Noncardiogenic Pulmonary Edema As Sequel Of Venous Air Embolism In A Case Of Operative Hysteroscopy - A Case Report.

Hysteroscopy is minimally invasive procedure performed widely for diagnosis and treatment of intrauterine and endocervical pathologies.Venous air embolism, though rare complication, is catastrophic if encountered.We report one such case of venous air embolism leading to non-cardiogenic pulmonary edema encountered by us during hysteroscopic uterine septum resection done for infertility under general anaesthesia. Quick identification, preventing further gas entry and timely intervention saved our patient.

Endocarditis infecciosa en canino con diagnóstico previo de síndrome vestibular periférico secundario a probable otitis media-interna: reporte de caso / Infectious Endocarditis in Dogs with a Previous Diagnosis of Peripheral Vestibular Syndrome Secondary to Probable Otitis Media-Interna: A Case Report

Resumen La endocarditis infecciosa es un proceso patológico de baja incidencia en la clínica diaria; su principal etiología son los agentes bacterianos, los cuales colonizan con mayor prevalencia de válvula mitral y aortica. En este artículo se presenta el estudio de un perro con diagnóstico previo de síndrome vestibular periférico secundario a probable otitis media-interna. Se presenta con un soplo de aparición súbita, claudicaciones intermitentes, inapetencia, depresión y fiebre, por lo cual se hace la valoración ecocardiográfica, donde se evidencia engrosamiento valvular mitral, acompañado de estructuras hiperecoicas en el borde libre que corresponden a lesiones vegetativas. Por medio de los criterios de Duke modificados se obtiene un diagnóstico definitivo de endocarditis infecciosa, para lo cual se realiza manejo médico intrahospitalario, sin evolución favorable. Los hallazgos clínicos y paraclínicos coinciden con lo reportado en la literatura. Los criterios de Duke modificados permiten orientar el diagnóstico y evidenciar signos clínicos de alarma. El manejo médico antimicrobiano deberá realizarse con base en hemocultivos y pruebas de sensibilidad, siempre teniendo en cuenta la prevalencia de patógenos y el origen primario de la infección. Se debe considerar como una patología con un pronóstico malo y un porcentaje de fatalidad alto. Finalmente, se concluye que la principal limitación del caso es la falta de confirmación histopatológica.

Abstract Infectious endocarditis is a pathological process with low incidence in the daily clinical practice. The main etiology are the bacterial agents that colonize with higher prevalence the mitral and aortic valves. This paper reports the case of a dog with a previous diagnosis of peripheral vestibular syndrome secondary to probable otitis media-interna. The dog has a sudden heart murmur, intermittent claudications, lack of appetite, depression and temperatures. It is performed an echocardiographic assessment that shows mitral valve thickening with hyperecoic structures in the free border that indicates vegetations. Using the Modified Duke Criteria, a definitive diagnosis of infectious endocarditis is concluded. The dog is provided a medical treatment at the clinic without success. The clinical and paraclinical findings match the background found in the literature. Modified Duke Criteria allow guiding the diagnosis process and uncovering the alarm clinical signs. Antimicrobial clinical treatment must be administered based on blood cultures and sensitivity tests and considering both the pathogen prevalence and infection primary origin. Doctors must deem this condition as a bad prognosis pathology with a high mortality percentage. Finally, it is concluded that the main limitation in this case is a lack of histopathological confirmation.

Consultorio de orientaciòn de cardilogía: epidemiología y perfil de la población / Cardiology guidance clinic: Epidemiology and profile of the population

