array:25 [
  "pii" => "S0870255115002735"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2015.05.007"
  "estado" => "S300"
  "fechaPublicacion" => "2015-12-01"
  "aid" => "725"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2015"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "sco"
  "cita" => "Rev Port Cardiol. 2015;34:785-6"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3027
    "formatos" => array:3 [
      "EPUB" => 180
      "HTML" => 2282
      "PDF" => 565
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:19 [
      "pii" => "S217420491500286X"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2015.12.009"
      "estado" => "S300"
      "fechaPublicacion" => "2015-12-01"
      "aid" => "725"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "sco"
      "cita" => "Rev Port Cardiol. 2015;34:785-6"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2117
        "formatos" => array:3 [
          "EPUB" => 137
          "HTML" => 1590
          "PDF" => 390
        ]
      ]
      "en" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
        "titulo" => "Left ventricular calcification in a patient with endomyocardial fibrosis"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "785"
            "paginaFinal" => "786"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Calcifica&#231;&#227;o ventricular esquerda num paciente com endomiocardiofibrose"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "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" => 1763
                "Ancho" => 1923
                "Tamanyo" => 598409
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Panel A&#58; Chest X-ray depicting left ventricular calcification &#40;arrow&#41;&#46; Panels B and C&#58; Continuous-wave Doppler echocardiographic evaluation showing intraventricular gradient and severe pulmonary hypertension respectively&#46; Panel D&#58; Cardiac-CT showing calcification of the basal anteroseptal and basal inferior left ventricular walls&#46; Panel E&#58; Endomyocardial biopsy depicting normal myocardium surrounded by foci of endomyocardial fibrosis&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Alfredo Renilla, Irene &#193;lvarez Pichel, Manuel Barreiro, Iria Silva"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Alfredo"
                "apellidos" => "Renilla"
              ]
              1 => array:2 [
                "nombre" => "Irene &#193;lvarez"
                "apellidos" => "Pichel"
              ]
              2 => array:2 [
                "nombre" => "Manuel"
                "apellidos" => "Barreiro"
              ]
              3 => array:2 [
                "nombre" => "Iria"
                "apellidos" => "Silva"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255115002735"
          "doi" => "10.1016/j.repc.2015.05.007"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115002735?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491500286X?idApp=UINPBA00004E"
      "url" => "/21742049/0000003400000012/v2_201704020102/S217420491500286X/v2_201704020102/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0870255115002747"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2015.07.009"
    "estado" => "S300"
    "fechaPublicacion" => "2015-12-01"
    "aid" => "726"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Cardiol. 2015;34:787-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2885
      "formatos" => array:3 [
        "EPUB" => 156
        "HTML" => 2129
        "PDF" => 600
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
      "titulo" => "Hanging by a thread&#58; Major detachment of an aortic prosthetic valve"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "787"
          "paginaFinal" => "788"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Deisc&#234;ncia grave de pr&#243;tese mec&#226;nica a&#243;rtica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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" => 845
              "Ancho" => 1700
              "Tamanyo" => 176076
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cardiac fluoroscopy &#40;left anterior oblique view&#41; showing systolic &#40;A&#41; and diastolic &#40;B&#41; position of the aortic prosthesis&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jennifer Mancio, Carla Almeida, Gustavo Pires-Morais, Lino Santos, Bruno Melica, Marco Oliveira, Alberto Rodrigues, Pedro Braga, Vasco Gama Ribeiro"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "Jennifer"
              "apellidos" => "Mancio"
            ]
            1 => array:2 [
              "nombre" => "Carla"
              "apellidos" => "Almeida"
            ]
            2 => array:2 [
              "nombre" => "Gustavo"
              "apellidos" => "Pires-Morais"
            ]
            3 => array:2 [
              "nombre" => "Lino"
              "apellidos" => "Santos"
            ]
            4 => array:2 [
              "nombre" => "Bruno"
              "apellidos" => "Melica"
            ]
            5 => array:2 [
              "nombre" => "Marco"
              "apellidos" => "Oliveira"
            ]
            6 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Rodrigues"
            ]
            7 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Braga"
            ]
            8 => array:2 [
              "nombre" => "Vasco"
