RESUMO
ABSTRACT: A 34-year-old woman, who was 11 months postpartum, underwent 99mTc-MIBI myocardial perfusion SPECT imaging for atypical symptomatology with normal baseline electrocardiogram and 2-dimensional echocardiography. She was lactating on and off, preferentially from the right breast. Analysis of the raw images revealed unilateral intense tracer uptake in the right breast region that persisted in the delayed spot views (24-hour postinjection). Although bilateral breast uptake of 99mTc-MIBI may be seen in postpartum scenario, unilateral breast uptake can also occur in patients with preferential lactation from 1 breast as seen in this case and should not be mistaken for pathology.
Assuntos
Imagem de Perfusão do Miocárdio , Adulto , Mama/diagnóstico por imagem , Feminino , Humanos , Lactação , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton ÚnicoAssuntos
Aneurisma Cardíaco/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico , Procedimentos Cirúrgicos Cardíacos/métodos , Angiografia Coronária , Ecocardiografia Doppler em Cores , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/cirurgiaRESUMO
Familial constrictive pericarditis is extremely rare. We report a case of two brothers both suffering constrictive pericarditis along with having multiple painless joint deformities. Genetic workup confirmed the clinical diagnosis of camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome CACP syndrome and also revealed a rare mutation in the causative gene.
Assuntos
Artropatia Neurogênica/genética , Coxa Vara/genética , DNA/genética , Deformidades Congênitas da Mão/genética , Mutação , Pericardite Constritiva/genética , Proteoglicanas/genética , Doenças Raras , Irmãos , Sinovite/genética , Adolescente , Artropatia Neurogênica/diagnóstico , Artropatia Neurogênica/metabolismo , Cateterismo Cardíaco , Criança , Coxa Vara/diagnóstico , Coxa Vara/metabolismo , Análise Mutacional de DNA , Ecocardiografia , Testes Genéticos , Deformidades Congênitas da Mão/diagnóstico , Deformidades Congênitas da Mão/metabolismo , Humanos , Masculino , Linhagem , Pericardite Constritiva/diagnóstico , Pericardite Constritiva/metabolismo , Proteoglicanas/metabolismo , Sinovite/diagnóstico , Sinovite/metabolismoRESUMO
BACKGROUND: Chronic constrictive pericarditis (CCP) is the end result of chronic inflammation of the pericardium. Developing countries continue to face a significant burden of CCP secondary to tuberculous pericarditis. Surgical pericardiectomy offers potential cure. However, there is paucity of echocardiography data in post-pericardiectomy patients vis-a-vis their clinical status. We studied the changes in multiple echocardiographic parameters in these patients before and after pericardiectomy. METHODS: Twenty-three patients (14 men, 9 women) who underwent pericardiectomy for CCP in the last 5 years (from January 2009 to December 2014) were subjected to detailed clinical and echocardiographic evaluation during the study period (between June 2013 and December 2014). Patients with residual symptoms of NYHA class II and below were considered as 'responders'. The data thus obtained were compared to the pre-operative parameters. RESULTS: After pericardiectomy, the incidence of vena caval congestion decreased from 100% to 15% (p<0.001). There was significant reduction in the mean left atrial size from 39.33±10.52mm to 34.45±10.08mm (p<0.001) and also the ratio of left atrium to aortic annulus from 1.93 to 1.69 (p<0.001) among 'responders' to pericardiectomy. Septal bounce was observed to persist in 5 (25%) patients after pericardiectomy. There was significant respiratory variation of 39.23±15.11% in the mitral E velocity before pericardiectomy. After pericardiectomy, this variation reduced to 14.43±7.76% (p<0.001). There was also significant reduction in the respiratory variation in tricuspid E velocities from 31.33±18.81% to 17.35±16.26% (p<0.001). After pericardiectomy, the mean ratio of mitral annular velocities, medial e': lateral e', reduced from 1.08 to 0.87 (p<0.03). The phenomenon of 'annulus reversus' was found to persist in 6 'responders', thereby reflecting a 50% reduction in its incidence after pericardiectomy (p<0.001). The ratio of mitral E to medial e' (E/e') increased from 4.21±1.35 before pericardiectomy to 6.91±2.62 after pericardiectomy (p=0.001). CONCLUSION: Among clinical responders to surgical pericardiectomy, echocardiographic assessment revealed a significant reduction in vena caval congestion, LA size, ratio of LA to aortic annulus, septal bounce, respiratory variation in mitral and tricuspid E velocities, mitral annular medial e' and the phenomenon of annulus reversus. Also, there was a significant rise in minimum tricuspid and mitral E velocities and the E/e' ratio.
