Image in Cardiology
Massive calcification involving a left ventricular false tendon
Calcificação cardíaca envolvendo um falso tendão ventricular esquerdo
Rui Plácido
, João Silva Marques, Maria José Amaro, Dulce Brito, Fausto J. Pinto, Ana G. Almeida
Autor para correspondência
Hospital Santa Maria, Serv Cardiologia I, Lisbon Academic Medical Centre, CCUL, Lisbon, Portugal
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7570
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Pinto, Ana G. Almeida" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Rui" "apellidos" => "Plácido" "email" => array:1 [ 0 => "placidorui@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "João" "apellidos" => "Silva Marques" ] 2 => array:2 [ "nombre" => "Maria José" "apellidos" => "Amaro" ] 3 => array:2 [ "nombre" => "Dulce" "apellidos" => "Brito" ] 4 => array:2 [ "nombre" => "Fausto J." "apellidos" => "Pinto" ] 5 => array:2 [ "nombre" => "Ana" "apellidos" => "G. Almeida" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Santa Maria, Serv Cardiologia I, Lisbon Academic Medical Centre, CCUL, Lisbon, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Calcificação cardíaca envolvendo um falso tendão ventricular esquerdo" ] ] "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" => 1232 "Ancho" => 1900 "Tamanyo" => 225813 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Two-dimensional transthoracic echocardiography, apical 4-chamber view, showing several nodular hyperechogenic masses with acoustic shadowing in the mid-left ventricular cavity (arrows); (B) three-dimensional transthoracic echocardiography, left ventricular full-volume view depicting all of the nodular masses within the left ventricular cavity (arrows); (C) two-dimensional Doppler color flow transesophageal echocardiography, mid-esophageal 3-chamber view with turbulent flow across the mid-left ventricular cavity; (D and E) steady-state free precession cine cardiac magnetic resonance, short-axis and 3-chamber long-axis views with a hypointense linear structure inside the left ventricle (arrowheads). LA: left atrium; LV: left ventricle; LVOT: left ventricular outflow tract; RV: right ventricle.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 70-year-old man with cardiovascular risk factors and a history of a heart murmur diagnosed during infancy, presenting with worsening exertional dyspnea during the previous six months. The physical examination showed a slow-rising carotid pulse, a grade III/VI mid-systolic murmur, crepitant rales on pulmonary auscultation and peripheral edema. Laboratory tests revealed a normal complete blood count, plasma brain natriuretic peptide level of 2500 pg/ml, normal levels of ionized calcium and phosphate and normal renal function. Echocardiographic study showed concentric left ventricular (LV) hypertrophy with preserved ejection fraction, mild diastolic dysfunction (impaired relaxation) and severe aortic valve stenosis with a valve area of 0.6 cm<span class="elsevierStyleSup">2</span>/m<span class="elsevierStyleSup">2</span>. Calcified masses were also observed in the mid-LV cavity on 2D and 3D echocardiography (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B, arrows; Videos 1 and 2), causing turbulent flow depicted by color Doppler (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C; Video 3). Steady-state free precession cine cardiac magnetic resonance (CMR) confirmed the presence of a transversely arranged membrane, suggestive of an anomalous, abnormally thickened and calcified band (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D and E, arrowheads; Video 4). This non-obstructive structure was connected to the anterolateral papillary muscle and the lateral LV wall by multiple fibrous filaments. The presence of fibrosis was excluded by late gadolinium enhancement CMR.