RESUMO
A 72-year-old woman, recently COVID-19 vaccinated with a third dose, was referred to our center for acute chest pain and dyspnea. On admission, the electrocardiography showed a STEMI on inferior derivations and the dyskinesia of the inferior wall was found at the first transthoracic echocardiogram. The coronary angiography did not show coronary artery disease. After 1 week, a huge posterolateral left ventricular (LV) aneurysm with initial signs of rupture was found and the patient underwent a Dor's procedure to exclude the LV aneurysm. As far as we know, this is the first reported case of Takotsubo following the COVID-19 vaccination requiring cardiac surgery.
RESUMO
Pulmonary hypertension (PH) is a hemodynamic condition characterized by chronically elevated mean pulmonary artery pressure (m-PAP ≥ 25 mmHg) measured at rest by right heart catheterization (RHC). It includes a pre-capillary and a post-capillary form. Pulmonary artery hypertension (PAH) is a pre-capillary form of PH potentially generated by several heterogeneous systemic disorders, whose main hemodynamic change is represented by severely increased pulmonary vascular resistance (PVR). In order to preserve an efficient right ventricular-arterial (RV-PA) coupling, the right ventricle (RV) adapts to this chronic increase of its afterload, with a compensatory hypertrophy, until RV dilatation and dysfunction occur. Right ventricular (RV) function and especially RV-PA coupling assessment showed to be very important prognostic markers in this subset of patients, especially for those with pre-capillary PH. The aim of this review is to provide a pathophysiological insight into the spectrum of RV adaptive changes occurring in response to chronic increase of RV afterload and to present the role of echocardiographic parameters as possible tools for early non-invasive evaluation of RV-PA coupling, before overt heart failure ensues.
RESUMO
BACKGROUND: Transesophageal echocardiography (TEE) is the method of choice for evaluating both anatomy and function of left atrial appendage (LAA). In contrast, conventional transthoracic echocardiography (TTE) does not result in images of sufficient quality to explore LAA. HYPOTHESIS: The aim of this study was to evaluate the potential role of TTE with harmonic frequency imaging (HFI) for assessing LAA normal anatomy and function. METHODS: The study group comprised 25 patients, (9 men, 16 women, mean age 51 years, range 20-82). The TTE as sessment of LAA both in fundamental frequency imaging (FFI) and HFI was performed using the apical two-chamber view, the longitudinal two-chamber view was used for TEE assessment of LAA. According to image quality, images were categorized into three classes: A: good quality, B: sufficient quality, C: poor quality. RESULTS: Transthoracic echocardiography conventional imaging allowed sufficient LAA visualization (class B) in only 5 of 25 patients (20%); the HFI resulted in adequate LAA visualization in 23 of 25 patients (92%). Images were of good quality (class A) in 18 of 23 patients and of sufficient quality (class B) in 5 of 23 patients. Transesophageal echocardiography achieved good quality images in 24 of 25 patients (96%). Average LAA maximum area determined by HFI and TEE was 3.46 +/-1.17 and 3.59 +/- 1.16 cm2, respectively; LAA minimum area was 1.81 +/- 0.98 and 1.77 +/- 0.97 cm2, respectively. Percent LAA area change was 51 +/- 16.5 and 50.9 +/- 16% with HFI and TEE, respectively. Statistical analysis showed no difference between the data obtained with the two methods. CONCLUSIONS: The results suggest that HFI TNE may be a useful tool for the exploration of LAA.
