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Assessment of Papillary Fibroelastoma of the Semilunar Valves by Three-Dimensional Echocardiography

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World Journal of Cardiovascular Diseases 2017年第12期7卷 429-434页

作者： Leonel Avendano-Pérez Nydia Avila-Vanzzini nild. espinola-zavaleta Laboratory of Non-Invasive Hemodynamics National Institute of Cardiology“Ignacio Chávez”TlalpanMexico Department of Out-Patients Clinic National Institute of Cardiology“Ignacio Chávez”TlalpanMexico

Papillary fibroelastoma is an uncommon tumor. Recognitions of this tumor have been improved thanks to modern imaging advances, which have made more patients to be identified, but at the same time, the management of this disease is still controversial. There aren’t enough studies to basic clinical actions. We present 2 interesting cases involving the semilunar valves. The purpose of presenting these cases is to review this rare disease and the superiority of the three-dimensional echocardiography in their diagnosis.

关键词： Heart Tumor Papillary Fibroelastoma Pulmonary Valve Aortic Valve Echocardiography

Compression of Left Main Coronary Artery in Patients with Pulmonary Artery Aneurysm and Pulmonary Hypertension

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World Journal of Cardiovascular Diseases 2019年第9期9卷 649-656页

作者： Diana Isabel Katekaru-Tokeshi , Zoila Ivonne Rodríguez-Urteaga Moises Jimenez-Santos nild. espinola-zavaleta Cardiology Department Hospital Nacional Dos de Mayo Lima Peru Cardiology Department Instituto Nacional Cardiovascular (INCOR) Lima Peru Computed Tomography Department Instituto Nacional de Cardiologia Ignacio Chavez Mexico City Mexico Nuclear Cardiology Department Instituto Nacional de Cardiologia Ignacio Chavez Mexico City Mexico Echocardiography Department Centro Medico ABC I.A.P. Mexico City Mexico

Background: Pulmonary artery aneurysm (PAA) is an unusual finding and its association with left main coronary (LMCA) compression is even more infrequent. Cardiac CT evaluates of presence and size of PAA and the degree of LMCA compression. The aim of this study is to describe two cases of adults with compression of LMCA with PAA associated with PDA and pulmonary hypertension. Case presentation: The first case is a 27-year-old man with PAA (78 mm diameter) and LMCA compression of 70% between the aortic sinus and the PAA. He presented angina as a manifestation of the LMCA compression. During follow-up the patient died. The second case is a 28-year-old man with PAA (110 mm diameter) that compresses LMCA in 55%, he rejected surgical treatment, but he is in close follow-up with medical treatment. Conclusion: Cardiac computed tomography played an important role both in the diagnosis and identification of high-risk PAA patients.

关键词： Left Main Coronary Artery Compression Pulmonary Artery Aneurysm Patent Ductus Arteriosus Pulmonary Hypertension

Long Term Follow-Up of Cardiotoxicity in Breast Cancer Treatment: A Case Report

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World Journal of Cardiovascular Diseases 2023年第3期13卷 130-137页

作者： Jose Luis Siller-Nava Adrian Espejel-Guzman Javier Serrano-Roman Aldo Cabello-Ganem Alexis D. Aparicio Ortiz nild. espinola-zavaleta Department of Nuclear Cardiology National Institute of Cardiology Ignacio Chavez Mexico City Mexico Mexican Social Security Institute IMSS Mexico City Mexico Department of Echocardiography ABC Medical Center I.A.P. Mexico City Mexico

Background: Cardiac toxicity is currently defined as a symptomatic decrease in Left Ventricular Ejection Fraction (LVEF) of more than 5% or an asymptomatic decrease of at least 10% to a value of under 50% in repeated evaluations on conventional transthoracic echocardiogram (TTE), as well as a Global Longitudinal Strain (GLS) value Aims: To highlight using GLS rather than modified Simpson 2D-LVEF for the evaluation of long-term cardiotoxicity. Case Presentation: The case concerns a 73-year-old female patient with a history of breast cancer chemotherapy and anthracyclines-based therapy who presented symptoms of late cardiac toxicity related to the chemotherapeutic treatment. In the following years, the patient remained asymptomatic with a 2D-LVEF of 48%, dilation of the left atrium was found, and the reservoir phase strain was severely decreased. Conclusion: The preferred method for evaluating cardiovascular complications associated with chemotherapy is the TTE, which is performed prior to the start of treatment, during therapy, and in the follow-up. Myocardial deformation as a predictor of cardiotoxicity allows the identification of subclinical heart failure.

