Isabel Maté

Aspergillus Aortitis After Cardiac Surgery

OBJECTIVES The aim of this study was to describe the clinical characteristics of Aspergillus aortitis in a small series of consecutive patients. BACKGROUND Aspergillus infection of the ascending aorta after cardiopulmonary bypass surgery has rarely been reported and has always resulted in death. METHODS Aspergillus aortitis was confirmed by pathologic and microbiologic analysis in eight men (61 +/- 8 years) of 9,375 consecutive patients who underwent cardiac surgery between 1975 and 2000. RESULTS Patients presented with Aspergillus aortitis after aortic valve replacement (n = 5), coronary revascularization (n = 2), or both (n = 1). Initial symptoms appeared between the immediate postoperative period and up to two years after surgery. All patients had prolonged fever. Ante-mortem diagnosis was established in only three patients for whom transthoracic echocardiography was suggestive of aortic pseudoaneurysm and was confirmed by thoracic computed tomography or aortography. All patients had negative peripheral blood cultures. Seven patients died at short-term follow-up, and the one surviving patient was promptly treated by surgery and antifungal drugs. Pathologic examination confirmed Aspergillus aortitis with multi-organ dissemination without heart involvement in all patients except for two, in whom aortic valve endocarditis was found. Fungal cultures confirmed the presence of Aspergillus fumigatus in all patients. CONCLUSIONS Aspergillus aortitis is typically found after aortic valve or coronary surgery. It commonly leads to lethal multi-organ dissemination without involvement of the intracardiac structure. This entity should be considered in patients with persistent fever and negative blood cultures after open-heart surgery involving significant aortic wall damage, irrespective of the postoperative period.Objectives The aim of this study was to describe the clinical characteristics of Aspergillusaortitis in a small series of consecutive patients.

Initial outcome of percutaneous balloon valvuloplasty in rheumatic tricuspid valve stenosis

Abstract Percutaneous balloon valvuloplasty (PBV) has been used as an effective treatment for some cases of valvular stenosis, mainly in the mitral, 1 pulmonary 2 and aortic 3 valves. Less experience has been achieved with this procedure for valvular tricuspid stenosis. 4–7 We present the immediate results of 5 cases of PBV in stenotic tricuspid valves.

Myocardial Involvement in Systemic Lupus Erythematosus: A Noninvasive Study of Left Ventricular Function

A relatively high incidence of heart failure is noted among patients with systemic lupus erythematosus (SLE) without clearly defined clinical causes. To evaluate left ventricular performance in patients with SLE without evidence of cardiovascular disease, noninvasive measurement of the systolic time intervals was carried out. Simultaneous recording of the electrocardiogram, phonocardiogram and carotid arterial pulsation were obtained in 25 patients with systemic lupus erythematosus and compared with 22 normal subjects. The patients with SLE had a shorter left ventricular ejection time (P less than 0.05), a longer pre-ejection period (P less than 0.02) and an increased ratio of pre-ejection period/left ventricular ejection time (P less than 0.005). These abnormalities on ventricular function were independent of age, duration of the disease, hypertension, renal involvement, anemia, immunologic activity and corticosteroid treatment. Several etiologic possibilities are discussed and the clinical usefulness of this method to detect and follow-up the cardiac dysfunction in systemic lupus erythematosus is emphasized.

Endocarditis por Coxiella burnetii: evolución a largo plazo de 20 pacientes

Introduccion y objetivos Coxiella burnetii es una causa cada vez mas frecuente de endocarditis infecciosa de evolucion subaguda asociada a una elevada morbimortalidad. Nuestro objetivo fue analizar, en una serie de 20 pacientes, la evolucion clinica, serologica y terapeutica a largo plazo. Metodos Se estudiaron retrospectivamente 20 pacientes ingresados (13 varones y 7 mujeres con una edad media de 42 ± 10 anos) entre 1982 y 1996, que cumplian criterios de Duke modificados por Raoult para endocarditis por fiebre Q. Resultados La endocarditis asento sobre protesis valvular en 14 pacientes y sobre valvula nativa en 6. Todos excepto uno recibieron tratamiento antibiotico, presentando la doxiciclina en monoterapia peor resultado que combinada con otros farmacos. Fueron sometidos a recambio valvular 15 pacientes, siendo la causa mas frecuente la disfuncion protesica. La mortalidad global fue del 40% (8 pacientes). Actualmente, todos los pacientes mantienen valores de anticuerpos antifase I elevados tras un seguimiento entre 19 y 156 meses (media de 74 ± 47 meses). En 5 pacientes se suspendio el tratamiento antibiotico, dada la negatividad microbiologica valvular, permaneciendo asintomaticos tras 15-65 meses (32 ± 30) de seguimiento. Conclusiones La endocarditis por fiebre Q se asocia a un alto indice de complicaciones severas que requieren cirugia de sustitucion valvular. Todos los pacientes mantienen titulos serologicos elevados de forma cronica, sin otros datos de infeccion activa, lo que plantea la posibilidad de retirar el tratamiento en algun enfermo con negatividad valvular microbiologica y cuestiona el valor de la persistencia de una serologia anormal como monitorizacion del tratamiento.

