Archivos Peruanos de Cardiología y Cirugía Cardiovascular
Archivos Peruanos de Cardiología y Cirugía Cardiovascular created in December 2019, is the official scientific journal of the Instituto Nacional Cardiovascular - INCOR del Seguro Social de Salud del Perú. It is an exclusively virtual publication, peer-reviewed, quarterly and free full-text access. It publishes, in Spanish and English, topics related to cardiovascular diseases, cardiovascular surgery and endovascular surgery at national and international level, within the standards of scientific publication. It includes original clinical or basic research articles, reviews, unpublished clinical cases, special articles, scientific letters and editorials.
Instituto Nacional Cardiovascular “Carlos Alberto Peschiera Carrillo” – INCOR, EsSalud
Use of beta-blockers and depressive symptoms in hypertensive older adults: a multicenter study
Objectives. To evaluate the association between beta-blocker use and the presence of depressive symptoms in older adults with hypertension (HTN). Materials and Methods. A cross-sectional observational study was conducted among patients from the Central FAP Hospital and the Naval Medical Center. Older adults with a diagnosis of HTN who had been receiving antihypertensive treatment for at least one month were included. Depressive symptoms were assessed using the PHQ-9 questionnaire. Social, clinical, and functional variables were analyzed using bivariate tests (Chi-square and Fisher’s exact test), as well as Poisson regression with robust variance to estimate crude and adjusted prevalence ratios (PR). Results. A total of 149 older adults were included. Of these, 27.5% were taking beta-blockers, and 39% presented depressive symptoms. No significant association was found between beta-blocker use and the presence of depressive symptoms (PR:1.09; 95% CI: 0.70–1.69; p = 0.693). In contrast, a higher risk of depressive symptoms was observed among patients with greater frailty (PR: 5.72; 95% CI: 2.17–15.0; p < 0.001) and a lower risk among those with technical or university education (PR: 0.43; 95% CI: 0.25–0.74; p = 0.003). Conclusions. No association was found between beta-blocker use and depressive symptoms in patients with HTN. Factors such as frailty, educational level, and duration of HTN diagnosis showed significant associations and should be considered in the comprehensive assessment of emotional risk in this population.
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Vascular ring due to double aortic arch as a cause of stridor and dysphagia in infancy: a case report
A double aortic arch is a rare congenital vascular anomaly with clinical significance in the pediatric population due to its potential to cause extrinsic compression of the trachea and esophagus. It should be suspected in infants with persistent respiratory and gastrointestinal symptoms refractory to conventional treatment. We report the case of a 2-year-7-month-old boy presenting with recurrent stridor, repeated respiratory infections, and progressive dysphagia. Cardiac CT angiography revealed a complete vascular ring causing tracheoesophageal compression. Dominance of the left aortic arch was identified, and surgical section and distal ligation of the non-dominant right arch were performed, without direct intervention on the tracheoesophageal structures. At the 12-month follow-up, there was complete resolution of symptoms and nutritional recovery. This case highlights the importance of maintaining high clinical suspicion and ensuring timely referral. Even when surgical correction is delayed, appropriate intervention can reverse symptoms and improve quality of life
Gender and ethnic disparities in carotid artery disease: experience from a national Peruvian hospital
Atherosclerotic carotid artery disease is a significant cause of cerebrovascular events worldwide. Current international guidelines for the management of this condition provide general recommendations that often overlook differences among specific population groups. Although sex- and race-related disparities in disease prevalence are acknowledged, there remains a notable lack of studies focused on the prevalence, progression, and management of carotid artery disease in Latina women.
