What is new in valvular heart disease ESC Guidelines 2021?

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Ser-en-el-mundo carnal, ser-en-la red virtual : Desafíos para una antropología de las subjetividades-corporalidades contemporáneas

El surgimiento y posterior consolidación de las nuevas “Tecnologías de la Información y la Comunicación” (las denominadas “TICS”) y, en especial, el fenómeno de internet constituyen un desafío para repensar los modos en que se construyen las subjetividades-corporalidades contemporáneas en tanto entrañan transformaciones en los modos de sociabilidad y lazos afectivos. Teniendo esto en cuenta, en primer lugar problematizamos ciertas interpretaciones intelectuales que califican como inauténticas a las formas de sociabilidad, subjetivación y los regímenes corporales que estas tecnologías promueven. Posteriormente, recuperando los desarrollos fenomenológicos, señalamos que si a mediados del siglo XX Merleau-Ponty reformuló la noción husserliana de ser-en-el mundo, planteando lo inescindible de la relación cuerpo-mundo, hoy nos vemos interpelados a dar cuenta del modo en que la redes virtuales son también parte de ese mundo. En este sentido, consideramos que la red virtual se ha convertido entonces en un horizonte más, de entre los infinitos posibles, del mundo de vida cotidiano y denominamos a esta estructura ontológica “ser-en-la-red”. Finalmente, consideramos que estos fenómenos actuales desestabilizan nuestras teorías modernas sobre las subjetividades-corporalidades en tanto nos obligan a cuestionar nuestras concepciones tradicionales de sujeto y cuerpo como algo individual, territorializado y estable, impulsándonos de este modo a construir nuevas herramientas conceptuales para dar cuenta de estos fenómenos actuales.Facultad de Ciencias Naturales y Muse

Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography

Aims The identification of responders to cardiac resynchronization therapy (CRT) remains a challenge. We assessed the role of dyssynchrony (DYS) and contractile reserve (CR) in identifying CRT responders. Methods and results Sixty-nine patients (55% with ischaemic aetiology) referred for CRT (ejection fraction 35%, New York Heart Association III, and QRS duration 120 ms) underwent baseline evaluation of DYS and dobutamine stress-echo [up to 40 mg/kg/min: CR was defined as a wall motion score index (WMSI) variation 0.20]. CRT responders were identified by clinical and/or echocardiographic [end-systolic volume (ESV) decrease 15%] follow-up criteria. During a median follow-up of 11 months, 46 patients (66%) were classified as clinical responders. Reverse remodelling was found in 34 of the 59 patients (58%) with echocardiographic follow-up. CR was present in 78% of clinical responders (P ? 0.001) and in 69% with reverse remodelling (P ? 0.005). DYS was equally present in the two groups. Reverse remodelling was correlated with rest-stress changes in ESV (r ? 0.439, P ? 0.003) and in WMSI (r ? 0.450, P ? 0.001), but not with DYS. CR (OR ? 6.2, 95% CI ? 1.4-27.6, P ? 0.015) was the best predictor of response to CRT. Conclusion Patients with CR show a favourable clinical and reverse LV remodelling response to CRT. This finding shifts the focus from electrical (dyssynchrony) to the myocardial substrate of functional response

Echocardiography and Pulmonary Arterial Hypertension

Pulmonary Arterial Hypertension (PAH) is an heterogeneous condition brought on by a wide range of causes. It is characterized by structural changes in small pulmonary arteries, that produce a progressive increase in pulmonary artery pressure and pulmonary vascular resistance, ultimately leading to right ventricle failure and death. Given the non-specific nature of its early symptoms and signs, PAH is often diagnosed in its advanced stages. Along with a careful clinical assessment and an accurate electrocardiogram/Chest X-ray interpretation, echocardiography is an essential test in the evaluation of patient with PAH. In fact it not only provides an accurate estimate of pulmonary pressure at rest and during exercise, but may also help to exclude any secondary causes, predict the prognosis, monitor the efficacy of specific therapeutic interventions and detect the preclinical stage of the disease

Type A Acute Aortic Dissection in Nonagenarian: Rare but Possible

Acute type A aortic dissection (TA-AAD) is a highly lethal clinical entity that can occur within a wide age range, associated with multiple aetiologies and various clinical presentations. In the very elderly type A aortic dissection frequently presents with non-specific symptoms and signs and is associated with high mortality and morbidity. Thus the clinician must have a high index of clinical suspicion in order to prompt the most appropriate diagnostic-therapeutic strategy.We report a nonagenarian women with TA-AAD, treated successfully with medical therapy

A novel missense mutation for Fabry disease detected by echocardiographic screening in left ventricular hypertrophy patients

Fabry disease is an X-linked lysosomal storage disease caused by mutations in the a-galactosidase A gene (GLA), leading to the absence or a reduction of the enzymatic activity of the encoded enzyme and subsequent progressive tissue accumulation of glycosphingolipids through-out all the body, with consequent multiorgan failure. Here, we report the case of a 57-year-old woman with Fabry disease due to a novel GLA gene mutation

Thrombus straddling a patent foramen ovale

We present a case of a 67-year-old male with pulmonary embolism. Transesophageal echocardiography (TEE) showed the presence of a mobile thrombus straddling the patent foramen ovale (PFO) and prolapsing into both atria. Treatment with heparin was started. Five days after admission, repeat TEE revealed a reduction in thrombus dimensions, so anticoagulation therapy was continued. Eleven days after admission, TEE showed complete disappearance of the thrombus

Acute heart failure after Caesaerean section: peri-partum or tako-tsubo cardiomiopathy?

A young woman undergoes Caesarean section at the 39th week of pregnancy: shortly after she develops acute cardiorespiratory failure. The electrocardiography shows sinus tachycardia and right bundle branch block. The ventriculography confirms the decrease of the pump function and the mid-ventricular ballooning of the left ventricle; the differential diagnosis is between peri-partum cardiomyopathy and stress induced tako-tsubo cardiomyopathy: the sudden onset, the results of the ventriculography and the complete recovery after 11 days of treatment for acute heart failure led the diagnosis towards tako-tsubo cardiomyopathy

Chlamydia Pneumoniae and Acute Aortic Syndrome: A Call for a Multi-Institutional Study

Chlamydia Pneumoniae (CP) infection is strongly associated with coronary artery disease, as well as with atherosclerosis of the carotid and peripheral arteries. However, the role of CP in the pathogenesis of aortic disease remains controversial. Our present experience suggests no correlation between a current infection with C. pneumoniae and acute aortic dissection. Well-designed large prospective studies are needed in order to clarify the pathophysiologic role of CP infection in acute and chronic aortic disease

Anterior mitral valve aneurysm perforation in a patient with preexisting aortic regurgitation

We report the case of a 71-year-old man hospitalized for acute heart failure. Transthoracic and transesophageal echocardiography showed mitral valve aneurysm (MVA) rupture and severe mitral regurgitation. No vegetations but significant aortic regurgitation were also observed. MVA perforation is a rare life-threatening condition that typically occurs as a complication of endocarditis but may also be associated with other diseases, in particular connective tissue disorders. In the present case, the absence of such etiology suggests a possible role for of aortic regurgitation in MVA rupture secondary to a “jet lesion” mechanism