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Anomalous origin of the pulmonary artery branches is a rare phenomenon. We describe a case of an adult with anomalous origin of the right pulmonary artery (hemitruncus arteriosus) associated with patent ductus arteriosus. Non-invasive imaging studies played an important role in the diagnosis and follow-up. Angiography allowed to determine the severity of pulmonary hypertension. He underwent surgical closure of patent ductus arteriosus, redirection of right pulmonary artery and atrioseptostomy with decrease of the pulmonary pressure in the follow-up. A high index of clinical suspicion of this entity is required in adults with heart failure, recurrent hemoptysis and pulmonary hypertension, because it could go unnoticed.

Background: A left ventricular aneurysm is a mechanical complication of a myocardial infarction that frequently develops on the anterior and apical wall. Survival of 3 to 5 years is 27% and 12%, respectively. Our objective is to report 3 cases of ventricular aneurysms in atypical locations and analyze the survival of these patients. Material and Methods: Three patients with suspicion of ventricular aneurysm after acute myocardial infarction who sought attention at our institution were included. All underwent transthoracic echocardiograms (TTE), cardiac magnetic resonance (CMR), nuclear cardiology (NC), coronary angiotomography and cardiac catheterization to assess the location and characteristics of the aneurysms, left ventricular systolic function and the anatomical and functional condition of the coronary arteries. Results: The mean age of studied patients was 58.33 ± 10.37 years. The locations of the ventricular aneurysms were lateral, inferior and septal. The patients received optimal medical treatment to control heart failure and were discharged in stable condition without early mortality. The mean follow-up was 6.33 years (intervals: 2 - 9) and during this period the patients were in NYHA functional class I/II. Conclusion: Left ventricular aneurysm is a late mechanical complication of an infarction that can develop in an atypical location. Diagnosis is achieved using non-invasive techniques such as TTE, CMR, NC, and coronary angiotomography. No mortality occurred among the patients during medium and long-term follow-up.

Myocardial Bridging (MB) refers to the band of myocardium that abnormally overlies a segment of a coronary artery. This paper quantitatively evaluates the influence of MB of the left anterior descending artery (LAD) on myocardial perfusion of the entire left ventricle. We studied 131 consecutive patients who underwent hybrid rest/stress 13N-ammonia positron emission tomography (PET) and coronary computed tomography angiography (CCTA) due to suspected myocardial ischemia. Patients with previous myocardial infarction and/or significant coronary artery disease (≥ 50% stenosis) were excluded. Myocardial perfusion measurements were compared between patients with and without LAD-MB. Additionally, we evaluated the relationship between anatomical characteristics (length and depth) of LAD-MB and myocardial perfusion measurements. 17 (13%) patients presented a single LAD-MB. Global myocardial perfusion reserve (MPR) was lower in patients with LAD-MB than in patients without LAD-MB (1.9 ± 0.5 vs. 2.3 ± 0.6, p

Introduccion En estudios de medicina nuclear se ha observado que la disminucion de la fraccion de expulsion del ventriculo izquierdo (FEVI) se asocia con enfermedad coronaria trivascular; en resonancia magnetica cardiaca (RMC) no se ha estudiado el papel que desempena la disminucion de la FEVI. Objetivo Evaluar la asociacion entre la disminucion de la FEVI y la isquemia cardiaca en pacientes con estudios de RMC con adenosina. Metodo Estudio transversal comparativo. Los criterios de inclusion fueron pacientes evaluados con RMC con adenosina entre enero de 2009 y junio de 2015. Se comparo el cambio en la FEVI en pacientes con estudio positivo versus pacientes con estudio negativo para isquemia por este metodo. Resultados Se incluyeron 59 pacientes: 41 del sexo masculino (70 %), edad de 59.7 ± 10.9 anos; 38 % de los estudios fueron positivos para isquemia. La delta de la FEVI (FEVI postestres - FEVI reposo) fue de -0.16 ± 5.9 versus 5.3 ± 4.7 (p

Metabolic syndrome (MetS) and diabetes mellitus (DM) have become over the past years a global burden of disease. They are one of the main risk factors for cardiovascular disease among others. CVDs represent the number one cause of death globally. Diabetes Mellitus’ prevalence, especially type 2, has increased dramatically in a short period increasing health care costs and mortality worldwide. Detecting coronary artery disease in diabetic patients with a myocardial perfusion imaging method such as PET/CT is the primary concern for this review. The most recent survey in Mexico done in 2012 reveals that an overall prevalence of 9.4% of the population has DM, which is roughly 6.4 million people with DM. Myocardial perfusion imaging with PET/CT has proven to be an accurate method to assess myocardial perfusion defects and viability in both symptomatic and asymptomatic patients with DM. In this review, we briefly describe the latest data on DM in Mexico and the use of MPI with PET/CT for patients with this disease, creating a discussion of the use of this technique as a screening method for endothelial dysfunction to prevent cardiovascular outcomes.

