Late diagnosis of congenital cardiovascular defect

Coarctation of the aorta (CoA) is a common congenital anomaly that is usually treated in infancy or childhood. Adult patients with coarctation have a high incidence of associated cardiac disorders, including valve diseases, atrial fibrillation and ischemic heart disease. Most patients with uncorrected CoA die before reaching the age of 50 from complications such as myocardial infarction, intracranial hemorrhage, congestive heart failure (HF), infective endocarditis or aortic dissection. We report the case of a 65 year-old woman admitted to hospital with symptoms of heart failure NYHA class IV. She had been treated for several years for refractory arterial hypertension and concomitant stenocardia (II CCS). The symptoms of HF had been increasing over several months. Outpatient echocardiography examination revealed significant, increasing mitral and tricuspid valve regurgitation with progressive left ventricular dysfunction. The patient was referred for surgical repair of the mitral and tricuspid valves. In-hospital echocardiography and angiography revealed descending aorta discontinuity at the level of the aortic isthmus. This congenital disease revealed during hospitalization was determined to be the underlying cause of all the symptoms the patient presented. Due to the clinical status of the patient, she was discharged from surgical procedures and put on medication. (Cardiol J 2012; 19, 2: 201–203

Surgical removal of stent from multiply stented vessel: problem with choice of place for anasthomosis — one year follow-up

Since the advent of percutaneous coronary intervention there have been increasing numbers of patients with so-called ‘full metaljacket’ coronary arteries disease. This is creating a challenging problem for the cardiac surgeon. A 73 year-old woman after theimplantation of two metal stents to the left anterior descending artery (LAD) and four to the right coronary artery (RCA), withejection fraction of 28%, significant mitral and tricuspid insufficiency, and high systolic pulmonary pressure, was admitted toour department with unstable angina and with symptoms of pulmonary oedema. Coronary angiogram revealed restenosis in allstents. She agreed to a coronary artery bypass graft (CABG) with mitral and tricuspid valve reconstruction. The RCA was openedjust above the postero-lateral branch. Due to lack of space, the metal stent was removed and saphenous bypass graft performed.Six months later, control angiography showed a properly working LITA–LAD graft; the stents in the RCA had been occluded aboveanasthomosis and the venous graft to RCA had been stenosed. Percutaneous cardiac intervention was performed and the metal stentwas implanted with good early effect. After a further six months, coronarography revealed in stent stenosis in the place of venousanasthomosis. The patient was qualified for conservative treatment. Long term results after such procedures are hard to predict;we believe patients should be qualified earlier for CABG and that doctors should avoid implanting too many stents into one artery

Tętniak prawdziwy po bezobjawowym zawale dolnej ściany lewej komory jako podłoże ciężkiej wtórnej niedomykalności mitralnej

Przedstawiony opis przypadku ukazuje nietypowy, bezobjawowy przebieg choroby wieńcowej z wytworzeniem tętniaka prawdziwego lewej komory, powodującego ciężką, przez długi czas skąpoobjawową, niedomykalność zastawki mitralnej

Complexity of changes in right ventricular morphology and function in patients undergoing cardiac surgery — 3D echocardiographic study

Background: An impairment of standard echocardiographic parameters of right ventricular (RV) function is a known phenomenon in patients undergoing cardiac surgery, but its significance remains unclear.Aims: This study aimed to assess changes in RV function in patients undergoing cardiac surgery using speckle tracking and 3D echocardiography.Methods: The study population comprised 122 patients referred for cardiac surgery. Transthoracic echocardiographic (TTE) examinations were performed: before the surgery (TTE1), 1 week after surgery (TTE2), and 1 year after surgery (TTE 3). Parameters measured during these examinations included both standard and advanced indices of the RV size and function, as well as a new parameter introduced by our team — RV shortening fraction (RV SF).Results: TTE1 was performed on average (standard deviation [SD]) 24 (15) hours before surgery, whereas TTE2 and TTE3 were performed on average 7.2 (3) days and 346 (75) days after the surgery, respectively. A postoperative impairment of parameters of RV longitudinal function was observed (P <0.001). However, neither the RV size assessed by both 2D and 3D techniques changed, nor the global RV function measured with the use of fractional area change and ejection fraction. Additionally, during the postoperative period, an increase in the value of an RV SF by 12.9% was observed. After 12 months we observed an improvement in the parameters of the longitudinal RV function.Conclusions: Uncomplicated cardiac surgery causes transient impairment of the longitudinal systolic RV function, with no influence on the global RV function. The preservation of global function results from increased RV SF. After 12 months, an improvement of the longitudinal function can be observed