ABSTRACT
Ventricular septal defect (VSD) is one of the most common congenital defects. It has a wide variety of clinical spectrum of presentation depending on the location and size of the defect. Generally, small restrictive VSDs present spontaneous closure during follow-up. A clinical case is presented with suspected persistent perimembranous VSD, with described intraoperative anatomical findings of aneurysmal cribriform membrane, ruling out VSD.
La comunicación interventricular (CIV) es uno de los defectos congénitos más comunes. Tiene una amplia variedad de espectro clínico de presentación dependiendo de la localización y tamaño del defecto. Por lo general, en los CIV restrictivos pequeños presentan un cierre espontáneo durante el seguimiento. Se presenta un caso clínico con sospecha de CIV perimembranosa persistente, con hallazgos anatómicos intraoperatorios descritos de membrana cribiforme aneurismática descartandose CIV.
Subject(s)
Humans , Female , Middle Aged , Heart Septal Defects, Ventricular/surgery , Heart Septal Defects, Ventricular/diagnostic imaging , Thorax/diagnostic imaging , Echocardiography , Intraoperative CareABSTRACT
Infective endocarditis (IE) is an infection of the inner lining of the heart, especially the heart valves, and carries high morbidity and mortality. It can manifest itself acutely or subacutely, the latter being more insidious. Diagnosis is challenging, especially in early stages, requiring high clinical suspicion using modified Duke criteria. Treatment involves antimicrobials and in certain cases cardiac surgery is essential. The clinical case presents a patient with a history of aortic valve replacement, who develops acute symptoms. Although the diagnosis of endocarditis is achieved, a por physical examination delays starting optimal treatment. Early diagnosis is crucial to avoid adverse outcomes. Post-hospital discharge follow-up is essential to identify possible long-term complications.
La endocarditis infecciosa es una infección del revestimiento interno del corazón, especialmente de las válvulas cardíacas, con alta morbimortalidad. Se manifiesta como aguda o subaguda, siendo esta última más insidiosa. El diagnóstico es desafiante, especialmente en etapas tempranas, requiriendo sospecha clínica en pacientes con fiebre, factores de riesgo cardiacos o no cardiacos y el uso de los criterios de Duke- International Society of Cardiovascular Infectious Diseases. El tratamiento implica antimicrobianos y en ciertos casos es imprescindible la cirugía cardiaca. Se presenta un caso clínico de un paciente con antecedentes de reemplazo valvular aórtico, que desarrolla síntomas agudos. Aunque se logra el diagnóstico de endocarditis, un examen físico poco exhaustivo causa retraso en el inicio del tratamiento óptimo. Un diagnóstico temprano es crucial para evitar resultados adversos. Es esencial la vigilancia estrecha post alta hospitalaria debido a complicaciones a largo plazo.
Subject(s)
Humans , Male , Middle Aged , Endocarditis/diagnosis , Endocarditis/therapy , Heart Valve Diseases/diagnosis , Splenic Infarction , Endocarditis/epidemiology , Heart Valve Diseases/surgeryABSTRACT
The bicuspid aortic valve corresponds to the most common valve defect in the general population. This can present asymptomatically as an incidental finding or symptomatically due to valve disease (stenosis and regurgitation), aortopathy, and infective endocarditis. Imaging techniques such as transthoracic and transesophageal echocardiography are fundamental pillars in diagnosis and treatment, determining the need for surgical intervention and the type of surgery to be performed. The case of a young patient with a less frequent bicuspid aortic valve phenotype is presented.
Subject(s)
Humans , Male , Adult , Aortic Diseases/etiology , Aortic Diseases/genetics , Bicuspid Aortic Valve Disease/complications , Heart Valve Diseases/diagnosis , Aortic Valve/surgery , Thorax/diagnostic imaging , Echocardiography, Doppler , Tomography, X-Ray Computed/methods , Echocardiography, TransesophagealABSTRACT
Neuromuscular diseases represent a rare cause of dilated myocardiopathy, among them Duchenne muscular dystrophy is the most common. Transthoracic echocardiography and cardiac magnetic resonance imaging can assess cardiac involvement early. The case of a patient diagnosed with Duchenne muscular dystrophy who develops cardiac involvement during cardiology follow-up is presented below.
