RESUMO
Cardiac masses are highly heterogeneous and vary widely in their clinical presentation, imaging features, and survival outcomes. Our understanding is limited by their rarity and the fact that few are confirmed based on surgical pathology. We set out to provide a comprehensive analysis of all cardiac masses resected at our institution from 1999 to 2015, including imaging methods and histopathologic findings. We found papillary fibroelastomas (PFEs) to be the most commonly resected benign cardiac masses, followed by myxomas. Patients with PFEs most frequently presented with cerebrovascular accidents and transient ischemic attacks, whereas those with myxomas were more likely to present with arrhythmias and palpitations. In contrast, primary malignant cardiac masses were much rarer; angiosarcoma was the predominant subtype with a poor prognosis. Renal cell carcinomas were the most commonly discovered primary cancer for metastatic cardiac masses, and calcified amorphous tumors were the most prevalent non-neoplastic masses. For the detection of cardiac masses, transthoracic echocardiography was the most frequently used but least sensitive of the imaging methods analyzed. Transesophageal echocardiography (TEE) was the most sensitive imaging method. Fluorodeoxyglucose Positron Emission Tomography had similar sensitivity to TEE but was the least frequently used imaging method. Computed tomography and magnetic resonance imaging performed well in detecting most masses; PFEs, for which TEE was the most sensitive, was the exception. In conclusion, we found that PFEs were the most commonly resected benign cardiac masses, and TEE was the most accurate imaging method for the detection of all surgically removed masses at our institution.
Assuntos
Neoplasias Cardíacas , Mixoma , Humanos , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/epidemiologia , Neoplasias Cardíacas/cirurgia , Ecocardiografia Transesofagiana/métodos , Ecocardiografia , Tomografia Computadorizada por Raios XRESUMO
Although a patent foramen ovale (PFO) is relatively common, confirmed reports of thrombus entrapped within a PFO are uncommon. Management of impending paradoxical embolism (IPE), also called a thrombus in transit, lacks consensus but includes systemic anticoagulation (e.g., heparin), systemic thrombolysis, or surgical thrombectomy. We present a case of IPE diagnosed with intraoperative transesophageal echocardiography (TEE) as well as a novel en bloc approach to atrial septal aneurysmectomy to minimize embolism and facilitate repair of the interatrial septum. Timely use of intraoperative TEE may aid in diagnosis and help guide the surgical approach to minimize embolic risk with an IPE.
Assuntos
Embolia Paradoxal , Forame Oval Patente , Comunicação Interatrial , Embolia Pulmonar , Trombose , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/prevenção & controle , Embolia Paradoxal/cirurgia , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/prevenção & controleRESUMO
A high-velocity gradient across the left ventricular outflow tract is most often caused by aortic valve stenosis. We describe the unusual case of a high-velocity gradient caused by a kinked ascending aortic graft in a 69-year-old man who had Marfan syndrome. The patient had a history of ascending aortic aneurysm and had previously undergone replacement of the aortic root and ascending aorta with use of a bioprosthetic valved graft. The kinking was caused by dilation of the native aortic arch. The patient underwent successful hemi-arch replacement and repair of the kinked graft. Late complications and reoperation after proximal aortic surgery in patients with Marfan syndrome are rare, and a high-velocity left ventricular outflow tract gradient caused by the kinking of the aorta is unusual.
Assuntos
Aneurisma Aórtico/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese Vascular , Prótese Vascular , Oclusão de Enxerto Vascular/etiologia , Insuficiência Cardíaca/etiologia , Implante de Prótese de Valva Cardíaca , Síndrome de Marfan/complicações , Idoso , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etiologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Ecocardiografia Doppler , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Síndrome de Marfan/diagnóstico , Desenho de Prótese , Recuperação de Função Fisiológica , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
BACKGROUND: Echocardiography has been shown to be a valuable resource in the diagnosis of many cardiac conditions, and can be used in all age groups, from the fetus to the oldest old. In the context of an increasingly aging population, the impact and utility of echocardiography in centenarians is largely unknown. This study is to determine whether echocardiography in centenarians aids in making clinical patient management decisions. METHODS: A retrospective review of echocardiograms from 1986 to 2014, at two affiliated tertiary centers, in individuals who were 100 years or older at the time of the examination. Patient and echocardiogram characteristics, management decisions based on echocardiography, and mortality were documented. RESULTS: 114 centenarians had echocardiograms, with ages ranging from 100 to 107 years (101 ± 1.4 years). In 82 of the centenarians evaluated (72%), no changes in management occurred as a consequence of the echocardiogram. From all management changes directly related to the echocardiogram, 81% (n = 26) of these corresponded to medication adjustments; interventional or surgical procedures followed the echocardiogram only in 4% (n = 5) of the total number of centenarians. Echocardiogram-based changes in management were only significant in patients that were referred for congestive heart failure (P = 0.02). After the echocardiogram was performed, 1-month and 1-year mortality were 15% and 47%, respectively. The median survival after the echocardiogram was obtained was 13 months (range 0.03 to 145 months), with no difference if there was a change or no change in management (P = 0.21). CONCLUSIONS: Among centenarians undergoing echocardiography, despite additional diagnostic information, echocardiograms in centenarians influence management in a minority of cases, most commonly in the form of medication changes for treatment of heart failure. A significant proportion of centenarians are deceased within a year of undergoing echocardiographic assessment. These findings may question the overall utility of echocardiography in these late survivors.
