2021;116(2 suppl 1) – ABC CARDIOL

Case Report

Covid-19 in Heart Transplant Recipients in São Paulo: A Case Series

Rafaela Vale de Miranda Soriano et al. João Manoel Rossi Neto Marco A. Finger Carolina Casadei Santos

Introduction

The disease caused by the new coronavirus (Covid-19), SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. By analogy to others respiratory infections, mainly based on the 2009 pandemic of the influenza virus H1N1,^, an increase in cases of pneumonia and progression to septic shock with acute respiratory distress syndrome was expected among recipients of solid-organ transplantation with Covid-19 in comparison with the non-transplanted population. However, immunosuppression in transplantation could theoretically revoke the hyperinflammatory syndrome secondary to the cytokine storm, responsible for the majority of deaths by Covid-19.^, Data on immunosuppression potentially leading to atypical clinical presentations or increasing the risk of adverse events in the presence of Covid-19 are conflicting.^,

We report our experience with heart transplant (HT) recipients diagnosed with Covid-19 at an institution with an HT program since 1992 in São Paulo, Brazil.

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Case Report

Coronary Vasoreactivity after Complete Bioresorption of Absorb BVS at 5-Year Follow-Up

Luis Renier Goncalves-Ramírez et al. Hipólito Gutíerrez Fabián Julca Maximiliano Germán Amado Escañuela … Gretel Varvaro Ignacio Amat-Santos

Introduction

Bioresorbable coronary scaffolds have been designed to prevent long-term complications related to permanent implantation of metallic stents. Everolimus-eluting bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, California) was one of the first bioresorbable vascular scaffolds (BVS) to be developed. Absorb BVS is a backbone of Poly-L-lactic acid coated with Poly-DL-lactic polymer, which elutes antiproliferative drug everolimus. BVS received CE Mark for the treatment of coronary artery disease in January 2011 and it was marketed in most European countries by 2012. Although good outcomes were initially described,^, recent studies have questioned the safety of the device, suggesting a higher incidence of thrombosis and myocardial infarction.^, Beyond this, structural and functional recovery of scaffolded coronary segments after BVS resorption has not been systematically searched in a consecutive real-world series. We describe a case of a patient who was studied by coronary angiography, optical coherence tomography (OCT) and coronary vasoreactivity test 5-year after BVS implantation.

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Case Report

Dilated Cardiomyopathy Reversibility in Sheehan's Syndrome: A Case Report

Maria Luíza Barbosa Fernandes Dourado et al. Taís Paiva da Costa Márcia Sampaio de Carvalho Carlos Geraldo Guerreiro de Moura

Introduction

Sheehan’s syndrome, discovered in 1937 by Harold Leeming Sheehan is described as pan-hypopituitarism secondary to pituitary necrosis after post-partum hemorrhage. The clinical condition presentation depends on the hormonal shortfall presented, and may involve changes in serum cortisol levels, thyroid function, growth hormones, breastfeeding and sex hormones. Although poorly described in the literature, there are reports of dilated cardiomyopathy associated with Sheehan’s syndrome, some with reversibility of cardiopathy after hormone replacement therapy. This paper reports a clinical case of Sheehan’s syndrome associated to dilated cardiomyopathy that displayed cardiac function improvement after hormone replacement therapy.

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Case Report

Antenatal Diagnosis of Double Aortic Arch

Natália Noronha et al. Angie Hobbs Patricia Caldas

Introduction

Congenital anomalies of the aortic arch affect 1-2% of the population and comprise a wide variety of abnormalities in the position and/or branching pattern of the aortic arch. Double aortic arch (DAA) represents 1-2% of all aortic arch anomalies and is characterized by persistence of both left and right embryonic aortic arches. It can be found either in isolation or, less frequently, in association with other cardiovascular or chromosomal abnormalities. Antenatal diagnosis of DAA may be challenging, as its distinction from other arch abnormalities like right aortic arch with left arterial duct or with an aberrant left subclavian artery is not always straightforward. The authors describe a case of antenatal diagnosis of DAA.

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Case Report

Systematic Staged Percutaneous Balloon Pulmonary Angioplasty in Severe Inoperable Chronic Thromboembolic Pulmonary Hypertension

Kazuhiro Dan et al. Akira Shionoda Hiromi Matsubara

Introduction

The treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is limited to pulmonary endarterectomy (PEA), drug therapy, and percutaneous balloon pulmonary angioplasty (BPA). The gold-standard treatment is PEA, and patients with CTEPH and proximal lesions are generally good surgical candidates. Perioperative complications and persistent pulmonary hypertension due to incomplete endarterectomy or secondary vasculopathy are typical problems after the procedure. A meta-analysis has shown that the efficacy of drug therapy for severe CTEPH is limited, and many patients do not achieve sufficiently reduced pulmonary artery (PA) pressure, even if exercise tolerance is marginally improved. Percutaneous BPA was first reported in 2001, but its safety was not proven at that time. As recently as one decade ago, pulmonary hypertension was first associated with poor prognosis. Fortunately, treatments for pulmonary hypertension have dramatically improved ever since, particularly for patients with CTEPH. BPA is still a challenging strategy, limited to a specific operator and facility, but its results have been improving.

