Actinic Papillary Fibroelastoma of the Left Ventricle

We present the case of a 69-year-old woman with a history of endometrial carcinoma in 1996, who underwent a total hysterectomy and bilateral adnexectomy. The patient also received chemotherapy (doxorubicin and cisplatinum) and local radiotherapy (50 Gy) because of a single lung metastasis, with total remission during later follow-up. During follow-up, 10 years later following radiotherapy, a transthoracic echocardiogram (TTE) revealed an image consistent with a primary cardiac tumor (papillary fibroelastoma) or metastatic cardiac tumor on the posteromedial papillary muscle. Cardiac magnetic resonance imaging (MRI) revealed a solid mass on the posteromedial papillary muscle with late enhancement, consistent with a primary cardiac tumor. During surgery, the tumor located in the posteromedial papillary muscle was resected. A pathological examination revealed the presence of a tumor mass with a core of dense connective tissue surrounded by a layer of hyperplastic endocardial cells characteristic of a papillary fibroelastoma. After 8 years of follow-up, the patient remains asymptomatic

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

Subaortic and mid-ventricular obstructive hypertrophic cardiomyopathy with an apical Aneurysm: a case report

BACKGROUND: Most patients with hypertrophic cardiomyopathy (HCM) have asymmetric septal hypertrophy and among them, 25% present dynamic subaortic obstruction. Apical HCM is unusual and mid-ventricular HCM is the most infrequent presentation, but both variants may be associated to an apical aneurysm. An even more rare presentation is the coexistece mid-ventricular and apical HCM. This case is a combination of obstructive HCM with mid-ventricular HCM and an apical aneurysm, which to date, has not been reported in the literature. CASE PRESENTATION: The patient is a 49 year-old lady who presents a combination of septal asymmetric hypertrophic cardiomyopathy (HCM) and midventricular HCM, a subaortic gradient of 65 mm Hg and a midventricular gradient of 20 mm Hg, plus an apical aneurysm. Her clinical presentation was an acute myocardial infarction in June 2005. One month after hospital discharge, the electrocardiogram (ECG) showed a right bundle branch block (RBBB) with no Q waves or ST segment elevation. Coronary angiography revealed normal coronary arteries, left ventricular hypertrophy and an apical aneurysm. CONCLUSION: This case is a rare example of an asymptomatic patient with subaortic and mid-ventricular hypertrophic cardiomyopathy, who presents a myocardial infarction and normal coronary arteries, and during the course of her disease develops an apical aneurysm

Papillary fibroelastoma of the left ventricle in a radiation-treated cancer patient

We present the case of a 69-year-old female patient with a history of endometrial carcinoma in 1996, who underwent a total hysterectomy and bilateral adnexectomy. The patient also received chemotherapy and mediastinal radiotherapy followed by cancer remission. Ten years later she presented with heart failure and her Doppler-echocardiogram showed severe mitral regurgitation with pulmonary hypertension and a papillary fibroelastoma in the left ventricle. In 2011, she underwent a mitral valve replacement with a biological prosthesis and the pathology exam revealed valve damage consistent with radiotherapy- induced changes and confirmed the presence of a papillary fibroelastoma. This unusual mechanism of papillary fibroelastoma should be disseminated among cardiology physicians and in patients who have survived for long periods after radiotherapy. It is important to remember that cardiac complications may indeed occur, and the treating physician is responsible for detecting them

Two-dimensional speckle tracking echocardiography for the assessment of atrial function

Echocardiography is the most common diagnostic method for assessing atrial function but the technique has some limitations. Traditionally, assessment of left atrial function has been performed by measuring volumes with 2D echocardiography. Additionally, it can be assessed with transmitral Doppler and pulmonary vein Doppler. Recently, an alternative method has been incorporated, namely, measurement of myocardial deformation with color tissue Doppler-derived strain. However, this method has several limitations, such as suboptimal reproducibility, angle-dependence, signal artifacts and the fact that it only measures regional strain and does not obtain information about the curved portion of the atrial roof. To overcome these limitations in the quantification of atrial function, the use of speckle tracking echocardiography (STE) strain has been proposed. This technique is not derived from Doppler but rather from 2D echocardiography; it is angle-independent and allows one to measure global as well as regional atrial strain. In this editorial, we describe the physical and pathophysiological concepts of STE and underline the clinical usefulness of this new technique

Speckle tracking echocardiography in the indeterminate form of Chagas disease

Fil: Cianciulli, Tomás Francisco. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Albarracín, Gerardo Ariel. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Napoli Llobera, Mariano. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Prado, Nilda Graciela. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología; Argentina.Fil: Saccheri, María Cristina. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Hernández Vásquez, Yolanda María. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología; Argentina.Fil: Méndez, Ricardo José. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Beck, Martín Alejandro. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Baez, Karina Giselle. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Balletti, Lorena Romina. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Background: Chagas disease is one of the most common diseases in Latin-America, and cardiac involvement is a significant cause of death. Assessment of myocardial strain may detect early myocardial damage. Objectives: To determine differences in longitudinal strain using speckle tracking to assess regional and global left ventricular function in patients with the indeterminate form of Chagas disease, in comparison with a control group. Methods: This is a retrospective matched case-control study, conducted in a single center. We evaluated 45 adult patients with Chagas disease, diagnosed with 2 serological methods, without evidence of cardiac involvement, who were compared with 45 healthy control subjects, who were sex- and age-matched. All patients underwent Doppler echocardiography and longitudinal strain with speckle tracking. Results: Median age was 59 years, and 60% were female. Echocardiographic parameters were similar in patients with Chagas and control subjects. In patients with Chagas, global strain differed significantly from that of control subjects (-17 vs -20.3, P < .001). Segmental strain showed 7 abnormal segments in patients with Chagas (P < .05). Conclusions: In patients with the indeterminate form of Chagas disease, global and segmental longitudinal peak systolic strain is reduced compared with healthy subjects, thus suggesting that it could be a sensitive technique to detect early myocardial damage. These findings could provide useful information regarding the pathophysiology of cardiac involvement and understand whether they might have prognostic usefulness or help develop strategies to modify the course and prognosis of patients with Chagas disease. A longitudinal prospective study would be necessary to validate our findings

Use of tissue doppler imaging for the early detection of myocardial dysfunction in patients with the indeterminate form of Chagas disease

Fil: Cianciulli, Tomás Francisco. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Saccheri, María Cristina. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Papantoniou, Alonso. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Méndez, Ricardo José. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Gagliardi, Juan Alberto. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Prado, Nilda Graciela. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología; Argentina.Fil: Riarte, Adelina. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología; Argentina.Fil: Morita, Luis Alberto. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Clérici, Javier Eduardo. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Lax, Jorge Alberto. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Chagas disease is one of the most common diseases in Latin America and heart involvement is the main cause of death. This study aimed to determine differences in tissue Doppler imaging (TDI) parameters in the assessment left and right ventricular function in patients with the indeterminate form of Chagas disease compared to those in healthy controls