Assuntos
Calcinose , Humanos , Calcinose/diagnóstico por imagem , Ecocardiografia , Feminino , Masculino , Diagnóstico Diferencial , IdosoRESUMO
Heart masses, including tumors (primary and secondary) and pseudotumor (cysts and thrombus), are rare entities, but of increasing interest in cardiac imaging areas. The clinical manifestations are related to the intracardiac effect of mass, embolization, and systemic symptoms in the case of tumors; however, some of them are detected incidentally. Nowadays, imaging techniques and the advancement of their tools perform the morphological, functional, and tissue characterization of the masses, and additionally know the anatomical relationships, which are crucial factors for the treatment and surgical planning.
Assuntos
Neoplasias Cardíacas , Humanos , Neoplasias Cardíacas/cirurgia , Ecocardiografia/métodos , Imageamento por Ressonância Magnética/métodos , Radiografia , CoraçãoRESUMO
A 31-year-old man was referred to our hospital because of exertional dyspnea and palpitations. Cardiac examination revealed a systolic murmur in the pulmonic area. Owing to the suspicion of pulmonary stenosis, cardiac magnetic resonance was notable for apical hypertrophy of the right ventricle and mixed pulmonary stenosis. (Level of Difficulty: Intermediate.).
Assuntos
Síndrome de Bland-White-Garland , Anomalias dos Vasos Coronários , Humanos , Síndrome de Bland-White-Garland/complicações , Síndrome de Bland-White-Garland/diagnóstico , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Coração , Artéria PulmonarRESUMO
Chagas cardiomyopathy (CC), caused by the protozoan Trypanosoma cruzi, is an important cause of cardiovascular morbidity and mortality in developing countries. It is estimated that 6 to 7 million people worldwide are infected, and it is predicted that it will be responsible for 200,000 deaths by 2025. The World Health Organization (WHO) considers Chagas disease (CD) as a Neglected Tropical Disease (NTD), which must be acknowledged and detected in time, as it remains a clinical and diagnostic challenge in both endemic and non-endemic regions and at different levels of care. The literature on CC was analyzed by searching different databases (Medline, Cochrane Central, EMBASE, PubMed, Google Scholar, EBSCO) from 1968 until October 2022. Multicenter and bioinformatics trials, systematic and bibliographic reviews, international guidelines, and clinical cases were included. The reference lists of the included papers were checked. No linguistic restrictions or study designs were applied. This review is intended to address the current incidence and prevalence of CD and to identify the main pathogenic mechanisms, clinical presentation, and diagnosis of CC.
RESUMO
Gaucher type 3C disease with porcelain aorta can cause severe hemodynamic impairment. We report the first case, to our knowledge, of a 13-year-old Mexican girl with a GBA1 homozygous c.1342G>C [p.Asp448His] (commonly known as p.D409H) pathogenic variant who underwent extensive aortic replacement. She has been on enzyme replacement therapy and is alive 5 years after surgery. (Level of Difficulty: Intermediate.).
RESUMO
BACKGROUND: The evaluation of long-term inflammatory response and function in postoperative patients with aortic valve replacement (AVR) deserves special analysis because it is important to try to prevent reoperation and improve durability and functionality of the prostheses. It is our objective METHODS: In this study, we included a cohort of patients with aortic valve damage treated by AVR with mechanical prosthesis, bio prosthesis and we included a control group. RESULTS: We found that IL-4 and osteopontin levels were higher in patients with mechanical vs biological prostheses (p=0.01 and p=0.04, respectively), osteoprotegerin (OPG) levels were decreased (p=0.01), women had lower levels of ET-1 and IL-6, (p=0.02) (p=0.04), respectively. Patients older than 60 years had decreased levels of IL-1ß p<0.001) and a higher concentration of IL-4 p<0.05). IL-1ß, OPG and TNFα were higher in patients with less than 5 years of evolution vs more than 10 years (p=0.004, p=0.02 and p=0.03, respectively). Factors such as age, gender, prosthetic and elevated IL-1B and ET-1 levels are associated with valve dysfunction prosthetic. These results indicate that the inflammatory involvement present prior to valve replacement may be perpetuated by various factors in the long term. CONCLUSIONS: The findings provide us with the opportunity to effectively treat patients with AVR in the postoperative period, which could prolong the functionality of the bio prostheses. TRIAL REGISTRATION NUMBER: NCT04557345.