Assuntos
Ecocardiografia Doppler/métodos , Pericardite Constritiva/diagnóstico , Pericárdio/diagnóstico por imagem , Adolescente , Adulto , Criança , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pericardiectomia , Pericardite Constritiva/fisiopatologia , Pericardite Constritiva/cirurgia , Pericárdio/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
A 17-year-old female presented with mild cyanosis. Imaging showed supracardiac total anomalous pulmonary venous connections with a vertical vein travelling between the left pulmonary artery and the left bronchus with significant obstruction. There was a huge post-stenotic aneurysm of the vertical vein.
Assuntos
Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Adolescente , Angiografia , Ecocardiografia , Feminino , Humanos , Imageamento Tridimensional , Tomografia Computadorizada por Raios XAssuntos
Fístula Arteriovenosa/terapia , Cateterismo Cardíaco/instrumentação , Anomalias dos Vasos Coronários/terapia , Vasos Coronários , Dispositivo para Oclusão Septal , Veia Cava Inferior/anormalidades , Fístula Arteriovenosa/diagnóstico por imagem , Pré-Escolar , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Humanos , Masculino , Desenho de Prótese , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagemRESUMO
This case demonstrates the development of secondary infundibular stenosis in a 10-year-old male child with documented large non-restrictive perimembranous ventricular septal defect in infancy - the classical Gasul phenomenon.
Assuntos
Comunicação Interventricular/complicações , Estenose Subvalvar Pulmonar/etiologia , Função Ventricular/fisiologia , Cateterismo Cardíaco , Criança , Diagnóstico Diferencial , Ecocardiografia Doppler em Cores , Comunicação Interventricular/diagnóstico , Humanos , Masculino , Estenose Subvalvar Pulmonar/diagnóstico , Pressão Ventricular/fisiologiaAssuntos
Fibrose Endomiocárdica/diagnóstico , Criança , Fibrose Endomiocárdica/terapia , Feminino , Humanos , ÍndiaAssuntos
Cardiomegalia/etiologia , Dextrocardia/diagnóstico , Doença de Depósito de Glicogênio Tipo II/diagnóstico , Situs Inversus/diagnóstico , Cardiomegalia/diagnóstico , Dextrocardia/complicações , Eletrocardiografia , Doença de Depósito de Glicogênio Tipo II/complicações , Humanos , Lactente , Masculino , Radiografia Torácica , Situs Inversus/complicaçõesRESUMO
4 months male child presented with failure to thrive. On general examination child had normal O2 saturation with characteristic elfin facies. Further evaluation of the patient showed major manifestations of Williams syndrome in form of supravalvar aortic stenosis, branched pulmonary artery stenosis along with cardiomyopathy. Although the entity is known, this article shows comprehensive diagnostic workup with the aid of multimodality imaging techniques. The genetic diagnosis of Williams syndrome was confirmed using fluroscent in situ hybridisation techniques (FISH). In this patient most of the manifestations of elastin vasculopathy were noted in the form of involvement of ascending aorta, pulmonary arteries and myocardium. We also want to emphasis the importance of echocardiography in newborn patients with dysmorphic facies as Williams syndrome can be easily missed in neonatal period.