Subject(s)
Humans , Male , Adult , Muscular Dystrophy, Duchenne/diagnosis , Muscular Dystrophy, Duchenne/genetics , Muscular Dystrophy, Duchenne/therapy , Cardiomyopathy, Dilated , Dystrophin/genetics , Muscular Dystrophy, Duchenne/classification , Muscular Dystrophy, Duchenne/physiopathology , Diagnosis, Differential , Heart FailureABSTRACT
Amyloidosis is a low-frequency disease that can cause compromise of different systems. We report a case of heart failure in an 81-year-old woman secondary to amyloidosis, in which the echocardiogram was a valuable diagnostic tool.
Subject(s)
Humans , Female , Aged, 80 and over , Pericardial Effusion/diagnosis , Pericardial Effusion/therapy , Amyloidosis , Radiography, Thoracic , Immunoglobulin Light Chains , Echocardiography, Transesophageal , Clinical Laboratory Techniques , Electrocardiography , Computed Tomography Angiography , Heart Failure/etiologyABSTRACT
Congenital mitral valve disease is a rare form of mitral regurgitation. The etiological diagnosis is often challenging. The transthoracic echocardiogram is presented as a good initial approach method. The case of a 29-year-old patient referred for the diagnosis of severe congenital mitral regurgitation in parachute is presented. This report aims to illustrate the clinical and echocardiographic presentation of congenital mitral regurgitation.
Subject(s)
Humans , Female , Adult , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/epidemiology , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnostic imaging , Echocardiography , Prevalence , Mitral Valve/surgery , Mitral Valve/diagnostic imagingABSTRACT
Cardiac myxomas are the most common benign primary tumors and are most often located in the left atrium at the level of the interatrial septum, with the characteristic of being pedunculated and highly mobile, which is why they sometimes interfere with the functioning of the mitral valve, generating variable degrees of stenosis and mitral insufficiency. Diagnosis is by echocardiography and treatment is surgical resection. We present the case of a patient with a large atrial myxoma and severe double mitral lesion.
Subject(s)
Humans , Female , Aged , Heart Neoplasms/diagnostic imaging , Myxoma/diagnosis , Echocardiography, Transesophageal , Diagnosis, Differential , Heart Atria/pathology , Heart Atria/diagnostic imaging , Heart Neoplasms/surgery , Myxoma/surgery , Myxoma/classification , Myxoma/physiopathologyABSTRACT
Congenital heart disease includes a wide range of heart defects that appear at birth, corresponding to the most frequent group of genetic alterations. They represent the most frequent birth defects in the world, affecting millions of newborns annually. Chile is not exempt from this public health problem, estimating a prevalence of 8-10 per 1,000 live births, similar to international figures. Some of these defects are not diagnosed in a timely manner due to various causes, including causes such as poor clinical translation and limited accessibility to the Public Health system. Thanks to the improvement of technological resources, more cases of congenital heart disease are diagnosed every day and the time of diagnosis is getting earlier. The case presented below refers to a 47-year-old male patient with several comorbidities, who underwent a Doppler echocardiogram during his hospitalization due to acute respiratory failure, where a systodiastolic flow was detected in one of the compatible pulmonary arteries, with a patent ductus arteriosus.
Subject(s)
Humans , Male , Middle Aged , Cardiac Catheterization/methods , Ductus Arteriosus, Patent/therapy , Septal Occluder Device , Echocardiography , Heart Defects, Congenital/diagnosisABSTRACT
Rupture of the ventricular septum with the appearance of an interventricular communication is an infrequent and life-threatening mechanical complication after acute myocardial infarction. The advent of coronary reperfusion therapies has reduced the incidence of this complication, but mortality remains high. The clinical presentation varies from mild compromise with exertional dyspnea to severe compromise with cardiogenic shock. In this pathology, early diagnosis is fundamental and surgical repair is the treatment of choice. In this article we report an interesting clinical case about a 77-year-old woman who was belatedly referred to our hospital and diagnosed with postinfarction rupture of the ventricular septum with an unfortunately fatal evolution. Relevance of this case lies in its atypical clinical presentation which led to a delay in diagnosis and a missed opportunity for early reperfusion therapy. An updated literature review about rupture of the ventricular septum complicating acute myocardial infarction was carried out.
