Image in Cardiology
Infective endocarditis: When an image surprises the echocardiographer
Endocardite infeciosa: quando a imagem surpreende o ecocardiografista
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array:24 [ "pii" => "S0870255120300056" "issn" => "08702551" "doi" => "10.1016/j.repc.2019.01.009" "estado" => "S300" "fechaPublicacion" => "2019-11-01" "aid" => "1468" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2019;38:831-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0870255120300032" "issn" => "08702551" "doi" => "10.1016/j.repc.2019.08.008" "estado" => "S300" "fechaPublicacion" => "2019-11-01" "aid" => "1466" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2019;38:833-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 91 "formatos" => array:3 [ "EPUB" => 15 "HTML" => 36 "PDF" => 40 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Management of prosthetic valve thrombosis complicated by ischemic stroke in pregnancy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "833" "paginaFinal" => "834" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tratamento da trombose de prótese valvular complicada por acidente vascular cerebral isquémico na gravidez" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ahmet Guner, Macit Kalçık, Emrah Bayam, Semih Kalkan, Mehmet Ozkan" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Ahmet" "apellidos" => "Guner" ] 1 => array:2 [ "nombre" => "Macit" "apellidos" => "Kalçık" ] 2 => array:2 [ "nombre" => "Emrah" "apellidos" => "Bayam" ] 3 => array:2 [ "nombre" => "Semih" "apellidos" => "Kalkan" ] 4 => array:2 [ "nombre" => "Mehmet" "apellidos" => "Ozkan" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120300032?idApp=UINPBA00004E" "url" => "/08702551/0000003800000011/v1_202002190705/S0870255120300032/v1_202002190705/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0870255120300044" "issn" => "08702551" "doi" => "10.1016/j.repc.2017.08.014" "estado" => "S300" "fechaPublicacion" => "2019-11-01" "aid" => "1467" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2019;38:829.e1-829.e3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 116 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 76 "PDF" => 27 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Assessment with intracoronary pressure and flow guidewire, at baseline and after intracoronary adenosine infusion, in a patient with Takotsubo syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "829.e1" "paginaFinal" => "829.e3" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Avaliação com guia de pressão/fluxo intracoronária, basal e após infusão de adenosina intracoronária em paciente com síndrome de Takotsubo" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1875 "Ancho" => 2500 "Tamanyo" => 577490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) ComboMap® screenshot showing simultaneous pressure and flow measurements recorded in the distal left anterior descending artery (LAD) in baseline conditions, before adenosine administration (fractional flow reserve [FFR] 0.89, coronary flow reserve [CFR] 1, hyperemic stenosis resistance [HSR] 1.86, hyperemic microvascular resistance [HMR] 15.6); (B) following adenosine administration (FFR 0.87, CFR 1, HSR 0.88, HMR 6.1); (C) baseline values in circumflex artery before adenosine administration (FFR 0.95, CFR 0.8, HSR 0.26, HMR 5.5); (D) values in circumflex artery following adenosine administration (FFR 0.94, CFR 1.4, HSR 0.27, HMR 4.3). Note the high HMR before adenosine administration and the greater response to adenosine in the LAD.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jeremias Bayon, Melisa Santás-Älvarez, Raymundo Ocaranza-Sánchez, Carlos González-Juanatey" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Jeremias" "apellidos" => "Bayon" ] 1 => array:2 [ "nombre" => "Melisa" "apellidos" => "Santás-Älvarez" ] 2 => array:2 [ "nombre" => "Raymundo" "apellidos" => "Ocaranza-Sánchez" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "González-Juanatey" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120300044?idApp=UINPBA00004E" "url" => "/08702551/0000003800000011/v1_202002190705/S0870255120300044/v1_202002190705/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Infective endocarditis: When an image surprises the echocardiographer" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "831" "paginaFinal" => "832" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marta Braga, Helena Nascimento, Carla Sousa, Paula Dias, Maria Júlia Maciel, Filipe Macedo" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Marta" "apellidos" => "Braga" "email" => array:1 [ 0 => "martabraga.hsj@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Helena" "apellidos" => "Nascimento" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Carla" "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Paula" "apellidos" => "Dias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Maria Júlia" "apellidos" => "Maciel" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Filipe" "apellidos" => "Macedo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Cardiology Department, Centro Hospitalar São João, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Medicine, Porto University, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Endocardite infeciosa: quando a imagem surpreende o ecocardiografista" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 794 "Ancho" => 2175 "Tamanyo" => 97199 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiogram: small mobile vegetation in the non-coronary sinus of Valsalva (A: arrow) and on the tricuspid valve (B: asterisk).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 46-year-old man with longstanding constitutional symptoms was admitted with sepsis and acute respiratory failure. He had undergone hematopoietic stem cell transplantation (HSCT) and was under immunosuppressive therapy due to graft-versus-host disease (GVHD).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Lung nocardiosis was diagnosed and he was put on imipenem and trimethoprim-sulfamethoxazole. Despite effective treatment, the patient presented recurrent fever. Transesophageal echocardiography documented exuberant multinodular vegetations involving all cusps of the aortic valve (maximum width 10 mm×12 mm) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B and Video 1), in a pattern resembling the Mercedes-Benz symbol (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C and D), causing severe aortic regurgitation (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E and F; Video 2). Vegetations were also seen in the non-coronary sinus of Valsalva (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A, arrow) and on the tricuspid valve (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B, asterisk). Aortic valve replacement was performed and no vegetations were found on the tricuspid valve. Blood cultures were persistently negative, as were microbiological analysis of the surgical specimen and serology for atypical agents. The patient eventually died due to neurological complications.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Infective endocarditis (IE) has been reported infrequently in HSCT recipients; GVHD is a risk factor. Although uncommon, <span class="elsevierStyleItalic">Nocardia</span> sp. was considered the most likely causative agent in view of the clinical context and imaging. The fastidious growth pattern of this bacterium and previous antibiotic therapy could explain the negative results of microbiological exams. Multimodality echocardiography, including transthoracic and transesophageal echocardiography and three-dimensional imaging, plays a central role in the diagnosis of IE, especially in complex infections. It offers a virtual preoperative perspective of the disease process that is crucial to surgical planning and patient outcome.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-12-08" "fechaAceptado" => "2019-01-13" "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0025" class="elsevierStylePara elsevierViewall">The following are the supplementary material to this article:</p> <p id="par0030" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary material" "identificador" => "sec0015" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1346 "Ancho" => 2502 "Tamanyo" => 301559 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiography: aortic valve vegetations (A, B) resembling the Mercedes Benz symbol (C, D); severe aortic regurgitation (E) (vena contracta 7 mm) and (F) (holodiastolic reverse flow in the descending aorta).</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" => 794 "Ancho" => 2175 "Tamanyo" => 97199 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiogram: small mobile vegetation in the non-coronary sinus of Valsalva (A: arrow) and on the tricuspid valve (B: asterisk).</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 443044 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 3 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 409533 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003800000011/v1_202002190705/S0870255120300056/v1_202002190705/en/main.assets" "Apartado" => array:4 [ "identificador" => "75834" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imagem em Cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003800000011/v1_202002190705/S0870255120300056/v1_202002190705/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120300056?idApp=UINPBA00004E" ]
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