María Luisa Rodríguez

Infective endocarditis and caseous calcification of the mitral annulus: The odd couple

Caseous calcification of the mitral annulus is an infrequent echocardiographic finding. The differential diagnosis includes other entities like tumors, abscess or thrombus. Both cardiac CT and cardiac MRI may be useful for its definitive diagnosis.

The importance of echocardiography in transcatheter aortic valve implantation: TAVI: a multimodality approach.

recently publishedin your journal about the importance of echocar-diography in transcatheter aortic valve implanta-tion (TAVI). We completely agree with theauthors regarding the major role of echocardiog-raphy in the selection of patients, prior to proce-dure, during the procedure, and also in thefollow-up. However, we think that in the era ofmultimodality imaging different techniques mustbe take into account, to provide a comprehen-sive assessment before and post TAVI. In thisaspect, multidetector computed tomography(MCT) plays an important role in patient screen-ing before TAVI, provides detailed anatomicassessment of the aortic root and valve annulus,assesses the suitability of iliofemoral access, anddetermines appropriate coaxial angles to opti-mize the valve implantation procedure.

A Giant Left Coronary Sinus of Valsalva Aneurysm After Type A Aortic Dissection

59-year-old woman with Marfan syndrome wasreferred for cardiac computed tomography withechocardiographic diagnosis of sinus of Valsalva aneu-rysm. Twenty years earlier, she had had an aortic typeA dissection. A mechanical prosthesis and a 30-mmsupracoronary graft were implanted. The right coronaryartery was reimplanted. Cardiac computed tomographyshowed a 10 7.8 cm aneurysm arising from the left sinusof Valsalva (Fig 1; note the descending aortic dissection[arrow] and the previous reimplantation of the rightcoronary artery [arrow]). Reintervention preserved themechanical prosthesis, and the aortic root was replaced.Coronary arteries were reimplanted following Cabrol’stechnique. Most sinus of Valsalva aneurysms are congen-ital.Acquiredaneurysmsarecausedbyconditionsaffectingthe aortic wall, such as infection, degenerative disease,or thoracic trauma [1]. In our case, although Marfan syn-drome was the main condition, prior replacement of thesupracoronary aorta alone can also be followed by recur-rent aneurysm formation at the level of the residual aorticroot. As regards diagnostic tools, echocardiography andcardiac computed tomography are complementary.

Cardiac computed tomography in the assessment of endocarditis complications

A 44-year-old woman with a prosthetic aortic valve was admitted to the cardiology department with shortness of breath and a new diastolic murmur. Transthoracic (TTE) and transesophageal echocardiography (TEE) were performed, the latter revealing a fistula between the aortic root and the right atrium (Figure 1A). Although blood cultures were negative, the final diagnosis was endocarditis. Prior to surgery,

Appropriate criteria for the use of cardiac computed tomography angiography

Dear Editor, We have read with great interest the manuscript recently published in your journal by Jin Kim et al. entitled: ‘Meaning of zero coronary calcium score in symptomatic patients referred for coronary computed tomographic angiography’.1 We completely agree with their conclusions; as it has been shown in different series previously published, that a calcium score of zero cannot rule out …

Acquired Valsalva sinus pseudoaneurysm after aortic valve replacement

Valsalva sinus pseudoaneurysms are uncommon. The main causes for the formation of pseudoaneurysms are endocarditis, previous enlargement of the aortic root, aortic regurgitation and the use of a composite graft. We report the case of a 79-year-old man with an aortic bioprosthesis implanted five years ago to treat severe aortic regurgitation (AR) with a normal aortic root. A new diastolic murmur was heard in the last clinical review, so the patient was referred for transthoracic echocardiography, which demonstrated severe AR and a dilated aortic root. Transesophageal echocardiography (Figures 1 and 2) confirmed severe AR with an aneurysmal dilatation of the non-coronary sinus,