Pulmonary artery dissection and conservative medical management.

Pulmonary artery dissection is a rare clinical entity, which has been related to pulmonary arterial hypertension. It is frequently presented as cardiogenic shock or sudden death, so diagnosis is often made at autopsy. The management with best results is surgery. We report a case of pulmonary artery dissection associated with previous aortic valve replacement with a favourable outcome, using conservative medical therapy.

Prosthetic mitral valve endocarditis due to Ochrobactrum anthropi: case report.

We describe a case of infective endocarditis in a prosthetic mitral valve due to Ochrobactrum anthropi. Although O. anthropi is an emerging pathogen in immunocompromised patients, infections with the bacterium have very rarely been documented in healthy hosts, and endocarditis is rare. To our knowledge, only two cases of O. anthropi endocarditis have been reported in the medical literature.

[Multivisceral infarcts are complication of invasive aspergillosis]. / Infartos viscerales múltiples detectados por TAC en la aspergilosis invasiva.

Aspergillus fumigatus is one of the species of Aspergillus that causes aspergillosis. The clinical picture of invasive-disseminated aspergillosis is generally characterized by fever and respiratory distress that usually follows a fatal course. This form of intensive aspergillosis is suffered by severely immunossuppressed patients. There is another clinical form of severe aspergillosis, aortic aspergillosis, that appears after cardiac surgery. We present two cases of invasive aspergillosis complicated by multiple visceral infarcts involving the liver, spleen, kidneys, pancreas, thiroid and brain. Infarcts were confirmed in necropsy and appeared to be caused by an overwhelming amount of intravascular hiphae, which were observed in the infarcted areas acting forming septic embolus. We believe that multi-visceral infarcts are an underestimated complication of invasive aspergillosis. Given the progressive increase in the population of immunossuppressed patients, clinicians have to aware of all the possible presentations of invasive aspergillosis.

Infartos viscerales múltiples detectados por TAC en la aspergilosis invasiva / Multivisceral infarcts are complication of invasive aspergillosis

La aspergilosis es una infección causada por el hongo Aspergillus fumigatus. En la aspergilosis invasiva y diseminada se produce un cuadro muy grave caracterizado por fiebre, síndrome respiratorio y generalmen te muerte. Estas formas aparecen en la inmunosupresión severa. Pero hay además una forma grave de aspergilosis, la aspergilosis aórtica, que se presenta en enfermos que, sin defecto inmunológico alguno, han sido sometidos a reemplazamiento valvular o cirugía coronaria. Damos a conocer dos casos de aspergilosis invasiva que cursaron con infartos viscerales múltiples: hepático, esplénico, renales, pancreáticos, tiroideos y cerebrales. Estos infartos fueron confirmados en la autopsia y parecían producidos por la ingente cantidad de hifas intravasculares, observadas en las áreas infárticas, que pudieron actuar a modo de émbolos sépticos, sin descartar una vasculitis aspergilar. Pensamos que los infartos multiviscerales constituyen una complicación subestimada en la aspergilosis invasiva. Es necesario que aprendamos a reconocer estas formas emergentes de aspergilosis invasiva, que serán más frecuentes cada día por el aumento de enfermos inmunodeprimidos (AU)

Aspergillus fumigatus is one of the species of Aspergillus that causes aspergillosis. The clinical picture of invasive-disseminated aspergillosis is generally charactericed by fever and respiratory distress that usually follows a fatal course. This form of invesive aspergillosis is suffered by severely immunossupressed patients. There is another clinical form of severe aspergillosis, aortic aspergillosis, that appears after cardiac surgery. We present two cases of invasive aspergillosis complicated by multiple visceral infarcts involving the liver, spleen, kidneys, pancreas, thiroid and brain. Infarcts were confirmed in necropsy and appeared to be caused by an overwhelming amount of intravascular hiphae, wich were observed in the infarcted areas acting forming septic embolus. We believe that multi-visceral infarcts are an underestimed complication of invasive aspergillosis. Given the progressive increse in the population of immunossupressed patients, clinicians have to aware of all the possible presentations of invasive aspergillosis (AU)

[Ventricular fibrillation secondary to radiofrequency application in ventricular tachycardia ablation]. / Fibrilación ventricular secundaria a la aplicación de radiofrecuencia en la ablación de una taquicardia ventricular.

Radiofrequency catheter ablation has become a first line therapy for several types of tachycardias because of its high efficacy and low complication rate. The development of proarrhythmic complications due to a direct effect of radiofrequency is very unusual. We describe a patient with previous myocardial infarction and well tolerated sustained monomorphic ventricular tachycardia who underwent catheter ablation of the tachycardia substrate. During two of the radiofrequency applications, ventricular fibrillation developed and external defibrillation was required.

