Left ventricular diverticulum, a rare echocardiographic finding: Two adult patients and review of the literature

Congenital diverticulum of the left ventricle is a very rare cardiac abnormality characterized by a local embryological development failure of the ventricular muscle. It may present as an isolated disorder or may be associated with other cardiac abnormalities. Clinically, it has been reported that it can lead to chest pain, arrhythmias, cardiac rupture, and sudden death, although frequently the course is asymptomatic. This article presents two illustrative cases of left ventricular diverticulum. The diagnosis was made by two-dimensional echocardiography and was confirmed by cardiac catheterization. There were no other thoracoabdominal or cardiac abnormalities. The patient was asymptomatic and surgical resection was not indicated. Given the few cases reported in the medical literature, the information available is scarce; hence, physicians should be trained to make the appropriate diagnosis

Left ventricular thrombus mimicking primary cardiac tumor in a patient with primary antiphospholipid syndrome and recurrent systemic embolism

Primary antiphospholipid syndrome (APS) is a well-defined entity characterized by spontaneous and recurrent abortion, thrombocytopenia and recurrent vascular thromboses (arterial and venous). Left ventricular thrombus mimicking primary cardiac tumor with recurrent systemic embolism has not been previously reported. In this report we describe a 39 year-old man admitted to hospital presenting with left hemiparesis and a peripheral embolism. He had no history of thrombotic events. Transthoracic echocardiography showed a large, polypoid and mobile mass (4.0 × 1.2 cm) attached to the apex of the left ventricle, highly suggestive of primary cardiac tumor. The patient subsequently underwent open heart surgery. The histological examination showed an older thrombus and a fresh thrombus. Post-operative laboratory tests showed lupus anticoagulant activity, confirming the primary APS diagnosis. The patient initiated treatment with oral anticoagulation (INR levels between 2 and 3) and was discharged 29 days after surgery. At ten month follow-up, he was symptom-free with long-term anticoagulation therapy. No evidence of intracardiac mass recurrence on two-dimensional echocardiography was seen. Intracardiac thrombus has been rarely reported as a complication of primary APS. Left ventricular mass mimicking primary cardiac tumor with recurrent systemic embolism has not been previously reported. Pre-operative investigations could not distinguish such a thrombus from a cardiac tumor and the diagnosis was made post-operatively

Unsteady undular bores in fully nonlinear shallow-water theory

We consider unsteady undular bores for a pair of coupled equations of Boussinesq-type which contain the familiar fully nonlinear dissipationless shallow-water dynamics and the leading-order fully nonlinear dispersive terms. This system contains one horizontal space dimension and time and can be systematically derived from the full Euler equations for irrotational flows with a free surface using a standard long-wave asymptotic expansion. In this context the system was first derived by Su and Gardner. It coincides with the one-dimensional flat-bottom reduction of the Green-Naghdi system and, additionally, has recently found a number of fluid dynamics applications other than the present context of shallow-water gravity waves. We then use the Whitham modulation theory for a one-phase periodic travelling wave to obtain an asymptotic analytical description of an undular bore in the Su-Gardner system for a full range of "depth" ratios across the bore. The positions of the leading and trailing edges of the undular bore and the amplitude of the leading solitary wave of the bore are found as functions of this "depth ratio". The formation of a partial undular bore with a rapidly-varying finite-amplitude trailing wave front is predicted for ``depth ratios'' across the bore exceeding 1.43. The analytical results from the modulation theory are shown to be in excellent agreement with full numerical solutions for the development of an undular bore in the Su-Gardner system.Comment: Revised version accepted for publication in Phys. Fluids, 51 pages, 9 figure

Early detection of left ventricular diastolic dysfunction in Chagas' disease

BACKGROUND: Chagas' disease may cause left ventricular diastolic dysfunction and its early detection in asymptomatic patients would allow to stratify the risk and to optimize medical treatment. The aim of this study is to investigate if transmitral Doppler flow can detect early abnormalities of the diastolic left ventricular function in patients during the indeterminate phase of Chagas' disease, in which the electrocardiogram (ECG), chest x-ray and 2-D echocardiogram (2D-echo) are normal. METHODS: a group of 54 patients with Chagas' disease was studied and compared to a control group of 27 subjects of similar age. All were assessed with an ECG, chest X-ray, 2-D echo, and transmitral Doppler flow. RESULTS: both groups had similar values in the 2D-echo. In patients with Chagas' disease, the transmitral Doppler showed a higher peak A velocity (control group: 0.44 m/sec, Chagas group: 0.55 m/sec, p = 0.001), a lower E/A ratio (control group: 1.45, Chagas group: 1.22, p < 0.05), and a lengthening of the deceleration time of early diastolic filling (control: 138.7 ± 26.8 msec, Chagas group: 167.9 ± 34.6 msec, p = 001), thus revealing an early disorder of the diastolic left ventricular function in patients with Chagas' disease. CONCLUSION: in patients with Chagas' disease who are in the indeterminate phase, transmitral Doppler flow allowed to identify early abnormalities of the left ventricular diastolic function, which provide useful clinical information for prognostic stratification and treatment

