ABSTRACT

The article describes coarctation of the aorta (CoA), a congenital defect that accounts for 5 to 7% of congenital heart disease, and its association with cardiovascular complications, especially in adulthood. This disorder is usually diagnosed late and is linked to high blood pressure, aneurysms, and cerebrovascular events. We present a clinical case of a 21-year-old young man, with no previous medical history, who developed a brain hematoma due to severe hypertension. During her evaluation, coarctation of the aorta and bicuspid aortic valve were diagnosed, treated by angioplasty with stent. The patient evolved favorably. The importance of early diagnosis and appropriate management, emphasizing the need to look for this pathology in cerebrovascular events in young people.

El artículo describe la coartación de la aorta (CoA), un defecto congénito que representa del 5 al 7% de las cardiopatías congénitas, y su asociación con complicaciones cardiovasculares, especialmente en la edad adulta. Este trastorno suele diagnosticarse tarde y está vinculado a hipertensión arterial, aneurismas y eventos cerebrovasculares. Se presenta un caso clínico de un joven de 21 años, sin antecedentes médicos previos, quien desarrolló un hematoma cerebral por hipertensión severa. Durante su evaluación, se diagnosticó coartación aórtica y válvula aórtica bicúspide, tratadas mediante angioplastia con stent. El paciente evolucionó favorablemente. Se destaca la importancia del diagnóstico temprano y el manejo adecuado, enfatizando la necesidad de buscar esta patología en eventos cerebrovasculares en jóvenes.

ABSTRACT

Fundamento: O envolvimento cardiovascular na COVID-19 foi extensivamente estudado. A ecocardiografia é uma técnica importante na identificação do acometimento cardíaco, servindo como excelente ferramenta para variáveis prognósticas. Objetivo: Analisar o impacto prognóstico do speckle tracking na análise do ventrículo esquerdo (VE) em pacientes com COVID-19 internados em unidades de terapia intensiva (UTI). Métodos: Pacientes com diagnóstico de COVID-19 admitidos na unidade de terapia intensiva foram submetidos a exame ecocardiográfico nas primeiras 48 horas de internação e divididos em dois grupos de acordo com o desfecho hospitalar (alta ou óbito). Os dados ecocardiográficos convencionais, e de strain longitudinal global do ventrículo esquerdo (SLGVE) e ventrículo direito (SLGVD) de ambos os grupos foram comparados pelo teste t de Student (variáveis contínuas) ou pelo teste do qui-quadrado (variáveis categóricas), considerando-se como estatisticamente significativo p < 0,05. Resultados: A média de idade foi de 56 ± 14 anos, e a proporção de homens e mulheres foi semelhante. A taxa de mortalidade foi de 64%, mais frequente em pacientes idosos e em pacientes com maior número de comorbidades. O SLGVE revelou valores menores nos pacientes que evoluíram para óbito, com ponto de corte abaixo de −18,1% (sensibilidade = 90,4%, especificidade = 96,6%) para esse desfecho e, após análise estatística multivariada, foi a única variável ecocardiográfica estatisticamente significativa. I O O Conclusão: O SLGVE é uma ferramenta importante na análise prognóstica desses pacientes, oferecendo uma nova janela de possibilidades para avaliar pacientes críticos com COVID-19. (AU)

Background: Cardiovascular involvement in COVID-19 has been extensively studied. Echocardiography is an important technique in identifying cardiac involvement, serving as an excellent tool for prognostic variables. Objectives: Analyze the prognostic impact of speckle tracking in analyzing the left ventricle in patients with COVID-19 admitted to intensive care units (ICUs). Methods: Patients diagnosed with COVID-19 admitted to the ICU underwent an echocardiographic examination within the first 48 hours of hospitalization and were divided into two groups according to hospital outcome (discharge or death). Conventional echocardiographic data, as well as global longitudinal strain of the left ventricle (LVGLS) and right ventricle (RVGLS) of both groups, were compared using Student's t test (for continuous variables) or the chi-square test (for categorical variables), considering p < 0.05 as statistically significant. Results: The average age was 56 ± 14 years, and the proportion of men and women was similar. The mortality rate was 64%, more frequent in elderly patients and in patients with a higher number of comorbidities. LVGLS revealed lower values in patients who progressed to death, with a cutoff point below −18.1% (sensitivity = 90.4%, specificity = 96.6%) for this outcome, and, after multivariate statistical analysis, it was found to be the only statistically significant echocardiographic variable. Conclusion: LVGLS is an important tool in the prognostic analysis of critically patients with COVID-19, offering a new window of possibilities for evaluating these patients. (AU)

