RESUMEN
Primary cardiac sarcoma is a rare type of intracardiac mass. This report describes a patient with atrial flutter who had a new right atrial mass incidentally discovered on transesophageal echocardiography. A thrombus was suspected based on radiographic appearance, but there was minimal change with anticoagulation. The mass was resected and found to be an undifferentiated pleomorphic cardiac sarcoma, an uncommon sub-type within the already rare category of primary cardiac neoplasms. This report highlights the importance of considering primary malignancy and thoroughly correlating radiographic and clinical evidence during the diagnostic workup of patients with intracardiac masses.
Asunto(s)
Fibrilación Atrial , Aleteo Atrial , Neoplasias Cardíacas , Sarcoma , Humanos , Ecocardiografía Transesofágica , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , Sarcoma/complicaciones , Sarcoma/diagnóstico , Sarcoma/cirugía , Atrios Cardíacos/diagnóstico por imagenRESUMEN
Background: Cellular transplantation has emerged as promising approach for treating cardiac diseases. However, a poor engraftment rate limits our understanding on how transplanted cardiomyocytes contribute to cardiac function in the recipient's heart. Methods: The CRISPR/Cas9 technique was employed for stable and constitutive gene expression in human-induced pluripotent stem-cell-derived cardiomyocytes (hiPSC-CMs). Myocardial infarction was induced in adult immunodeficient mice, followed by intramyocardial injection of hiPSC-CMs expressing either CCND2/channelrhodopsin 2 (hiPSC-CCND2OE/ChR2OECMs) or CCND2/luciferase (hiPSC-CCND2OE/LuciOECMs). Six months later, hemodynamics and intramural electrocardiogram were recorded upon blue light illuminations in anesthetized, open-chest mice. Results: Blue light resets automaticity of spontaneously beating hiPSC-CCND2OE/ChR2OECMs in culture, but not that of hiPSC-CCND2OE/LuciOECMs. Response to blue light was also observed in mice carrying large (>106 cells) intracardiac grafts of hiPSC-CCND2OE/ChR2OECM but not in mice carrying hiPSC-CCND2OE/LuciOECMs. The former exhibited single premature ventricular contractions upon light illumination or ventricular quadrigeminy upon second-long illuminations. At the onset of premature ventricular contractions, maximal systolic ventricular pressure decreased while ventricular volume rose concomitantly. Light-induced changes reversed upon resumption of sinus rhythm. Conclusions: We established an in vivo model for optogenetic-based modulation of the excitability of donor cardiomyocytes in a functional, reversible, and localized manner. This approach holds unique value for studying electromechanical coupling and molecular interactions between donor cardiomyocytes and recipient hearts in live animals.
Asunto(s)
Células Madre Pluripotentes Inducidas , Infarto del Miocardio , Complejos Prematuros Ventriculares , Animales , Humanos , Células Madre Pluripotentes Inducidas/metabolismo , Ratones , Infarto del Miocardio/metabolismo , Miocitos Cardíacos/metabolismo , Optogenética , Complejos Prematuros Ventriculares/metabolismoRESUMEN
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.
Asunto(s)
Aneurisma de la Aorta/cirugía , Válvula Aórtica/cirugía , Bioprótesis , Implantación de Prótesis Vascular , Prótesis Vascular , Oclusión de Injerto Vascular/etiología , Insuficiencia Cardíaca/etiología , Implantación de Prótesis de Válvulas Cardíacas , Síndrome de Marfan/complicaciones , Anciano , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/etiología , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Remoción de Dispositivos , Ecocardiografía Doppler , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/fisiopatología , Oclusión de Injerto Vascular/cirugía , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Masculino , Síndrome de Marfan/diagnóstico , Diseño de Prótesis , Recuperación de la Función , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
Microbubble formation occurs due to the cavitation phenomenon. We report a rare echocardiographic finding of microbubbles in a patient's aorta and left ventricle due to pump thrombosis in the left ventricle assist device, requiring pump exchange surgery.
