Role of echocardiogram in decision making for surgery in endocarditis.

Infective endocarditis is a serious disease that carries significant morbidity and mortality. Adequate treatment is based on a high degree of clinical suspicion, accurate microbiologic diagnosis, and high-quality imaging. Echocardiography has been shown to be a fundamental tool for diagnosis and management. Currently accepted Duke criteria include blood cultures and echocardiography. Transthoracic and transesophageal echocardiography play a critical role in the decision-making process, especially when surgical treatment is contemplated. Because infective endocarditis is considered a medical and surgical disease, and considering that the current rate of surgery is about 50%, echocardiography has definite value in preoperative diagnosis and surgical planning, intraoperative confirmation of lesions and quality of repair or replacement before and after cardiopulmonary bypass, and postoperative assessment.

Fate of left atrial function as determined by real-time three-dimensional echocardiography study after radiofrequency catheter ablation for the treatment of atrial fibrillation.

Radiofrequency catheter ablation has been demonstrated to be effective in the treatment of patients with atrial fibrillation. However, its impact on left atrial (LA) function has not been widely studied. The purpose of the present study was to evaluate the impact of radiofrequency catheter ablation on LA function in patients with atrial fibrillation. Thirty-eight patients with symptomatic drug-refractory atrial fibrillation were treated with circumferential pulmonary vein ablation (CPVA). LA volumes and function were assessed with real-time 3-dimensional echocardiography before and 6 months after the procedure. The effectiveness of CPVA was evaluated at 6-month follow-up. Recurrence of the arrhythmia was defined as any documented (clinically or on 24-hour Holter electrocardiography) atrial tachyarrhythmia lasting>30 seconds after the first 12 weeks after the procedure. CPVA induced a reduction of maximum LA volume (from 55+/-15 to 48+/-16 ml, p<0.001), without impairment in LA function, measured as the active emptying percentage of total volume (32+/-29% vs 39+/-33%, p=NS). At follow-up, 21 patients (61.8%) had no recurrences. Maximum LA volumes were significantly larger in patients who presented with recurrences compared with those who did not (64+/-18 vs 50+/-11 ml, p=0.01). In conclusion, CPVA induces a reduction in LA volume without a deleterious impact on function, and, of importance, real-time 3-dimensional echocardiography is a useful noninvasive imaging tool to follow up LA remodeling and function in these patients.

Cryopreserved mitral homograft in the tricuspid position for infective endocarditis: a valve that can be repaired in the long-term (13 years).

Herein is reported the long-term repair of a cryopreserved mitral homograft in the tricuspid position. A 34-year-old HIV-infected patient underwent tricuspid valve replacement in 1991 with a cryopreserved mitral homograft because of infective endocarditis. Chronic tricuspid regurgitation secondary to repeated endocarditis led to reoperation 13 years later. Mitral valve repair was performed with a rigid ring as there was annular dilatation; the valve tissue was intact. One year later, transthoracic echocardiography showed no tricuspid regurgitation. The cryopreserved mitral homograft is a potentially repairable valve in the long-term.

[Clinical and echocardiographic follow-up of patients with hypertrophic obstructive cardiomyopathy treated by percutaneous septal ablation]. / Seguimiento clínico y ecocardiográfico de pacientes con miocardiopatía hipertrófica obstructiva tratados con ablación septal percutánea.

INTRODUCTION AND OBJECTIVES: Alcohol septal ablation is a therapeutic option for patients with hypertrophic obstructive cardiomyopathy who remain symptomatic despite medical treatment. Our aim was to monitor clinical and echocardiographic progression in patients with hypertrophic obstructive cardiomyopathy treated by septal ablation at our center. METHODS: Thirty-five septal ablations were performed in 34 patients (79% male) who had symptomatic hypertrophic obstructive cardiomyopathy despite optimum medical treatment. The procedure was successful in 32 (i.e., the reduction in left ventricular outflow tract pressure gradient, or LVOTPG, was >50%). During clinical and echocardiographic follow-up, New York Heart Association (NYHA) functional class and LVOTPG were monitored. RESULTS: The patients' mean age was 63 (12) years. The mean follow-up period was 9 (3) months. Immediately after septal ablation, LVOTPG decreased significantly, from 74.2 (25.3) mm Hg to 26 (25) mm Hg (P<.001), and remained low throughout follow-up. Moreover, echocardiography showed that the interventricular septum thickness also decreased during follow-up, from 19 (3) mm to 15 (2) mm (P<.0001). A significant improvement in NYHA functional class (from 93% in class III-IV to 84% in class I-II) was also observed. Two deaths occurred within 48 hours after the procedure. The most frequent complication was complete heart block (20%; n=6). CONCLUSIONS: Alcohol septal ablation is effective in patients with hypertrophic obstructive cardiomyopathy who remain symptomatic despite medical treatment. However, the procedure is associated with a significant rate of complications and should, therefore, be reserved for selected patients, in particular for elderly patients and those with comorbid conditions.