ABSTRACT

El linfoma cardiaco primario, un tipo extremadamente raro de linfoma no Hodgkin de células B, presenta una incidencia aproximada de 0.02-2% entre los tumores cardíacos malignos. Se asocia frecuentemente con manifestaciones como alteraciones del ritmo cardíaco, derrame pericárdico refractario y masas cardiacas. El diagnóstico definitivo se logra mediante biopsia, siendo esencial descartar diseminación hematógena con PET-CT. La literatura indica una predominancia de afectación de las cavidades derechas y una supervivencia que varía significativamente según la afectación del ventrículo izquierdo y la presencia de arritmias. Las opciones terapéuticas no están bien definidas, pero la quimioterapia como R-CHOP ha mostrado eficacia, aunque el pronóstico generalmente es pobre debido a complicaciones como progresión de la enfermedad, arritmias y sepsis. Este caso subraya la importancia de considerar el linfoma cardiaco en pacientes con síntomas cardiacos inexplicables, destacando la necesidad de un enfoque diagnóstico y terapéutico multidisciplinario y específico.

Primary cardiac lymphoma, an extremely rare type of B-cell non-Hodgkin lymphoma, has an incidence of approximately 0.02-2% among malignant cardiac tumors. It is frequently associated with manifestations such as cardiac rhythm disturbances, refractory pericardial effusion and cardiac masses. Definitive diagnosis is achieved by biopsy, being essential to rule out hematogenous dissemination with PET-CT. The literature indicates a predominance of right chamber involvement and survival that varies significantly according to left ventricular involvement and the presence of arrhythmias. Therapeutic options are not well defined, but chemotherapy such as R-CHOP has shown efficacy, although the prognosis is generally poor due to complications such as disease progression, arrhythmias and sepsis. This case underscores the importance of considering cardiac lymphoma in patients with unexplained cardiac symptoms, highlighting the need for a multidisciplinary and specific diagnostic and therapeutic approach.

ABSTRACT

La enfermedad de Kawasaki (EK) es una vasculitis febril aguda, multisistémica de causa desconocida y la principal causa de cardiopatía adquirida pediátrica en países desarrollados. Cursa con fiebre mayor de cinco días, alteraciones en mucosa oral, linfadenopatías, rash (exantema), compromiso de miembros y/o inyección conjuntival. Puede haber compromiso hepático que puede abarcar desde un aumento leve de transaminasas hasta hepatitis colestásica grave o hidropesía (hidrops) vesicular, o ambas. Se presenta a una paciente de 5 años cuyo cuadro comenzó con una hepatitis febril aguda colestásica, sin causa aparente. Al día 14 de evolución agregó inyección conjuntival no purulenta, descamación periungueal y trombocitosis. Ante la sospecha de EK atípica se realizó ecocardiograma que informó afección coronaria. Resulta importante tener en cuenta la variabilidad de síntomas en la EK, ya que la rápida instauración del tratamiento adecuado disminuye la aparición y gravedad de las complicaciones asociadas. (AU)

Kawasaki Disease (KD) is an acute, multisystemic febrile vasculitis of unknown cause and is the leading cause of acquired pediatric heart disease in developed countries. It presents with a fever lasting more than five days, oral mucosa alterations, lymphadenopathy, rash, limb involvement, or conjunctival injection. Hepatic involvement can range from mild transaminase elevation to severe cholestatic hepatitis or gallbladder hydrops. We present a case of a 5-year-old patient whose condition began with acute febrile cholestatic hepatitis of unknown origin. On the 14th day of illness, the patient developed non-purulent conjunctival injection, periungual desquamation, and thrombocytosis. Suspecting atypical KD, we performed an echocardiogram, revealing coronary involvement. It is essential to consider the variability of symptoms in KD, as the prompt initiation of appropriate treatment reduces the occurrence and severity of associated complications. (AU)

ABSTRACT

Ventricular septal defect (VSD) is one of the most common congenital defects. It has a wide variety of clinical spectrum of presentation depending on the location and size of the defect. Generally, small restrictive VSDs present spontaneous closure during follow-up. A clinical case is presented with suspected persistent perimembranous VSD, with described intraoperative anatomical findings of aneurysmal cribriform membrane, ruling out VSD.