Assuntos
Bioprótese , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Interleucina-4 , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
We present the case of a young male patient with an initial diagnosis of a rhabdomyoma that was surgically treated at a different hospital when he was 17. After a 2-year disease-free period, the patient presented another intra-cardiac mass. He refused surgical treatment and died 5 years later. Post-mortem immunochemistry studies of both tumors led to the diagnosis of a primary malignant cardiac PEComa with histopathologic characteristics that resembled a rhabdomyoma with abundant "spider cells."
RESUMO
The authors of the image chapters of the National Association of Cardiologists of Mexico (ANCAM) and the Mexican Society of Cardiology (SMC), as well as personnel from the Department of Medicine and Nutrition of the University of Guanajuato, together with prominent experts in cardiovascular imaging from Mexico, have collaborated in the review, analysis and expansion of the various health strategies published in the first year of the coronavirus disease 2019 (COVID-19) pandemic, to safely perform cardiac imaging studies. This update aims to reduce the risk of COVID-19 transmission among patients and health-care personnel in the CT, MRI, and nuclear cardiology services. This work was expanded with supplementary information available free of charge on the website www.ancam-imagen.com.
Los capítulos de imagen de la Asociación Nacional de Cardiólogos de México (ANCAM) y de la Sociedad Mexicana de Cardiología (SMC), así como personal del Departamento de Medicina y Nutrición de la Universidad de Guanajuato, en conjunto con destacados expertos de la imagen cardiovascular en México, han colaborado en la revisión, análisis y ampliación de las diversas estrategias sanitarias publicadas en los primeros 15 meses de la pandemia de enfermedad por coronavirus 2019 (COVID-19) para realizar con seguridad los estudios de imagen cardiaca; esta actualización tiene como objetivo principal disminuir el riesgo de transmisión de la COVID-19 entre los pacientes y el personal de salud en los servicios de tomografía, resonancia y cardiología nuclear. Este trabajo se amplió con información suplementaria disponible sin costo en el sitio www.ancam-imagen.com.
Assuntos
COVID-19 , Cardiologia , Controle de Infecções , Sociedades Médicas , COVID-19/prevenção & controle , Sistema Cardiovascular/diagnóstico por imagem , Humanos , MéxicoRESUMO
The Fontan operation was introduced in 1968 as a palliative treatment for patients with univentricular heart physiology. Natural history and outcomes are poor. By 10 years after Fontan operation, most patients will develop any complication such as tachyarrhythmias, any spectrum of Fontan-associated liver disease, protein-losing enteropathy, heart failure, thrombosis, and infective endocarditis among others. Echocardiography and magnetic resonance imaging (MRI) are the first-line diagnostic tools for detecting such complications. Clinical and imaging follow-up are a mainstay for the evaluation of this patients.
