Accidente vascular encefálico isquémico como manifestación de mixoma auricular. Presentación de un caso

La enfermedad cerebrovascular constituye una de las principales causas de muerte a nivel mundial. Múltiples factores desencadenan los accidentes vasculares encefálicos isquémicos, entre ellas los tumores cardiacos, como el mixoma auricular. Se presenta el caso de una paciente femenina de 32 años, que al examen físico mostró afasia motora, hemiplejia fascio-braquio-crural derecha y discreta paresia de la mirada vertical con nistagmos. Se realizaron estudios de imagen (tomografía de cráneo, ecocardiograma transtorácico y angiotomografía de vasos de cuello) sugerentes de embolización sistémica en el territorio de la carótida izquierda, secundarios a la fragmentación de un tumor cardiaco. Se decide derivar a la paciente a cirugía cardiovascular para endarectomía carotídea con exéresis del tumor cardiaco, el cual evolucionó satisfactoriamente. Persistió el daño neurológico debido al tiempo transcurrido entre el diagnóstico y el tratamiento. Teniendo en cuenta la baja frecuencia del mixoma cardiaco y la posibilidad de asociarse con ictus isquémico se decide presentar este caso.

Cerebrovascular disease is one of the main causes of death worldwide. Multiple factors trigger ischemic strokes, including cardiac tumors such as atrial myxoma. A 32-years-old female patient, who on physical examination showed motor aphasia, right fascio-brachio-crural hemiplegia and discrete vertical gaze paresis with nystagmus is presented. Imaging studies were performed (skull tomography, transthoracic echocardiogram and angiotomography of neck vessels) suggestive of systemic embolization in the left carotid territory, secondary to the fragmentation of a cardiac tumor. It was decided to refer the patient to cardiovascular surgery for carotid endarectomy with excision of the cardiac tumor, which progressed satisfactorily. Neurological damage persisted due to the time elapsed between diagnosis and treatment. Taking into account the low frequency of cardiac myxoma and the possibility of being associated with ischemic stroke, it was decided to present this case.

Quadricuspid Aortic Valve with Ruptured Sinus of Valsalva Aneurysm: a Case Report

Abstract Quadricuspid aortic valve (QAV) and sinus of Valsalva aneurysm (SVA) are rare congenital anomalies. We report an elderly patient with QAV associated with a ruptured SVA to the right atrium. Transthoracic echocardiographic and computed tomographic images are presented. We emphasize the important role of computed tomography angiography in establishing and confirming the diagnosis and facilitating treatment planning. The patient was successfully operated by a minimally invasive approach.

Estudo Morfofuncional do Átrio Esquerdo Isolado de um Modelo Experimental de Hipertensão Pulmonar em Ratos / Isolated Left Atrium Morphofunctional Study of an Experimental Pulmonary Hypertension Model in Rats

Resumo Fundamento A alta incidência de arritmias atriais na hipertensão pulmonar (HP) pode estar associada a um prognóstico ruim, e o átrio esquerdo (AE) pode desempenhar um papel neste quadro. Um achado importante nos estudos de HP é que a remodelação do AE é subestimada. Objetivo Este estudo investigou a morfologia e a função mecânica do AE, bem como a suscetibilidade ao desenvolvimento de arritmias em um modelo de HP induzida por monocrotalina (HP-MCT). Métodos Ratos Wistar com 4 semanas de idade receberam 50 mg/kg de MCT. Foram realizadas análises eletrocardiográficas e histológicas para avaliar o estabelecimento do modelo de HP-MCT. O tecido foi montado em banho de órgão isolado para caracterizar a função mecânica do AE. Resultados Em comparação com o grupo controle, o modelo de HP-MCT apresentou hipertrofia do AE e alterações da atividade elétrica cardíaca, conforme evidenciadas pelo aumento da duração da onda P, PR e intervalo QT. Não foi observada alteração no inotropismo do AE isolado de ratos com HP-MCT; no entanto, o tempo para atingir a contração máxima foi atrasado. Finalmente, não observamos diferença na suscetibilidade à arritmia no AE dos ratos com HP-MCT após o protocolo de estimulação intermitente. Conclusão A remodelação morfofuncional do AE não levou ao aumento da suscetibilidade à arritmia ex vivo após a aplicação do protocolo de estimulação intermitente.