La comunicación interventricular (CIV) es uno de los defectos congénitos más comunes. Tiene una amplia variedad de espectro clínico de presentación dependiendo de la localización y tamaño del defecto. Por lo general, en los CIV restrictivos pequeños presentan un cierre espontáneo durante el seguimiento. Se presenta un caso clínico con sospecha de CIV perimembranosa persistente, con hallazgos anatómicos intraoperatorios descritos de membrana cribiforme aneurismática descartandose CIV.

ABSTRACT

A análise do strain pela técnica de ST2D tem seu papel bem documentado e representa uma importante ferramenta complementar na avaliação da mecânica cardíaca, agregando valor na identificação de injúria miocárdica incipiente e subclínica em diferentes cenários clínicos. Um expressivo avanço relacionado à ecocardiografia foi o desenvolvimento do ST3D, que tem o potencial de superar muitas limitações intrínsecas à tecnologia bidimensional, oferecendo parâmetros adicionais de deformação miocárdica (como por exemplo a area strain) e uma quantificação mais abrangente da geometria e função do miocárdio ventricular esquerdo, a partir de uma única aquisição de imagem. Dentre as suas principais limitações, destacam-se a baixa resolução temporal e espacial, além da dependência de imagens de boa qualidade e do operador bem treinado. Embora seja uma técnica relativamente recente, ainda em desenvolvimento, vários estudos experimentais e algumas investigações clínicas já demonstraram a reprodutibilidade e a potencial aplicabilidade do ST3D. Este artigo tem o objetivo de agregar informações para uma adequada análise do strain tridimensional do ventrículo esquerdo e explorar os seus principais pontos de vulnerabilidade, discutindo variáveis importantes para aumentar a acurácia e a reprodutibilidade desta tecnologia. (AU)

The role of strain analysis using 2-dimensional speckle tracking (2DST) has been well documented, and it represents an important complementary tool in the assessment of cardiac mechanics, adding value in the identification of incipient and subclinical myocardial injury in different clinical scenarios. A significant advance related to echocardiography was the development of 3-dimensional speckle tracking (3DST), which has the potential to overcome many limitations intrinsic to 2-dimensional technology, offering additional parameters of myocardial deformation (such as area strain) and a more comprehensive quantification of the geometry and function of the left ventricular myocardium, based on a single image acquisition. Among its main limitations, the low temporal and spatial resolution stands out, in addition to the dependence on high-quality images and a well-trained operator. Although it is a relatively recent technique that is still under development, several experimental studies and some clinical investigations have already demonstrated the reproducibility and potential applicability of 3DST. The objective of this article is to add information about adequate analysis of 3-dimensional left ventricular strain and explore its main points of vulnerability, discussing important variables to increase the accuracy and reproducibility of this technology. (AU)

ABSTRACT

Introducción: Los leiomiomas uterinos son un tipo de neoplasia benigna de frecuente aparición en mujeres de edad reproductiva, relacionados con enfermedad tromboem- bólica venosa. Este vínculo surge del efecto producido por la compresión de fibromas que genera estasis venosa en la región pelviana. Sin embargo, este pareciera no ser el único factor que lo relaciona con el desarrollo posterior de hipertensión pulmonar, sino que su presencia es gatillo de una serie de fenómenos que influyen sobre la vasculatu - ra pulmonar y también a nivel sistémico. Método: Revisión de una serie de casos (seis) atendidos en nuestra unidad, seguido de una revisión sobre la relación entre leiomio- mas y distintas formas de hipertensión pulmonar con una revisión desde la fisiopatología. Resultado y conclusiones: Encontramos sustento bibliográfico en los múltiples caminos fisiopatológicos que relacionan los mediadores vasculares comunes, que parecieran ser el punto clave en la relación entre estas dos patologías.

