BACKGROUND: pheochromocytoma is a neuroendocrine tumor that secretes high levels of catecholamines and it is able to exert serious cardiovascular effects. The cardiac involvement is the most frequent, with reported conditions such as transient myocardial dysfunction, acute coronary syndrome and ventricular arrhythmias. CLINICAL CASE: we reported a 36 year-old woman without cardiovascular history. She presented with an adrenergic crisis after surgery leading to acute heart failure and acute myocardial infarction. The electrocardiogram showed an ST-segment elevation and positive enzymatic curve, motion alterations in echocardiography and ventriculography without coronary arteries lesions. She was screened for secondary hypertension protocol with a 24 hour urine free catecholamine sample that was clearly elevated. Abdomen computed tomography and magnetic resonance imaging showed a tumor located in the right adrenal gland and she underwent surgical resection. CONCLUSIONS: pheochromocytoma has different clinical presentations that may delay the diagnosis. Early recognition of catecholamine-induced cardiomyopathy and adequate management reduces morbidity and mortality.
Adrenal Gland Neoplasms/complications , Myocardial Infarction/etiology , Pheochromocytoma/complications , Adult , Female , Humans
BACKGROUND: Takotsubo syndrome is a cardiopathy characterized by a dyskinesia or left ventricular apical ballooning and subsequent recovery of ventricular function. We undertook this study to present a case of Takotsubo syndrome. CLINICAL CASE: We present the case of a 60-year-old female with a 26-year history of systemic arterial hypertension treated with 40 mg of termisartan daily. She started with headache after an emotional event (witness to an aggression of her son) associated with elevation of blood pressure that was suddenly accompanied by intense oppressive chest pain and neurovegetative symptoms. Electrocardiogram showed ST-segment elevation in anteroseptal and lateral derivations. Catheterization showed a 50% obstruction in the anterior descending artery and apical dyskinesia with hypercontractile base and 35% left ventricular ejection fraction. We performed stent angioplasty in the responsible artery. Nuclear medicine study showed extensive apical infarction, and echocardiogram agreed with transient apical dyskinesia and basal hypercontractility. After a 1-month evolution, echocardiogram mobility was completely recovered and myocardial perfusion study was normal 4 months later. CONCLUSIONS: We show a transitory apical ballooning secondary to acute myocardial infarction associated with a significantly stressful event that resulted in complete improvement of ventricular function with percutaneous coronary intervention during the following 4 months.
Takotsubo Cardiomyopathy , Female , Humans , Middle Aged , Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/therapy
Introducción: El síndrome de takotsubo es una cardiomiopatía que se caracteriza por discinesia o balonamiento apical del ventrículo izquierdo y recuperación posterior de la función ventricular. El objetivo fue presentar un caso de síndrome de takotsubo. Caso clínico: Mujer de 60 años con antecedente se hipertensión arterial sistémica de 26 años de evolución, tratada con 40 mg de termisartán al día. Inició con cefalea posterior a evento emocional asociado a descontrol hipertensivo, que súbitamente se acompañó de dolor precordial opresivo intenso y descarga neurovegetativa; el electrocardiograma mostró elevación del segmento ST anteroseptal y lateral alto. El cateterismo mostró una lesión de 50 % en la descendente anterior y discinesia apical con hipercontractilidad de las bases, fracción de expulsión del ventrículo izquierdo de 35 %. Se realizó angioplastia y stent en la arteria responsable. El estudio de medicina nuclear mostró infarto extenso apical, y el ecocardiograma evidenció discinesia extensa apical e hipercontractilidad basal. Al mes de evolución se recuperó por completo la movilidad, ratificada por ecocardiografía; el estudio de perfusión miocárdica a los cuatro meses fue normal. Conclusiones: Se muestra un caso con balonamiento apical transitorio secundario a infarto agudo del miocardio asociado a evento de estrés importante, que mostró mejoría completa de la función ventricular con intervención coronaria percutánea a los cuatro meses de seguimiento.
