Archivos Peruanos de cardiologia y cirugia cardiovascular最新文献

Interatrial septal occlusion devices hinder the transseptal approach for atrial fibrillation ablation, making it necessary to have imaging methods that safely guide transseptal puncture, such as intracardiac echocardiography (ICE). We describe the case of a 49-year-old patient with symptomatic paroxysmal atrial fibrillation, refractory to antiarrhythmic drugs, wearing an interatrial septal occlusion device, with a previous unsuccessful ablation attempt. Atrial fibrillation ablation was performed using the Carto V7 3D mapping system, the transseptal puncture was guided by ICE, and the procedure was successful. This case report highlights the importance of multimodality imaging to achieve successful and effective transseptal puncture for atrial fibrillation ablation in patients with interatrial septal occlusion devices.

Objective: To describe the quality of life in patients with idiopathic ventricular arrhythmias treated at the Instituto Nacional Cardiovascular INCOR in Lima -Peru.

Materials and methods: . Analytical and cross-sectional study of patients with idiopathic ventricular arrhythmias treated by 3D ablation or antiarrhythmic therapy between July 2017 and December 2019 to whom the SF-36 health questionnaire was applied to assess quality of life related to health.

Results: Fifty-two patients with idiopathic ventricular arrhythmias were included (34 underwent 3D ablation, and 18 underwent antiarrhythmic therapy only). The percentage of recurrence (14.7% vs. 50%, p=0.01) and adverse effects (0% vs. 22.2%, p=0.011) were lower in the 3D ablation group compared to the antiarrhythmic group. The mean standardized scores obtained from the Spanish version of the Health Survey SF-36v2, applied to the 3D ablation and antiarrhythmic groups were 85.1 vs 68.4 (p<0.001), respectively. Were found statistically significant differences in 6 of the eight components that evaluate health-related quality of life: physical function (96.0 vs. 76.0, p<0.001), physical role (93.4 vs. 61.1, p<0.001), general health (74.5 vs. 47.4, p<0.001), vitality (69.9 vs 54.7, p=0.008), emotional role (92.2 vs. 77.8, p=0.006) and mental health (73.8 vs. 60, p<0.001).

Conclusions: Patients with idiopathic ventricular arrhythmias who underwent 3D ablation have a higher mean standardized score for health-related quality of life.

Human immunodeficiency virus (HIV) infection was associated with increased morbidity and mortality, predominantly for opportunistic infections, before using antiretroviral therapy. With this, patients have experienced increased survival and cardiovascular compromise too. The etiology of these clinical conditions could be related to the infection itself, adverse events associated with antiretroviral therapy, or adverse events produced by the combination with other drugs. Some of these conditions have an acute onset, and their rapid recognition is vital for a better prognosis.

Gerbode Defect (GD) is a rare congenital heart disease that mainly affects the upper portion of the membranous septum, generating a shunt between the left ventricle and the right atrium. Even though most cases are congenital, it has also been reported acquired cases due to cardiac surgery, infective endocarditis, acute ischemic heart disease, and invasive percutaneous procedures. The diagnostic workup includes the clinical evaluation and the echocardiographic study. Here, we present the case of a 43-year-old adult patient with an incidental finding of a congenital GD in the context of acute appendicitis. Imaging plays a role in the diagnostic workup of congenital diseases; in this case, it allowed us to identify more details and the decision-making for our patient.

Median sternotomy is the Gold Standard access for surgical revascularization of the myocardium, but it is not free of complications, especially in patients with multiple comorbidities. Minimally invasive access offers the advantage of avoiding sternotomy, achieving a more accelerated postoperative recovery, with less hospital stay time and a higher level of satisfaction with quality of life. We present the case of a 49-year-old male patient, diabetic, hypertensive, smoker, with multiarterial coronary artery disease, very symptomatic, who underwent surgical revascularization by left mini-thoracotomy.

We present the case of a 56-year-old male patient with a history of atrial flutter for six months; he was admitted to the hospital for presenting a mass of 8 cm in maximum diameter in the right atrium, which prolapsed through the tricuspid valve into the right ventricle. Emergency surgery was scheduled, performing exeresis of the tumor and tricuspid annuloplasty. The Pathological anatomy determined that the removed mass corresponded to a cardiac lipoma.