Assuntos
Técnica de Fontan , Cardiopatias Congênitas , Trombose , Ecocardiografia , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Trombose/diagnóstico por imagem , Trombose/etiologiaRESUMO
BACKGROUND: Ventricular tachycardia (VT) is one of the main predictors of mortality in Chagas cardiomyopathy (CC). Although the substrate of sustained and nonsustained-VT (NS-VT) seems to be the same, little is known about the distribution of late enhancement (LE). Our aim was to compare the clinical findings and the amount and patterns of LE in Chagas disease according to the presence and type of VT. METHODS AND RESULTS: Magnetic resonance imaging was performed in 54 Chagas seropositive patients: 8 indeterminate and 46 with CC of whom 15 were without VT, 13 with NS-VT, and 18 with sustained-VT (S-VT). There were 31 males (57%), mean age was 55.9 ± 12.2 years. LE was found in 87% of all patients and in 50%, 80%, and 100% of the indeterminate, without VT and VT groups, respectively. The percentage of LE increased progressively in the indeterminate, CC without VT, and CC with VT groups; without a significant difference between NS-VT and S-VT (0.93%, 15.2%, 23.2%, and 21.4%, respectively). The amount of LE increased with the functional class. LE in the basal and mid lateral wall was more frequent in VT, without difference between S-VT and NS-VT. The only predictor of VT was the percentage of LE, odds ratio (OR), 6.2; (95% confidence interval [CI], 3.7-28.4; P = .01) with a cutoff of Odds Ratio 17.1%. CONCLUSIONS: The amount of LE increases in relation to the clinical stage of the disease and its functional class in Chagas seropositive patients. The amount of LE was the main predictor of VT, without difference between S-VT and NS-VT.
Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Eletrocardiografia , Imagem Cinética por Ressonância Magnética , Taquicardia Ventricular/diagnóstico , Potenciais de Ação , Adulto , Idoso , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/fisiopatologia , Meios de Contraste/administração & dosagem , Feminino , Gadolínio DTPA/administração & dosagem , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Volume Sistólico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Função Ventricular Esquerda , Função Ventricular DireitaRESUMO
INTRODUCTION: Patients with chronic kidney disease undergoing haemodialysis (HD) therapy have high morbidity and mortality, the main causes are cardiovascular events followed by infectious disease. Infectious problems originate from the vascular access, especially when such access is through a central venous catheter. CASE PRESENTATION: We described a 72-year-old man with end-stage renal disease, requiring HD, with fever and purulent discharge at the catheter insertion site. Transthoracic echocardiography revealed a 39 × 27 mm mobile mass in the right atrium. Magnetic resonance imaging showed a 53 × 45 × 36 mm mass suggesting myxoma. The patient underwent surgery and a mass of approximately 5 × 6 cm was found attached to the floor of the right atrium, next to the inferior vena cava outlet, without affecting the tricuspid valve or the interatrial septum. Histopathology reported infected thrombus. This case confirms that sometimes it is difficult to perform a differential diagnosis between intracardiac masses. The patient showed full clinical recovery during this period and was discharged. Currently, he is in good clinical condition and attends follow-up clinic of nephrology, regularly. DISCUSSION: In HD patients, a high index of suspicion is very important in the early recognition and management of infective endocarditis. Imaging studies are very useful for the diagnosis of intracardiac masses, but sometimes it is difficult to differentiate one mass from another. In our case, despite the multimodal approach, the histopathological study was the one that gave us the definitive diagnosis.
RESUMO
Resumen Los tumores cardiacos constituyen una patología poco frecuente (0.002-0.3%) en todos los grupos de edad, sin embargo tienen importancia clínica por el órgano que comprometen. Se clasifican en primarios (benignos o malignos) y secundarios (metástasis). De los primarios el mixoma es el tumor benigno más común, y el sarcoma representa la mayoría de las lesiones malignas. Las metástasis cardiacas son más frecuentes que los tumores primarios. Las manifestaciones clínicas de los tumores cardiacos son poco específicas y varían de acuerdo a su localización, tamaño y agresividad. El uso de tomografía computada multidetector (TCMD) y resonancia magnética (RM) nos ayuda a tener conocimiento de la localización, el tamaño, las relaciones anatómicas y el compromiso de las estructuras adyacentes; además, la RM ayuda a la caracterización tisular del tumor. Es por eso que los estudios en imagen cardiovascular no invasiva tienen un papel importante en la caracterización de estas lesiones y su diagnóstico diferencial entre ellas.
