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AIMS AND OBJECTIVES: New electrophysiology tools like intracardiac echocardiography (ICE) might help to minimize and early detect complications during cardiac ablation procedures. The aim of the study was to assess the utility and vascular safety of ICE during catheter ablation of complex cardiac arrhythmias in a medium-volume training center. METHODS: Prospective, observational study consisted of consecutive patients who underwent catheter-based ablation of complex cardiac arrhythmias. All procedures were performed using three-dimensional electro-anatomical mapping and routine cannulation of right and left femoral veins. The ICE probe was initially positioned at the mid-level of the right atrium and properly moved to monitor different steps of the procedure and identify complications. All procedure-related vascular complications were registered. RESULTS: One hundred two patients (age 61.4 ± 13.1 years, 69 male) underwent 110 ablation procedures. Pulmonary vein isolation was the most common ablation substrate (55.4%). Ventricular tachycardia (17.2%) and left atrial flutter procedures (16.4%) were also common. The use of ICE enabled us to early initiate anticoagulation and to optimize the transseptal puncture. It also provided the capability to early detect life-threatening complications such as tamponade (3.6%), along with important information during the procedure such as exact catheter location, lesion formation, and stability during radiofrequency delivery. Such benefits were not associated with a higher number of vascular complications. CONCLUSION: The use of ICE during catheter-based ablation of complex cardiac substrates provides technical features that may decrease complications and increase accuracy while applying radiofrequency, especially in training centers where fellows start to perform complex procedures.
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Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/cirugía , Ablación por Catéter/métodos , Ecocardiografía/métodos , Endosonografía/métodos , Cirugía Asistida por Computador/métodos , Cardiología/educación , Educación , Femenino , Humanos , Masculino , Radiología/educación , Resultado del TratamientoRESUMEN
Minimal objective evidence exists regarding management of Friedreich's ataxia (FRDA). Antioxidant and recombinant human erythropoietin therapies have been considered potential treatments to slow progression of FRDA in a small number of studies. The primary objective of the current study was to test the efficacy, safety, and tolerability of triple therapy-darbepoetin alfa, idebenone, and riboflavin-in FRDA in a clinical pilot study. Patients included in this study were nine females, 16 to 45 years of age (average 28 ± 8), diagnosed with FRDA with confirmed GAA repeat expansion mutations in the FXN gene and a GAA repeat ≥400 on the shorter allele. Patients had a baseline score between 8 and 28.5 (average 20.7 ± 8.3) on the scale for the assessment and rating of ataxia and 94.3 ± 27.2 g/m(2) in left ventricular mass index (LVMI). Patients had been treated with triple therapy with 150 µg darbepoetin alfa every 2 or 3 weeks, 10-20 mg/kg/day idebenone, and 10-15 mg/kg/day riboflavin for 32 ± 19.4 months (range of 8-56 months). Triple therapy was tolerated. Although not statistically significant, improvement of ataxia was observed during the first six 4-month periods of the study. Furthermore, a small decrease in disease progression during the first 2 years of treatment was observed. Long-term statistically nonsignificant improvement of LVMI and stability of the echocardiographic parameters could be considered. Triple therapy may slow disease progression of FRDA.
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Antioxidantes/uso terapéutico , Eritropoyetina/análogos & derivados , Ataxia de Friedreich/tratamiento farmacológico , Hematínicos/uso terapéutico , Riboflavina/uso terapéutico , Ubiquinona/análogos & derivados , Adolescente , Adulto , Antioxidantes/administración & dosificación , Darbepoetina alfa , Quimioterapia Combinada/métodos , Eritropoyetina/administración & dosificación , Eritropoyetina/uso terapéutico , Femenino , Ataxia de Friedreich/diagnóstico , Hematínicos/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Riboflavina/administración & dosificación , Ubiquinona/administración & dosificación , Ubiquinona/uso terapéutico , Adulto JovenRESUMEN
We describe a preliminary clinical experience with 3D transesophageal echocardiography (3D TEE) in an 84-year-old man with severe aortic stenosis and multiple comorbidity, who underwent percutaneous aortic valve implantation. Although 3D TEE monitoring is not a standard procedure during aortic valve replacement procedure (PAVR), when used in combination with conventional 2D-TEE contributes to improving adequate patient selection and provides more accurate information to the interventional cardiologist during positioning, deployment, and early function of the prosthesis.