Objective: To evaluate the degree of incomplete revascularization in patients with multiarterial coronary artery disease who underwent percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) using the Syntax revascularization index (SRI) and its relationship to major cardiovascular events during follow-up.

Materials and methods: Observational, retrospective study with 4-year follow-up of patients with multiarterial coronary artery disease who underwent surgical or percutaneous coronary revascularization, in whom the baseline Syntax score (SSb) and the residual Syntax score (SSr) were calculated. The Syntax Revascularization Index (SRI) was determined with the following formula: SRI = (1- [SSr/SSb]) x 100, and major cardiovascular events at 4-year follow-up were compared.

Results: Two hundred patients (100 in each group) were evaluated. Mean SSr in group 1 was 83.2%, and in group 2, 79.0% (p=0.88). Mean complete revascularization was 41% in the first group and 35% in the second. A cutoff point of ≤90% of IRS had the best accuracy for predicting major cardiovascular events (area under the curve of 0.60; 95% CI: 0.49-0.71, p<0.05). In multivariate analysis IRS was an independent predictor of major cardiovascular events (HR 2.6; 95%CI: 1.32-3.22, p= 0.043).

Conclusions: The Syntax Revascularization Index may be useful for measuring the degree of revascularization in patients with multiarterial coronary artery disease treated percutaneously or surgically. An SRI ³90% may be an acceptable target for revascularization.

Objective: Cardiac Rehabilitation (CR) programs based on telehealth are an alternative in the context of a pandemic and represent an opportunity to continue in the intervention of cardiovascular diseases (CVD). The present study aims to evaluate the effect of a Cardiac Tele-Rehabilitation (CTR) program on quality of life, anxiety/depression index, exercise safety and Level Of disease awareness in patients discharged from a national referral institute in times of pandemic.

Methods: A pre-experimental study in cardiac patients who entered the cardiac rehabilitation program at INCOR from August to December 2020. The study included low-risk patients who were administered a questionnaire (on cardiovascular disease, exercise safety, anxiety/depression, and quality of life) at the beginning and end of the program, which was applied through a virtual platform. Descriptive and comparative before-after analysis was used through hypothesis testing.

Results: Sixty-four patients were included (71.9% male). The mean age was 63.6 ±11.1 years. Regarding exercise safety, an increase in the mean score was found after the application of the program (3.06 ± 0.8 to 3.18 ± 0.7, p=0.324). Concerning anxiety, the mean score was reduced from 8.61 to 4.75, while for depression, the reduction was from 7.27 to 2.92. Regarding the quality-of-life score, the global component improved from 111.48 to 127.92.

Conclusions: The CTR program implemented through a virtual platform during the COVID-19 pandemic enhanced quality of life and decreased stress and depression in cardiac patients discharged from a national cardiovascular referral center.

Systemic light chain amyloidosis is a disease characterized by the accumulation of amyloid protein in multiple organs and systems. We present the case of a 52-year-old male patient with a diagnosis of systemic light chain amyloidosis associated with cardiac and renal involvement. A renal biopsy showed the presence of renal amyloidosis associated with proteinuria, and the patient was referred for cardiovascular evaluation. The baseline electrocardiogram showed micro voltage in frontal leads that were discordant with the left ventricular hypertrophy evidenced in the transthoracic echocardiogram (TTE). Cardiac magnetic resonance imaging (CMR) confirmed the presence of cardiac amyloid infiltration with a pattern of extensive ventricular late-gadolinium enhancement. Despite being referred and receiving specific systemic chemotherapy treatment, the evolution was not favorable after four months of follow-up with worsening cardiac infiltration, increasing values of biomarkers, and progression of dyspnea. The TTE was useful in revealing the unfavorable evolution and worsening of diastolic function parameters and increased wall thickness in the context of infiltration. The electrocardiogram and echocardiogram were easily accessible tools that allowed the monitoring of the response to treatment.