Aneurisma apical en paciente con miocardiopatía hipertrófica / Apical aneurysm in a patient with hypertrophic cardiomyopathy

We report a 51-year-old asymptomatic male, with type II diabetes, referred to our outpatient clinic due to ST and T alterations on the precordial leads on the electrocardiogram. The echocardiogram showed apical akinesia and left ventricular hypertrophy. There were no angiographic lesions in the coronary angiography. In the left ventriculography, a hyperdynamic left ventricle with suspected left ventricular hypertrophy and an apical aneurysm were found. The cardiac magnetic resonance confirmed those findings, without late gadolinium enhancement. According to the European Cardiology Society Risk Score, the patient had a low sudden death risk. However, this score does not consider the presence of an aneurysm as risk factor for sudden death, but it is considered in the 2017 ACC/AHA Heart Rhythm Society Guidelines, as a major risk factor. Therefore a defibrillator was implanted, and he was discharged on permanent oral anticoagulation.

Chagas disease in Virgem da Lapa, Minas Gerais, Brazil: left ventricle aneurysm and the risk of death in the 24-year interval

BACKGROUND Left ventricular aneurysm (LVA) is indicator of high morbidity in Chagas' disease. A cross-sectional study performed identified LVA in 18.8% of the chronic chagasic patients (CCP). OBJECTIVE Determine the risk of death of patients with chronic chagasic cardiopathy (CCC) and LVA in 24-year interval. MATERIAL AND METHODS In 1995 a cohort of 298 CCP was evaluated by anamnesis, physical examination, EKG and ECHO and classified in groups: G0 = 86 without cardiopathy; G1 = 156 with cardiopathy without LVA and G2 = 56 with cardiopathy and LVA. 38 patients of G0 and G1 used benznidazole. Information about the deaths was obtained in the notary, death certificates, hospital records and family members. FINDINGS Were registered 113 deaths (37.9%): 107 (35.9%) attributed to cardiopathy and 6 (2.0%) to other causes (p < 0.05). Amongst these 107 deaths, 10 (11.6%) occurred in G0; 49 (31.4%) occurred in G1 and 48 (85.7%) occurred in G2 (p < 0.05). The risk of death was 2.7 and 7.4 times significantly higher in G2, than in G1 and G0, respectively. CONCLUSION Chronic chagasic patients with LVA and ejection fraction < 45% have a higher risk of death than those without.

Symmetrical peripheral gangrene complicating ventricular pseudoaneurysm: a report of an unusual case and a brief review of the literature

Abstract Symmetrical peripheral gangrene is an ischemic necrosis simultaneously involving the distal portions of two or more extremities without any proximal arterial obstruction or vasculitis. It may occur as a result of a large number of infectious and non-infectious causes. A few cases of symmetrical peripheral gangrene associated with cardiac disease have been described in the literature. We describe a case of symmetrical peripheral gangrene complicating ventricular pseudoaneurysm, probably a hitherto unreported occurrence. In this report, we sought to emphasize the importance of cardiac evaluation while dealing with a case of symmetrical peripheral gangrene.

Aneurisma ventricular direito chagásico diagnosticado pelo ecocardiograma / Chagasic right ventricular aneurysm diagnosed by echocardiography

A presença de aneurisma ventricular direito na cardiopatia chagásica é pouco descrita na literatura, sendo achado principalmente de estudos anatomopatológicos. Exceção feita a pesquisas realizadas há mais de duas décadas, estudos com ecocardiografia não têm apresentado este achado. Relata-se o caso de um paciente portador de cardiopatia chagásica, com insuficiência cardíaca refratária e presença de aneurisma ventricular esquerdo e direito, ao estudo ecocardiográfico transtorácico. Discutem-se os motivos da raridade do achado de aneurisma no ventrículo direito.

