RESUMO
Masses on the interatrial septum are usually caused by myxomas or thrombi within a patent foramen ovale. We report a 53-year-old male patient with a hollow mass within the left atrium that was incidentally found during a routine transthoracic echocardiography. Further investigation of the mass with transesophageal two- and three-dimensional echocardiography has revealed that the mass was a localized aneurysm of a patent foramen ovale tunnel. While aneurysms of interatrial septum are relatively common in normal population, to the best of our knowledge, present case is the first report of a localized aneursym of a patent foramen ovale tunnel.
Assuntos
Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana/métodos , Forame Oval Patente/diagnóstico , Forame Oval/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico , Átrios do Coração/diagnóstico por imagem , Forame Oval Patente/complicações , Aneurisma Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Ebstein's anomaly is a rare CHD that is characterised by caudal displacement of the functional tricuspid annulus and a dysfunctional tricuspid valve owing to a failure of proper leaflet coaptation. We present a balanced variant of Ebstein's anomaly, in which the overgrowth of the septal leaflet had allowed proper coaptation of the tricuspid leaflets, thus preserving the valve function.
Assuntos
Anomalia de Ebstein/diagnóstico , Ecocardiografia/métodos , Insuficiência da Valva Tricúspide/congênito , Valva Tricúspide/diagnóstico por imagem , Adolescente , Anomalia de Ebstein/fisiopatologia , Humanos , Masculino , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/fisiopatologiaRESUMO
BACKGROUND: Coronary artery anomalies are a heterogeneous group of congenital disorders presenting with a wide spectrum of symptoms, ranging from vague chest pain to sudden cardiac death. Despite available data, there is no consensus about the classification, nomenclature, and outcomes of coronary anomalies in the normally connected heart. In this study, we aimed to investigate clinical and angiographic characteristics of coronary arterial anomalies, as well as the frequency of atherosclerotic involvement in anomalous coronaries, diagnosed at a tertiary referral centre. METHODS: We retrospectively reviewed coronary angiograms performed between 2011 and 2015 for the presence of a coronary anomaly. A total of 111 patients with a final diagnosis of coronary anomaly were included in the study group. We also recruited 110 age- and sex-matched patients who underwent coronary angiography because of symptomatic coronary artery disease as controls. RESULTS: Among 36,893 coronary angiograms, 111 (0.30%) major coronary anomalies were found. Compared with controls, the prevalence of significant atherosclerotic coronary disease was lower in patients with coronary anomalies and stable symptoms (p=0.02); however, the prevalence of significant coronary atherosclerosis was similar among patients admitted with unstable angina or myocardial infarction (p>0.05). Compared with controls, patients with an anomalous left anterior descending coronary artery had significantly less atherosclerotic involvement than those in whom the left anterior descending artery was not anomalous (p=0.005). CONCLUSIONS: Although coronary artery anomalies are cited as a cause for myocardial ischaemia, atherosclerotic coronary artery disease is also frequent and may offer an alternative explanation to ischaemic symptoms. No predisposition to accelerated atherosclerosis was found, however, and atherosclerotic involvement was less frequent in some anomalous vessels.