BACKGROUND: Takotsubo syndrome is a cardiopathy characterized by a dyskinesia or left ventricular apical ballooning and subsequent recovery of ventricular function. We undertook this study to present a case of Takotsubo syndrome. CLINICAL CASE: We present the case of a 60-year-old female with a 26-year history of systemic arterial hypertension treated with 40 mg of termisartan daily. She started with headache after an emotional event (witness to an aggression of her son) associated with elevation of blood pressure that was suddenly accompanied by intense oppressive chest pain and neurovegetative symptoms. Electrocardiogram showed ST-segment elevation in anteroseptal and lateral derivations. Catheterization showed a 50% obstruction in the anterior descending artery and apical dyskinesia with hypercontractile base and 35% left ventricular ejection fraction. We performed stent angioplasty in the responsible artery. Nuclear medicine study showed extensive apical infarction, and echocardiogram agreed with transient apical dyskinesia and basal hypercontractility. After a 1-month evolution, echocardiogram mobility was completely recovered and myocardial perfusion study was normal 4 months later. CONCLUSIONS: We show a transitory apical ballooning secondary to acute myocardial infarction associated with a significantly stressful event that resulted in complete improvement of ventricular function with percutaneous coronary intervention during the following 4 months.
Humans , Female , Middle Aged , Takotsubo Cardiomyopathy , Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/therapy
OBJECTIVE: We present two cases of Patent Foramen Ovale (PFO) treated with percutaneous Amplatzer device. METHOD: The first case corresponds to 48 years old woman with Ebstein's disease with moderate to severe hemodynamic repercussion and three cerebrovascular accidents, the last one under coumarin treatment, she received antiarrhythmic medication and despite of it developed 1st degree AV block, supraventricular and ventricular ectopia, rigth branch block. The second case corresponds to a 22 years old man with antecedents of cerebrovascular accident at the age of 21 with sequelae of convulsive crisis. Both patients were percutaneously treated with Amplatzer devices. The first patient was treated with a foramen ovale device and second with septal occluder due to the diameter of the foramen. Both patients have remained asymptomatic during the follow-up period. CONCLUSIONS: The PFO devices are indicated for patients with a history of cerebrovascular accidents.
Heart Septal Defects, Atrial/surgery , Prostheses and Implants , Prosthesis Implantation/methods , Adult , Ebstein Anomaly/complications , Female , Follow-Up Studies , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/diagnosis , Humans , Male , Middle Aged , Stroke/prevention & control , Time Factors , Treatment Outcome
Propósito: Se presentan los 2 casos de foramen oval permeable tratados con dispositivo de Amplatzer por vía percutánea. Método: El primero del sexo femenino de 48 años y con antecedentes de enfermedad de Ebstein moderada a severa y de 3 accidentes vasculares cerebrales, siendo el último bajo efecto anticoagulante, manejada con antiarrítmicos a pesar de lo cual presentó bloqueo auriculoventricular (a-v) de primer grado, aumento del automatismo supraventricular y ventricular de diferente foco y bloqueo de rama derecha. El segundo paciente masculino de 22 años con antecedente de un evento embólico cerebral a los 21 años con secuelas de crisis convulsivas. Ambos fueron tratados por vía percutánea para implante de dispositivo de Amplatzer, el primero para foramen oval permeable (FOP) y el segundo con dispositivo para comunicación interatrial por el diámetro del foramen. Los dos pacientes se encuentran asintomáticos. Conclusiones: El cierre de FOP por vía percutánea está indicado en pacientes con antecedentes de eventos cerebrales transitorios o permanentes y se sospeche esta vía como fuente embolígena. La técnica es fácil de realizar pero se requiere de un mayor número de pacientes para concluir.
Objective: We present two cases of Patent Foramen Ovale (PFO) treated with percutaneous Amplatzer device. Method: The first case corresponds to 48 years old woman with Ebstein's disease with moderate to severe hemodynamic repercussion and three cerebrovascular accidents, the last one under coumarin treatment, she received antiarrhythmic medication and despite of it developed 1st degree AV block, supraventricular and ventricular ectopia, rigth branch block. The second case corresponds to a 22 years old man with antecedents of cerebrovascular accident at the age of 21 with sequelae of convulsive crisis. Both patients were percutaneously treated with Amplatzer devices. The first patient was treated with a foramen ovale device and second with septal occluder due to the diameter of the foramen. Both patients have remained asymptomatic during the follow-up period. Conclusions: The PFO devices are indicated for patients with a history of cerebrovascular accidents.