关键词： Cardiotoxicity Breast Cancer Global Longitudinal Strain Left Ventricular Ejection Fraction Heart Failure

Mechanical Complications after Myocardial Infarction: A Comprehensive Review

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World Journal of Cardiovascular Diseases 2024年第1期14卷 43-60页

作者： Alexis D. Aparicio-Ortiz María Natalia Alonso-Jimenez Adrian Espejel-Guzman Aldo Cabello-Ganem Javier Serrano-Roman Santiago Luna-Alcala nild. espinola-zavaleta Department of Nuclear Cardiology National Institute of Cardiology Ignacio Chavez Mexico City Mexico Department of Echocardiography ABC Medical Center Mexico City Mexico

Mechanical complications of myocardial infarction are potentially fatal events that can occur after an acute myocardial infarction. While the introduction of primary percutaneous reperfusion and fibrinolysis has reduced the incidence of these complications to less than 1%. These complications pose significant hemodynamic consequences and necessitate prompt diagnosis. Echocardiography, cardiac magnetic resonance imaging, and computed tomography are valuable tools for establishing an accurate and expedited diagnosis. Consequently, it is imperative to conduct further scientific research to enhance hemodynamic stabilization techniques such as intra-aortic balloon counterpulsation and extracorporeal membrane oxygenation, in addition to exploring new surgical procedures that can reduce mortality resulting from mechanical complications. This article aims to provide a comprehensive review of mechanical complications following myocardial infarction and their correlation with multi-imaging, facilitating a better understanding of these complications.

关键词： Infarction Mechanical Complications Echocardiography Magnetic Resonance

Occlusion with a Vascular Plug of a Congenital Circumflex Coronary Artery—Right Ventricle Fistula with Coronary Steal Phenomenon

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World Journal of Cardiovascular Diseases 2024年第11期14卷 689-694页

作者： Gilberto H. Acosta-Gutiérrez Camila Ponce-Acosta Roberto Cano-Zarate Maria Jose Santa-Ana-Bayona Jose A. Garcia-Montes nild. espinola-zavaleta Nuclear Cardiology Department National Institute of Cardiology Ignacio Chavez Mexico City Mexico Mexican Faculty of Medicine La Salle University Mexico City Mexico Magnetic Resonance Department National Institute of Cardiology Ignacio Chavez Mexico City Mexico Pediatric Interventional Cardiology Department National Institute of Cardiology Ignacio Chavez Mexico City Mexico

Background: Coronary fistulas are abnormal communications with a worldwide prevalence of 0.002% in the general population. Aim: The aim of this study is to present a case of a congenital coronary artery fistula presented with coronary steal and describe this phenomenon. Methods: A systematic search was conducted to explore the relationship between the coronary steal phenomenon and coronary artery diseases using the PubMed database. Case Presentation: A seven-month-old female patient, was admitted to the hospital presenting diaphoresis on feeding and failure to thrive. Physical examination denotes continuous murmur in the fourth intercostal space left parasternal border (IV/VI) crescendo-decrescendo, wide and permanent unfolding of S2 (S1-A2-P2). An echocardiogram shows enlargement of right cavities, dilatation of the left coronary artery, circumflex artery connected to the right ventricle, and pulmonary artery systolic pressure of 45 mmHg. Tomography angiography demonstrated dilatation of the circumflex artery and a tortuous trajectory towards the posterior wall of the right ventricle, suggesting a coronary fistula. Results: The findings were corroborated by catheterization and a vascular plug (Amplatzer AVP II) was successfully placed. During follow-up complete obliteration was observed, with adequate weight gain and no associated symptoms. Conclusion: This case illustrates a distinctive clinical manifestation of congenital coronary artery fistula associated with the coronary steal phenomenon, establishing a new paradigm for the early diagnosis and management of this condition in the pediatric population.

