Archivos Peruanos de cardiologia y cirugia cardiovascular最新文献

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition that can occur during the late pregnancy or puerperium. A 31-year-old woman with a recent twin pregnancy presented with heart failure symptoms nine days postpartum. On admission, she had volume overload and hemodynamic compromise, which was rapidly reversed with inotropic levosimendan support. Echocardiography revealed a left ventricular ejection fraction (LVEF) of 20% with global hypokinesia. Once stabilized, she was discharged on heart failure medication, bromocriptine, and warfarin. Cardiac magnetic resonance imaging at five weeks demonstrated a preserved LVEF of 57% and no evidence of myocardial scarring or edema. During the 4-year follow-up, the patient remained stable with no new pregnancies. This case highlights the importance of considering PPCM in the differential diagnosis of heart failure in the peripartum period after excluding other etiologies. It also describes the successful use of bromocriptine in facilitating recovery of systolic function without long-term complications.

Multiple Aneurysmal Arterial Disease (MAD) is an extremely rare arterial vascular condition and is produced by an abnormal alteration of smooth muscle cells and neutrophils, producing a multiple-aneurysmal degeneration. We present the case of a 36-year-old patient with a MAD in the cerebral territory and extremities with no surgical indication; however, with an aneurysm of the right inferior renal segmental artery, inferior mesenteric artery, left common iliac artery, and right internal iliac artery with surgical indication. An open approach with single-stage surgical repair, including graft interposition, bypass, exclusion, and vascular reimplantation, was performed. The surgical and postoperative course was uneventful, and the patient was discharged with an indication for outpatient follow-up. The open approach may be the best option for young patients with MAD, especially in the abdominopelvic region, without the need for high resources, with satisfactory results and improved patient survival.

Objective: To determine the clinical, diagnostic, and therapeutic profile of patients with left intraventricular thrombus (LVT) in three high-complexity centers in Medellín, Colombia, between January 2000 and January 2022.

Materials and methods: This was an observational and cross-sectional study that included 307 patients with LVT. Hospital records were analyzed to identify the clinical and therapeutic profile, and thrombus resolution and systemic embolism were evaluated. Univariate and bivariate analyses were performed using Fisher's exact test and a logistic regression model.

Results: The prevalence of LVT was 9.75%. In 85% of cases, LVT was diagnosed using transthoracic echocardiography; 75.9% of patients were male, and the median age was 62 years. The most frequent comorbidities were heart failure (95.77%) and hypertension (69.7%).LVT occurred in 27% of cases in the context of acute coronary syndrome (ACS). Low molecular weight heparin (LMWH) was administered in 78.5% of cases, and warfarin was the most commonly used anticoagulant (82.7%). Hemorrhagic complications occurred in 19.2%, mainly gastrointestinal, and 35% of patients achieved thrombus resolution. Systemic embolism developed in 30% of cases, primarily affecting the central nervous system. Overall mortality was 15%.

Conclusions: The prevalence of LVT was 9.75%. Warfarin remains the standard treatment, although alternative therapies are used in special cases. Apical dysfunction was associated with systemic embolism.

Infective endocarditis is a disease that affects mainly the endocardial surface of the heart and cardiac valves (native or prosthetic). The main risk factors for developing infective endocarditis are male sex, older age, intracardiac shunts, prosthetic valves, rheumatic, and congenital heart disease, intracardiac devices, intravenous drugs use, immunosuppression, and hemodialysis. Streptococci and Staphylococci spp. have been the most frequent isolated organisms. On the other hand, the most common fungal organism in infective endocarditis is Candida albicans (24-46%), followed by Aspergillus spp. (25%), and a few cases by Cryptococcus neoformans, which are associated with higher rate of mortality. This case provides an interesting case of Cryptococcus neoformans native valve infective endocarditis in a young woman with stage IV chronic kidney disease and severe malnutrition.

Objective: To determine the age-standardized rate of acute myocardial infarction (AMI) events and its trend in recent years.

Materials and methods: An ecological study of secondary data on morbidity in emergency areas of Peruvian hospitals between 2018 and 2023 was conducted. Cases of AMI in adults aged 20 years or older were identified using ICD-10 codes. Age-standardized AMI event rates per 100,000 person-years were calculated. In addition, the change in event rate between extreme years was calculated, and a Poisson regression was used to estimate the annual percentage change in event rates along with their 95% confidence interval (CI), adjusting for age and calendar year. These rates were stratified by sex and political-administrative regions.

Results: 28,088 AMI events were recorded between 2018 and 2023. The national age-standardized rate increased from 22.77 in 2018 to 25.60 per 100,000 person-years in 2023, with an annual percentage change of 6.72% (95% CI 4.25-9.25). Men had higher AMI event rates compared to women throughout the study period. In addition, the highest event rates were observed in the Constitutional Province of Callao, San Martin and Loreto.

Conclusions: Our findings provide a better understanding of the epidemiology of AMI in Peru and its evolution in recent years, important data to improve prevention, treatment and resource distribution strategies for the management of AMI.

