Revista de Ecocardiografía Práctica y Otras Técnicas de Imagen Cardíaca

Encircled heart. Massive circumferential pericardial effusion associated with juvenile autoinflammatory syndrome. Case report

Daniel Grados Saso — 2026-04-20

Juvenile idiopathic arthritis is a rare systemic inflammatory disease. Serositis is a well-known clinical manifestation but may result in complications such as cardiac tamponade or constrictive pericarditis. We present the case of a patient with acute pericarditis with severe pericardial effusion associated with clinical signs of arthritis and skin rash, with a final diagnosis of juvenile idiopathic arthritis, who was treated with anti-L1 with good evolution.

Dehiscencia completa de tubo valvulado aórtico, evaluación y correlación entre eco doppler color y tomografía multislice cardíaca. Reporte de caso

Bruno Nicolás Strada — 2026-04-20

Aortic dilation is found in approximately 50-83 % of children with Marfan syndrome and progresses over time. Prophylactic aortic root repair has had the greatest impact on the survival of patients with MFS and a dilated aortic root. In its elective form, proximal aortic replacement has 30-day morbidity and mortality of 1.5 %. However, emergency replacement (within 24 h of consultation) is associated with increased 30-day mortality by 11.7 %. This underscores the importance of carefully timing elective surgical intervention to avoid the increased risk with emergency operations.

Obstructive giant hiatal hernia: echocardiographic diagnosis and therapeutic approach in a frail elderly patient. Case report

Mario José Recio Ibarz — 2026-04-20

Large hiatal hernias may rarely cause cardiovascular manifestations. We present the case of an 82-year-old woman with cognitive impairment and a history of postprandial syncope, who presented with haemodynamically poorly tolerated atrial fibrillation after food intake. Transthoracic echocardiography revealed a compressive mass obstructing the left ventricle, corresponding to a large hiatal hernia. The patient responded favourably with conservative medical treatment. This case highlights the importance of considering digestive causes as potential triggers for arrhythmia and the need for a comprehensive diagnostic and therapeutic approach, especially in elderly patients with significant comorbidities.

Vieussens' arterial ring with pulmonary fistula diagnosed by coronary computed tomography angiography (CCTA). Case report.

Pamela Tufiño Sánchez — 2026-04-20

The Vieussens arterial ring (VAR) is a remnant coronary vascular network found in almost half of the population. Its presence in healthy patients is not clinically significant, as it does not carry blood flow; however, in patients with cardiovascular diseases, mainly obstructive types, it provides significant support and a source of collateral irrigation. We present the case of a 53-year-old asymptomatic male patient referred for coronary angiotomography evaluation after a positive exercise test for ischemia associated with episodes of ventricular tachycardia. The study revealed, as an incidental finding, a Vieussens arterial ring with a fistula to the pulmonary artery, allowing precise definition of the vascular pathway and its relationship to adjacent structures. Coronary artery angiotomography has become an important study for its detection and characterization due to its high spatial resolution and great anatomical detail, surpassing coronary angiography in several aspects

Recurrent Ischemic Stroke as the Initial Manifestation of Marantic Endocarditis Diagnosed by Transthoracic and Transesophageal Echocardiography: Case Report

Leire Uriarte Ugarte — 2026-04-20

Marantic endocarditis is a rare and serious condition with significant morbidity and mortality related to the underlying cause. Its diagnosis is based on the exclusion of other aetiologies using imaging techniques, among which transoesophageal echocardiography is particularly important. We present a case of marantic endocarditis that presented as recurrent stroke, which will serve to review the key aspects of the disease: its aetiology, diagnostic methods, and the most appropriate therapeutic approach.

Giant aneurysm involving the left anterior descending coronary artery. Case report

Jonathan Melena Zapata — 2026-04-20

Giant coronary artery aneurysm (GCAA) is defined as a dilation greater than four times its normal diameter, although its low incidence, serious complications can arise from this clinical condition. Its diagnosis is made through multimodal imaging such as coronary angiography and coronary angiotomography for adequate anatomical characterization. Current guidelines do not establish a specific treatment, so management can be clinical, surgical or interventional. We present the case of a 48-year-old female patient who presented with acute coronary syndrome, identifying a giant aneurysm in the anterior descending artery associated with thrombosis. The patient was treated by angioplasty and antithrombotic therapy. Through this case we highlight the need for a multidisciplinary team as well as the individualization
of each patient for making therapeutic decisions.

Multimodality imaging in cardiac arrest secondary to severe pectus excavatum and aortic regurgitation: case report

María Noelia Pizá — 2026-04-20

Pectus excavatum is the most common congenital deformity of the chest cavity. In severe cases, it can compress the heart chambers and cause serious complications. We present the case of a 44-year-old man who was resuscitated from cardiac arrest in which severe pectus excavatum coexisted with severe aortic insufficiency. Imaging studies showed that the heart was markedly displaced to the left hemithorax and that there was a narrowing with kinking of the origin of the right coronary artery. It also allowed to quantify the severity of the aortic insufficiency. In this case, multimodal cardiac imaging was essential for identifying the impact of pectus excavatum and aortic insufficiency on cardiac structure and function, which made it possible to establish the pathophysiological mechanism of cardiac arrest and guide clinical management.