              "apellidos" => "Gama Ribeiro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204915002871"
        "doi" => "10.1016/j.repce.2015.12.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002871?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115002747?idApp=UINPBA00004E"
    "url" => "/08702551/0000003400000012/v1_201512210110/S0870255115002747/v1_201512210110/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0870255115002437"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2015.06.007"
    "estado" => "S300"
    "fechaPublicacion" => "2015-12-01"
    "aid" => "713"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Cardiol. 2015;34:781-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4465
      "formatos" => array:3 [
        "EPUB" => 209
        "HTML" => 3634
        "PDF" => 622
      ]
    ]
    "pt" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Imagem em Cardiologia</span>"
      "titulo" => "Complica&#231;&#245;es de enfarte do mioc&#225;rdio&#58; ecocardiograma para diagn&#243;stico diferencial de sopro card&#237;aco"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "781"
          "paginaFinal" => "783"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Complications of myocardial infarction&#58; Echocardiography for differential diagnosis of heart murmur"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figura 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 941
              "Ancho" => 3000
              "Tamanyo" => 319916
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ecocardiograma transtor&#225;cico a mostrar SAM da v&#225;lvula mitral &#40;A&#44; seta&#41; a contribuir&#44; juntamente com a hipercontratilidade dos segmentos basais&#44; para a obstru&#231;&#227;o din&#226;mica da c&#226;mara de sa&#237;da do VE&#44; que &#233; evidenciada pela presen&#231;a de fluxo turbulento na mesma &#40;B&#44; seta&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "In&#234;s Cruz, Daniel Caldeira, Bruno Stuart, Carlos Cotrim, Isabel Jo&#227;o, H&#233;lder Pereira"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "In&#234;s"
              "apellidos" => "Cruz"
            ]
            1 => array:2 [
              "nombre" => "Daniel"
              "apellidos" => "Caldeira"
            ]
            2 => array:2 [
              "nombre" => "Bruno"
              "apellidos" => "Stuart"
            ]
            3 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Cotrim"
            ]
            4 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Jo&#227;o"
            ]
            5 => array:2 [
              "nombre" => "H&#233;lder"
              "apellidos" => "Pereira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204915002445"
        "doi" => "10.1016/j.repce.2015.11.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915002445?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115002437?idApp=UINPBA00004E"
    "url" => "/08702551/0000003400000012/v1_201512210110/S0870255115002437/v1_201512210110/pt/main.assets"
  ]
  "en" => array:16 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
    "titulo" => "Left ventricular calcification in a patient with endomyocardial fibrosis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "785"
        "paginaFinal" => "786"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Alfredo Renilla, Irene &#193;lvarez Pichel, Manuel Barreiro, Iria Silva"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Alfredo"
            "apellidos" => "Renilla"
            "email" => array:1 [
              0 => "dr&#46;renilla&#64;gmail&#46;com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Irene &#193;lvarez"
            "apellidos" => "Pichel"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Manuel"
            "apellidos" => "Barreiro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Iria"
            "apellidos" => "Silva"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Cardiology Division&#44; V&#46; Alvarez-Buylla Hospital&#44; Asturias&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Cardiology Division&#44; Central University Hospital of Asturias&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Calcifica&#231;&#227;o ventricular esquerda num paciente com endomiocardiofibrose"
      ]
    ]
    "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" => 1742
            "Ancho" => 1900
            "Tamanyo" => 600149
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Panel A&#58; Chest X-ray depicting left ventricular calcification &#40;arrow&#41;&#46; Panels B and C&#58; Continuous-wave Doppler echocardiographic evaluation showing intraventricular gradient and severe pulmonary hypertension respectively&#46; Panel D&#58; Cardiac-CT showing calcification of the basal anteroseptal and basal inferior left ventricular walls&#46; Panel E&#58; Endomyocardial biopsy depicting normal myocardium surrounded by foci of endomyocardial fibrosis&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 40-year-old male with an implanted pacemaker&#44; who had lived in a tropical country for more than 15 years&#44; was admitted because of congestive heart failure&#46; The chest X-ray showed mild cardiomegaly and marked calcification of the left ventricle &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#44; arrow&#41;&#46; The transthoracic echocardiogram revealed