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1.
J Forensic Sci ; 68(1): 176-184, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36480239

RESUMO

Anomalous papillary muscle (APM) insertion into the anterior mitral valve leaflet is often associated with hypertrophic cardiomyopathy (HCM) but is reported in other cases as a rare finding. Mere presence does not strictly imply hemodynamic disturbance, and several types exist, with various impacts on left ventricular outflow tract (LVOT) obstruction. The interpretation of isolated anomaly is challenging at autopsy because significant LVOT obstruction is dynamic. We analyzed autopsy cases with APM regarding the site of PM insertion and origin, number of PM bellies, anomalous insertions, heart weight, left ventricle (LV) thickness, LV endocardial fibrosis, subjects' age, sex, cause, and manner of death. A total of 20 cases were identified. Fourteen were identified incidentally, while in 670 systematically examined hearts, the APM was identified in six cases, indicating a prevalence of 0.9%. In eight cases, the manner of death was natural (one case with HCM), and in 12 non-natural. Type II anomaly of PM was most frequent (n = 8), followed by Type III (n = 7) and Type I (n = 5). Subjects who died of natural causes were significantly older and had heavier hearts (median 455 g vs. 330 g; p < 0.05) without difference in LV thickness (median 16 mm vs. 15 mm; p > 0.05). Histology performed in four cases showed a pattern of direct insertion of cardiomyocytes into the leaflet's thick fibrous tissue with a narrow overlapping zone. The APM is rare, can be easily overlooked, and does not imply significant pathology per se. We discussed proper assessment of the significance of this anomaly at autopsy.


Assuntos
Cardiomiopatia Hipertrófica , Valva Mitral , Humanos , Valva Mitral/patologia , Músculos Papilares/anormalidades , Músculos Papilares/patologia , Autopsia , Ventrículos do Coração/patologia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/patologia
2.
BMC Vet Res ; 18(1): 448, 2022 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-36564735

RESUMO

BACKGROUND: Myxomatous mitral valve disease (MMVD) is the most common diagnosed cardiovascular disease in dogs. Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) tests are used to diagnose congestive heart failure, but there are conflicting reports about their value in diagnosing the subclinical stages of MMVD in dogs. Moreover, the diagnostic value of blood lipoproteins in dogs with MMVD is still unclear. The purpose of this study was to assess the serum concentrations of ANP, BNP and lipoproteins of dogs with MMVD and to evaluate the correlation of the levels of ANP and BNP with lipoproteins. RESULTS: This study was performed on 24 dogs with MMVD and 10 healthy dogs. Dogs with MMVD were classified in to stages B1 (n = 11), B2 (n = 6), C (n = 4) and D (n = 3) groups according to the classification suggested by American College of Veterinary Internal Medicine guidelines. Our results showed that the mean serum BNP levels were significantly increased for all MMVD groups compared to control dogs. The mean serum ANP levels for the stage B2, C and D groups were significantly higher than the control group, while the mean serum ANP concentrations did not differ significantly between the stage B1 and control groups. An increase in BNP level was observed in 87.5% of patients. Although BNP concentrations were elevated in 100% of dogs with stages C, D and B2, high BNP was observed in 72.72% of dogs with stage B1. Regarding ANP, 58.33% of patients had an increase in ANP. However, elevated ANP levels were found in only 27.27% of patients in stage B1, while increased ANP levels were observed in 66.66 and 100% of patients in stage B2 and C/D groups respectively. Also, in all patients with MMVD, the mean serum concentrations of high-density lipoprotein cholesterol (HDL-C) were approximately 1.7 to 2 times significantly lower than the control group. Additionally, the mean serum low-density lipoprotein cholesterol (LDL-C) increased significantly (1.9-2.7 times) compared to the control group. There was a significant inverse correlation between HDL-C and BNP, and HDL-C and ANP. LDL-C showed a significant positive correlation with BNP, and ANP. Also, LDL-C, but not HDL-C, had a significant positive correlation with LA/AO ratio, LVIDd, LVIDdN and VHS. BNP and ANP showed a significant positive correlation with LA/AO, LVIDd, LVIDdN and VHS. CONCLUSIONS: Serum BNP has a greater diagnostic value than serum ANP in dogs with MMVD. In addition, serum BNP can be used to determine the subclinical stages of B1 and B2 MMVD. This study also suggests that dogs with subclinical MMVD, showed an increase in BNP along with a decrease in HDL-C and an increase in LDL-C, which are known to be risk factors for cardiovascular diseases in human. However, it seems that high LDL-C is more involved in the pathogenesis of MMVD than low HDL-C. Therefore, periodic testing of serum lipoproteins is recommended in high-risk patients, even if total cholesterol levels are normal.


