6 of them showed persistence of vegetations (55%).