Consensus Statement on Cardiac Diseases in Elderly Patients: Abbridged version

According to the 2014 World Health Statistics published by the World Health Organization, (1) life expectationhas been prolonged, so that for a girl born in 2012 life expectancy is around 73 years, while for a boy it is 68years, representing a 6-year increase with respect to the 1990 average. However, there are differences amongcountries; thus, in high-income countries, the probability of life expectancy for a boy is 76 years, 16 more thanfor those living in low-income countries, and in the case of girls the difference is even higher, reaching 19 years(82 vs. 63 years). In Argentina, survival has also extended to 77 for women and 73 for men. This marked increasein life expectancy has led to the growth of the elderly population, and it is expected that the populationover 80 years will be four times higher in the forthcoming years

Repercusión de la elevación de troponina T con valores normales de creatincinasa sobre la función ventricular en los síndromes coronarios agudos

Background The role of elevated troponins to predict changes on ventricular function in patients with high creatine kinase (CK) levels has been well established; yet, little is known about the clinical significance of high troponin levels with normal CK levels. Objective To analyze the relation between Troponin T (TnT) levels and global and regional left ventricular function in patients with acute coronary syndromes (ACS) with normal CK and CK-MB levels. Material and Methods We included patients admitted to the coronary care unit due to ACS within 48 hours from symptoms onset with elevated TnT levels measured by quantitative determination and normal CK and CK-MB levels. Biomarkers were measured at baseline, 24 and 48 hours. Left ventricular function was analyzed by two-dimensional echocardiography at admission and before discharge, and compared with the highest levels of the biomarkers. Ejection fraction, regional wall motion and global systolic longitudinal strain based on speckle-tracking technique were evaluated. Results Thirty patients with ACS were included. The highest median value of TnT was 0.13 ìg/L (interquartile range, 0.07-0.25) measured 24 hours after admission. Left ventricular ejection fraction was 62.9%±10% at admission and 62.8%±10.3% before discharge. Wall motion index was 1.04±0.1 and 1.03±0.1, respectively. Systolic strain at admission was 14.93±3 and improved before discharge 16.51±3.33 (p = 0.0003). Conclusions High TnT values in ACS with normal CK levels do not modify global or regional left ventricular function assessed by conventional echocardiography. The evaluation of systolic strain using a more sensitive technique detects transient abnormalities. These findings might question the definition of acute myocardial infarction based on high troponin levels, considering that the classical definition is based on elevated CK values which are associated with changes in ventricular function.Introduccion La repercusion de la elevacion de troponinas sobre la funcion ventricular izquierda en pacientes que no presentan aumento de creatincinasa (CK) por sobre el valor normal se conoce poco, a diferencia de lo que ocurre con los que presentan elevacion de CK. Objetivos Analizar la relacion entre los valores de troponina T (TnT) y la funcion ventricular izquierda global y regional en pacientes con sindromes coronarios agudos (SCA) sin elevacion de CK total ni de CK-MB. Material y metodos Se estudiaron pacientes ingresados a Unidad Coronaria con SCA que durante las primeras 48 horas de evolucion presentaron elevacion de TnT medida cuantitativamente con valores normales de CK y CK-MB. Se dosaron los biomarcadores en forma basal, a las 24 y a las 48 horas. Los valores mas elevados se utilizaron para compararlos con la funcion ventricular izquierda medida con ecocardiografia bidimensional transtoracica efectuada al ingreso y antes del alta hospitalaria. Se evaluaron la fraccion de eyeccion, la motilidad parietal regional y la deformacion sistolica longitudinal global del ventriculo izquierdo, esta ultima mediante la tecnica de speckle tracking. Resultados Se incluyeron 30 pacientes con SCA. La TnT mas elevada (mediana, rango intercuartil) fue de 0,13 mg/L (0,07-0,25) correspondiente a las 24 horas del ingreso. La fraccion de eyeccion ventricular izquierda en el primer ecocardiograma fue del 62,9% �} 10% y en el segundo, del 62,8% �} 10,3%. El indice de motilidad parietal fue de 1,04 �} 0,1 y de 1,03 �} 0,1. La deformacion sistolica tuvo un valor de .14,93 �} 3 al ingreso, que mejoro antes del alta con un valor de .16,51 �} 3,33 (p = 0,0003). Conclusiones La elevacion de TnT en los SCA sin elevacion concomitante de CK no altera la funcion ventricular global ni regional medida con metodologias convencionales. Utilizando un metodo mas sensible que mide la deformacion sistolica ventricular se detectan alteraciones transitorias. Esto podria cuestionar la definicion de infarto agudo de miocardio basada en la elevacion de troponinas, teniendo en cuenta que la definicion clasica basada en la CK suele repercutir, en mayor o en menor grado, sobre la funcion ventricular

