Unusual sequelae after percutaneous mitral valvuloplasty: A Doppler echocardiographic study

AbstractPercutaneous mitral valvuloplasty is a promising new technique for the treatment of mitral stenosis, with a relatively low complication rate reported to date. To assess the sequelae of this procedure, Doppler echocardiographic studies were prospectively performed before and after percutaneous mitral valvuloplasty in a series of 172 patients (mean age 53 ± 17 years). After balloon dilation, mitral valve area increased from 0.9 ± 0.3 to 2 ± 0.8 cm2(p < 0.0001), mean gradient decreased from 16 ± 6 to 6 ± 3 mm Hg (p < 0.0001) and mean left atrial pressure decreased from 24 ± 7 to 14 ± 6 mm Hg (p < 0.0001).Although most patients were symptomatically improved, six (4%) were identified who had unusual sequelae evident on Doppler echocardiographic examination immediately after percutaneous mitral valvuloplasty. These included rupture of a posterior mitral valve leaflet, producing a flail distal leaflet portion with severe mitral regurgitation detected on Doppler color flow mapping (n = 1); asymptomatic rupture of the chordae tendineae attached to the anterior mitral valve leaflet with systolic anterior motion of the ruptured chordae into the left ventricular outflow tract (n = 1); a double-orifice mitral valve (n = 1); and evidence of a tear in the anterior mitral valve leaflet (n = 3), producing on both pulsed Doppler ultrasound and color flow mapping a second discrete jet of mitral regurgitation in addition to regurgitation through the main mitral valve orifice. All six patients made a satisfactory recovery and none has required mitral valve replacement.In a small percent of cases, percutaneous mitral valvuloplasty may produce unusual disruption of the mitral valve and supporting apparatus that may be readily detected by Doppler echocardiographic studies

WHF Recommendations for the Use of Echocardiography in Chagas Disease

Chagas disease (ChD) represents a significant health burden in endemic regions of Latin America and is increasingly being recognized as a global health issue. The cardiac involvement in ChD, known as Chagas cardiomyopathy (ChCM), is the most severe manifestation and a leading cause of heart failure and mortality in affected individuals. Echocardiography, a non-invasive imaging modality, plays a crucial role in the diagnosis, monitoring, and risk stratification of ChCM. This consensus recommendation aims to provide guidance on the appropriate use of echocardiography in ChD. An international panel of experts, including cardiologists, infectious disease specialists, and echocardiography specialists, convened to review the available evidence and provide practical recommendations based on their collective expertise. The consensus addresses key aspects related to echocardiography in ChD, including its role in the initial evaluation, serial monitoring, and risk assessment of patients. It emphasizes the importance of standardized echocardiographic protocols, including the assessment of left ventricular function, chamber dimensions, wall motion abnormalities, valvular involvement, and the presence of ventricular aneurysm. Additionally, the consensus discusses the utility of advanced echocardiographic techniques, such as strain imaging and 3D echocardiography, in assessing myocardial mechanics and ventricular remodeling

La predicción del futuro: desde el oráculo de Delfos hasta la medicina actual

De acuerdo a la leyenda, Plutarco sacerdote del templo de Apolo, atribu&iacute;a los poderes prof&eacute;ticos dela pitonisa de Delfos a unos vapores (&ldquo;pneuma&rdquo;),que sal&iacute;an de fisuras del piso del templo (1). Cuandoarque&oacute;logos franceses empezaron a excavar lasruinas de Delfos alrededor de 1890 esperabanencontrar un templo de m&aacute;rmol elaborado conestatuas finas y un santuario tallado en la roca confisuras en el piso (2). Para su extra&ntilde;eza las excavaciones s&oacute;lo revelaron las fundaciones del templo de Apolo junto a columnas ca&iacute;das. El piso estaba cubierto de una espesa capa de yeso natural,y no hab&iacute;a ninguna fisura o caverna. A. Poppe (3),clasicista acad&eacute;mico ingl&eacute;s de enorme prestigio afirm&oacute; que las teor&iacute;as de gases que sal&iacute;an de unas fisuras o cavernas del piso eran probablemente otra ficci&oacute;n

Estado actual de la enfermedad de Chagas en Venezuela y de su manejo terapéutico

Se presenta el an&aacute;lisis cl&iacute;nico de 965 sujetos (676 asintom&aacute;ticos y 289 sintom&aacute;ticos) y las muertes de 160 con sus causas posibles.Clinical analysis of 965 subjects (676 asymptomatic and 289 symptomatic) and of 160 deaths including possible causes is presented