Fungal endocarditis, more than a surgical indication and echocardiographic findings. Case report

Juan Sebastián Cabrera Hernández — 2026-04-20

Fungal infective endocarditis is a rare condition with a high mortality rate, in which cardiac imaging plays a fundamental role in diagnosis, risk stratification, and therapeutic decision-making. We present the case of an 82-yearold female patient with multiple comorbidities and frailty who presented with decompensated heart failure secondary to Candida auris infectious endocarditis involving the mitral valve. Transesophageal echocardiography showed a mixed echogenic cystic mass attached to the posterior mitral annulus, measuring 4.2 × 3.4 cm, with independent movement from the valve plane. In addition, moderate generalized hypokinesis and severe mitral regurgitation (IV/IV) were evident, with a vena contracta of 1.0 cm. Given the high surgical risk, social condition, and frailty, surgical management was ruled out, and antifungal treatment with caspofungin and fluconazole was initiated, continued long-term in palliative care. This case highlighted the importance of a comprehensive assessment of surgical risk and patient frailty in therapeutic decision-making, emphasizing the value of transesophageal echocardiography as a decisive tool for the diagnosis and management of fungal endocarditis, a complex entity that requires an individualized and multidisciplinary approach.

Double surprise evaluated by ultrasound and CT: two independent flows from a single structure. A case report.

Marta Antonio Martín — 2026-04-20

Aneurysm of the sinus of Valsalva (ASV) is a rare anomaly that is usually asymptomatic and may be associated with other structural heart abnormalities, such as bicuspid aortic valve. Its complication due to rupture with fistulisation towards the right heart chambers can lead to haemodynamic instability and high morbidity and mortality. We present the case of a 51-year-old man with heart failure in whom imaging studies led to a diagnosis of bicuspid aortic valve associated with a ruptured non-coronary Valsalva sinus aneurysm fistulising to the right
atrium. This case is an example of how multimodal imaging is necessary for the accurate assessment of complex cardiac lesions.

Apical intramyocardial dissection after myocardial infarction diagnosed by transthoracic echocardiography and cardiac magnetic resonance: case report

Carlos Andrés Castro-Galvis — 2026-04-20

Myocardial dissection represents an unusual and potentially fatal form of mechanical complication after acute myocardial infarction, characterized by the separation of necrotic myocardial layers and the formation of a contained hematic cavity. We present the case of a patient with a history of percutaneous coronary revascularization, who developed a dissection confined to the apex of the left ventricle. Transthoracic echocardiography identified a neocavity delimited by a mobile endomyocardial plane, a finding later confirmed by cardiac magnetic resonance imaging, which ruled out free rupture or intracavitary communication. The patient was managed conservatively, with favorable clinical evolution. This case emphasizes the critical role of multimodal imaging in the detection and structural characterization of this entity, as well as in risk stratification and therapeutic planning. Echocardiography, combined with advanced techniques such as
MRI, is an indispensable tool in the management of this rare postischemic complication.

The Heart-Brain Syndrome in clinical practice: A comprehensive approach from cardiac imaging for differential diagnosis

José Alberto Sánchez-Guerra — 2026-04-20

Introduction: Stroke heart syndrome (SHS) is a frequent and clinically relevant condition characterized by myocardial injury, arrhythmias, or acute ventricular dysfunction secondary to severe neurological damage. Troponin elevation, present in a high percentage of patients, poses the dilemma of distinguishing between neurogenic stress cardiomyopathy and a true acute coronary syndrome (ACS) that may either cause or result from the cerebral event. Objective: To provide clinical cardiologists and cardiac imaging specialists with a practical, evidence based framework in which noninvasive imaging techniques play a central role for the differential diagnosis and management of SHS. Development: An integrative pathophysiological update is presented, ranging from classical neurohumoral mechanisms to recent findings on inflammation and genetic susceptibility. Based on this foundation, the different clinical phenotypes of SHS are delineated and a sequential diagnostic approach is detailed. Bedside-applicable algorithms are provided to guide the selection and interpretation of each imaging modality: transthoracic and transesophageal echocardiography, cardiac magnetic resonance, and computed tomography. Conclusion: The structured application of these algorithms allows optimization of diagnostic accuracy, refinement of risk stratification, and support for personalized therapeutic management in this particularly challenging patient population.

Ultrasound of systemic venous congestion (VExUS) by using transesophageal echocardiography (T-VExUS) in critically ill patients: general aspects and technical description.

Juan Antonio Calderón González — 2026-04-20

Introduction. Systemic venous congestion is a factor of morbidity and mortality in heart failure and other critical conditions. It can be identified through transthoracic and abdominal ultrasonography using the VExUS Score to predict the development of acute kidney injury after cardiac surgery, as well as in other Intensive Care Unit (ICU). There is limited information in the literature regarding this examination via the transesophageal approach (T-VExUS) as a complement to point-of-care ultrasound in critically ill patients. Objective. Synthesize the acutal evidence on the VExUS examination generalities, describe the transesophageal approach technique as well as possible advantages and limitations regarding the abdominal approach. Methods. A narrative review of PubMed and Google Scholar (September 2015 to September 2025), supplemented by past relevant studies. The images were obtained as part of the hemodynamic evaluation using TEE performed in the ICU, utilizing standardized esophageal and transgastric windows with some additional probe manipulations.
Key Content and Findings. T-VExUS can provide decisive data on hemodynamic status within the ICU. It is an effective alternative that resolves the visibility issues of the conventional method in critically ill patients, especially when combined with a TEE. Conclusion. T-VExUS is a fundamental hemodynamic tool that allows the evaluation of venous congestion in critical patients when the physical limitations of the clinical environment make the standard abdominal approach impossible.

Mitral annular disjunction: when a true observation becomes a conceptual error

Beder Gustavo Farez — 2026-04-20