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Estenosis de la Válvula Aórtica/cirugía , Ecocardiografía Tridimensional/métodos , Ecocardiografía Transesofágica/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Cirugía Asistida por Computador/métodos , Anciano de 80 o más Años , Humanos , Masculino , Resultado del TratamientoRESUMEN
Chagas disease is an emerging infectious disease in Europe and other non-endemic areas, mainly owing to migration from endemic areas. We aimed at investigating the value of advanced echocardiography (ECHO) and cardiac magnetic resonance (CMR) in patients newly diagnosed with Chagas disease to compare findings with those of electrocardiogram (ECG) and conventional ECHO and thus detecting cardiac abnormalities. We included consecutive patients with newly diagnosed Chagas disease and registered cardiac test results (ECG, ECHO, and CMR). We divided ECHO parameters into three tiers: 1) left ventricular ejection fraction, regional wall motion abnormality, and left ventricular diastolic dimension (ECHO-1); 2) other common ECHO parameters (ECHO-2); and 3) global longitudinal strain (GLS) (ECHO-3). Cardiac magnetic resonance included global and segmental biventricular function, the presence of myocardial fibrosis, and edema. The study comprised 100 patients from South America. The mean age was 43.9 ± 0.9 years, and 66% were women. Mean time living in Spain was 9.7 ± 0.5 years. The ECG revealed ≥ 2 abnormal findings in 47% of patients. ECHO-1 was abnormal in 22% of patients, ECHO-2 in 52%, and GLS in 16%. Cardiac magnetic resonance was abnormal in 50% of cases, and in 3% of these, ECHO was normal. When ECG and conventional ECHO were taken together, abnormalities were detected in 83% of patients. This value increased to 86% and 92% for GLS and CMR, respectively. These findings suggest that ECG and conventional ECHO should be used routinely as standard cardiac tests for newly diagnosed cases of Chagas disease. The value of advanced ECHO techniques and CMR is low.
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Cardiomiopatía Chagásica/diagnóstico , Enfermedad de Chagas/patología , Corazón/fisiopatología , Enfermedades Transmisibles Emergentes , Ecocardiografía/métodos , Electrocardiografía/métodos , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , América del Sur , España , Función Ventricular IzquierdaRESUMEN
Patent foramen ovale (PFO) is a relatively common congenital condition which has been implicated in cryptogenic stroke as a result of paradoxical thromboembolism by right-to-left shunting. Many studies have demonstrated that transcatheter PFO closure significantly reduced the incidence of recurrent strokes in a small group of high-risk patients with PFO and atrial septal aneurysm compared with antithrombotic drugs. Two-dimensional transoesophageal echocardiography (2D TEE) has become the election technique for guiding patent foramen ovale closure. Real-time Three-dimensional transoesophageal echocardiography (3D TEE) may be potentially superior to 2D TEE in the accurate assessment of the morphology and efficacy of transcatheter closure devices because of a better spacial orientation.
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Cateterismo Cardíaco/métodos , Ecocardiografía Tridimensional/métodos , Ecocardiografía Transesofágica/métodos , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/terapia , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: Increasing life expectancy in Western countries in the last decades has resulted in a significant gradual increasing number of octogenarians referred for cardiac surgery. There is a need for a critical evaluation of the long-term surgical outcome and quality of life in the elderly. The aim of this study is to identify risk factors of mortality in octogenarians undergoing cardiac surgery and to assess the long term survival and quality of life. PATIENTS AND METHOD: Data were reviewed on 150 patients aged over 80 years--mean age (standard deviation): 82.7 (2.5) years--who underwent cardiac surgery at our institution in the last 26 years. We analyzed clinical and epidemiological variables included in the European System for Cardiac Operative Risk Evaluation (euroSCORE), in-hospital morbidity and mortality, long term survival and quality of life after cardiac surgery. RESULTS: The 30-day mortality rate was 30.1%, with a mean hospital stay of 16.5 days (13-27). Emergent procedure, reparation of postinfarction ventricular ruptures, New York Heart Association functional class IV, chronic renal failure and previous myocardial infarction were independent predictors of in-hospital mortality. Mean follow up was 72.2 (9.9) months with survival rates of 87.3% and 57% at 1 and 5 years, respectively. Late postoperative quality of life in our 53 long-term survivors was significantly better than prior to surgery. New York Heart Association functional class improved from 2.52 to 1.48. Most survivors (97.7%) were satisfied with present quality of life CONCLUSIONS: Cardiac surgery in octogenarians is associated with increased in-hospital mortality rate and longer hospital stay. Our findings support that cardiac surgery can be performed in a selected elderly population with good long-term survival and quality of life.
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Procedimientos Quirúrgicos Cardíacos , Factores de Edad , Procedimientos Quirúrgicos Cardíacos/mortalidad , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación , Masculino , Satisfacción del Paciente , Selección de Paciente , Pronóstico , Calidad de Vida , Factores de Riesgo , Resultado del TratamientoRESUMEN
Arrhythmogenic right ventricular (RV) dysplasia or cardiomyopathy is a familiar heart muscle disease, characterized by progressive fibrofatty replacement of RV myocardium. Echocardiography can be used to evaluate the wide spectrum of abnormalities that range from a normal RV to severe RV dilation, with localized aneurysms. In the context of a positive family history, even minimal RV abnormalities represent a disease expression. This suggests the need for a careful echocardiographic investigation focusing in subtle structural changes. However, echocardiography may be limited by poor endocardial visualization in several patients. Contrast echocardiography may improve endocardial border delineation in these cases and, thus, the ability to assess arrhythmogenic RV dysplasia or cardiomyopathy at the initial stages of the disease.