Introduction: Uterine leiomyomas are a type of benign neoplasm that frequently appears in women of reproductive age, related to venous thromboembolic disease. This link arises from the effect produced by the compression of fibroids, which generates venous stasis in the pelvic region. However, this seems not to be the only factor that re- lates it to the subsequent development of pulmonary hypertension, but rather its presence is a trigger for a series of phenomena that influence the pulmonary vasculature and also at a systemic level. Method: Review of a series of cases (six) cared for in our unit, followed by a review on the relationship between leiomyomas and different forms of pulmonary hypertension with a review from the pathophysiology. Result and conclusions: We found bibliographic support in the multiple pathophysiological paths that relate the common vascular mediators, which appear to be the key point in the relationship between these two pathologies.

ABSTRACT

La anomalía de Ebstein es una cardiopatía congénita rara y poco frecuente caracterizada por el adosamiento de los velos valvulares tricuspídeos; en la etapa prenatal se estima que su incidencia corresponde a un 3% de todas las cardiopatías diagnosticadas. Se presenta el caso de un feto con diagnóstico de anomalía de Ebstein a quien se le realizó un diagnóstico prenatal adecuado, lo que permitió planificar el nacimiento neonatal con un equipo multidisciplinario integral. Debido a la rareza del diagnóstico prenatal de esta entidad, se describe el caso clínico y los hallazgos imagenológicos representativos.

Ebsteins anomaly is a rare and infrequent congenital heart disease characterized by the attachment of the tricuspid valve leaflets; in the prenatal stage it is estimated that its incidence corresponds to 3% of all diagnosed heart diseases. We present the case of a fetus diagnosed with Ebsteins anomaly who underwent an adequate prenatal diagnosis, which made it possible to plan the neonatal birth with a comprehensive multidisciplinary team. Due to the rarity of the prenatal diagnosis of this entity, the clinical case and the representative imaging findings are described.

ABSTRACT

Objective: To explore the feasibility of using two-dimensional speckle tracking echocardiography for measuring right ventricular strain and function in healthy adults, and to analyze the impact of age and gender. Methods: This study is a cross-sectional study. Healthy adults who underwent physical examination in the Physical Examination Center of Beijing Hospital from January 1, 2020 to January 1, 2021 were included. Two researchers independently measured various right ventricular longitudinal strain indices using the Echopac software, including (global longitudinal strain (GLS), apical longitudinal strain (ALS), midventricle longitudinal strain (MLS), basal longitudinal strain (BLS), free wall GLS (FWGLS), free wall ALS (FWALS), free wall MLS (FWMLS) and free wall BLS (FWBLS)) as well as tricuspid annular plane systolic excursion (TAPSE) and right ventricle-fraction of area change (RVFAC). The above indicators were taken as the average of two physicians. The consistency of the measurements by two physicians was evaluated by the within-group correlation coefficient (ICC). Results: A total of 233 subjects were included, including 137 males, aged (58.5±14.2) years. ICC values was all above 0.8 with excellent agreement. The values of FWGLS and GLS in healthy adults were -26.63% and -21.89%, respectively. There was no statistically significant difference in TAPSE ((2.06±0.41)cm vs. (2.10±0.39)cm, P=0.510) and RVFAC ((51.17±9.91)% vs. (50.89±8.65)%, P=0.826) between males and females. The values of various right ventricular long axis strain indicators (GLS, ALS, MLS, BLS, FWGLS, FWMLS, FWMLS, FWBLS) in females aged 18 to 40 and 41 to 65 years were higher than those in males of the same age (all P<0.05), while there was no statistically significant difference in the values of various right ventricular long axis strain indicators between the sexes in subjects aged 65 years and above (all P>0.05). In females, the right ventricular GLS, ALS, MLS, FWGLS, FWALS, FWMLS, and FWBLS values in the groups aged 18 to 40 and 41 to 65 years were significantly higher than those in the group aged 65 years and above (all P<0.05). In contrast, no significant differences were found in these indices among different age groups in males (all P>0.05). Conclusions: Using two-dimensional speckle tracking technology in echocardiography to measure right ventricular strain indicators is feasible and highly reproducible. Gender and age have an impact on right ventricular strain indicators.