Abstract Cardiac tumors, are a rare pathology (0.002-0.3%) in all age groups, however, they have a clinic importance, due the affected organ. They are classified in primary (benign or malignant) and secondary (metastasis) types. Among primary type, mixoma, is the most common benign tumor, and sarcoma represents most of the malignant injuries. Cardiac metastasis are more frequent than primary tumors. Clinic effects of cardiac tumors are unspecific and vary according their location, size and agresivity. The use of Multidetector Computed Tomography (MDCT) and Magnetic Resonance Imaging (MRI) assist on the location, sizing, anatomical relationships and the compromise of adyacents structures, besides, MRI is useful for tissue characterization of the tumor. Due to the previous reasons, studies based on noninvasive cardiovascular imaging, have an important role on the characterization of these lesions and the differential diagnosis among them.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Imageamento por Ressonância Magnética , Técnicas de Imagem Cardíaca , Tomografia Computadorizada Multidetectores , Neoplasias Cardíacas/diagnóstico por imagem , Rabdomioma/diagnóstico por imagem , Sarcoma/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Mixoma/diagnóstico por imagemRESUMO
Objetivo: Establecer la correlación y la concordancia del grado de severidad de insuficiencia pulmonar entre la ecocardiografía y la resonancia magnética en la población pediátrica de un hospital de tercer nivel de atención. Métodos: Se estudiaron 20 pacientes con diagnóstico de cardiopatía congénita con insuficiencia pulmonar, a quienes se les realizaron ecocardiograma transtorácico y resonancia magnética. Se calculó: relación de la vena contracta y el chorro de insuficiencia pulmonar, tiempo de hemipresión, presencia de flujo diastólico reverso en tronco pulmonar e índice de insuficiencia pulmonar; en cuanto a la resonancia magnética: la fracción y el volumen regurgitante. Se realizó análisis de correlación mediante coeficiente de correlación de Spearman y prueba de Tau B. Resultados:La tetralogía de Fallot corregida representó el 60% de la muestra. La correlación fue significativa en la fracción y el volumen regurgitante de la resonancia magnética, así como en las variables ecocardiográficas índice de insuficiencia pulmonar en modo M, vena contracta y porcentaje de vena contracta/arteria pulmonar. La correlación entre los grados de insuficiencia pulmonar por resonancia magnética y ecocardiografía fue 0,85 (p < 0,001). Conclusiones: La vena contracta y el porcentaje VC/AP son variables que tienen alta correlación con la fracción y el volumen regurgitante de la resonancia magnética nuclear para evaluar la insuficiencia pulmonar en pacientes en posoperatorio de cardiopatía congénita.
Motivation: To establish the correlation and concordance of the degree of severity of pulmonary insufficiency between echocardiography and magnetic resonance in pediatric population of a third level hospital. Methods: 20 patients diagnosed with congenital heart disease and with pulmonary insufficiency were studied, they underwent a transthoracic echocardiogram and a magnetic resonance. The relationship of the vena contracta, the pulmonary regurgitation jet, the pressure half-time time, the presence of reversed end-diastolic flow and the pulmonary insufficiency index were calculated. With regards to the magnetic resonance, both fraction and regurgitant volume were measured. An analysis of the correlation was conducted.by means of the Spearman correlation and the Tau B. Results: Corrected Fallot's tetralogy represented 60% of the sample. The correlation was significant in the fraction and the regurgitant volume of the magnetic resonance, as well as in the echocardiographic variables of M-mode pulmonary insufficiency, vena contracta and vena contracta/pulmonary artery percentage. The correlation between the degrees of pulmonary insufficiency by magnetic resonance and echocardiogram was 0.85 (p < 0.001). Conclusions: Vena contracta and the VC/PA percentage are variables that present high correlation with the fraction and the regurgitant volume of nuclear magnetic resonance to assess pulmonary insufficiency in patients after a congenital cardiac disease surgery.