Effectiveness of balloon percutaneous valvuloplasty for stenotic bioprosthetic valves in different positions

Abstract Percutaneous balloon valvuloplasty has been used as treatment for native valvular stenosis in the mitral, aortic, pulmonary and tricuspid positions. 1–4 It has also been used as palliative therapy for stenotic bioprosthetic valves. 5–8 In this study we present the immediate results and midterm follow up of percutaneous balloon valvuloplasty of 5 bioprosthetic valves in different positions.

A recidivant primary cardiac osteosarcoma: the role of bone scans

Primary cardiac tumors are infrequent, less than 15-20% are malignant, and most of them are sarcomas. Primary recidivant cardiac osteosarcomas are extremely rare, only a few cases have been reported, and the prognosis is ominous. We report a case of a primary cardiac osteosarcoma in a 70-year-old woman who was admitted to the hospital for evaluation of congestive heart failure. Despite the wide resection of the tumor, a local and metastatic recurrence was diagnosed. In this report, we illustrate the utility of image techniques for the diagnosis and the monitoring of primary cardiac tumors, especially the role of bone scintigraphy. This technique is not a routine procedure for the cardiologist, but it has been very useful in this case in order to decide the optimal treatment.

Bradycardia-dependent interatrial block with retrograde left atrial activation.

A patient with a peculiar interatrial block is reported. The electrocardiogram showed a short PR interval and negative P waves in II, III, and aVF, which were preceded, 0-07 s earlier, by another positive P wave present in the right praecordial leads which were absent in the limb leads. From the study with His bundle electrograms, high right atrial electrograms, and bipolar oesophageal electrocardiograms, it could be proved that atrioventricular, His-Purkinje, and right intra-atrial conduction were normal, and that P waves recorded in limb leads represented left atrial depolarization; whereas the ones in the right praecordial leads corresponded to right atrial activation. The vectorial analysis from both P waves and atrial potentials showed that the left atrium was activated in a retrograde fashion, because of an interatrial block. This block was bradycardia dependent and it disappeared in the cycles shorter than 800 ms.

Disappearance of right bundle branch block with left anterior hemiblock when associated with a type B pre-excitation syndrome

Abstract A patient with mitral valve disease showing RBBB plus LAH with an intermittent association of type B pre-excitation is presented. The bifascicular block is masked by the existence of pre-excitation. The RBBB image is entirely canceled and the LAH is altered because its inital forces are replaced by a delta wave. The electrical axis in the frontal plane is also modified. The mechanism of production of this ventricular complex is explained on the basis of the premature excitation of the right ventricle and the sum of forces produced by the activation through the posteroinferior division of the left bundle.

Infective Endocarditis of Unusual Location Following Surgical Correction of a Complex Congenital Heart Disease

A 40‐year‐old woman from Ecuador diagnosed with a complex congenital heart disease was admitted complaining of fever chills, night sweats, and productive cough 6 months after surgical correction of the anomalies. An echocardiography showed vegetations located on the interatrial pericardium patch. To the best of our knowledge, this is the first reported case of postoperative infective endocarditis on this location. Copyright

Left ventricular cavity obliteration: hemodynamic behavior of the postextrasystolic beat

Abstract Thirteen patients with angiographic left ventricular cavity obliteration are analyzed. No transvalvular or subvalvular gradients were present except in two cases with a mild gradient after amyl nitrite inhalation. The commonest clinical features were chest pain (60%) and dyspnea (23%). Electrocardio-graphically proved left ventricular hypertrophy (70%) was prominent. The echocardiograms showed asymmetric septal hypertrophy (40%), symmetric hypertrophy (20%), systolic anterior motion of the anterior leaflet of the mitral valve (60%), and mitral valve prolapse (20%). In all the patients changes in systolic intraventricular pressure in the post-extrasystolic beat were evaluated and a decrease in intraventricular pressure was found in every case. In the four cases with extrasystoles recorded in the aorta a similar decrease of aortic pressure was found. This behavior is completely different in the hypertrophic cardiomyopathy with obstruction to the left ventricular outflow tract, where there is an increase in intraventricular pressure and a decrease in aortic pressure in the postextrasystolic beat. Left ventricular cavity obliteration is an angiographic phenomenon which is common in hypercontractile states, being an usual finding in hypertrophic cardiomyopathy. In cases without obstruction to the left ventricular outflow tract, the decrease in aortic pressure is caused by a different mechanism than the one involved in cases with obstruction. In cases without obstruction, the decrease in post-extrasystolic aortic pressure corresponds to a decrease in intraventricular pressure, whereas in subaortic stenosis there is an increase both of intraventricular pressure and gradient with the subsequent decrease in aortic pressure.