ABSTRACT

Objective: To explore the feasibility of using two-dimensional speckle tracking echocardiography for measuring right ventricular strain and function in healthy adults, and to analyze the impact of age and gender. Methods: This study is a cross-sectional study. Healthy adults who underwent physical examination in the Physical Examination Center of Beijing Hospital from January 1, 2020 to January 1, 2021 were included. Two researchers independently measured various right ventricular longitudinal strain indices using the Echopac software, including (global longitudinal strain (GLS), apical longitudinal strain (ALS), midventricle longitudinal strain (MLS), basal longitudinal strain (BLS), free wall GLS (FWGLS), free wall ALS (FWALS), free wall MLS (FWMLS) and free wall BLS (FWBLS)) as well as tricuspid annular plane systolic excursion (TAPSE) and right ventricle-fraction of area change (RVFAC). The above indicators were taken as the average of two physicians. The consistency of the measurements by two physicians was evaluated by the within-group correlation coefficient (ICC). Results: A total of 233 subjects were included, including 137 males, aged (58.5±14.2) years. ICC values was all above 0.8 with excellent agreement. The values of FWGLS and GLS in healthy adults were -26.63% and -21.89%, respectively. There was no statistically significant difference in TAPSE ((2.06±0.41)cm vs. (2.10±0.39)cm, P=0.510) and RVFAC ((51.17±9.91)% vs. (50.89±8.65)%, P=0.826) between males and females. The values of various right ventricular long axis strain indicators (GLS, ALS, MLS, BLS, FWGLS, FWMLS, FWMLS, FWBLS) in females aged 18 to 40 and 41 to 65 years were higher than those in males of the same age (all P<0.05), while there was no statistically significant difference in the values of various right ventricular long axis strain indicators between the sexes in subjects aged 65 years and above (all P>0.05). In females, the right ventricular GLS, ALS, MLS, FWGLS, FWALS, FWMLS, and FWBLS values in the groups aged 18 to 40 and 41 to 65 years were significantly higher than those in the group aged 65 years and above (all P<0.05). In contrast, no significant differences were found in these indices among different age groups in males (all P>0.05). Conclusions: Using two-dimensional speckle tracking technology in echocardiography to measure right ventricular strain indicators is feasible and highly reproducible. Gender and age have an impact on right ventricular strain indicators.

ABSTRACT

[RESUMEN]. Introducción: A pesar de ser extremadamente raros, los tumores cardíacos conforman un importante desafío diagnóstico de la práctica cardiooncológica. Los lipomas son la segunda neoplasia primaria benigna en orden de frecuencia, representan entre un 8 a 12% de los tumores cardíacos primarios benignos en adultos. Materiales, métodos: Presentamos un caso clínico de una paciente estudiada y diagnosticada en nuestra institución. Descripción: Se presenta a una paciente de 21 años, de género femenino, sin factores de riesgo cardiovasculares, que fue referida a nuestra institución con diagnóstico de lipoma cardíaco. Su presentación inicial incluyó taquicardia ventricular sostenida con descompensación hemodinámica, que respondió favorablemente a la cardioversión eléctrica. Tras su ingreso, se llevaron a cabo estudios diagnósticos adicionales para obtener una caracterización más precisa de la masa y facilitar la toma de decisiones terapéuticas. El ecocardiograma transtorácico reveló la presencia de una masa en el septum interventricular basal, con extensión a la pared inferior de ambos ventrículos. La resonancia cardíaca posterior confirmó la naturaleza lipídica de la masa, que se presentaba de manera homogénea, con lí- mites definidos, sin realce en ninguna fase del contraste endovenoso y encapsulada, sin afectar estructuras adyacentes. La ausencia de realce precoz y tardío permitió descartar la vascularización y la presencia de tejido fibroso, respectivamente, consolidando así el diagnóstico de lipoma. Después de una evaluación exhaustiva por el equipo cardiovascular de nuestro hospital, se decidió de manera conjunta no proceder con una intervención quirúrgica debido a la ubicación anatómica del tumor y al elevado riesgo de morbimortalidad asociado. La alternativa consensuada fue la implantación de un cardiodesfibrilador, considerando el historial de arritmia severa y el riesgo de recurrencia en esta paciente. Conclusión: Se presenta un caso infrecuente de tumor cardíaco, que genera grandes desafíos diagnósticos y terapéuticos. Se optó por un tratamiento conservador con el propósito de prevenir la recurrencia de eventos arrítmicos.