Abstract Background The high incidence of atrial arrhythmias in pulmonary hypertension (PH) might be associated with poor prognosis, and the left atrium (LA) may play a role in this. An important finding in PH studies is that LA remodeling is underestimated. Objective This study investigated LA morphology and mechanical function, as well as the susceptibility to develop arrhythmias in a monocrotaline-induced PH (MCT-PH) model. Methods Wistar rats aged 4 weeks received 50 mg/kg of MCT. Electrocardiography and histology analysis were performed to evaluate the establishment of the MCT-PH model. The tissue was mounted in an isolated organ bath to characterize the LA mechanical function Results Compared with the control group (CTRL), the MCT-PH model presented LA hypertrophy and changes in cardiac electrical activity, as evidenced by increased P wave duration, PR and QT interval in MCT-PH rats. In LA isolated from MCT-PH rats, no alteration in inotropism was observed; however, the time to peak contraction was delayed in the experimental MCT-PH group. Finally, there was no difference in arrhythmia susceptibility of LA from MCT-PH animals after the burst pacing protocol. Conclusion The morphofunctional remodeling of the LA did not lead to increased susceptibility to ex vivo arrhythmia after application of the burst pacing protocol.

Rare Presentation of Sinus of Valsalva Aneurysm Treated by Aortic Valve Reimplantation Technique

Abstract Sinus of Valsalva aneurysm is a rare cardiac abnormality which can be acquired or of congenital origin. A spontaneous rupture into the right atrium is possible and, if not adequately treated, may result in a progressive heart failure due to the left-to-right intracardiac shunt. If ruptured sinus of Valsalva aneurysm is diagnosed, surgical repair is indicated, and different surgical techniques have been reported. If concomitant aortic regurgitation is present, aortic valve replacement is usually performed. Herein, we describe an uncommon clinical presentation of a ruptured sinus of Valsalva aneurysm which has been corrected by aortic valve reimplantation.

Promedio de presión arterial en 24 horas y cambios ecocardiográficos tempranos / 24 hour blood pressure monitoring and early echocardiographic findings

Resumen Introducción: la hipertensión arterial es uno de los factores principales de morbimortalidad cardiovascular, con una prevalencia en aumento, por lo cual se considera como uno de los factores principales prevenibles y tratables de mortalidad1. En Colombia no se cuenta con datos que correlacionen cambios ecocardiográficos con los valores obtenidos en el monitoreo ambulatorio de presión arterial en 24 horas. Objetivo: evaluar las posibles relaciones entre la presión arterial sistólica y diastólica promedio en 24 horas con los desenlaces: grosor relativo de pared (GRP), volumen auricular izquierdo indexado, fracción de eyección ventricular izquierda (FEVI) y masa ventricular indexada. Materiales y métodos: estudio observacional, descriptivo, de corte transversal, en pacientes colombianos con datos ecocardiográficos y resultados de MAPA del servicio de cardiología del Hospital de San José, entre junio de 2018 y diciembre de 2019. Resultados: se incluyeron 70 pacientes; se encontró posible relación entre la presión arterial sistólica promedio en 24 horas y el volumen auricular izquierdo indexado (p = 0.004), la presión arterial diastólica promedio en 24 horas y el grosor relativo de pared (p = 0.032). Conclusión: en este estudio se encontró una posible asociación entre volumen auricular izquierdo y presión arterial sistólica promedio en 24 h, GRP y presión arterial diastólica promedio en 24 h. Se hacen necesarios más estudios para confirmar estos hallazgos.

Abstract Introduction: Arterial hypertension is one of the main factor associated with cardiovascular morbidity and mortality with increasing prevalence, so it is considered as a key factor to treat to decrease cardiovascular disease. There is no data in Colombia that correlates echocardiographic parameters with meassures of blood pressure obtained by a 24 h ambulatory blood pressure monitoring. Objective: To evaluate possible relations between 24 hour blood pressure monitoring and relative wall thickness, left atrial volume index, left ventricular ejection fraction and ventricular mass index. Materials and methods: A cross sectional, observational, descriptive trial in Colombian patients between june 2018 to dicember 2019 with echocardiographic and 24 h blood pressure monitoring data from the cardiology deparment of the Hospital de San José. Results: 70 patients were included. a possible relation was found between 24 h systolic blood pressure monitoring and 24 h diastolic pressure monitoring with left atrial volume index (p = 0.004) and relative wall thickness (p = 0.032) respectively. Conclusion: A possible association was found between 24 h systolic blood pressure monitoring and 24 h diastolic blood pressure monitoring with left atrial volume index and relative wall thickness respectively. It is necessary to conduct more studies to confirm this finding.