Adult , Female , Humans , Male , Middle Aged , Heart Septal Defects, Atrial/surgery , Prostheses and Implants , Prosthesis Implantation/methods , Ebstein Anomaly/complications , Follow-Up Studies , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/diagnosis , Stroke/prevention & control , Time Factors , Treatment Outcome
OBJECTIVES: To analyze immediate and long-term results of balloon dilation for aortic coarctation in a three-center experience in Mexico, and to determine factors associated with increased risk. BACKGROUND: Results demonstrated that the procedure is effective and safe, however its use in some groups is still controversial, specially in neonates and infants. METHODS: In a ten-year period, 333 patients with aortic coarctation on underwent balloon dilation with an immediate success rate of 93.7% and a major complication incidence of 1.8%. Of the total cohort, 272 patients were followed for a period of 24.3 +/- 20 months. Demographic and procedural data were analyzed to determine factors related to a poor outcome or to sustained high blood pressure. RESULTS: Cox regression analysis found age (risk ratio 3.42 p = 0.0001), isthmic hypoplasia (risk ratio 4.64, p < 0.0001), and post-dilation gradient (risk ratio 2.19, p = 0.0113) as independent risk factors for a follow-up event, mainly restenosis. Age at dilation was the only independent factor related to sustained hypertension with a seven-fold increase in the risk. CONCLUSIONS: Balloon dilation is an effective and safe alternative to treat aortic coarctation. Patients younger than one year of age, with severe isthmic hypoplasia and a post-dilation gradient > 20 mmHg have the highest risk to develop an event in the follow-up period. When the dilation procedure is performed in patients older than 10 years of age, and specially those older than 20 years, the probability that they remain or develop high blood pressure is increase.
Angioplasty, Balloon , Aortic Coarctation/therapy , Adolescent , Adult , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Mexico , Middle Aged
We performed transcatheter closure of an atrial septal defect (ASD) using an Amplatzer device in three patients, 2 women and 1 male child, aged 12, 54, and 4 years, respectively, coursing with ostium secundum ASD. Two with left to right shunt and the third with bidirectional shunt. The transesophageal echocardiogram revealed ASD with diameters of 13, 15, and 10 mm, the diameter with expanded catheter balloon was of 30, 26, and 17 mm, respectively. The superior border of the atrial septum was bigger than 5 mm in all three patients, whereas the inferior border could not be found through echocardiography in the patients aged 12 and 4 years. Amplatzer devices of 30, 26, and 17 mm were implanted, the inferior border of the first two could be supported on the aortic wall and the superior border on the septum. We observed a 100% occlusion in these two cases through ecocolor-Doppler. In the third patient, an inferior border of 16 mm and a superior border of 8 mm were determined, achieving and immediate and fast installation of the device with 100% occlusion. All three patients were in stable conditions, asymptomatic and without shunt at their one-month follow-up as revealed by a trans-thoracic echocardiography. It is concluded that the Amplatzer device is technically easy to install and yields adequate results even in patients with ample ASD and without inferior border of the inter-atrial septum.
Heart Septal Defects, Atrial/surgery , Prostheses and Implants , Child , Child, Preschool , Female , Humans , Male , Middle Aged
Se valoraron resultados y seguimiento del cierre de conducto arterioso con dispositivo de Rashkind. Se colocaron 66 dispositivos en 63 pacientes: 41 mujeres y 22 hombres, con edad promedio de 8.2 + 7.5 años. Se determinó el diámetro del conducto, la presencia o ausencia de fuga residual inmediata y evolución mínimo a 1 año bajo control ecocardiográfico. Las determinaciones hemodinámicas mostraron: morfología tipo A en 49, C en 7 y E en 7 pacientes, con diámetro de 4.2 ñ 1.4 mm (extremos de 2.3 y 8.7 mm) y un Qp/Qs de 2.2 + 1.5 (extremos de 0.7 y 8.6). Se colocaron 45 dispositivos n§ 17 y 18 del n§ 12. La fuga residual inmediata fue del 65 por ciento (n-41); a las 24 hrs. del 31.7 por ciento (n-20) y al año del 7.9 por ciento (n-5). A 3 pacientes, con fuga persistente, se les colocó una 2a. sombrilla, en otro se instaló además del dispositivo de Rashkind una espiral endovascular (coil) y un paciente se encuentra en espera de un segundo oclusor. Las complicaciones menores se presentaron en el 15.8 por ciento (n-10). Los resultados indican un índice de oclusión a las 24 hrs. del 68.3 por ciento y al año del 92.0 por ciento; ningún paciente presentó embolia del dispositivo, hemólisis, ni obstrucción de las ramas pulmonares. Por lo anterior consideramos que la oclusión del conducto arterioso con dispositivo de Rashkind es una opción segura y efectiva para su tratamiento.
