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"cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Infective endocarditis complicated by aortic dissection and aorto-right ventricular fistula" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "393" "paginaFinal" => "394" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Adriana Pereira, Rui Pontes dos Santos, Nuno Moreno, Alexandra Castro, João Azevedo, Paula Pinto" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Adriana" "apellidos" => "Pereira" "email" => array:1 [ 0 => "adrianaicpereira@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Rui Pontes" "apellidos" => "dos Santos" ] 2 => array:2 [ "nombre" => "Nuno" "apellidos" => "Moreno" ] 3 => array:2 [ "nombre" => "Alexandra" "apellidos" => "Castro" ] 4 => array:2 [ "nombre" => "João" "apellidos" => "Azevedo" ] 5 => array:2 [ "nombre" => "Paula" "apellidos" => "Pinto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Endocardite infecciosa complicada por disseção aórtica e por fístula entre o ventrículo direito e a aorta" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figures 1 and 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1v2.jpeg" "Alto" => 1120 "Ancho" => 3311 "Tamanyo" => 285373 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiogram showing aortic valve endocarditis with perivalvular abscess and dilatation of the ascending aorta. Ao: ascending aorta; LA: left atrium; LV: left ventricle; red arrow: vegetations; white arrow: perivalvular abscess.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infective endocarditis (IE) is a serious and complex disease with high morbidity and mortality. Heart failure, perivalvular extension and embolic events are well-known complications of IE. By contrast, the association of IE and acute aortic dissection (AAD) is extremely rare.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of an 83-year-old woman with hypertension, atrial fibrillation and recent hospitalization due to complicated urinary tract infection, who presented in the emergency department due to sudden depression of mental status. On physical examination she presented confusion, fever, a harsh systolic aortic murmur with associated diastolic murmur and mild signs of congestive heart failure. Head computed tomography revealed a recent ischemic area. Transthoracic followed by transesophageal echocardiography revealed multiple sessile masses on the ventricular surface of a calcified bicuspid aortic valve, compatible with vegetations; moderate aortic regurgitation; an image compatible with a perivalvular abscess; and severe (52 mm) dilatation of the ascending aorta, without intimal flap (<a class="elsevierStyleCrossRef" href="#fig0005">Figures 1 and 2</a>, Video 1). Transthoracic and transesophageal echocardiograms were repeated on the third day due to development of acute pulmonary edema, and revealed a de novo aortic dissection extending from the aortic root to the brachiocephalic trunk (<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 3 and 4</a>; Videos 2 and 3), and a fistula from the aortic root to the right ventricle (Videos 4 and 5). The patient was referred immediately for cardiac surgery but considered unsuitable due to mental status; her clinical status deteriorated progressively culminating in death.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In this case, the patient presented with severe complications of IE. Associated aortic dissection is uncommon, with few cases described in the literature.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" 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" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-04-13" "fechaAceptado" => "2016-08-01" "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0045" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia><elsevierMultimedia ident="upi0020"></elsevierMultimedia><elsevierMultimedia ident="upi0025"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary material" "identificador" => "sec0035" ] ] ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figures 1 and 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1v2.jpeg" "Alto" => 1120 "Ancho" => 3311 "Tamanyo" => 285373 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiogram showing aortic valve endocarditis with perivalvular abscess and dilatation of the ascending aorta. Ao: ascending aorta; LA: left atrium; LV: left ventricle; red arrow: vegetations; white arrow: perivalvular abscess.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1330 "Ancho" => 2501 "Tamanyo" => 269757 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiogram showing acute dissection of the ascending aorta.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1173 "Ancho" => 1626 "Tamanyo" => 94136 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiogram showing aortic dissection extending to the brachiocephalic trunk. 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2022 September | 39 | 41 | 80 |
2022 August | 29 | 47 | 76 |
2022 July | 40 | 26 | 66 |
2022 June | 35 | 14 | 49 |
2022 May | 33 | 24 | 57 |
2022 April | 40 | 37 | 77 |
2022 March | 48 | 32 | 80 |
2022 February | 52 | 24 | 76 |
2022 January | 69 | 20 | 89 |
2021 December | 43 | 34 | 77 |
2021 November | 44 | 35 | 79 |
2021 October | 63 | 36 | 99 |
2021 September | 47 | 28 | 75 |
2021 August | 51 | 30 | 81 |
2021 July | 62 | 20 | 82 |
2021 June | 49 | 21 | 70 |
2021 May | 111 | 37 | 148 |
2021 April | 83 | 71 | 154 |
2021 March | 77 | 12 | 89 |
2021 February | 74 | 27 | 101 |
2021 January | 47 | 21 | 68 |
2020 December | 53 | 12 | 65 |
2020 November | 60 | 10 | 70 |
2020 October | 49 | 20 | 69 |
2020 September | 70 | 11 | 81 |
2020 August | 36 | 11 | 47 |
2020 July | 46 | 6 | 52 |
2020 June | 46 | 6 | 52 |
2020 May | 38 | 6 | 44 |
2020 April | 43 | 9 | 52 |
2020 March | 54 | 13 | 67 |
2020 February | 88 | 11 | 99 |
2020 January | 49 | 5 | 54 |
2019 December | 43 | 7 | 50 |
2019 November | 36 | 10 | 46 |
2019 October | 50 | 3 | 53 |
2019 September | 36 | 7 | 43 |
2019 August | 25 | 6 | 31 |
2019 July | 43 | 17 | 60 |
2019 June | 15 | 9 | 24 |
2019 May | 27 | 8 | 35 |
2019 April | 18 | 13 | 31 |
2019 March | 16 | 7 | 23 |
2019 February | 30 | 12 | 42 |
2019 January | 11 | 6 | 17 |
2018 December | 15 | 8 | 23 |
2018 November | 41 | 20 | 61 |
2018 October | 66 | 19 | 85 |
2018 September | 32 | 10 | 42 |
2018 August | 23 | 3 | 26 |
2018 July | 20 | 3 | 23 |
2018 June | 30 | 8 | 38 |
2018 May | 30 | 15 | 45 |
2018 April | 52 | 5 | 57 |
2018 March | 35 | 7 | 42 |
2018 February | 36 | 2 | 38 |
2018 January | 22 | 4 | 26 |
2017 December | 39 | 7 | 46 |
2017 November | 24 | 9 | 33 |
2017 October | 18 | 12 | 30 |
2017 September | 37 | 12 | 49 |
2017 August | 46 | 12 | 58 |
2017 July | 31 | 13 | 44 |
2017 June | 34 | 16 | 50 |