Right-sided cervical aortic arch in Loeys–Dietz syndrome

AbstractLoeys–Dietz syndrome is an autosomal dominant connective tissue disorder that is characterized by skeletal abnormalities, craniofacial malformations, and predisposition for aortic aneurysm with tortuosity. We report a case of a right-sided cervical aortic arch associated with the Loeys–Dietz syndrome. To the best of our knowledge, this combination has not been described in the literature.<Learning objective: The Loeys–Dietz syndrome is characterized by vascular findings such as arterial aneurysm or tortuosity with skeletal and craniofacial malformation. We report for the first time a patient with right-sided cervical aortic arch associated with this syndrome. The patient underwent surgical reconstruction.

Dissection of the interventricular septum after compressive blunt chest trauma

We report the case of a 21-year-old woman who was referred after a severe compressive blunt trauma in the context of job injury. Myocardial contusion is a common injury; however, rupture of the ventricular septum after blunt chest trauma is a rare event. Echocardiography revealed a large ventricular septal rupture with two small ventricular septal defects. The patient was a candidate for surgical repair after early conservative management. We discuss about the prevalence and management of this rare traumatic complication

Thrombus-in-Transit Entrapped in a Partially Ligated Left Atrial Appendage

A 54-year-old man referred to our center with Barlow’s disease and severe mitral regurgitation. He had atrial fibrillation (AF) rhythm, with a mildly enlarged left atrium (LA). Transesophageal echocardiography (TEE) showed no clot in the LA and LA appendage; there was only mild spontaneous echo contrast in the LA appendage. The patient underwent mitral valve repair and the Maze operation, during which the LA appendage was ligated with the double suture technique. He was discharged from the hospital in good condition and in sinus rhythm. He was recommended Warfarin and PT control. One month later, he returned with the complaint of vision loss twice in the left eye each time for a few seconds. The AF rhythm had returned.TEE demonstrated a fresh and mobile thrombus entrapped in the LA appendage with a small portion in the LA (Figures 1 and 2). Laboratory tests showed therapeutic international normalized ratio (INR). The patient refused re- operation.  Plavix was added to his medication, and he was discharged

Patent ductus arteriosus associated with congenital anomaly of coronary artery

We reported a case of patent ductus arteriosus (PDA) with congenital anomaly of coronary arteries as abnormal origin of right coronary artery (RCA) and left coronary artery (LCA) from a single ostium of the right coronary sinus. A 21-year-old man referred to our institution for evaluation of cardiac murmur. He has suffered from palpitation and atypical chest pain for three months. On physical examination, a continuous murmur was heard in the second left parasternal space. Transthoracic echocardiography showed normal left and right ventricular size and systolic function (LVEF = 55%). Main pulmonary artery (PA) and left pulmonary artery (LPA) branch were considerably dilated. Considering normal coronary flow, lack of clinical evidence of myocardial ischemia and echocardiography findings, patient underwent surgical closure of PDA via left thoracotomy and after five days discharged uneventfully

Heart and lung metastases from endometrial stromal sarcoma in a forty-two-year-old woman

Introduction: Low-grade endometrial stromal sarcoma (LG-ESS) is a malignant intrauterine tumor that rarely presents with distant metastasis. Simultaneous lung and cardiac metastases from LG-ESS is also an extremely rare event. Case Presentation: A 42-year-old woman presented with dyspnea and exercise intolerance. She had a history of hysterectomy and left salpingoophorectomy. She underwent second laparotomy as well as right oophorectomy after new finding of vaginal mass with histopathologic diagnosis of LG-ESS. Cardiac imaging techniques demonstrated tumoral process in the right atrium and ventricle, coronary sinus, and pulmonary outlet tract as well as multiple metastases in the lung fields. Successful complete surgical resection of the metastatic tumor in the right side of the heart and then radiotherapy were done. After 28 months, follow-up examination revealed no abnormality. Conclusions: We describe the first documented case of isolated intracardiac and lung metastases of a LG-ESS without concurrent abdominal or caval metastasis

Physician-Related Factors Affecting Cardiac Rehabilitation Referral

Background: Despite the positive impact of cardiac rehabilitation (CR) on quality of life and mortality, the majority of people who could benefit from this program fail to participate in it. The lack of referral from the physician is a common reason that patients give for not seeking CR. The objective of this study was to compare factors affecting CR referral by cardiologists. Methods: A cross-sectional survey of 122 cardiologists, including 89 general cardiac specialists and 33 fellows in cardiology from 11 major cardiology training centers in Iran, was done in 2010. They responded to the 14- item investigator-generated survey, examining the physician&amp;rsquo;s attitudinal and knowledge factors affecting CR referral. Results: 47.9% of the subjects reported having available CR centers but only 6.6% reported continuous medical education on the topic. 90.7% of the physicians reported that less than 15% of patients are referred to CR centers. The main factor affecting the low referral rate was limited general knowledge about CR programs (79.5%) such as program attributes and benefits, methods of reimbursement. Lack of insurance coverage, unavailability of CR centers in the community and low physicians&amp;rsquo; fee were other factors reported by the physicians. Conclusion: Cardiologists&amp;rsquo; inadequate general knowledge of and attitude toward CR programs seem to be a potential threat for cardiac prevention and rehabilitation in some societies

Giant left atrial aneurysm

AbstractCongenital aneurysmal dilatation of the left atrium is a rare anomaly that could be associated with supraventricular arrhythmias and life-threatening systemic embolization. We describe a 32-year-old man with a giant left atrial aneurysm diagnosed with new imaging modalities that underwent surgical resection with good results.<Learning objective: Left atrial aneurysms are rare and characterized by their origin from an otherwise normal atrium, a clearly defined communication with the atrial cavity, and their intrapericardial location. Because of associated complications, early diagnosis and surgical excision are mandatory even in asymptomatic, otherwise healthy patients. The evaluations with cardiac imaging techniques should be considered in any patient with an unexplained abnormality on the chest radiograph or initial echocardiography.