Assuntos
Doenças do Cão , Doenças das Valvas Cardíacas , Humanos , Cães , Animais , Valva Mitral/patologia , Peptídeo Natriurético Encefálico , Fator Natriurético Atrial , LDL-Colesterol , Doenças do Cão/patologia , Doenças das Valvas Cardíacas/veterinária , Lipoproteínas
3.
G Ital Cardiol (Rome) ; 23(11): 872-875, 2022 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-36300390

RESUMO

Caseous calcification of the mitral annulus is an uncommon variant of mitral annular calcification. It appears as a round echodense mass containing central areas of echolucencies resembling liquefaction and with no flow in the central zone on color Doppler. In most cases it involves the posterior mitral annulus region, particularly in female subjects. The pathogenesis remains unclear: hypercholesterolemia and the dissolution of lipid-rich macrophages may be implicated in liquefaction necrosis. Transthoracic and transesophageal echocardiography represents the most reliable technique for diagnosis, whereas cardiac magnetic resonance imaging is the choice in doubtful cases. We report the case of an 82-year-old female patient describing different aspects of this particular clinical condition.


Assuntos
Calcinose , Doenças das Valvas Cardíacas , Feminino , Humanos , Idoso de 80 Anos ou mais , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Calcinose/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Ecocardiografia Transesofagiana , Lipídeos
4.
J Card Surg ; 37(11): 3722-3728, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36116053

RESUMO

BACKGROUND: Mitral valve repair using expanded polytetrafluoroethylene sutures to replace mitral chordae tendineae is a well-established procedure. However, the incidence of neo-chordae failure causing recurrent mitral regurgitation is not well defined. METHODS: We have reviewed the reported cases of complications after mitral valve repair related to the use of neo-chordae. This study was mainly carried out through PubMed, Medline, and Google Chrome websites. RESULTS: We have identified a total of 26 patients presenting with rupture of polytetrafluoroethylene neo-chordae, mostly being described as isolated cases. Few other cases of recurrent mitral regurgitation with hemolysis were found, where reoperation was not caused by neo-chordal failure but most likely by technical errors. At pathological investigation the findings were substantially similar in all reported cases. The neo-chordae retained their length and pliability, became covered with host tissue and rupture was mainly related to suture size. Mild calcification was observed not interfering with chordal function; chordal infection did never occur. CONCLUSIONS: The use of artificial neo-chordae provides excellent late results with durable mitral valve repair stability. Chordal rupture may occur late postoperatively leading to reoperation because of recurrent mitral regurgitation. Despite its rarity, this potential complication should not be overlooked during follow-up of patients after mitral valve repair using artificial neo-chordae.


Assuntos
Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Cordas Tendinosas/patologia , Cordas Tendinosas/cirurgia , Humanos , Valva Mitral/patologia , Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Politetrafluoretileno , Suturas
5.
J Card Surg ; 37(10): 3336-3341, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36054469

RESUMO

Mitral regurgitation in hypertrophic obstructive cardiomyopathy (HOCM) is mainly due to systolic anterior motion (SAM) and may be abolished in most of the patients by extended myectomy alone. However, a minority of HOCM patients may present mitral regurgitation due to organic mitral valve (MV) anomalies (such as MV leaflet prolapse, chordal rupture, leaflet cleft, and fibrosis) which need to be addressed. In addition, when the thickness of the interventricular septum is not particularly pronounced, shallow myectomy may not be enough to eliminate SAM and additional procedures have been proposed, including MV replacement, anterior leaflet plication/extension, reorientation of papillary muscles, secondary chordae cutting, and edge-to-edge technique. MV repair in the context of hypertrophic cardiomyopathy is certainly more challenging due to the suboptimal exposure of the MV related to the presence of a hypertrophic left ventricle and a not particularly dilated left atrium. The simplest, least time-consuming repair technique should, therefore, be chosen. In this setting, the edge-to-edge technique has the great advantage of being an easy, quick, and reproducible procedure. The disease process of HOCM is not confined to the myocardium, but also involves the MV apparatus, which plays a critical role in dynamic left ventricular outflow tract (LVOT) obstruction. A comprehensive approach utilizing multimodality imaging, particularly echocardiography and cardiac magnetic resonance, has identified multiple abnormalities of the MV complex that have enhanced our understanding of the mechanisms of SAM and LVOT obstruction in HOCM.


