Insuficiencia Mitral Severa secundaria a "Cleft" Mitral Aislado: revisión a partir de un caso clínico / Severe Mitral Insufficiency secondary to Isolated Mitral Cleft: Review from a clinical case

Resumen El "cleft" mitral es un defecto congénito raro que se encuentra comúnmente asociado a otras patologías no obstante, en raras ocasiones puede encontrarse como un defecto aislado. Dicho hallazgo es de suma importancia desde el punto de vista clínico ya que es una causa reparable de insuficiencia mitral, sin necesidad de someterse a reemplazo valvular. Su diagnóstico es primariamente mediante ecocardiografía, en la que el uso del 3D como técnica permite la correcta delimitación de la extensión de la lesión, así como la valoración a detalle del resto del aparato valvular mitral. Presentamos un caso de Insuficiencia Mitral severa en la infancia de causa no clara en un inicio, en la cual, por medio de ecocardiografía transtorácica 3D se logró identificar una hendidura aislada de la valva anterior como etiología y descartar otras posibles etiologías y/o mecanismos.

Abstract Severe Mitral Insufficiency secondary to Isolated Mitral Cleft: Review from a clinical case Severe mitral valve reguritacion secondary to an Isolated cleft of the mitral valve: a review based on a clinical case Mitral Cleft is a rare congenital defect that is commonly associated with others pathologies; nevertheless, in rare occasions it can be found as an isolated defect. This finding is paramount from clinical perspective as it is a reparable defect and not necessarily ends in valvular replacement. Its assessment is primarily by transthoracic echocardiography with the addition of 3D technology that provides a more detailed delimitation of the extent of the lesion, as well as detailed assessment of the whole mitral valve apparatus. In this article, we present a case of severe mitral regurgitation without a clear ethiology at glance, but posteriorly identified with the aid of transthoracic 3D echocardiography, as an isolated mitral cleft and also, allowed to rule out other possible etiologies and mechanisms.

Importance of three-dimensional speckle tracking in the assessment of left atrial and ventricular dysfunction in patients with myotonic dystrophy type 1.

INTRODUCTION AND AIM: Myotonic dystrophy type 1 (DM1) is a multisystem disease in which cardiac involvement is common. The aim of this study was to identify early changes in left atrial (LA) mechanics and left ventricular (LV) systolic function in patients with myotonic dystrophy type 1 using three-dimensional (3D) speckle tracking echocardiography (3D-STE). METHODS: This observational study included 25 patients with DM1 and 25 healthy volunteers. We assessed LA and LV global strain parameters using 3D-STE. RESULTS: Patients with DM1 showed significantly lower longitudinal LA strain (22.85%±5.06 vs. 26.82%±5.15; p=0.008 in univariate analysis and p=0.026 in multivariate analysis) and global LV longitudinal strain (-13.55%±1.82 vs. -16.11%±1.33; p<0.001 in univariate analysis and p<0.001 in multivariate analysis), which was not observed with LA area tracking (p=0.412) or LV global circumferential strain (p=0.879), global radial strain (p=0.058), area tracking (p=0.092) or twist (p=0.992). CONCLUSION: LA and LV global longitudinal strain is significantly decreased in patients with DM1, which may be an early marker of subclinical dysfunction in these patients.

Evaluación de la función ventricular y auricular derecha con ecocardiografía 3D en tromboembolia pulmonar aguda / Assessment of right ventricular and atrial function with 3D echocardiography in acute pulmonary embolism

Introducción: La tromboembolia pulmonar aguda (TEP) es un padecimiento grave. La ecocardiografía tridimensional (ECO-3D) es un método accesible, novedoso y preciso para cuantificar la función ventricular y auricular derechas. A la fecha, no existen suficientes estudios que evalúen su papel en esta entidad. Objetivo: Determinar la utilidad del ECO-3D en la evaluación de la función ventricular y auricular derecha, y el riesgo de complicaciones cardiovasculares en pacientes con TEP aguda. Material y métodos: Se analizaron 35 pacientes, admitidos al HC CMN SXXI con TEP por angioTAC, mediante equipo Phillips IE 33, se midieron parámetros bidimensionales (2D) y 3D relacionados con función ventricular y auricular derecha (TomTec y qlab 10). Se evaluaron complicaciones cardiovasculares intrahospitalarias. Resultados: El riesgo relativo de eventos cardiovasculares mayores combinados (ECMC) intrahospitalarios por ECO-3D fue: índice de esfericidad de la aurícula derecha > 1.32; RR 20.3 IC 95% 2.9-13.8; p = 0.0001, FEVD RR 7.3 IC 95% 2.5-20.9; p = 0.0001, VDFVD > 77 mL RR de 7.3 IC 95% 2.56-20.9; p = 0.0001, VSFVD RR 5.5 IC 95% 2.26-13.3; p = 0.0001. El análisis multivariado mostró tres predictores de riesgo independiente: índice de esfericidad de la aurícula derecha > 1.32, TEP masiva y presión arterial media. Conclusiones: La evaluación combinada mediante ecocardiografía 3D de función ventricular y auricular derechas permiten una evaluación cuantitativa, predicción del riesgo para la presentación de complicaciones cardiovasculares y tiempo de estancia intrahospitalarios en pacientes con TEP aguda.

Introduction: Acute pulmonary embolism (PE) is a serious condition. Tridimensional Ecocardiography (3D ECHO) is an accessible, novel and accurate method for determination of right ventricular and atrial function. To date there are insufficient studies to assess their role in this entity. Objective: Determine the usefulness of ECO-3D in evaluating right atrial and ventricular function, and the risk of cardiovascular complications in patients with acute PE. Material and methods: 35 patients were admitted to the HC CMN SXXI with PE by CT angiogram, we analized 2D and 3D parameters by Philips iE33, right atrial and ventricular function (TomTec and QLAB 10). Hospital cardiovascular complications were evaluated. Results: The relative risk of major combined cardiovascular events for 3D ECHO was: right atrial sphericity index > 1.32; RR 20.3 95% CI 2.9-13.8; p = 0.0001, RVEF RR 7.3 95% CI 2.5-20.9; p = 0.0001, RVEDV> 77 mL RR 2.56 95% CI 7.3-20.9, p = 0.0001, RR 5.5 RVESV 95% CI 2.26-13.3; p = 0.0001. Multivariate analysis showed three independent risk predictors: right atrial sphericity index > 1.32, massive PE and mean arterial pressure. Conclusions: The combined assessment by 3D echocardiography right ventricular and atrial function allow a quantitative assessment, risk prediction for cardiovascular complications and presentation of time-hospital stay in patients with acute PE.

Pacemaker lead-related tricuspid stenosis successfully treated with percutaneous balloon valvuloplasty guided by 3D echocardiography.

The most common etiology of tricuspid stenosis is rheumatic, and in most cases it is associated with valvular regurgitation. Interestingly, there have been reports of tricuspid stenosis without associated valvular regurgitation, mostly related to pacemaker leads. Percutaneous tricuspid valvuloplasty may be a therapeutic alternative to surgery in cases of pure tricuspid stenosis without other concomitant valvulopathies. We report the case of a 52-year-old woman with pacemaker lead-related tricuspid stenosis successfully treated with percutaneous valvuloplasty guided by 3D echocardiography.