Assuntos
Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anomalias dos Vasos Coronários/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Turquia/epidemiologia , Adulto JovemAssuntos
Falso Aneurisma/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ruptura Cardíaca/diagnóstico por imagem , Idoso , Falso Aneurisma/complicações , Evolução Fatal , Ruptura Cardíaca/complicações , Ventrículos do Coração/diagnóstico por imagem , Humanos , MasculinoRESUMO
Currently, tricuspid valve infective endocarditis (TVIE) is encountered in daily clinical practice more frequently due to the increasing prevalence of illicit intravenous drug use and the implantation of intracardiac devices. In this study, we compared findings from intra-operative live/real time three-dimensional transesophageal echocardiograms (3DTEE) and two-dimensional transesophageal echocardiograms (2DTEE) of 10 patients who underwent surgery for native tricuspid valve (TV) endocarditis. Unlike 2DTEE, 3DTEE allowed en face visualization of the 3 TV leaflets from both, atrial and ventricular aspects, in 9 of the 10 cases. In the remaining patient, in whom 3DTEE could not identify all 3 leaflets en face, the TV was found essentially destroyed at surgery. Using 3DTEE, the number of vegetations was accurately reported when compared with the surgical record. Furthermore, the orientation of each vegetation was the same as noted in the surgical findings. 2DTEE missed the identification of vegetations in 5 patients. The attachment site of vegetations to the TV were also not characterized by 2DTEE in 5 patients. In all 10 cases, 3DTEE characterized the vegetations more accurately with larger dimensions, including those in the azimuthal axis, and volumes. In addition, a perivalvular abscess that lead to surgical intervention was identified by 3DTEE, however, missed by 2DTEE. In conclusion, 3DTEE allows en face visualization of the TV apparatus permitting accurate description of the number and dimensions of vegetations identified by our surgical standard, which ultimately informs patients' prognosis and dictates the timing and planning for surgical intervention. Its use should be in conjunction with 2DTEE when evaluating TVIE.
Assuntos
Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Estudos de Coortes , Endocardite/microbiologia , Endocardite/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Tricúspide/microbiologia , Valva Tricúspide/cirurgiaRESUMO
Emboli are among the most feared complications of interventional cardiology. Although surgery is needed in most cases for the removal of peripheric foreign body emboli, some may be extracted by percutaneous intervention. We present a case of retrieval of a femoral sheath fragment via contralateral femoral access, wiring of the sheath fragment, and retrieval with an 'anchoring balloon' system.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Embolia/etiologia , Artéria Femoral/cirurgia , Infarto do Miocárdio/terapia , Complicações Pós-Operatórias/etiologia , Embolectomia com Balão/métodos , Intervalo Livre de Doença , Eletrocardiografia , Embolia/cirurgia , Artéria Femoral/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Complicações Pós-Operatórias/cirurgiaRESUMO
OBJECTIVES: Recent studies have reported a strong independent association between increased red cell distribution width (RDW) and the risk of adverse outcomes in patients with heart failure, stable coronary disease, and acute coronary syndromes. However, in this study we aimed to determine the impact of an elevated RDW level on the postinterventional thrombolysis in myocardial infarction (TIMI) flow and intrahospital mortality in patients with acute anterior myocardial infarction (AMI). METHODS: A total of 763 patients with acute AMI undergoing a primary percutaneous coronary intervention were evaluated retrospectively. Upon admission, the RDW level was measured by an automated complete blood count. Postinterventional TIMI flow and intrahospital mortality was documented for all patients from hospital registries. The patients were classified according to the RDW level. RDW more than 14.8% was defined as elevated RDW. All groups were compared statistically according to the preinterventional characteristics. RESULTS: Elevated RDW was found to be an independent predictor of increased intrahospital mortality in multivariate regression analysis (hazard ratio: 3.677, 95% confidence interval: 1.228-11.008, P=0.02). Other independent predictors for intrahospital mortality were diabetes mellitus (hazard ratio: 6.743, 95% confidence interval: 1.941-23.420, P=0.003), smoking (hazard ratio: 6.779, 95% confidence interval: 1.505-30.534, P=0.013), and creatinine more than 0.8 mg/dl (hazard ratio: 7.982, 95% confidence interval: 1.759-36.211, P=0.007). However, there were no independent predictors for TIMI including elevated RDW. CONCLUSION: A high admission RDW level in patients with acute AMI undergoing a primary percutaneous coronary intervention was associated with an increased risk for intrahospital cardiovascular mortality, but was not associated with worse postinterventional TIMI flow.