[ABSTRACT]. Introduction: Despite being extremely rare, cardiac tumors pose a significant diagnostic challenge in cardio-oncology practice. Lipomas rank as the second most common primary benign neoplasm, accounting for 8 to 12% of primary benign cardiac tumors in adults. Materials and Methods: We present a clinical case of a patient studied and diagnosed at our institution. Description: A 21-year-old female patient, without cardiovascular risk factors, was referred to our institution with a diagnosis of cardiac lipoma. Her initial presentation included sustained ventricular tachycardia with hemodynamic decompensation, successfully managed with electrical cardioversion. Following admission, additional diagnostic studies were conducted to achieve a more precise characterization of the mass and guide therapeutic decision-making. Transthoracic echocardiography revealed a mass in the basal interventricular septum, extending to the inferior wall of both ventricles. Subsequent cardiac resonance confirmed the lipid nature of the mass, presenting homogeneously with well-defined borders, no enhancement in any phase of intravenous contrast, encapsulated, and without involvement of adjacent structures. The absence of early and late enhancement ruled out tumor vascularization and fibrous tissue, respectively, confirming the diagnosis of a lipoma. Following a comprehensive evaluation by our hospital's cardiovascular team, a joint decision was made to refrain from surgical intervention due to the anatomical location of the tumor and the associated high risk of morbidity and mortality. The consensus alternative was the implantation of a cardioverter-defibrillator, considering the patient's history of severe arrhythmia and the risk of recurrence. Conclusion: An infrequent case of cardiac tumor, that is associated with diagnostic and therapeutic challenges, is described. A conservative treatment was chosen aiming to prevent the recurrence of arrhythmic events.

ABSTRACT

Introdução: Disfunção ventricular esquerda como preditor independente de mortalidade na doença de Chagas. A deformação longitudinal global (DLG) é uma modalidade ecocardiográfica emergente com possível valor incremental na detecção precoce de envolvimento cardíaco. Objetivo: Comparar a função ventricular esquerda com múltiplos parâmetros ecocardiográficos entre pacientes com formas indeterminadas e crônicas de Chagas, e realizar uma revisão da literatura. I O O Metodologia: Neste estudo observacional, 11 pacientes com diagnóstico confirmado de doença de Chagas foram avaliados. Os indivíduos foram distribuídos da seguinte forma: cinco com as formas indeterminadas e seis com as formas crônicas. A avaliação ecocardiográfica convencional foi acompanhada pela medida da DLG. Resultados: A média da fração de ejeção do ventrículo esquerdo (FEVE) foi de 33 ± 2,88 e a DLG média do ventrículo esquerdo foi de -10,76 ± 2,20 na forma crônica, em comparação com 57,80 ± 6,49 e -17,34 ± 3,82, respectivamente no grupo indeterminado. A contratilidade foi reduzida em segmentos das paredes inferior, inferoseptal e ântero-septal em ambos os grupos. Essas alterações segmentares no grupo indeterminado podem ser atribuídas ao dano miocárdico precoce por inflamação e fibrose, mesmo antes de uma disfunção ventricular esquerda significativa se tornar evidente. Conclusão: A análise da deformação longitudinal na forma indeterminada tem potencial valor incremental à análise convencional da fração de ejeção quando comparada a pacientes com cardiomiopatia chagásica crônica, principalmente com a análise segmentar individual, mas o impacto e o significado clínico dessas técnicas ainda são desconhecidos.(AU)

Introduction: Left ventricular dysfunction as an independent predictor of mortality in Chagas disease. Global longitudinal strain (GLS) is an emerging echocardiographic modality with possible incremental value in early detection of cardiac involvement. Objective: Compare left ventricular function with multiple echocardiographic parameters between patients with the indeterminate and chronic forms of Chagas, and perform a literature review. Methods: In this observational study, 11 patients with a confirmed diagnosis of Chagas disease were evaluated. Individuals were distributed as follows: five with the indeterminate and six with the chronic forms. Conventional echocardiographic evaluation was followed by GLS measurement. I O O Results: The mean left ventricle ejection fraction left ventricular ejection fraction (LVEF) was 33 ± 2.88, and the mean GLS of the left ventricle was -10.76 ± 2.20 in the chronic form as compared to 57.80 ± 6.49 and -17.34 ± 3.82, respectively in the indeterminate group. Contractility was reduced in segments of the inferior, inferoseptal and anteroseptal walls in both groups. These segmental alterations in the indeterminate group may be attributed to early myocardial damage from inflammation and fibrosis, even before significant left ventricular dysfunction is evident. Conclusion: Analysis of longitudinal strain in the indeterminate form has potential incremental value to the conventional analysis of ejection fraction when compared to patients with chronic Chagas cardiomyopathy, especially with individual segmental analysis, but the impact and clinical significance of these techniques are still unknown. (AU)

