RESUMO
INTRODUCTION: Papillary fibroelastoma (PFE) is a benign cardiac tumor that is currently detected more often due to the technological improvements in echocardiography. OBJECTIVES: To describe the echocardiographic features of PFE and correlate them with the clinical presentation and initial treatment. MATERIALS AND METHODS: A prospective analysis of patients with a diagnosis of PFE was conducted between 2000 and 2015. We assessed the clinical history, symptoms at the time of diagnosis, echocardiographic features, and initial treatment. RESULTS: Fifty-four patients with a diagnosis of PFE by echocardiography were included. The incidence was 0.038%. Mean age was 62±16 years; 50% were male. Forty-six percent of patients had symptoms at the time of diagnosis, the most frequent of which was transient ischemic accident (TIA). Embolic episodes occurred in 31% of patients, mainly to the brain. PFEs were valvular in 70.4% of cases and multiple in 13%. Mean maximum length was 1.18±0.58 cm, and 44% were mobile. PFEs >1.5 cm were most often found in the heart valves (56.8% vs 10.8%; P=.045). There was no significant relation between size, mobility, location and number of tumors, and the presence of embolism or symptoms. Most frequent treatment was oral anticoagulation in 48.6%, followed by simple tumor resection in 42.8% of cases. CONCLUSIONS: PFE is a small tumor, predominantly valvular and benign, but entails a high incidence of cerebral embolism. The initial approach should be individualized according to clinical manifestations, comorbidities, and the experience of the surgical center.
Assuntos
Ecocardiografia Doppler/métodos , Ecocardiografia Transesofagiana/métodos , Fibroma/diagnóstico , Neoplasias Cardíacas/diagnóstico , Idoso , Procedimentos Cirúrgicos Cardíacos , Feminino , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Papilares , Estudos ProspectivosRESUMO
Congenital diverticulum of the left ventricle is a very rare cardiac abnormality characterized by a local embryological development failure of the ventricular muscle. It may present as an isolated disorder or may be associated with other cardiac abnormalities. Clinically, it has been reported that it can lead to chest pain, arrhythmias, cardiac rupture, and sudden death, although frequently the course is asymptomatic. This article presents two illustrative cases of left ventricular diverticulum. The diagnosis was made by two-dimensional echocardiography and was confirmed by cardiac catheterization. There were no other thoracoabdominal or cardiac abnormalities. The patient was asymptomatic and surgical resection was not indicated. Given the few cases reported in the medical literature, the information available is scarce; hence, physicians should be trained to make the appropriate diagnosis.
Assuntos
Divertículo/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Achados Incidentais , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/etiologia , Angiocardiografia , Cateterismo Cardíaco , Divertículo/complicações , Divertículo/congênito , Feminino , Cardiopatias Congênitas/complicações , Ventrículos do Coração/anormalidades , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Adulto JovemRESUMO
Intermittent aortic regurgitation (AR) is an unusual complication after a mechanical prosthetic replacement. We describe a rare case of intermittent dysfunction of a bileaflet mechanical aortic prosthetic valve in a 41-year-old man with a 21 mm Tri-technologies prosthetic valve implanted 4 years before. Transthoracic echocardiography (TTE) before discharge was normal and prosthesis-patient mismatch was ruled out. He was admitted to our hospital because of mild dyspnoea at effort. TTE revealed acute and severe intermittent AR. The patient underwent surgery, during which abnormal proliferation of subvalvular pannus overgrowth on the inflow aspect of the prosthesis was found impeding the normal closure of one of the discs of the prosthesis. The pannus formation was resected, the Tri-technologies prosthetic valve was prophylactic explanted and a 23 mm St Jude Medical bileaflet mechanical prosthesis valve was implanted. We describe the role of TTE and the limitation of the cinefluoroscopy in the diagnosis of Tri-technologies prosthetic dysfunction.
Assuntos
Insuficiência da Valva Aórtica/etiologia , Valva Aórtica , Próteses Valvulares Cardíacas/efeitos adversos , Doença Aguda , Adulto , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia , Humanos , Masculino , Desenho de Prótese , Falha de Prótese , Reoperação , Resultado do TratamentoRESUMO
We report a very rare case of ascending aortic replacement complicated by acute supravalvular aortic stenosis. A 53-year-old man was referred to our Institution for evaluation of a systolic murmur and congestive heart failure. He had undergone elective ascending aortic replacement one month previously due to acute type A aortic dissection. On admission, transesophageal echocardiography revealed a proximal leak with a pseudoaneurysm compressing the aortic graft and generating a systolic gradient of 84 mmHg. The patient underwent reoperation, the graft was removed and a new Dacron graft was put in place.