Objective: Chronic Chagas Cardiomyopathy (CCC) carries a high risk of embolic events due to structural changes in the left ventricle and frequent conduction disorders. However, there is limited data on anticoagulant prescription patterns and factors influencing the use of direct oral anticoagulants (DOACs) in these patients. This study aims to characterize CCC patients based on the anticoagulant therapy received and identify factors associated with DOACs use.

Materials and methods: A cross-sectional study was conducted at a tertiary-level hospital in Colombia between 2019-2022. Multivariate logistic regression models were used to assess factors associated with anticoagulant therapy and DOACs use.

Results: Among 224 CCC patients, 65.7% (n=153) were on anticoagulants, with DOACs being the most prescribed (53%). Notably, 35% of patients at high risk of stroke (CHA2DS2-VASc) were not receiving anticoagulants. Atrial fibrillation (OR 256.08; 95% CI 61.94-1058.72), ventricular aneurysms (OR 4.82; 95% CI 1.54-15.09), and reduced interventricular septal thickness (OR 0.75; 95% CI 0.60-0.92) were associated with anticoagulant use. DOACs were mainly prescribed for patients with atrial fibrillation (OR 13.29; 95% CI 2.47-71.56) and high bleeding risk (HAS-BLED ≥3, OR 11.36; 95% CI 1.15-112.11).

Conclusions: A significant proportion of CCC patients were not receiving anticoagulants despite their high risk of stroke and embolic events. The use of anticoagulation was significantly associated with atrial fibrillation, the presence of ventricular aneurysms and reduced interventricular septal thickness. It is crucial to raise awareness among healthcare professionals in endemic areas to improve treatment.

Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease with an important course due to systemic compromise. SLE is frequently associated with antiphospholipid syndrome, and pulmonary thromboembolism (PE) is particularly common. It is extremely rare for PE to be the initial clinical presentation and even more uncommon for it to coincide with cardiac tamponade, representing a challenge in diagnosis and management. We present a case of a 42-year-old woman with recurrent PE with severe pleural and pericardial effusion, hemodynamic instability, and cardiac tamponade. Laboratory workup revealed hypocomplementemia, leukopenia, negative SLE antibodies, and a positive lupus anticoagulant. This case emphasizes the importance of determining the etiology of PE, assessing risk classification, and implementing proper management, which are crucial for the patient's survival and outcome.

We present the case of a patient with Andersen-Tawil syndrome (ATS), a rare genetic disorder characterized by the presence of ventricular arrhythmias, skeletal dysmorphic features, and periodic muscle paralysis. The diagnosis was delayed due to the non-simultaneity of symptom presentation. The report highlights the importance of investigating neurological symptoms in the presence of ventricular arrhythmias of unclear origin or cardiac symptoms in patients with periodic paralysis. The diagnosis was confirmed by the identification of a mutation in the KCNJ2 gene (c.224C>T(p.Thr75Met)); this specific mutation has not been reported in the gnomAD database, suggesting a minor allele frequency (MAF) of less than 1%. The patient is currently managed pharmacologically with a beta-blocker and remains free of arrhythmias.

Hypertrophic cardiomyopathy has a different presentation spectrum, including left ventricular outflow tract obstruction. The most common phenotype is the asymmetric septal variant, with the mid-apical variant being rare. On the other hand, there are specific mutations associated with hypertrophic cardiomyopathy, with the Filamin C variant being an unusual condition in these patients. Therefore, we present the case of a 23-year-old male patient with a diagnosis of hypertrophic cardiomyopathy in whom a Filamin C variant was documented. Given the inadequate response and persistence of symptoms to medical management, a myectomy procedure was performed with a transapical approach, with subsequent improvement in clinical symptoms and outflow tract obstruction. This case illustrates a rare variant with a surgical approach different from the conventional transaortic approach, with marked improvement in symptoms.

Objective: Several studies have demonstrated an association between frailty and worse outcomes in patients with acute coronary syndrome (ACS); however, there is a lack of evidence from Colombia. This study aims to evaluate the association between frailty and the risk of adverse outcomes in patients over 65 years old diagnosed with ACS.

Materials and methods: A prospective cohort study was conducted, including patients over 65 years old who underwent coronary angiography due to an ACS diagnosis at a hospital in Medellín, Colombia. Frailty was assessed using the FRAIL scale. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included length of hospital stay and a composite outcome of in-hospital or 30-day mortality, contrast-induced nephropathy (CIN), acute heart failure, cardiogenic shock, hemorrhagic complications, and vascular complications.

Results: A total of 112 patients were included. Frail patients (n=35, 31.3%) were older, had a lower socioeconomic status, higher GRACE scores, and more severely compromised coronary vessels. A significant association was observed between frailty and 30-day mortality (relative risk [RR] 19.00, 95% confidence interval [CI]: 5.04-72.61; p<0.001), the composite outcome (RR 4.57, 95% CI: 2.56-8.34; p<0.001), and longer hospital stays (9 days vs. 5 days in the non-frail group).

Conclusions: A considerable number of patients over 65 years old with ACS were frail. Frailty was associated with adverse in-hospital and 30-day outcomes.