Significant valvular heart disease in wild-type transthyretin amyloidosis: prevalence and impact on survival
Objective. There are limited data on the prevalence and prognostic impact of significant valvular heart disease in patients with wild-type transthyretin cardiac amyloidosis (ATTRwt). The aim of this study was to describe the prevalence of aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR) in this population and, secondarily, to evaluate their impact on survival. Methods. This was a retrospective, single-center cohort study including patients diagnosed with ATTRwt between 2011 and 2024. We calculated the prevalence of each significant valvular heart disease, and Kaplan-Meier survival curves were generated to estimate two-year all-cause mortality, stratified according to the presence or absence of each significant valvular disease. Finally, a multivariable Cox regression was performed to assess their association with survival. Results. We included 154 patients, with a mean age of 81 (±7) years; 85% (n=131) were male. Significant TR was the most prevalent valvular disease (27%, n=41), followed by significant MR (20%, n=30) and AS (13%, n=20). Patients with significant TR had a higher incidence of all-cause mortality compared to those without significant TR (41% vs. 16%, log-rank test, p=0.0007), whereas no differences were observed between patients with and without significant AS or MR. In multivariable Cox models, significant TR was independently associated with higher mortality, regardless of age, the presence of other valvular diseases, and NT-proBNP levels. Conclusions. Significant TR was the most prevalent valvular disease in patients with ATTRwt and was associated with lower survival in this population.
Aortic valve assessment by cardiac tomography: application in clinical practice
Aortic valve disease is a highly prevalent and clinically significant condition in the general population. Cardiac computed tomography (CT) has emerged as a widely available imaging modality that provides high-resolution static and dynamic information, enabling comprehensive evaluation of valve anatomy and function. This technique complements echocardiography and other imaging tools, adding incremental value to clinical decision-making. Its principal applications include identifying the etiology of valvular disease, grading severity, and assessing adjacent structures, all of which are critical for therapeutic planning. This non-systematic review synthesizes the evidence on the role of CT in the assessment of the aortic valve, focusing on aortic stenosis, aortic regurgitation, infective endocarditis, and postoperative evaluation. The current body of evidence underscores the expanding role of CT in the integrated diagnosis and longitudinal management of aortic valve disease.
Acute cardiorenal decompensation in the setting of chronic renal artery stenosis treated with successful renal artery stenting. A case report
Atherosclerotic renal artery stenosis may present with resistant hypertension, hypertensive crisis, ischemic nephropathy, and cardiac destabilization. Although early studies of renal artery stenting showed promise, later trials found no benefit over medical therapy—yet often excluded high-risk, acute cases. We describe an 85-year-old male with cardiovascular risk factors who developed a hypertensive crisis, acute kidney injury, and flash pulmonary edema. An angiogram revealed severe ostial right renal artery stenosis. Stenting resulted in the rapid resolution of the acute crisis and restoration of baseline renal function. This case underscores the potential benefit of revascularization in select high-risk presentations of renal artery stenosis.
Combined leadless pacing and subcutaneous defibrillation strategy in a high-risk patient: first case report from Peru
We present the case of a 51-year-old male with non-ischemic dilated cardiomyopathy and complete atrioventricular block, who was previously implanted with a cardiac resynchronization therapy defibrillator. The patient developed signs of pocket infection with a high risk of extrusion. Partial system extraction was performed, followed by 14 days of intravenous antibiotic therapy. Due to a history of ventricular fibrillation and permanent pacing dependency, and in the absence of viable transvenous access, a sequential implantation strategy was adopted using a leadless pacemaker (Micra AV, Medtronic) and a subcutaneous implantable cardioverter-defibrillator (EMBLEM, Boston Scientific). Both procedures were completed without complications, and the patient showed favorable recovery, with effective pacing, no arrhythmic recurrences, and no signs of infection at the six-month follow-up. This case illustrates the feasibility of a fully leadless approach in high-risk patients with contraindications to conventional transvenous systems.
