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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.

The cardiovascular sequelae by the SARS-COV-2 infection is prevalent in a significant portion of the recovered patients from the acute presentation of the SARS-COV-2. Actually, the clinic cardiac control of the post-acute COVID syndrome has been working out without a well-established protocol, making the appropriate diagnosis of the cardiac diseases produced by the different damage mechanisms from COVID-19.Standardize cardiovascular care and the follow up of COVID-19 survivors in the function on disease severity and identify patients who develop SPC-19A for timely care.Through an extensive bibliographic review, this article has the purpose of provide the necessary information to make possible the early diagnosis and following of the cardiac complications that has been recorded trough the months after the acute disease from COVID-19.Las secuelas cardiovasculares ocasionadas por la enfermedad por coronavirus 2019 (COVID-19) son frecuentes en una importante proporción de los pacientes recuperados del cuadro agudo de la enfermedad. Hasta el día de hoy el seguimiento cardiológico del síndrome agudo post-COVID-19 (SPC-19A) se ha realizado de forma heterogénea y sin directrices que permitan al clínico identificar oportunamente los cambios que preceden a enfermedades cardiológicas derivadas de los distintos mecanismos de daño inducidos por COVID-19.Estandarizar la atención y seguimiento cardiovascular de los supervivientes de COVID-19 en función de la gravedad de la enfermedad e identificar a los pacientes que desarrollen SPC-19A para su atención oportuna.Mediante una revisión extensa de bibliografía, este documento tiene la intención de unificar y proporcionar la información necesaria para diagnosticar y dar seguimiento a las complicaciones cardiacas que se han documentado en los meses posteriores a la resolución de la COVID-19 aguda.

Introduccion Los defectos cardiacos congenitos constituyen el 30% de todas las anomalias congenitas. La prevalencia es de 8/1,000 recien nacidos vivos, sin predominio de genero. Para una planificacion quirurgica optima es esencial una evaluacion precisa de la anatomia en los defectos cardiacos congenitos. Las modalidades de imagen como el ecocardiograma, la angiografia por cateterismo cardiaco, la tomografia computarizada (TC) o la resonancia magnetica (RM) se utilizan de forma regular para el diagnostico de las cardiopatias congenitas. Estos metodos pueden proporcionar reconstrucciones virtuales en reconstruccion volumetrica o 3D, pero no replicas tactiles reales de la anatomia cardiaca. Objetivo Realizar modelos de corazon impresos en 3D con la finalidad de proporcionar replicas tactiles 3D reales de la anatomia cardiaca para visualizar de forma detallada todas las perspectivas posibles de las estructuras extracardiacas o intracardiacas. Metodos Los datos de la imagen se obtuvieron en formato DICOM, se editaron en el paquete de software "3D slicer 4.3" y se exportaron para la impresion en formato de archivo (.stl). Resultados y conclusiones Con la impresion 3D se puede evaluar de forma detallada la anatomia intracardiaca y extracardiaca con modelos cardiacos en tiempo real. Esta tecnica es de gran utilidad, sobre todo en los defectos cardiacos congenitos complejos, ya que permite hacer una planificacion precisa del procedimiento quirurgico. Introduction Congenital heart disease makes up for 30% of all congenital anomalies. The prevalence is 8/1,000 live newborns, without predominance of gender. Imaging methods such as echocardiography, angiography, computed tomography or magnetic resonance imaging must be routinely used in congenital heart disease. The mentioned methods can provide virtual reconstructions in volumetric reconstruction or in three dimensional (3D), but only 3D-printed heart models can provide real 3D tactile replicas of cardiac anatomy. Objective To make 3D printed heart models in order to provide real 3D tactile replicas of the cardiac anatomy that allow a detailed visualization from all possible perspectives, either of extracardiac or intracardiac structures. Methods This information is useful for surgical decision making, especially in patients with complex cardiac defects. DICOM, edited in a software package “3D slicer 4.3” and exported for printing in file format (.stl). Results and conclusions With 3D printing, the intracardiac and extracardiac anatomy can be evaluated in detail with real-scale cardiac models of the patient, avoiding unexpected findings. This technique is very useful especially in complex congenital heart defects, since it allows precise planning of the surgical procedure.

