Unruptured left coronary sinus of Valsalva aneurysm with bicuspid aortic valve stenosis and left ventricular inferior wall ischemia

Left coronary sinus of Valsalva aneurysm is a rare condition, and combination with aortic valve stenosis is veryun common. The diagnosis by transthoracic echocardiography (TTE) could be difficult and can easily be interpreted as aortic root dilatation only. Even the computed tomography of the chest (CTscan) and transesophageal echocardiography (TEE) will not give a definite diagnosis unless we think of this pathology. We report a case of unruptured left coronary sinus of Valsalva aneurysm (ULSVA) in 39-year-old male patient combined with stenosis of bicus pidaortic valve and complete heart block. He has a permanent pacemaker (PPM) implanted and was operated successfully with aortic valve replacement (AVR) and direct closure of the ULSVA

Efficacy and Safety of Tunneled Pleural Catheters in Adults with Malignant Pleural Effusions: A Systematic Review

BackgroundMalignant pleural effusions (MPE) are a frequent cause of dyspnea and discomfort at the end of cancer patients' lives. The tunneled indwelling pleural catheter (TIPC) was approved by the FDA in 1997 and has been investigated as a treatment for MPE.ObjectiveTo systematically review published data on the efficacy and safety of the TIPC for treatment of MPE.DesignWe searched the MEDLINE, EMBASE, and ISI Web of Science databases to identify studies published through October 2009 that reported outcomes in adult patients with MPE treated with a TIPC. Data were aggregated using summary statistics when outcomes were described in the same way among multiple primary studies.Main measuresSymptomatic improvement and complications associated with use of the TIPC.Key resultsNineteen studies with a total of 1,370 patients met criteria for inclusion in the review. Only one randomized study directly compared the TIPC with the current gold standard treatment, pleurodesis. All other studies were case series. Symptomatic improvement was reported in 628/657 patients (95.6%). Quality of life measurements were infrequently reported. Spontaneous pleurodesis occurred in 430/943 patients (45.6%). Serious complications were rare and included empyema in 33/1168 patients (2.8%), pneumothorax requiring a chest tube in 3/51 (5.9%), and unspecified pneumothorax in 17/439 (3.9%). Minor complications included cellulitis in 32/935 (3.4%), obstruction/clogging in 33/895 (3.7%) and unspecified malfunction of the catheter in 11/121 (9.1%). The use of the TIPC was without complication in 517/591 patients (87.5%).ConclusionsBased on low-quality evidence in the form of case series, the TIPC may improve symptoms for patients with MPE and does not appear to be associated with major complications. Prospective randomized studies comparing the TIPC to pleurodesis are needed before the TIPC can be definitively recommended as a first-line treatment of MPE