ABSTRACT
Complex coronary lesions represent challenging findings for percutaneous coronary intervention and potentially lead to complications during their approach. We present the case of a patient with decompensated heart failure of ischemic origin who presented multiple complex lesions on coronary angiography. The initial approach to the marginal artery was complicated by a severe coronary perforation that was satisfactorily resolved and in the second moment, a bifurcation lesion of the right coronary artery was successfully treated using the inverted Culotte technique.
Las lesiones coronarias complejas representan hallazgos desafiantes para la intervención coronaria percutánea y potencialmente exponen a complicaciones durante su abordaje. Reportamos el caso de un paciente con falla cardíaca descompensada de etiología isquémica que en la angiografía coronaria presentó múltiples lesiones complejas. El abordaje inicial de la arteria marginal se complicó con una perforación coronaria severa que se trató con éxito; en un segundo momento se abordó satisfactoriamente una lesión en bifurcación de la coronaria derecha con técnica de Culotte invertido.
ABSTRACT
Williams-Beuren syndrome (WBS) is a multisystem congenital disorder, whose cardiovascular defects are the leading cause of death. We present the case of a 38-year-old man with features of heart failure. The imaging studies showed a typical supravalvular aortic stenosis and a hammock mitral valve, this last, being a rare congenital disease. This is the first case reported of a hammock mitral valve in a patient with this chromosomopathy.
Subject(s)
Aortic Stenosis, Supravalvular , Heart Failure , Williams Syndrome , Male , Humans , Adult , Williams Syndrome/complications , Mitral Valve , Heart Failure/complicationsABSTRACT
Non-valvular Infective endocarditis (IE) is exceedingly rare; however, its incidence has risen in tandem with the increased usage of intracardiac devices and the growing prevalence of risk factors associated with IE. We present a clinical case involving an 18-year-old patient with IE occurring at an atypical location, concomitant with central venous catheter bloodstream infection. The patient underwent targeted antibiotic therapy but ultimately required surgical resection of the vegetation due to multiple risk factors associated with a poor prognosis. This case underscores the importance of maintaining a low threshold of suspicion for IE and emphasizes the need for heightened vigilance regarding non-valvular tissues hosting foreign bodies. These less common locations pose a risk for vegetation development. Additionally, we underscore the pivotal role of 3D echocardiography tools in anatomically characterizing the vegetation, including dimensions, implantation area, and related anatomy. These tools provide realistic images that facilitate informed decision-making. Furthermore, the timely selection of surgical intervention in patients at elevated risk of therapeutic failure is a cornerstone in effective management.
La endocarditis infecciosa (EI) no valvular es extremadamente infrecuente; sin embargo, su incidencia ha aumentado paralelamente al incremento del uso de dispositivos intracardiacos y a la creciente prevalencia de factores de riesgo asociados a la EI. Se presenta un caso clínico de un paciente de 18 años con EI en una localización atípica, concomitante con infección del torrente sanguíneo por catéter venoso central. El paciente fue sometido a un tratamiento antibiótico específico, pero finalmente requirió la resección quirúrgica de la vegetación debido a múltiples factores de riesgo asociados a un mal pronóstico. Este caso resalta la importancia de mantener un umbral bajo de sospecha de EI y hace hincapié en la necesidad de una mayor vigilancia de los tejidos no valvulares que albergan cuerpos extraños. Estas localizaciones menos frecuentes suponen un riesgo para el desarrollo de vegetación. Asimismo, subrayamos el papel fundamental de las herramientas de ecocardiografía tridimensional en la caracterización anatómica de la vegetación, incluidas las dimensiones, el área de implantación y la anatomía relacionada. Estas herramientas proporcionan imágenes realistas que facilitan la toma de decisiones informadas. Además, la selección oportuna de la intervención quirúrgica en pacientes con alto riesgo de fracaso terapéutico es una piedra angular en el manejo eficaz.
ABSTRACT
Objective: To describe the initial experience in ablation of cardiac arrhythmias using 3D mapping at the Instituto Nacional Cardiovascular INCOR (Lima, Peru). Methods: A retrospective descriptive study was carried out. During February 2020, data was collected from the medical records of all patients in whom ablation was performed using 3D mapping from July 2017 to December 2019. This procedure was performed in patients with symptomatic arrhythmia refractory to antiarrhythmic therapy. Results: Data were collected from 123 patients (median age: 46 years, 64.2% male), who had a median time of illness of 6 years. Among the arrhythmias treated, 19% had atrial fibrillation, 17.5% atrial tachycardia, 17.5% idiopathic ventricular arrhythmias, 16.6% Wolf Parkinson White syndrome / Atrioventricular reentrant tachycardia, 11.1% ventricular arrhythmias of the His-Purkinje conduction system, 9.5% scar related ventricular tachycardia associated, 6.4% atrial flutter and 2.4% intranodal tachycardia. The median fluoroscopy time was 26 minutes. Ablation was acutely successful in 95.9% of cases, acute complications were observed in 4.8%, and recurrence-free survival during the first year of follow-up was 74%. Conclusions: Our experience in ablation of cardiac arrhythmias using 3D mapping had a high acute success rate, low frequency of complications, and one-year recurrence-free survival of 74 %.
