RESUMO
Resumen La erosión tardía de la pared auricular y de la aorta es una causa infrecuente, pero potencialmente mortal en los pacientes que han sido sometidos al cierre percutáneo de un defecto del septum auricular, en especial cuando existe una alta relación entre el tamaño del dispositivo escogido con el tamaño del defecto y la presencia de bordes insuficientes. Presentamos el caso de un hombre de 70 años con un episodio de colapso hemodinámico secundario a taponamiento cardiaco debido a erosión muy tardía de la aurícula derecha por un Amplatzer® implantado 4 años atrás para el cierre de un defecto septal auricular. Conclusión La erosión tardía de los dispositivos de cierre percutáneo para los defectos atriales, aunque infrecuente, deberá ser tenida en cuenta en los pacientes que presentan colapso hemodinámico.
Abstract Late atrial wall and aorta erosion is a rare cause of potential fatallity in patients who have undergone percutaneous closure of an atrial septal defect, especially when a high ratio device to defect is chosen, and an insufficient aortic rim is present. We report the case of a 70 year old male with an episode of hemodinamic collapse secondary to cardiac tamponade due to a late erosion of a 4 years ago implanted Amplatzer® used to close an atrial septal defect. Conclusion Very late wall erosion of an atrial septal closure device, although uncommon, should be suspected in patients presenting with hemodynamic collapse.
Assuntos
Humanos , Masculino , Idoso , Complicações Pós-Operatórias/etiologia , Dispositivo para Oclusão Septal/efeitos adversos , Átrios do Coração/lesões , Comunicação Interatrial/cirurgia , Fatores de TempoRESUMO
UNLABELLED: Late atrial wall and aorta erosion is a rare cause of potential fatallity in patients who have undergone percutaneous closure of an atrial septal defect, especially when a high ratio device to defect is chosen, and an insufficient aortic rim is present. We report the case of a 70 year old male with an episode of hemodinamic collapse secondary to cardiac tamponade due to a late erosion of a 4 years ago implanted Amplatzer(®) used to close an atrial septal defect. CONCLUSION: Very late wall erosion of an atrial septal closure device, although uncommon, should be suspected in patients presenting with hemodynamic collapse.
Assuntos
Átrios do Coração/lesões , Comunicação Interatrial/cirurgia , Complicações Pós-Operatórias/etiologia , Dispositivo para Oclusão Septal/efeitos adversos , Idoso , Humanos , Masculino , Fatores de TempoRESUMO
A 36-year-old woman who had received long-term treatment with chloroquine for systemic lupus erythematosus developed a third degree atrioventricular block and required a permanent pacemaker. Notably, left ventricular thickening and mild systolic dysfunction were noticed on echocardiography as well as on cardiac MRI. As there was no clear explanation for myocardial findings, the patient underwent an endomyocardial biopsy that demonstrated vacuolar degeneration of myocytes on light microscopy and curvilinear bodies on electron microscopy, both findings consistent with chloroquine toxicity. The drug was withheld and treatment with candesartan and carvedilol was prescribed. At 2-year follow-up, the patient remained asymptomatic and left ventricular systolic function had improved. Physicians who prescribe antimalarial drugs for rheumatic diseases should be aware of the potentially life-threatening effects of chloroquine on the heart.