Objective: To determine the prevalence of coronary anomalies (CA) in patients evaluated by 64-detector computed tomography (CT) at the Instituto Nacional Cardiovascular in Peru between 2016 and 2020. Materials and methods: Retrospective observational study, coronary artery CT scans of 1486 patients were performed on a 64-detector row CT scanner and reviewed in search for coronary anomalies. Results: The prevalence of CA detected by CT was 4.71% (70 cases) of which 64.3% were male. Abnormalities of origin were the most frequent, of which the origin of a coronary artery from the opposite coronary sinus was the most common (48.6%), with the right coronary being the main anomalous artery (31%), and the main path was interarterial (31%). Anomalous origin of the left main coronary from the pulmonary artery was found in 5 patients. Among the anomalies of the intrinsic coronary arterial anatomy ...

Objetivo: determinar la prevalencia de anomalías coronarias (AC) en pacientes evaluados por tomografía computarizada (TC) de 64 detectores en el Instituto Nacional Cardiovascular en el Perú entre los años 2016 a 2020. Materiales y métodos: estudio observacional retrospectivo, en el cual se revisaron las TC de arterias coronarias de 1486 pacientes, realizadas en un tomógrafo de 64 filas de detectores, en busca de anomalías coronarias. Resultados: la prevalencia de AC detectada por TC fue de 4,71% (70 casos) de ellos 64,3% varones. Las anomalías de origen fueron las más frecuentes, de ellas el nacimiento de una arteria coronaria desde el seno coronariano opuesto fue la más común (48,6%), siendo la coronaria derecha la principal arteria anómala (31%), y el principal trayecto fue el interarterial (31%). El origen anómalo del tronco coronario izquierdo desde la arteria pulmonar s...

Objective: To determine the prevalence of coronary anomalies (CA) in patients evaluated by 64-detector computed tomography (CT) at the Instituto Nacional Cardiovascular in Peru between 2016 and 2020. Materials and methods: Retrospective observational study, coronary artery CT scans of 1486 patients were performed on a 64-detector row CT scanner and reviewed in search for coronary anomalies. Results: The prevalence of CA detected by CT was 4.71% (70 cases) of which 64.3% were male. Abnormalities of origin were the most frequent, of which the origin of a coronary artery from the opposite coronary sinus was the most common (48.6%), with the right coronary being the main anomalous artery (31%), and the main path was interarterial (31%). Anomalous origin of the left main coronary from the pulmonary artery was found in 5 patients. Among the anomalies of the intrinsic coronary arterial anatomy ...

We present the case of a 62-year-old male who presented with oppressive chest pain and was then diagnosed with acute myocardial infarction and received reperfusion treatment with primary angioplasty. In the evolution, he had a new episode of myocardial infarction, so complementary studies were carried out that led to the diagnosis of Takayasu’s arteritis. Unfortunately, he presented a torpid evolution despite the established management. The clinical presentation in patients older than 60 years is uncommon, so it is important to consider it within the differential diagnosis in patients with diffuse coronary disease and recurrent myocardial ischemia, due to the rapid progression and high morbidity and mortality despite successful revascularization strategies.

Se presenta el caso de un paciente varón de 62 años que cursó con dolor torácico opresivo; fue diagnosticado de infarto agudo de miocardio y recibió tratamiento de reperfusión con angioplastia primaria. En la evolución cursó con un nuevo episodio de infarto de miocardio, por lo que se realizaron estudios complementarios que condujeron al diagnóstico de arteritis de Takayasu. Desafortunadamente, presentó una evolución tórpida a pesar del manejo instaurado. Es infrecuente la presentación clínica en pacientes mayores de 60 años, por ello es importante considerarlo dentro del diagnóstico diferencial en pacientes con enfermedad coronaria difusa e isquemia miocárdica recurrente, debido a la rápida progresión y elevada morbimortalidad, incluso a pesar de estrategias de revascularización exitosas.

We present the case of a 62-year-old male who presented with oppressive chest pain and was then diagnosed with acute myocardial infarction and received reperfusion treatment with primary angioplasty. In the evolution, he had a new episode of myocardial infarction, so complementary studies were carried out that led to the diagnosis of Takayasu’s arteritis. Unfortunately, he presented a torpid evolution despite the established management. The clinical presentation in patients older than 60 years is uncommon, so it is important to consider it within the differential diagnosis in patients with diffuse coronary disease and recurrent myocardial ischemia, due to the rapid progression and high morbidity and mortality despite successful revascularization strategies.