RESUMEN
BACKGROUND: The cardiopulmonary benefits of pectus excavatum repair have been debated. Echocardiographic speckle-tracking strain and strain rate have been used to evaluate and detect subclinical myocardial dysfunction in patients receiving cardiotoxic chemotherapy, and patients with valvular heart disease. This technology was applied to evaluate the effects of pectus excavatum surgery on left ventricular (LV) and right ventricular (RV) function. METHODS: Speckle tracing strain evaluation was performed on intraoperative transesophageal echocardiographic images acquired immediately before and after Nuss repair in adult patients (aged 18 years or more) from 2011 to 2014. Standard severity and compression indices were measured on chest imaging performed before pectus excavatum repair. RESULTS: In total, 165 patients with transesophageal echocardiographic images during repair were reviewed (71.5% male; mean age 33.0 years; range, 18 to 71; Haller index 5.7; range, 2.3 to 24.3). Significant improvement after repair was seen in global RV longitudinal strain (-13.5% ± 4.1% to -16.7% ± 4.4%, p < 0.0001) and strain rate (-1.3 ± 0.4 s-1 to -1.4 ± 0.4 s-1, p = 0.0102); LV global circumferential strain (-18.7% ± 5.7% to -23.5% ± 5.8%, p < 0.0001) and strain rate (-1.5 ± 0.5 s-1 to -1.9 ± 0.8 s-1, p = 0.0003); and LV radial strain (24.1% ± 13.5% to 31.1% ± 16.4%, p = 0.0050). There was a strong correlation between preoperative right atrial compression on transesophageal echocardiogram and improvement in RV global longitudinal strain rate immediately after pectus repair. CONCLUSIONS: Mechanical compression and impaired RV and LV strain is improved by Nuss surgical repair of pectus deformity.
Asunto(s)
Tórax en Embudo/cirugía , Función Ventricular , Adolescente , Adulto , Anciano , Fenómenos Biomecánicos , Ecocardiografía Transesofágica , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Estudios Retrospectivos , Adulto JovenRESUMEN
Aortic stenosis (AS) is a disease that progresses slowly for years without symptoms, so patients need to be carefully managed with appropriate follow up and referred for aortic valve replacement in a timely manner. Development of symptoms is a clear indication for aortic valve intervention in patients with severe AS. The decision for early surgery in patients with asymptomatic severe AS is more complex. In this review, we discuss how to identify high-risk patients with asymptomatic severe AS who may benefit from early surgery.
RESUMEN
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.
Asunto(s)
Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/etiología , Ecocardiografía/métodos , Índice de Severidad de la Enfermedad , Calcificación Vascular/diagnóstico por imagen , Anciano , Arizona , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Calcificación Vascular/complicacionesRESUMEN
BACKGROUND: Valvuloarterial impedance (Zva) was introduced as a prognostic measure in patients with aortic stenosis (AS). However, it is unclear whether Zva has a prognostic impact on survival after surgical aortic valve replacement (AVR) in patients with severe AS with preserved ejection fraction (EF). METHODS: We retrospectively reviewed 929 consecutive patients who had AVR. We investigated 170 elderly patients (age >65â years, mean 76â years) who had AVR secondary to severe AS (mean gradient ≥40â mmâ Hg; aortic valve area ≤1â cm(2); peak velocity ≥4â m/s). Patients with EF <50%, greater than moderate aortic regurgitation, prior heart surgery and concomitant mitral or tricuspid valve surgery were excluded. Zva was calculated and the patients were divided into two groups; low Zva, Zva <4.3 (n=82) and high Zva, Zva ≥4.3 (n=88). The end point was all-cause of death. Survival curves were calculated according to Kaplan-Meier method. RESULTS: Age, prevalence of hypertension, diabetes, chronic kidney disease (CKD), atrial fibrillation, symptoms, EF, E/e' and concomitant coronary artery bypass graft were not different between the groups. Survival was not different between the groups at 5â years (70% in low Zva and 81% in high Zva; p=0.21) and for the entire follow-up period (p=0.23). Only age was a significant factor in predicting survival by multivariate analyses in Cox proportional hazards model after adjusting for Zva, CKD, atrial fibrillation and hypertension. CONCLUSIONS: Our results suggest that preoperative Zva does not have a prognostic impact on postoperative survival in elderly patients with severe AS with preserved EF. Further investigation is needed to elucidate the controversial results.
