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Hemitruncus arteriosus is a rare congenital heart disease characterized by the abnormal origin of one of the branches of the pulmonary artery from the ascending aorta. In most cases, its diagnosis is made during childhood; in addition, due to its high morbidity and mortality, its asymptomatic evolution and survival to adulthood is extremely unusual. We present the case of a 30-year-old male patient, with a history of surgical closure of patent ductus arteriosus during childhood, who was asymptomatic until a year ago, in whom hemitruncus arteriosus was diagnosed after recurrent episodes of hemoptysis.

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We present a 64-year-old woman who underwent mitral, aortic, and tricuspid valve (TV) replacement with mechanical prostheses. Two months after TV surgery, she presented third-degree atrioventricular block. After attempting to place a pacemaker lead through the coronary sinus, it was placed through the mechanical valve in the tricuspid position as the last option. At 1 year of follow-up, the device shows no signs of dysfunction, and the prosthesis has moderate regurgitation.

Assuntos

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INTRODUCTION: Coronary artery occlusion due to fusion of a leaflet to the sinotubular junction is a rare finding that we should consider in the differential diagnosis of young patients who have aortic regurgitation and angina. PATIENT AND METHOD: We present a young female with severe aortic regurgitation due to right coronary fusion who underwent mini-invasive aortic valve reconstruction. RESULTS: Postoperative evolution was satisfactory. The patient was discharged on the 5th postoperative day and after 3.5 years of follow-up he remains in functional class I, without anticoagulant treatment and with mild aortic regurgitation. COCNCLUSION: The Ozaki technique can be used in patients with aortic regurgitation due to single leaflet dysfunction.

Assuntos

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Objective: To determine the discriminative capacity of myocardial perfusion with single photon emission tomography (SPECT) to predict coronary obstructions by coronary angiography. To determine mortality and major cardiovascular events at follow-up. Materials and methods: . Retrospective observational study with clinical follow-up in patients undergoing SPECT and then coronary angiography. We excluded patients with myocardial infarction and percutaneous and/or surgical revascularization in the previous 6 months. Results: 105 cases were included in the study. The most commonly used SPECT protocol was pharmacological (70%). Patients with perfusion defect ≥10% of total ventricular mass (TVM) had significant coronary lesions (SCL) in 88% of cases (sensitivity 87.5% and specificity 83%). On the other hand, having ischemia ≥10% of the TVM was associated with 80% SCL (sensitivity: 72%, specificity: 65%). Clinical follow-up at 48 months evidenced that a perfusion defect ≥ 10% was predictive of major cardiovascular events (MACE) in both univariate (HR=5.3; 95%CI 1.2 - 22.2; p=0.022) and multivariate (HR= 6.1; 95%CI 1.3 - 26.9; p= 0.017) analyses. Conclusions: . Having a perfusion defect ≥10% of the MVT in the SPECT study predicted with high probability and sensitivity the existence of SCL (>80%); moreover, this group had higher MACE at follow-up.

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Objective: : To determine the prevalence of coronary anomalies (CA) in patients evaluated by 64-detector computed tomography (CT) at the Instituto Nacional Cardiovascular in Peru between 2016 and 2020. Materials and methods: Retrospective observational study, coronary artery CT scans of 1486 patients were performed on a 64-detector row CT scanner and reviewed in search for coronary anomalies. Results: The prevalence of CA detected by CT was 4.71% (70 cases) of which 64.3% were male. Abnormalities of origin were the most frequent, of which the origin of a coronary artery from the opposite coronary sinus was the most common (48.6%), with the right coronary being the main anomalous artery (31%), and the main path was interarterial (31%). Anomalous origin of the left main coronary from the pulmonary artery was found in 5 patients. Among the anomalies of the intrinsic coronary arterial anatomy the most frequent was the double left anterior descending artery (10%). Coronary fistulas accounted for 11.4% of cases. Conclusions: The prevalence of CA detected by 64-detector CT in a Peruvian institute was 4.71%. The most frequent coronary anomaly was the origin of the right coronary artery from the left coronary sinus with interarterial trajectory.

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We present the case of a 62-year-old male who presented with oppressive chest pain and was then diagnosed with acute myocardial infarction and received reperfusion treatment with primary angioplasty. In the evolution, he had a new episode of myocardial infarction, so complementary studies were carried out that led to the diagnosis of Takayasu's arteritis. Unfortunately, he presented a torpid evolution despite the established management. The clinical presentation in patients older than 60 years is uncommon, so it is important to consider it within the differential diagnosis in patients with diffuse coronary disease and recurrent myocardial ischemia, due to the rapid progression and high morbidity and mortality despite successful revascularization strategies.

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Rupture of a Valsalva aneurysm in the adult is extremely rare and is often complicated by acute heart failure. We present the case of a 39-year-old patient with a non-coronary sinus of Valsalva aneurysm complicated by rupture into the right atrium associated with severe aortic regurgitation and moderate tricuspid regurgitation. The treatment was surgical and was based on the repair with a pericardial patch over the aneurysm, aortic valve replacement, and tricuspid plasty. We emphasize the importance of an early diagnosis and timely surgical treatment due to the high associated mortality.

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Objective: To determine the epidemiological, clinical, electrocardiographic, imaging characteristics and main therapeutic strategies performed in patients with arrhythmogenic cardiomyopathy treated in a national reference cardiovascular institute. Materials and methods: Observational, descriptive and retrospective study that attempts to identify the clinical characteristics, complementary tests and therapeutic strategies performed in patients with arrhythmogenic cardiomyopathy treated at the Instituto Nacional Cardiovascular - INCOR EsSalud in Lima, Peru. Results: Thirteen patients were found with arrhythmogenic cardiomyopathy. The median age at which the diagnosis was made was 38.2 years and 69.3% were male. The most frequent clinical manifestations were tachycardic palpitations (92.3%), presyncope (84.6%) and heart failure (69.2%). 23% of the patients suffered a cardiac arrest. All the patients presented at least one episode of ventricular tachycardia, 92.3% with complete left bundle branch block morphology and upper axis. 76.9% received an implantable cardioverter defibrillator (ICD), 15.3% underwent ablation and 15.3% received a heart transplant. 84.6% of the patients live to this day. Conclusions: Arrhythmogenic cardiomyopathy predominantly affected the young and male population. All the patients had a potentially fatal ventricular arrhythmia. Biventricular disease by echocardiography and cardiac magnetic resonance occurred in 69.2% and 100% of the cases, respectively. The therapeutic strategies used were antiarrhythmic medical treatment, placement of an ICD as secondary prevention, ablation, and heart transplantation. To date, 84.6% of patients survive.

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Coronary artery fistulas are rare clinical entities and their association with giant coronary aneurysms is even more unusual. Most fistulas are asymptomatic, but aneurysms could develop symptoms depending on their diameter. We present a patient with chest pain and cardiac arrest, who later developed cardiac tamponade that needed emergency surgery, due to rupture of a giant coronary aneurysm developed from confluent coronary artery fistulas from two coronary arteries to pulmonary artery.