Atypical presentation and percutaneous repair of ascending aortic pseudoaneurysm: a case report.

Background: Ascending aortic pseudoaneurysms (AAPs) are an unusual complication of cardiac or aortic surgery and are associated with a high risk of complications and mortality. Guidelines recommend surgical repair. There is few data concerning percutaneous occlusion of AAP. We present a case of syncope due to vascular and heart chamber compression by a large post-surgical AAP that was filled through a focal leak. Ascending aortic pseudoaneurysm was successfully occluded percutaneously. Case summary: A 66-year-old man with a mechanical aortic prosthesis and a Dacron tube in the ascending aorta presented with syncope due to compression of the right atrium and superior vena cava by a large peritube collection. A computed tomography angiography (CTA) showed a large AAP that was filled through a small focal dehiscence of the tube proximal suture. Patient was dismissed for surgery due to high surgical risk. Then, AAP was successfully occluded percutaneously via a 6-French radial access and local anaesthesia. Discussion: In patients with syncope and previous cardiac surgery, aortic complications should be ruled out. Although transthoracic echocardiography may be useful, CTA is the recommended diagnostic test for ruling out post-surgical AAP and allows the characterization of the number, localization, and size of the leaks. In selected patients with high surgical risk and favourable anatomic characteristics, a percutaneous closure could be indicated.

Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT / Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document

La resonancia magnética se ha convertido en técnica de imagen de primera línea en muchas situaciones clínicas. El número de pacientes portadores de dispositivos cardiovasculares, como los dispositivos cardiovasculares electrónicos implantables, ha crecido de modo exponencial. Aunque se han descrito complicaciones y efectos adversos cuando estos pacientes se someten a exploraciones de resonancia magnética, la evidencia clínica actual respalda la seguridad de realizar estos estudios cuando se cumplen unas normas y recomendaciones dirigidas a minimizar los posibles riesgos. El Grupo de Trabajo de Cardiorresonancia Magnética y Cardiotomografía Computarizadas de la Sociedad Española de Cardiología (SEC-GT CRMTC), la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (SEC-Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología), la Sociedad Española de Radiología Médica (SERAM) y la Sociedad Española de Imagen Cardiotorácica (SEICAT) han elaborado el presente documento, que revisa la evidencia disponible en este campo y establece las recomendaciones necesarias para que los pacientes portadores de dispositivos cardiovasculares electrónicos implantables y otros dispositivos puedan acceder con seguridad a este instrumento diagnóstico (AU)

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool (AU)

Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document.

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.

The valve uptake index: improving assessment of prosthetic valve endocarditis and updating [18F]FDG PET/CT(A) imaging criteria.

AIMS: Diagnosis of prosthetic valve endocarditis (PVE) by positron emission computed tomography angiography (PET/CTA) is based on visual and quantitative morpho-metabolic features. However, the fluorodeoxyglucose (FDG) uptake pattern can be sometimes visually unclear and susceptible to subjectivity. This study aimed to validate a new parameter, the valve uptake index [VUI, maximum standardized uptake value (SUVmax)-mean standardized uptake value (SUVmean)/SUVmax], designed to provide a more objective indication of the distribution of metabolic activity. Secondly, to re-evaluate the utility of traditionally used PVE imaging criteria and determine the potential value of adding the VUI in the diagnostic algorithm of PVE. METHODS AND RESULTS: Retrospective analysis of 122 patients (135 prosthetic valves) admitted for suspicion of endocarditis, with a conclusive diagnosis of definite (N = 57) or rejected (N = 65) PVE, and who had undergone a cardiac PET/CTA scan as part of the diagnostic evaluation. We measured the VUI and recorded the SUVmax, SUVratio, uptake pattern, and the presence of endocarditis-related anatomic lesions. The VUI, SUVmax, and SUVratio values were 0.54 ± 0.1 vs. 0.36 ± 0.08, 7.68 ± 3.07 vs. 3.72 ± 1.11, and 4.28 ± 1.93 vs. 2.16 ± 0.95 in the 'definite' PVE group vs. the 'rejected' group, respectively (mean ± SD; P < 0.001). A cut-off value of VUI > 0.45 showed a sensitivity, specificity, and diagnostic accuracy for PVE of 85%, 88%, and 86.7% and increased diagnostic ability for confirming endocarditis when combined with the standard diagnostic criteria. CONCLUSIONS: The VUI demonstrated good diagnostic accuracy for PVE, even increasing the diagnostic power of the traditionally used morphometabolic parameters, which also confirmed their own diagnostic performance. More research is needed to assess whether the integration of the VUI into the PVE diagnostic algorithm may clarify doubtful cases and thus improve the diagnostic yield of PET/CTA.

An Uncommon Cause of Dyspnea: Usefulness of Multimodality Cardiac Imaging.

Pericardial lipomas are very uncommon benign primary cardiac tumors. We describe the case of a patient with symptomatic large pericardial mass who presented with heart failure. Multimodality cardiac imaging helped us in the diagnosis of this unusual entity. (Level of Difficulty: Intermediate.).

Aortic Arch Mycotic Aneurysm Due to Scedosporium Apiospermum Reconstructed With Homografts.

A 39-year-old female, active parenteral drug user was diagnosed of spondylodiscitis. A computed tomography (CT) scan showed an extensive aortic arch aneurysm. A positron emission tomography (PET)-CT scan, showing significant aortic wall uptake of the tracer through the whole aortic arch and the D8-D9 intervertebral disc, allowed us to suspect an aortitis despite negative blood cultures. The aneurysm was resected and reconstructed with 2 aortic homografts. Cultures of specimens from the aortic wall were positive to the fungi Scedosporium apiospermum. A new PET-CT scan 4 months after surgery showed absence of tracer uptake both at the homografts site and intervertebral disc.