Assuntos
Humanos , Ecocardiografia , Imageamento por Ressonância MagnéticaRESUMO
Cardiac tumors, are a rare pathology (0.002-0.3%) in all age groups, however, they have a clinic importance, due the affected organ. They are classified in primary (benign or malignant) and secondary (metastasis) types. Among primary type, mixoma, is the most common benign tumor, and sarcoma represents most of the malignant injuries. Cardiac metastasis are more frequent than primary tumors. Clinic effects of cardiac tumors are unspecific and vary according their location, size and agresivity. The use of Multidetector Computed Tomography (MDCT) and Magnetic Resonance Imaging (MRI) assist on the location, sizing, anatomical relationships and the compromise of adyacents structures, besides, MRI is useful for tissue characterization of the tumor. Due to the previous reasons, studies based on noninvasive cardiovascular imaging, have an important role on the characterization of these lesions and the differential diagnosis among them.
Assuntos
Técnicas de Imagem Cardíaca , Neoplasias Cardíacas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia Computadorizada Multidetectores , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/diagnóstico por imagem , Rabdomioma/diagnóstico por imagem , Sarcoma/diagnóstico por imagem , Teratoma/diagnóstico por imagemRESUMO
The I/D insertion/deletion polymorphism of the angiotensin-converting enzyme has been related to hypertension. This polymorphism also seems to have gender related implications. Angiotensin II contributes to the production and release of oxygen reactive species that react with nitric oxide, inactivating its effects. Objective: To establish whether the ACE I/D polymorphism correlates with nitric oxide plasma metabolites in healthy men and women. Methods: Among 896 subjects between 18 and 30 years of age range, 138 fulfilled inclusion criteria. The polymorphism was identified by polymerase chain reaction, and blood nitric oxide metabolites were analyzed following the method described by Bryan. Results: Both systolic and diastolic arterial pressures were higher in men than in women (107/67 vs. 101/65 mmHg, p < 0.001). In terms of the ACE gene, there were differences in the concentration of nitric oxide metabolites in men with the I/D and D/D genotypes when compared to carriers of the I/I genotype (33.55 and 29.23 vs. 53.74 pmol/ml; p = <0.05), while there were no significant differences in women when compared by genotype. Men with the D/D genotype had higher systolic blood pressure than I/D carriers (111 vs. 104 mmHg, p < 0.05). We observed no arterial blood pressure differences in women when grouped by ACE genotype. Conclusions: The ACE D/D genotype was associated with nitric oxide metabolite levels and systolic blood pressure in clinically healthy men while it had no effect in women.
El polimorfismo inserción/deleción del gen de la enzima convertidora de la angiotensina (polimorfismo I/D de la ECA), se relaciona con hipertensión y sus efectos podrían estar asociados al género. La angiotensina II contribuye a la producción y liberación de especies reactivas de oxígeno, que reaccionan con el óxido nítrico (ON), inactivándolo. Objetivo: Conocer si existen diferencias en la concentración de metabolitos de ON en hombres y mujeres sanos que puedan estar influidas por el polimorfismo I/D de la ECA. Métodos: De 896 sujetos de entre 18 y 30 años, 138 cumplieron los criterios de inclusión. El polimorfismo fue identificado usando reacción en cadena de la polimerasa y los metabolitos de ON fueron analizados en sangre usando el método de Bryan. Resultados: Las presiones sistólica y diastólica fueron más elevadas en hombres que en mujeres (107/67 vs. 101/65 mmHg p < 0.001). En relación con el genotipo, existieron diferencias significativas en la concentración de metabolitos de ON en los hombres con genotipos I/D, D/D comparados con los portadores del genotipo I/I (33.55 y 29.23 vs. 53.74 pmol/ml, respectivamente; p = <0.05). No hubo diferencias significativas en las mujeres portadoras de los diferentes genotipos. Respecto a la presión arterial, los hombres con genotipo D/D presentaron mayor presión arterial sistólica que aquellos portadores de I/D (111 vs. 104 mmHg, p < 0.05). En las mujeres no se observaron diferencias significativas comparándolas por genotipo. Conclusiones: El genotipo D/D de la ECA está asociado con el nivel de metabolitos de ON en plasma y la presión arterial sistólica en hombres clínicamente sanos; esta asociación no se observa en las mujeres.