Enfermedad carcinoide cardiaca multivalvular / Multivalvular carcinoid heart disease

Hombre de 67 años de edad, enviado a valoración ecocardiográfica por cuadro clínico de 6 meses de evolución con: disnea de esfuerzo, edemas de miembros inferiores y fatiga. Se encuentra doble lesión de la válvula tricúspide con: estenosis e insuficiencia severa, insuficiencia pulmonar severa; y compromiso valvular izquierdo con: insuficiencia mitral y aórtica severas, asociadas a engrosamiento y rigidez valvular. El paciente tenía como antecedente tumor neuroendocrino de íleon, metastásico a pulmón e hígado. En este caso se discuten los hallazgos ecocardiográficos característicos del síndrome carcinoide con compromiso multivalvular como hallazgo inusual de este raro síndrome.

A 67 year-old man is sent to echocardiographic assessment for 6 month history of exertional: dyspnea, edema of the lower extremities, fatigue, double lesions in tricuspid valve with: severe stenosis and severe regurgitation, severe pulmonary valve regurgitation; and left side valvular disease with: severe aortic regurgitation and severe mitral regurgitation, all of them associated with valvular thickening, rigidity, in a patient with history of neuroendocrine tumor, with lung and liver metastases. This case discuss the echocardiographic findings suggestive of carcinoid multivalvular and left side valvular disease as unusual finding in this rare syndrome.

The Diagnosis of Rheumatic Fever and Rheumatic Heart Disease / Монголын Анагаах Ухаан

The Jones criteria is a clinical guideline for the diagnosis of rheumatic fever(RF) and carditis. The clinical features were divided into major and minor categories. Major manifestations include carditis, joint symptoms, subcutaneous nodules, erythema marginatum and chorea. The minor manifestations comprised clinical fi ndings(fever, artralgia, cardialgia,abdominal pain, nose bleeding ) and laboratory markers(Leukocytosis, elevated erythrocyte sedimentation rate and C-reactive protein, prolonged PR on ECG). It was proposed that the presence of two major, or one major and two minor manifestations offered reasonable clinical evidence of rheumatic activity.Carditis is the single most important prognostic factor in RF; only valvulitis leads to permanent damage and its presence determines the prophylactic strategy. The clinical diagnosis of carditis in an index attack of RF is based on the presence of signifi cant murmurs (suggestive of mitral and aortic regurgitation), pericardial rub, or unexplained cardiomegaly with congestive heart failure.Myocarditis(alone) in the absence of valvulitis is unlikely to be of rheumatic origin and by itself should not be used as a basis for such a diagnosis. Two dimentional echo-Doppler and colour fl ow Doppler echocardiography are most sensitive for detecting structural abnormality, abnormal blood fl ow and valvular regurgitation. This method can detect all audible valvular regurgitations to be dThe use of 2D echo-Doppler and colour fl ow Doppler echocardiography may prevent the overdaignosis of a functional murmur as a valvular heart disease. Similarly, the overinterpretation of physiological or trivial valvular regurgitation may result in misdiagnosis of iatrogenic valvular disease. Accurate interpretation of the echocardiographic signals is therefore important.

Doppler Echocardiographic Study on the Changes of Cardiac Performance and Valvular Regurgitation before and after Hemodialysis

In 22 end-stage renal disease patients on regular hemodialysis, echocardiographic study including 2-D Doppler echocardiogrphy was performed to evaluate the effect of hemodialysis on cardiac performance and the degree of valvular regurgitation. After hemodialysis, there were significant improvement of ventricular contractility and reduction of circulating volume in accordance with the reduction of degree of valvular regurgitation in comparison with before hemodialysis. We postulate that the reduction of valvular regurgitation after hemodialysis is caused by relief of hypervolemic state.