Archivos Peruanos de cardiologia y cirugia cardiovascular最新文献

Aortic valve disease is a highly prevalent and clinically significant condition in the general population. Cardiac computed tomography (CT) has emerged as a widely available imaging modality that provides high-resolution static and dynamic information, enabling comprehensive evaluation of valve anatomy and function. This technique complements echocardiography and other imaging tools, adding incremental value to clinical decision-making. Its principal applications include identifying the etiology of valvular disease, grading severity, and assessing adjacent structures, all of which are critical for therapeutic planning. This non-systematic review synthesizes the evidence on the role of CT in the assessment of the aortic valve, focusing on aortic stenosis, aortic regurgitation, infective endocarditis, and postoperative evaluation. The current body of evidence underscores the expanding role of CT in the integrated diagnosis and longitudinal management of aortic valve disease.

Takotsubo Syndrome (TTS) is characterized by transient left ventricular dysfunction, often triggered by emotional or physical stress. While negative emotional events are common triggers, positive emotional events can also induce a rare variant known as Happy Heart Syndrome (HHS). This case report describes a 53-year-old male who presented with acute chest pain following a positive emotional stimulus: a birthday call offering him an opportunity to play with his favorite music group. Initial workup suggested an acute myocardial infarction, but coronary angiography revealed no obstruction. Left ventriculography showed the classic apical ballooning pattern of TTS. The patient was diagnosed with HHS. This case underscores the importance of considering positive emotional triggers in the diagnosis of TTS and highlights the need for further research into its diverse presentations and management strategies.

Clinical case of an 86-year-old male patient presenting with a late anterior myocardial infarction without reperfusion is reported. Initial echocardiographic assessment revealed a rare and complex mechanical complication: intramyocardial dissection of the left ventricular apex associated with interventricular septal rupture. Given the severity of the condition, an urgent surgical intervention was undertaken using a bovine pericardial patch. Although the initial postoperative course was favourable, multiple subsequent complications ultimately led to the patient's death from ventricular arrhythmia on day 50th of hospitalisation. This report underscores the importance of timely diagnosis and multidisciplinary management of this rare clinical entity.

The management of ST-segment elevation myocardial infarction (STEMI) after reperfusion requires critical decision-making in patients with multivessel disease (MVD), acute heart failure, and left ventricular (LV) thrombus. Complete revascularisation of non-culprit lesions ≥70% is recommended either during the index procedure or within the first 19 days, particularly in haemodynamically stable patients. Coronary artery bypass grafting is indicated for high-risk anatomy or complex lesions following successful percutaneous coronary intervention, where a hybrid approach may combine percutaneous intervention with surgery, and timing should be adjusted according to whether a stent was implanted. Post-infarction heart failure, which occurs in 28-31% of cases, requires urgent management; continuous monitoring and timely intervention can reduce complications. In patients with cardiogenic shock or mechanical complications, intra-aortic balloon pump support and inotropes may be necessary. Right ventricular infarction is managed with volume resuscitation, urgent revascularisation, and, when required, pharmacological support or pacing. LV thrombus, more frequent after anterior infarction with LVEF <50%, mandates early detection by echocardiography and/or tomography, and prompt anticoagulation, preferably with warfarin, with triple therapy considered in patients at high thrombotic risk. This manuscript outlines recommendations to optimise prognosis through early, evidence-based, and individualised interventions.

Objectives: To evaluate the association between beta-blocker use and the presence of depressive symptoms in older adults with hypertension (HTN).

Materials and methods: A cross-sectional observational study was conducted among patients from the Central FAP Hospital and the Naval Medical Center. Older adults with a diagnosis of HTN who had been receiving antihypertensive treatment for at least one month were included. Depressive symptoms were assessed using the PHQ-9 questionnaire. Social, clinical, and functional variables were analyzed using bivariate tests (Chi-square and Fisher's exact test), as well as Poisson regression with robust variance to estimate crude and adjusted prevalence ratios (PR).

Results: A total of 149 older adults were included. Of these, 27.5% were taking beta-blockers, and 39% presented depressive symptoms. No significant association was found between beta-blocker use and the presence of depressive symptoms (PR:1.09; 95% CI: 0.70-1.69; p = 0.693). In contrast, a higher risk of depressive symptoms was observed among patients with greater frailty (PR: 5.72; 95% CI: 2.17-15.0; p < 0.001) and a lower risk among those with technical or university education (PR: 0.43; 95% CI: 0.25-0.74; p = 0.003).

Conclusions: No association was found between beta-blocker use and depressive symptoms in patients with HTN. Factors such as frailty, educational level, and duration of HTN diagnosis showed significant associations and should be considered in the comprehensive assessment of emotional risk in this population.