Rol del volumen conducido como mecanismo compensador de la disfunción de aurícula izquierda en la estenosis aórtica grave / Role of Conduit Volume as Compensating Mechanism for Left Atrial Dysfunction in Severe Aortic Stenosis

RESUMEN Introducción: La aurícula izquierda (AI) tiene un rol central en el mantenimiento del volumen sistólico (VS) en presencia de disfunción diastólica (DD) del ventrículo izquierdo (VI) a través de la función de reservorio, conducción y contracción. En individuos normales, la contribución del volumen auricular (conducción y contracción) al VS es de aproximadamente 60 - 70%, siendo el resto completado por el volumen conducido (VC) definido como el volumen de sangre que pasa desde las venas pulmonares al VI durante el lleno pasivo, sin producir cambios en el volumen auricular. En la DD del VI, a medida que las presiones de lleno aumentan y se acercan al límite de reserva de la precarga, la AI se comporta predominantemente como un conducto con disminución de las fases de reservorio, conducción y contracción, con el consiguiente aumento del VC. La estenosis aórtica (EAo) grave se caracteriza por DD en los estadios iniciales y disfunción de la AI en los estadios más avanzados. Objetivo: Analizar el rol del VC como mecanismo compensador de la disfunción de la AI para completar el lleno del VI en la EAo grave. Material y métodos: 210 pacientes (pac.) (edad 69 ± 11 años, 48% mujeres) con EAo grave (índice de área valvular 0,37 ± 0,12 cm2/m2) fueron estudiados con eco-Doppler. La función de la AI fue evaluada mediante la fracción de vaciado de AI (FVAI) como la diferencia entre el volumen máximo (Mx) (incluye las fases de conducción y contracción) y el volumen mínimo (Mn) /Mx x 100 y el strain pico de AI. La contribución del VC al volumen sistólico (VS) fue estimada como porcentaje de VS (VC%): VS - (AI Mx - Mn)/VS × 100. Los volúmenes de AI, el VS y la fracción de eyección del VI (FEVI) fueron calculados por el método de Simpson. El grado de DD fue clasificado de acuerdo con las recomendaciones de la ASE/EACVI y los pac. fueron divididos en 3 grupos: DD grado I (98 pac.), DD grado II (74 pac.) y DD grado III (38 pac.). Resultados: El VC% se correlacionó negativamente con la FVAI (r = - 0,57, p < 0,0001), el strain pico de AI (r = - 0,38, p < 0,001) y positivamente con el grado de DD (r = 0,35, p < 0,001). La FEVI se correlacionó con la FVAI (r = 0,45, p < 0,01) y el VC% (r = - 0,33, p < 0,001). En el grupo DD grado III el VS fue mantenido por el aumento del VC% a pesar de la significativa disminución de la FVAI y el strain pico de la AI. Conclusión: La disfunción de la AI expresada como la disminución de la FVAI y el strain pico de la AI se correlaciona con un aumento de la contribución del VC al VS (VC%). En pacientes con EAo grave, a medida que la DD progresa, el VS es mantenido a expensas del incremento del VC como un mecanismo compensador de la disfunción de la AI.

