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

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

Valvular surgery in donor hearts before orthotopic heart transplantation

Background: Donor heart shortage has extended the waiting time and increased the mortality of patients on the transplant waiting list. Widening old standard donor criteria has successfully increased the number of heart transplantations, but for many years, a valve disease in a donor heart has been considered a primary contraindication for organ donation. Aims: To analyse the results of aortic and mitral valvular surgery in marginal donor hearts with valvulopathy before orthotopic heart transplantation. Methods: Between January 2012 and November 2015, we performed 53 heart transplantations in our department. In four donors, echocardiography performed at the time of organ procurement showed a valvular disease: three had moderate-to-severe mitral regurgitation; and one had moderately severe aortic valve stenosis. Results: The mean bench mitral repair and aortic replacement time, aortic cross-clamp time and total ischaemic time were: 18 (range 7–25) minutes, 78.7 (range 57–98) minutes and 184 (range 89–255) minutes, respectively. Intraoperative transoesophageal echocardiography showed good mitral repair or aortic prosthetic valve function, and good right and left ventricular function. One patient died of infectious pneumonia after 1 month. The mean duration of follow-up for the patients discharged home was 75 ± 13 months, and all have returned to an active unrestricted lifestyle. Conclusions: Our limited series demonstrates that conventional valvular procedures performed on otherwise healthy donor hearts with mitral and aortic valve pathology can efficaciously expand the donor pool for orthotopic cardiac transplantation and decrease the mortality rate on the waiting list