Late complications of coarctation of the aorta

Background: The mechanism of the late complications after coarctation repair remains unclear, and this common congenital heart disease affects patients and perplexes physicians in terms of prevention and treatment. Methods: From 2004 to 2008, 13 patients (1 adolescent and 12 adults) with repaired or unrepaired coarctation of the aorta were operated on in this department due to valve disorder or aortic aneurysm. Results: The late complications were mitral and tricuspid regurgitation with congestive heart failure in 1, aortic valve disorder in 4, ascending aortic aneurysm in 3, saccular arch aneurysm in 1, and pseudoaneurysm in ascending, at isthmus, and descending aorta (Ortner’s syndrome) in 1 patient each, respectively. Recoarctation occurred in 3 (25%) patients, 23, 29, and 36 years after coarctation repair. One patient had persistent hypertension. Conclusions: Patients with repaired coarctation of the aorta may eventually develop late complications including valve disorders, aortic aneurysm or pseudoaneurysm, in adolescence or adulthood, especially in the patient population associated with bicuspid aortic valve or complex congenital heart defects. Patients with unrepaired coarctation of the aorta, who can live to adulthood easily, may have a lack of associated anomalies. A regular follow-up is recommended for the patients with coarctation of the aorta in order to have a full-scope observation and prompt treatment when necessary

Mitral valve thrombus, embolic events, carotid artery stenosis and patent foramen ovale

Patent foramen ovale (PFO) is associated with high prevalence of stroke and systemic embolisation. A 53-year-old man had mitral valve thrombus and PFO diagnosed by echocardiography, in addition to carotid artery stenosis and embolic events including transient ischemia attack, retinal artery occlusion and left kidney infarct. Surgical removal of the mitral valve thrombus and concomitant coronary artery bypass were performed under cardiopulmonary bypass. We believe this is the sole reported case of mitral valve thrombus associated with a PFO. Due to their embolic potential, concomitant PFOs should be closed during heart operations, and independent ones deserve interventional management in high-risk patients

Późne powikłania koarktacji aorty

Wstęp: Mechanizm powstawania późnych powikłań po operacji koarktacji aorty jest nadal niejasny, zapobieganie im oraz ich leczenie nie tylko stanowi problem dla pacjentów, ale także dla lekarzy. Metody: W latach 2004-2008 13 pacjentów (1 nastolatek i 12 dorosłych) zarówno po operacji koarktacji aorty, jak i niepoddanych zabiegowi naprawczemu koarktacji aorty było operowanych w klinice autorów z powodu wady zastawki lub tętniaka aorty. Wyniki: Wśród późnych powikłań wystąpiły: niedomykalność zastawki dwudzielnej i trójdzielnej z zastoinową niewydolnością serca - u 1 pacjenta; wada zastawki aortalnej - u 4; tętniak aorty wstępującej - u 3; tętniak workowaty łuku aorty - u 1; tętniak rzekomy aorty wstępującej - u 1; tętniak rzekomy cieśni aorty - u 1; tętniak rzekomy aorty zstępującej (zespół Ortnera) - u 1 pacjenta. Rekoarktacja wystąpiła u 3 osób (25%), w okresie 23, 29 i 36 lat po operacji koarktacji aorty. U 1 chorego doszło do utrwalonego nadciśnienia tętniczego. Wnioski: Zarówno u nastoletnich, jak i dorosłych pacjentów po operacji koarktacji aorty mogą wystąpić późne powikłania, takie jak wada zastawki, tętniak aorty lub tętniak rzekomy, zwłaszcza wśród chorych z dwupłatkową zastawką aortalną lub z mnogimi wadami wrodzonymi serca. U osób, które nie zostały poddane operacji koarktacji aorty i osiągnęły dorosły wiek bez komplikacji związanych z chorobą podstawową, nie wykazano dodatkowych anomalii. Wskazana jest regularna obserwacja pacjentów z koarktacją aorty, aby w razie potrzeby wdrożyć odpowiednie leczenie

Mitral valve cleft associated with secundum atrial septal defect: case report and review of the literature

Mitral valve cleft associated with secundum atrial septal defect (ASD) is uncommon. We report a 39-year-old male patient manifesting symptoms of congestive heart failure 3 months before admission. Echocardiography showed typical mitral valve prolapse and a large ASD of the secundum type. He was diagnosed as severe mitral regurgitation and ASD. At operation, severe mitral valve prolapse with additional degenerative leaflets and a middle-sized cleft in the anterior leaflet were noted. A large ASD of a mixed central and inferior vena cava type was found. Mitral valve repair was impossible. The mitral valve was replaced with an ATS prosthesis. The ASD was repaired with a pericardial patch. Three slow arrhythmias, including nodal rhythm, sinus bradycardia and atrial fibrillation, complicated his early postoperative course. The literature of this entity was reviewed, and the etiology of the postoperative slow arrhythmias was discussed

Skrzeplina na płatkach zastawki mitralnej, incydenty zatorowe, zwężenie tętnicy szyjnej oraz przetrwały otwór owalny

