Papers by Gustavo Avegliano
Cardiovascular diagnosis and therapy, 2014
Motor vehicle accident (MVA) account for most cases of traumatic rupture of the tricuspid valve. ... more Motor vehicle accident (MVA) account for most cases of traumatic rupture of the tricuspid valve. Valve rupture during an MVA is generated by an abrupt deceleration coupled with an increase in right-side cardiac pressures (Valsalva maneuver and thorax compression). A 39-year-old asymptomatic man was referred for an echocardiogram due to the presence of a systolic murmur. He had no prior significant medical history, except for a remote MVA 3 years ago. Real-time 3D echocardiography (RT3DE) showed a tear in the body of the anterior leaflet and not at the cord, as was suggested by two-dimensional transthoracic echocardiography (2D-TTE). Based on these findings, the mechanism was considered anterior leaflet rupture of the tricuspid valve, secondary to chest blunt trauma. The anterior leaflet was repaired using two polytetrafluoroethylene sutures, and tricuspid annuloplasty with an Edwards ring was performed. Multimodality imaging helps to determine timing of surgery in asymptomatic traum...
Revista española de cardiología, 2007
The American journal of cardiology, Jan 15, 2002
Although many cardiovascular conditions result in low cardiac output, PLE is infrequently seen. T... more Although many cardiovascular conditions result in low cardiac output, PLE is infrequently seen. This may be due to the unique physiology after the Fontan operation, an unnatural state in which derangement of both the arterial and venous systems is present. Hsia et al 17 recently demonstrated unique patterns of subdiaphragmatic venous flow after the Fontan operation, suggesting altered impedance to emptying of the portal venous system. Abnormalities of intestinal venous drainage may impact on intestinal perfusion pressure and contribute to elevation in MVR, compounding the degree of mesenteric hypoperfusion seen. 18
Introduccio´n y objetivos: El foramen oval permeable (FOP) es la causa má s frecuente de ictus cr... more Introduccio´n y objetivos: El foramen oval permeable (FOP) es la causa má s frecuente de ictus criptogé nico en menores de 55 añ os. La ecocardiografía transesofá gica (ETE) ha sido aceptada como la té cnica diagnó stica de referencia. El propó sito del estudio es comparar la exactitud de la ecocardiografía transtorá cica (ETT), la ETE y el Doppler transcraneal (DTC) en el diagnó stico y la cuantificació n del FOP. Me´todos: Se estudió de forma prospectiva a 134 pacientes. Se practicaron simultá neamente DTC y ETT, y DTC y ETE con moderada sedació n, utilizando la inyecció n de suero salino agitado para detectar cortocircuito derecha-izquierda. Resultados: Se diagnosticó FOP a 93 pacientes. El cortocircuito se visualizó basalmente por DTC en el 69% de los FOP, por ETT en el 74% y por ETE en el 58%. La maniobra de Valsalva aumentó el diagnó stico del cortocircuito de forma similar en las tres té cnicas (26-28%). La ETT y el DTC mostraron mayor sensibilidad (el 100 y el 97%; diferencias no significativas) que la ETE en el diagnó stico de FOP (86%; p < 0,001). El DTC practicado durante la ETE no diagnosticó 12 (13%) cortocircuitos previamente diagnosticados en el estudio durante la ETT. La severidad del cortocircuito tambié n se subestimó mediante la ETE. Conclusiones: La ETT permite un adecuado diagnó stico y cuantificar la severidad del FOP. La ETE tiene menor sensibilidad y tiende a subestimar la severidad del cortocircuito.
Echocardiography (Mount Kisco, N.Y.), 2014
Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial in... more Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial infarction (AMI) less than 1%. After cardiogenic shock, LVWR constitutes the most common cause of in-hospital death in AMI patients. Around 40% of all LVWR occurred during the first 24 hours and 85% within the first week. In the present case, 76 hours following the intervention, LVWR was observed likely due to a small infarction at the lateral left ventricular wall possibly due to the marginal lesion. Our patient refused surgery and was followed clinically. Eighteen months later, real time three-dimensional echocardiography showed a pseudoaneurysm.
International Journal of Mineral Processing, 2011
Introduction and objectivesPatent foramen ovale (PFO) is the most common cause of cryptogenic str... more Introduction and objectivesPatent foramen ovale (PFO) is the most common cause of cryptogenic stroke in patients younger than 55. Transesophageal echocardiography (TEE) has been accepted as the reference diagnostic technique. The purpose of this study was to compare the accuracy of transthoracic echocardiography (TTE), TEE and transcranial Doppler (TCD) in the diagnosis and quantification of patent foramen ovale.