Assuntos
Cardiomiopatia Hipertrófica , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Obstrução do Fluxo Ventricular Externo , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/complicações , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/cirurgia
6.
Kyobu Geka ; 75(9): 714-717, 2022 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-36156522

RESUMO

A 73-year-old woman with multiple episodes of cerebral infarction was diagnosed with nonbacterial thrombotic endocarditis( NBTE) and antiphospholipid antibody syndrome. Transesophageal echocardiography revealed highly mobile tumors both in the mitral and the aortic valve, and the patient underwent aortic and mitral valve replacement. Pathologically, tumor of the mitral valve was a thrombus, and that of the aortic valve was a papillary fibroelastoma. Early after surgery, a recurrent thrombus was found in the left atrium, but no organ embolization ensued, and the patient had no adverse event for six months thereafter. Surgery is indicated only in limited cases of NBTE, because postoperative anticoagulation therapy is hard to manage and clinical outcome is poor.


Assuntos
Síndrome Antifosfolipídica , Endocardite , Trombose , Idoso , Anticoagulantes , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/patologia , Endocardite/complicações , Endocardite/diagnóstico por imagem , Endocardite/cirurgia , Feminino , Humanos , Valva Mitral/patologia , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/cirurgia
7.
Kyobu Geka ; 75(9): 722-725, 2022 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-36156524

RESUMO

A calcified amorphous tumor( CAT) is a non-neoplastic cardiac tumor, which has been reported to be associated with hemodialysis dependent end-stage renal disease. We report a case of CAT attached to mitral annular calcification (MAC) in the posterior leaflet annulus of the mitral valve in a 56-year-old man who had been receiving peritoneal dialysis for three years. The CAT grew to 10 mm long in a half year. Peritoneal dialysis dependent end-stage renal disease is associated with MAC. Additionally, MAC-related CAT has been reported growing rapidly. We should perform periodic echocardiography not only for hemodialysis patients but also for peritoneal dialysis patients. When CAT is diagnosed, operation should be performed early to prevent embolism such as cerebral infarction.


Assuntos
Calcinose , Neoplasias Cardíacas , Doenças das Valvas Cardíacas , Falência Renal Crônica , Diálise Peritoneal , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etiologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/patologia , Falência Renal Crônica/terapia , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Valva Mitral/cirurgia
8.
J Biomech ; 142: 111226, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35963102

RESUMO

Barlow's Disease affects the entire mitral valve apparatus causing mitral regurgitation. Standard annuloplasty procedures lead to an average of 55% annular area reduction of the end diastolic pre-operative annular area in Barlow's diseased valves. Following annular reduction, mitral valvuloplasty may be needed, usually with special focus on the posterior leaflet. An in silico pipeline to perform annuloplasty by utilizing the pre- and -postoperative 3D echocardiographic recordings was developed. Our objective was to test the hypothesis that annuloplasty ring sizes based on a percentage (10%-25%) decrease of the pre-operative annular area at end diastole can result in sufficient coaptation area for the selected Barlow's diseased patient. The patient specific mitral valve geometry and finite element model were created from echocardiography recordings. The post-operative echocardiography was used to obtain the artificial ring geometry and displacements, and the motion of the papillary muscles after surgery. These were used as boundary conditions in our annuloplasty finite element analyses. Then, the segmented annuloplasty ring was scaled up to represent a 10%, 20% and 25% reduction of the pre-operative end diastolic annular area and implanted to the end diastolic pre-operative finite element model. The pre-operative contact area decrease was shown to be dependent on the annular dilation at late systole. Constraining the mitral valve from dilating excessively can be sufficient to achieve proper coaptation throughout systole. The finite element analyses show that the selected Barlow's diseased patient may benefit from an annuloplasty ring with moderate annular reduction alone.


Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Ecocardiografia Tridimensional , Análise de Elementos Finitos , Humanos , Valva Mitral/anatomia & histologia , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/etiologia , Resultado do Tratamento
9.
Cardiovasc Pathol ; 61: 107462, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35952984

RESUMO

A 45-year-old man was clinically diagnosed with mitral valve regurgitation 2 years before death. The autopsy showed left ventricular hypertrophy and mitral valve prolapse of the bileaflet with billowing valve and excessively thickened leaflet, the findings of which were consistent with Barlow's disease. Microscopically, destruction of the 3-layer structure of the mitral valve and advanced interstitial fibrosis of the left ventricular wall were evident. Additionally, a marked but limited reduction in conduction fibers was found in the branching point of the left and right branches, as seen in cases of idiopathic complete atrioventricular block. Genetic investigation using whole-exome sequencing showed some genetic variants with uncertain significance. In patients with Barlow's disease, a marked reduction of conduction fibers might be a subtype of sudden cardiac death. The overlap of some arrhythmogenic substrate in the heart may increase the risk of sudden cardiac death with asymptomatic Barlow's disease.


Assuntos
Prolapso da Valva Mitral , Masculino , Humanos , Pessoa de Meia-Idade , Autopsia , Resultado do Tratamento , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/genética , Valva Mitral/patologia , Morte Súbita Cardíaca/etiologia
10.
J Am Coll Cardiol ; 80(7): 722-738, 2022 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-35953138

RESUMO

Mitral annular calcification (MAC) is a common and challenging pathologic condition, especially in the context of an aging society. Surgical mitral valve intervention in patients with MAC is difficult, with varying approaches to the calcified annular anatomy, and the advent of transcatheter valve interventions has provided additional treatment options. Advanced imaging provides the foundation for heart team discussions and management decisions concerning individual patients. This review focuses on the prognosis of, preoperative planning for, and management strategies for patients with MAC.


Assuntos
Calcinose , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento
12.
Am J Case Rep ; 23: e936545, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35781282

RESUMO

BACKGROUND In cardiac amyloidosis (CA), misfolded proteins deposit in the extracellular space of cardiac tissue. These deposits classically cause restrictive cardiomyopathy with diastolic dysfunction. Although there are at least 30 proteins known to cause amyloid aggregates, 2 main types make up most diagnosed cases: light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR). Since CA is considered a rare condition, it is often underdiagnosed or recognized in the advanced stages. Once amyloid deposits involve the heart tissue, they are associated with a worse outcome and higher mortality rates, especially in patients presenting symptoms of heart failure. CASE REPORT We report a case of a 22-year-old man presenting with acute severe mitral regurgitation, secondary to posterior mitral leaflet chordae tendineae rupture (CTR). Surgical mitral valve replacement with a mechanical prosthesis was performed, and cardiac tissue biopsy samples were obtained. After surgery, the patient improved significantly but suddenly presented with hemodynamic deterioration, until he died due to severe hemodynamic compromise and multiorgan failure. Although the etiology of the CTR was not established before surgical intervention, the histopathological analysis suggested CA. CONCLUSIONS CA diagnosis can be complex, especially in a 22-year-old-man with atypical clinical and imaging manifestations. In this patient, other differential diagnoses were considered, since CA presenting in a young patient is a rare phenomenon and acute mitral regurgitation secondary to CTR presents more frequently in other heart conditions. Furthermore, rapid postoperative deterioration resulted in the patient's death before biopsy samples were available because suspicion of amyloidosis had not been raised until that point.


Assuntos
Neuropatias Amiloides Familiares , Ruptura Cardíaca , Insuficiência da Valva Mitral , Doença Aguda , Adulto , Neuropatias Amiloides Familiares/complicações , Cordas Tendinosas/diagnóstico por imagem , Cordas Tendinosas/patologia , Ruptura Cardíaca/complicações , Ruptura Cardíaca/cirurgia , Humanos , Masculino , Valva Mitral/patologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Adulto Jovem
14.
Echocardiography ; 39(7): 906-917, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35733298