Assessment of left ventricular dyssynchrony by real-time three-dimensional echocardiography.

INTRODUCTION AND OBJECTIVES: A number of different imaging methods have been proposed as possible tools for assessing left ventricular (LV) mechanical dyssynchrony. The aim of this study was to evaluate the usefulness of real-time three-dimensional echocardiography (RT3DE) for studying LV mechanical dyssynchrony. METHODS: In total, 60 individuals underwent RT3DE, including 10 healthy volunteers, 23 patients with acute ST-segment elevation myocardial infarction and 27 patients with dilated cardiomyopathy. The LV volume was recorded throughout the full cardiac cycle using RT3DE, after which LV mechanical dyssynchrony was determined. The extent of LV mechanical dyssynchrony was characterized using the systolic dyssynchrony index (SDI), which was calculated from the variation in the time required to reach the minimum regional systolic volume in the 16 LV segments analyzed. RESULTS: The SDI was significantly higher in patients with dilated cardiomyopathy, at 14.3%+/-7.5% compared with 1.5%+/-0.7% in healthy volunteers and 8.1%+/-7.1% in acute myocardial infarction patients (ANOVA, P< .001). Basal and mid ventricular segments showed the greatest delays. All patients with dilated cardiomyopathy received cardiac resynchronization therapy. In this patient subgroup, the SDI exhibited an immediate significant decrease (to 9.7%+/-6.8%; P< .05) and a progressive decrease during 6 months of follow-up (to 4.9%+/-3.1%; P< .05). CONCLUSIONS: The new imaging technique of RT3DE can be used to assess LV mechanical dyssynchrony and is able to identify the LV segments with the greatest time delays.

Estudio de la asincronía ventricular izquierda con ecocardiografía tridimensional en tiempo real / Assessment of Left Ventricular Dyssynchrony by Real-Time Three-Dimensional Echocardiography

Introducción y objetivos. Se han propuesto diferentestécnicas de imagen para estudiar la asincronía mecánicadel ventrículo izquierdo (VI). El objetivo del estudio fue evaluar la utilidad de la ecocardiografía tridimensional en tiempo real (E3DTR) para estudiar la asincronía mecánica del VI.Métodos. Se estudió con E3DTR a 60 sujetos: 10 voluntarios sanos, 23 pacientes con un infarto agudo demiocardio con elevación del segmento ST y 27 pacientescon miocardiopatía dilatada. A partir de la adquisición del volumen completo del VI mediante E3DTR, se evaluó laasincronía mecánica ventricular. La asincronía mecánicadel VI se definió a partir del índice sistólico de asincronía ventricular (ISA), calculado a partir de la dispersión del tiempo al mínimo volumen regional sistólico de 16 segmentos ventriculares.Resultados. Los pacientes con miocardiopatía dilatadapresentaron un ISA significativamente mayor (el 14,3% ±7,5% frente al 1,5% ± 0,7% en los voluntarios sanos y el8,1% ± 7,1% en los pacientes con infarto agudo de miocardio; ANOVA, p < 0,001); los segmentos ventricularesmás retrasados fueron los localizados a nivel medio-basal. Todos los pacientes con miocardiopatía dilatada fueron tratados con terapia de resincronización cardiaca. En este subgrupo de pacientes, el ISA se redujo significativamente en la fase aguda (9,7% ± 6,8%; p < 0,05) y de forma progresiva a los 6 meses de seguimiento (4,9% ± 3,1%; p < 0,05).Conclusiones. La E3DTR es una nueva técnica deimagen que permite el estudio de la asincronía mecánicaventricular y localizar los segmentos ventriculares más retrasados

Introduction and objectives. A number of differentimaging methods have been proposed as possible toolsfor assessing left ventricular (LV) mechanicaldyssynchrony. The aim of this study was to evaluate theusefulness of real-time three-dimensionalechocardiography (RT3DE) for studying LV mechanicaldyssynchrony.Methods. In total, 60 individuals underwent RT3DE,including 10 healthy volunteers, 23 patients with acuteST-segment elevation myocardial infarction and 27patients with dilated cardiomyopathy. The LV volume wasrecorded throughout the full cardiac cycle using RT3DE,after which LV mechanical dyssynchrony was determined. The extent of LV mechanical dyssynchrony was characterized using the systolic dyssynchrony index(SDI), which was calculated from the variation in the time required to reach the minimum regional systolic volume in the 16 LV segments analyzed.Results. The SDI was significantly higher in patientswith dilated cardiomyopathy, at 14.3%±7.5% comparedwith 1.5%±0.7% in healthy volunteers and 8.1%±7.1% inacute myocardial infarction patients (ANOVA, P<.001).Basal and mid ventricular segments showed the greatestdelays. All patients with dilated cardiomyopathy receivedcardiac resynchronization therapy. In this patientsubgroup, the SDI exhibited an immediate significantdecrease (to 9.7%±6.8%; P<.05) and a progressivedecrease during 6 months of follow-up (to 4.9%±3.1%;P<.05).Conclusions. The new imaging technique of RT3DEcan be used to assess LV mechanical dyssynchrony andis able to identify the LV segments with the greatest time delays

