Teresa López Fernández

Cardiotoxicity from the cardiologist's perspective

Screening programs and contemporary multidisciplinary management of oncologic patients have resulted in lower mortality and improved outcomes. Nevertheless, treatment-related cardiac toxicity has been recognized as a major side effect, negatively affecting quality of life and prognosis in cancer survivors. Physicians involved in the care of these patients should be familiar with the effects of chemotherapy and radiotherapy on the heart, as well as the tests that may facilitate early diagnosis and prompt referral to cardiology units with expertise in the management of oncologic patients. This special report focuses on the mechanisms of cardiotoxicity and the techniques (including basic and advanced imaging and biomarkers) used in the cardiac evaluation of cancer patients.

Unusual Case of Huge In-transit Thrombus: a Challenge for Three-dimensional Echocardiography

A 29-year-old woman was admitted to the emergency room of our hospital with sudden dyspnea and pleuritic pain. Ten months previously she had had a normal full term delivery, after which she experienced deep venous thrombosis. At emergency room admission, her heart rate was 110 bpm and blood pressure was 90/69 mmHg. An S1Q3T3 pattern was observed on electrocardiography. Computed tomography (CT) study disclosed a massive pulmonary thromboembolism (Fig. 1A). Transthoracic echocardiography (TTE) (Figs. 1B and C, video 1) showed large masses (white arrows) in both atria, protruding through the 2 atrioventricular valves (Ao, aorta; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle). We performed 2-dimensional (2D) (Figs. 1D-F, video 2) and 3D (Figs. 2A and B, videos 3-6) transesophageal echocardiography (TEE), which demonstrated that the patient had a large, morphologically complex mass (white arrow) passing through a patent foramen ovale. The patient was surgically treated with thrombectomy (Fig. 2C) and suturing of the foramen ovale. Pathology confirmed the diagnosis of a thrombus. The patient was discharged 1 week later with no incidents. Pulmonary thromboembolism is a common complication of deep venous thrombosis, but demonstration of the thrombus in transit is unusual. Because of the considerable risk of systemic embolism, the treatment of choice is surgical thrombectomy. Although no cases have yet been recorded in the literature, 3D TEE may be useful to accurately show the anatomy of the mass and interatrial septum.

Selection of the Best of 2016 in Echocardiography in Heart Valve Disease

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Percutaneous balloon mitral valvuloplasty and closure of the left atrial appendage: Synergy of two procedures in one percutaneous intervention

Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease. We report the case of a 57-year-old-woman with significant MS and permanent AF, in New York Heart Association functional class II, who despite adequate oral anticoagulation with acenocoumarol, presented several clinical episodes of systemic thromboembolism in the last four years. It was decided to perform a combined percutaneous procedure, including both PMV and percutaneous LAA closure with the Amplatzer Cardiac Plug device. No significant acute complications occurred and the patient was discharged on indefinite treatment with acenocoumarol associated with aspirin 100 mg/d for three months. After a one-year follow-up, there have been no new embolic episodes or other complications.