We present the case of a 41-year-old woman with left atrial isomerism, severe sinus node dysfunction, and left ventricular hypertrabeculation, who required implantation of a dual-chamber implantable cardioverter-defibrillator with left bundle branch area pacing. Her family history revealed multiple cases of heterotaxy and conduction disorders. Genetic testing identified a heterozygous interstitial duplication on chromosome 17q23.2 involving the MED13 gene, whose clinical significance has not yet been determined.

Objective: The presence of coronary lesions of less than 50% in patients with myocardial ischaemia is a common diagnosis in cardiac catheterisation laboratories. The aim of this study was to determine the clinical course of patients with myocardial ischaemia in the absence of obstructive coronary lesions.

Materials and methods: A prospective analytical study was conducted in 110 patients of both sexes with documented myocardial ischaemia and coronary lesions of less than 50% on coronary angiography. The follow-up period was three years.

Results: The mean age was 64.5 ± 7.2 years, with a predominance of females (57%). The most prevalent risk factors were hypertension (58.2%) and dyslipidaemia (44.5%). In 8.3% of cases, re-hospitalisation was required, with heart failure reported as the leading cause (6.5%). Cardiovascular event-free survival during follow-up was 80%, and was higher in patients without coronary lesions. A higher incidence of cardiovascular events was associated with diabetes mellitus, a family history of ischaemic heart disease, and chronic kidney disease.

Conclusions: Patients with myocardial ischaemia in the absence of obstructive coronary lesions experienced adverse events during follow-up, particularly those with diabetes mellitus, a family history of ischaemic heart disease, and chronic kidney disease.

Introduction: Introduction. In Ecuador, there is limited data on the treatment of patients with heart failure (HF).

Objective: This study aimed to determine the rate of use of prognosis-modifying drugs and their association with prognosis.

Materials and methods: A retrospective observational study was conducted on patients with chronic HF included in the "Los Ceibos" registry between January 2017 and December 2022. Patients were followed for a median of 2.28 years (interquartile range [IQR]: 1.25-3.49).

Results: A total of 711 patients diagnosed with HF were included. Among them, 82.7% (n=588) received angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNIs); 82.3% (n=585) received beta-blockers (BBs); and 51.3% (n=365) were treated with mineralocorticoid receptor antagonists (MRAs). Among patients with HFrEF, those receiving triple therapy (ACEI/ARB/ARNI + BB + MRA) had lower all-cause mortality compared to other groups (38.8%, log-rank p=0.014). In patients with Heart Failure with preserved Ejection Fraction (HFpEF), no mortality differences were observed according to the number of medications used (log-rank p=0.720). MRA use was not associated with a prognostic benefit in HFpEF (p>0.05). Patients receiving triple therapy with ARNI + BB + MRA had better survival during follow-up compared to any other drug combination (log-rank p=0.027).

Conclusions: A high rate of ACEI/ARB/ARNI and BB use was observed. The use of triple therapy, particularly the combination of ARNI + BB + MRA, was associated with improved prognosis in patients with HFrEF over a four-year follow-up period. No prognostic benefit of MRA use was observed in patients with HFpEF.

Vascular rings represent less than 1% of congenital cardiovascular anomalies, with double aortic arch being the most common variant. It is typically diagnosed in infants, with respiratory symptoms in over 90% of cases. We present the case of a 31-year-old male patient with recurrent childhood respiratory infections and asthma, who presented with progressive dysphagia. Contrast-enhanced computed tomography angiography revealed a double aortic arch with right-sided dominance, and the esophagram revealed compression of the proximal third of the esophagus. A left posterolateral thoracotomy was performed with division of the distal left arch, division of the ligamentum arteriosum, adhesions release, and thoracic aorta reconstruction. Postoperative recovery was favorable, with complete resolution of symptoms. Double aortic arch is rarely diagnosed in adulthood. This case highlights its atypical presentation, with predominant gastrointestinal symptoms, and the importance of considering it in the differential diagnosis of dysphagia.

The aortopulmonary window is a rare congenital heart defect. Isolated aortopulmonary window, without other associated anomalies, accounts for up to 25% of all cases. Surgical closure has long been, and remains, the gold standard in many cardiovascular centres. However, percutaneous closure has emerged as a viable alternative using various types of occluder devices, selected based on the morphology, size, and rims of the defect to minimise complications such as valvular interference or coronary ostial obstruction. We report the case of an infant with an isolated aortopulmonary window successfully treated with percutaneous closure using a muscular ventricular septal defect occluder device, with no complications. The patient was discharged 48 hours after the procedure.