72 research outputs found
Incidental computed tomography diagnosis of a rare triad consisting of absence of coronary sinus, persistent left superior vena cava, and scimitar syndrome
We report a case of an unusual congenital triad consisting of absence of coronary sinus, persistent left superior vena cava and scimitar
syndrome incidentally found in a CT-scan performed on a female complaining of exertional dyspnea
Miocarditis aguda: diagnóstico mediante resonancia magnética cardiaca
Cardiomyopathies are a common cause of morbidity
and mortality. Myocarditis, which is included
among specific cardiomyopathies, frequently presents
non-specific clinical manifestations and thus may be
difficult to diagnose, or even be misdiagnosed. Traditionally
employed diagnostic techniques, including
endomyocardial biopsy, have been shown to be of limited
value. Following its overall implantation in clinical
practice, cardiac magnetic resonance imaging (MRI) is
nowadays widely considered to be the best non-invasive
diagnostic tool available for diagnosing myocarditi
Cardiac resynchronization therapy and valvular cardiomyopathy after corrective surgery
Cardiac resynchronization therapy (CRT) has been
shown to have clinical benefits in certain groups of
patients with advanced heart failure (HF). However,
patients with valvular cardiomyopathy are
underrepresented in randomized clinical studies. The aim
of this study was to assess the medium-term (i.e., at 6
months) effects of CRT in patients with HF exclusively
due to valvular disease. The study included 40
consecutive patients who underwent CRT device
implantation. At 6 months, there were improvements in
functional class, left ventricular remodeling, and
intraventricular dyssynchrony parameters in treated
patients. In this particular subgroup of patients, the
benefits of CRT were similar to those observed in patients
with HF due to other etiologies
Efecto de la localización del electrodo ventricular izquierdo sobre los parámetros ecocardiográficos de asincronÃa en pacientes sometidos a terapia de resincronización cardÃaca
Introduction and objectives. Cardiac resynchronization
therapy has been shown to be an option in the treatment
of patients with congestive heart failure. The current
indication for this treatment is based on clinical and electrocardiographic
criteria, although echocardiography has
also been shown to be a useful tool for the diagnosis of
ventricular dyssynchrony. The aim of this study was to assess
left ventricular dyssynchrony by echocardiography
and to evaluate the effect of the stimulation site on the
magnitude of resynchronization.
Patients and method. We studied 25 patients with biventricular
stimulation (left ventricular lead located in a lateral
position in 13 patients, and in an anterior position in
12). A complete echo-Doppler evaluation, including left
ventricular ejection fraction, ventricular diameters and parameters
of inter- and intraventricular dyssynchrony, was
performed before implantation and 3 months after the
procedure, with the device connected and disconnected.
Results. Left ventricular ejection fraction increased significantly
from 23.7 (6.5) to 27.8 (5.5) (P=.007) at 3
months. In the group as a whole, biventricular pacing was
associated with a significant decrease in all intraventricular
dyssynchrony parameters (septal-to-lateral wall motion
delay and septal-to-posterior wall motion delay). This decrease
in septal-to-posterior wall motion delay and septalto-
lateral wall motion delay was significantly greater in patients
with the electrode implanted in the lateral position
(58.1 ms vs 118 ms; P=.02) than with the lead in the anterior
position (39.5 ms vs 86.5 ms; P=.04). Three patients,
all with the electrode in an anterior location, were considered
non-responders.
Conclusions. Left lateral free wall stimulation provided
significantly better intraventricular resynchronization compared
to stimulation at an anterior site. Echocardiography
is a useful tool to evaluate changes in intra- and interventricular
synchrony related to the pacing site
Safety, feasibility, and hemodynamic response of regadenoson for stress perfusion CMR
Owing to its pharmacodynamics and posology, the use of regadenoson for stress cardiac magnetic resonance (CMR) has
potential advantages over other vasodilators. We sought to evaluate the safety, hemodynamic response and diagnostic
performance of regadenoson stress-CMR in routine clinical practice. All regadenoson stress-CMR examinations performed
between May 2017 and July 2020 at our institution were retrospectively reviewed. A total of 698 studies were included
for the final analysis. A conventional stress/rest protocol was performed using a 1.5T MRI scanner (Magnetom Aera, Siemens Healthineers, Erlangen, Germany). Adverse events, clinical symptoms, and hemodynamic response were assessed.
Diagnostic accuracy of the test was evaluated in patients who underwent invasive coronary angiography. Nearly half of
patients (48.5%) remained asymptomatic. Most common clinical symptoms included dyspnea (137, 19.6%), chest pain
(116, 16.6%) and flushing (44, 6.3%). Two patients (0.28%) could not complete the examination due to severe hypotension or unbearable chest pain. Overall, an increase in heart rate (HR) response (36.2% [IQR: 22.5–50.9]) and a decrease
in systolic and diastolic blood pressure (BP) (median systolic BP response of -5% [IQR: -11.5-0.6]; median diastolic BP
response of -6.3 mmHg [IQR: -13.4-0]) was observed. Patients with symptoms induced by regadenoson showed higher
HR response (40.3%, IQR: 26.4–56.1 vs. 32.4%, IQR: 19-45.6, p<0.001), whereas a blunted HR response was observed
in diabetic (29.6%, IQR: 18.4–42 p<0.001), obese (31.7%, IQR: 20.7–46.2 p=0.005) and patients aged 70 years or
older (32.9%, IQR: 22.6–43.1 p<0.001). Overall, regadenoson stress-CMR showed 95.65% (IQ 91.49–99.81) sensitivity,
54.84% (IQ 35.71–73.97) specificity, 86.99% (IQ 82.74–94.68) positive predictive value, and 77.27% (IQ 57.49–97.06)
negative predictive value for detecting significant coronary stenosis as compared with invasive coronary angiography.