left ventricular thickening&#44; calcification of the basal segments &#40;Videos 1&#8211;3&#41;&#44; significant intraventricular gradient &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41; and severe pulmonary hypertension &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46; Cardiac computed tomography &#40;CT&#41; confirmed the presence of endomyocardial calcification of the basal anteroseptal and basal inferior left ventricular walls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41;&#46; Coronary angiography ruled out coronary artery disease and endomyocardial biopsy demonstrated foci of endomyocardial fibrosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E&#41;&#46; Treatment with furosemide and spironolactone was started&#46; After the addition of beta-blockers&#44; a decrease in intraventricular gradient &#40;52 mmHg to 30 mmHg&#41; was seen and a significant improvement in symptoms was observed&#46; After three-month follow-up the patient is stable in NYHA class II&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Endomyocardial fibrosis is an infrequent disease&#44; more prevalent in tropical countries&#44; that causes progressive restrictive cardiomyopathy leading to congestive heart failure&#46; The presence of endomyocardial calcification in this condition is very rare&#46; Although calcified opacities in the left ventricle may be seen on the chest X-ray&#44; other imaging tests are needed to establish the diagnosis&#46; Given the acoustic shadowing caused by the calcium&#44; echocardiography is technically limited as a diagnostic tool&#44; but it may be useful to evaluate the hemodynamic repercussions of the calcification&#46; Calcium strongly attenuates X-rays&#44; appears bright on CT scans and is readily differentiated from surrounding tissue&#46; Cardiac CT is therefore an accurate technique to evaluate the extent and anatomic distribution of endomyocardial calcification&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0015" 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 no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0020" 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&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0030" 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&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-03-24"
    "fechaAceptado" => "2015-05-28"
    "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></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary material"
            "identificador" => "sec0040"
          ]
        ]
      ]
    ]
    "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" => 1742
            "Ancho" => 1900
            "Tamanyo" => 600149
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Panel A&#58; Chest X-ray depicting left ventricular calcification &#40;arrow&#41;&#46; Panels B and C&#58; Continuous-wave Doppler echocardiographic evaluation showing intraventricular gradient and severe pulmonary hypertension respectively&#46; Panel D&#58; Cardiac-CT showing calcification of the basal anteroseptal and basal inferior left ventricular walls&#46; Panel E&#58; Endomyocardial biopsy depicting normal myocardium surrounded by foci of endomyocardial fibrosis&#46;</p>"
        ]
      ]
      1 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:3 [
          "fichero" => "mmc1.mp4"
          "ficheroTamanyo" => 1269215
          "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
            ]
          ]
        ]
      ]
      2 => array:5 [
        "identificador" => "upi0010"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:3 [
          "fichero" => "mmc2.mp4"
          "ficheroTamanyo" => 1144731
          "Video" => array:2 [
            "mp4" => array:2 [
              "fichero" => "mmc2.m4v"
              "poster" => "mmc2.jpg"
            ]
            "flv" => array:5 [
              "fichero" => "mmc2.flv"
              "poster" => "mmc2.jpg"
              "tiempo" => 0
              "alto" => 0
              "ancho" => 0
            ]
          ]
        ]
      ]
      3 => array:5 [
        "identificador" => "upi0015"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:3 [
          "fichero" => "mmc3.mp4"
          "ficheroTamanyo" => 1493811
          "Video" => array:2 [
            "mp4" => array:2 [
              "fichero" => "mmc3.m4v"
              "poster" => "mmc3.jpg"
            ]
            "flv" => array:5 [
              "fichero" => "mmc3.flv"
              "poster" => "mmc3.jpg"
              "tiempo" => 0
              "alto" => 0
              "ancho" => 0
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003400000012/v1_201512210110/S0870255115002735/v1_201512210110/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/08702551/0000003400000012/v1_201512210110/S0870255115002735/v1_201512210110/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115002735?idApp=UINPBA00004E"
]
Partilhar
Informação da revista
Vol. 34. Núm. 12.
Páginas 785-786 (dezembro 2015)
Partilhar
Partilhar
Baixar PDF
Mais opções do artigo
Vol. 34. Núm. 12.
Páginas 785-786 (dezembro 2015)
Image in Cardiology
Open Access
Left ventricular calcification in a patient with endomyocardial fibrosis
Calcificação ventricular esquerda num paciente com endomiocardiofibrose
Visitas
9275
Alfredo Renillaa,b,
Autor para correspondência
dr.renilla@gmail.com

