Las anomalías coronarias se presentan en 1,7% de la población general y causan el 33% de las muertes súbitas en personas jóvenes durante un esfuerzo extenuante. El uso de técnicas de imagen cardíaca ha permitido expandir el conocimiento sobre el diagnóstico de estas anomalías. Existen tres tipos de acuerdo a la clasificación de Greenberg: anomalías de origen, de curso y de terminación. Las de mayor importancia son las que causan alteraciones hemodinámicas y son la atresia coronaria, la anomalía de la arteria coronaria izquierda desde la arteria pulmonar/ anomalía de la arteria coronaria derecha desde laarteria pulmonar, el curso interarterial cuando nacen del seno coronario opuesto, las fístulas coronarias y las ectasias coronarias. La evaluación por angiotomografía coronaria multidetector permite caracterizarlas desde el ostium hasta su terminación, y para demostrar las consecuencias clínicas en el paciente existen técnicas de imagen como la resonancia magnética cardíaca de estrés, la ecocardiografía de estrés, la tomografía computarizada por emisión de fotón único y la angiografía coronaria con evaluación por flujo de reserva coronaria o radio instantáneo de onda libre que permiten definir el tratamiento.
Endocarditis due to mycobacterial pathogens is a very rare entity, linked with hospital environment and early after valve replacement, with only a few cases reported of Mycobacterium abscessus. To our knowledge, there are 13 case reports in the literature, with only one case on native valve. A 66-year old male patient, with no previous intravenous drug use, and mechanical aortic valve replacement with myocardial revascularization (posterior descendent artery) eleven years ago, presented with fever and dyspnea, transthoracic echocardiography showed a 7x5 mm-sized vegetation in the aortic prosthetic valve, and thickness in mitral-aortic fibrosa extended to mitral anterior leaflet (Panel A). Blood cultures reported fast growing mycobacteria, and microarray genetic testing revealed Mycobacterium abscessus. HIV, B and C hepatitis testing results were negative. Antibiotic therapy started with imipenem, cotrimoxazole and amikacin, and after culture guided adjustment, continued with amikacin and tygecicline. One month after, patient presented persistence of positive blood cultures and a new transthoracic echocardiography reported abscessus in mitral-aortic fibrosa (Panel B), after that finding, surgery was planned, the aortic valve was replaced by another mechanical prostheses. Patient was discharged after multiple negative blood cultures and clinical stablility. Three months after, patient presented fever, empirical antibiotic treatment was tigecicline and amikacin, blood cultures reported Mycobacterium abscessus, new transthoracic echocardiography revealed 11x8 mm-sized vegetation, and new abscessus on mitral-aortic fibrosa (Panel C). Blood cultures remain positive, and new valve replacement is decided by Heart Team with bad prognosis, after surgery patient died. Pathology department reported valve prosthesis with inflammatory infiltrate, with presence of grampositive bacilli, and positive Ziehl-Neelsen stain (Panel E,D). Non-tuberculous mycobacteria is an emergent pathogen group, with wide spectrum of infections, specially reported in lung, soft tissues and eyes, with few cases reported of cardiac disease. These pathogens showed multidrug resistance, and high mortality. The most large series report 50 patient affected with mycobacterial endocarditis, and seven caused by Mycobacterium absccesus. There are several problems regarding treatment, with a lack of consensus among it; literature suggest early susceptibility test for macrolides (clarythromicin), aminoglucosides, quinolones, cotrimoxaole, tygecicline and carbapenem antibiotic. Treatment usually involves initial combination antimicrobial therapy with macrolide plus intravenous agents for at least 2 weeks to several months followed by oral macrolide-based therapy. In vitro MIC of tygecicline are low, and the drug should also be considered in treatment regimen. Abstract P1695 Figure. Echocardiography and pathology images
with general protection measures and a total reorganization in its logistics to prevent the transmission of this virus while at the same time providing a continuum of care to cardiovascular emergencies at the beginning of the pandemic, considering that these are the leading cause of death worldwide.
La perforación cardíaca por electrodo de marcapasos es una de las complicaciones posteriores al implante que se presenta con una frecuencia baja, pero su gravedad justifica que el diagnóstico sea temprano para evitar complicaciones fatales. En este artículo se presenta dos casos de perforación cardíaca por electrodo de marcapasos temporal en donde se observa la utilidad de la cardio-TC con o sin contraste, para confirmar la presencia del electrodo en el espacio pericárdico o incluso fuera de éste.
Introduction:The significance of troponin I (Tn-I) elevation after percutaneous coronary intervention (PCI) is the subject of debate. Objective: To determine cardiovascular prognosis associated with Tn-I elevation one year after successful elective PCI. Methods: Observational, retrospective, longitudinal study. Patients who underwent successful elective PCI were included and divided in two groups: with and without Tn-I elevation, in order to compare the occurrence of major adverse cardiac events (MACE) at 1 year; post-PCI Tn-I was correlated with demographic and angiographic characteristics. Results: Tn-I elevation was detected in 32 patients (35.2%). Elevation was more common in patients with multivascular and more complex coronary artery disease, and with peri-PCI complications. MACE incidence at one year was higher in the elevated
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