ABSTRACT Background: The left atrium (LA) plays a key role in maintaining stroke volume (SV) in the presence of left ventricular (LV) diastolic dysfunction (DD) through its reservoir, conduit and booster pump function. In normal subjects, the contribution of atrial volume (conduit and booster pump function) to the SV is approximately 60-70%, and the rest is completed by the conduit volume (CV), defined as the blood volume that flows from the pulmonary veins to the LV during passive filling, without producing changes in the atrial volume. In LVDD, when ventricular filling pressures increase and the limits of preload reserve are reached, the LA behaves predominantly as a conduit with reduction of the reservoir, conduit, and booster pump function, resulting in increased CV. Severe aortic stenosis (AS) is characterized by DD in the early stages and LA dysfunction in more advanced stages. Objective: The aim of the present study was to analyze the role of CV as a compensating mechanism for LA dysfunction to complete LV filling in severe AS. Methods: A total of 210 patients (pts.), aged 69 ± 11 years, with 48% if women, with severe AS (aorta aortic valve area index 0.37 ± 0.12 cm2/m2) were assessed using Doppler echocardiography. Left atrial function was assessed though LA emptying fraction (LAEF) as the difference between maximum LA volume (maxLAV), which includes conduction and contraction phases, and minimum LA volume (minLAV)/maxLAV ×100, and peak LA strain. The contribution of CV to stroke volume (SV) was estimated as percentage of SV (CV%): SV - (maxLAV - minLAV) /SV × 100. Left atrial volume, SV and LV ejection fraction (LVEF) were calculated using the Simpson's method. Diastolic dysfunction was staged according to the ASE/EACVI recommendations, and the pts. were divided into 3 groups: DD grade 1 I (98 pts.), DD grade 2 II (74 pts.) and DD grade 3 III (38 pts.). Results: The CV% had a negative correlation with LAEF (r = -0.57, p < 0.0001) and peak LA strain (r = - 0.38, p < 0.001), and a positive correlation with DD grade (r = 0.35, p < 0.001). LVEF correlated with LAEF (r = 0.45, p < 0.01) and CV% (r = - 0.33, p < 0.001). In the DD grade III group, the SV was maintained by the increased CV% despite the significant reduction of LAEF and peak LA strain. Conclusions: Left atrial dysfunction, expressed as decreased LAEF and peak LA strain, correlates with greater contribution of the CV to the SV (CV%). In patients with severe AS, as DD progresses, the SV is preserved due to increased CV as a compensating mechanism for LA dysfunction.

Fast growth rate of a right atrial myxoma

ABSTRACT Primary cardiac tumors are rare, with an incidence between 0.0017 and 0.19%, and are asymptomatic in up to 72% of cases. Approximately 75% of tumors are benign, and nearly 50% of these are myxomas. Concerning location, 75% of myxomas are in the left atrium, 15 to 20% in the right atrium, and more rarely in the ventricles. The finding of cardiac myxomas usually implies immediate surgical excision to prevent embolic events and sudden cardiac death. Reports with documented growth rate are rare, and the actual growth rate remains a controversial issue. We report the rapid growth rate of a right atrial myxoma in an oligosymptomatic 69-year-old patient, with negative previous echocardiographic history in the last two years, who refused surgery upon diagnosis, enabling monitoring of myxoma growth.

Cardiac Masses: Pathological and Surgical Features - A Multicenter Study

Abstract Introduction: This study aimed to review the surgical excision results and pathological diagnostic features of rarely observed intracardiac masses in the light of the literature. Diagnosis and treatment approaches and complications were evaluated. Methods: Forty patients (26 females, mean age 52.1±18.1 years, and 14 males, mean age 48.1±20.5 years), who had undergone surgery for intracardiac mass between January 2008 and December 2018, were included in this study. The patients' data were analyzed retrospectively from the medical records of both centers. Results: When the pathological diagnoses were examined, 85.8% of the masses (n=35) were observed to be benign (benign tumor + hydatid cyst) and 14.2% (n=5) were malignant tumors. The masses were most commonly located in the left atrium (75%, n=30), and this was followed by the right ventricle (12.5%, n=5), right atrium (7.5%, n=3), and left ventricle (5%, n=2). Of the patients, 7.5% (n=3) died during the early postoperative period, while the remaining 92.5% (n=37) were discharged with healing. In the histopathological diagnosis of the patients, in whom in-hospital major adverse cardiovascular events were observed, there was malignancy in two cases. Conclusion: Intracardiac masses, which have pathological features, are severe life-threatening problems. In-hospital mortality is frequent, especially in malignant tumors.

A Rare Associated Anomaly in Tetralogy of Fallot: Scimitar Syndrome in an Infant

Abstract Pulmonary venous connections may be infrequently abnormal in patients with tetralogy of Fallot (TOF). A special subgroup of partial anomalous pulmonary venous return,"scimitar cyndrome", and its coexistence with TOF is less frequently reported. It may proceed unnoticed, as cyanosis already predominates in the clinical picture. This uncommon association must be kept in mind for patients with TOF who have an accessory flow in the inferior vena cava, especially when all pulmonary venous return to the left atrium is not clearly seen.

Coexistent mitral stenosis and left circumflex coronary artery to left atrial fistula in a patient with severe pulmonary hypertension

Abstract Coronary artery to left atrial fistula is rare in patients with mitral stenosis. We report an interesting case of a patient with concomitant mitral valve stenosis and coronary fistulae, originating from the left circumflex artery and drained into the left atrium with two terminal orifices.