The hospitalized patient with severe aortic stenosis
Recommendations for the management of ST elevation myocardial infarction after reperfusion
The management of ST-segment elevation acute myocardial infarction after reperfusion involves critical decisions for patients with multivessel disease (MVD), acute heart failure, and left ventricular (LV) thrombus. Complete revascularization of non-culprit lesions ≥70% is recommended during the initial intervention or within the first 19 days, particularly in stable patients. Coronary artery bypass grafting is indicated for high-risk anatomies or complex lesions following a successful coronary intervention, where a hybrid strategy combines percutaneous intervention with surgery, with timing adjusted based on whether a stent was implanted. Post-infarction heart failure is common (28-31%) and requires urgent treatment. Continuous monitoring and prompt intervention can reduce complications. In cases of shock or mechanical complications, an intra-aortic balloon pump and inotropic support may be necessary. Right ventricular infarction is managed with volume support, urgent revascularization, and, if needed, pharmacological support or pacing. LV thrombus, which is more common in previous infarcts with LVEF <50%, requires early diagnosis through echocardiography and/or tomography, along with early anticoagulation, preferably with warfarin, considering triple therapy in cases of high thrombotic risk. This manuscript presents recommendations aimed at optimizing prognosis through early and personalized interventions based on the most recent evidence.
Immune checkpoint inhibitor-induced myocarditis: a comprehensive review with clinical case insights
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy by significantly improving long-term outcomes across multiple malignancies. Despite their benefits, ICIs can lead to immunerelated adverse events, including rare but severe cardiovascular toxicity such as myocarditis, which can be life-threatening. This comprehensive review aims to explore and discuss the mechanisms, clinical presentation, diagnostic challenges, and management strategies of ICI-induced myocarditis, emphasizing the need for early detection and timely intervention. As the use of ICIs continues to expand, further research is essential to fully elucidate the underlying mechanisms and optimize therapeutic strategies to mitigate this potentially fatal complication while maintaining the efficacy of cancer therapy.
Single-stage repair of aortic arch hypoplasia and ventricular septal defect in a low-weight infant: a case report from a resource-limited center
Aortic arch hypoplasia associated with ventricular septal defect (VSD) is a life-threatening congenital condition that demands early intervention. In low-resource settings, the lack of advanced tools complicates the safe use of selective antegrade cerebral perfusion (SACP) and innovative repair techniques such as interdigitating patch reconstruction. We describe the case of a newborn with severe aortic arch hypoplasia and a large perimembranous VSD who underwent successful one-stage surgical correction. The repair included aortic arch reconstruction using an interdigitating bovine pericardial patch and VSD closure under SACP delivered via direct brachiocephalic trunk cannulation. Despite the challenges of limited monitoring and equipment, the infant had an excellent clinical outcome. This case highlights the feasibility of adapting high-complexity cardiac techniques in resource-limited environments when surgical fundamentals and teamwork are prioritized. With strategic planning, multidisciplinary coordination, and adherence to evidence-based principles, successful single-stage repair of complex congenital heart disease is achievable even in under-resourced settings.
Intramyocardial dissection of the left ventricle and post-myocardial infarction interventricular septal rupture. A clinical case
Clinical case of an 86-year-old male patient presenting with a late anterior myocardial infarction without reperfusion is reported. Initial echocardiographic assessment revealed a rare and complex mechanical complication: intramyocardial dissection of the left ventricular apex associated with interventricular septal rupture. Given the severity of the condition, an urgent surgical intervention was undertaken using a bovine pericardial patch. Although the initial postoperative course was favourable, multiple subsequent complications ultimately led to the patient’s death from ventricular arrhythmia on day 50th of hospitalisation. This report underscores the importance of timely diagnosis and multidisciplinary management of this rare clinical entity.
Takotsubo syndrome triggered by a pleasant emotional event: a case report
Takotsubo Syndrome (TTS) is characterized by transient left ventricular dysfunction, often triggered by emotional or physical stress. While negative emotional events are common triggers, positive emotional events can also induce a rare variant known as Happy Heart Syndrome (HHS). This case report describes a 53-year-old male who presented with acute chest pain following a positive emotional stimulus: a birthday call offering him an opportunity to play with his favorite music group. Initial workup suggested an acute myocardial infarction, but coronary angiography revealed no obstruction. Left ventriculography showed the classic apical ballooning pattern of TTS. The patient was diagnosed with HHS. This case underscores the importance of considering positive emotional triggers in the diagnosis of TTS and highlights the need for further research into its diverse presentations and management strategies.