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Adult , Administration, Cutaneous , Ductus Arteriosus, Patent/therapy , Prostheses and Implants , Heart Defects, Congenital/therapy , Congenital Abnormalities/therapy , Echocardiography
Nuestro objetivo es presentar la experiencia inicial de cierre de conducto arterioso, con un nuevo dispositivo de Gianturco-Grifka, en el Hospital General del Centro Médico "La Raza". Se trata de un paciente femenino de 4 años de edad, asintomática, a quien se le detectó soplo continuo a los 3 años 7 meses de edad. El estudio ecocardiográfico demostró la persistencia de conducto arterioso cónico largo, de 4.9 mm de diámetro, presión sistólica de la arteria pulmonar de 35 mm Hg, con QP/QS 1.6:1. El estudio hemodinámico diagnóstico encontró un conducto arterioso cónico largo de 5 mm de diámetro tipo A1 de Krichenko. Se procedió al cierre del conducto arterioso permeable con dispositivo de Gianturco-Grifka de 7 mm, hasta obtener la oclusión del 100 por ciento de dicho conducto, lo cual se verificó por angiografía. No se presentaron complicaciones ni accidentes durante el procedimiento. Es necesario el empleo de este dispositivo en un mayor número de pacientes para determinar a largo plazo sus beneficios y sus limitaciones, sin embargo podemos concluir que técnicamente es fácil de utilizar y se obtiene una mayor disminución de la fuga residual que se presenta con otros dispositivos.
Humans , Female , Child, Preschool , Heart Defects, Congenital/therapy , Cardiac Catheterization/methods , Ductus Arteriosus, Patent/therapy , Cardiology/trends , Congenital Abnormalities/therapy , Prostheses and Implants
El objetivo fue valorar la evolución a corto y largo plazo en pacientes sometidos a valvuloplastía pulmonar (VP), e identificar los factores pronóstico para el fracaso. Se estudiaron 109 pacientes, 60 mujeres y 49 hombres con edad promedio de 7.04 ñ 8.4 años. El gradiente pulmonar previo fue de 89.53 ñ 37.23 mmHg y post-valvulopastía de 20.8 ñ 19.41 mmHg. (p < 0.0001), 43 pacientes presentaron gradiente infundibular post-valvular en 8 años de seguimiento fue 20.75 ñ 14.32 (p< 0.001). El porcentaje de éxito fue 86.2 por ciento, con una mortalidad global de 1.9 por ciento, complicaciones menores en 15.2 por ciento, falla del procedimiento en 13.8 por ciento. El 66.1 por ciento tenía estenosis pulmonar aislada y el 33.9 por ciento, presentaba lesiones asociadas. La reestenosis fue del 6.7 por ciento. Separando el análisis entre el grupo de éxito y de fracaso, las variables significativas que se encontraron en el grupo de fracaso fueron edad menor de 3.5 años y la morfología valvular displásica (p< 0.05) o combinada (p< 0.05), teniendo mayor número de complicaciones (p< 0.05). Los resultados inmediatos en el grupo de fracaso fueron un gradiente alto post-valvuloplastía (p< 0.05). La valvuloplastía pulmonar es procedimiento electivo tanto por sus resultados inmediatos como a largo plazo, siendo en nuestro medio un método efectivo y seguro
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Adult , Middle Aged , Catheterization , Catheterization/adverse effects , Pulmonary Valve Stenosis/surgery , Pulmonary Valve/surgery , Pulmonary Valve Stenosis/physiopathology , Follow-Up Studies , Blood Pressure/physiology , Pulmonary Valve