Valor do Diâmetro do Átrio Esquerdo com Escore CHA2DS2-Vasc na Predição da Trombose Atrial Esquerda/Trombose de Apêndice Atrial Esquerdo na Fibrilação Atrial Não Valvar / Value of left atrial diameter with CHA2DS2-VASc score in predicting left atrial/left atrial appendage thrombosis in non-valvular atrial fibrillation

Resumo Fundamentos A fibrilação atrial é a arritmia persistente mais comum e é o principal fator que leva ao tromboembolismo. Objetivo Investigar o valor do diâmetro do átrio esquerdo combinado com o escore CHA2DS2-VASc na predição da trombose atrial esquerda/trombose de apêndice atrial esquerdo na fibrilação atrial não valvar. Métodos Trata-se de estudo retrospectivo. 238 pacientes com fibrilação atrial não valvar foram selecionados e divididos em dois grupos: trombose e não trombose. Determinou-se o escore CHA2DS2-VASc. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados A análise de regressão logística multivariada revelou que histórico de acidente vascular cerebral/ataque isquêmico transitório, doença vascular, escore CHA2DS2-VASc, DAE, DDFVE e FEVE foram fatores de risco independentes para trombose atrial esquerda/trombose de apêndice atrial esquerdo (p<0,05). A análise da curva ROC ( Receiver Operating Characteristic ) revelou que a área sob a curva para o escore CHA2DS2-VASc na predição de trombose atrial esquerda/trombose de apêndice atrial esquerdo foi de 0,593 quando o escore CHA2DS2-VASc foi ≥3 pontos, e a sensibilidade e especificidade foram 86,5% e 32,6%, respectivamente, enquanto a área sob a curva para o DAE na predição de trombose atrial esquerda/trombose de apêndice atrial esquerdo foi 0,786 quando o DAE foi ≥44,17 mm, e a sensibilidade e especificidade foram 89,6% e 60,9%, respectivamente. Entre os diferentes grupos CHA2DS2-VASc, a taxa de incidência de trombose atrial esquerda/trombose de apêndice atrial esquerdo em pacientes com DAE ≥44,17 mm foi maior do que em pacientes com DAE <44,17 mm (p <0,05). Conclusão O escore CHA2DS2-VASc e o DAE estão correlacionados com a trombose atrial esquerda/trombose de apêndice atrial esquerdo na fibrilação atrial não valvar. Para pacientes com escore CHA2DS2-VASc de 0 ou 1, quando o DAE é ≥44,17 mm, o risco de trombose atrial esquerda/trombose de apêndice atrial esquerdo permaneceu alto. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Atrial fibrillation is the most common persistent arrhythmia, and is the main factor that leads to thromboembolism. Objective To investigate the value of left atrial diameter combined with CHA2DS2-VASc score in predicting left atrial/left atrial appendage thrombosis in non-valvular atrial fibrillation. Methods This is a retrospective study. 238 patients with non-valvular atrial fibrillation were selected and divided into two groups: thrombosis and non-thrombosis. CHA2DS2-VASc score was determined. P<0.05 was considered statistically significant. Results Multivariate logistic regression analysis revealed that the history of stroke/transient ischemic attack, vascular disease, CHA2DS2-VASc score, left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were independent risk factors for left atrial/left atrial appendage thrombosis (p<0.05). Receiver operating characteristic curve analysis revealed that the area under the curve for the CHA2DS2-VASc score in predicting left atrial/left atrial appendage thrombosis was 0.593 when the CHA2DS2-VASc score was ≥3 points, and sensitivity and specificity were 86.5% and 32.6%, respectively, while the area under the curve for LAD in predicting left atrial/left atrial appendage thrombosis was 0.786 when LAD was ≥44.17 mm, and sensitivity and specificity were 89.6% and 60.9%, respectively. Among the different CHA2DS2-VASc groups, the incidence rate of left atrial/left atrial appendage thrombosis in patients with LAD ≥44.17 mm was higher than patients with LAD <44.17 mm (p<0.05). Conclusion CHA2DS2-VASc score and LAD are correlated with left atrial/left atrial appendage thrombosis in non-valvular atrial fibrillation. For patients with a CHA2DS2-VASc score of 0 or 1, when LAD is ≥44.17 mm, the risk for left atrial/left atrial appendage thrombosis remained high. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Transcatheter Interatrial Shunts for the Treatment of Heart Failure with Preserved Ejection Fraction

