Image in Cardiology
Left-sided endocarditis extending to the right chambers: Usefulness of three-dimensional echocardiography in preoperative assessment
Endocardite esquerda com extensão direita: utilidade da ecocardiografia tridimensional na avaliação pré-operatória
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"Ancho" => 2333 "Tamanyo" => 132942 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Left heart catheterization: (A) radial access made impossible due to the tortuosity of the subclavian artery, which prevented passage of the guidewire; (B) contrast-guided puncture of the left femoral artery; (C) catheterization by femoral access revealing a mobile thread-like structure (arrow), consistent with a thrombus.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carina Arantes, Jorge Marques, Sílvia Ribeiro, Catarina Quina-Rodrigues, Glória Abreu, Sérgia Rocha" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Carina" "apellidos" => "Arantes" ] 1 => array:2 [ "nombre" => "Jorge" "apellidos" => "Marques" ] 2 => array:2 [ "nombre" => "Sílvia" "apellidos" => "Ribeiro" ] 3 => array:2 [ "nombre" => "Catarina" "apellidos" => "Quina-Rodrigues" ] 4 => array:2 [ "nombre" => "Glória" "apellidos" => "Abreu" ] 5 => array:2 [ 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"licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2017;36:317-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1395 "formatos" => array:3 [ "EPUB" => 159 "HTML" => 933 "PDF" => 303 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Fever in an elderly patient unmasks Brugada syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "317" "paginaFinal" => "318" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Febre num idoso desmascara síndrome de Brugada" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" 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array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Teresa" "apellidos" => "López Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Ulises" "apellidos" => "Ramírez Valdiris" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Juan" "apellidos" => "Caro Codón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Inés" "apellidos" => "Ponz de Antonio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Sandra" "apellidos" => "Rosillo Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "José María" "apellidos" => "Mesa García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "Mar" "apellidos" => "Moreno Yangüela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Cardiology Department, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cardiac Surgery Deparment, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Endocardite esquerda com extensão direita: utilidade da ecocardiografia tridimensional na avaliação pré-operatória" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1417 "Ancho" => 1883 "Tamanyo" => 261091 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiography in mid-esophageal view: (A) two-dimensional transesophageal echocardiography (2D-TEE) showing a cavity between the aortic prosthesis and the right atrium RA corresponding to a PA, which communicates with the RA (blue arrow) and with the RV through the base of the TSL (yellow arrow); (B) three-dimensional transesophageal echocardiography (3D-TEE), showing the PA from the RA in the middle of the image, the aortic prosthesis on the left, the superior vena cava on the right, the interatrial septum at the top and the TSL at the bottom; (C) 2D-TEE showing turbulent flow from the PA to the RA and to the RV; (D) 3D-TEE image showing the same defects in more detail. PA: pseudoaneurysm; RA: right atrium; RV: right ventricle; TSL: tricuspid septal leaflet.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0195" class="elsevierStylePara elsevierViewall">A 35-year-old man was admitted to our hospital because of dyspnea. He had undergone surgery two months before, in another hospital, for replacement of the aortic and mitral valves with mechanical prostheses due to infective endocarditis. No signs of active infection were found. A IV/VI holosystolic murmur was detected at the left sternal border. On transthoracic echocardiography, turbulent flow was observed in the anterior area of the aortic root (AR). Three-dimensional transesophageal echocardiography (3D-TEE) showed a pseudoaneurysm (PA) in the anterior area of the aortic annulus extending to the right atrium (RA) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B, <a class="elsevierStyleCrossRef" href="#sec0020">Video 1</a>). Turbulent flow was detected from the PA to the RA (blue arrow) and to the right ventricle (RV) (yellow arrow), the latter through the base of the tricuspid septal leaflet (TSL) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C and D, white star).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0200" class="elsevierStylePara elsevierViewall">In the operating room, a small defect was seen in the anterior area of the aortic annulus (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A). After the RA was opened, a PA communicating with the RA through the perimembranous septum was found (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B and C). The PA was opened and another defect was seen communicating with the RV through the base of the TSL (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D). Both defects were repaired with bovine pericardial patches, the TSL was reconstructed and a new mechanical aortic prosthesis was implanted.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">In complex cases of endocarditis, 3D-TEE provides an accurate picture of the anatomical defects, which enables optimal planning of the surgical strategy.</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0085" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0090" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0095" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0100" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-04-05" "fechaAceptado" => "2016-04-14" "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0210" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0025" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1417 "Ancho" => 1883 "Tamanyo" => 261091 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiography in mid-esophageal view: (A) two-dimensional transesophageal echocardiography (2D-TEE) showing a cavity between the aortic prosthesis and the right atrium RA corresponding to a PA, which communicates with the RA (blue arrow) and with the RV through the base of the TSL (yellow arrow); (B) three-dimensional transesophageal echocardiography (3D-TEE), showing the PA from the RA in the middle of the image, the aortic prosthesis on the left, the superior vena cava on the right, the interatrial septum at the top and the TSL at the bottom; (C) 2D-TEE showing turbulent flow from the PA to the RA and to the RV; (D) 3D-TEE image showing the same defects in more detail. PA: pseudoaneurysm; RA: right atrium; RV: right ventricle; TSL: tricuspid septal leaflet.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1415 "Ancho" => 1972 "Tamanyo" => 597640 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Surgical photographs: (A) a small defect in the anterior area of the aortic annulus; (B) the PA with a previous pericardial patch after the RA was opened; (C) a defect communicating with the perimembranous septum (blue arrow); (D) the PA after being opened with a defect communicating with the RV (yellow arrow) through the base of the TSL (white star). PA: pseudoaneurysm; RA: right atrium; RV: right ventricle; TSL: tricuspid septal leaflet.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 288673 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000004/v1_201704230025/S2174204917300995/v1_201704230025/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000004/v1_201704230025/S2174204917300995/v1_201704230025/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300995?idApp=UINPBA00004E" ]
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