[Proarrhythmic effect following radiofrequency catheter ablation of repetitive monomorphic ventricular arrhythmia]. / Efecto proarrítmico tras la ablación con radiofrecuencia de una arritmia ventricular monomórfica repetitiva.

Radiofrequency catheter ablation is a first line therapy for many supraventricular and some ventricular tachycardias due to a high success rate and a low probability of complications. Although the majority of them are related to the catheterization technique, some are due to a direct effect of radiofrequency application. We report a patient with a nonsustained, repetitive, monomorphic ventricular arrhythmia that presented, after a successful radiofrequency ablation, an incessant sustained monomorphic ventricular tachycardia requiring a new ablation procedure.

[Congenital dysplasia of tricuspid valve (Ebstein like) in a 73-year-old male with severe tricuspid insufficiency]. / Displasia congénita de la válvula tricúspide (Ebstein like) en un varón de 73 años con insuficiencia tricuspídea severa.

Multiple congenital abnormalities in the structure of the tricuspid valve have been described and, the majority of cases could be considered as variations of Ebstein's anomaly. The onset of the symptoms and the diagnosis depend on the severity of the valve dysfunction and the right ventricular function and size. The age at diagnosis ranges from birth to adulthood, but a delayed diagnosis is rare when tricuspid regurgitation is severe. We cite as an example the case of a 73 year-old male classified as class I of the NYHA up to 5 months before, since then he developed progressive ascitis and edema on his legs. The physical examination suggested severe tricuspid regurgitation. We performed a transtoracic and transesophageal ecocardiogram that showed severe dysplasia in the tricuspid leaflets, severe regurgitation because of lack of adequate joining, dilatation of right chambers and right ventricular systolic dysfunction.

[Aortic dilation and dissection in a patient with Turner syndrome]. / Dilatación y disección aórtica en un paciente con síndrome de Turner.

The ascending aortic dilatation and its dissection is a not very frequent finding in patients with Turner syndrome. The high incidency of structural anomalies in the aortic wall and the severity of its complications, makes it necessary to watch these patients very closely. We present an asymptomatic patient, affected with Turner syndrome, ascending aortic dilatation and aortic wall dissection.

[Focal auricular fibrillation: catheter ablation with radiofrequency]. / Fibrilación auricular focal: ablación con catéter mediante radiofrecuencia.

Although atrial fibrillation is usually caused by multiple circulating reentrant wavelets, a focal origin has recently been reported. This focal source could be successfully treated by discrete radiofrequency catheter ablation. We report a patient without structural heart disease, but with multiple episodes of palpitations related to atrial premature beats, irregular atrial tachycardia and atrial fibrillation. The electrophysiological study demonstrated that all the atrial arrhythmias were due to the same focus firing irregularly and exhibiting a unique and centrifugal pattern of activation. Successful radiofrequency catheter ablation of the focus was performed, without complications. After three months follow-up the patient is asymptomatic and she has not presented arrhythmia recurrences.

[Acute myocardial infarction secondary to Wegener's granulomatosis]. / Infarto agudo de miocardio secundario a granulomatosis de Wegener.

Wegener's granulomatosis (WG) is a necrotizing and granulomatous vasculitis that usually affects the upper and lower respiratory tract and the kidneys. Cardiac involvement is rare although pericarditis, coronary arteritis, myocarditis, valvulitis and arrhythmias have been described. Acute myocardial infarction with clinical expression is an exceptional complication of Wegener's granulomatosis. We report a case of a 30-year-old man with Wegener's granulomatosis who suffered an acute myocardial infarction during the initial phase of the disease, following seven days of treatment with glucocorticoids and cyclophosphamide. Transthoracic echocardiography showed abnormal regional wall motion with septal hypokinesia and apical akinesia. Cardiac catheterization revealed an ectasic segment in the proximal left anterior descending coronary artery and total occlusion in the mid-segment. Medical therapy with prednisone and cyclophosphamide was continued. No complications and initial remission were achieved.

[Biventricular diverticulosis associated with rheumatic heart disease: apropos of a case]. / Diverticulosis biventricular asociada a cardiopatía reumática: a propósito de un caso.

We report a case of a 58-year-old woman with rheumatic mitral stenosis scheduled for percutaneous valvuloplasty. Prior left and right ventricular angiograms showed multiple diverticula at left ventricular apical and diaphragmatic walls and right ventricular diaphragmatic wall. Chest x-ray and echocardiogram were normal. Magnetic resonance imaging was concordant with catheterization findings and ruled out other cardiac malformations. The risk of ventricular perforation changed our indication of percutaneous valvuloplasty in favor of open heart commissurotomy.