Assuntos
Aorta/patologia , Dissecção Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Sobrevivência de Enxerto , Doença Aguda , Aorta/cirurgia , Estenose da Valva Aórtica/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
Marfan's syndrome is a hereditary connective tissue disease, in which cardiovascular abnormalities (especially aortic root dilatation) are the most important cause of morbidity and mortality. In this report, we describe two 24-year-old twins, with a history of surgery for lens subluxation and severe cardiovascular manifestations secondary to Marfan's syndrome. One of the twins suffered a type A aortic dissection, which required replacement of the ascending aorta, and the other twin had an aneurysmal dilatation of the ascending aorta (46mm) and was prescribed medical treatment with atenolol and periodic controls to detect the presence of a critical diameter (50mm) that would indicate the need for prophylactic surgery.
Assuntos
Aorta/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Síndrome de Marfan/diagnóstico por imagem , Gêmeos Monozigóticos , Adulto , Dissecção Aórtica/etiologia , Aorta/patologia , Aneurisma Aórtico/etiologia , Atenolol/uso terapêutico , Humanos , Masculino , Síndrome de Marfan/complicações , UltrassonografiaRESUMO
Acute prosthetic valve dysfunction due to leaflet escape is a mode of structural valve failure of mechanical prostheses which is associated with a high mortality. In this report, we describe the case of a 32-year-old patient, who underwent mitral valve replacement with a Tri-technologies bileaflet valve three years ago, and was admitted to the hospital on August 2005, in cardiogenic shock. He discontinued oral anticoagulation therapy four months ago. Transthoracic and transesophageal echocardiograms showed acute-onset massive mitral regurgitation with normal left ventricular function. The patient underwent emergency surgery, during which one leaflet was found to be absent and the other leaflet was fixed due to prosthetic thrombus.
Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Insuficiência da Valva Mitral/etiologia , Valva Mitral/patologia , Falha de Prótese , Doença Aguda , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Choque Cardiogênico/etiologia , UltrassonografiaRESUMO
The "edge to edge" or "double-orifice" technique is an alternative surgical option of mitral valve repair to treat mitral regurgitation. Echocardiography is very useful to evaluate the postoperative valve function, but since this technique is not frequently used, there is little experience about its echocardiographic features, which are different from those of the classic mitral valve repair. In this report, we present a patient who underwent this repair with a modified approach called "triple-orifice technique" and was evaluated by transthoracic and transesophageal echocardiography.
Assuntos
Ecocardiografia , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Ponte Cardiopulmonar , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/etiologia , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Most patients with hypertrophic cardiomyopathy (HCM) have asymmetric septal hypertrophy and among them, 25% present dynamic subaortic obstruction. Apical HCM is unusual and mid-ventricular HCM is the most infrequent presentation, but both variants may be associated to an apical aneurysm. An even more rare presentation is the coexistence mid-ventricular and apical HCM. This case is a combination of obstructive HCM with mid-ventricular HCM and an apical aneurysm, which to date, has not been reported in the literature. CASE PRESENTATION: The patient is a 49 year-old lady who presents a combination of septal asymmetric hypertrophic cardiomyopathy (HCM) and midventricular HCM, a subaortic gradient of 65 mm Hg and a midventricular gradient of 20 mm Hg, plus an apical aneurysm. Her clinical presentation was an acute myocardial infarction in June 2005. One month after hospital discharge, the electrocardiogram (ECG) showed a right bundle branch block (RBBB) with no Q waves or ST segment elevation. Coronary angiography revealed normal coronary arteries, left ventricular hypertrophy and an apical aneurysm. CONCLUSION: This case is a rare example of an asymptomatic patient with subaortic and mid-ventricular hypertrophic cardiomyopathy, who presents a myocardial infarction and normal coronary arteries, and during the course of her disease develops an apical aneurysm.
Assuntos
Cardiomiopatia Hipertrófica/complicações , Aneurisma Cardíaco/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/patologia , Feminino , Aneurisma Cardíaco/diagnóstico , Ventrículos do Coração , Humanos , Hipertrofia Ventricular Esquerda/etiologia , Pessoa de Meia-IdadeRESUMO
We report the transesophageal echocardiogram of a patient who was admitted to the intensive care unit with a diagnosis of acute ischemic stroke, in whom a large atrial septal aneurysm (ASA) was seen bulging toward the right atrium with marked spontaneous echo contrast (SEC) inside but without thrombi, suggesting that ASA and SEC could represent a new association with higher embolic risk.