Introducción: Las cardiopatías congénitas (CC) son las anomalías congénitas más frecuentes. Representan el 0,8-1,2% de todos los defectos del nacimiento y tienen una prevalencia de alrededor de 5,8 por cada 1000 personas. El Servicio de Cardiología del Hospital Garrahan es un centro de referencia nacional y de países limítrofes donde se realizan 18000 consultas anuales. Los pacientes que concurren por primera vez se atienden en el consultorio de orientación. Objetivo: Describir la epidemiologia y perfil de los pacientes que asisten diariamente al consultorio de orientación de cardiología infantil en un hospital pediátrico de tercer nivel de Buenos Aires. Métodos: Entre septiembre de 2017 y febrero de 2018 se recolectaron los datos de 1000 pacientes atendidos en forma consecutiva en el consultorio de orientación de cardiología. A la totalidad de los pacientes se les realizó anamnesis, examen físico cardiovascular, electrocardiograma, y en los casos en los que se consideró necesario, saturometría, radiografía de tórax y/o ecocardiograma. Las variables a considerar fueron edad, procedencia, presencia o ausencia de cardiopatías congénitas o adquiridas, soplo, cianosis, insuficiencia cardíaca, estado nutricional, síndromes genéticos asociados, métodos diagnósticos e indicaciones terapéuticas implementadas. Se subdividió la población en cinco grupos: Grupo A (pacientes con cardiopatía congénita), Grupo B (cardiopatías operadas), Grupo C (miocardiopatías), Grupo D (arritmias), Grupo E (corazón sano). Resultados: La edad mediana fue 4.86 años (0.03 a 18.9 años). El 64% de los pacientes procedían de la provincia de Buenos Aires. Los motivos de consulta fueron: interconsultas internas 29.5%, derivación por cardiopatía 27.2%, soplo 17.6%, síncope 7%, segunda opinión 5.1%, arritmias 4.8%, precordialgia 3.1%, palpitaciones 2.6%, episodio paroxístico 1.4%, cardiomegalia 0.7%, disnea 0.5%, mal progreso de peso 0.3%. El 10.6% tenían un síndrome genético. Grupo A: 252 pacientes con una edad mediana de 1.9 años. Las cardiopatías acianóticas con hiperflujo pulmonar fueron las más frecuentes (66.66%, 168/252). Grupo B: 51 pacientes, 23.52%(12/51) fueron Fallot reparados en otra institución. Grupo C: 22 pacientes, siendo la miocardiopatía hipertrófica la más frecuente. Grupo D: 47 pacientes, la preexcitación ventricular fue el hallazgo más frecuente (34,04%, 16/47). Grupo E: 628 pacientes, 45.70% (287/628) derivados por pediatras del área ambulatoria, principalmente para valoración de pacientes con enfermedades sistémicas o síndromes genéticos. Conclusión: Los motivos de derivación al consultorio de orientación de cardiología fueron muy diversos. La mayoría de los pacientes provenían de provincia de Buenos Aires. Solamente el 37.2% presentó algún problema cardiológico de base. El 91% de los pacientes que consultaron por soplo, no tuvieron cardiopatía. El grupo correspondiente a los pacientes con cardiopatías no operadas (grupo A) fue el de menor edad (mediana de 1.9 años) y las cardiopatías simples no cianóticas con hiperflujo pulmonar representaron el 66.66% de las cardiopatías. La implementación del ecocardiograma portátil en el consultorio de orientación permitió confirmar el diagnóstico y definir la conducta terapéutica en el 29.4% de los pacientes durante la primer consulta (AU)

Introduction: Congenital heart defects (CHD) are the most common congenital abnormalities. They account for 0.8-1.2% of all birth defects and have a prevalence of around 5.8 per 1000 people. The Department of Cardiology of Garrahan Hospital is a national and bordering-country reference center, receiving 18000 consultations annually. Patients seen for the first time are assessed at the cardiology guidance clinic. Objective: To describe the epidemiology and profile of patients who seen daily at the child cardiology guidance clinic of a third-level pediatric hospital in Buenos Aires. Methods: Between September 2017 and February 2018, data from 1000 patients consecutively seen at the cardiology guidance clinic were collected. All patients underwent anamnesis, cardiovascular physical examination, electrocardiogram and, if considered necessary, pulse oximetry, chest x-ray, and/or echocardiogram. The variables considered were age, place of origin, presence or absence of congenital or acquired heart disease, murmur, cyanosis, heart failure, nutritional status, associated genetic syndromes, diagnostic methods, and treatment. The population was divided into five groups: Group A (patients with congenital heart defects), Group B (operated cardiopathies), Group C (myocardiopathies), Group D (arrhythmias), Group E (healthy heart). Results: Median age was 4.86 years (0.03 to 18.9 years). Overall, 64% of patients came from the province of Buenos Aires. The reasons for consultation were: internal consultations 29.5%, cardiac shunt 27.2%, murmur 17.6%, syncope 7%, second opinion 5.1%, arrhythmias 4.8%, precordialgia 3.1%, palpitations 2.6%, paroxysmal episode 1.4%, cardiomegaly 0.7%, dyspnea 0.5%, 0.3% poor weight gain. A genetic syndrome was identified in 10.6%. Group A: 252 patients with a median age of 1.9 years. Acyanotic congenital heart defect with pulmonary hyperflow was the most common (66.66%, 168/252). Group B: 51 patients, 23.52% (12/51) had tetralogy of Fallot repaired at another institution. Group C: 22 patients, in whom hypertrophic cardiomyopathy was the most common. Group D: 47 patients, in whom ventricular preexcitation was the most common finding (34.04%, 16/47). Group E: 628 patients, 45.70% (287/628) referred by pediatricians from the outpatient clinics, mainly for the assessment of systemic diseases or genetic syndromes. Conclusion: The reasons for referral to the cardiology guidance clinic were varied. Most of the patients came from the province of Buenos Aires. Only 37.2% had an underlying heart disease. Of the patients who consulted because of a murmur, 91% did not suffer from heart disease. The group of patients with congenital heart disease who had not undergone surgery (group A) was the youngest (median 1.9 years) and simple non-cyanotic heart disease with pulmonary hyperflow accounted for 66.66% of heart diseases. The implementation of the portable echocardiography in the guidance clinic confirmed the diagnosis and defined the management in 29.4% of patients during the first consultation (AU)