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Displasia Ventricular Derecha Arritmogénica/diagnóstico por imagen , Ecocardiografía , Ecocardiografía Doppler en Color , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Cuerpos Extraños/etiología , Lesiones Cardíacas/etiología , Tabiques Cardíacos , Traumatismo Múltiple/etiología , Heridas por Arma de Fuego/complicaciones , Adulto , Ecocardiografía Transesofágica , Femenino , Estudios de Seguimiento , Cuerpos Extraños/diagnóstico por imagen , Lesiones Cardíacas/diagnóstico por imagen , Tabiques Cardíacos/diagnóstico por imagen , Humanos , Lesión Pulmonar/diagnóstico por imagen , Lesión Pulmonar/etiología , Traumatismo Múltiple/diagnóstico por imagen , Radiografía , Heridas por Arma de Fuego/diagnóstico por imagenAsunto(s)
Ecocardiografía Tridimensional/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Estenosis de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/cirugía , Cirugía Asistida por Computador/métodos , Adulto , Sistemas de Computación , Femenino , Humanos , Resultado del TratamientoRESUMEN
Primary cardiac sarcomas are rare. A 63-year-old woman presented with progressive symptoms of fatigue, palpitations, and dyspnea. Transthoracic echocardiography detected a mass in the left atrium, fixed and probably attached to the interatrial septum suggestive of myxoma. Transesophageal echocardiography confirmed the existence of a large lobulated mass in the left atrium measuring 45 mm × 25 mm in diameter. Subsequent cardiac magnetic resonance imaging showed a mass of heterogeneous appearance, with broad base of implantation on the posterior wall of the left atrium. The extension study with multidetector computed tomography showed superficial infiltration of the atrial wall, without involvement of the mitral valve or pulmonary veins and no extension to other extracardiac structures. The patient underwent surgery resecting a bilobed mass, smooth and yellowish, strongly attached to the posterior wall of left atrium. The pathologic study was consistent with the diagnosis of myxofibrosarcoma.
RESUMEN
INTRODUCTION AND OBJECTIVES: Malignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy of percutaneous balloon pericardiotomy as the initial treatment of choice for these effusions. METHODS: Retrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of percutaneous balloon pericardiotomies carried out in a single center in patients with advanced cancer. RESULTS: Seventeen percutaneous balloon pericardiotomies were performed in 16 patients with a mean age of 66.2 (15.2) years. Fourteen patients had pathologically confirmed metastatic neoplastic disease, 3 had previously required pericardiocentesis, and in the remaining patients percutaneous balloon pericardiotomy was the first treatment for the effusion. All patients had a severe circumferential effusion, and most presented evidence of hemodynamic compromise on echocardiography. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up (median, 44 [interquartile range, 36-225] days). One patient developed a large pleural effusion that did not require treatment. Three patients needed a new pericardial procedure: 2 had elective pericardial window surgeries and 1 had a second percutaneous balloon pericardiotomy. CONCLUSIONS: Percutaneous balloon pericardiotomy is a simple, safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches.
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Derrame Pericárdico/cirugía , Pericardiectomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Derrame Pericárdico/etiología , Pericardiectomía/instrumentación , Estudios RetrospectivosAsunto(s)
Electrodos Implantados/efectos adversos , Prótesis Valvulares Cardíacas , Marcapaso Artificial/efectos adversos , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Anciano , Ecocardiografía Transesofágica , Femenino , Humanos , Radiografía Torácica , Insuficiencia de la Válvula Tricúspide/etiologíaRESUMEN
A 26-year-old woman presented with acute hemolysis 1 month after percutaneous closure of an atrial septal defect. Three-dimensional transesophageal echocardiography was used to establish the diagnosis of a fistula from the aorta, toward the device and both atria. The patient required urgent surgical correction. Transcatheter closure of atrial septal defects has proven to be a highly successful alternative to surgery in the appropriate patient. Cardiac perforation and device erosion of the aortic wall are infrequent but potentially lethal complications of percutaneous occluder device insertion. Supportive features of device erosion include a wrong preimplantation assessment of the rims, the device extends across the atrial septum, and the device encroaches on the surrounding structures. In this case, the presumed mechanism of aortic fistula was aortic erosion by the left atrial disk of the occluder device.