Abstract Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome, which accounts for about 50% of patients with heart failure (HF). The morbidity and mortality associated with HFpEF is similar to HFrEF. Clinical trials to date have failed to show a benefit of medical therapy for HFpEF, which may due to lack of uniform phenotypes and heterogeneous population. In addition, medical therapy proven for HFrEF may not address the pathophysiologic basis for HFpEF. Left atrial remodeling and dysfunction is central to HFpEF and accounts for secondary pulmonary hypertension and pulmonary vascular congestion that frequently occurs with exertion. Interatrial shunts represent a novel treatment modality for HFpEF. These shunts allow for left atrial decongestion and a reduction in pulmonary venous hypertension during exercise leading to improvements in hemodynamics, functional status and quality of life. Trials to date have demonstrated safety and short-term efficacy of these devices for HFpEF. The long-term benefits are currently being evaluated in ongoing trials. If effective, the use of interatrial shunts may be a new therapeutic paradigm for the treatment of HFpEF.

Assessment of left atrial function by strain in patients with acute ischemic stroke left atrial function and acute stroke

SUMMARY OBJECTIVE: Myocardial speckle-tracking echocardiography can detect subtle abnormalities in the left atrial function. In this study, we aimed to investigate the relationship between left atrial myocardium and tissue function n assessed by two-dimensional speckle-tracking echocardiography and the National Institutes of Health Stroke Scale score in patients with acute ischemic stroke. METHOD: The study was composed of 80 patients (45 men, 35 women, mean age: 67±15 years) with acute ischemic stroke. The patients were divided into two groups based on the calculated National Institutes of Health Stroke Scale score (group 1, National Institutes of Health Stroke Scale score < 16; group 2, National Institutes of Health Stroke Scale score ≥ 16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac functions were evaluated using two-dimensional speckle-tracking echocardiography within 48 hours from admission to the neurology care unit. RESULTS: There were no significant differences between the patients' clinical parameters. Left ventricular ejection fraction was significantly higher in group 1 than in group 2 (59.2±5.6 to 51.4±6.3, p=0.024). Left atrial longitudinal strain was significantly higher in group 1 than in group 2 (34.48±9.73 to 26.27±7.41, p=0.019). There were no significant differences between other echocardiographic parameters. CONCLUSION: Our results suggest that left atrial longitudinal strain is associated with stroke severity during admission in patients with acute ischemic stroke. Left atrial longitudinal strain is an indicator of left atrial myocardial function.

Fístula coronário-cavitária da artéria coronária circunflexa para o átrio esquerdo como provável etiologia de insuficiência cardíaca: relato de caso / Coronary­cavitary fistula of the circumflex coronary artery to the left atrium as a probable etiology of heart failure: a case report

Fístulas de artérias coronárias têm incidência baixa, sendo diagnosticadas mais frequentemente pelo ecocardiograma ou angiotomografia coronariana, embora a cineangiocoronariografia seja o método padrão-ouro. Têm origem mais comumente na artéria coronária direita, sendo a drenagem para câmaras de baixa pressão o mais habitual. O tratamento pode ser expectante, cirúrgico ou percutâneo. Este relato descreve o caso de uma rara apresentação de insuficiência cardíaca, dada por fístula da coronária circunflexa com drenagem para o átrio esquerdo. (AU)

Coronary artery fistulas have a low incidence and are often diagnosed by echocardiography or coronary computed tomography angiography, although coronary angiography is the gold standard. They commonly originate in the right coronary artery, with drainage to low-pressure chambers being the most frequent finding. Treatment can be expectant, surgical, or percutaneous. This report describes a case of a rare presentation of heart failure due to a fistula of the circumflex coronary artery with drainage into the left atrium. (AU)

Mortality rates of surgical techniques for correcting atrioventricular disjunction

Abstract We compared the mortality rates of two surgical techniques for correction of atrioventricular disjunction in 10 out of 720 patients who underwent mitral valve replacement from 2005 to 2012. In group I, the mitral annulus was fixed with bovine pericardial strips; in group II, a 'patch' of bovine pericardium was sutured and extended from the base of the lateral and medial papillary muscles, covered the posterior wall of the left ventricle, went through the posterior mitral annulus, and ended in the posterior wall of the left atrium adjacent to the mitral ring. The group II technique showed a lower mortality.

