Viviane Tiemi Hotta

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Report of an Adult Case

We report the clinical findings, pathophysiology, diagnostic characteristics, and surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in a 26-year-old female patient with a clinical diagnosis of coronary heart disease.

Remodelado inverso de aurícula izquierda en pacientes con estenosis de válvula mitral tras valvuloplastia percutánea: estudio ecocardiográfico bidimensional y tridimensional

INTRODUCTION AND OBJECTIVES The left atrium is clinically relevant in patients with mitral valve stenosis. The objective of this study was to analyze the effects of percutaneous balloon valvuloplasty on left atrium volumes and the left atrium emptying fraction in symptomatic mitral valve stenosis patients using 2-dimensional and real-time 3 -dimensional transthoracic echocardiography. METHODS We carried out a prospective study of 28 consecutive symptomatic mitral valve stenosis patients, aged 22-72 (39 [11.5]) years, 24/28 (85.6%) women, who underwent to percutaneous balloon valvuloplasty between March 2009 and May 2011. Patients underwent 2- and 3-dimensional transthoracic and transesophageal echocardiography (atrial fibrillation) and invasive mitral valve area measurement. Echocardiographic analysis was performed before, 72 h after and 12 months after percutaneous balloon valvuloplasty. The following parameters were analyzed: a) mitral valve area (2-dimensional planimetry, pressure half-time, 3-dimensional echocardiography, invasive hemodynamic measurement); b) indexed left atrium maximum and indexed minimum volumes, and c) left atrium emptying fraction. RESULTS The 3-dimensional parameters of the mitral valve stenosis patients before and 72 h and 12 months after percutaneous balloon valvuloplasty were as follows: a) mitral valve area: 0.9 (0.1) cm(2); 1.8 (0.2) cm(2) (P<.001); 1.7 (0.2) cm(2) (P<.001); b) left atrium maximum volumes: 49.9 (12) mL/m(2); 42 (11.4) mL/m(2) (P<.001); 40.3 (10.2) mL/m(2) (P<.001), and c) left atrium emptying fraction: 30.1 (9.4%); 40.6 (7.4%) (P<.001); 44.1 (8%) (P<.001), respectively. CONCLUSIONS In symptomatic mitral valve stenosis patients who underwent percutaneous balloon valvuloplasty analysis by 2- and 3-dimensional echocardiography, improvements in left atrium reverse remodeling and left atrium emptying fraction were observed 72 h and 12 months after the procedure.

Echocardiographic Parameters and Survival in Chagas Heart Disease with Severe Systolic Dysfunction

Background Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. Objective To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%. Methods Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. Results In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m2 were associated with a significant increase in mortality (log rank p < 0.0001). Conclusion The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.

Comparison between 2D and 3D echocardiography in the evaluation of reverse remodeling after CRT

BACKGROUND Echocardiography is a useful method for screening and assessing response to cardiac resynchronization therapy (CRT). 3D echocardiography has already established its role in the evaluation of ventricular volumes and ejection fraction (LVEF) with excellent correlation of results when compared with MRI. OBJECTIVE To compare the evaluation of ventricular volumes (LVDV, LVSV), LVEF, and LV mass before and after CRT by 2D echocardiography and three-dimensional echocardiography. METHODS We evaluated 24 patients with heart failure (HF), functional class (FC) III or IV (NYHA), sinus rhythm QRS ≥ 120 ms, during an optimized therapy for HF undergoing CRT. We conducted electrocardiogram (ECG), clinical evaluation, 2D and 3D echocardiography before, three and six months after CRT. The comparison between the techniques was performed using Pearsons correlation (r). RESULTS At baseline, the correlation between methods was 0.96 for evaluation of LVDV, 0.95 for evaluation of LVSV, 0.87 for LVEF and 0.72 for LV mass. After three months of CRT, the correlation between methods for analysis of LVDV was 0.96, 0.95 for LVSV, 0.95 for LVEF, and 0.77 for LV mass. After six months of CRT, the correlation between 2D and 3D echocardiography for analysis of LVDV was 0.98, 0.91 for LVSV, 0.96 for LVEF, and 0.85 for LV mass. CONCLUSION This study reported was a reduction of LVDV, LVSV, besides improvement in LVEF after CRT. There was an excellent correlation between the 2D and 3D echocardiography for evaluation of ventricular volumes and LVEF, and a good correlation between methods for evaluation of left ventricular mass before and after CRT.FUNDAMENTO: La ecocardiografia consiste en metodo muy util para seleccion y evaluacion de respuesta a la terapia de resincronizacion cardiaca (TRC). El ecocardiograma tridimensional ya tiene su papel establecido en la evaluacion de los volumenes ventriculares y fraccion de eyeccion ventricular izquierda (FEVI) con excelente correlacion de resultados cuando es comparado a la resonancia nuclear magnetica (RNM). OBJETIVO: Comparar la evaluacion de los volumenes ventriculares (VDVI, VSVI), FEVI y masa del VI antes y despues de la TRC por la ecocardiografia bi (Eco 2D) y tridimensional (Eco 3D). METODOS: Fueron evaluados 24 pacientes con insuficiencia cardiaca (IC), clase funcional (CF) III o IV (NYHA), ritmo sinusal QRS > 120 ms, en vigencia de terapeutica optimizada para IC sometidos a TRC. Fueron realizados electrocardiograma (ECG), evaluacion clinica, Eco 2D y 3D antes, tres y seis meses despues de la TRC. La comparacion entre las tecnicas fue realizada utilizando la correlacion de Pearson (r). RESULTADOS: En el momento basal, la correlacion entre los metodos fue de 0,96 para evaluacion del VDVI, 0,95 para evaluacion del VSVI, 0,87 para FEVI, y 0,72 para masa del VI. Despues de tres meses de la TRC, la correlacion entre los metodos para analisis del VDVI fue de 0,96, 0,95 para VSVI, 0,95 para FEVI, y 0,77 para masa del VI. Despues de seis meses de la TRC, la correlacion entre el Eco 2D y 3D para analisis del VDVI fue de 0,98, 0,91 para VSVI, 0,96 para FEVI, y 0,85 para masa del VI. CONCLUSION: En este estudio fue observada reduccion de los VDVI,VSVI, ademas de mejora de la FEVI despues de la TRC. Hubo excelente correlacion entre el Eco 2D y el 3D para evaluacion de los volumenes ventriculares y FEVI, y buena correlacion entre los metodos para evaluacion de la masa ventricular izquierda antes y despues de la TRC.