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

In normal heart, the real atrioventricular septum separates the morphological right atrium from the anatomic left ventricle. It has two portions; the anterosuperior is membranous and the posteroinferior is muscular. The latter is located between the mitral annulus and the tricuspid annulus. The peripheral atrioventricular junction is constituted by an extension of epicardial fat between the walls of atria and ventricles. In atrioventricular septal defect (AVSD) which is due to deficiency of myocardial tissue at AV junction, the membranous septum is absent and there is also a deficiency in the perimembranous muscular tissue. AVSD has received numerous designations in the past including endocardial cushion defect, persistent embryonic atrioventricular canal, atrioventricular canal defect, and ostium primum atrial septal defect. Defect of the endocardial atrioventricular cushions is a nonspecific designation since it can include the absence of right atrioventricular connection and double inlet left ventricle.

Coronary artery aneurysms are a relatively infrequent finding with an incidence of 1% to 2% per year. Its cause can be atherosclerosis, congenital or due to other causes less common. Its initial manifestation can be myocardial infarction and sudden death as a result of rupture or distal embolization. The large coronary aneurysms, non-atherosclerotic, located in the common part of the left main coronary artery are exceptional. The diagnostic method of choice is the coronary angiography; however, non-invasive techniques such as transthoracic including tridimensional mode and transesophageal echocardiography, magnetic resonance imaging and computed tomography may have an important role in the detection and follow-up of these anomalies. The natural history of coronary aneurysm is not quite known. We present the case of a patient of 44 years, following an acute coronary event was diagnosed with an aneurysm in the left main and antiphospholipid syndrome. The patient received conservative treatment on the basis of antiplatelet and anticoagulant without presenting major cardiovascular events or other complications in 12 years of follow-up.

The study of patients with coronary artery disease by means of gated SPECT has been well established. One of the major limitations of this technique is the detection of myocardial perfusion defects in the presence of multivessel or three-vessel coronary artery disease due to balanced ischemia. Quantification of myocardial blood flow by positron emission tomography allows not only to study cardiac perfusion and function but also to determine the coronary flow reserve which has a better correlation with significant stenosis in patients with trivascular disease. The aim of this study was to demonstrate through a case report and literature review the importance of performing quantification of coronary blood flow in this group of patients.

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.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.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%.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.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.

To evaluate the agreement between de ECG leads with ST elevation and the myocardial segments that present myocardial edema in the MRI study, in patients with acute myocardial infarction.There were included 91 patients with a first ST elevation myocardial infarction (STEMI) with reperfusion therapy during the first 12 hours of onset symptoms, in whom a Cardiovascular Magnetic Resonance (CMR) was done (mean 3 day after the ischemic event). Among the ECG leads (thoracic circle), there were identified those with ST higher elevation. In the CMR there were evaluated the myocardial segments with edema (T2-weighted sequence with hyperintensity).The ECG leads with the best sensibility in the detection of injury, corresponding to cellular edema, were: basal anterior and anteroseptal: V2; basal inferoseptal LIII and aVF; basal inferior and inferolateral: LIII; basal anterolateral V7-V9; mid anterior and anteroseptal:V2 and V3; mid inferoseptal, inferior and inferolateral: LIII and aVF; mid anterolateral V2 and V8; apical anterior and septal: V2-V4; apical inferior and lateral: LII, LIII and aVF; apex: V2-V4.The surface ECG leads with higher ST elevation corresponded to the myocardial segments with more important edema (defined as someone with hyperintensity in the T2- weighted MRI sequence).

A case of a two month infant with complex congenital heart disease (aortic coarctation with ventricular septal defect) associated to a cellular brain migration failure is presented. The management strategy consisted on the correction of congenital heart disease by means of a two-stage surgery without a further preoperative evaluation of the neurological status. The patient developed several perioperative complications such as two episodes of cardiac arrest, reconnection to cardiopulmonary bypass, cardiac tamponade, chilothorax and septic shock. A neurological protocol consisting in electroencephalography, brain magnetic resonance and Single Photon Emission Computed Tomography (SPECT) was practiced during the postoperative period, which detected microgyria with paquigyria and a cellular brain migration failure was suspected. The final outcome was death due to multisystemic failure and the autopsy confirmed the neurological disease, as well as poor life function prognosis. Should the heart-brain binomial had been considered in an integral preoperative evaluation, the therapeutical approach could have been modified.

