Fernando Barturen

Seudoaneurisma de la fibrosa mitroaórtica secundario a la desinserción parcial de una prótesis mecánica aórtica

Presentamos el caso de una mujer con un seudoaneurisma yatrogenico de la fibrosa mitroaortica por debajo de una protesis aortica. La desinsercion parcial de la sutura proximal del anillo se baraja como la etiologia mas probable. Esta inusual patologia fue documentada por ecocardiografia transesofagica como hallazgo inesperado en una paciente asintomatica que fallecio por un hematoma cerebral. Se comentan los aspectos diagnosticos, terapeuticos y pronosticos de esta infrecuente entidad.

Aturdimiento miocárdico en el contexto de hemorragia subaracnoidea

Myocardial stunning has been poorly described in patients with cerebrovascular accidents. We present a patient in whom severe anteroapical wall motion abnormalities and extensive anterior ST-segment elevation developed after subarachnoid hemorrhage. Total recovery ensued within 2 days. Coronary vasospasm induced by stroke-related sympathetic surge might be the determinant factor of this cardiac event.

Arteria subclavia derecha aberrante

La aparicion de molestias subxifoideas inespecificas en una nina de 12 anos motivo la realizacion de un esofagograma con bario. Este demostro la presencia de una muesca posterior de forma concava en la porcion media del esofago. Sospechando una anomalia de los grandes vasos, la paciente fue remitida para la realizacion de un ecocardiograma bidimensional. El estudio fue normal en las estructuras cardiacas, pero en la proyeccion supraesternal (panel superior izquierdo) se observo, en el corte longitudinal del arco, un arco aortico izquierdo del que nacian cuatro troncos supraaorticos en el siguiente orden: arteria carotida comun derecha (ACCD), arteria carotida comun izquierda (ACCI), arteria subclavia izquierda (ASI) y arteria subclavia derecha aberrante (ASDA). El estudio con Doppler color (panel inferior izquierdo) mostro el flujo en el interior de los troncos supraaorticos codificado en rojo hacia el transductor y en la aorta toracica descendente, codificado en azul, alejandose del transductor. La tomografia espiral computarizada del arco aortico confirmaba los hallazgos ecocardiograficos. En la reconstruccion tridimensional en la proyeccion oblicua-lateral izquierda (panel superior derecho) se observaba el nacimiento independiente de los cuatro troncos siendo la ASDA el ultimo vaso que emergia del arco. Este vaso aberrante (flecha) nacia del segmento posteroinferior del arco aortico distal y cruzaba hacia el brazo derecho posterior a la traquea (panel inferior derecho). La presencia de una ASDA asintomatica indujo a mantener una conducta expectante sin intervencionismo. IM A G E N E S E N CA R D I O L O G I A

Right Lateral Transthoracic Approach Mimicking Standard Transesophageal Echocardiographic Views in a Patient with Giant Left Atrium

We describe the case of a patient with long-standing severe mitral periprosthetic regurgitation and a giant left atrium. The patient was referred for surgery. On the third postoperative day, after resuture of the dehiscence of the valve sewing ring, the patient complained of dyspnea. Transthoracic ultrasound examination was performed to eliminate pleural effusion. The severe right lateral displacement of an aneurysmatic left atrial cavity contacting with the thoracic wall allowed us to obtain excellent images of the posterior cardiac anatomy by a right lateral thoracic view. The new transthoracic approach made it possible to safely assess the atrial side of the mitral prosthesis, eliminating mitral regurgitation after surgery without transesophageal echocardiographic examination.

Left ventricular pseudoaneurysm with left atrium tamponade: A rare postinfarction complication☆☆☆★

A 65-year-old man was readmitted to the hospital with deep-vein thrombophlebitis 3 weeks after suffering a small infarction. Two days after the patient was readmitted severe symptoms of cardiac failure developed. Transthoracic echocardiographic examination showed an unusual echo-free space adjacent to the lateral wall of the left atrium. No further diagnostic information could be obtained from precordial examinations. Single-plane transesophageal echocardiography demonstrated the presence of a ruptured aneurysm in the posterolateral wall of the left ventricle and a pseudoaneurysm, which was severely compressing the left atrial cavity. On color-flow Doppler examination a tear was detected in the wall of the left ventricular aneurysm close to the posterior atrioventricular sulcus. Pericardial adhesions because of coronary artery bypass grafting performed 10 years before may have contributed to the unusual location of this left ventricular pseudoaneurysm, complicated with left atrium tamponade after myocardial infarction.

Arco aórtico derecho y arteria subclavia izquierda aberrante

Rev Esp Cardiol 2003;56(8):817 817 A 38-year-old woman with no relevant clinical history was referred to the cardiology department by the gastroenterologist to assess symptoms of dysphagia. The esophagogram demonstrated a left posterior concave notch in the medial portion of the esophagus, of probable vascular etiology. A transthoracic echocardiogram ruled out associated congenital heart disease. Three-dimensional reconstructions of the great vessels obtained by helical computed tomography of the aortic arch revealed the anatomic relationships of this region in the anteroposterior view (upper right panel). The ascending aorta (AA) curved to the right of the trachea above the right main bronchus. The four main vessels arose independently in the following order: the first, running toward the left cervical region, was the left common carotid (>); the second, ascending to the right of the trachea, was the right common carotid (>>); the third was the right subclavian artery (>>>), which gave rise to the right vertebral artery a point more distal than usual; and the last was the left subclavian artery. The posteroanterior view (upper left panel) showed the left subclavian to be an aberrant artery (ALSA) emerging as the last vessel from a 22 mm aortic diverticulum (dv) which corresponded to an embryonic remnant of the left dorsal aorta. (In cases of left aortic arch with anomalous right subclavian artery, this IM AG E S I N CA R D I O L O G Y

Visualización de un trombo en el cayado aórtico desde la fosa yugular en un paciente con déficit de proteína C

Presentamos el caso de un varon de 63 anos que de forma simultanea presento infartos cerebral, mesenterico y renal de caracter embolico. El estudio ecocardiografico mostro una miocardiopatia dilatada idiopatica sin fuentes emboligenas intracardiacas. La visualizacion de la porcion proximal del cayado, alineando la arteria innominada desde la ventana de la fosa yugular, permitio observar el trombo «amenazante» casual. El estudio hematologico revelo un grave deficit de proteina C funcional.