Subvalvular Mitral Pseudoaneurysm Evaluated by Three‐Dimensional Echo

(Echocardiography 2010;27:473‐475)

New Equation for Prediction of Reverse Remodeling after Cardiac Resynchronization Therapy

Objectives: To integrate data from two‐dimensional echocardiography (2D ECHO), three‐dimensional echocardiography (3D ECHO), and tissue Doppler imaging (TDI) for prediction of left ventricular (LV) reverse remodeling (LVRR) after cardiac resynchronization therapy (CRT). It was also compared the evaluation of cardiac dyssynchrony by TDI and 3D ECHO. Methods: Twenty‐four consecutive patients with heart failure, sinus rhythm, QRS ≥ 120 msec, functional class III or IV and LV ejection fraction (LVEF) ≤ 0.35 underwent CRT. 2D ECHO, 3D ECHO with systolic dyssynchrony index (SDI) analysis, and TDI were performed before, 3 and 6 months after CRT. Cardiac dyssynchrony analyses by TDI and SDI were compared with the Pearsons correlation test. Before CRT, a univariate analysis of baseline characteristics was performed for the construction of a logistic regression model to identify the best predictors of LVRR. Results: After 3 months of CRT, there was a moderate correlation between TDI and SDI (r = 0.52). At other time points, there was no strong correlation. Nine of twenty‐four (38%) patients presented with LVRR 6 months after CRT. After logistic regression analysis, SDI (SDI > 11%) was the only independent factor in the prediction of LVRR 6 months of CRT (sensitivity = 0.89 and specificity = 0.73). After construction of receiver operator characteristic (ROC) curves, an equation was established to predict LVRR: LVRR =−0.4LVDD (mm) + 0.5LVEF (%) + 1.1SDI (%), with responders presenting values >0 (sensitivity = 0.67 and specificity = 0.87). Conclusions: In this study, there was no strong correlation between TDI and SDI. An equation is proposed for the prediction of LVRR after CRT. Although larger trials are needed to validate these findings, this equation may be useful to candidates for CRT. (Echocardiography 2012;29:678‐687)

Comparação entre a ecocardiografia 2D e 3D na avaliação do remodelamento reverso após a TRC