To determine the application of PET in monitoring patients with Takayasu's arteritis (TA) with Inflammatory activiti (IA) and this correlation with established clnical criteria.35 patients diagnosed with TA were enrolled. Determination of erythrocyte sedimentation rate, C -reactive protein, fibrinogen and a complete blood count was performed and clinical criteria of activity were applied. A baseline PET was performed in all patients. Those who were positive for IA received drug treatment. Among the group of active patients, ten were randomized to undergo another PET scan and clinical criteria determination to evaluate inflammatory activity after 6 months of treatment. We compared clinical criteria with PET capacity to determine IA. The results between the initial and final PET were finally compared.Clinical criteria had a sensitvity of 63% and a specificity of 90% to show IA. Sensivity decreased after 6 months of treatment to 27%.This is the first prospective study that compares the findings of PET before and after treatment for IA in patients with TA. Clinical criteria lack sensitivity for the detection of IA in the follow-up after treatment.PET is a diagnostic technique with high sensitivity and specificity for the diagnosis and monitoring of patients with TA and inflammatory activity.

The endothelium plays an important role in the regulation of the intracellular fluid, vascular permeability, and modulation of vascular focal tone and angiogenesis. Endothelial dysfunction is manifested by the loss of the endothelium ability to modulate physiology changes in its vascular bed, and actually it is considered a prognostic marker of coronary artery disease. The relevance of assessing endothelial dysfunction relies in that it has been observed in different pathologies like DM, dyslipidemia, hypertension, tabaquism and in immunologic diseases like antiphospholipid syndrome and systemic lupus. PET is a non invasive method that allows the absolute quantification of myocardial blood flow during rest, stress and adrenergic stimulation, which allows to asses endothelial function. Therefore PET is a useful diagnostic technique to identify patients with endothelial dysfunction, and in the assessment of its response to administered therapy, allowing an optimal control and prevention of secondary adverse events of these diseases.

The purpose of this study was to determine the effect of treatment, with Metformin alone or with the combination of Glimepiride/Metformin, on coronary endothelial function in asymptomatic patients with recently diagnosed type 2 diabetes mellitus (DM) Methods: 16 asymptomatic patients with type DM2 and 15 healthy controls (HC) were studied. At baseline and after treatment, myocardial blood flow (MBF) was measured with 13N-ammonia Possitron Emission Tomography (PET) at rest, during cold pressor testing (CPT) and during pharmacologic stress with adenosine. The endothelial dependent vasodilation index (EDVI), myocardial flow reserve (MFR) and the percentage of the change between rest MBF and CPT MBF (%deltaMBF) were calculated as markers of endothelial function. MBF was normalized to the rate pressure product (RPP).EDVI and %deltaMBF were significantly lower in diabetic patients before treatment in comparison with HC demonstrating endothelial dysfunction in the former. Treatment with Glimepiride/Metformin significantly increased EDVI and %deltaMBF in diabetic patients from baseline, thus showing an improvement in coronary endothelial function.

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.

It used to be thought that the consequences of coronary artery disease were final, and that the prognosis of the patient was limited to the extent of the ventricular dysfunction. This paradigm changed radically when the concept of hibernating myocardium was introduced, which states the existence of tissue that can regain contractile function after being re-vascularized. This introduced a new concept in cardiology: myocardial viability. This work presents a clear example of the importance of detecting myocardial viability in selected patients, due to the impact not only in treatment but in prognosis as well. It is also emphasized that positron emission tomography (PET) is the gold standard method to detect myocardial viability.

At the beginning of the evaluation of Coronary Artery Disease (CAD), Coronary Multidetector Computed Tomography (MDCT) was exclusively used to detect calcified plaques in coronary arteries through the Calcium Score, whose value by itself is limited. Nowadays, thanks to the technological advancements, potential clinical applications, with this method, include detection of coronary arterial stenosis, assessment of coronary bridges, and evaluation of anomalous coronaries. The intraluminal coronary stent evaluation is not possible yet, but this might become possible with the new-generation scanners. At the moment, the published results seem to be promising, nonetheless, the enthusiasm generated by this method should be accompanied by adequate training, as well as by its validation and certification.

