Leopoldo Perez de Isla

Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC).

Non-thrombotic PE does not represent a distinct clinical syndrome. It may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the diagnosis difficult. With the exception of severe air and fat embolism, the haemodynamic consequences of non-thrombotic emboli are usually mild. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity.

Functional mitral regurgitation after a first non-ST segment elevation acute coronary syndrome: very-long-term follow-up, prognosis and contribution to left ventricular enlargement and atrial fibrillation development

Objective To assess the relationship between functional mitral regurgitation (MR) after a non-ST segment elevation acute coronary syndrome (NSTSEACS) and long-term prognosis, ventricular remodelling and further development of atrial fibrillation (AF), since functional MR is common after myocardial infarction. Design and setting Prospective cohort study conducted in a tertiary referral centre. Patients We prospectively studied 237 patients consecutively discharged in New York Heart Association class I–II (74% men; mean age 66.1 years) after a first NSTSEACS. All underwent an ECG the first week after admission and were echocardiographically and clinically followed-up (median 6.95 years). Results MR was detected in 95 cases (40.1%) and became an independent risk factor for the development of heart failure (HF) and major adverse cardiovascular events (MACE) (per MR degree, HRHF 1.71, 95% CI 1.138 to 2.588, p=0.01; HRMACE 1.49, 95% CI 1.158 to 1.921, p=0.002). Left ventricular diastolic (grade I 12.7±40.7; grade II 26.8±12.4; grade III 46.3±50.9 mL, p=0.01) and systolic (grade I 10.4±37.3; grade II 10.12±12.7; grade III 36.8±46.0 mL, p=0.02) mean volumes were higher after follow-up in patients with MR, in proportion to the initial degree of MR. In the rhythm analysis (126 patients; previously excluding those with any history of AF) during follow-up, 11.4% of patients with degree I MR, 14.3% with degree II MR and 75% with degree III MR developed AF, while only 5.1% of those with degree 0 developed AF, p<0.001. Conclusions MR is common after an NSTSEACS. The presence and greater degree of MR confers a worse long-term prognosis after a first NSTSEACS. This can in part be explained by increased negative ventricular remodelling and increased occurrence of AF.

Clinical and hemodynamic results after direct transcatheter aortic valve replacement versus pre-implantation balloon aortic valvuloplasty: A case-matched analysis.

To evaluate the safety and midterm hemodynamic results of direct transcatheter aortic valve replacement (TAVR) without pre‐implantation balloon aortic valvuloplasty (BAV).

Calcified right ventricular thrombus and antiphospholipid syndrome

Antiphospholipid syndrome has been associated with venous and arterial thrombotic events but intracardiac thrombosis is rare. We describe a case about a 30-year-old woman, admitted with a 6-month history of arthralgia, fatigue, and intermittent fever. Subsequent investigation revealed the presence of a large and calcified mass in the right ventricular outflow tract attached to the subvalvular tricuspid apparatus. Cardiac surgery was performed and histological examination demonstrated it to be composed entirely of calcified thrombus. Screening laboratory evaluation for hypercoagulable states confirmed the diagnosis of antiphospholipid syndrome.

Giant Pericardial Cyst Compressing the Heart

Institute, Hospital Universitario San Carlos, Madrid, Spain; and the yRadiodiagnostic Service, Hospital Universitario San Carlos, Madrid, Spain. Manuscript received January 27, 2013; accepted February 19, 2013. Journal of the American College of Cardiology Vol. 62, No. 10, 2013 2013 by the American College of Cardiology Foundation ISSN 0735-1097/

Rocking Aortic Valve Prosthesis: A 3-Dimensional Transesophageal Echocardiography View

36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2013.02.102

Intermittent Trapping of a Tilting-Disc Mitral Prosthesis

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 40-year-old man was brought to our hospital because of resuscitated cardiac arrest. On the transthoracic echocardiography (TTE) an almost-complete dehiscence of a mechanical aortic valve that caused massive acute aortic

Tricuspid annular plane systolic excursion inaccuracy to assess right ventricular function in patients with previous tricuspid annulopasty

A 57-year-old woman presented to our emergency room complaining of palpitations and crescent dyspnea. She had carried a tilting-disk mitral valve prosthesis since 1985. The ECG showed atrial tachycardia with 2:1 conduction (Figure 1). Her arterial pressure was 75/50 mm Hg, but signs of hypoperfusion were not apparent. On heart auscultation, prosthetic clicks were erratically audible. Transthoracic and transesophageal echocardiograms were performed (Figure 2A). They demonstrated that the valve opened once between 3 and 4 beats (Movies …

Malfunctioning Mitral Valve-in-Valve Bioprosthesis Assessment by 3-Dimensional Transesophageal Echocardiography

OBJETIVES The clinical and prognostic usefulness of tricuspid annular plane systolic excursion (TAPSE) is well established. However, the ability of TAPSE to assess right ventricular (RV) function in patients with previous tricuspid valve annulopasty is controversial. This study examined the TAPSE suitability in patients with previous tricuspid valve annuloplasty using right ventricular fractional area change (RVFAC) as reference method. METHODS We retrospectively analyzed 53 patients who underwent tricuspid valve annuloplasty at our hospital between 2013 and 2016. TAPSE and RVFAC were obtained in preoperative and postoperative periods using standard methodology. RESULTS Mean age was 68±12years and 34 patients (64.1%) were women. TAPSE decreased significantly after surgery in comparison with pre-surgical values (17±4.2 Vs 12.9±4.1mm, p<0.001). On the contrary, RVFAC did not change significantly after surgery (37±9.2 Vs 36.2.9, p=0.25). The correlation between RVFAC and TAPSE was better in the preoperative (r=0.63, p<0.0001) than in the postoperative period (r=0.38, P=0.005). Good intra- and interobserver agreement for TAPSE and RVFAC was obtained, with intraclass correlation coefficients of 0.97 and 0.92 for TAPSE; and 0.90 and 0.85 for RVFAC, respectively. CONCLUSIONS These findings suggest that TAPSE is not suitable after tricuspid valve annuloplasty and it leads to an underestimation of RV systolic function. It seems to be appropriate to rely on echocardiographic parameters of global RV function such as RVFAC in this context.

Acute aortic dissection with ongoing right coronary artery and aortic valve involvement

An 85-year-old woman presented to the emergency department with symptoms of acute heart failure. The patient had an extensive cardiac history, including a bioprosthetic mitral valve replacement (Mosaic II, number 2) in 1994 and a transcatheter transapical Edwards SAPIEN THV 23 mitral valve implant within the mitral bioprosthesis (valve-in-valve implantation) in 2010 because of bioprosthetic valve failure. Physical examination revealed heart failure signs, and blood analysis showed hemolytic anemia with 8 g/dL hemoglobin, low serum haptoglobin, and high levels of lactate dehydrogenase. With clinical suspicion of prosthetic valve hemolysis, a transesophageal echocardiogram was performed. …