Assuntos
Infarto Miocárdico de Parede Anterior/mortalidade , Infarto Miocárdico de Parede Anterior/terapia , Circulação Coronária , Índices de Eritrócitos , Intervenção Coronária Percutânea/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Infarto Miocárdico de Parede Anterior/sangue , Infarto Miocárdico de Parede Anterior/diagnóstico , Infarto Miocárdico de Parede Anterior/fisiopatologia , Distribuição de Qui-Quadrado , Feminino , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Admissão do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: We aimed to observe the relationship of the metabolic syndrome and proarrythmogenic ECG parameters and to evaluate a possible correlation of these parameters to the metabolic syndrome score in patients without overt diabetes mellitus. METHODS: The study population consisted of 142 patients with the metabolic syndrome and 170 age- and gender-matched control subjects. In the ECG recordings, resting heart rate, QRS duration, corrected QT duration and corrected QT dispersion were measured. Patients were classified into three groups based on number of fulfilled metabolic syndrome criteria: group 1 (three metabolic syndrome criteria), group 2 (four metabolic syndrome criteria) and group 3 (five metabolic syndrome criteria). RESULTS: Patients with the metabolic syndrome had a higher increased resting heart rate, QTcd, prolonged QRS and QTc duration. Resting heart rate increases significantly parallel to the increase in the metabolic syndrome score across the groups, whilst QRS duration remained unchanged. QTc duration and QTc dispersion were significantly higher in groups 2 and 3 when compared to group 1. However, no significant differences were observed between groups 2 and 3. CONCLUSION: We demonstrated that the metabolic syndrome and its score related with increased resting heart rate and prolonged repolarization durations in patiens without overt diabetes mellitus. These pro arrhythmogenic parameters could be used in the development of risk stratification schemes for sudden cardiac death in patients with the metabolic syndrome.
Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/fisiopatologia , Adulto , Algoritmos , Índice de Massa Corporal , Estudos de Casos e Controles , Diabetes Mellitus/diagnóstico , Eletrocardiografia , Teste de Esforço , Feminino , Humanos , Masculino , Síndrome Metabólica/diagnóstico por imagem , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , UltrassonografiaRESUMO
BACKGROUND: Symptomatic cardiac injury after blunt chest trauma is relatively rare, and valvular injury is even more rare. The valves most commonly affected are tricuspid. Automobile accidents are mostly responsible for this type of injury. OBJECTIVES: Unlike with the mitral valve, post-traumatic tricuspid heart valve insufficiency is usually well tolerated. Indeed, severe tricuspid regurgitation can resolve spontaneously. CASE REPORT: A 68-year-old woman with no previous cardiac or medical history was brought to our Emergency Department after an automobile accident. She had chest pain and shortness of breath upon admission. Transthoracic echocardiographic examination revealed severe tricuspid regurgitation with rupture of the chordae tendineae and prolapse of the valve cusps into the right atrium during systole. An electrocardiogram was consistent with second-degree Mobitz II atrioventricular block on admission, which subsequently progressed to complete atrioventricular block on day 3. During follow-up with close hemodynamic monitoring, her symptoms disappeared and repeat echocardiography revealed a regression in the severity of tricuspid regurgitation. Operative repair of the tricuspid valve was deemed unnecessary and the patient was discharged with medical therapy on the eighth day after admission. CONCLUSIONS: It is important to be aware of traumatic tricuspid regurgitation after non-penetrating chest trauma. Close follow-up may suffice in some patients with stable hemodynamic conditions, and regression of tricuspid regurgitation can be expected during follow-up.
Assuntos
Acidentes de Trânsito , Bloqueio Atrioventricular/etiologia , Traumatismos Torácicos/complicações , Insuficiência da Valva Tricúspide/etiologia , Ferimentos não Penetrantes/complicações , Idoso , Bloqueio Atrioventricular/diagnóstico , Cateterismo Cardíaco , Dor no Peito/etiologia , Dispneia/etiologia , Ecocardiografia , Feminino , Humanos , Índice de Gravidade de Doença , Insuficiência da Valva Tricúspide/diagnóstico , Conduta ExpectanteRESUMO
The coexistence of Brugada syndrome and Wolff-Parkinson-White (WPW) syndrome is a very rare phenomenon. We describe a 31-year-old patient without any previous cardiac disorder admitted to our hospital due to palpitations and concomitantly diagnosed as WPW syndrome and treated with radiofrequency catheter ablation. He was later diagnosed with Brugada syndrome and followed-up 2 years without any symptoms. We discuss other previously reported cases in literature, in which these two conditions exist simultaneously.