Monoclonal gammopathy evolving into sytemic amyloidosis with cardiac involvement. A case report
We report a case of systemic light chain amyloidosis with cardiac involvement, preceded by a monoclonal IgG lambda gammopathy. The clinical diagnosis was based on signs of heart failure, elevated biomarkers, and imaging findings. The diagnosis was confirmed by elevated light chains in the blood and urine, and the presence of amyloid deposits in the periumbilical fat biopsy and in different segments of the digestive tract. Treatment with daratumumab plus bortezomib plus dexamethasone was initiated, and autologous hematopoietic stem cell therapy was administered 22 months after diagnosis, with a favorable clinical outcome.
Monoclonal Gammopathy of Undetermined Significance
Case report of heterotaxy syndrome with sinus node dysfunction and left ventricular hypertrabeculation: clinical and genetic insights
We present the case of a 41-year-old woman with left atrial isomerism, severe sinus node dysfunction, and left ventricular hypertrabeculation, who required implantation of a dual-chamber implantable cardioverter-defibrillator with left bundle branch area pacing. Her family history revealed multiple cases of heterotaxy and conduction disorders. Genetic testing identified a heterozygous interstitial duplication on chromosome 17q23.2 involving the MED13 gene, whose clinical significance has not yet been determined.
Risk factors for postoperative acute kidney injury after cardiac surgery
Objectives. To describe the frequency of postoperative acute kidney injury (AKI) following cardiac surgery and to analyse risk factors for its development. Materials and methods. We conducted an observational analytical cohort study using prospective data from adult patients who underwent cardiac surgery between 2003 and 2023 at a high-complexity centre in Argentina. AKI was defined according to KDIGO criteria. Risk factors were assessed using logistic regression. Results. A total of 13,215 patients were analysed, with a mean age of 64 years; most were men (75.7%). The frequency of AKI was 7.3%, with an in-hospital mortality of 4.7%. Independent risk factors included advanced age (OR: 1.05, p<0.001), urgent surgery (OR: 2.87, p<0.001), cardiopulmonary bypass (OR: 1.41, p<0.001), and comorbidities such as chronic obstructive pulmonary disease and preoperative anaemia. Asymptomatic status prior to surgery was identified as a protective factor. Conclusions. The frequency of postoperative AKI is comparable to international registries. The main predictors of risk were age, surgical urgency, and use of cardiopulmonary bypass. Identifying risk factors can improve perioperative prevention and management in cardiac surgery.
Implementation and adaptation of the Society of Thoracic Surgeons´ standardized nomenclature for congenital heart surgery in a Peruvian hospital
Objective. To describe the process of implementing a congenital heart surgery database at the National Cardiovascular Institute (INCOR) in Peru, adapted to the standardized nomenclature of the Society of Thoracic Surgeons, and to present clinical–surgical outcomes in terms of morbidity and mortality within the framework of comprehensive multidisciplinary care. Materials and Methods. A prospective observational study was conducted in three phases: feasibility, database construction, and prospective data collection. Variables were adapted to the institutional context, and the process included a pilot test, strategic planning, multidisciplinary training, role assignment, monitoring, and periodic statistical analysis. Results. A total of 500 consecutive patients were registered between May 2022 and July 2023. Septal defects were the most common surgical indication. The most frequent complications included cardiac dysfunction and arrhythmias. In-hospital mortality was 7.6%. The database incorporated preoperative nutritional and dental assessments. Although 27.2% of the forms were fully completed, the remainder showed limitations such as missing data and the need for additional verification of information across modules. Conclusion. The implementation of a congenital heart surgery registry in Peru is feasible even in a resource-limited setting. This system allows the identification of critical areas for improving care and optimizing clinical outcomes, establishing a foundation for future quality improvement initiatives.
The role of agitated saline contrast echocardiography in the evaluation of pulmonary hypertension
The diagnostic approach to pulmonary hypertension using cardiac imaging, particularly echocardiography, provides a practical, accessible, and highly valuable tool. It helps establish the initial diagnostic probability, offers prognostic information, and supports aetiological assessment. The agitated saline contrast test, also referred to as bubble contrast echocardiography, can aid not only in confirming the diagnosis but also in characterising the condition and identifying various underlying causes of pulmonary hypertension.