Obecność przetrwałego otworu owalnego wiąże się z większą częstością występowania mózgowych i systemowych incydentów zatorowych. W niniejszej pracy przedstawiono przypadek 53-letniego pacjenta z potwierdzoną w badaniu echokardiograficznym skrzepliną na płatkach zastawki mitralnej oraz przetrwałym otworem owalnym, a także z rozpoznanym zwężeniem tętnicy szyjnej. U chorego zaobserwowano incydenty zatorowe pod postacią przemijających ataków niedokrwiennych mózgu, zamknięcia tętnicy siatkówki oraz zawału niedokrwiennego lewej nerki. Chirurgiczne usunięcie skrzepliny z zastawki mitralnej połączone z jednoczesnym zabiegiem pomostowania wieńcowego wykonano techniką krążenia pozaustrojowego. Autorzy niniejszego opracowania uważają, że jest to jedyny potwierdzony przypadek kliniczny współistnienia skrzepliny w obrębie aparatu zastawki mitralnej oraz przetrwałego otworu owalnego. W związku ze swoim wysokim potencjałem zatorowym współistniejący przetrwały otwór owalny powinien zostać zamknięty podczas wykonywania zabiegów kardiochirurgicznych z jakiejkolwiek innej przyczyny. Niezależnie od powyższych przypadków sama obecność przetrwałego otworu owalnego u pacjentów wysokiego ryzyka również stanowi wskazanie do postępowania interwencyjnego

Imaging morphology of cardiac tumours

Background: Cardiac tumours are very uncommon and are the topic of little investigation. Imaging features offer reliable diagnostic evidence for cardiac tumours, but diagnostic confusion may arise when tumours with similar features are present. Methods: Between January 2003 and July 2008, 34 patients were operated on for cardiac tumours in this institute. The patients’ ages ranged from 31 to 81 years with an average of 54.8 ± 14.2 years. Thirty (88.2%) tumours were primary [19 (55.9%) myxomas, 8 (23.5%) papillary fibroelastomas, and 1 (2.9%) cavernous hemangioma were benign, 1 (2.9%) recurrent fibrous histiocytoma (undifferentiated sarcoma) and 1 (2.9%) leiomyosarcoma were malignant], and 4 (11.8%) were secondary [1 (2.9%) metastatic cardiac leiomyoma, and 3 (8.8%) were renal cell carcinomas]. Results: Cardiac myxomas represented more than half of the cardiac tumours of this patient series, necessitating surgical resection. More than half of these cardiac myxomas originated from the intraatrial septum with a stalk. Most of them appeared as a round or ovoid soft mass on echo, as a hypoattenuated lesion on computed tomography or magnetic resonance imaging, and with a soft gelatinous appearance on gross appearance. Cardiac papillary fibroelastomas were valvular or subvalvular, mostly pedicled by a short stalk, and all of them were £ 1 cm in size. The cavernous hemangioma was isointense on magnetic resonance imaging and tensile and slithy in gross specimen. Recurrent fibrous histiocytoma, leiomyosarcoma, intravenous leiomyoma and renal cell carcinoma resembled a myxoma on echocardiography due to their soft, friable, and mobile features. There were no misdiagnoses based on preoperative imaging features comparable to surgical and histopathologic findings in this surgical series. Conclusions: Imaging morphology plays a key role in the preoperative differential diagnosis of cardiac tumours. Imaging features could reliably predict primary versus secondary, and benign versus malignant among cardiac tumours. The accurate preoperative imaging assessment of cardiac tumours necessitating surgical resection has become increasingly important in the decision-making of a surgical approach, method, and resection extent

Subclinical postoperative atrial fibrillation: a randomized trial

BackgroundPostoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, requiring interventions and prolonging hospital stay. POAF is associated with increased mortality and a higher rate of systemic thrombo-embolism. The rates of recurrent AF, optimal follow-up and management remain unclear. We aimed to evaluate the incidence of recurrent atrial fibrillation (AF) events, during long term follow-up in patients with POAF following cardiac surgery.MethodsPatients with POAF and a CHA2DS2-VASc score of ≥2 were randomized in a 2:1 ratio to either implantation of a loop recorder (ILR) or ECG monitoring using periodic Holters. Participants were followed prospectively for 2 years. The primary end point was the occurrence of AF longer than 5 min.ResultsThe final cohort comprised of 22 patients, of whom 14 received an ILR. Over a median follow up of 25.7 (IQR of 24.7–44.4) months, 8 patients developed AF, representing a cumulative annualized risk of AF recurrence of 35.7%. There was no difference between ILR (6 participants, 40%) and ECG/Holter (2 participants, 25% p = 0.917). All 8 patients with AF recurrence were treated with oral anticoagulation. There were no cases of mortality, stroke or major bleeding. Two patients underwent ILR explantation due to pain at the implantation site.ConclusionsThe rate of recurrent AF in patients with POAF after cardiac surgery and a CHA2DS2-VASc score of ≥2 is approximately 1 in 3 when followed systematically. Further research is need to assess the role of ILRs in this population

Case reportGastrointestinal haemorrhage after off-pump coronary artery bypass

Gastrointestinal haemorrhage secondary to off-pump coronary artery bypass grafting (OPCABG) surgery is uncommon but lethal. We describe an 83-year-old male patient who developed gastrointestinal haemorrhage after successful off-pump CABG. He received intensive treatment, but further deteriorated following noradrenaline infusion, and subsequently died six days after surgery. Off-pump technique in combination with an extensive calcified arterial system could lead to mesenteric ischaemia accounting for the postoperative gastrointestinal haemorrhage, which might be exacerbated by the use of noradrenaline in this octogenarian patient

Chorzy trudni nietypowiCavernous hemangioma of the right atrium

Cardiac hemangioma is a rare primary benign tumour, localised in the right atrium in 23% of cases. In a 60-year-old patient, who complained of remote chest discomfort and recent exertional palpitation, a right atrial mass was discovered by magnetic resonance imaging and echocardiography. A selective operation was performed and the tumour was resected. Histology revealed it to be a cavernous hemangioma. Due to the potential risks associated with cardiac hemangioma, surgical resection and postoperative follow-up are recommended