Spontaneous mechanical rupture of a papillary muscle effectively resolved by mitral valve repair

We report a case of spontaneous mechanical papillary muscle rupture. In theory, the papillary muscle works as a shock absorber that compensates for geometric changes of left ventricular wall. We believe that the aetiology of papillary muscle rupture, in this case, is linked to the physical and mechanical strains exerted on the papillary. We performed a mitral valve repair with excellent short- and long-term results

Symptomatic compression of the pulmonary artery by a thymic cyst

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Subcutaneous and elephantine sarcoidosis successfully treated with chloroquine

The case of a man, who presented with subcutaneous nodules and plaques as well as marked lymphoedema is reported here. Elephantiasis sarcoidosis is an exceptional clinical presentation. Physical examination and investigations failed to demonstrate any evidence of systemic sarcoidosis elsewhere. Chloroquine led to a dramatic improvement within two months. This case is compared with those recently published and it is concluded that chloroquine should be the therapy of choice for severe cutaneous sarcoidosis

Floating thrombus in the ascending aorta revealed by peripheral arterial embolism

A floating thrombus in the ascending aorta is rarely found in clinical practice and is an uncommon cause of peripheral arterial embolization. When there is minimal atherosclerosis or a normal aorta, the management of such a lesion is poorly defined. Currently, there is no clear consensus concerning optimal treatment. Herein, we report 2 cases of ascending aortic thrombus that are complicated by a peripheral embolic event. Due to the risk of recurrent systemic embolism, particularly with strokes, surgical thrombectomy with ascending aortic wall replacements was performed. We believe that floating ascending aorta thrombus represents a serious source of systemic embolism and stroke. Surgical removal is easy to perform with good clinical outcomes. Conservative treatments such as anticoagulation or thromboaspiration may be considered in high-risk or inoperable patients

Postinflammatory rupture of right coronary artery ostium complicating Behçet disease

Introduction: Behçet disease (BD) is a chronic relapsing inflammatory disease of unknown etiology, characterized by variable clinical manifestations. Methods: A 28-year-old woman with BD Cardiovascular and Bipolar Disorder underwent emergency surgical treatment of ascending aortic pseudoaneurysm for ruptured right coronary ostium.A modified Bentall procedure with tricuspid annuloplasty, surgical thrombectomy, and a single coronary artery bypass using a saphenous vein graft was performed. A biological prosthesis was used initially but subsequently deteriorated. We then successfully performed a valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI). Results: The postoperative recovery was uneventful and at follow-up, two years post valve procedure, the patient was completely symptom-free. She remains under long-term medical surveillance. Conclusion: The management of BD with cardiac involvement must be led by a multidisciplinary team

Is bilateral internal thoracic artery grafting a safe option for chronic dialysis patients?

Background The use of bilateral internal thoracic artery (BITA) grafting has been proposed for dialysis patients with multivessel coronary artery disease, primarily because of hypothetical long-term survival benefits. Aims To investigate the outcome of BITA grafting in dialysis patients. Methods This was a retrospective analysis of the use of BITA grafting in 105 consecutive patients with end-stage renal failure on chronic dialysis in three European centres with extensive experience in BITA. Baseline patient characteristics, operative data, early postoperative complications and late survival were reviewed. Outcomes of patients from one of the three centres who underwent either BITA (n = 40) or single internal thoracic artery (SITA) grafting (n = 19) were also analysed; a one-to-one propensity score (PS)-matched analysis was performed. Results There were 19 (18.1%) hospital deaths. Despite differences in preoperative patient characteristics and surgical features, in each centre, hospital mortality was greater than the 75th percentile of expected operative risk (EuroSCORE II). Diseased ascending aorta and extracardiac arteriopathy were found to be predictors of hospital death (odds ratio 9.7; P = 0.006) and complicated hospital course (odds ratio 2.54; P = 0.035), respectively. The 7-year non-parametric estimates of freedom from all-cause death and cardiac or cerebrovascular death were 59% (95% confidence interval: 52.3–65.7%) and 75.6% (95% confidence interval: 71.2–80%), respectively. There were no significant differences in early and late outcomes between BITA and SITA PS-matched groups. Conclusions BITA grafting remains a risky operation for chronic dialysis patients, even when performed routinely. No long-term survival benefits for the use of BITA versus SITA were proven