Browsing by Author "Rodrigues, Ricardo C."
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- Incomplete Shone’s complex: adult age diagnosisPublication . Rodrigues, Ricardo C.; Correia, André; Serrão, Gomes; Faria, Paula; Gomes, Susana; Pereira, DécioA 25-year-old male with previous history of heart surgery was referred for a control echocardiogram. He had been operated when he was 5 years old for reparation of aortic coarctation and the excision of a subaortic membrane, and was then lost to follow-up. No other changes were detected previously or during surgery. The patient was clinically stable without medication and the physical exam was unremarkable. The echocardiogram showed normal left ventricular function, but bicuspid aortic valve (figure 1 A), conditioning mild aortic stenosis, and a parachute mitral valve (figure 1 B, C) with single papillary muscle (figure 1 D, E – arrow) were present, with slight increase in transmitral velocity and mild regurgitation. No residual coarctation was present. Shone’s complex is a rare congenital heart disease consisting of several levels of left-sided obstructive lesions including supravalvar mitral ring, parachute mitral valve subaortic stenosis and coarctation of aorta, being classified as complete (if all levels are present) or incomplete (if only 2 or 3 lesions are present). Our patient had a previous surgical intervention and no correction was made for two undiagnosed lesions. Furthermore, the main critical problem associated with this condition appears to be mitral valve obstruction which was not significant in our patient. A conservative approach was decided and at 3-year follow-up no events occurred. This case highlights the importance of exhaustive preoperative echocardiographic evaluation and reminds us that, in the presence of two-levels of left-side cavities obstruction, other possible related anatomical lesions must be excluded.
- Interrupted aortic arch in a 58-year-old patientPublication . Rodrigues, Ricardo C.; Correia, André; Silva, Bruno; Gomes, Susana; Pereira, DécioA 58-year-old male patient was evaluated in the cardiology outpatient setting after an episode of hypertension and atrial fibrillation. He was also an ex-moker.Echocardiogram revealed slight left ventricular dilation with diastolic dysfunction and a systolic function in the lower normality level, as well as a rheumatic valvar disease with moderate mitral stenosis and slight aortic valve involvement, atrial enlargement and pulmonary hypertension. After an episode of acute pulmonar oedema the patient was referred for coronary catheterization. A right femoral approach was attempted and progression of the guidewire was not possible due to na interrupted aortic arch (IAA) (figure 1A), that was confirmed by right radial approach (figure 1B). The coronary arteries had no ignificant stenosis but the circumflex artery had an anomalous origin. A CT-scan confirmed an interrupted aortic arch (IAA) in the descending aorta, 27 mm below the left subclavian artery, and a short, 15-mm occluded segment Interrupted aortic arch in a 58-year-old patientcharacterized, originating from the right coronary Valsalva sinus and separated from the right coronary artery (figure 1D, arrow; figure 1F). The patient was submitted to cardiac correction surgery with the implantation of an intrapericardial Dacron conduit connecting both aortic ends. The periprocedural period was uneventful and at 1-year follow-up the patient was clinically stable with no cardiac complications. This IAA was an incidental finding, and it may have arisen from progression of an undiagnosed coarctation of the aorta while the absence of the ductus arteriosus was probably due to a progressive occlusion.
- Trombose de stent em tronco da coronária esquerdaPublication . Rodrigues, Ricardo C.; Coreia, André; Serrão, Marco Gomes; Pereira, Décio