RESUMO
OBJECTIVES: Guidelines have recommended aortic valve surgery in asymptomatic patients with severe aortic stenosis and a large aortic valve calcium burden. The purpose of this study was to determine whether visual assessment of aortic valve calcium and stenosis severity are reliable based on 2-dimensional echocardiography alone. METHODS: We prospectively enrolled 68 patients with aortic stenosis and compared them with 30 control participants without aortic stenosis. All had aortic valve calcium score assessment by computed tomography. In a random order, 2-dimensional images without hemodynamic data were independently reviewed by 2 level 3-trained echocardiographers, who then classified these patients into categories based on aortic valve calcium and stenosis severity. RESULTS: The 68 patients (mean age ± SD, 74 ± 10 years) were classified as having mild (n = 28), moderate (n = 22), and severe (n = 18) aortic stenosis. When the observers were asked to grade the degree of valve calcification, the agreement between them was poor (κ = 0.33-0.39). The visual ability to determine stenosis severity compared with Doppler echocardiography had high specificity (81% and 88% for observers 1 and 2). However, sensitivity was unacceptably low (56%-67%), and the positive predictive value was poor (44%-50%). Agreement was fair (κ= 0.58-0.69) between the observers for determining severe stenosis. CONCLUSIONS: Our results suggest that visual assessment of aortic valve calcium has high interobserver variability; the visual ability to determine severe aortic stenosis has low sensitivity but high specificity. Our results may have important implications for treatment of patients with aortic stenosis and guiding the use of handheld echocardiography. Further research with larger cohorts is needed to validate the variability, sensitivity, and specificity reported in our study.
Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/etiologia , Ecocardiografia/métodos , Índice de Gravidade de Doença , Calcificação Vascular/diagnóstico por imagem , Idoso , Arizona , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Calcificação Vascular/complicaçõesRESUMO
The pulmonary valve is the least affected site for valvular papillary fibroelastoma. With increasing use of routine echocardiography and other modalities of imaging, pulmonary valve papillary fibroelastomas (PVPFE) are being recognized more frequently. PVPFE is more often an incidental diagnosis and symptomatic patients usually present with shortness of breath. Embolic phenomena and right ventricular outflow tract obstruction are the most serious complications of PVPFE. Since PVPFE is rare, the purpose of this systematic review is to address demographic characteristics, the clinical presentation, management, and outcome of this benign tumor of the pulmonary valve.
Assuntos
Ecocardiografia/métodos , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Ecocardiografia Transesofagiana , Doenças das Valvas Cardíacas/diagnóstico por imagem , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura EspontâneaRESUMO
Osteogenesis imperfecta (OI) or "brittle bone disease" is a rare connective tissue hereditary disorder. The most common clinical presentation of OI is bone fractures. OI also involves extraskeletal structures; however, cardiovascular manifestations are rare. In this report, we describe the cardiovascular anomalies of patients with OI who underwent valve surgery and review the literature on this subject.