RESUMEN
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.
Asunto(s)
Enfermedades de las Válvulas Cardíacas/etiología , Osteogénesis Imperfecta/complicaciones , Adulto , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/cirugía , Prolapso de la Válvula Aórtica/diagnóstico por imagen , Prolapso de la Válvula Aórtica/etiología , Prolapso de la Válvula Aórtica/cirugía , Ecocardiografía Doppler en Color , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/etiología , Prolapso de la Válvula Mitral/cirugíaAsunto(s)
Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/patología , Ecocardiografía Transesofágica , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Aorta/cirugía , Aneurisma de la Aorta/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis Vascular , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Rotura EspontáneaAsunto(s)
Ecocardiografía Transesofágica/métodos , Fibroma/diagnóstico por imagen , Fibroma/cirugía , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Mixoma/diagnóstico por imagen , Mixoma/cirugía , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Primarias Múltiples/cirugía , Anciano , Diagnóstico Diferencial , Femenino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Humanos , Enfermedades Raras/diagnóstico por imagen , Enfermedades Raras/cirugíaRESUMEN
BACKGROUND: To determine sensitivity and specificity of E wave velocity in patients with severe chronic organic mitral regurgitation (MR) and normal left ventricular ejection fraction (EF) and to evaluate prevalence of A wave dominance in patients with severe MR. METHODS: We compared 35 patients with quantified severe, chronic, quantified, organic MR due to flail/prolapsed leaflets who had reparative surgery with 35 age-matched control subjects. EXCLUSION CRITERIA: EF < 60%, atrial fibrillation, and more than mild aortic regurgitation. RESULTS: Mean [standard deviation (SD)] age [70 (8) years vs. 69 (8) years; p = 0.94] and mean (SD) EF [66% (6%) vs. 65% (4%); p = 0.43] were not different between the two groups. Mean (SD) E wave velocity was greater in case patients than control subjects [1.2 (0.3) m/sec vs. 0.7 (0.15) m/sec; p < 0.001]. However, E wave velocity of 1.2 m/sec had a sensitivity of only 57% [95% confidence interval (CI), 41-7 and a specificity of 100% (95% CI, 90-100%) in identifying severe MR. E wave velocity of 0.9 m/sec had a more optimal combined sensitivity (89%; 95% CI, 74-95%) and specificity (86%; 95% CI, 71-94%). A wave dominance was seen in 18% of case patients and 66% of control subjects (p < 0.001). CONCLUSION: E wave velocity of 1.2 m/sec is specific not sensitive for severe organic MR; E wave velocity of 0.9 m/sec has better sensitivity and specificity. A wave dominance pattern alone cannot exclude patients with severe organic MR. Our findings highlight the importance of a comprehensive echocardiographic exam rather than relying on a few Doppler parameters in diagnosing MR.