Seguimiento clínico y ecocardiográfico de pacientes con miocardiopatía hipertrófica obstructiva tratados con ablación septal percutánea / Clinical and echocardiographic follow-up of patients with hypertrophic obstructive cardiomyopathy treated by percutaneous septal ablation

Introducción y objetivos. La ablación septal percutánea (ASP) es una opción terapéutica para pacientes con miocardiopatía hipertrófica obstructiva (MCHO) con mala respuesta al tratamiento médico. El objetivo fue evaluar de forma prospectiva la evolución clínica y ecocardiográfica de los pacientes con MCHO tratados con ASP en nuestro centro. Métodos. Se practicaron 35 ASP en 34 pacientes (79% varones) con MCHO sintomática pese a que recibían un tratamiento médico optimizado. Se consideró eficaz en 32 (reducción del gradiente de presión en el tracto de salida del ventrículo izquierdo [GPTSVI] > 50%). Se realizó un seguimiento clínico y ecocardiográfico, y se evaluaron la clase funcional (CF) y el GPTSVI. Resultados. La edad media fue de 63 ± 12 años. El seguimiento medio fue de 9 ± 3 meses. Inmediatamente después de la ASP se redujo de manera significativa el GPTSVI (74,2 ± 25,3 a 26 ± 25 mmHg; p < 0,001) y se mantuvo así durante todo el seguimiento. Asimismo, se redujo el grosor del septo interventricular (de 19 ± 3 a 15 ± 2 mm; p < 0,0001). La CF de los pacientes mejoró (desde un 93% en CF III-IV de la NYHA hasta un 84% en CF I-II). Dos pacientes fallecieron en las primeras 48 h posprocedimiento y la complicación más frecuente fue el bloqueo auriculoventricular completo (n = 6, 20%). Conclusiones. La ASP es una terapia eficaz en pacientes con MCHO sintomática refractaria al tratamiento médico. Sin embargo, se asocia con un riesgo significativo de complicaciones, por lo que se reserva para pacientes seleccionados, especialmente para los de mayor edad o con alguna comorbilidad asociada

Introduction and objectives. Alcohol septal ablation is a therapeutic option for patients with hypertrophic obstructive cardiomyopathy who remain symptomatic despite medical treatment. Our aim was to monitor clinical and echocardiographic progression in patients with hypertrophic obstructive cardiomyopathy treated by septal ablation at our center. Methods. Thirty-five septal ablations were performed in 34 patients (79% male) who had symptomatic hypertrophic obstructive cardiomyopathy despite optimum medical treatment. The procedure was successful in 32 (i.e., the reduction in left ventricular outflow tract pressure gradient, or LVOTPG, was >50%). During clinical and echocardiographic follow-up, New York Heart Association (NYHA) functional class and LVOTPG were monitored. Results. The patients' mean age was 63 (12) years. The mean follow-up period was 9 (3) months. Immediately after septal ablation, LVOTPG decreased significantly, from 74.2 (25.3) mm Hg to 26 (25) mm Hg (P<.001), and remained low throughout follow-up. Moreover, echocardiography showed that the interventricular septum thickness also decreased during follow-up, from 19 (3) mm to 15 (2) mm (P<.0001). A significant improvement in NYHA functional class (from 93% in class III-IV to 84% in class I-II) was also observed. Two deaths occurred within 48 hours after the procedure. The most frequent complication was complete heart block (20%; n=6). Conclusions. Alcohol septal ablation is effective in patients with hypertrophic obstructive cardiomyopathy who remain symptomatic despite medical treatment. However, the procedure is associated with a significant rate of complications and should, therefore, be reserved for selected patients, in particular for elderly patients and those with comorbid conditions

Trombosis intracardíaca y síndrome antifosfolípido primario. Un caso familiar / Primary Antiphospholipid Syndrome and Intracardiac Thrombosis. A Family Case Report

El síndrome antifosfolípido es una entidad clínica poco frecuente que se manifiesta por fenómenos trombóticos de repetición en pacientes jóvenes sin factores de riesgo cardiovascular. Sus formas de presentación son múltiples, pero las más frecuentes son las pérdidas fetales de repetición y el accidente cerebrovascular. La afección cardíaca es menos frecuente. Describimos un caso familiar que se ha presentado con trombosis intracardíaca y embolia cerebral secundaria (AU)

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