Mar Moreno-Yangüela

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.

Triple therapy with deferiprone, idebenone and riboflavin in Friedreich's ataxia – open-label trial

The objective of the study was to test the efficacy, safety and tolerability of triple therapy with deferiprone, idebenone and riboflavin in Friedreichs ataxia (FRDA) patients in a clinical pilot study.

3D Transesophageal echocardiographic guidance and monitoring of percutaneous aortic valve replacement.

We describe a preliminary clinical experience with 3D transesophageal echocardiography (3D TEE) in an 84‐year‐old man with severe aortic stenosis and multiple comorbidity, who underwent percutaneous aortic valve implantation. Although 3D TEE monitoring is not a standard procedure during aortic valve replacement procedure (PAVR), when used in combination with conventional 2D‐TEE contributes to improving adequate patient selection and provides more accurate information to the interventional cardiologist during positioning, deployment, and early function of the prosthesis. (Echocardiography 2010;27:84‐86)

Triple therapy with darbepoetin alfa, idebenone, and riboflavin in Friedreich's ataxia: an open-label trial.

Minimal objective evidence exists regarding management of Friedreich’s ataxia (FRDA). Antioxidant and recombinant human erythropoietin therapies have been considered potential treatments to slow progression of FRDA in a small number of studies. The primary objective of the current study was to test the efficacy, safety, and tolerability of triple therapy—darbepoetin alfa, idebenone, and riboflavin—in FRDA in a clinical pilot study. Patients included in this study were nine females, 16 to 45xa0years of age (average 28u2009±u20098), diagnosed with FRDA with confirmed GAA repeat expansion mutations in the FXN gene and a GAA repeat ≥400 on the shorter allele. Patients had a baseline score between 8 and 28.5 (average 20.7u2009±u20098.3) on the scale for the assessment and rating of ataxia and 94.3u2009±u200927.2xa0g/m2 in left ventricular mass index (LVMI). Patients had been treated with triple therapy with 150xa0μg darbepoetin alfa every 2 or 3xa0weeks, 10–20xa0mg/kg/day idebenone, and 10–15xa0mg/kg/day riboflavin for 32u2009±u200919.4xa0months (range of 8–56xa0months). Triple therapy was tolerated. Although not statistically significant, improvement of ataxia was observed during the first six 4-month periods of the study. Furthermore, a small decrease in disease progression during the first 2xa0years of treatment was observed. Long-term statistically nonsignificant improvement of LVMI and stability of the echocardiographic parameters could be considered. Triple therapy may slow disease progression of FRDA.

Percutaneous Balloon Pericardiotomy as the Initial and Definitive Treatment for Malignant Pericardial Effusion

INTRODUCTION AND OBJECTIVESnMalignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy of percutaneous balloon pericardiotomy as the initial treatment of choice for these effusions.nnnMETHODSnRetrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of percutaneous balloon pericardiotomies carried out in a single center in patients with advanced cancer.nnnRESULTSnSeventeen percutaneous balloon pericardiotomies were performed in 16 patients with a mean age of 66.2 (15.2) years. Fourteen patients had pathologically confirmed metastatic neoplastic disease, 3 had previously required pericardiocentesis, and in the remaining patients percutaneous balloon pericardiotomy was the first treatment for the effusion. All patients had a severe circumferential effusion, and most presented evidence of hemodynamic compromise on echocardiography. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up (median, 44 [interquartile range, 36-225] days). One patient developed a large pleural effusion that did not require treatment. Three patients needed a new pericardial procedure: 2 had elective pericardial window surgeries and 1 had a second percutaneous balloon pericardiotomy.nnnCONCLUSIONSnPercutaneous balloon pericardiotomy is a simple, safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches.

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.

Real Time Three-Dimensional Transesophageal Echocardiography for Guiding Percutaneous Mitral Valvuloplasty

(ECHOCARDIOGRAPHY, Volume 26, July 2009)

Utility of Intracardiac Echocardiography for Catheter Ablation of Complex Cardiac Arrhythmias in a Medium‐Volume Training Center

New electrophysiology tools like intracardiac echocardiography (ICE) might help to minimize and early detect complications during cardiac ablation procedures. The aim of the study was to assess the utility and vascular safety of ICE during catheter ablation of complex cardiac arrhythmias in a medium‐volume training center.

Left atrial myxofibrosarcoma: Diagnostic approach through imaging techniques

Primary cardiac sarcomas are rare. A 63-year-old woman presented with progressive symptoms of fatigue, palpitations, and dyspnea. Transthoracic echocardiography detected a mass in the left atrium, fixed and probably attached to the interatrial septum suggestive of myxoma. Transesophageal echocardiography confirmed the existence of a large lobulated mass in the left atrium measuring 45xa0mmxa0×xa025xa0mm in diameter. Subsequent cardiac magnetic resonance imaging showed a mass of heterogeneous appearance, with broad base of implantation on the posterior wall of the left atrium. The extension study with multidetector computed tomography showed superficial infiltration of the atrial wall, without involvement of the mitral valve or pulmonary veins and no extension to other extracardiac structures. The patient underwent surgery resecting a bilobed mass, smooth and yellowish, strongly attached to the posterior wall of left atrium. The pathologic study was consistent with the diagnosis of myxofibrosarcoma. <Learning objective: Primary cardiac tumors are among the most challenging disease entities to diagnose because of their rarity and highly variable and usually nonspecific clinical presentation. Although the definitive diagnosis of a cardiac tumor, whether benign or malignant and the tumor type is provided by histological examination, imaging techniques are essential for confirming the existence of a cardiac mass and characterizing the tumor before obtaining a sample for pathologic examination.>.

Surgical repair of complex endocarditis.

PERIVALVULAR EXTENSION IS THE MOST FREQUENT CAUSE OF UNCONTROLLED INFECTION in patients with infective endocarditis (IE), and extension to the mitral-aortic intervalvular fibrosa (MAIVF) occurs in 30% of patients undergoing surgery for IE [(1)][1]. The MAIVF is a thin, relatively avascular fibrous