Asunto(s)
Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Válvula Mitral/diagnóstico por imagen , Válvula Pulmonar/diagnóstico por imagen , Válvula Tricúspide/diagnóstico por imagen , Anuloplastia de la Válvula Cardíaca , Ecocardiografía , Femenino , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Persona de Mediana Edad , Válvula Mitral/cirugía , Válvula Pulmonar/cirugía , Resultado del Tratamiento , Válvula Tricúspide/cirugíaAsunto(s)
Diafragma/diagnóstico por imagen , Ecocardiografía , Atrios Cardíacos/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Anciano de 80 o más Años , Diafragma/patología , Atrios Cardíacos/patología , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patología , Humanos , MasculinoAsunto(s)
Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Anuloplastia de la Válvula Mitral/efectos adversos , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Complicaciones Posoperatorias/cirugía , Falla de Prótesis , Ecocardiografía , Ecocardiografía Doppler en Color , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Reoperación , Técnicas de SuturaRESUMEN
The occurrence of aorto-right ventricular (aorto-RV) fistula after prosthetic aortic valve replacement is rare. Transthoracic echocardiography (TTE) with color-flow Doppler, transesophageal echocardiography (TEE), or both may be required for diagnosis. A 42-year-old woman sought care for palpitations and dyspnea due to atrial flutter 2 weeks after prosthetic aortic valve replacement and graft replacement of the ascending aorta. TTE and TEE revealed left-to-right shunt due to aorto-RV fistula.
Asunto(s)
Válvula Aórtica/cirugía , Aleteo Atrial/diagnóstico por imagen , Implantación de Prótesis Vascular , Fístula/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Prótesis Valvulares Cardíacas , Ventrículos Cardíacos/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Fístula Vascular/diagnóstico por imagen , Adulto , Diagnóstico Diferencial , Ecocardiografía , Ecocardiografía Transesofágica , Femenino , Fístula/etiología , Cardiopatías/etiología , Humanos , Fístula Vascular/etiologíaRESUMEN
Exposure to the anorectic drug fenfluramine, alone or in combination with phentermine, a noradrenergic central nervous system stimulant, has been associated with unusual cardiac valvular morphology and resultant regurgitation of the left- and right-sided heart valves. The prevalence of significant valvular disease associated with the use of these anorectic drugs is reported to be as high as 23%. Herein, we report the occurrence of multivalvular disease and pulmonary hypertension associated with fenfluramine-phentermine use, discovered in an obese 59-year-old woman before expected gastric bypass surgery.
Asunto(s)
Fármacos Antiobesidad/efectos adversos , Fenfluramina/efectos adversos , Enfermedades de las Válvulas Cardíacas/inducido químicamente , Válvulas Cardíacas/efectos de los fármacos , Obesidad/tratamiento farmacológico , Fentermina/efectos adversos , Combinación de Medicamentos , Ecocardiografía Doppler en Color , Femenino , Derivación Gástrica , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/fisiopatología , Válvulas Cardíacas/diagnóstico por imagen , Válvulas Cardíacas/fisiopatología , Humanos , Hipertensión Pulmonar/inducido químicamente , Persona de Mediana Edad , Obesidad/cirugíaRESUMEN
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.
Asunto(s)
Quiste Mediastínico/diagnóstico por imagen , Anciano , Biopsia con Aguja , Femenino , Humanos , Quiste Mediastínico/patología , Persona de Mediana Edad , Pericardiectomía , Radiografía Torácica , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos X , Ultrasonografía IntervencionalAsunto(s)
Cardiopatía Carcinoide/complicaciones , Foramen Oval Permeable/terapia , Prótesis Valvulares Cardíacas , Anciano , Cardiopatía Carcinoide/diagnóstico por imagen , Resultado Fatal , Femenino , Humanos , Válvula Pulmonar/patología , Insuficiencia del Tratamiento , Válvula Tricúspide/patología , Estenosis de la Válvula Tricúspide , UltrasonografíaRESUMEN
Although rare, periprosthetic valvular regurgitation can cause hemolytic anemia. We present the case of a 63-year-old man who had an unusual presentation of hemolytic anemia due to periprosthetic mitral valve regurgitation (PMVR) in the presence of cold agglutinins. Due to high surgical risk, PMVR was percutaneously closed with three Amplatzer devices under the guidance of three-dimensional transesophageal echocardiography.