关键词： Coronary Artery Disease Coronary Vessel Anomalies Embolization Therapeutics

Corrected Transposition of the Great Arteries with Ebstein’s Anomaly, Dysplasia of the Mitral Leaflets and Persistence of Left Superior Vena Cava in an Adult

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World Journal of Cardiovascular Diseases 2020年第2期10卷 50-56页

作者： Aureo Campos-Tello Giancarlo A. Valle Luis M. Milla Angel D. Cueva Sara Ramirez-Flores Oscar García-Rosadio Pablo A. Mendoza nild. espinola-zavaleta Department of Cardiology Hospital Nacional Dos de Mayo Lima Peru Department of Electrophysiology Hospital Nacional Dos de Mayo Lima Peru Department of Nuclear Cardiology National Institute Ignacio Chavez Mexico City Mexico

Introduction: Congenitally corrected transposition of the great arteries (cc-TGA) is a congenital heart disease rarely described among adult population, especially if it is associated with other abnormalities such as Ebstein’s anomaly and abnormal origin of coronary arteries. Case presentation: Twenty-two-year-old woman admitted to intensive care unit with acute decompensated heart failure. The transthoracic echocardiography demonstrated atrioventricular and ventriculoarterial discordance. The left-sided atrioventricular valve, in this case, the tricuspid valve, showed apical displacement of the septal valve suggesting Ebstein’s anomaly. The computed tomography corroborated these findings and additionally showed a left superior vena cava and an abnormal origin of the coronary arteries. The patient is in NYHA functional class II, receiving treatment with diuretic, digitalis, beta-blockers and angiotensin-converting enzyme (ACE) inhibitor. Conclusion: This is a very interesting case of an adult in the third decade of life with cc-TGA associated with abnormalities not described in the literature that had reached adulthood. Noninvasive images play an important role in its diagnosis.

关键词： Corrected Transposition Echocardiography Ebstein’s Anomaly Computed Tomography

Risk Factors for Starr-Edwards Prosthetic Valve Dysfunction: New Insights into an Old Prosthesis

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World Journal of Cardiovascular Diseases 2019年第3期9卷 149-157页

作者： Grecia Iveth Maryelis Raymundo-Martinez Rodrigo Gopar-Nieto Diego Araiza-Garaygordobil Pablo Martínez-Amezcua Alejandro Cabello-Lopez Laura Leticia Rodríguez-Chavez nild. espinola-zavaleta Cardiology Fellow-In-Training Instituto Nacional de Cardiologia Ignacio Chavez Mexico City Mexico Coronary Care Unit Instituto Nacional de Cardiología Ignacio Chavez Mexico City Mexico Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore USA Occupational Health Research Unit Centro Medico Nacional Siglo XXI Mexico City Mexico Out-Patient Clinic Instituto Nacional de Cardiología Ignacio Chavez Mexico City Mexico Department of Nuclear Cardiology Instituto Nacional de Cardiologia Ignacio Chavez Mexico City Mexico

Background: Starr-Edwards prosthetic valves were used for valve replacement, but due to their high thrombogenic risk, they were withdrawn from market. Nevertheless, there are some cases of Starr-Edwards prosthetic valve carriers that have shown long-term survival reaching up to 50 years. The objective of this study was to determine survival in 12 patients with mechanical Starr-Edwards?prosthetic valve and risk factors for predicting valve dysfunction. Methods: Cross-sectional study of patients who had valve replacement with a Starr-Edwards prosthetic valve in a single center from 1968 to 1990. Socio-demographic data, valvular dysfunction variables and mortality were recorded. Logistic regression models to determine valvular dysfunction were constructed. Survival was analyzed with Cox regression and Kaplan-Meier survival curves. Results: A total of 12 patients were analyzed. The median age was 59 years (48.5 - 64). Eleven patients had normal right and left ventricular function. The most common cause of valve replacement was rheumatic valve disease (75%) and it was more frequently in mitral position (50%). Valvular dysfunction was detected in 3 patients (25%). Atrial fibrillation had the highest association with valvular dysfunction (P = 0.005). Stroke was seen in 25% of the population and the overall mortality was 33.3%. Conclusions: The survival of patients with Starr-Edwards prosthetic valve was 66.66% in the 50-year follow-up. Atrial fibrillation had the highest association with prosthetic valvular dysfunction.

