Velocity time integral for right upper pulmonary vein in VLBW infants with patent ductus arteriosus

OBJECTIVE: Early diagnosis of significant patent ductus arteriosus reduces the risk of clinical worsening in very low birth weight infants. Echocardiographic patent ductus arteriosus shunt flow pattern can be used to predict significant patent ductus arteriosus. Pulmonary venous flow, expressed as vein velocity time integral, is correlated to ductus arteriosus closure. The aim of this study is to investigate the relationship between significant reductions in vein velocity time integral and non-significant patent ductus arteriosus in the first week of life. METHODS: A multicenter, prospective, observational study was conducted to evaluate very low birth weight infants (<1500 g) on respiratory support. Echocardiography was used to evaluate vein velocity time integral on days 1 and 4 of life. The relationship between vein velocity time integral and other parameters was studied. RESULTS: In total, 98 very low birth weight infants on respiratory support were studied. On day 1 of life, vein velocity time integral was similar in patients with open or closed ductus. The mean vein velocity time integral significantly reduced in the first four days of life. On the fourth day of life, there was less of a reduction in patients with patent ductus compared to those with closed patent ductus arteriosus and the difference was significant. CONCLUSIONS: A significant reduction in vein velocity time integral in the first days of life is associated with ductus closure. This parameter correlates well with other echocardiographic parameters and may aid in the diagnosis and management of patent ductus arteriosus.

Tratamiento de estenosis sintomática de venas pulmonares secundaria a ablación por radiofrecuencia

El aislamiento de las venas pulmonares mediante la aplicación de radiofrecuencia es un tratamiento efectivo de la fibrilación auricular. Una de las complicaciones potenciales y de mayor compromiso clínico de esta técnica invasiva es la estenosis de una o varias venas pulmonares. Esta complicación puede ser tratada mediante angioplastia con o sin colocación de stent, logrando una adecuada mejoría clínica, aunque con un alto índice de recurrencia por re-estenosis.

Isolation of the pulmonary veins by applying radiofrequency is an effective treatment for atrial fibrillation. One of the potential complications with higher clinical compromise utilizing this invasive technique is the occurrence of stenosis of one or more pulmonary veins. This complication can be treated by angioplasty with or without stent implantation, with an adequate clinical improvement, but with a high rate of restenosis.

Primary malignant fibrous histiocytoma involving the left pulmonary vein presenting as a left atrial tumor.

A 35‑year-old woman presented with 4 months history of progressively increasing intermittent dyspnea and hemoptysis. Transthoracic echocardiography revealed a loculated mass in the left atrium (LA). A provisional diagnosis of LA myxoma was made. Intraoperatively the tumor was found extending into and closely adherent to the left pulmonary vein and could not be completely cleared off from the pulmonary venous wall. The histopathological examination of the tumor revealed it to be a myxoid malignant fibrous histiocytoma.

Hemodynamic Change in Pulmonary Vein Stenosis after Radiofrequency Ablation: Assessment with Magnetic Resonance Angiography

We present a case of pulmonary vein (PV) stenosis after radio-frequency (RF) ablation, in which a hemodynamic change in the pulmonary artery was similar to that of congenital PV atresia on time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA). A 48-year-old man underwent RF ablation due to atrial fibrillation. The patient subsequently complained of hemoptysis, dyspnea on exertion, and right chest pain. Right PV stenosis after catheter ablation was diagnosed through chest computed tomography and lung perfusion scan. Pulmonary TR-MRA revealed the pulmonary artery via systemic arterial collaterals and draining systemic collateral veins. On a velocity-encoded cine image, the flow direction of the right pulmonary artery was reversed in the diastolic phase and the left pulmonary artery demonstrated continuous forward flow throughout the cardiac cycle. These hemodynamic changes were similar to those seen in congenital unilateral PV atresia.

Tratamiento no farmacológico de la fibrilación auricular / Non pharmacological treatment of atrial fibrillation

La fibrilación auricular es la arritmia que genera más hodpitalizaciones y gastos en atención de la salud. La prevalencia de la fibrilación auricular aumenta con la edad de la población y otros factores. Estimamos que en Venezuela puede haber unas 230.000 personas que sufren. El tratamiento farmacológico con los antiarrítmicos disponibles no ha producido una solución satisfactoria al problema. De hecho se estima que después de un año de seguimiento, los antiarrítmocos más eficaces sólo alcanzan a mantener en ritmo sinusal a menos del 30% los pacientes. Este fallo de los antirrítmicos ha estimulado la investigación para conseguir métodos no farmacológicos para el tratamiento de la fibrilación auricular. En 1982 se describión la ablación del nodo AV para el control de la respuesta ventricular y, después, la ablación quirúrgica y por catéter para restablecer el ritmo sinusal. Presentamos una revisión acerca del tratamiento no farmacológico de la fibrilación auricular, con particular énfacis en la ablación por catéter, y nuestros resultados en la serie inicial de pacientes que hemos tratado por este medio en mérida, Venezuela.

Atrial fibrillation (AF) is the arrhythmia that causes the highest number of hospital admissions and health expenses. The prevalence of AF increases with age and several other factors. We estimate that 230,000 persons suffer from AF in Venezuela. Antiarrhytmic drugs have not been found to be adequate for AF treatment. Indeed, at one-year follow-up, recent research has found that the most powerful antiarrhytmics drugs are able to maintain sinus rhythm in less than 30% of patients. This failure of pharmacotherapy stimulated researh to find non-pharmacological means to treat AF. AV nodal ablation was introduced in 1982 for ventricular rate response control and surgical and catheter ablation techniques were later designed to achieve sinus rhythm. In this article we review the non-pharmacological treatment of AF putting special emphasis on catheter ablation. We also present some preliminary results obtained from the theatment of patients in Mérida(Venezuela).