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">LV false tendons are fibromuscular structures of varying length and thickness that traverse the ventricular cavity and are accepted as anatomic variants. Calcium deposits in the heart are common in older persons and have been described in association with coronary artery disease, dilated cardiomyopathy, aorto-mitral valvular disease and renal disease. We report a case of massive left ventricular false tendon calcification associated with aortic valve calcification and stenosis.</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="par0015" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0030" 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" => "2014-02-08" "fechaAceptado" => "2014-03-29" "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0040" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia><elsevierMultimedia ident="upi0020"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0035" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1232 "Ancho" => 1900 "Tamanyo" => 225813 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Two-dimensional transthoracic echocardiography, apical 4-chamber view, showing several nodular hyperechogenic masses with acoustic shadowing in the mid-left ventricular cavity (arrows); (B) three-dimensional transthoracic echocardiography, left ventricular full-volume view depicting all of the nodular masses within the left ventricular cavity (arrows); (C) two-dimensional Doppler color flow transesophageal echocardiography, mid-esophageal 3-chamber view with turbulent flow across the mid-left ventricular cavity; (D and E) steady-state free precession cine cardiac magnetic resonance, short-axis and 3-chamber long-axis views with a hypointense linear structure inside the left ventricle (arrowheads). LA: left atrium; LV: left ventricle; LVOT: left ventricular outflow tract; RV: right ventricle.</p>" ] ] 1 => array:7 [ "identificador" => "upi0005" "etiqueta" => "Video 1" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 638790 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Two-dimensional transthoracic echocardiography: apical 4-chamber view showing several nodular hyperechogenic masses with acoustic shadowing in the mid-left ventricular cavity.</p>" ] ] 2 => array:7 [ "identificador" => "upi0010" "etiqueta" => "Video 2" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 912154 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Three-dimensional transthoracic echocardiography: left ventricular full-volume view depicting all of the nodular masses within the left ventricular cavity.</p>" ] ] 3 => array:7 [ "identificador" => "upi0015" "etiqueta" => "Video 3" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc3.mp4" "ficheroTamanyo" => 686419 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc3.flv" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc3.m4v" "poster" => "mmc3.jpg" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Two-dimensional transesophageal Doppler color flow echocardiography: mid-esophageal 3-chamber view with turbulent flow across the mid-left ventricular cavity.</p>" ] ] 4 => array:7 [ "identificador" => "upi0020" "etiqueta" => "Video 4" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc4.mp4" "ficheroTamanyo" => 180783 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc4.flv" "poster" => "mmc4.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc4.m4v" "poster" => "mmc4.jpg" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Steady-state free precession cine cardiac magnetic resonance: 3-chamber long-axis view with a hypointense linear structure inside the left ventricle. There is a mild signal void in the left ventricular chamber consistent with the presence of turbulent flow in this location.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003300000011/v1_201411200056/S0870255114002637/v1_201411200056/en/main.assets" "Apartado" => array:4 [ "identificador" => "357" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Imagens em cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003300000011/v1_201411200056/S0870255114002637/v1_201411200056/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002637?idApp=UINPBA00004E" ]