Translational medicine and atrial fibrillation: ¿What new therapies are available?
Double aortic arch in Honduras: unusual cause of dysphagia in an adult patient. A case report
Vascular rings represent less than 1% of congenital cardiovascular anomalies, with double aortic arch being the most common variant. It is typically diagnosed in infants, with respiratory symptoms in over 90% of cases. We present the case of a 31-year-old male patient with recurrent childhood respiratory infections and asthma, who presented with progressive dysphagia. Contrast-enhanced computed tomography angiography revealed a double aortic arch with right-sided dominance, and the esophagram revealed compression of the proximal third of the esophagus. A left posterolateral thoracotomy was performed with division of the distal left arch, division of the ligamentum arteriosum, adhesions release, and thoracic aorta reconstruction. Postoperative recovery was favorable, with complete resolution of symptoms. Double aortic arch is rarely diagnosed in adulthood. This case highlights its atypical presentation, with predominant gastrointestinal symptoms, and the importance of considering it in the differential diagnosis of dysphagia.
Follow-up of patients with myocardial ischemia and non-obstructive coronary lesions
Objective. The presence of coronary lesions of less than 50% in patients with myocardial ischaemia is a common diagnosis in cardiac catheterisation laboratories. The aim of this study was to determine the clinical course of patients with myocardial ischaemia in the absence of obstructive coronary lesions. Materials and methods. A prospective analytical study was conducted in 110 patients of both sexes with documented myocardial ischaemia and coronary lesions of less than 50% on coronary angiography. The follow-up period was three years. Results. The mean age was 64.5 ± 7.2 years, with a predominance of females (57%). The most prevalent risk factors were hypertension (58.2%) and dyslipidaemia (44.5%). In 8.3% of cases, re-hospitalisation was required, with heart failure reported as the leading cause (6.5%). Cardiovascular event-free survival during follow-up was 80%, and was higher in patients without coronary lesions. A higher incidence of cardiovascular events was associated with diabetes mellitus, a family history of ischaemic heart disease, and chronic kidney disease. Conclusions. Patients with myocardial ischaemia in the absence of obstructive coronary lesions experienced adverse events during follow-up, particularly those with diabetes mellitus, a family history of ischaemic heart disease, and chronic kidney disease.
Pharmacological treatment of patients with chronic heart failure: a subanalysis of an ecuadorian registry
Introduction. Introduction. In Ecuador, there is limited data on the treatment of patients with heart failure (HF). Objective. This study aimed to determine the rate of use of prognosis-modifying drugs and their association with prognosis. Materials and methods. A retrospective observational study was conducted on patients with chronic HF included in the “Los Ceibos” registry between January 2017 and December 2022. Patients were followed for a median of 2.28 years (interquartile range [IQR]: 1.25-3.49). Results. A total of 711 patients diagnosed with HF were included. Among them, 82.7% (n=588) received angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor–neprilysin inhibitors (ARNIs); 82.3% (n=585) received beta-blockers (BBs); and 51.3% (n=365) were treated with mineralocorticoid receptor antagonists (MRAs). Among patients with HFrEF, those receiving triple therapy (ACEI/ARB/ARNI + BB + MRA) had lower all-cause mortality compared to other groups (38.8%, log-rank p=0.014). In patients with Heart Failure with preserved Ejection Fraction (HFpEF), no mortality differences were observed according to the number of medications used (log-rank p=0.720). MRA use was not associated with a prognostic benefit in HFpEF (p>0.05). Patients receiving triple therapy with ARNI + BB + MRA had better survival during follow-up compared to any other drug combination (log-rank p=0.027). Conclusions. A high rate of ACEI/ARB/ARNI and BB use was observed. The use of triple therapy, particularly the combination of ARNI + BB + MRA, was associated with improved prognosis in patients with HFrEF over a four-year follow-up period. No prognostic benefit of MRA use was observed in patients with HFpEF.