International Journal of Rheumatic Diseases, 2013
Non-valvular cardiac disease in the antiphospholipid syndrome (APS) has been scanty studied. We w... more Non-valvular cardiac disease in the antiphospholipid syndrome (APS) has been scanty studied. We wanted to assess the prevalence and evolution of left myocardial disease, pulmonary hypertension and intracardiac thrombi in a cohort of APS patients. A total of 53 patients with APS, either primary (n = 34, 64%) or associated to lupus (n = 19, 36%) and 20 controls were included. Initial transthoracic echocardiography assessment was performed in patients at diagnosis, with echocardiography controls performed along mean follow-up of 12 years. Prevalence of myocardial disease in APS cohort was assessed taking into account primary risk factors (hemodynamically significant valvular disease, systemic hypertension, diabetes, alcoholism, myocardial infarction or myocarditis), the same as for pulmonary hypertension (severe left ventricular dysfunction or chronic lung disease). Left myocardial disease had a prevalence of 3.8% (2/53 patients), not different from controls (P = 0.12). Both patients had diastolic dysfunction grade I that maintained stability throughout echocardiographic follow-up period. Pulmonary hypertension had a prevalence of 11.3% (6/53 patients), not different from controls (P = 0.12); all cases were related to pulmonary embolism. Patients diagnosed with pulmonary hypertension in baseline maintained stable pressures throughout follow-up in the absence of new thrombosis. Intracardiac thrombi had a prevalence of 1.8% (1/53 patients), not different from controls (P = 0.4), without changes along echocardiographic follow-up. Pulmonary hypertension is the most prevalent non-valvular cardiac manifestation in APS, with an evolution associated with thromboembolic disease, while left myocardial disease and intracardiac thrombi would be rare manifestations in APS.
Revista española de cardiología, 2002
A 40-year-old woman without heart disease suffered two embolic episodes in both legs due to a thr... more A 40-year-old woman without heart disease suffered two embolic episodes in both legs due to a thrombus of the aortic valve. Transesophageal echocardiography performed after the first episode was considered normal, but a second study performed after the second embolism demonstrated a thrombus in the non-coronary leaflet that failed to resolve with the intravenous administration of heparin for two weeks. Surgical excision of the mass revealed a thrombus on an otherwise healthy aortic valve. The case is interesting because it is an exceptional cause of systemic embolism and the patient did not present a prothrombotic status in coagulation studies. The 3 years of follow-up was uneventful.
Journal of Cardiovascular Medicine, 2014
Hypertrophic cardiomyopathy (HCM) is a disease with marked genetic and phenotypic heterogeneity. ... more Hypertrophic cardiomyopathy (HCM) is a disease with marked genetic and phenotypic heterogeneity. It is well known that obstructive septal forms of this disease entail worse clinical outcome compared with nonobstructive septal and apical forms. The objective of this study was to analyze the differences in left ventricular diastolic function in different subgroups of HCMs and to assess the influence of the location of myocardial hypertrophy and the presence of dynamic obstruction on impairment of diastolic function and its correlation with the clinical status. We studied 86 patients with HCM; 27 with the obstructive asymmetric septal type (OAS), 37 with the nonobstructive asymmetric septal type (NOAS) and 22 with apical hypertrophic cardiomyopathy (ApHCM). Patients underwent conventional and tissue Doppler echocardiography and were assessed applying the latest recommendations regarding diastolic dysfunction. Cardiac magnetic resonance was used to study the various morphologic subtypes and quantify left ventricular mass (LVM). The early diastolic annular velocity (e&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;) was significantly lower in OAS with a median of 5 cm/s compared with NOAS with 7 cm/s and ApHCM with 7.5 cm/s (P = 0.0002), and the E/e&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; ratio was 8.5 in ApHCM, 10 in NOAS and 14 in OAS (P = 0.0001); no significant differences were found in LVM or maximal wall thickness. In HCM, the location of left ventricular hypertrophy and the presence of dynamic obstruction affect the degree of diastolic dysfunction; impairment is greater in patients with the OAS type, and markedly less in patients with apical involvement.