[Gene therapy for heart failure]. / Terapia génica en la insuficiencia cardiaca.

Gene therapy as a therapeutic strategy for Heart Failure, is an area that within the last 10 years has experienced an important increase in research, becoming one of the most promising areas to obtain a successful therapy for heart failure due to the possibility of correcting the basic defects observed at the cellular level in this pathology. One of the first things to consider on the use of this therapy is the way to deliver the genetic material, Adenovirus, and Adeno-associated virus, have shown the best capabilities in the myocardium; the delivery by local means has shown best results when compared with peripheral administration. Multiple physiopathological mechanisms susceptible of modifying by gene therapy have been identified, including the regulation of Ca2+ fluxes during excitation-contraction coupling, altered intracellular signalling, and adrenergic system, blockade of apoptosis and angiogenesis. The objective of this review, is to made a recount about the status of the literature and analyze future perspectives for gene therapy.

Terapia génica en la insuficiencia cardiaca / Gene therapy for heart failure

Gene therapy as a therapeutic strategy for Heart Failure, is an area that within the last 10 years has experienced an important increase in research, becoming one of the most promising areas to obtain a successful therapy for heart failure due to the possibility of correcting the basic defects observed at the cellular level in this pathology. One of the first things to consider on the use of this therapy is the way to deliver the genetic material, Adenovirus, and Adeno-associated virus, have shown the best capabilities in the myocardium; the delivery by local means has shown best results when compared with peripheral administration. Multiple physiopathological mechanisms susceptible of modifying by gene therapy have been identified, including the regulation of Ca2+ fluxes during excitation-contraction coupling, altered intracellular signalling, and adrenergic system, blockade of apoptosis and angiogenesis. The objective of this review, is to made a recount about the status of the literature and analyze future perspectives for gene therapy.

Transcriptional analysis of the human cardiac calsequestrin gene in cardiac and skeletal myocytes.

Calsequestrin is the main calcium-binding protein inside the sarcoplasmic reticulum of striated muscle. In mammals, the cardiac calsequestrin gene (casq2) mainly expresses in cardiac muscle and to a minor extent in slow-twitch skeletal muscle and it is not expressed in non-muscle tissues. This work is the first study on the transcriptional regulation of the casq2 gene in cardiac and skeletal muscle cells. The sequence of the casq2 genes proximal promoter (180 bp) of mammals and avians is highly conserved and contains one TATA box, one CArG box, one E-box, and one myocyte enhancer factor 2 (MEF-2) site. We cloned the human casq2 gene 5'-regulatory region into a luciferase reporter expression vector. By functional assays we showed that a construct containing the first 288 bp of promoter was up-regulated during myogenic differentiation of Sol8 cells and had higher transcriptional activity compared with longer constructs. In neonatal rat cardiac myocytes, the larger construct containing 3.2 kb showed the highest transcriptional activity, demonstrating that the first 288 bp are sufficient to confer muscle specificity, whereas distal sequences may act as a cardiac-specific enhancer. Electrophoretic mobility shift assay studies demonstrated that the proximal MEF-2 and CArG box sequences were capable of binding MEF-2 and serum response factor, respectively, whereas the E-box did not show binding properties. Functional studies demonstrated that site-directed mutagenesis of the proximal MEF-2 and CArG box sites significantly decreased the transcription of the gene in cardiac and skeletal muscle cells, indicating that they are important to drive cardiac and skeletal muscle-specific transcription of the casq2 gene.

Función del retículo sarcoplásmico y su papel en las enfermedades cardíacas / Function and role of the sarcoplasmic reticulum in heart disease

The sarcoplasmic reticulum (SR) constitutes the main intracellular calcium store in striated muscle and plays an important role in the regulation of excitation-contraction-coupling (ECC) and of intracellular calcium concentrations during contraction and relaxation. The regulation of ECC occurs due to the interaction among the main proteins of the SR that are the calcium release channel or ryanodine receptor, the Ca2+-ATPase, phospholamban and calsequestrin. Due to the importance of ECC in the physiopathology of a number of cardiac diseases, the role of the SR and its components has been widely investigated in some pathologies, specifically cardiac hypertrophy, heart failure, and hereditary arrhythmias. Therefore, the SR proteins constitute an area of research of great interest for the development of new genetic and pharmacologic therapies; from this derives the importance of understanding the function of the SR. This review analyzes the expression, structure, and function of the main SR proteins, their role on myocardial contraction and relaxation and in the changes that occur in cardiac pathologies.

[Function and role of the sarcoplasmic reticulum in heart disease]. / Función del retículo sarcoplásmico y su papel en las enfermedades cardíacas.

The sarcoplasmic reticulum (SR) constitutes the main intracellular calcium store in striated muscle and plays an important role in the regulation of excitation-contraction-coupling (ECC) and of intracellular calcium concentrations during contraction and relaxation. The regulation of ECC occurs due to the interaction among the main proteins of the SR that are the calcium release channel or ryanodine receptor, the Ca2+-ATPase, phospholamban and calsequestrin. Due to the importance of ECC in the physiopathology of a number of cardiac diseases, the role of the SR and its components has been widely investigated in some pathologies, specifically cardiac hypertrophy, heart failure, and hereditary arrhythmias. Therefore, the SR proteins constitute an area of research of great interest for the development of new genetic and pharmacologic therapies; from this derives the importance of understanding the function of the SR. This review analyzes the expression, structure, and function of the main SR proteins, their role on myocardial contraction and relaxation and in the changes that occur in cardiac pathologies.