关键词： Prosthetic Valve Starr-Edwards Survival Valvular Heart Disease

Multi-Image Studies of Atypical Location of Ventricular Aneurysms and Survival: Clinical Cases Series

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World Journal of Cardiovascular Diseases 2019年第8期9卷 524-537页

作者： Gyselle Camacho-Camacho Isabel Carvajal-Juárez Hector Guatibonza-Zambrano Alejandra de la Torre Aloha Meave-Gonzalez Candace Keirns Erick Alexanderson-Rosas Alondra Flores-García nild. espinola-zavaleta Department of Nuclear Cardiology National Institute of Cardiology Ignacio Chavez Mexico City Mexico Department of Resonance Imaging National Institute of Cardiology Ignacio Chavez Mexico City Mexico International Medical Interpreters Association Boston ME USA Department of Physiology School of Medicine UNAM Mexico City Mexico Department of Echocardiography ABC Medical Center I.A.P. Mexico City Mexico

Background: A left ventricular aneurysm is a mechanical complication of a myocardial infarction that frequently develops on the anterior and apical wall. Survival of 3 to 5 years is 27% and 12%, respectively. Our objective is to report 3 cases of ventricular aneurysms in atypical locations and analyze the survival of these patients. Material and Methods: Three patients with suspicion of ventricular aneurysm after acute myocardial infarction who sought?attention at our institution were included. All underwent transthoracic echocardiograms (TTE), cardiac magnetic resonance (CMR), nuclear cardiology (NC),?coronary angiotomography and cardiac catheterization to assess the location and characteristics of the aneurysms, left ventricular systolic function and the?anatomical and functional condition of the coronary arteries. Results: The mean age of studied patients was 58.33 ± 10.37 years. The locations of the ventricular aneurysms were lateral, inferior and septal. The patients received optimal medical treatment to control heart failure and were discharged in stable condition without early mortality. The mean follow-up was 6.33 years (intervals: 2 - 9) and during this period the patients were in NYHA functional class I/II. Conclusion: Left ventricular aneurysm is a late mechanical complication of an infarction that can develop in an atypical location. Diagnosis is achieved using non-invasive techniques such as TTE, CMR, NC, and coronary angiotomography. No mortality occurred among the patients during medium and long-term follow-up.

关键词： Aneurysm Myocardial Infarction Echocardiography Cardiac Magnetic Resonance Coronary Angiogram Survival

An Unusual Presentation of Aortic Dissection and Aneurysmatic Disease in Marfan Syndrome: A Case Report

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World Journal of Cardiovascular Diseases 2022年第6期12卷 297-303页

作者： Adrian Espejel-Guzman Valente Fernandez-Badillo Javier Serrano-Roman Enrique Solorzano-Pinot Sergio Criales-Vera Maria Del Carmen Lopez-Rodriguez Candace Keirns Daniel Zagal-Cardoso nild. espinola-zavaleta Department of Nuclear Cardiology National Institute of Cardiology Ignacio Chavez Mexico City Mexico Department of Computed Tomography National Institute of Cardiology Ignacio Chavez Mexico City Mexico Department of Clinical Cardiology National Institute of Cardiology Ignacio Chavez Mexico City Mexico Shelby County Health Department Memphis TN USA Department of Echocardiography ABC Medical Center I.A.P. Mexico City Mexico

Marfan’s syndrome (MFS) is an autosomal dominant disorder characterized by aortic root dilation, mitral valve prolapse and aortic regurgitation. The typical aneurysm location involves the thoracic aorta (60%). Thoracoabdominal aortic dissections are quite infrequent (10%). A type A aortic dissection can have fatal complications, such as aortic rupture and cardiac tamponade, and a prompt diagnosis is crucial. The present case involves a 46-year-old patient with Marfan’s syndrome who was admitted to the emergency department for dyspnea. The patient presented congestive signs and manifestations suggesting acute heart failure. An initial transthoracic echocardiogram (TTE) showed ventricular hypertrophy and diastolic dysfunction. Additionally, TTE showed plurivalvular regurgitation, pulmonary hypertension (42 mmHg), aortic dilatation, and a dissection flap. Coronary computed tomography angiography (CCTA) was performed, confirming the suspicion of ascending aortic dissection. The patient underwent a three-stage intervention for the repair of all the defects, with adequate recovery. This was a rare presentation of aortic dissection in MFS, which was a diagnostic challenge for the heart team.

关键词： Marfan-Syndrome Aortic-Dissection Heart-Failure