Subject(s)
Humans , Female , Aged , Ventricular Septal Rupture/physiopathology , Ventricular Septal Rupture/epidemiology , Shock, Cardiogenic , Platelet Aggregation Inhibitors/therapeutic use , Echocardiography , Risk Factors , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/therapy , Myocardial Infarction/complicationsABSTRACT
Improvements in energy resolution of modern positron emission tomography (PET) detectors have created opportunities to implement energy-based scatter correction algorithms. Here, we use the energy information of auxiliary windows to estimate the scatter component. Our method is directly implemented in an iterative reconstruction algorithm, generating a scatter-corrected image without the need for sinograms. The purpose was to implement a fast energy-based scatter correction method on list-mode PET data, when it was not possible to use an attenuation map as a practical approach for the scatter degradation. The proposed method was evaluated using Monte Carlo simulations of various digital phantoms. It accurately estimated the scatter fraction distribution, and improved the image contrast in the simulated studied cases. We conclude that the proposed scatter correction method could effectively correct the scattered events, including multiple scatters and those originated in sources outside the field of view.
ABSTRACT
Infective endocarditis (IE) correspond to a serious condition of the endocardium, with clinical and classic risk factors. Heart failure is described as the main complication and cause of mortality. A 58-year-old diabetic female patient, with fever, weight loss and history of 10 months of fatigue, is presented below. She is hospitalized in Hospital Regional de Talca, in Medicine Service, where she is diagnosed of right IE by blood cultures (Streptococcus Sanguis) and transthoracic echocardiogram, that showed vegetations in the tricuspid valve and severe insufficiency. Without clinical improvement despite antibiotic treatment, echocardiography is repeated, showing persistence of vegetations and insufficiency, so that surgical resolution is decided, taking place in Hospital Gustavo Grant Benavente Concepción, with clinical recovery after surgery. It highlights a classic and larval presentation of the disease, but without classic risk factors for right IE, also associated with glomerulonephritis. The antibiotic eliminated bacteremia, but the valve damage was already established.
Subject(s)
Humans , Female , Middle Aged , Endocarditis , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/diagnostic imaging , Cardiac Surgical Procedures , Pericardium/surgery , Pericardium/transplantation , Tricuspid Valve/surgery , Tricuspid Valve/diagnostic imaging , Risk FactorsABSTRACT
La rehabilitación cardiovascular es una estrategia terapéutica necesaria, segura y con evidencia científica para tratar la cardiopatía isquémica y reducir su morbimortalidad. No obstante, está subutilizada en todo el mundo. Esta revisión se centra en la potencialidad de esta estrategia para generar cardioprotección y, particularmente, en la capacidad del ejercicio físico para inducir un fenotipo cardioprotector contra el daño generado por la isquemia-reperfusión. Se abordan los principales mecanismos moleculares del daño y de la protección, incluyendo el precondicionamiento isquémico inducido por el ejercicio. También se tratan adaptaciones cardioprotectoras que el ejercicio físico genera en el tejido vascular y el sistema autónomo (AU)
Cardiovascular rehabilitation is an essential, safe and scientifically validated means of treating ischemic heart disease and of reducing its associated morbidity and mortality. Nevertheless, this approach is underused around the world. This review focuses on the potential of cardiovascular rehabilitation for promoting cardioprotection, with particular emphasis on the ability of physical exercise to induce a cardioprotective phenotype that counteracts ischemia-reperfusion injury. The text also discusses the principal molecular mechanisms involved in both tissue damage and protection against damage, and in the ischemic preconditioning induced by exercise. In addition, the cardioprotective adaptations in vascular tissue and the autonomic nervous system brought about by physical exercise are considered (AU)