New atypical advanced interatrial block with triphasic morphology
Mediastinitis in pediatric cardiac surgery: an unusual complication. A single-center experience
Objectives. Mediastinitis is an unusual postoperative complication in pediatric cardiovascular surgery, associated with high morbidity and mortality. Case reports are limited, especially in Latin America, where cardiac surgery has advanced significantly. Materials and methods. Retrospective study of mediastinitis post-cardiac surgery cases at a high-complexity center in Colombia, between January 2015 and June 2023. A detailed description of the clinical characteristics and therapeutic approaches was conducted. Results. A population of 16 children with mediastinitis was characterized, predominantly male (68.7%); 62.5% were aged of 1–3 months. The most common defects were transposition of the great arteries and univentricular heart. Gram-negative bacteria (37.5%) were the most common isolates, followed by gram-positive bacteria (25%). Vacuum-assisted closure (VAC) was required in 43.7% of cases. Conclusion. Advances in congenital heart disease management have led to complications such mediastinitis, prompting the development of therapeutic strategies that would benefit from better characterization in high-complexity centers to improve outcomes.
Performance of scoring systems for predicting mortality after cardiacsurgery in the elderly
Objective. To evaluate the predictive ability of traditional risk scores and frailty assessment for 30-day mortality in elderly patients undergoing cardiac surgery. Materials and Methods. A single-center retrospective cohort study was conducted, including elderly patients (≥75 years old) who underwent cardiac surgery between January 2005 and December 2015. EuroSCORE II, STS (Society of Thoracic Surgeons) score, Charlson Comorbidity Index, and Electronic Frailty Index scores were calculated to assess their predictive ability for 30-day mortality using receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC). Results. A total of 203 patients were included during the study period, of whom 33% underwent isolated coronary bypass surgery. The overall 30- day mortality rate was 17.6%. Patients who died within the first 30 days exhibited higher scores on EuroSCORE II, STS, and the Electronic Frailty Index. The areas under the ROC curves were: EuroSCORE II, 0.74 (95% CI: 0.66-0.81); STS, 0.66 (95% CI: 0.57-0.77); Charlson Comorbidity Index, 0.60 (95% CI: 0.49-0.70); and Electronic Frailty Index, 0.63 (95% CI: 0.52-0.73). Conclusions. In this cohort of elderly patients undergoing cardiac surgery, EuroSCORE II demonstrated the best performance in predicting 30-day mortality.
Right ventricular uncoupling in acute heart failure with preserved or mildly reduced ejection fraction: a simple parameter to predict long-term mortality
Introduction. Risk prediction in acute heart failure (AHF) has led to the development of multiple prognostic models. Emerging data highlight the prognostic significance of right ventricular (RV) to pulmonary artery (PA) uncoupling, which has been linked to adverse outcomes. Among patients with heart failure with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF), a highly heterogeneous group, the prognostic relevance of RV-PA uncoupling in forecasting longterm mortality is still not well defined. This study aimed to evaluate the association between RV-PA uncoupling and long-term mortality in a cohort of hospitalized HFpEF and HFmrEF patients. Materials and Methods. We performed a retrospective analysis based on a prospective registry of adult patients admitted with a primary diagnosis of AHF between 2015 and 2020. Eligible patients had a left ventricular ejection fraction (LVEF) > 40%. The main outcome was all-cause mortality over long-term follow-up. RV-PA coupling was quantified using the ratio between tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP). Results. Out of 465 patients, simultaneous estimation of TAPSE and sPAP was feasible in 361 cases (77%). During a median follow-up of 20.9 months, 100 patients (27.7%) died. A TAPSE/sPAP ratio of 0.38 was identified as the optimal cut-off for risk discrimination. Notably, 41.8% of patients had values below this threshold. Multivariable analysis confirmed that RV-PA uncoupling (TAPSE/sPAP < 0.38) was independently associated with increased long-term mortality (HR: 2.21; 95% CI 1.26–3.81; P = 0.005). Conclusion. In patients hospitalized for AHF with preserved and mildly reduced ejection fraction, RV-PA uncoupling, as determined by the TAPSE/sPAP ratio, was independently associated with long-term all-cause mortality. This echocardiographic parameter may help identify a subgroup of patients at higher risk during follow-up.