Aneurisma del seno de Valsalva roto con fístula a ventrículo derecho. Presentación de un caso clínico y revisión de la literatura / Aneurisma do seio de Valsalva roto com fístula para ventrículo direito. Apresentação de um relato de caso e revisão da literatura / Valsalva sinus aneurysm ruptured with right ventricular fistula. Presentation of a clinical case and review of the literature

La presencia de un aneurisma de seno de Valsalva es bastante rara. Esta condición anatómica puede terminar en la ruptura y fistulización a diferentes estructuras cardíacas, con una posible evolución clínica catastrófica. El diagnóstico de esta enfermedad puede resultar laborioso; sin embargo, un dato clínico importante es la presencia de un soplo continuo, que aunque no es específico de esta patología, orienta en el abordaje y detección de posibles causas. La conjunción de la clínica, los hallazgos ecocardiográficos y hemodinámicos, mediante angiocardiografía, resulta primordial en la adecuada caracterización de esta anomalía. De acuerdo a su historia natural, todos los pacientes deben ser tratados quirúrgicamente.

The presence of a Valsalva sinus aneurysm is quite rare. This anatomical condition can end in the rupture and fistulization to different cardiac structures, with a possible catastrophic clinical evolution. The diagnosis of this disease can be laborious; however, an important clinical finding is the presence of a continuous murmur, which although not specific to this pathology, guides in the approach and detection of possible causes. The conjunction of clinic, echocardiographic and hemodynamic findings, through angiocardiography, is primordial in the adequate characterization of this anomaly. According to their natural history, all patients should be treated surgically.

A presença de um aneurisma do seio de Valsalva é muito rara. Esta condição anatômica pode resultar em ruptura e fistulización de diferentes estruturas cardíacas, com uma possível evolução clínica catastrófica. O diagnóstico desta doença pode ser trabalhoso; no entanto, um importante achado clínico é a presença de um sopro contínuo, que embora não seja específico para esta doença, orientada na abordagem e detecção de possíveis causas. A combinação de achados clínicos, ecocardiográficos e hemodinâmicos por angiografia é fundamental na caracterização adequada desta anomalia. De acordo com a sua história natural, todos os pacientes devem ser tratados cirurgicamente.

Ventana aortopulmonar / Aortopulmonary window

La ventana aortopulmonar es una causa poco frecuente de insuficiencia cardiaca en el neonato. Debe ser descartada en caso de existir edema pulmonar sin los shunts izquierda-derecha más frecuentes. Presentamos las imágenes ecocardiográficas de un recién nacido que ingresó con clínica de insuficiencia cardiaca en nuestra institución.

The aortopulmonary window is a rare cause of heart failure in the neonate. It must be ruled out if there are signs of pulmonary edema without the most frequents left-right shunts. We report the echocardiographic images of a newborn who was admitted with symptoms of heart failure at our institution.

A rare case of double orifice mitral valve with flail leaflet with embryological significance – A case report.

Mitral valve having a double orifice opening into the left ventricle is an uncommon anomaly, In this case study we describe about a 25 years old female who came to cardiology outpatient block with exertional dysnea , the abnormality was suspected by a murmur ,further investigation Colour Doppler echocardiography showed congenital double-orifice mitral valve. This finding was confirmed by open heart surgery, and her mitral valve was successfully repaired.

Careful Auscultation after Detection of Bacteremia Leading to a Diagnosis of Patent Ductus Arteriosus in Adult / General Medicine

A 40-year-old woman visited our emergency room (ER) with fever and shaking chills. Blood cultures for suspicion of urinary tract infection revealed bacteremia two days later. Since <i>Streptococcus mitis</i> was detected, infective endocarditis was strongly suspected. In addition to her history of dental calculus removal, careful cardiac auscultation revealed a continuous murmur, leading to the existence of patent ductus arteriosus (PDA). PDA was confirmed by echocardiography and 3D-CT angiography. The patient was successfully treated by antibiotics and then received transcatheter PDA closure. Careful auscultation after detection of bacteremia led to a diagnosis of PDA.

Musical murmur in a dog with acute chordae tendineae rupture / 대한수의학회지

A 6 year-old, spayed female, Maltese dog was presented with precordial thrill and mild coughing. Thoracic auscultation revealed a grade V/VI systolic murmur with maximal intensity over the left apex characterized by musical murmur. Echocardiography revealed mild myxomatous degeneration of mitral valve and ruptured chordae tendineae. Musical murmur was produced due to the vibration of ruptured piece of chordae tendineae along with regurgitant flow. After treatment with furosemide and ramipril, clinical signs resolved and precordial thrill reduced. This case report describes typical clinical signs and phonocardiogram of musical murmur in a dog with acute chordae tendineae rupture.