Subject(s)
Humans , Myocardial Ischemia/rehabilitation , Cardiovascular Diseases/rehabilitation , Exercise Therapy/methods , Treatment Outcome , Reperfusion Injury/rehabilitation , Ischemic Preconditioning, Myocardial/methodsABSTRACT
Las metaloproteinasas de la matriz extracelular (MMP) estánimplicadas en procesos fisiológicos y patológicos e intervienen en larotura de la matriz extracelular (ECM). Las MMP constituyen unafamilia de endopeptidasas neutras dependientes de zinc, capaces dedegradar los componentes esenciales de la matriz. Los inhibidorestisulares endógenos de las MMP (TIMP), una clase de inhibidores delas MMP, reducen la degradación proteolítica excesiva de la ECM.La degradación de la ECM es crucial para el crecimiento tumoralmaligno, invasión, metástasis y angiogénesis. Se han descrito cambiosen las MMP y sus inhibidores durante la carcinogénesis y tambiénque unas y otros regulan las vías señalizadoras mediante larotura de otros sustratos que los de la matriz, tales como citoquinas,quimioquinas y factores de crecimiento. Como ciertas MMP limitanel crecimiento tumoral, su identificación e intervención terapéuticaen combinación con la quimioterapia convencional ha de proporcionarun medio para la terapia del cáncer(AU)
The extracellular matrix metalloproteinases (MMP) are involved in physiological and pathological processes, through the cleavage ofextracellular matrix (ECM) and non-matrix substrates. MMP are afamily of zinc-dependent neutral endopeptidases capable of degradingessentially all matrix components. Endogenous tissue inhibitors ofmetalloproteinases (TIMP), one kind of MMP inhibitors, reduce theexcessive proteolytic ECM degradation. Degradation of ECM is crucialfor malignant tumor growth, invasion, metastasis and angiogenesis.A variety of reports describe the correlated changes in MMP and TIMPduring the formation of cancer, and also that MMP and TIMP may actas regulators of signaling pathways through the cleavage of nonmatrixsubstrates, including cytokines, chemokines, and growthfactors. As certain MMP limit tumor growth, identification of properMMP in combination with conventional chemotherapy is expected toprovide a feasible approach for cancer therapy(AU)
Subject(s)
Matrix Metalloproteinases/pharmacology , Matrix Metalloproteinases/pharmacokinetics , Metalloproteases/pharmacology , Metalloproteases/pharmacokinetics , Extracellular Matrix/chemistry , Extracellular Matrix , Endopeptidases/pharmacology , Endopeptidases/pharmacokinetics , Matrix Metalloproteinases/metabolism , Metalloproteases/metabolismABSTRACT
Throughout the 13 years of recognizing the Brugada syndrome as a separate entity, there has been a search for invasive and non-invasive markers for detecting risk of life-threatening arrhythmic events, particularly for asymptomatic individuals in whom the first manifestation may be sudden cardiac death. Hence, the preclinical diagnosis is pivotal for adequate and timely preventive measures. The objective of this study was to compare various non-invasive markers to characterize and stratify patients at risk. Late potentials, QT interval, QT dispersion, and heart variability were analyzed over a two-year period, in 20 patients (17 men and 3 women) with the Brugada syndrome (symptomatic and asymptomatic) and compared with 20 normal individuals similar in age and gender (control group). Late potentials were present in 80% of patients versus 5% in the control group (p < 0.0001); all of these with recurrent episodes had late potentials. In conclusion, this is the most important non-invasive marker for risk stratification, recurrences and inducibility of malignant arrhythmias during electrophysiological testing. Markers, invasive and non-invasive, should be considered integrally, for a better diagnostic and prognostic approach to reality.