BACKGROUND Echocardiography is a useful method for screening and assessing response to cardiac resynchronization therapy (CRT). 3D echocardiography has already established its role in the evaluation of ventricular volumes and ejection fraction (LVEF) with excellent correlation of results when compared with MRI. OBJECTIVE To compare the evaluation of ventricular volumes (LVDV, LVSV), LVEF, and LV mass before and after CRT by 2D echocardiography and three-dimensional echocardiography. METHODS We evaluated 24 patients with heart failure (HF), functional class (FC) III or IV (NYHA), sinus rhythm QRS ≥ 120 ms, during an optimized therapy for HF undergoing CRT. We conducted electrocardiogram (ECG), clinical evaluation, 2D and 3D echocardiography before, three and six months after CRT. The comparison between the techniques was performed using Pearsons correlation (r). RESULTS At baseline, the correlation between methods was 0.96 for evaluation of LVDV, 0.95 for evaluation of LVSV, 0.87 for LVEF and 0.72 for LV mass. After three months of CRT, the correlation between methods for analysis of LVDV was 0.96, 0.95 for LVSV, 0.95 for LVEF, and 0.77 for LV mass. After six months of CRT, the correlation between 2D and 3D echocardiography for analysis of LVDV was 0.98, 0.91 for LVSV, 0.96 for LVEF, and 0.85 for LV mass. CONCLUSION This study reported was a reduction of LVDV, LVSV, besides improvement in LVEF after CRT. There was an excellent correlation between the 2D and 3D echocardiography for evaluation of ventricular volumes and LVEF, and a good correlation between methods for evaluation of left ventricular mass before and after CRT.FUNDAMENTO: La ecocardiografia consiste en metodo muy util para seleccion y evaluacion de respuesta a la terapia de resincronizacion cardiaca (TRC). El ecocardiograma tridimensional ya tiene su papel establecido en la evaluacion de los volumenes ventriculares y fraccion de eyeccion ventricular izquierda (FEVI) con excelente correlacion de resultados cuando es comparado a la resonancia nuclear magnetica (RNM). OBJETIVO: Comparar la evaluacion de los volumenes ventriculares (VDVI, VSVI), FEVI y masa del VI antes y despues de la TRC por la ecocardiografia bi (Eco 2D) y tridimensional (Eco 3D). METODOS: Fueron evaluados 24 pacientes con insuficiencia cardiaca (IC), clase funcional (CF) III o IV (NYHA), ritmo sinusal QRS > 120 ms, en vigencia de terapeutica optimizada para IC sometidos a TRC. Fueron realizados electrocardiograma (ECG), evaluacion clinica, Eco 2D y 3D antes, tres y seis meses despues de la TRC. La comparacion entre las tecnicas fue realizada utilizando la correlacion de Pearson (r). RESULTADOS: En el momento basal, la correlacion entre los metodos fue de 0,96 para evaluacion del VDVI, 0,95 para evaluacion del VSVI, 0,87 para FEVI, y 0,72 para masa del VI. Despues de tres meses de la TRC, la correlacion entre los metodos para analisis del VDVI fue de 0,96, 0,95 para VSVI, 0,95 para FEVI, y 0,77 para masa del VI. Despues de seis meses de la TRC, la correlacion entre el Eco 2D y 3D para analisis del VDVI fue de 0,98, 0,91 para VSVI, 0,96 para FEVI, y 0,85 para masa del VI. CONCLUSION: En este estudio fue observada reduccion de los VDVI,VSVI, ademas de mejora de la FEVI despues de la TRC. Hubo excelente correlacion entre el Eco 2D y el 3D para evaluacion de los volumenes ventriculares y FEVI, y buena correlacion entre los metodos para evaluacion de la masa ventricular izquierda antes y despues de la TRC.

Acute Myocardial Infarction and Severe Prosthetic Dysfunction after Bentall Procedure.

Coronary artery anastomotic dehiscence is a rare complication following aortic procedures. A 59-year-old male previously underwent replacement of the ascending aorta and aortic valve because of ascending aorta aneurysm and severe aortic regurgitation. Eight years after the procedure, he presented with acute myocardial infarction. Transesophageal echocardiography (TEE) and coronary angiography revealed coronary artery dehiscence. This finding rarely occurs after a Bentall procedure; however, if it does, it usually occurs in the early postoperative period and is associated with an infectious etiology. In this case, coronary dehiscence presented with myocardial infarction years after the procedure and was first suspected after TEE.

Cardiac and peripheral autonomic control in restrictive cardiomyopathy

Autonomic dysfunction determines the advance of dilated cardiomyopathy (DCM) and is related to poor outcomes. However, this autonomic imbalance is unknown in patients with restrictive cardiomyopathy (RCM) even though they have similar symptoms and poor quality of life as DCM patients have. The aim of this study was to evaluate if autonomic and neurovascular controls were altered in RCM patients.

Complication of hybrid treatment in type B aortic dissection diagnosed by echocardiography

This case illustrates an unusual and fatal complication after endovascular treatment of type B aortic dissection and highlights the role of echocardiography in the early diagnosis of complications. In this case, a patient with previous diagnosis of chronic type B aortic dissection and moderate aortic regurgitation underwent endovascular repair of the proximal descending aorta and conservative surgical correction of the aortic valve. On early postoperative, a transesophageal echocardiogram and aortic angiotomography demonstrated proximal endoleak by contrast extravasation around the proximal graft attachment site, causing compression of the stent in its middle portion, resulting in narrowing with reduced cross‐sectional area.