Assuntos
Doenças das Valvas Cardíacas/etiologia , Osteogênese Imperfeita/complicações , Adulto , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Prolapso da Valva Aórtica/diagnóstico por imagem , Prolapso da Valva Aórtica/etiologia , Prolapso da Valva Aórtica/cirurgia , Ecocardiografia Doppler em Cores , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso da Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/etiologia , Prolapso da Valva Mitral/cirurgiaAssuntos
Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico por imagem , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Adulto , Insuficiência da Valva Aórtica/cirurgia , Fístula Arteriovenosa/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , UltrassonografiaAssuntos
Ecocardiografia Transesofagiana/métodos , Fibroma/diagnóstico por imagem , Fibroma/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/cirurgia , Idoso , Diagnóstico Diferencial , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Humanos , Doenças Raras/diagnóstico por imagem , Doenças Raras/cirurgiaAssuntos
Doenças das Valvas Cardíacas/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Anuloplastia da Valva Cardíaca , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/cirurgia , Humanos , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Valva Pulmonar/cirurgia , Resultado do Tratamento , Valva Tricúspide/cirurgiaAssuntos
Diafragma/diagnóstico por imagem , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Idoso de 80 Anos ou mais , Diafragma/patologia , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Humanos , MasculinoAssuntos
Implante de Prótese de Valva Cardíaca/efeitos adversos , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Complicações Pós-Operatórias/cirurgia , Falha de Prótese , Ecocardiografia , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Reoperação , Técnicas de SuturaRESUMO
Takotsubo cardiomyopathy is characterized by chest pain, electrocardiographic abnormalities such as ST-segment elevation or depression, and elevated cardiac enzyme levels. Left ventriculography reveals transient akinesis of the involved segment of the myocardial wall (usually the left ventricular apex) and compensatory hyperkinesis of the noninvolved myocardium, which appears as apical ballooning during systole. Existing criteria for the diagnosis of takotsubo cardiomyopathy include the absence of obstructive coronary artery disease. Indeed, previous investigators have found incidental stenosis in only a minority of patients.Herein, we present the unusual case of an 84-year-old woman who sustained 4 episodes of takotsubo cardiomyopathy in 18 years. At the time of the initial episode, coronary angiography revealed no substantial stenosis. Concomitant with the 2nd episode, stenosis in the 1st obtuse marginal branch was treated with stenting. No new lesions were apparent after the patient's 3rd presentation, and the previously placed stent was patent. During the 4th (current) presentation, we detected and percutaneously treated severe stenoses in the patient's left anterior descending coronary artery and 2nd obtuse marginal branch.Although this report is of a single patient only, it definitively illustrates that severe coronary artery disease can occur in patients who have takotsubo cardiomyopathy. We recommend the thorough evaluation of possible coronary artery disease in high-risk patients, even upon the strong clinical suspicion of takotsubo cardiomyopathy.
Assuntos
Estenose Coronária/complicações , Cardiomiopatia de Takotsubo/complicações , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/instrumentação , Angiografia Coronária , Estenose Coronária/diagnóstico , Estenose Coronária/terapia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Stents , Cardiomiopatia de Takotsubo/diagnóstico , Resultado do TratamentoRESUMO
The main determinant of survival in amyloid light chain amyloidosis is cardiac involvement. The rate of change in wall thickness may be a strong predictor of survival. After treatment, some hematologic responders have had documented regression of wall thickness by echocardiography with resolution of heart failure symptoms. Herein, we demonstrate a case of treated immunoglobulin light chain cardiac amyloidosis with echocardiographic wall thinning and cardiac biopsies demonstrating complete histologic remission. This observation suggests a mechanism of treatment response and that with appropriately timed treatment, cardiac deposition of amyloid fibrils can be completely reversed.
Assuntos
Amiloidose/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Amiloide/metabolismo , Amiloidose/tratamento farmacológico , Amiloidose/metabolismo , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Tretoquinol , UltrassonografiaRESUMO
Pericardial cysts are most commonly located at the cardiophrenic angle or, rarely, in the posterior or anterior superior mediastinum. The majority of pericardial cysts are asymptomatic and are found incidentally. Symptomatic pericardial cysts present with dyspnoea, chest pain, or persistent cough. We describe four patients with symptomatic pericardial cysts who were treated with either echocardiographically guided percutaneous aspiration or video-assisted thoracoscopic surgery, or both; thoracotomy; or conservative therapy.
Assuntos
Cisto Mediastínico/diagnóstico por imagem , Idoso , Biópsia por Agulha , Feminino , Humanos , Cisto Mediastínico/patologia , Pessoa de Meia-Idade , Pericardiectomia , Radiografia Torácica , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: While using echocardiography to guide endomyocardial biopsy (EMB), the authors have identified acute intracardiac thrombus formation related to the procedure, a hitherto unreported complication. The aims of this study were to identify the procedural details and characteristics of patients who developed this complication between June 2008 and April 2009 and to describe their outcomes and management. METHODS: In total, 415 right ventricular biopsies were performed during this period. Of these, 189 were echocardiographically guided, and the medical records of these patients were reviewed retrospectively. RESULTS: There were eight cases of acute right-sided intracardiac thrombus formation in seven patients (about 4% of the echocardiographically guided group) at the time of biopsy. The indications for EMB were heart transplant surveillance in six patients and suspected cardiac amyloidosis in one patient. Three cases were performed via a transjugular approach and four via a femoral approach. Four patients had histories of prior thromboses, and one patient had a defined clotting diathesis. Management included either immediate thrombus aspiration or postprocedural anticoagulation. There were no overt occurrences of pulmonary thromboembolism. CONCLUSIONS: Acute thrombus formation is a complication of EMB. If this complication is unrecognized, and therefore untreated, pulmonary thromboembolism may result. This may have important clinical implications in patients undergoing routine repeated surveillance EMB after cardiac transplantation. The authors recommend performing transthoracic echocardiography during EMB, particularly in patients with histories of thrombosis, because this group of patients may be at increased risk for procedural thrombosis, and procedural echocardiography permits early recognition and treatment of this complication.