Resultados inmediatos y seguimiento a largo plazo de la valvuloplastia mitral percutánea

Introduccion El tratamiento de la estenosis mitral ha cambiado en las ultimas decadas. Se ha demostrado que, frente al tratamiento quirurgico, la valvuloplastia mitral percutanea (VMP) presenta resultados hemodinamicos comparables y una evolucion similar. Objetivo Evaluar la eficacia y la evolucion clinica y ecocardiografica inmediata y a largo plazo de la VMP. Material y metodos Se incluyeron 132 pacientes que habian sido sometidos a VMP, con una mediana de seguimiento de 48 meses. Se considero exito primario cuando se obtuvo un area pos-VMP . 1,5 cm2. En el seguimiento se evaluaron: muerte, necesidad de reemplazo valvular mitral o de nueva VMP y reestenosis valvular. Resultados La media de edad fue de 44,6 anos; el 88,5% de los pacientes (n = 115) eran de sexo femenino. La mediana del area valvular mitral pre-VMP era de 0,90 cm2 (IIC 25-75: 0,81-1,00), la presion sistolica de la arteria pulmonar era de 44 mm Hg (IIC 25-75: 35-52) y el puntaje ecocardiografico, de 7 (IIC 25-75: 6-9). Se obtuvo exito primario en 104 pacientes (78,8%). En el seguimiento a 4 anos, el 86,5% de los pacientes (n = 109) se encontraban asintomaticos. Se registraron tres muertes intrahospitalarias (2,2%) y tres en el seguimiento (2,2%). Se realizo una nueva VMP en 10 pacientes y reemplazo valvular mitral en cuatro. Las variables asociadas con reestenosis en el seguimiento fueron el puntaje ecocardiografico > 8 (p = 0,04) y el area valvular mitral pos-VMP < 1,8 cm2 (p = 0,02). Luego del analisis multivariado, el area valvular mitral pos-VMP < 1,8 cm2 fue el unico predictor de reestenosis (OR: 2,6; IC 95%: 1,08-6,25). Conclusiones La VMP es segura y eficaz, eficacia que se mantiene a largo plazo. Los mejores resultados inmediatos se obtienen en pacientes con puntaje ecocardiografico bajo y en ritmo sinusal, mientras que aquellos con un area valvular mitral mayor pos-VMP son los que presentan menor reestenosis en el seguimiento

Loss of maternally derived human herpesvirus-6 immunity and natural infection in argentinian infants

AbstractBackground: Human herpesvirus-6 (HHV-6) infection is widespread throughout the world. No data are available in Argentina about the loss of maternally derived HHV-6 immunity and natural infection in infants.Methods: A population of 100 pregnant women and 407 children between 1 and 15 months of age were assayed by indirect immunofluorescence to detect and quantify specific IgG anti-human herpesvirus-6 (anti-HHV-6) antibodies in Córdoba City, Argentina.Results: There was no significant difference in the positive rate between infants aged 1 to 9 months (range, 43.6–35.5%) and pregnant women (37%). Seropositive ratio dropped in the 10-month group (23.33% seropositive) and rose sharply in the 11-month group (38.89%), 12-month (60.61 %), and 13- to 15-month group (63.46%). The geometric mean titer (GMT) for infants in the 12 to 15 months age group (23.4–41.64) was significantly higher than the GMT for infants 10 months of age (11.04) (P < 0.05 with the Tukey-HSD test).Conclusions: This study shows a significant association between loss of passive HHV-6 antibody and age among infants. The results support evidence that HHV-6 enters the susceptible population at 11 months, leading to a high prevalence of antibodies in children between 13 and 15 months of age