Rupture of a Valsalva aneurysm in the adult is extremely rare and is often complicated by acute heart failure. We present the case of a 39-year-old patient with a non-coronary sinus of Valsalva aneurysm complicated by rupture to the right atrium associated with severe aortic regurgitation and moderate tricuspid regurgitation. The treatment was surgical and was based on the repair with a pericardial patch over the aneurysm, aortic valve replacement, and tricuspid plasty. We emphasize the importance of an early diagnosis and timely surgical treatment due to the high associated mortality.

La ruptura de un aneurisma de seno de Valsalva en el adulto es extremadamente infrecuente y suele complicarse con falla cardiaca aguda. Presentamos el caso de un paciente de 39 años con un aneurisma de seno de Valsalva no coronariano, complicado con ruptura hacia aurícula derecha y asociado con insuficiencia aórtica severa y tricuspídea moderada. El tratamiento fue quirúrgico y estuvo basado en la reparación con parche de pericardio sobre el aneurisma, reemplazo valvular aórtico y plastia tricuspídea. Resaltamos la importancia de un diagnóstico precoz y un tratamiento quirúrgico oportuno debido a la elevada mortalidad asociada.

Rupture of a Valsalva aneurysm in the adult is extremely rare and is often complicated by acute heart failure. We present the case of a 39-year-old patient with a non-coronary sinus of Valsalva aneurysm complicated by rupture to the right atrium associated with severe aortic regurgitation and moderate tricuspid regurgitation. The treatment was surgical and was based on the repair with a pericardial patch over the aneurysm, aortic valve replacement, and tricuspid plasty. We emphasize the importance of an early diagnosis and timely surgical treatment due to the high associated mortality.

El hemitruncus arterioso es una cardiopatía congénita rara caracterizada por el origen anómalo de alguna de las ramas de la arteria pulmonar a partir de la aorta ascendente. En la mayoría de los casos su diagnóstico se realiza durante la infancia; además, por su elevada morbimortalidad es extremadamente inusual su evolución asintomática y supervivencia hasta la etapa adulta. Presentamos el caso de un varón de 30 años con antecedente de cierre quirúrgico de persistencia del conducto arterioso en la infancia, que cursó asintomático hasta hace un año, y se le diagnosticó hemitruncus arterioso a partir de episodios recurrentes de hemoptisis.

Las fístulas de arterias coronarias son entidades clínicas infrecuentes y su asociación con aneurismas coronarios gigantes, es aún más inusual. La mayoría de las fístulas son asintomáticas, por otro lado, los aneurismas podrían desarrollar síntomas según su diámetro. Presentamos el caso clínico, de un paciente con dolor torácico y arresto cardíaco, que posteriormente desarrolló taponamiento cardíaco con necesidad de cirugía de emergencia, por ruptura de aneurisma coronario gigante desarrollado a partir de fístulas de arterias coronarias confluentes desde dos arterias coronarias hacia la arteria pulmonar.

Hemitruncus arteriosus is a rare congenital heart disease characterized by the abnormal origin of one of the branches of the pulmonary artery from the ascending aorta. In most cases, its diagnosis is made during childhood; in addition, due to its high morbidity and mortality, its asymptomatic evolution and survival to adulthood is extremely unusual. We present the case of a 30-year-old male patient, with a history of surgical closure of patent ductus arteriosus during childhood, who was asymptomatic until a year ago, in whom hemitruncus arteriosus was diagnosed after recurrent episodes of hemoptysis.

Hemitruncus arteriosus is a rare congenital heart disease characterized by the abnormal origin of one of the branches of the pulmonary artery from the ascending aorta. In most cases, its diagnosis is made during childhood; in addition, due to its high morbidity and mortality, its asymptomatic evolution and survival to adulthood is extremely unusual. We present the case of a 30-year-old male patient, with a history of surgical closure of patent ductus arteriosus during childhood, who was asymptomatic until a year ago, in whom hemitruncus arteriosus was diagnosed after recurrent episodes of hemoptysis.

Objective. To determine the discriminative capacity of myocardial perfusion with single photon emission tomography (SPECT) to predict coronary obstructions by coronary angiography. To determine mortality and major cardiovascular events at follow-up. Materials and methods. Retrospective observational study with clinical follow-up in patients undergoing SPECT and then coronary angiography. We excluded patients with myocardial infarction and percutaneous and/or surgical revascularization in the previous 6 months. Results: 105 cases were included in the study. The most commonly used SPECT protocol was pharmacological (70%). Patients with perfusion defect ≥10% of total ventricular mass (TVM) had significant coronary lesions (SCL) in 88% of cases (sensitivity 87.5% and specificity 83%). On the other hand, having ischemia ≥10% of the TVM was associated with 80% SCL (sensitivity: 72%, specif...