Background ECG is widely used in the evaluation of patients with acute myocarditis. Magnetic resonance imaging (MRI) has emerged as the most important imaging tool in the diagnosis of myocarditis. The objective of this study is to determine the agreement between ECG and MRI findings in patients with acute myocarditis. Methods This is a retrospective cohort that includes 32 consecutive patients with acute myocarditis. ST elevation (STE) in mm was registered in every ECG lead. In every myocardial segment the presence of late enhancement (LE) was registered. Results STE was found in 75% of the patients, with the inferolateral region being the most frequently affected (46.9%). LE was found in most of the patients (87.5%); the inferolateral wall was also the most frequently affected (50%). There was a moderate agreement between the inferolateral localization of STE and LE in patients with acute myocarditis, k = 0.43, p = 0.01. There was no agreement for the other localizations. Conclusion There was a moderate agreement between the localization of STE and LE only in the inferolateral localization. LE localization based on the STE localization cannot be inferred, neither vice versa in another localization different from the inferolateral.

Objectives To evaluate the mid-term outcomes, and the aortic remodeling in Marfan syndrome (MFS) patients with type B dissection that were treated with endovascular repair. Background MFS is a relative contraindication to thoracic endovascular aortic repair (TEVAR). Mid-term aortic outcomes data in MFS after TEVAR are limited, and the occurrence of late events remains unclear. Methods Of 89 patients that underwent TEVAR between September 2002 and February 2011, 10 patients with mid-term follow-up fulfilled the Ghent criteria for MFS and complicated type B dissection. High risk for open surgery was documented in 90%. Results The mean age was 35.1 ± 9.4 years and all patients presented with acute aortic syndrome complicating a chronic type B dissection (DeBakey type IIIb). Five patients underwent a Bentall surgical procedure previous to endovascular repair, and in four patients initial TEVAR was followed by surgery of the ascending aorta. Treatment was limited to endovascular repair in only one patient. In-hospital mortality was 10%. At a mean follow-up of 59.6 ± 38.9 months, the cumulated mortality was of 20% and late mortality 11.1%. The rate of secondary endoleak was 44.4%, and late reintervention of 33.3%. Survival freedom from cardiovascular death at 8 years was 80.0%, and positive remodeling was documented in 37.5% of patients. Conclusions Our results suggest that TEVAR is feasible, safe, and associated with a high reintervention rate and reduced rate of positive aortic remodeling in patients with Marfan syndrome. Survival at 8 years was comparable to contemporary series of open repair. © 2012 Wiley Periodicals, Inc.

Coronary artery dilatations-aneurysms and ectasia-are an uncommon and frequently unrecognized incidental finding in patients with coronary artery disease. Aneurysms and ectasia are associated with a vast group of disorders, and the evaluation and characterization of coronary aneurysms and ectasia represent a great diagnostic task with clinical and therapeutic implications. The underlying etiology is variable and includes degenerative, congenital, inflammatory, infectious, toxic, and traumatic causes. Unlike aneurysms, ectasia is more frequently seen in association with atherosclerosis or as a compensatory mechanism in those cases in which a proximal stenosis is noted in the opposite coronary artery; ectasia is also seen in some coronary artery anomalies, such as anomalous origin from the pulmonary artery, or as a result of a high-flow state, as seen in coronary artery fistulas. The diagnostic approach depends on the clinical scenario, and nowadays, noninvasive evaluation with multidetector computed tomography is possible. Imaging assessment should include evaluation of (a) the distribution, (b) maximal diameter, (c) presence or absence of intraluminal thrombi, (d) number, (e) extension, and (f) associated complications such as myocardial infarction. This article presents an overview of the definition, classification, etiology, clinical manifestations, and potential complications of coronary artery aneurysms and ectasia.

