Images in Intensive Medicine
Use of echo-contrast in the diagnosis of coronary fistula rupture
Uso de ecocontraste en el diagnóstico de rotura de una fístula coronaria
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Keituqwa Yáñez, S. Nicolás Franco, E. Pinar Bermúdez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Keituqwa Yáñez" "email" => array:1 [ 0 => "ivankeituqwa@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Nicolás Franco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Pinar Bermúdez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos y Electroestimulación Cardiaca, Hospital General Universitario Rafael Méndez, Lorca, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cardiología, Sección de Hemodinámica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de ecocontraste en el diagnóstico de rotura de una fístula coronaria" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1498 "Ancho" => 1667 "Tamanyo" => 137358 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The coronary angiography confirms the presence of pseudoaneurysm (PA) of the coronary fistula.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0055" class="elsevierStylePara elsevierViewall">Seventy-six-year-old male with a prior history of chronic ischemic cardiomyopathy (percutaneous revascularization of left and right anterior descending arteries) and coronary fistula from common trunk to known right atrium who presents to the ER complaining of chest pain and posterior asthenia and progressive dyspnea of one-week duration. During his stay at the ER, the patient develops hypotension and severe desaturation, which is why he is admitted to the ICU where one transthoracic echocardiogram (TTE) procedure is conducted that confirms the presence of massive pericardial effusion of up to 4.3<span class="elsevierStyleHsp" style=""></span>cm (<a class="elsevierStyleCrossRef" href="#sec0010">video 1</a>). A pericardial drainage procedure is conducted and the TTE with systemic injection of 3<span class="elsevierStyleHsp" style=""></span>ml of sulfur hexafluoride (Sonovue<span class="elsevierStyleSup">®</span>) confirms the presence of bubbles from this solution in the pericardium (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> and <a class="elsevierStyleCrossRef" href="#sec0010">video 2</a>). After stabilizing the patient and on suspicion of coronary fistula rupture, one coronary angiography is conducted that confirms the presence of pseudoaneurysm of the fistula (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> and <a class="elsevierStyleCrossRef" href="#sec0010">video 3</a>) as the possible cause for the bleeding that is later sealed. The patient was discharged from the hospital after six (6) days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">This case summarizes the utility of echocardiograms in the ICU setting, as well as that of echo-contrast that is also useful in multiple clinical situations.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Keituqwa Yáñez I, Nicolás Franco S, Pinar Bermúdez E. Uso de ecocontraste en el diagnóstico de rotura de una fístula coronaria. Med Intensiva. 2018;42:e26–e27.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0070" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="ecp0015"></elsevierMultimedia><elsevierMultimedia ident="ecp0020"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1328 "Ancho" => 1667 "Tamanyo" => 160626 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transverse parasternal plane with zoom at posterior wall level.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PE: pericardial effusion; EC: echo-contrast; PW: posterior wall; LV: left ventricle.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1498 "Ancho" => 1667 "Tamanyo" => 137358 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The coronary angiography confirms the presence of pseudoaneurysm (PA) of the coronary fistula.</p>" ] ] 2 => array:7 [ "identificador" => "upi0005" "etiqueta" => "Video 1" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 13055211 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Subcostal plane. Severe pericardial effusion.</p>" ] ] 3 => array:7 [ "identificador" => "ecp0015" "etiqueta" => "Video 2" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 12967080 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Parasternal plane. Transverse with zoom on the posterior wall showing the presence of echo-contrast in pericardial effusion.</p>" ] ] 4 => array:7 [ "identificador" => "ecp0020" "etiqueta" => "Video 3" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc3.mp4" "ficheroTamanyo" => 584883 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc3.flv" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc3.m4v" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Coronary angiography with presence of pseudoaneurysm of coronary fistula.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004200000009/v1_201811250605/S2173572718301711/v1_201811250605/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004200000009/v1_201811250605/S2173572718301711/v1_201811250605/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718301711?idApp=WMIE" ]
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