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Case Report

Pericardial Masses: A Rare Presentation of Tuberculous Pericarditis Documented by 3D Echocardiography

Alex dos Santos Felix et al. Viviane Belidio Pinheiro da Fonseca Rodrigo Coelho Segalote Larissa Franco de Andrade … Deborah Louize da Rocha Vianna Palmieri Ana Paula dos Reis Velloso Siciliano

Learning Points

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Case Report

Three-dimensional Echocardiography Reveals the True Enemy in a Young Male with ST-Elevation Myocardial Infarction and Severe Mitral Regurgitation: Posterior Mitral Valve “Pseudo-Cleft” and Prolapse

Sorina Mihaila et al. Andreea Elena Velcea Luigi Paolo Badano Vinereanu Dragos Denisa Muraru

Introduction

Three-dimensional echocardiography (3DE) plays an increasingly important role in the diagnosis of valvular heart disease, in the assessment of valvular morphology in an anatomical manner, and in establishing valve repairability, beyond the limitations of conventional two-dimensional echocardiography (2DE).

We report the case of a young patient presenting with acute anterior ST-segment elevation myocardial infarction and severe mitral regurgitation (MR) after successful primary percutaneous coronary intervention (PCI) of the left anterior descending artery, whose three-dimensional transesophageal echocardiography (3D TEE) revealed an unexpected cause of the MR, namely, complex mitral valve (MV) pathology consisting of prolapse of the P_2-3 scallops, flail chordae, and pseudo-cleft of the posterior leaflet separating the P₁ from the P₂ segment.

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Case Report

Very Long Apneas during Prone Position in a Lean Patient with Coronary Artery Disease: Implications for the Cardiovascular Risk

Sofia Fontanello Furlan et al. Viktor Sinkunas Pedro Rodrigues Genta Geraldo Lorenzi Filho Luciano F. Drager

Introduction

Obstructive sleep apnea (OSA) is a common condition characterized by recurrent upper airway obstructions during sleep, promoting intermittent hypoxia and sleep fragmentation. Traditional risk factors for OSA include male gender and obesity. Overall, patients with severe OSA presented longer events and more severe hypoxemia. Supine sleep is consistently associated with more severe OSA rates in adults. However, the relationship between OSA indices and prone position is inconsistent. Here, we reported a very peculiar presentation of OSA characterized by very long respiratory events in a prone position in a lean female patient with a history of high blood pressure, diabetes mellitus, chronic kidney disease under dialysis therapy and a recent diagnosis of coronary artery disease (CAD).

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Case Report

When Everything goes Wrong

Helder Santos et al. Hugo Miranda Mariana Santos Inês Almeida … Joaquim Peixoto Joana Chin Lurdes Almeida

Introduction

The Bentall procedure was described for the first time 50 years ago and has undergone several improvements through the years. This technique is considered to be a longstanding and safe procedure. However, as any surgery, it can have several complications such as anastomotic pseudoaneurism, myocardial infarction and endocarditis.

In developed countries with differentiated access to health care and prophylaxis, endocarditis is an uncommon pathology, associated to frequent complications and high mortality rates. Antibiotic therapy aims to eradicate the responsible microorganism. However, some of the drugs used cause several side effects, like the DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome.

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Case Report

Isolated Right Ventricle Myocardial Infarction – Is the Right Ventricle Still the Forgotten Ventricle?

Ana Marques et al. Inês Cruz Alexandra Briosa Isabel João … Sofia Almeida Hélder Pereira

Introduction

Isolated right ventricular myocardial infarction is extremely rare, and it is often silent, with only 25% of patients developing clinically evident hemodynamic manifestations on presentation. Current management of acute myocardial infarction is based on prompt diagnosis and immediate revascularization. About 90% of patients presenting with ST-segment elevation myocardial infarction have an explanatory coronary artery stenosis or occlusion. Myocardial infarction with non-obstructive coronary arteries (MINOCA) should lead the treating physician to investigate underlying causes, since failure to identify the underlying cause may result in inadequate and inappropriate therapy in these patients.

We describe a case of isolated right ventricular myocardial infarction with normal physical examination, transthoracic echocardiograms, and non-obstructive coronary artery disease on coronary angiography, whose definitive diagnosis was established by cardiac magnetic resonance imaging.

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