Percutaneous aortopulmonary window closure using muscular ventricular septal defect occluder. Instituto Nacional de Salud del Niño San Borja Lima- Perú. Case Report
The aortopulmonary window is a rare congenital heart defect, and the aortopulmonary window without other associated defects represents up to 25% of these defects. Surgical closure has been and is the gold standard in many cardiovascular centers. However, percutaneous closure is being performed with different types of occluders, considering the type of defect, size, and edges in order to avoid complications such as valvular or coronary ostial involvement. We present the case of an infant with an aortopulmonary window who underwent percutaneous closure with a muscular ventricular septal defect occluder device without complications and was discharged 48 hours after the procedure.
Comparison of the epidemiological, clinical and diagnostic characteristics of infective endocarditis of native and prosthetic valves in a Peruvian reference center
Objective. To compare the epidemiological, clinical and diagnostic characteristics of patients with native valve infective endocarditis (NVIE) and prosthetic valve infective endocarditis (PVIE) treated in a Peruvian reference center. Materials and methods. A retrospective, descriptive study was conducted on patients diagnosed with NVIE and PVIE at the Instituto Nacional Cardiovascular (INCOR), EsSalud, between 2017 and 2023. Results. A total of 65 NVIE and 55 PVIE cases were identified, with community-acquired infections predominating (92.3% in NVIE, 83.6% in PVIE). PVIE patients were older (mean age: 63.7 vs. 46.1 years, p<0.001) and had more comorbidities. The key predisposing factor in PVIE was prior endocarditis (20.0%) and valve repair (14.5%), while congenital heart disease (41.5%) and valvular disease (21.5%) predominated in NVIE. Fever and dyspnea were the most common symptoms in both groups. The aortic valve was the most frequently affected (78.5% in NVIE, 87.3% in PVIE). NVIE was associated with vegetation (92.3%) and leaflet perforations (41.5%), while PVIE showed more abscesses (34.5%) and pseudoaneurysms (36.4%). Cardiac computed tomography identified vegetations and pseudoaneurysms in both groups. Blood cultures were positive in 49.2% of NVIE and 65.5% of PVIE, with Streptococcus species predominant in NVIE and Staphylococcus species in PVIE. Surgical treatment was performed in 96.7% of NVIE and 82.6% of PVIE cases. Conclusions. NVIE predominantly affected younger patients with congenital heart disease, while PVIE was more common in older patients with comorbidities. Transesophageal echocardiography and microbiological findings were essential for diagnosis.
Irreversible cardiotoxicity induced by trastuzumab: a systematic review based on a pharmacovigilance case report
Irreversible cardiotoxicity (IC) induced by trastuzumab (TZB) is a rare but serious adverse event. As a result, its characteristics and the specific factors related to exposure remain poorly understood. This study aims to synthesize and evaluate the existing evidence on IC. We presented a pharmacovigilance case of longterm IC and conducted a systematic review (SR) of the clinical manifestations of cases reported worldwide. We reported the case using the CARE guidelines checklist and assessed the causality using the modified Algorithm of Karch and Lasagna. Following PRISMA guidelines, we conducted the SR using defined terms in PubMed, Embase, Scopus, and Web of Science from inception until June 2023. This SR included five case reports, including the pharmacovigilance case reported by us. While patients exhibited different severe clinical characteristics, receiving TZB at a 6 mg/kg dose was consistent. Despite varying treatment durations, the median time of IC diagnosis was 10 months, and the average difference between the basal and the final left ventricular ejection fraction was roughly 30%. According to the modified Karch and Lasagna algorithm, all cases were ranged from possible to probable. While TZB is generally considered a reversible cardiotoxic antineoplastic, clinicians and regulators must be aware of the potential IC risk with long-term manifestations. Vigilant cardiac monitoring and further research are crucial to better understanding and managing this serious adverse event.
Anatomical variant and venous access: the challenge of persistent left vena cava in neonates