Subject(s)
Bundle-Branch Block/physiopathology , Adult , Death, Sudden , Electrocardiography , Evoked Potentials , Female , Humans , Male , Prospective Studies , SyndromeABSTRACT
Throughout the 13 years of recognizing the Brugada syndrome as a separate entity, there has been a search for invasive and non-invasive markers for detecting risk of life-threatening arrhythmic events, particularly for asymptomatic individuals in whom the first manifestation may be sudden cardiac death. Hence, the preclinical diagnosis is pivotal for adequate and timely preventive measures. The objective of this study was to compare various non-invasive markers to characterize and stratify patients at risk. Late potentials, QT interval, QT dispersion, and heart variability were analyzed over a two-year period, in 20 patients (17 men and 3 women) with the Brugada syndrome (symptomatic and asymptomatic) and compared with 20 normal individuals similar in age and gender (control group). Late potentials were present in 80% of patients versus 5% in the control group (p < 0.0001); all of these with recurrent episodes had late potentials. In conclusion, this is the most important non-invasive marker for risk stratification, recurrences and inducibility of malignant arrhythmias during electrophysiological testing. Markers, invasive and non-invasive, should be considered integrally, for a better diagnostic and prognostic approach to reality.
Subject(s)
Adult , Female , Humans , Male , Bundle-Branch Block , Death, Sudden , Electrocardiography , Evoked Potentials , Prospective Studies , SyndromeABSTRACT
Se hizo una revisión actualizada sobre el precondicionamiento isquémico y la hipótesis patogénica más aceptada de la cardioprotección ejercida por la fase tardía o segunda ventana del precondicionamiento isquémico. Los más recientes datos generados por la intensa investigación en este campo, avalan que la generación de este fenotipo defensivo del cardiomiocito es un fenómeno poligénico, el cual requiere la activación simultánea de múltiples genes de estrés. La hipótesis del óxido nítrico como elemento dual, iniciador y mediador, ha permitido lograr una explicación coherente en la interconexión de los principales mediadores moleculares involucrados en dicha cardioprotección. La identificación de las bases moleculares de este fenómeno brindarán, sin duda, el marco conceptual apropiado para el desarrollo de nuevas estrategias terapéuticas que van desde el uso de fármacos o procedimientos que mimeticen la segunda ventana del precondicionamiento isquémico o la aplicación de técnicas genéticas que permitan de alguna manera lograr mantener el miocardio en un estado defensivo sostenido(AU)
Subject(s)
Humans , Animals , Myocardial Infarction/therapy , Myocardial Infarction/drug therapy , Nitric Oxide/therapeutic use , Ergometry , Ischemic Preconditioning, Myocardial , Models, AnimalABSTRACT
Se hizo una revisión actualizada sobre el precondicionamiento isquémico y la hipótesis patogénica más aceptada de la cardioprotección ejercida por la fase tardía o segunda ventana del precondicionamiento isquémico. Los más recientes datos generados por la intensa investigación en este campo, avalan que la generación de este fenotipo defensivo del cardiomiocito es un fenómeno poligénico, el cual requiere la activación simultánea de múltiples genes de estrés. La hipótesis del óxido nítrico como elemento dual, iniciador y mediador, ha permitido lograr una explicación coherente en la interconexión de los principales mediadores moleculares involucrados en dicha cardioprotección. La identificación de las bases moleculares de este fenómeno brindarán, sin duda, el marco conceptual apropiado para el desarrollo de nuevas estrategias terapéuticas que van desde el uso de fármacos o procedimientos que mimeticen la segunda ventana del precondicionamiento isquémico o la aplicación de técnicas genéticas que permitan de alguna manera lograr mantener el miocardio en un estado defensivo sostenido.