Regadenoson is a well-tolerated vasodilator that can be safely employed for stress perfusion CMR, with high diagnostic
performanc
Tratamiento de la insuficiencia cardÃaca avanzada mediante estimulación biventricular. Experiencia inicial en una serie de 22 casos consecutivos
Recent data suggest that biventricular pacing may play
an important role in treating advanced heart failure in the presence of a
significant interventricular and/or intraventricular conduction disorder by
correcting cardiac dysynchrony. In this article, we review the initial technical
and clinical experience with cardiac resynchronization therapy in an
electrophysiology laboratory. METHODS: The first 22 consecutive patients with
severe congestive heart failure, ejection fraction < 0.35, NYHA functional class
III or IV, and QRS duration > 120 ms who were implanted biventricular pacemakers
were studied. Clinical, electrocardiographic, and echocardiographic evaluations
were made before and three months after pacemaker implantation. Acute functional
capacity testing with peak oxygen uptake was measured during biventricular pacing
and during intrinsic rhythm or right ventricular pacing three months after the
implantation procedure. RESULTS: The success rate of pacemaker implantation was
95%. Pre-discharge left ventricular pacing was achieved in 91%, with an average
pacing threshold of 1.53 (1.04) volts. NYHA functional class improved (p = 0.039)
from 3.4 (0.7) to 2.3 (0.78). The rate of hospitalization for heart failure
decreased from an average of 3.12 (0.58) three months before the procedure to
1.38 (0.34) three months after the procedure. Peak oxygen uptake was
significantly greater (p = 0.028) during biventricular pacing: 14.89 (2.1)
ml/min/kg, than during intrinsic rhythm or right ventricular pacing: 12.65 (2.3)
ml/min/kg. CONCLUSIONS: Cardiac resynchronization therapy can be performed safely
and with a high success rate in the electrophysiology laboratory. Biventricular
pacing seems to improve the symptoms of congestive heart failure in patients with
evidence of atrioventricular and/or interventricular/intraventricular
dysynchrony. An acute benefit in peak oxygen uptake was associated with
biventricular pacing after the implantation procedure
Trasplante celular y terapia regenerativa con células madre
Uno de los campos de la medicina que más expectativas
ha levantado en los últimos años es la terapia celular
con células madre. El aislamiento de células embrionarias
humanas, la aparente e inesperada potencialidad
de las células madre adultas y el desarrollo de la terapia
génica nos lleva a imaginar un futuro esperanzador para
un importante número de enfermedades actualmente
incurables. A lo largo de las siguientes páginas vamos a
tratar de dibujar el panorama de la investigación con
células madre, describiendo los principales logros en este
campo asà como algunas de las preguntas pendientes de
responder. A pesar de las grandes expectativas, es fundamental
que mantengamos un espÃritu crÃtico y realista a la
hora de analizar los avances cientÃficos en este área
Severe cardiac and abdominal manifestations without lung involvement in a child With COVID-19
Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic, affecting humans of all ages. Clinical features of the pediatric population have been published, but there is not yet enough information to make a definitive description. Fever is typical, as it is respiratory symptom. Rarely are the infection and complications severe, and, when they are, it is almost always in a patient with another underlying disease. However, some otherwise healthy children with COVID-19 do suffer critical organ injury, such as acute myocarditis, heart failure and gastrointestinal inflammation. The mechanism of these organ damages remains unclear. An otherwise normally healthy 13-year-old male was admitted to the pediatric intensive care unit with acute abdomen pain, possible myocarditis and a suspected diagnosis of COVID-19. Noteworthy basal findings were ventricular extrasystoles in the electrocardiogram (EKG) and moderate left ventricular systolic dysfunction. Chest X-ray was normal. Blood tests revealed altered levels of inflammation factors (C-reactive protein (CRP), D-dimer, fibrinogen, interleukin 6 (IL-6)), lymphopenia and elevated cardiac enzymes. The first test for polymerase chain reaction (PCR) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. The patient’s condition worsened, and he entered cardiogenic shock (hypotension, tachycardia and oliguria). He was vomiting continuously, which made pain control difficult; imaging of his abdomen was undertaken. There was no response to fluid resuscitation, and so milrinone and epinephrine were administered. Empiric treatment began with azithromycin, foscarnet, carnitine and immunoglobulins. Hydroxychloroquine was given before the results of repeated SARSCoV-2 and serology tests were available. Tocilizumab was administered once COVID-19 had been confirmed and massive inflammation had been observed. Progressively the clinical situation and the levels
of the parameters studied improved. The patient was discharged 8 days after admission. Most children with SARS-CoV-2 infection are asymptomatic or present only mild symptoms. However, physicians should be aware of atypical and severe manifestations that may occur in the hyperinflammatory phase of the illness
Trasplante cardÃaco
A heart transplant is at present considered the
treatment of choice in cases of terminal cardiac insufficiency
refractory to medical or surgical treatment. Due
to factors such as the greater life expectancy of the
population and the more efficient management of acute
coronary syndromes, there is an increasing number of
people who suffer from heart failure. It is estimated
that the prevalence of the disease in developed countries
is around 1%; of this figure, some 10% are in an
advanced stage and are thus potential receptors of a
heart transplant. The problem is that it is still not possible
to offer this therapeutic form to all of the patients
that require it. Consequently, it is necessary to optimise
the results of the heart transplant through the
selection of patients, selection and management of
donors, perioperative management and control of the
disease due to graft rejection. Since the first transplant
carried out in 1967, numerous advances and changes
have taken place, which has made it possible to
increase survival and quality of life of those who have
received a new heart. In this article we review the most
relevant aspects of the heart transplant and the challenges
that are currently faced
- …