Corresponding author.
, Irene Álvarez Pichelb, Manuel Barreirob, Iria Silvab
a Cardiology Division, V. Alvarez-Buylla Hospital, Asturias, Spain
b Cardiology Division, Central University Hospital of Asturias, Spain
Este item recebeu

Under a Creative Commons license
Informação do artigo
Texto Completo
Baixar PDF
Estatísticas
Figuras (1)
Material adicional (3)
Texto Completo

A 40-year-old male with an implanted pacemaker, who had lived in a tropical country for more than 15 years, was admitted because of congestive heart failure. The chest X-ray showed mild cardiomegaly and marked calcification of the left ventricle (Figure 1A, arrow). The transthoracic echocardiogram revealed left ventricular thickening, calcification of the basal segments (Videos 1–3), significant intraventricular gradient (Figure 1B) and severe pulmonary hypertension (Figure 1C). Cardiac computed tomography (CT) confirmed the presence of endomyocardial calcification of the basal anteroseptal and basal inferior left ventricular walls (Figure 1D). Coronary angiography ruled out coronary artery disease and endomyocardial biopsy demonstrated foci of endomyocardial fibrosis (Figure 1E). Treatment with furosemide and spironolactone was started. After the addition of beta-blockers, a decrease in intraventricular gradient (52 mmHg to 30 mmHg) was seen and a significant improvement in symptoms was observed. After three-month follow-up the patient is stable in NYHA class II.

Figure 1.

Panel A: Chest X-ray depicting left ventricular calcification (arrow). Panels B and C: Continuous-wave Doppler echocardiographic evaluation showing intraventricular gradient and severe pulmonary hypertension respectively. Panel D: Cardiac-CT showing calcification of the basal anteroseptal and basal inferior left ventricular walls. Panel E: Endomyocardial biopsy depicting normal myocardium surrounded by foci of endomyocardial fibrosis.

(0.57MB).

Endomyocardial fibrosis is an infrequent disease, more prevalent in tropical countries, that causes progressive restrictive cardiomyopathy leading to congestive heart failure. The presence of endomyocardial calcification in this condition is very rare. Although calcified opacities in the left ventricle may be seen on the chest X-ray, other imaging tests are needed to establish the diagnosis. Given the acoustic shadowing caused by the calcium, echocardiography is technically limited as a diagnostic tool, but it may be useful to evaluate the hemodynamic repercussions of the calcification. Calcium strongly attenuates X-rays, appears bright on CT scans and is readily differentiated from surrounding tissue. Cardiac CT is therefore an accurate technique to evaluate the extent and anatomic distribution of endomyocardial calcification.

Ethical disclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflicts of interest

The authors have no conflicts of interest to declare.

Appendix A
Supplementary material

(1.21MB)
(1.09MB)
(1.42MB)

Copyright © 2015. Sociedade Portuguesa de Cardiologia
Baixar PDF
Idiomas
Revista Portuguesa de Cardiologia
Opções de artigo
Ferramentas
Material Suplementar
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Ao assinalar que é «Profissional de Saúde», declara conhecer e aceitar que a responsável pelo tratamento dos dados pessoais dos utilizadores da página de internet da Revista Portuguesa de Cardiologia (RPC), é esta entidade, com sede no Campo Grande, n.º 28, 13.º, 1700-093 Lisboa, com os telefones 217 970 685 e 217 817 630, fax 217 931 095 e com o endereço de correio eletrónico revista@spc.pt. Declaro para todos os fins, que assumo inteira responsabilidade pela veracidade e exatidão da afirmação aqui fornecida.