ABSTRACT

A oclusão percutânea de apêndice atrial esquerdo (AAE) é uma alternativa à anticoagulação oral para pacientes com fibrilação atrial (FA) ou flutter, com risco elevado para eventos cardioembólicos, porém com histórico ou risco elevado de sangramento. Nos últimos anos, têm sido desenvolvidas novas gerações de dispositivos oclusores, que, somadas à maior experiência dos operadores, tornaram o procedimento seguro quando bem indicado. O estudo ecocardiográfico transesofágico tem papel central na avaliação da morfologia do AAE, seleção do tamanho dos dispositivos, assim como no monitoramento com imagem durante o procedimento cardiovascular estrutural. (AU)

Percutaneous occlusion of the left atrial appendage (LAA) is an alternative to oral anticoagulation for patients with atrial fibrillation (AF) or flutter who have high risk of cardioembolic events, but with a history or high risk of bleeding. In recent years, new generations of occluder devices have been developed, which, combined with greater experience of operators, have made it a safe procedure when properly indicated. Transesophageal echocardiography (TEE) plays a central role in assessing the morphology of the LAA, selecting device size, and image monitoring during the structural cardiovascular procedure. (AU)

ABSTRACT

A avaliação ecocardiográfica criteriosa do ventrículo direito (VD), embora desafiadora e por vezes negligenciada, é de fundamental importância no diagnóstico de determinadas patologias, tais como a cardiomiopatia arritmogênica (CMA) ­ doença miocárdica hereditária associada ao desenvolvimento de arritmias ventriculares, insuficiência cardíaca e morte súbita. Este artigo tem o objetivo de revisar os critérios diagnósticos propostos na Task Force de 2010 e as modificações sugeridas pelos critérios de Pádua de 2020, além de ilustrar o uso potencial de técnicas avançadas de ecocardiografia para detecção mais precoce e definição prognóstica. (AU)

Careful echocardiographic evaluation of the right ventricle, although challenging and sometimes neglected, is of utmost importance in the diagnosis of certain pathologies, such as arrhythmogenic cardiomyopathy (ACM) ­ a hereditary myocardial disease associated with the development of ventricular arrhythmias, heart failure, and sudden death. This article aims to review the diagnostic criteria proposed in the 2010 Task Force and the modifications suggested by the 2020 Padua criteria, as well as illustrate the potential use of advanced echocardiography techniques for earlier detection and prognostic definition. (AU)

ABSTRACT

Este artigo de revisão explora o uso combinado do Doppler Transcraniano (DTC) com ecocardiograma transtorácico (ETT) e transesofágico (ETE) para investigar o Forame Oval Patente (FOP), uma condição encontrada em cerca de 25-27% da população adulta. O FOP é um remanescente da circulação fetal e a causa mais comum de shunt interatrial. Está associado a complicações clínicas como síndrome de platipneia-ortodeóxia, apneia do sono obstrutiva, enxaqueca e acidente vascular cerebral (AVC). A avaliação do FOP é geralmente realizada por meio de ETT e ETE, mas o DTC, um método de alta sensibilidade e menos utilizado, também é importante. O DTC detecta shunts de forma indireta em pacientes acordados e utiliza o escore de graduação de sinais microembólicos (MES) para classificar a gravidade do shunt. A técnica envolve a injeção de uma solução de contraste na veia antecubital durante a manobra de Valsalva, onde o aparecimento de microbolhas nos primeiros ciclos cardíacos indica um shunt intracardíaco. Relato de caso que ilustra a eficácia do DTC no rastreamento inicial de um paciente com suspeita de FOP, utilizando ETT, DTC e ETE. A conclusão destaca o papel crucial do DTC como uma ferramenta diagnóstica, especialmente relevante no manejo terapêutico de pacientes com AVC criptogênico. O estudo faz referência a várias publicações científicas, proporcionando uma base teórica para o uso combinado de DTC, ETT e ETE na investigação de FOP. (AU)