Metabolic syndrome represents a growing burden in the Mexican population with an increasing presence as evidenced by the most recent epidemiological data, showing a prevalence of 49.8 % in 2006. The cardiovascular hazard of metabolic syndrome has been proven in numerous occasions; these patients present an increased risk of cardiovascular dis- ease not only because of epicardial coronary occlusion but also from microvascular disease secondary to endothelial dysfunction. Myocardial perfusion imaging using both single-photon emission computed tomography and positron emission tomography can be effectively used for the evaluation of established coronary artery disease as well as in the assessment of high-risk asymptomatic pa- tients. In this review, we briefly discuss the role of myo- cardial perfusion imaging studies and its current and po- tential applications for patients with metabolic syndrome.

Nowadays, there is a wide array of imaging studies available for the evaluation of coronary artery disease, each with its particular indications and strengths. Cardiac single photon emission tomography is mostly used to evaluate myocardial perfusion, having experienced recent marked improvements in image acquisition. Cardiac PET has its main utility in perfusion imaging, atherosclerosis and endothelial function evaluation, and viability assessment. Cardiovascular computed tomography has long been used as a reference test for non-invasive evaluation of coronary lesions and anatomic characterization. Cardiovascular magnetic resonance is currently the reference standard for non-invasive ventricular function evaluation and myocardial scarring delineation. These specific strengths have been enhanced with the advent of hybrid equipment, offering a true integration of different imaging modalities into a single, simultaneous and comprehensive study.

Erick Alexanderson Rosas,* Aloha Meave Gonzalez, and Moises Jimenez-Santos Departamento de Cardiologia Nuclear, Division de Imagen Cardiovascular No Invasiva, Instituto Nacional de Cardiologia ‘‘Ignacio Chavez’’, Mexico City, Mexico Departamento de Resonancia Magnetica y Tomografia Cardiaca, Division de Imagen Cardiovascular No Invasiva, Instituto Nacional de Cardiologia ‘‘Ignacio Chavez’’, Mexico City, Mexico Unidad PET/CT Ciclotron, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico

State-of-the-art multidetector computed tomographic (CT) technology has replaced invasive angiography for evaluation of patients suspected to have aortic disease. Although most aortic disease is associated with atherosclerosis (ie, aneurysms and dissection), the spectrum of aortic disease is vast and includes various congenital and acquired entities. Radiologists should also be familiar with uncommon aortic diseases, which are divided into those that are congenital in origin and acquired disorders, and with their findings at multidetector CT. The first group includes patent ductus arteriosus, aortic hypoplasia, aortic coarctation, interrupted aortic arch, aortopulmonary window, common arterial trunk, supravalvular aortic stenosis, and vascular rings. The acquired disorders include aortic dissection due to extension of a coronary artery dissection, Marfan syndrome, large-vessel vasculitis such as Takayasu arteritis, and mycotic aneurysms. Finally, specific conditions associated with therapeutic maneuvers--such as recoarctation, stent-graft rupture, and endoleaks--can also be assessed with multidetector CT. Multidetector CT is an alternative tool helpful in establishing the primary diagnosis, defining anatomic landmarks and their relationships, and identifying associated cardiovascular anomalies. It is also an adjunct in the evaluation of complications during follow-up.

Objectives The aim of this study was to use coronary computed tomographic (CT) angiography to characterize coronary artery involvement in patients with known Takayasu arteritis who present with anginal chest pain or shortness of breath. Background Takayasu arteritis is a primary vasculitis of the large vessels, which mainly affects the aorta and its branches but can also involve the coronary arteries. Coronary CT angiography allows visualization of the coronary vessels and can be used to detect both stenotic and nonstenotic coronary artery lesions. Methods Eighteen consecutive patients with Takayasu arteritis and angina (typical or atypical) and/or dyspnea underwent contrast-enhanced 64-slice coronary CT angiography. The arterial injury was classified according to the Numano classification. Three patients had prior known coronary artery disease. Coronary arteries were evaluated concerning the presence of obstructive and nonobstructive lesions, and differences between the clinical presentations of patients with and without coronary artery involvement on CT angiography were analyzed. Results Coronary artery involvement was found in 8 patients (44.4%), 3 of them with clinical activity. A total of 19 coronary lesions were present (13 in ostial locations, 5 in proximal coronary artery segments, and 1 in a mid segment). Eight lesions exceeded 50% diameter reduction (2 in ostial locations and 6 in proximal coronary artery segments). Median disease duration was significantly different between patients with coronary artery involvement (176 months; range 13 to 282 months) compared with those without (21 months; range 1 to 142 months) (p = 0.013). Conclusions Coronary CT angiography allows the assessment of coronary artery involvement in patients with Takayasu arteritis. These data confirm prior observations that most coronary lesions are in ostial or proximal coronary artery locations. Disease duration in patients with coronary artery involvement is longer than in patients without.