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| 2024 Abril | 43 | 22 | 65 |
| 2024 Maro | 46 | 20 | 66 |
| 2024 Fevereiro | 51 | 26 | 77 |
| 2024 Janeiro | 60 | 29 | 89 |
| 2023 Dezembro | 38 | 28 | 66 |
| 2023 Novembro | 47 | 21 | 68 |
| 2023 Outubro | 35 | 19 | 54 |
| 2023 Setembro | 49 | 18 | 67 |
| 2023 Agosto | 54 | 16 | 70 |
| 2023 Julho | 58 | 9 | 67 |
| 2023 Junho | 55 | 16 | 71 |
| 2023 Maio | 66 | 18 | 84 |
| 2023 Abril | 60 | 4 | 64 |
| 2023 Maro | 44 | 17 | 61 |
| 2023 Fevereiro | 34 | 17 | 51 |
| 2023 Janeiro | 46 | 5 | 51 |
| 2022 Dezembro | 49 | 21 | 70 |
| 2022 Novembro | 46 | 19 | 65 |
| 2022 Outubro | 54 | 25 | 79 |
| 2022 Setembro | 49 | 36 | 85 |
| 2022 Agosto | 58 | 37 | 95 |
| 2022 Julho | 69 | 31 | 100 |
| 2022 Junho | 58 | 22 | 80 |
| 2022 Maio | 61 | 33 | 94 |
| 2022 Abril | 74 | 33 | 107 |
| 2022 Maro | 63 | 30 | 93 |
| 2022 Fevereiro | 57 | 28 | 85 |
| 2022 Janeiro | 50 | 26 | 76 |
| 2021 Dezembro | 33 | 19 | 52 |
| 2021 Novembro | 40 | 38 | 78 |
| 2021 Outubro | 51 | 71 | 122 |
| 2021 Setembro | 46 | 30 | 76 |
| 2021 Agosto | 55 | 29 | 84 |
| 2021 Julho | 44 | 22 | 66 |
| 2021 Junho | 43 | 22 | 65 |
| 2021 Maio | 72 | 22 | 94 |
| 2021 Abril | 71 | 26 | 97 |
| 2021 Maro | 92 | 17 | 109 |
| 2021 Fevereiro | 95 | 20 | 115 |
| 2021 Janeiro | 47 | 13 | 60 |
| 2020 Dezembro | 35 | 10 | 45 |
| 2020 Novembro | 49 | 17 | 66 |
| 2020 Outubro | 30 | 12 | 42 |
| 2020 Setembro | 32 | 7 | 39 |
| 2020 Agosto | 30 | 3 | 33 |
| 2020 Julho | 44 | 8 | 52 |
| 2020 Junho | 29 | 11 | 40 |
| 2020 Maio | 47 | 3 | 50 |
| 2020 Abril | 35 | 18 | 53 |
| 2020 Maro | 39 | 4 | 43 |
| 2020 Fevereiro | 108 | 13 | 121 |
| 2020 Janeiro | 27 | 6 | 33 |
| 2019 Dezembro | 29 | 7 | 36 |
| 2019 Novembro | 61 | 7 | 68 |
| 2019 Outubro | 33 | 15 | 48 |
| 2019 Setembro | 55 | 8 | 63 |
| 2019 Agosto | 31 | 9 | 40 |
| 2019 Julho | 23 | 12 | 35 |
| 2019 Junho | 21 | 4 | 25 |
| 2019 Maio | 32 | 10 | 42 |
| 2019 Abril | 37 | 21 | 58 |
| 2019 Maro | 41 | 16 | 57 |
| 2019 Fevereiro | 80 | 14 | 94 |
| 2019 Janeiro | 84 | 11 | 95 |
| 2018 Dezembro | 100 | 16 | 116 |
| 2018 Novembro | 84 | 8 | 92 |
| 2018 Outubro | 100 | 16 | 116 |
| 2018 Setembro | 38 | 11 | 49 |
| 2018 Agosto | 32 | 12 | 44 |
| 2018 Julho | 29 | 4 | 33 |
| 2018 Junho | 33 | 4 | 37 |
| 2018 Maio | 56 | 15 | 71 |
| 2018 Abril | 40 | 2 | 42 |
| 2018 Maro | 74 | 7 | 81 |
| 2018 Fevereiro | 58 | 8 | 66 |
| 2018 Janeiro | 40 | 2 | 42 |
| 2017 Dezembro | 53 | 16 | 69 |
| 2017 Novembro | 41 | 10 | 51 |
| 2017 Outubro | 22 | 3 | 25 |
| 2017 Setembro | 35 | 6 | 41 |
| 2017 Agosto | 37 | 19 | 56 |
| 2017 Julho | 33 | 7 | 40 |
| 2017 Junho | 47 | 13 | 60 |
| 2017 Maio | 48 | 10 | 58 |
| 2017 Abril | 28 | 3 | 31 |
| 2017 Maro | 39 | 4 | 43 |
| 2017 Fevereiro | 18 | 4 | 22 |
| 2017 Janeiro | 19 | 7 | 26 |
| 2016 Dezembro | 30 | 16 | 46 |
| 2016 Novembro | 19 | 6 | 25 |
| 2016 Outubro | 14 | 8 | 22 |
| 2016 Setembro | 14 | 8 | 22 |
| 2016 Agosto | 12 | 6 | 18 |
| 2016 Julho | 6 | 7 | 13 |
| 2016 Junho | 10 | 8 | 18 |
| 2016 Maio | 4 | 7 | 11 |
| 2016 Abril | 30 | 2 | 32 |
| 2016 Maro | 54 | 10 | 64 |
| 2016 Fevereiro | 55 | 30 | 85 |
| 2016 Janeiro | 63 | 10 | 73 |
| 2015 Dezembro | 48 | 8 | 56 |
| 2015 Novembro | 50 | 12 | 62 |
| 2015 Outubro | 41 | 11 | 52 |
| 2015 Setembro | 43 | 9 | 52 |
| 2015 Agosto | 46 | 7 | 53 |
| 2015 Julho | 42 | 6 | 48 |
| 2015 Junho | 28 | 4 | 32 |
| 2015 Maio | 46 | 9 | 55 |
| 2015 Abril | 42 | 7 | 49 |
| 2015 Maro | 26 | 14 | 40 |
| 2015 Fevereiro | 38 | 15 | 53 |
| 2015 Janeiro | 56 | 19 | 75 |
| 2014 Dezembro | 101 | 49 | 150 |
| 2014 Novembro | 46 | 18 | 64 |
Mostrar tudo