Subject(s)
Humans , Animals , Ergometry , Models, Animal , Myocardial Infarction , Nitric Oxide/therapeutic use , Ischemic Preconditioning, MyocardialABSTRACT
El precondicionamiento isquémico posee un efecto cardioprotector que depende de mecanismos metabólicos. Nos propusimos demostrar a través de la isquemia inducida por el ejercicio, la presencia del precondicionamiento isquémico clásico y la segunda ventana. Se incluyeron 14 pacientes, 9 masculinos y 5 femeninos, con una cardiopatía isquémica demostrada por coronariografia o estudio de perfusión miocárdica y prueba ergométrica positiva. A todos se les realizó 3 pruebas ergométricas consecutivas (Erg. I, Erg. II y Erg. III), con un intervalo entre Erg I y Erg II de 30 min y entre Erg II y Erg III de 24 h. Se encontraron diferencias significativas entre las medias de Erg. I y II (p ú,001) y entre Erg I y III ( p ú ,05) en las variables: duración de la isquemia (434 s ± 228, 300 s ± 177, 314 s ± 226); depresión del segmento ST (-2,9 mm ± 1,3, -2,1 mm ± 1,3, -2,2 mm ± 1,1); variación de la pendiente de la relación ST/FC (-507 mm/s ± 188, -360 mm/s ± 225, - 402 mm/s ± 180); y entre Erg. I y Erg. III (p ú,05) en la duración de angina (243 s ±66, 172 s ± 109, 122 s ± 90). Los doble productos en las variables medidas tuvieron incremento en Erg. II y III en relación con Erg. I, pero sin significación estadística p> , 05. Concluimos que la isquemia inducida por el ejercicio generó menor evidencia de isquemia a los 30 min. A las 24 h también se encontró una tendencia de reducción isquémica, aunque de menor intensidad. El precondicionamiento isquémico pudiera ser el mecanismo generador de ambas cardioprotecciones(AU)
Subject(s)
Humans , Male , Female , Ischemic Preconditioning, Myocardial , Exercise Test/methodsABSTRACT
El precondicionamiento isquémico posee un efecto cardioprotector que depende de mecanismos metabólicos. Nos propusimos demostrar a través de la isquemia inducida por el ejercicio, la presencia del precondicionamiento isquémico clásico y la segunda ventana. Se incluyeron 14 pacientes, 9 masculinos y 5 femeninos, con una cardiopatía isquémica demostrada por coronariografia o estudio de perfusión miocárdica y prueba ergométrica positiva. A todos se les realizó 3 pruebas ergométricas consecutivas (Erg. I, Erg. II y Erg. III), con un intervalo entre Erg I y Erg II de 30 min y entre Erg II y Erg III de 24 h. Se encontraron diferencias significativas entre las medias de Erg. I y II (p ú,001) y entre Erg I y III ( p ú ,05) en las variables: duración de la isquemia (434 s ± 228, 300 s ± 177, 314 s ± 226); depresión del segmento ST (-2,9 mm ± 1,3, -2,1 mm ± 1,3, -2,2 mm ± 1,1); variación de la pendiente de la relación ST/FC (-507 mm/s ± 188, -360 mm/s ± 225, - 402 mm/s ± 180); y entre Erg. I y Erg. III (p ú,05) en la duración de angina (243 s ±66, 172 s ± 109, 122 s ± 90). Los doble productos en las variables medidas tuvieron incremento en Erg. II y III en relación con Erg. I, pero sin significación estadística p> , 05. Concluimos que la isquemia inducida por el ejercicio generó menor evidencia de isquemia a los 30 min. A las 24 h también se encontró una tendencia de reducción isquémica, aunque de menor intensidad. El precondicionamiento isquémico pudiera ser el mecanismo generador de ambas cardioprotecciones
Subject(s)
Exercise Test , Myocardial Ischemia , Ischemic Preconditioning, MyocardialABSTRACT
Los programas de rehabilitación cardiaca integral han confirmado con el tiempo ser un tratamiento válido en la cardiopatía isquémica. En un comienzo estos programas excluían a los ancianos y a los pacientes considerados de alto riesgo, pero con el decursar del tiempo se han evidenciado útiles y provechosos resultados también en adultos de la tercera edad; por tal motivo, hemos decidido presentar un marco referencial que aborde todas las aristas de esta temática, permitiéndole al lector tener una clara percepción de los efectos y beneficios desarrollados por este grupo etáreo cuando se vincula a los citados programas, con el objetivo final de poder generalizar el concepto de la posible y necesaria incorporación del adulto mayor a esta modalidad terapéutica