Rare association between giant-cell aortitis and giant-cell aortic valvulitis.

Giant cell arteritis (GCA) is a type of chronic vasculitis that affects medium and large-caliber arteries, frequently related to aortic involvement and, consequently, to aneurysm formation. However, associated valvulitis with giant cells is uncommon. We describe the case of a 50-year-old female patient with aortic aneurysm and valvular insufficiency, whose anatomopathological examination revealed giant-cell aortic valvulitis associated with giant cell aortitis.

Zero-contrast imaging for the assessment of transcatheter aortic valve implantation in candidates with renal dysfunction.

BACKGROUND: Candidates for transcatheter aortic valve implantation (TAVI) are currently evaluated using computed tomography angiography and invasive cardiac catheterization as an essential part of case selection and pre-procedure interventional planning. However, both imaging methods utilize iodinated agents, which may cause contrast-induced nephropathy, particularly in patients with baseline renal dysfunction. This study aimed to describe a zero-contrast imaging protocol for pre-TAVI evaluation in patients with advanced renal impairment. METHODS: The pre-TAVI zero-contrast scheme consisted of the following multi-modality combinations: (1) gadolinium-free magnetic resonance imaging (three-dimensional navigator-echo with electrocardiogram-gated steady-state free-precession series); (2) iodinated-free multislice computed tomography electrocardiogram-gated; (3) lower limb arterial duplex scan ultrasound; and (4) transesophageal echocardiography. Ultimately, TAVI was performed for those deemed good candidates, and contrast was allowed during the intervention; however, operators were strongly advised to utilize the least volume possible of iodinated agents. This pilot survey included ten patients with symptomatic aortic stenosis and renal dysfunction who underwent zero-contrast multi-modality imaging. RESULTS: All the patients ultimately underwent TAVI. The intervention was successful in all cases, without ≥ moderate residual aortic regurgitation, prosthesis embolization, annulus rupture, major vascular complications, stroke, or death during index hospitalization. The creatinine clearance remained stable throughout the observation period (baseline: 26.85 ± 12.55 mL/min; after multi-modality imaging: 26.76 ± 11.51 mL/min; post-TAVI at discharge: 29.84 ± 13.98 mL/min; p = 0.3 all). CONCLUSION: The proposed contrast-free imaging protocol appears to be a promising clinical tool for pre-TAVI evaluation in patients with severe renal dysfunction.

Rare association between giant-cell aortitis and giant-cell aortic valvulitis

ABSTRACT Giant cell arteritis (GCA) is a type of chronic vasculitis that affects medium and large-caliber arteries, frequently related to aortic involvement and, consequently, to aneurysm formation. However, associated valvulitis with giant cells is uncommon. We describe the case of a 50-year-old female patient with aortic aneurysm and valvular insufficiency, whose anatomopathological examination revealed giant-cell aortic valvulitis associated with giant cell aortitis.

Computed tomography angiography in the planning of transcatheter aortic valve replacement: a step-by-step approach.

Aortic valve stenosis is the most common acquired valvular heart disease. Transcatheter aortic valve implantation, also known as transcatheter aortic valve replacement (TAVR), is an important treatment option for symptomatic aortic stenosis in patients at any level of surgical risk. The role of computed tomography angiography (CTA) has expanded considerably in recent years, and it has now become the imaging method of choice for the planning of TAVR. Therefore, radiologists should understand the main aspects of this imaging modality, including the appropriate technique and protocol to acquire reliable CTA images and to create a useful radiology report. The aim of this study was to review the most important aspects of CTA for TAVR planning.

A estenose da válvula aórtica é a doença cardíaca valvar adquirida mais comum. A substituição transcateter da válvula aórtica (TAVR), ou implante transcateter da válvula aórtica, é uma importante opção no tratamento da estenose aórtica sintomática, independente do risco cirúrgico do paciente. O papel da angiotomografia computadorizada cresceu consideravelmente nos últimos anos e tornou-se o método de escolha no planejamento de TAVR. Assim, o radiologista deve compreender os principais aspectos dessa modalidade, incluindo técnica e protocolo, a fim de adquirir imagens confiáveis e compor um relatório para a realização do procedimento. O objetivo deste ensaio é revisar os pontos mais importantes que precisam ser avaliados na angiotomografia no planejamento de TAVR.

Computed tomography angiography in the planning of transcatheter aortic valve replacement: a step-by-step approach / Angiotomografia computadorizada no planejamento de substituição transcateter da válvula aórtica: uma abordagem passo a passo

Abstract Aortic valve stenosis is the most common acquired valvular heart disease. Transcatheter aortic valve implantation, also known as transcatheter aortic valve replacement (TAVR), is an important treatment option for symptomatic aortic stenosis in patients at any level of surgical risk. The role of computed tomography angiography (CTA) has expanded considerably in recent years, and it has now become the imaging method of choice for the planning of TAVR. Therefore, radiologists should understand the main aspects of this imaging modality, including the appropriate technique and protocol to acquire reliable CTA images and to create a useful radiology report. The aim of this study was to review the most important aspects of CTA for TAVR planning.

Resumo A estenose da válvula aórtica é a doença cardíaca valvar adquirida mais comum. A substituição transcateter da válvula aórtica (TAVR), ou implante transcateter da válvula aórtica, é uma importante opção no tratamento da estenose aórtica sintomática, independente do risco cirúrgico do paciente. O papel da angiotomografia computadorizada cresceu consideravelmente nos últimos anos e tornou-se o método de escolha no planejamento de TAVR. Assim, o radiologista deve compreender os principais aspectos dessa modalidade, incluindo técnica e protocolo, a fim de adquirir imagens confiáveis e compor um relatório para a realização do procedimento. O objetivo deste ensaio é revisar os pontos mais importantes que precisam ser avaliados na angiotomografia no planejamento de TAVR.