Right ventricular aneurysm in Chagas Cardiopathy is rarely mentioned in literature. The few reports are from anatomopathological studies. Echocardiographic studies had not described this abnormality, except for few articles published more than two decades ago. This is a patient presenting with advanced cardiac failure and biventricular aneurism diagnosed by echocardiography. The reason for the rarity diagnosis of right ventricular aneurysm are discussed.

Aneurisma do septo interatrial em adultos: diagnóstico e classificação / Atrial septal aneurysm in adult patients: diagnosis and classification

O aneurisma do septo interatrial é uma malformação com prevalência de até 10 por cento quando o estudo ecocardiográfico transesofágico é utilizado para o diagnóstico. Embora não exista um consenso em relação ao tamanho necessário para o diagnóstico, tamanhos da base e da protrusão máxima dentro do átrio iguais ou superiores a 15mm são utilizados com relativa frequência. Após o diagnóstico, uma adequada classificação do aneurisma deve ser feita, para definir o grau e tipo de movimentação, o átrio no qual acontece o abaulamento principal e a relação com o ciclo cardiorrespiratório.

Atrial septal aneurysm is a malformation with a prevalence of up to 10 percent when transesophageal echocardiography is used for diagnosis. Although there is no consensus about the required size for the diagnosis, a diameter of the base and a maximal projection of the aneurysm into an atrial chamber greater than or equal to 15 mm are used relatively often. After the diagnosis, a proper classification of the aneurysm should be made to define the degree and type of motion, the atrium in which the main bulging occurs and its relationship to cardiorespiratory cycle.

Spontaneous rupture of an aneurysm of the sinus of Valsalva into the right atrium, associated with an atrial septal aneurysm / Ruptura espontánea de un aneurisma del seno de Valsalva a la aurícula derecha en una paciente con aneurisma del septum interatrial

Aneurysms of the sinus of Valsalva (SV) and the atrial septum are a rare association. We report the case of a 28-year-old woman, who was admitted to our department complaining of progressive dyspnea of 10 days of evolution, five hours previous to her admission to the hospital; she presented sudden oppressive anterior chest pain, accompanied by palpitations. The presence of rupture of the right SV to the right atrium was clinically confirmed, by echocardiography and hemodynamic studies. In addition, an associated atrial septal aneurysm was found. She underwent surgical correction through sinusplasty without requiring aortic valve replacement. The patient presented persistent postoperative atrioventricular block, which required a permanent pacemaker. Clinical evolution was satisfactory. To our knowledge, this case is a rare combination of two isolated malformations, without previous events that could explain the rupture of the right SV.

Los aneurismas del seno de Valsalva y del septum interauricular son una asociación rara. Informamos el caso de una mujer de 28 años de edad con un cuadro de disnea progresiva en los últimos 10 días, al cual se agregó dolor precordial opresivo, cinco horas previas a su ingreso. Se comprobó clínicamente, por ecocardiografía y hemodinamia la presencia de ruptura del seno de Valsalva derecho hacia el atrio derecho. Un hallazgo interesante fue la presencia de un aneurisma del septum interauricular asociado. La paciente fue sometida a corrección quirúrgica con plastía del seno de Valsalva, sin requerir reemplazo valvular aórtico. En el postoperatorio presentó bloqueo aurículo-ventricular persistente, requiriendo implante de marcapaso definitivo. Su evolución fue satisfactoria. Este es un caso de una rara asociación de dos malformaciones aisladas.

Isolated Noncompaction of Ventricular Myocardium: a Magnetic Resonance Imaging Study of 11 Patients