RESUMO

BACKGROUND: Transesophageal echocardiography (TEE) is the gold standard for the detection of valvular vegetations (VV). Differentiating small VV from degenerative changes is challenging and prone to inter-observer variability. We evaluated inter-observer agreement regarding aortic (AV) and mitral valve (MV) findings on TEEs ordered for suspected infective endocarditis (IE). METHODS: A total of 349 consecutive TEEs were evaluated. Studies were classified as "definite, possible, or no" IE with valve masses classified further by morphology. Nine faculty echocardiographers scored randomly selected TEEs of the AV (N = 38) and MV (N = 35). Inter-reader variability was calculated using the Fleiss/Scott Kappa (Kf). RESULTS: Positive blood cultures were present in 81% and 45% had definite IE by the modified Duke criteria. There was moderate reader agreement regarding the presence of a valvular mass for both the AV (Kf = .41, 95% CI [.30-.53]) and MV (Kf = .49, 95% CI [.34-.65]). For diagnosis of IE, there was fair agreement for the AV (Kf = .29, 95% CI [.18-.42]) and moderate agreement for the MV (Kf = .53, 95% CI [.36-.70]). Masses described as large, multi-lobulated, or pedunculated were more frequently categorized as clinical IE, (p < .006, both valves), however those with filamentous lesions were not (p < .001, both valves). CONCLUSIONS: In a large academic center, the inter-observer agreement for the presence of a left sided valvular mass was moderate and agreement regarding the final diagnosis of IE was fair to moderate, with better agreement among readers evaluating the MV. Lesion morphology is associated with the clinical diagnosis of IE.


Assuntos
Endocardite Bacteriana , Endocardite , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Ecocardiografia Transesofagiana , Endocardite/complicações , Endocardite/diagnóstico por imagem , Endocardite Bacteriana/complicações , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Variações Dependentes do Observador
15.
Am J Med Genet A ; 188(8): 2443-2447, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35679177

RESUMO

We report a neonate with severe Marfan syndrome (MS), prenatally identified to have persistent atrial tachycardia, biventricular dysfunction, and an unusual structure within the atria. Detailed postnatal echocardiographic evaluation and cross-sectional imaging confirmed congenital pseudoaneurysm of the mitral-aortic intervalvular fibrosa. Emergent testing by next-generation sequencing identified a FBN1 pathological variant, key to establishing goals of care. To our knowledge, this is the first reported case of a congenital pseudoaneurysm of the mitral-aortic intervalvular fibrosa in MS.


Assuntos
Falso Aneurisma , Síndrome de Marfan , Falso Aneurisma/patologia , Valva Aórtica/patologia , Ecocardiografia , Humanos , Recém-Nascido , Síndrome de Marfan/complicações , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/genética , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia
16.
J Card Surg ; 37(9): 2862-2863, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35690898

RESUMO

A 60-year-old male presented with sudden onset chest pain and pulmonary edema. The investigation confirmed torrential aortic regurgitation of a bicuspid valve. At surgery, a ruptured fibrous strand was identified which had been supporting the left-right cusp commissure with loss of attachment to the aortic wall. This case demonstrates that fibrous strands may be present as a supporting structure of the aortic valve, and rupture can be a rare cause of torrential aortic regurgitation, similar in pathogenesis to how it may be associated with acute severe mitral regurgitation and chordae tendineae rupture.


Assuntos
Insuficiência da Valva Aórtica , Ruptura Cardíaca , Insuficiência da Valva Mitral , Doença Aguda , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Cordas Tendinosas/diagnóstico por imagem , Cordas Tendinosas/patologia , Cordas Tendinosas/cirurgia , Fibrose , Ruptura Cardíaca/diagnóstico por imagem , Ruptura Cardíaca/etiologia , Ruptura Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Ruptura
17.
Echocardiography ; 39(7): 954-956, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35751387

RESUMO

Three-dimensional (3D) echocardiography is an important tool in the evaluation of mitral valve anatomy. We illustrate a case of a 67-year-old female who was admitted for non-ST-elevation myocardial infarction (NSTEMI) and underwent two-vessel coronary artery bypass grafting for surgical disease. Her two-dimensional (2D) echocardiographic images intraoperatively demonstrated a mass on the posterior mitral valve leaflet which created a diagnostic challenge; 3D transesophageal imaging was crucial in identifying the true nature of the pathology to be mitral annular calcification with supra-annular extension.


Assuntos
Ecocardiografia Tridimensional , Doenças das Valvas Cardíacas , Insuficiência da Valva Mitral , Idoso , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Feminino , Doenças das Valvas Cardíacas/patologia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia
18.
J Med Case Rep ; 16(1): 205, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35570306