Objetivo. Determinar la capacidad discriminativa de la perfusión miocárdica con tomografía de emisión de fotón único (SPECT) para predecir obstrucciones coronarias por coronariografía. Determinar la mortalidad y eventos cardiovasculares mayores en el seguimiento. Materiales y métodos. Estudio observacional retrospectivo con seguimiento clínico en pacientes sometidos a SPECT y luego coronariografía. Excluimos pacientes con infarto de miocardio y revascularización percutánea y/o quirúrgica en los seis meses previos. Resultados. Se incluyeron 105 casos en el estudio. El protocolo de SPECT más usado fue el farmacológico (70%). Los pacientes que tenían defecto de perfusión mixto (isquemia e infarto) ≥10% de la masa ventricular total (MVT) presentaron en el 88% de los casos lesiones coronarias significativas (LAS) (sensibilidad 87,5% y especificidad 83%). Por otro lado, el t...

Objective. To determine the discriminative capacity of myocardial perfusion with single photon emission tomography (SPECT) to predict coronary obstructions by coronary angiography. To determine mortality and major cardiovascular events at follow-up. Materials and methods. Retrospective observational study with clinical follow-up in patients undergoing SPECT and then coronary angiography. We excluded patients with myocardial infarction and percutaneous and/or surgical revascularization in the previous 6 months. Results: 105 cases were included in the study. The most commonly used SPECT protocol was pharmacological (70%). Patients with perfusion defect ≥10% of total ventricular mass (TVM) had significant coronary lesions (SCL) in 88% of cases (sensitivity 87.5% and specificity 83%). On the other hand, having ischemia ≥10% of the TVM was associated with 80% SCL (sensitivity: 72%, specif...

Coronary artery fistulas are rare clinical entities, and their association with giant coronary aneurysms is even more unusual. Most fistulas are asymptomatic, in the other hand, aneurysms could develop symptoms depending on their diameter. We present the clinical case about a patient with chest pain and cardiac arrest, who later developed cardiac tamponade with the need for emergency surgery, due to rupture of a giant coronary aneurysm developed from confluent coronary artery fistulas from two coronary arteries to pulmonary artery.

Objetivo. Determinar las características epidemiológicas, clínicas, electrocardiográficas, imagenológicas y principales estrategias terapéuticas realizadas en los pacientes con cardiomiopatía arritmogénica tratados en un instituto cardiovascular de referencia nacional. Materiales y métodos. Estudio observacional, descriptivo y retrospectivo que busca identificar las características clínicas, exámenes complementarios y estrategias terapéuticas en pacientes con cardiomiopatía arritmogénica tratados en el Instituto Nacional Cardiovascular – INCOR EsSalud en Lima – Perú. Resultados. Se encontraron trece pacientes con cardiomiopatía arritmogénica. La mediana de edad en la que se realizó el diagnóstico fue 38,2 años y el 69,3% de los afectados era de sexo masculino. Las manifestaciones clínicas más frecuentes fueron las palpitaciones taquicárdicas (92,3%), el presí...

Coronary artery fistulas are rare clinical entities, and their association with giant coronary aneurysms is even more unusual. Most fistulas are asymptomatic, in the other hand, aneurysms could develop symptoms depending on their diameter. We present the clinical case about a patient with chest pain and cardiac arrest, who later developed cardiac tamponade with the need for emergency surgery, due to rupture of a giant coronary aneurysm developed from confluent coronary artery fistulas from two coronary arteries to pulmonary artery.

Objective. To determine the epidemiological, clinical, electrocardiographic, imaging characteristics and main therapeutic strategies performed in patients with arrhythmogenic cardiomyopathy treated in a national reference cardiovascular institute. Materials and methods. Observational, descriptive and retrospective study that attempts to identify the clinical characteristics, complementary tests and therapeutic strategies performed in patients with arrhythmogenic cardiomyopathy treated at the National Cardiovascular Institute - INCOR EsSalud in Lima, Peru. Results. Thirteen patients were found with arrhythmogenic cardiomyopathy. The median age at which the diagnosis was made was 38.2 years and 69.3% of those affected were male. The most frequent clinical manifestations were tachycardic palpitations (92.3%), presyncope (84.6%) and heart failure (69.2%). 23% of the patients suffered a cardi...