Julián Vega

Spontaneous rupture of tricuspid valve papillary muscle in pulmonary hypertension secondary to HIV infection. Report of one case

Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42-year-old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who presented with an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilator therapy. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully controlled with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a life saving and useful approach in this condition.Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42 years old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who developed an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilators. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully managed with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a live saving and useful approach in this condition.

Rotura espontánea de válvula tricúspide en un paciente con hipertensión pulmonar secundaria a VIH

Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42-year-old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who presented with an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilator therapy. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully controlled with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a life saving and useful approach in this condition.Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42 years old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who developed an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilators. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully managed with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a live saving and useful approach in this condition.

Utilidad de los biomarcadores en Insuficiencia Cardiaca en la práctica clínica

The assessment of patients with a suspected cardiac failure aims to an early and precise diagnosis and risk stratification. Only natriuretic peptides have demonstrated to be clinically useful. Brain natriuretic peptide stands out due to its diagnostic and prognostic value. However its results should be cautiously interpreted in the clinical context, bearing in mind possible confounders. The combination of markers can provide a better risk stratification and compensates the limitations of individual markers. Each new marker gives a new insight on the underlying physiopathology of cardiac failure and proposes new therapeutic approaches.

Reparación de una perforación valvular mitral como secuela de endocarditis, aporte de la ecocardiografía tridimensional

Resumen Reportamos un caso de reparacion de perforacion valvular mitral en un joven de 18 anos que consulta por disnea de esfuerzos y con el an-tecedente remoto de una artritis septica de rodilla tratada. En el examen fisico se encontro un soplo holosistolico 4/6 en el foco mitral. Se realizo un ecocardiograma transtoracico (ETT) que objetivo una insuficiencia mitral severa, con un jet de recorri-do muy excentrico originado desde anterior, sospe-chando una perforacion del velo anterior, sin lograr caracterizarla por dicha tecnica. Se complemento el estudio con un ecocardiograma transesofagico (ETE) en una plataforma EPIQ 7 cv (PHILIPS), que identifico en el cuerpo del segmento 2 del velo an-terior mitral (A2) una posible perforacion. El anali-sis de la valvula mediante ETE tridimensional (3D), confirmo una perforacion circular de bordes netos, de dimensiones maximas 6x6 mm, localizada en el cuerpo de A2. El analisis 3D aporto valiosa informa-cion para programar la reparacion valvular, la cual se efectuo mediante un parche de pericardio autolo-go fresco (sin fijacion en glutaraldehido) y una anu-loplastia con un anillo rigido, con optimo resultado y sin complicaciones.

Síncope secundario a mixoma gigante del anillo mitral: Reporte de un caso

We report a 23 years old woman, with three recent exertional syncopes. Transthoracic (TTE) and transesophageal (TEE) echocardiography found a large heterogeneous mass (38 x 35 mm) arising from the posterior mitral annulus, protruding in systole through the left ventricular outflow tract (LVOT). Heart MRI confirmed the echocardiography findings, suggesting a cardiac myxoma. Cardiac surgery accomplished the complete resection of the lesion, confirming a mass arising from the posterior mitral annulus and preserving mitral anatomy and function. Pathology was positive for a myxoma. Uneventful evolution allowed the discharge of the patient at the fifth postoperative day. Control TTE discarded any complication.

Rotura espontánea de válvula tricúspide en un paciente con hipertensión pulmonar secundaria a VIH: Report of one case

Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42-year-old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who presented with an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilator therapy. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully controlled with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a life saving and useful approach in this condition.Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42 years old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who developed an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilators. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully managed with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a live saving and useful approach in this condition.

Tormenta eléctrica en síndrome de Brugada tratada exitosamente con infusión de isoproterenol

We report A 22 years old male who experienced several episodes of syncope within a time frame of few hours. In the emergency room, multiple ventricular fibrillation episodes where documented along with a type 1 Brugada ECG pattern. Isoproterenol in continuous infusion was started, which normalized the ECG pattern and avoided the recurrence of arrhythmias. The patient was implanted with an automated defibrillator and discharged 3 days after admission.We report a 22-year-old male who experienced several episodes of syncope within a timeframe of few hours. In the emergency room, multiple ventricular fibrillation episodes where documented along with a type 1 Brugada ECG pattern. Isoproterenol in continuous infusion was started, normalizing the ECG and avoiding further arrhythmia recurrences. The patient was implanted with an automated defibrillator and discharged 3 days after admission.