Congenital Antithrombin Deficiency in a Pregnant Woman with Right Atrium Thrombosis

BACKGROUND: One of the rare causes of venous thromboembolism in pregnancy is antithrombin III deficiency. Antithrombin III deficiency is estimated to carry a 30% risk of venous thrombotic  complication during each pregnancy and postpartum.CASE DETAILS: We present thea case of a A 21-year-old pregnant woman (Para 1+) with a history of  large atrial septal defect repair at our hospital (Imam Ali Hospital, 2 May 2014). The patient, with  unknown history of antithrombin III deficiency, was admitted at our emergency center with dyspnea and chest pain for the rule out of tamponade. She presented with a right atrial thrombosis in the second  trimester of pregnancy despite the use of therapeutic doses of heparin and warfarin in the postoperative  period as thromboembolic prophylaxis. The risk of warfarin emberyopaty led to termination of pregnancy, and successful redo-cardiac surgery outcome was achieved with the combined use of therapeutic  anticoagulation and regular plasma-derived antithrombin concentrate infusions to normalize her  antithrombin levels.CONCLUSSION: She recovered from the operation uneventfully, and wad discharged in the 12th postoperative day. In the 6th month of follow-up, antithrombin III increased to 70% in more stable level  and transethoracic echocardiography showed no recurrence of right atrial thrombus formation. This case  leads to further debate regarding whether full anticoagulation should be a worthy preventive measure for  venous thromboembolic prophylaxis after an open heart surgery complicated by pregnancy in a women  with inherited antithrombin III deficiency. This point may become more relevant as further experience is  gained with the use of recombinant human antithrombin in known cases during open cardiac surgery.KEYWORDS: pregnancy, antithrombin ш deficiency, cardiac surger

The Largest Reported Dissecting Aneurysm of Ascending Aorta Following Aortic Valve Replacement Accompanied by Superior Vena Cava Syndrome

BACKGROUND: Ascending aortic dissection (AAD) is a rare and serious complication of aortic valve replacement. Multiple risk factors such as connective tissue disease, aortic wall thinning, aortic diameter, calcification of wall, structural features of aortic wall and associated diseases have been considered as a predisposing factor for the occurrences of AAD. Preoperative recognition of these variables with proper intra intra operative logic judgment may decrease tehe incidence of this complication.CASE DETAILS: We herein present a huge ascending aorta with dissecting aneurysm (AAD) with a largeintra-operative diameter (15cm) that has not been recorded in the medical literature so far. He presented with dyspnea, chest pain and amazing symptom of superior vena cava syndrome. The patient underwent open heart surgery with resection of ascending aorta aneurysm with classic Bentall operation. The post-operative period was associated with uneventful course and the patient was discharged with good condition on 12th post-operative day.CONCLUSION: A six months’ follow-up revealed abolishment of chest pain and superior vena cava (SVC) syndrome and good prosthetic composite graft function with no recurrence of pseudo aneurysm or dissection.KEYWORDS: aneurysm, ascending aorta, superior vena cava syndrom

Echocardiographic evaluation of mitral geometry in functional mitral regurgitation

<p>Abstract</p> <p>Objectives</p> <p>We sought to evaluate the geometric changes of the mitral leaflets, local and global LV remodeling in patients with left ventricular dysfunction and varying degrees of Functional mitral regurgitation (FMR).</p> <p>Background</p> <p>Functional mitral regurgitation (FMR) occurs as a consequence of systolic left ventricular (LV) dysfunction caused by ischemic or nonischemic cardiomyopathy. Mitral valve repair in ischemic MR is one of the most controversial topic in surgery and proper repairing requires an understanding of its mechanisms, as the exact mechanism of FMR are not well defined.</p> <p>Methods</p> <p>136 consecutive patients mean age of 55 with systolic LV dysfunction and FMR underwent complete echocardiography and after assessing MR severity, LV volumes, Ejection Fraction, LV sphericity index, C-Septal distance, Mitral valve annulus, Interpapillary distance, Tenting distance and Tenting area were obtained.</p> <p>Results</p> <p>There was significant association between MR severity and echocardiogarphic indices (all p values < 0.001). Severe MR occurred more frequently in dilated cardiomyopathy (DCM) patients compared to ischemic patients, (p < 0.001). Based on the model, only Mitral valve tenting distance (TnD) (OR = 22.11, CI 95%: 14.18 – 36.86, p < 0.001) and Interpapillary muscle distance (IPMD), (OR = 6.53, CI 95%: 2.10 – 10.23, p = 0.001) had significant associations with MR severity.</p> <p>Mitral annular dimensions and area, C-septal distance and sphericity index, although greater in patients with severe regurgitation, did not significantly contribute to FMR severity.</p> <p>Conclusion</p> <p>Degree of LV enlargement and dysfunction were not primary determinants of FMR severity, therefore local LV remodeling and mitral valve apparatus deformation are the strongest predictors of functional MR severity.</p