Estudio morfopatológico de la conexión anómala total de venas pulmonares / Morphopathologic study of total anomalous pulmonary venous connection

To know the morphological features and the frequency of pulmonary anomalous connection types, 106 hearts from the collection of the Instituto Nacional de Cardiologia Ignacio Chávez were studied with the segmental sequential system. The atrial situs, connections of cardiac segments, morphology of cardiac chambers, interatrial septum, venous collector, sites of anomalous pulmonary venous connection and associated anomalies were determined. Darling's classification was used. The atrial situs was: solitus (73), dextroisomerism (30) and inversus (3). In the supradiaphragmatic level the supracardiac connection (44) was distributed into superior vena cava (24) and vertical vein (20). The cardiac level (39) was divided into venous coronary sinus (22) and to the right atrium (17). The infradiaphragmatic level was to the portal vein (10) and the mixed group (13) had different combinations. 100 hearts had atrial septal defect and 6 had patent foramen ovale. The hearts with dextroisomerism had several intracardiac malformations; 14 specimens had obstructed venous collectors. Three important aspects in diagnosis are: site of anomalous connection, size of atrial septal defect and obstruction in the venous collector; this information is valuable to understand the physiopathology, to establish the diagnosis and to help the surgeon to chose the best surgical strategy.

A Case of Pulmonary Vein Tumor Presenting as a Left Atrial Mass

Primary cardiac tumors are extremely rare and can originate within the heart or be the result of tumor spread from other sites. We report a female patient with a pulmonary vein tumor extending into the left atrium that had a suspicious primary malignant origin with a sacral metastatic carcinoma. The patient was admitted complaining of pain in her buttock area as a result of a sacral tumor. It was believed that the sacral tumor was a metastasis from the imaging study and clinical manifestation. The primary malignant origin was evaluated. The chest CT showed a left atrium thrombus-like lesion without a pulmonary abnormality. After a transesophageal echocardiogram, the patient was diagnosed with a pulmonary vein tumor extending to the left atrium. The patient was given palliative radiotherapy for the sacral pain. Initially, the clinical impression was a metastatic sacral tumor with a thromboembolism of the left atrium. However, this patient was finally diagnosed with a pulmonary vein tumor with a left atrium extension by a transesophageal echocardiogram.

Morphofunctional study of the junction between the left atrium and the pulmonary veins in patient with pulmonary hypertension

OBJECTIVE: To study the arrangement of the myocardial fiber bundles at the pulmonary venous left atrial junction in patients with pulmonary hypertension, and to discuss the pathophysiological importance of this element in the etiology of acute pulmonary edema. METHODS: We obtained 12 hearts and their pulmonary vein extremities from postmortem examinations of patients with the anatomicopathological diagnosis of acute pulmonary edema. The specimens, which had no grossly visible morphological cardiac alterations, were fixed in 10 percent formalin, and the muscular arrangement of the pulmonary venous left atrial junctions was analyzed. This material was then isolated, embedded in paraffin, underwent serial cutting (50 æm of thickness), and was stained with Azam's trichrome. RESULTS: We observed in our specimens that: a) the myocardial fiber bundles that originate in the atrial wall and involve the openings of the pulmonary veins were fewer than those observed in healthy material; b) the myocardial fiber bundles that extend into the pulmonary veins were shorter than those found in material originating from individuals with no pulmonary hypertension. CONCLUSION: Anatomical changes that result in a reduction in the amount of myocardial fiber bundles in the pulmonary venous left atrial junction, isolated or associated with other factors, may be the cause of disorders in pulmonary circulation, leading to an increase in pulmonary venous pressure, and, consequently, to acute pulmonary edema

Tetralogía de Fallot con drenaje venoso pulmonar anómalo total: Entidad clínica rara, pero asociaciación importante / Fallot's tetralogy with total anomalous pulmonary venous drainage: rare clinical entity, but important association

Se analiza el caso de una lactante menor con diagnóstico de tetralogía de Fallot, cardiopatía congénita cianógena más frecuente en nuestro medio, pero esta vez asociada a un drenaje venoso anómalo total, persistencia de la vena cava superior izquierda drenando en el seno coronario y comunicación interauricular. La entidad clínica descrita es rara, pero muy importante a considerar en el momento de tomar una decisión quirúrgica, ya que los procedimientos paliativos en este tipo de asociación, si llegan a realizarse son catastróficos y fatales. Se hace especial énfasis en los procedimientos no invasivos, como métodos que complementan la orientación diagnóstica del caso

Resección pulmonar ampliada con sección y sutura de miocardio auricular / Pulmonary resection from sectión and suture of atrial myocardial

Los tumores localizados en el parénquima pulmonar, en especial con invasión del hilio, pueden crecer hacia la aurícula izquierda siguiendo las venas pulmonares. En estos casos la resección radical es posible mediante la sección y sutura de la pared auricular en un sitio distal a la invasión neoplásica, simplemente colocando un clamp adecuado, sin necesidad de circulación extracorpórea. Se comunican 4 casos sin mortalidad operatoria ni complicaciones de significación. No pudieron lograrse prolongadas sobrevidas en 3 de los pacientes en quienes se observaron recurrencia a los 12, 24 y 31 meses respectivamente. El restante con tumor carcinoide, vive un año después de la operación. Cuando sea factible la resección pulmonar con inclusión de parte de la pared auricular, puede brindar resultados satisfactorios en relación a una enfermedad de la magnitud de un tumor hiliar con invasión de las venas pulmonares o del corazón mismo.