Hypercholesterolemia prompts to endothelial dysfunction (ED) and ED predisposes to atherogenesis. ED appears early in the course of atherogenesis and it is considered a coronary artery disease (CAD) marker.To assess endothelial function (EF) using Positron Emission Tomography (PET) in asymptomatic patients with recent dyslipidemia diagnosis and without history of ischemic heart disease and previous hypolipemiant treatment.Fourteen asymptomatic patients with recent dyslipidemia diagnosis (6 months) were studied by obtaining a lipid profile, blood glucose, and a three phase 13N-ammonia PET scan: rest, cold pressor test (CPT) and pharmacologic stress with adenosine. EF was assessed by calculating the coronary flow reserve (CFR), endothelial-dependant vasodilatation index (EDVI), and coronary blood flow increase percentage in CPT (% Delta CF).79% of patients with dyslipidemia had ED and all their values were lower than those previously published as normal: rest coronary flow 0.44 +/- 0.12 vs 0.57 +/- 0.147 (p = 0.002), CPT coronary flow 0.57 +/- 0.17 vs 0.88 +/- 0.26 (p = 0.001), stress coronary flow 1.24 +/- 0.05 vs 1.81 +/- 0.35 (p = 0.005), EDVI 1.28 +/- 0.25 vs 1.53 +/- 0.24 (p 0.017), CRF 2.79 +/- 0.94 vs 3.15 +/- 0.48 (p 0.198) and % Delta CF 29.08 +/- 24.62% vs 53 +/- 24.60% (p 0.022).Asymptomatic patients in early stages of dyslipidemia showed a greater ED prevalence that was detected by 13N-ammonia PET scan.

To evaluate the utility of the cardiovascular magnetic resonance imaging (cMRI) for quantify the aortic area in adult patients with pure aortic stenosis (AS).Comparative cross-sectional study, blinded, in patients with AS, without another valvular pathology associated. A transthoracic echocardiogram (TTE) and cMRI were performed, in all of them. Results were analyzed by Student t test and ji-square, considering significant values p0.05. Bayesian analysis and ROC curve, for the determination of the disease severity.No were significant differences with respect to quantification of the speed of transvalvular flow between both methods (TTE 4.593 +/- 0.9114 m/s vs. cMRI 4.233 +/- 0.6894 m/s, p = 0.080), nor the ejection fraction (TTE 54.27 +/-16.451 vs. cMRI 48.40 +/-17.332, p = 0.760). The cMRI seems to underestimate the maximum and medium gradients compared with the TTE, in 12.53 mm Hg and 10.07 mm Hg respectively. The sensitivity for the diagnosis of severe aortic stenosis is 90% with specificity 80%.The cMRI is a useful diagnostic method for the evaluation of patients with pure aortic valve stenosis, as good as TTE. cMRI can to be a diagnostic alternative in cases with limitations to TTE.

The study of atherosclerotic disease in coronary arteries is fundamental since it is the first cause of death in the Western hemisphere. The gold standard for its diagnosis is invasive angiography, but it contributes to an increase in costs for this group of patients. Nowadays fourth generation computed tomography (CT) equipments can construct acquisition data of up to 256 images in only 400 milliseconds (ms), which is 900 to 1000 times faster than first generation apparatus. CT multidetector (CTMD) is the noninvasive choice diagnosis method for a vascular evaluation of the thorax. Its role in the study of the heart was limited, but today it is possible to obtain three-dimensional heart and whole body images in only seconds. CTMD is a fast, low-cost, noninvasive method that generates cardiac and extra cardiac images without adjacent structure interference. The higher temporal resolution due to an increase of the gantry's rotation and new reconstruction algorithms, as well as its higher spatial resolution and elevated time acquisition due to the presence of more detectors, have permitted CTMD to give significantly better and precise diagnosis of coronary arteries.

When aneurysm of the root of aorta, bicuspid aorta valve and coarctation coexist, surgical repair involves technical problems. We present the case of a patient in whom initial correction of the coarctation was made by means of interventional treatment, with an impressive and practically immediate resolution of heart failure. In a second intervartional, the aortic root pathology was corrected through the Bentall and de Bono's surgical technique. We present the short- and mid-term results. In addition this case demostrates the little well-know fact, that the patients with bicuspid aorta also have cystic media degeneration of the wall of the aorta.

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.