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Image in Cardiology
Left heart failure, a challenging diagnosis in cardiology
Insuficiência cardíaca esquerda, um desafio diagnóstico em cardiologia
Miryan Cassandraa,
Autor para correspondência
m.cassandra.soares@gmail.com

Corresponding author.
, Inês Almeidaa, Rogério Teixeiraa, Joana Trigob, Marco Costaa, Lino Gonçalvesa
a Serviço de Cardiologia do Centro Hospitalar e Universitário de Coimbra – Hospital Geral, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
b Serviço de Cardiologia do Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE – Hospital de S. Pedro, Vila Real, Portugal
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fluoroscopy during percutaneous patent ductus arteriosus closure&#58; left&#44; a continuous flow can be seen from the aorta to the pulmonary artery &#40;yellow arrow&#41;&#59; center&#44; during device placement &#40;yellow arrow&#41;&#59; right&#44; after the procedure the device is properly positioned with no residual shunt &#40;yellow arrow&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Patent ductus arteriosus &#40;PDA&#41; is one of the most common congenital heart defects&#44; and causes left ventricular volume overload&#46; However&#44; it is a rare finding among adults due to the lack of symptoms related to its small size&#44; and it is not usually associated with other congenital lesions&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 53-year-old woman was referred for percutaneous closure of a PDA&#46; She had undergone a secundum atrial septal defect &#40;ASD&#41; closure in 2007&#44; detected after a cryptogenic stroke&#46; After this procedure&#44; her clinical history was remarkable for fatigue&#44; dyspnea and orthopnea with New York Heart Association &#40;NYHA&#41; functional class III&#44; and a continuous murmur was heard over the left sternal border&#46; A routine transthoracic echocardiogram performed in 2013 revealed a continuous flow from the aorta towards the pulmonary artery&#44; with left-sided chamber dilation &#40;ejection fraction 50&#37;&#41; and normal pulmonary artery pressure&#46; The device previously implanted at the atrial septum was correctly positioned and without residual shunt &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The PDA was closed by placing an Amplatzer&#8482; Duct Occluder guided by fluoroscopy and intracardiac echocardiography &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; The procedure was uneventful&#46; The 12-month follow-up showed significant clinical improvement &#40;NYHA functional class II&#41;&#44; no residual shunt&#44; and normal left chamber dimensions &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In this case&#44; the association with an ASD may have delayed the clinical manifestations of the PDA&#44; as the previous left-to-right shunt probably compensated for the left ventricular volume overload&#46; It is crucial to perform a complete high-quality echocardiogram in such patients with congenital heart disease&#44; in order to screen for associated anomalies&#46;</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&#46;</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&#46;</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&#46;</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&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiogram &#40;parasternal short-axis view&#41;&#58; color Doppler displays a continuous turbulent flow from the aorta to the left branch of the pulmonary artery&#44; consistent with a patent ductus arteriosus&#46;</p>"
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ISSN: 08702551
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