Revista Española de Cardiología (English Edition), 2010
The American Journal of Emergency Medicine, 2014
Essential thrombocytosis (ET) falls under the umbrella of myelo-7 proliferative disorders, which ... more Essential thrombocytosis (ET) falls under the umbrella of myelo-7 proliferative disorders, which also includes chronic myelogenous 8 leukemia, polycythemia vera, and myelofibrosis with myeloid 9 metaplasia. Essential thrombocytosis results from a clonal prolifera-10 tion of megakaryocites within the bone marrow, leading to an 11 absolute elevation of platelets that can cause both hemorrhagic and 12 thrombotic complications. 13 This report details an uncommon presentation of ET with coronary 14 embolism and papillary muscle rupture. 15 Essential thrombocytosis (ET) falls under the umbrella of myeloprolif-16 erative disorders, which also includes chronic myelogenous leukemia, 17 polycythemia vera, and myelofibrosis with myeloid metaplasia [1,2]. 18 Essential thrombocytosis results from a clonal proliferation of megakar-19 yocites within the bone marrow, leading to an absolute elevation of platelets 20 that can cause both hemorrhagic and thrombotic complications [3,4]. 21 This report details an uncommon presentation of ET with coronary 22 risk factors for thrombotic complications in a historical cohort of 100 patients with 70 essential thrombocythemia. J Clin Oncol 1990;8(3):556-62. 71 [4] Qanadli SD1, Rangheard AS, Lacombe P. Intraluminal thrombus of the ascending 72 aorta with systemic embolism detected by spiral CT.
Aims Intramural haematoma (IMH) forms part of the acute aortic syndrome presenting physiopatholog... more Aims Intramural haematoma (IMH) forms part of the acute aortic syndrome presenting physiopathologic and evolutive patterns different from those of aortic dissection. The aim of this study was to determine the mortality and predictive factors of IMH in the first 3 months of evolution.
European Heart Journal, 2010
To determine the usefulness of contrast echocardiography in the diagnosis of aortic dissection (A... more To determine the usefulness of contrast echocardiography in the diagnosis of aortic dissection (AD) and in the assessment of findings necessary for adequate patient management.
Circulation, 2003
Background-Aortic intramural hematoma (IMH) evolves very dynamically in the short-term to regress... more Background-Aortic intramural hematoma (IMH) evolves very dynamically in the short-term to regression, dissection, or aortic rupture. The aim of the present study was to assess the long-term clinical and morphological evolution of medically treated IMH. Methods and Results-Fifty of 68 consecutive patients with aortic IMH monitored clinically and by imaging techniques at 3, 6, and 12 months and annually thereafter were prospectively studied. Mean follow-up was 45Ϯ31 months. In the first 6 months, total IMH regression was observed in 14 and progression to aortic dissection in 18 patients; in 14 of these, the dissection was localized, and 12 later developed pseudoaneurysm. At the end of follow-up, the IMH had regressed completely without dilatation in 17 patients (34%), progressed to classical dissection in 6 (12%), evolved to fusiform aneurysm in 11 (22%), evolved to saccular aneurysm in 4 (8%), and evolved to pseudoaneurysm in 12 (24%). Evolution to dissection was related to echolucency (PϽ0.02) and to longitudinal extension of IMH (PϽ0.01). Multivariate analysis showed an independent association between regression and smaller maximum aortic diameter and between aneurysm formation and atherosclerotic ulcerated plaque and absence of echolucent areas in IMH. Conclusions-The most frequent long-term evolution of IMH is to aortic aneurysm or pseudoaneurysm. Complete regression without changes in aorta size is observed in one third of cases, and progression to classical dissection is less common. A normal aortic diameter in the acute phase is the best predictor of IMH regression without complications, and absence of echolucent areas and atherosclerotic ulcerated plaque are associated with evolution to aortic aneurysm. (Circulation. 2003;108:583-589.)
fac.org.ar
... of Acute Aortic Syndrome Arturo Evangelista, MD; Gustavo Avegliano, MD; Cristina Elorz, MD; T... more ... of Acute Aortic Syndrome Arturo Evangelista, MD; Gustavo Avegliano, MD; Cristina Elorz, MD; Teresa González-Alujas, MD; Herminio García del Castillo, MD ... 14. Kronzon I, Demopoulos L, Schrem SS, Pasternack P, McCauley D, Freedberg RS. ...
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Papers by Gustavo Avegliano