Assuntos
Anormalidades Múltiplas , Ecocardiografia Doppler/métodos , Imageamento Tridimensional/métodos , Estenose da Valva Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Síndrome de Williams/diagnóstico , Diagnóstico Diferencial , Humanos , Lactente , MasculinoAssuntos
Doenças Cardiovasculares/patologia , Ponte de Artéria Coronária/métodos , Estenose Coronária/cirurgia , Artéria Torácica Interna/patologia , Angiografia/métodos , Constrição Patológica/patologia , Humanos , Anastomose de Artéria Torácica Interna-Coronária , Masculino , Artéria Torácica Interna/diagnóstico por imagem , Pessoa de Meia-Idade , Veia Safena/transplanteAssuntos
Falso Aneurisma/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Cardiomegalia/diagnóstico por imagem , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Valva Mitral/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Ecocardiografia/métodos , Fibrose/diagnóstico por imagem , Humanos , Masculino , Valor Preditivo dos Testes , Ruptura , Sensibilidade e EspecificidadeRESUMO
Permanent pacemaker lead-induced tricuspid regurgitation is extremely uncommon. We report a patient with severe tricuspid stenosis detected 10 years after permanent single chamber pacemaker implantation in surgically corrected congenital heart disease. The loop at the level of the tricuspid valve may have caused endothelial injury and eventually led to stenosis. Percutaneous balloon valvotomy for such stenosis has not been reported from India.
Assuntos
Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Comunicação Interventricular/cirurgia , Marca-Passo Artificial/efeitos adversos , Estenose da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/cirurgia , Criança , Ecocardiografia , Feminino , HumanosRESUMO
Ruptured sinus of Valsalva aneurysm is a rare anomaly and an associated coarctation of aorta is even rarer. A combination of such defects is traditionally treated surgically. The surgery is necessarily staged and done through different approaches. We report successful simultaneous transcatheter treatment of both these defects performed in the same setting in an acutely ill adult male patient with a good intermediate-term follow-up.
Assuntos
Aneurisma Roto/diagnóstico , Aneurisma Roto/cirurgia , Coartação Aórtica/diagnóstico , Coartação Aórtica/cirurgia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/cirurgia , Dispositivo para Oclusão Septal , Seio Aórtico , Stents , Adulto , Humanos , MasculinoRESUMO
Presence of multiple cardiovascular manifestations of the Marfan syndrome in the same patient is not commonly encountered. We present a 49 year-old lady with this syndrome who presented with decompensated heart failure. Evaluation revealed presence of extensive Stanford type A aortic dissection alongwith severe aortic and mitral incompetence. However, the patient declined surgery and was discharged on medical management. At a year's follow-up, she had dyspnea of NYHA class II with persistent cardiovascular findings.
Assuntos
Doenças da Aorta/etiologia , Insuficiência Cardíaca/etiologia , Doenças das Valvas Cardíacas/etiologia , Síndrome de Marfan/complicações , Doenças da Aorta/diagnóstico por imagem , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Síndrome de Marfan/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia , UltrassonografiaRESUMO
Isolated single coronary artery without other congenital cardiac anomalies is very rare among the different variations of anomalous coronary patterns. The prognosis in patients with single coronary varies according to the anatomic distribution and associated coronary atherosclerosis. If the left main coronary artery travels between the aorta and pulmonary arteries, it may be a cause of sudden cardiac death. We present multimodality images of a single coronary artery, in which the whole coronary system originated by a single trunk from the right sinus of Valsalva with inter-arterial course of left main coronary artery. This rare type of single coronary artery was classified as RII-B type according to Lipton's scheme of classification. A significant flow-limiting lesions were found in the right coronary artery that was successfully treated with percutaneous coronary intervention.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto Miocárdico de Parede Inferior/cirurgia , Intervenção Coronária Percutânea , Angiografia Coronária , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
We report a novel technique 'the kissing catheter technique' for retrieval of a broken catheter fragment in a patient undergoing closure of a patent ductus arteriosus.
RESUMO
Transcatheter closure of a large hypertensive patent ductus arteriosus is challenging with scant data about it. Even more challenging is retrieval of an embolized Amplatzer duct occluder. We report successful closure of a 12 mm large ductus with the Amplatzer muscular VSD occluder (post myocardial infarction) after percutaneous retrieval of the embolized, largest available, 16/14 mm Amplatzer duct occluder.