A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis.

Left ventricular hypertrophy is a risk factor for cardiovascular mortality in patients on peritoneal dialysis (PD). Because icodextrin has a greater ultrafiltration power compared with glucose-based solutions for long dwell, it could improve left ventricular mass by reducing fluid overload. This was a randomized clinical trial that included patients on PD recruited from 2 teaching hospitals, in Sao Paulo-Brazil. Patients were allocated to the control glucose group (GLU) or the intervention icodextrin (ICO) group. Clinical and cardiac magnetic resonance image (MRI) parameters were evaluated at baseline and 6 months after randomization. The primary outcome was the change in left ventricular mass adjusted by surface area (ΔLVMI), measured by cardiac MRI. A total of 22 patients completed the study (GLU, N = 12 and ICO, N = 10). Baseline characteristics such as age, sex, underlying disease, and time on dialysis were similar in both groups. At baseline, 17 patients (77.3%) presented with left ventricular hypertrophy with no difference between groups (p = 0.748). According to the total body water (TBW)/extracellular water (ECW) ratio, 36.8% and 80% of patients from GLU and ICO groups, respectively, were considered hypervolemic (p = 0.044). During follow-up, ΔLVMI was 3.9 g/m (- 10.7, 2.2) in GLU and 5.2 (- 26.8, 16.8) in ICO group (p = 0.651). ΔLVMI correlated with change in brain natriuretic peptide (r = 0.566, p = 0.044), which remained significant in a multiple regression analysis. The use of the icodextrin-based solution in prevalent patients on PD compared with a glucose-based solution was not able to improve LMV. A larger randomized trial with a longer follow-up period may be needed to show changes in LVM in this patient population.Trial registration: this study has been registered at ReBEC (Registro Brasileiro de Ensaios Clinicos) under the identification #RBR-2mzhmj2, available at: https://ensaiosclinicos.gov.br/pesquisador .

COVID-19 myocarditis: a case report.

A male patient with flu-like symptoms and tomography and laboratory diagnosis of severe acute respiratory syndrome. He developed acute cardiac dysfunction during admission and was submitted to a cardiac magnetic resonance imaging examination, which confirmed acute myocarditis, indicating cardiac involvement by coronavirus disease 2019. A review and discussion about coronavirus disease 2019-related cardiac manifestations are reported, focusing on the imaging findings to make diagnosis.

Diagnostic Accuracy of 320-Row Computed Tomography for Characterizing Coronary Atherosclerotic Plaques: Comparison with Intravascular Optical Coherence Tomography.

BACKGROUND/PURPOSE: This study sought to determine the diagnostic accuracy of 320-row computed tomography (320CT) for characterizing coronary atherosclerotic plaques in comparison with optical coherence tomography (OCT). METHODS/MATERIALS: From 32 patients, 42 coronary segments were evaluated and co-registered by both 320CT and OCT. 320CT vulnerable plaque characteristics included low attenuation plaque (LAP) (<30HU), napkin-ring sign (NRS), positive remodeling (PR) and spotty calcification (SC). The presence of macrophage, neovascularization and cholesterol crystals was also determined by OCT. RESULTS: Minimal lumen area was 2.78 ±â€¯1.23 mm by OCT and 3.29 ±â€¯1.49 mm by 320CT (p < 0.001). Noncalcified plaques were classified accordingly by both methods in 88.2% of the cases (p = 0.005). There was no association between any 320CT plaque type and OCT fibroatheroma (p = 0.62). The combination of 2 or more of the 320CT vulnerable plaque characteristics was associated with the presence of macrophage (74.2 vs. 25.8%; p = 0.034) and cholesterol crystals (85.7 vs. 14.3%; p = 0.04), but not with neovascularization (p = 0.65). The presence of all four characteristics demonstrated an accuracy of 75.1% for detecting OCT fibroatheroma. CONCLUSIONS: 320CT is useful for non-invasive evaluation of calcified and noncalcified tissue characteristics of coronary atheroma. The combination of all four 320CT vulnerable plaque characteristics provided the highest accuracy for detecting fibroatheromas. SUMMARY: 320CT is useful for non-invasive evaluation of calcified and noncalcified tissue characteristics of coronary atheroma. The combination of all 320CT vulnerable plaque characteristics (low attenuation plaque (<30HU), napkin-ring sign, positive remodeling and spotty calcification) provided the highest accuracy for detecting fibroatheromas compared to optical coherence tomography.

COVID-19 myocarditis: a case report / Miocardite na COVID-19: um relato de caso

ABSTRACT A male patient with flu-like symptoms and tomography and laboratory diagnosis of severe acute respiratory syndrome. He developed acute cardiac dysfunction during admission and was submitted to a cardiac magnetic resonance imaging examination, which confirmed acute myocarditis, indicating cardiac involvement by coronavirus disease 2019. A review and discussion about coronavirus disease 2019-related cardiac manifestations are reported, focusing on the imaging findings to make diagnosis.

RESUMO Paciente do sexo masculino apresentando síndrome gripal aguda com diagnóstico tomográfico e laboratorial de infecção por síndrome respiratória aguda grave. Evoluiu com disfunção cardíaca aguda durante a internação, motivo pelo qual foi submetido à ressonância magnética cardíaca, que confirmou miocardite aguda, indicando acometimento cardíaco por COVID-19. Foram realizadas revisão e discussão sobre o acometimento cardíaco na COVID-19, com ênfase nos aspectos por imagem para o diagnóstico.