Giant left atrium associated with massive thrombus formation 14 years after orthotopic heart transplantation

Abstract We report the case of a 60-year-old patient who underwent orthotopic heart transplant 14 years earlier. Routine echocardiography showed giant masses in the left atrium. There were no symptoms or thromboembolic events in the past. Magnetic resonance imaging study revealed very enlarged left atrium (8.7 × 10.6 cm) occupied by irregular smooth mass (7 × 5 × 6.1 cm) with a stalk that was attached to the posterior left atrial wall in the area of graft suture lines. Intraoperative examination revealed a massive thrombus (12 × 10 cm) that filled almost the entire left atrial area.

Predictors of left atrial thrombus in acute ischemic stroke patients without atrial fibrillation: A single-center cross-sectional study

SUMMARY INTRODUCTION: The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke (AIS) patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE). METHODS: In this single-center, retrospective study, we enrolled 149 consecutive AIS patients. All of the patients underwent a TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT. RESULTS: Among all cases, 14 patients (9.3%) had a diagnosis of LAT based on the TEE examination. In a multivariate analysis, elevated mean platelet volume (MPV), low left-ventricle ejection fraction (EF), creatinine, and reduced left-atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area under the receiver operating characteristic curve analysis for MPV was 0.70 (95%CI: 0.57-0.83; p = 0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT. CONCLUSION: AIS patients with low ventricle EF and elevated MPV should undergo further TEE examination to verify the possibility of a cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in such patients without AF.

RESUMO INTRODUÇÃO: O presente estudo teve como objetivo determinar indicadores independentes do trombo auricular esquerdo (LAT) em doentes com acidente vascular cerebral isquêmico agudo (AIS) sem fibrilação auricular (AF) utilizando ecocardiografia transesofágica (TEE). MÉTODOS: Neste único centro, estudo retrospectivo, inscrevemos 149 pacientes consecutivos com AIS. Todos os pacientes foram submetidos a exame de TEE para detectar LAT no prazo de dez dias após a admissão. A análise de regressão logística multivariada foi realizada para avaliar preditores independentes do final. RESULTADO: Entre todos os casos, 14 pacientes (9,3%) tiveram um diagnóstico de exame tardio no TEE. Numa análise multivariada, volume médio de plaquetas (VMP) elevado, fração de ejeção do ventrículo esquerdo baixo (EF), creatinina e uma velocidade de pico de esvaziamento do átrio esquerdo reduzida (LAA) foram indicadores independentes da LAT. A área sob a análise da curva característica de operação do receptor para VMP foi de 0,70 (95% IC: 0, 57-0, 83; p=0,011). Com o valor-limite ideal de 9,45, o VMP teve uma sensibilidade de 71,4% e uma especificidade de 63% para prever mais tarde. CONCLUSÃO: Os doentes AIS com EF ventricular baixa e VMP elevado devem ser submetidos a um exame de TEE adicional para determinar a possibilidade de origem cardioembólica. Além disso, esta investigação pode fornecer novas informações sobre a aplicabilidade do VMP para prever tardiamente os doentes sem AF.

A modified beagle model of inducible atrial fibrillation using a right atrium pacemaker

Abstract Objective: To modify the chronic atrial fibrillation of atrial tachycardia pacing in beagles with a homemade pacemaker placed outside the body and to evaluate connective tissue growth factor and fibrosis of atrial tissue in our modified atrial tachycardia pacing beagle model. Methods: Twelve adult beagles of either sex were randomly divided into an atrial tachycardia pacing group and a control group (n=6 in each group). We performed the temporary pacemaker implantation at the right atrial appendage and put the pacemaker into the pocket of dog clothing in the atrial tachycardia pacing group. After eight weeks of atrial tachycardia pacing, the electrocardiography, transthoracic echocardiography, hematoxylin-eosin staining, and Masson's staining of the right atrial appendages were performed along with the immunohistochemistry, quantitative real-time polymerase chain reaction, and Western blot analysis of connective tissue growth factor, collagen I, and collagen III. Results: In the atrial tachycardia pacing group, atrial fibrillation was induced in five beagles (83.3%); the left atrium enlarged significantly; more canines had mitral regurgitation; and the Masson's staining, quantitative real-time polymerase chain reaction, and Western blot results demonstrated more obvious fibrosis of the left atrium. Conclusion: The modified beagle model of atrial fibrillation using a right atrium pacemaker outside the body was effective, increased connective tissue growth factor and collagen I messenger ribonucleic acid overexpression, and induced atrial fibrosis.