Elena Refoyo

Role of real-time three-dimensional transoesophageal echocardiography for guiding transcatheter patent foramen ovale closure

Patent foramen ovale (PFO) is a relatively common congenital condition which has been implicated in cryptogenic stroke as a result of paradoxical thromboembolism by right-to-left shunting. Many studies have demonstrated that transcatheter PFO closure significantly reduced the incidence of recurrent strokes in a small group of high-risk patients with PFO and atrial septal aneurysm compared with antithrombotic drugs. Two-dimensional transoesophageal echocardiography (2D TEE) has become the election technique for guiding patent foramen ovale closure. Real-time Three-dimensional transoesophageal echocardiography (3D TEE) may be potentially superior to 2D TEE in the accurate assessment of the morphology and efficacy of transcatheter closure devices because of a better spacial orientation.

Evaluación de tamaño, función y rangos de normalidad de la asincronía de la aurícula izquierda en sujetos sanos mediante ecocardiografía tridimensional

El tamano y la funcion de la auricula izquierda tienen implicaciones pronosticas muy importantes. Nuestro objetivo fue evaluar el tamano, la funcion y la sincronia mecanica de la AI mediante ecocardiografia tridimensional (eco-3D), para establecer los valores de referencia normales. Sesenta y tres sujetos sanos fueron estudiados en 2 hospitales. Todos ellos fueron sometidos a una ecocardiografia bidimensional (eco-2D) y eco-3D. Para la valoracion de la asincronia, se obtuvo la desviacion estandar del tiempo que cada segmento auricular emplea en alcanzar el minimo volumen regional durante la sistole auricular, normalizado por el intervalo RR (IDS 16). El valor medio del IDS 16 fue 15,4 ± 10,9. En conclusion, la asincronia, el tamano y la funcion de la AI pueden ser analizados mediante eco-3D.

Real-time representation of multielectrode ablation catheters by integration of computed tomographic geometry with three-dimensional electroanatomic mapping of left atrium and pulmonary veins

t B f s t P l s a S t v A m c t f w t R l A 36-year-old man without apparent structural heart disase was referred for catheter ablation of atrial fibrillation. e had weekly episodes of palpitations that were resistant to iltiazem, propranolol, and flecainide. Short bursts of atrial achycardia and fibrillation were demonstrated on ECGs and 4-hour ambulatory ECG Holter monitoring recorded on ifferent days. The patient underwent 64-detector multislice omputed tomography (CT) of the left atrium and pulmoary veins before the ablation procedure. A 24-pole ring-shaped catheter (yellow in Figure 1) and custom octapolar ablation catheter (white in Figure 1) ere introduced into the left atrium for mapping and abla-

Three-Dimensional Echocardiographic Assessment of Left Atrial Size and Function and the Normal Range of Asynchrony in Healthy Individuals

Left atrial size and function are very important prognostic factors. Our aim was to evaluate left atrial size, function and mechanical synchrony using three-dimensional echocardiography in order to establish normal reference values. The study involved 63 healthy individuals enrolled at two hospitals. All underwent two-dimensional and three-dimensional echocardiography. Mechanical asynchrony was assessed by determining the standard deviation of the time each left atrial segment took to reach the minimum volume during atrial systole, normalized by the RR interval. The mean value for this normalized standard deviation was 15.4+/-10.9. In conclusion, it is possible to analyze left atrial asynchrony, size and function using three-dimensional echocardiography.

Sudden cardiac arrest due to atrioventricular block: A diagnostic challenge

Sudden cardiac arrest survivors continue to be a challenge for cardiologists. An appropriate initial diagnostic approach is crucial for planning a successful therapeutic strategy. We report the case of a 62-year-old woman who suffered an out-of-hospital cardiac arrest due to third-degree atrioventricular (AV) block. Despite suspected acute coronary syndrome, the coronary angiogram proved inconclusive, while cardiac magnetic resonance imaging ruled out other differential diagnoses such as acute myocarditis. The reversible nature of the AV block rendered permanent pacing unnecessary.

Advanced Cardiovascular Magnetic Resonance Techniques in Grown-Up Congenital Heart Disease

PurposeCongenital heart diseases comprise a complex population in which functional and anatomic evaluation with cardiac magnetic resonance (CMR) acquires utmost importance in the decision-making process. The use of new CMR technologies can help us understand the physiopathology and improve risk stratification.Recent FindingsEfforts towards a better understanding of the processes that underlie the occurrence of adverse events in these patients, mainly heart failure and arrhythmia, have been made in the last years. Early identification of subclinical myocardial involvement by means of detection of changes at the cellular level (fibrosis and extracellular expansion) or impaired ventricular mechanics (deformation techniques) is now possible thanks to late gadolinium enhancement/T1 mapping and strain respectively.SummaryPreliminary studies suggest that the presence of fibrosis, either replacement or diffuse fibrosis, and the detection of impaired deformation parameters or significant dyssynchrony are related to outcomes. Assessment of intracardiac and great vessels flow with 4D flow imaging is an attractive research tool that offers a comprehensive evaluation of hemodynamic status and the possibility of obtaining new promising functional parameters.

Extensive Chest Wall Destruction Secondary to a Large Ventricle Pseudoaneurysm: A Surgical Challenge

Left ventricular pseudoaneurysms have become a rare complication of acute myocardial infarction, occurring in approximately 2% of cases and even less frequently when primary percutaneous intervention can be performed. Regardless of treatment strategy, left ventricle pseudoaneurysms are associated with a high mortality rate. We report on the extremely rare occurrence of a patient surviving two episodes of free wall rupture associated with extensive chest wall destruction and secondary traumatic rib fractures. The key to success in this case is related to both the cardiac and chest wall repair.

Diagnostic Value of NT-proBNP for Early Identification of Chagas Cardiomyopathy in Non-endemic Areas

Chagas disease is the first cause of nonischemic heart disease in Latin America and is associated with considerable morbidity and mortality. The prevalence of this condition has increased in Europe as a consequence of current migratory trends. Once the heart disease is established in this condition, there is no benefit from treating the infection. Hence, it is essential to achieve a prompt diagnosis to change the course and prognosis of the disease. Natriuretic peptide analysis has shown diagnostic and prognostic value in several cardiomyopathies. Our aim was to achieve prompt detection of Chagas cardiomyopathy by analyzing the Nterminal pro-B-type natriuretic peptide (NT-proBNP), evaluating several echocardiographic parameters of diastolic dysfunction and systolic function, and determining the regional systolic shortening by myocardial strain measurement. A prospective, observational study was carried out in 85 patients with positive serology for Trypanosoma cruzi between January 2015 and June 2016. All patients underwent NT-proBNP determination by chemiluminescence immunoassay, electrocardiography (ECG), and transthoracic echocardiography (TTE). In patients with abnormalities, cardiac magnetic resonance (MR) imaging was additionally performed. The statistical analysis used SPSS v.21. Correlations of NTproBNP concentrations with the ejection fraction and diastolic dysfunction parameters (mainly the indexed atrial volume and the E/e’ ratio) were analyzed using the Pearson test. The sensitivity and specificity of NT-proBNP for predicting Chagas cardiomyopathy

Left atrial appendage fistula mimicking a paravalvular prosthetic regurgitation.

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5][![Graphic][6] ][6] A 50-year-old woman presented to the emergency department with febricula 2 months after mitral valve replacement and left atrial appendage (LAA) closure due to mitral stenosis.