Presentación clínica de coartación de aorta, relato de casos: revisión de manejo actual / Clinical presentation of aortic coarctation: review of current management: a case series report

La coartación de Aorta es una cardiopatía congénita que se presenta con insuficiencia cardiaca congestiva precozmente sobre todo en la edad neonatal y que, de no ser diagnosticada oportunamente evoluciona con elevadísima morbi-mortalidad. Cuando sobrevive a la barrera de la primera infancia, cursa con hipertensión arterial sistémica, pudiendo debutar incluso con un accidente cerebrovascular, con resultado fatal para el paciente, ó dejarlo con incapacidades como secuela. Resaltamos la importancia del correcto y detallado examen clínico cardiovascular, que incluya la palpación adecuada de los pulsos periféricos así como la medición de la presión arterial sistémica, debido a que siempre cursa con hipertensión arterial en los miembros superiores y ausencia de pulsos en los miembros inferiores. Tratado correctamente presenta bajo riesgo de complicaciones y de mortalidad.

Aortic coarctation is a congenital heart defect that presents with early congestive heart failure, especially during the neonatal stage, and which if not opportunely diagnosed progresses with a high degree of morbidity and mortality. When patients survive the barrier of early childhood, they continue having such problems as systemic arterial hypertension, and run risks of outcomes such as fatal or incapacitating cerebrovascular accident. We emphasize the importance of a careful and detailed clinical cardiovascular examination, to include adequate taking of the peripheral pulses and measurement of systemic blood pressure, since this always presents with hypertension in the upper limbs and an absence of pulses in the legs. Treated adequately, it presents little risk of complications or mortality.

Echocardiographic Findings in Children with Heart Murmur Detected at Mass Health Screening in Kyeong-Nam Province

PURPOSE: This study was designed to analyze the results of echocardiographic findings in children with heart murmur detected at mass health screening in Kyeong-Nam province. METHODS: Between 1996 and 2001, children with heart murmur underwent the echocardiographic examination at Gyoeongsang National University Hospital. RESULTS: The number of children examined was 129 in 1996, 26 in 1997, 44 in 1998, 61 in 1999, 60 in 2000, and 49 in 2001. By the echocardiographic examination, innocent murmur was the most commonly diagnosed(31-65%) and ventricular septal defect(VSD) was the most common cardiac defect. Between 1996 and 1998, complex cyanotic heart diseases were more frequent. The number of patients undergoing surgical treatment was 9 in 1996, 10 in 1997, 7 in 1998, 5 in 1999, 2 in 2000, and 2 in 2001. CONCLUSION: By the echocardiographic examination, functional murmur was the most commonly diagnosed and VSD was the most common cardiac defect. Currently, heart defects detected tend to be more simple and the surgical treatment needed seems to decrease in number.

Abordagem da criança com sopro cardíaco. Importância diagnóstica dos exames complementares não-invasivos / Approaching to the Child With Heart Murmur. Diagnostic Relevance of Noninvasive Laboratory Tests

PURPOSE--To determine the benefits of noninvasive tests in the characterization of heart disease in children referred due to heart murmur. METHODS--Two hundred and thirty three consecutive children were fully examined with the aid of the electrocardiograma (ECG), chest X-ray and echocardiogram (ECHO). The patients were divided in 2 groups according to the initial diagnosis of innocent murmur (n = 23) and pathological murmur (n = 210). A comparison was made between the initial and final diagnosis after the noninvasive tests. Statistical analysis was employed through the qui-square test. RESULTS--The initial diagnosis did not change after ECG. The chest X-ray induced the diagnosis of idiopathic dilatation of the main pulmonary artery in one case and of cardiomyopathy in 8 cases, confirmed in only one. After ECHO, the initial diagnosis of innocent murmur was maintained in 70 of the cases, while 30 had some form of heart disease. In 80 of the pathologic murmur group, the diagnosis did not change after ECHO, while 20 were considered as having an innocent murmur. In the 2 groups together, the concordance index between initial and final diagnosis after ECHO reached 90. Statistically, a non-significant difference was found between the 2 groups. CONCLUSION--Careful clinical examination is mandatory in the initial evaluation of children with heart murmur. ECG and chest X-ray does not change the initial clinical diagnosis. After ECHO, the diagnosis changing was low (10), as long as clinical mistakes are eliminated. The initial diagnosis of innocent murmur excludes the necessity of noninvasive tests with a small possibility of error. EKG, chest X-ray and ECHO should be reserved to cases with obvious or persistent suspicious heart disease after clinical examination.

A cause of transient systolic murmur in neonates physiologic pulmonary artery stenosis

No abstract available.