OBJECTIVE: To retrospectively summarize the cardiac magnetic resonance imaging (CMRI) findings of isolated noncompaction of ventricular myocardium (INVM). MATERIALS AND METHODS: Eleven patients (M:F = 9:2; mean age, 35 years) were evaluated. Steady-state free precession (SSFP), fast spin echo (SE) sequence, SSFP cine imaging, and delayed enhanced inversion recovery spoiled gradient echo (IR-SPGR) sequence were used for showing abnormal myocardium, measuring ratio of noncompacted/compacted myocardium layers (NC/C ratio), and detecting myocardial viability. The left ventricle was divided into nine segments and a NC/C ratio > 2.3 in diastole was used as cutoff value in diagnosing left INVM. The right ventricle was assessed qualitatively. RESULTS: Cardiac MRI indicated left INVM in seven patients, right INVM in one patient and biventricle INVM in three patients. Characteristic CMRI changes included prominent trabeculations, deep intertrabecular recesses and an increase in the NC/C ratio. The most frequently involved segments was left ventricular apex. Three patients had abnormal high signals within the trabecular structures on SE T2 weighted image. One ventricular aneurysm and one apical thrombus were also observed. Delayed enhancement was seen in six of nine patients with subendocardial and transmural patterns. CONCLUSION: There are CMRI features that might be characteristic for INVM.

Incessant ventricular tachycardia acutely controlled with off-pump coronary artery bypass surgery and aneurysmal plication

There are many treatment modalities available to acutely terminate incessant ventricular tachycardia with variable success rates, but some cases tend to prove refractory to all of them. We report a 59-year-old woman presenting with incessant ventricular tachycardia. Echocardiography revealed a large true apical aneurysm and severe left ventricular dysfunction. The arrhythmia was controlled in the operating room after off-pump coronary artery bypass surgery and plication of the apical aneurysm

Aneurisma de apêndice de atrial esquerdo gigante / Large left atrial appendage aneurysm

O aneurisma de apêndice atrial esquerdo é uma entidade extremamente rara e diagnosticada, na maioria das vezes, a partir da segunda década de vida, sendo patologia geralmente oligossintomática e diagnóstico de caráter ocasional. Este caso refere-se a um paciente de 21 anos, com quadro de taquicardia supraventricular sustentada sintomática. O diagnóstico foi feito a partir do ecocardiograma transtorácico, após o achado de aumento de área cardíaca em radiografia do tórax. O tratamento cirúrgico é mandadório e o paciente foi submetido à cirurgia para ressecção do apêndice atrial.

Hypertrophic Cardiomyopathy Complicated by Left Ventricular Apical Necrosis and Aneurysm in a Young Man: FDG-PET Findings

A 29-year old male was transferred to our hospital with an abnormal chest X-ray finding diagnosed as hypertrophic cardiomyopathy with apical necrosis and aneurysm formation. Four years after the initial hospitalization, we confirmed the aneurysm and necrosis using both integrated positron emission tomography (PET) and computed tomography (CT) scanning. The F-18 2-fluoro-2-deoxy-D-glucose (FDG) PET/CT enabled precise localization of the aneurysm, which was found to be composed of semi-lunar calcification of non-metabolic myocardium. A contrast-enhanced CT angiography showed an hour-glass appearance of the left ventricular cavity. The integrated PET/CT fusion scanner is a novel multimodality technology that allows for a comprehensive analysis of the anatomical and functional status of complex heart disease. Based on these findings, long standing mechanical and physiologic abnormalities may have led to chronic ischemia in the hypertrophied myocardium, induced necrosis and calcification at the cardiac apex.

Cardiomiopatia de Takotsubo: uma causa rara de choque cardiogênico simulando infarto agudo do miocárdio / Takotsubo cardiomiopathy: a rare cause of cardiogenic shock simulating acute myocardial infarction

Cardiomiopatia de Takotsubo é uma causa rara de aneurisma ventricular esquerdo agudo, na ausência de coronariopatia, só recentemente descrita na literatura mundial. Os sintomas podem assemelhar-se aos do infarto agudo do miocárdio com dor torácica típica. A imagem do balonamento ventricular sugestivo de haltere ou "Takotsubo" (dispositivo utilizado no Japão para prender Octopus) é característico desta nova síndrome e usualmente há desaparecimento do movimento discinético até o 18º dia do início dos sintomas, em média.

Covered stents deployed for coarctation of aorta with aneurysm.