RESUMO

BACKGROUND: Doppler transthoracic echocardiography is routinely performed to measure peak mitral inflow velocities in the assessment of left ventricular diastolic function. The limitations of echocardiography are well documented, but its accuracy in the measurement of transmitral peak velocity in the presence of aortic valve regurgitation has not yet been compared with four-dimensional flow cardiac magnetic resonance imaging. Four-dimensional flow cardiac magnetic resonance imaging offers time-resolved cross-sectional velocity information that can be used to investigate mitral inflow peak velocity. We present a case report demonstrating the potential superior capabilities of four-dimensional flow cardiac magnetic resonance imaging in accurately detecting mitral inflow velocities over Doppler echocardiography in patients with aortic regurgitation. CASE PRESENTATION: A 67-year-old Caucasian female presented to our outpatient cardiology clinic with exertional dyspnea. Doppler transthoracic echocardiography identified moderate to severe aortic regurgitation. Mapping of mitral inflow peak velocities proved challenging with Doppler echocardiography. Additionally, four-dimensional flow cardiac magnetic resonance imaging with automated three-dimensional flow streamlines was performed, which allowed for more accurate detection of mitral inflow peak velocities. CONCLUSIONS: Doppler echocardiography has a limited role in mitral inflow assessment where aortic regurgitation is present. In such cases, four-dimensional flow cardiac magnetic resonance imaging is an alternative imaging technique that may circumvent this issue and allow mitral inflow assessment.


Assuntos
Insuficiência da Valva Aórtica , Insuficiência da Valva Mitral , Idoso , Insuficiência da Valva Aórtica/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Estudos Transversais , Feminino , Sopros Cardíacos , Humanos , Imageamento por Ressonância Magnética , Valva Mitral/patologia , Insuficiência da Valva Mitral/diagnóstico por imagem
19.
J Card Surg ; 37(8): 2437-2439, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35578332

RESUMO

INTRODUCTION: Accessory left atrial cords are fibroelastic structures found in the left atrium. Left atrial cords may be associated with mitral valve disease, atrial fibrillation, stroke, and other congenital left-side anomalies. METHODS: We presented the case of a man with severe Mitral Regurgitation and two accessories left atrial cords attached to P2 scallop by a single tendon and performed a literature review using PUBMED/MEDLINE, Web of Science, and EMBASE databases on December 4, 2021. RESULTS: According to our review, accessory left atrial cords were found more frequently in women (36 patients, 62%), more frequently attached to the mitral valve (66% of reports) and mitral regurgitation was the most frequently reported pattern of mitral valve disease (64.2%). No other cases of double left atrial cords attached to P2 segment were found. CONCLUSION: Accessory left atrial chords may be related to mitral valve disease and other left-side congenital abnormalities. These structures were found more frequently in females and A2 insertion was the most frequently observed pattern in the review.


Assuntos
Fibrilação Atrial , Átrios do Coração/patologia , Doenças das Valvas Cardíacas/patologia , Insuficiência da Valva Mitral , Valva Mitral/patologia , Fibrilação Atrial/complicações , Feminino , Doenças das Valvas Cardíacas/complicações , Humanos , Masculino , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/patologia
20.
Am J Case Rep ; 23: e936296, 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35440533

RESUMO

BACKGROUND Caseous calcification of the mitral annulus (CCMA) is an uncommon form of mitral annular calcification and can be misdiagnosed as heart abscess, neoplasm, or other lesions occupying the atrioventricular groove. Data regarding imaging follow-up of patients with CCMA are limited. This report presents a case of CCMA with a 3-year imaging follow-up. CASE REPORT A 66-year-old asymptomatic woman was referred to our cardiology department for further evaluation of a rapidly expanding intracardiac mass observed using transthoracic echocardiography (TTE) in an outpatient setting. A neoplasm was suspected. Echocardiographic examination was normal 5 years ago, and 2 years later, TTE revealed an echodense structure (10×10 mm) occupying the atrioventricular groove. Three years later, TTE revealed an increase in the size of the lesion (21×18 mm) and a mild acoustic shadow. Cardiac magnetic resonance imaging revealed a pathological mass (20×20×37 mm) in the posterior portion of the mitral annulus that extended into the left ventricle. Using computed tomography, a round mass (20×19×39 mm) with a demarcated area of calcification was revealed in the posterior portion of the mitral annulus. Thus, the intracardiac mass was diagnosed as CCMA. Although there was a considerable increase in lesion size (doubling of lesion size within 3 years), normal intracardiac flow and asymptomatic course of the disease remained. Therefore, this patient underwent conservative management with imaging follow-up. CONCLUSIONS In cases of atypical presentation of CCMA, multimodal imaging may provide an accurate diagnosis and important information regarding the course of the disease.


Assuntos
Calcinose , Doenças das Valvas Cardíacas , Idoso , Calcinose/diagnóstico por imagem , Calcinose/patologia , Ecocardiografia/métodos , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia
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