This review article explores the combined use of Transcranial Doppler (TCD) with transthoracic (TTE) and transesophageal (TEE) echocardiography to investigate Patent Foramen Ovale (PFO), a condition found in approximately 25-27% of the adult population. PFO is a remnant of fetal circulation and the most common cause of interatrial shunt. It is associated with clinical complications such as platypnea-orthodeoxia syndrome, obstructive sleep apnea, migraine, and stroke. PFO assessment is generally performed using TTE and TEE, but TCD, a highly sensitive and less used method, is also important. TCD indirectly detects shunts in awake patients and uses the microembolic signal (MES) grading score to classify shunt severity. This technique involves injecting a contrast solution into the antecubital vein during the Valsalva maneuver to detect intracardiac shunt by observing microbubble appearance in the first cardiac cycles. The case report illustrates the effectiveness of TCD in the initial screening of a patient with suspected PFO using TTE, TCD and TEE. The conclusion highlights that TCD is a crucial diagnostic tool, particularly relevant for the therapeutic management of patients with cryptogenic stroke. Several scientific publications are referenced, providing a theoretical foundation for the combined use of TCD, TTE, and TEE in PFO investigation. (AU)

ABSTRACT

As doenças cardiovasculares (DCV) são a principal causa de morte no Brasil, com o envelhecimento sendo um grande fator de risco. Estudos indicam que a prevalência de DCV aumenta com a idade, afetando a hipertrofia ventricular, disfunção diastólica e fibrilação atrial. A miopatia atrial, relacionada ao envelhecimento, tem sido mais estudada, com o estresse oxidativo e a inflamação crônica sendo investigados como agentes causadores desse processo. A função atrial esquerda tem sido mais analisada com destaque para seu papel na performance cardíaca. Técnicas atuais de análise ecocardiográfica, como o speckle tracking, permitem uma avaliação detalhada da função atrial, mostrando vantagens em relação à análise do volume atrial máximo. Estudos revelam a importância do strain atrial na previsão de eventos cardiovasculares. Com o envelhecimento, há uma redução progressiva das funções atriais, e novas medidas estão sendo desenvolvidas para detectar precocemente a disfunção atrial, o que pode impactar as futuras diretrizes e a definição dos padrões normais relacionados à idade. (AU)

Cardiovascular diseases (CVD) are the main cause of death in Brazil, with aging being a major risk factor. Research indicates that there is a higher occurrence of cardiovascular disease as individuals age, impacting ventricular hypertrophy, diastolic dysfunction, and atrial fibrillation. Atrial myopathy, associated with aging, has received considerable attention, with oxidative stress and chronic inflammation under investigation as contributing factors. Left atrial function has been extensively studied, focusing on its role in cardiac performance. Modern echocardiographic techniques, such as speckle tracking, provide a detailed assessment of atrial function, offering advantages over traditional methods of assessing maximum atrial volume. Studies reveal the important role of atrial strain in predicting cardiovascular events. The aging process brings a progressive reduction in atrial functions, and new measures are being developed to detect atrial dysfunction early, with a potential impact on future guidelines and the definition of normal agerelated standards. (AU)

ABSTRACT

Com o avanço tecnológico, o exame físico não é mais suficiente para uma avaliação mais assertiva de pacientes criticamente enfermos, principalmente em reécm-nascidos prematuros onde os sinais clínicos podem não ser interpretados de forma objetiva. Desta forma, há um grande interesse no treinamento de médicos neonatologistas para sua realização, determinando que os grandes centros mundiais já o façam de forma permanente nos seus programas de residência e educação médica continuada. O presente artigo de revisão trata da nossa experiência no ensino do ecocardiograma focado institucional. (AU)

With technological advancement, physical examination is no longer sufficient for a more accurate assessment of critically ill patients, especially in premature newborns where clinical signs may not be interpreted objectively. Therefore, there is great interest in training neonatologists in its practice, with major global centers already incorporating it permanently into their residency and continuing medical education programs. This review article discusses our experience in teaching institutionally focused echocardiography. (AU)