Three patients presented to us with upper extremity hypertension and aortic coarctation. Aortic angiograms and spiral computerized tomography delineated the anatomy at the site of coarctation and the associated small aneurysmal dilation. They were taken up for percutaneous stenting of the coarctation segment with cheathum-platinum covered stents. Post-deployment, there was a significant fall in pullback gradients and exclusion of the aneurysms.

Aneurisma do átrio direito associado à hidropisia fetal: diagnóstico por ecocardiografia fetal / Right atrial aneurysm associated to fetal hydrops: diagnosis through fetal echocardiography

Os aneurismas de átrio direito são entidades raramente relatadas na prática cardiológica, especialmente em vida intra-uterina, e podendo ser confundidos com derrame pericárdico e anomalia de Ebstein da valva tricúspide. Apresentamos revisão da literatura e ilustramos com caso de diagnóstico pré-natal de aneurisma de átrio direito cursando com sinais de hidropisia.

Calcified ductal aneurysm with severe aortic regurgitation.

A rare case of calcified aneurysm of the ductus arteriosus with severe aortic regurgitation is presented. We believe this is the first report of such a case in the English literature.

Sindrome platipnea-ortodeoxia por foramen oval permeable, aneurisma del septum interauricular y paralisis del hemidiafragma derecho / Platypnea-orthodeoxia syndrome, atrial septal aneurysm and right hemidiaphragmatic elevation with a right-to-left shunt through a patent foramen ovale

El síndrome platipnea-ortodeoxia (SPO) está caracterizado por disnea e hipoxemia en posición erecta que mejoran con el decúbito supino. Se presenta un paciente de 75 años sin antecedentesremarcables, con cuadro de disnea de 7 días de evolución. La radiografía y tomografía de tórax mostraron una elevación del hemidiafragma derecho (confirmándose su parálisis por radioscopia) sin alteraciones en el parénquima pulmonar y mediastino. El ecocardiograma contrastado evidenció un foramen oval permeable y un aneurisma del septum interauricular. La angiografía pulmonar descartó tromboembolismo o malformación vascular y las presiones en la arteria pulmonar fueron normales, sin evidencia de shunt. Al momento de ambos estudios, realizados en decúbito supino, el paciente no tenía síntomas. En la evolución, la disnea también se manifestó en esa postura y el paciente espontáneamente adoptó el decúbito lateral derecho donde la oxemia era normal. Se realizó un ecocardiograma transesofágico contrastado que mostró un shunt derecha-izquierda intracardíaco y se colocó un dispositivo de Alplatzer para el cierre de la comunicación interauricular. Los gases arteriales post-procedimiento fueron normales. Se resalta la particularidad del SPO secundario a shunt intracardíaco sin gradiente de presión entre las cavidades.

Complicações mecânicas do infarto agudo do miocárdio com supradesnivelamento do segmento ST / Mechanical complications of acute ST-segment elevation myocardial infarction

Neste artigo são discutidas as principais complicações mecânicas que podem surgir na evolução pós-infarto agudo do miocárdio, incluindo insuficiência mitral isquêmica, comunicação interventricular, rotura da parede livre do ventrículo e aneurisma de ventrículo esquerdo.

Aneurisma apical e hipertrofia ventricular esquerda / Apical aneurysm and left ventricular hypertrophy

A 59-year-old woman presented with an embolic transient ischemic attack and a history of controlled hypertension for 16 years. Both echocardiogram and MRI showed severe biventricular hypertrophy and an apical aneurysm with a thrombus. The occurrence of an apical aneurysm in the presence of cardiac hypertrophy is a rare finding and has been described in patients with hypertrophic cardiomyopathy. However, it has not been reported in patients with systemic arterial hypertension. In this patient the lack of a relationship between the severity of the hypertrophy and the levels of blood pressure, together with the presence of histologic disorganization of myocardial cardiac muscle cells by endomyocardial biopsy suggested the diagnosis of hypertrophic cardiomyopathy.