Right Ventricular Outflow Tract Obstruction in a Middle Aged Man with Right-Sided Aortic Arch

Congenital diseases causing an obstruction of the right ventricular outflow tract are difficult to precisely diagnose, especially in elderly patients. We report a case of a 49-year-old man who presented to our hospital with longstanding shortness of breath on exertion. He was finally diagnosed as right ventricular outflow tract obstruction and referred for surgical correction. The patient had a history of descending aorta dissection which was treated by thoracic stent grafting. By that time right-sided aortic arch was diagnosed. The coexistence of right ventricular outflow tract obstraction and right sided aortic arch in the same patient is very rare, to the best of our knowledge

Frozen Elephant Trunk: A technique which can be offered in complex pathology to fix the whole aorta in one setting

We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk technique in a patient with chronic type B aortic dissecting aneurysm associated with arch and ascending aorta dilatation, proximal aortic disease and coronary disease. The case was further complicated due to the involvement of the abdominal vessels and preexisting femoral to femoral crossover bypass. In addition the patient had a tracheostomy for laryngeal cancer

The Contribution of Cardiac Magnetic Resonance Imaging to the Diagnosis of Cardiac Diseases

Background: Cardiac magnetic resonance imaging (MRI) has been established in clinical practice as a valid imaging modality for the diagnosis of various cardiovascular disorders. Objectives: To underline the importance of cardiac MRI as an alternative non - invasive imaging method for the diagnosis and follow-up of cardiac patients based on findings from our own recent experience. Patients and Methods: The study included all cardiac patients referred for cardiac MRI over a period of one year. Cardiac MRI studies were performed with the use of a 1.5-Tesla scanner using a body phased-array coil, breath and ECG-triggering. Almost all cardiac sequences were gated to the patient’s cardiac cycle. Cine imaging for the evaluation of cardiac volumes and heart motion was performed using a cine breath-hold true short-axis and true four-chamber sequence with whole left ventricular coverage. Black blood imaging for the assessment of morphology was acquired on a true short-axis and true four-chamber view. Depending on the pathology under investigation, special sequences were added to the imaging protocol, such as late-enhancement imaging after gadolinium administration. Results: The study cohort comprised 114 patients who were referred for cardiac MRI with the following indications and clinical diagnoses: myocarditis (n=29), arrhythmogenic right ventricular cardiomyopathy (ARVC; n=27), valvular heart disease (n=23), history of myocardial infarction (n=13; seeking myocardial viability), hypertrophic (n=12), or dilated (n=2), or tako-tsubo (n=1), or non-compaction (n=2) cardiomyopathy, pericardial effusion (n=2) and various intracardiac masses (n=3). Cardiac MRI confirmed the clinical diagnosis and gave further specific information in 52% of myocarditis cases, in 37% of suspected ARVC cases, in 38% of coronary artery disease patients regarding myocardial viability, while it confirmed all other clinical diagnoses (100% match). Conclusions: Cardiac MRI represents a clinically useful imaging method for the diagnosis of various cardiac disorders since it has the capability of providing highly accurate and reproducible measurements of cardiac hemodynamics in addition to the detailed demonstration of cardiac anatomical structures

Cor triatriatum presenting as heart failure with reduced ejection fraction: a case report

Cor triatriatum is a rare congenital cardiac malformation and it usually refers to the left atrium. We report an unusual case of cor triatriatum in a 33 - year old woman presented with congestive heart failure caused by left ventricular systolic dysfunction

Αρρυθμιογόνος Δυσπλασία της Δεξιάς Κοιλίας με Κλινική Εικόνα Οξέος Στεφανιαίου Συνδρόμου – Πιθανή Μυοκαρδίτιδα;

Γυναίκα ηλικίας 58 ετών προσήλθε στην Κλινική με συσφιγκτικό οποσθοστερνικό άλγος συνοδευόμενο από αίσθημα παλμών και λιποθυμική τάση από ωρών. Το ΗΚΓ επιφανείας έδειξε ρυθμική ταχυκαρδία με ευρέα QRS συμπλέγματα (διάρκειας 160 ms) με μορφολογία LBBB, αριστερό άξονα και μήκος κύκλου 390 ms (154 bpm) (Εικόνα 1). Η ταχυκαρδία ανατάχθηκε ηλεκτρικά με τη δεύτερη προσπάθεια εξωτερικής συγχρονισμένης απινίδωσης (150 & 200 joules).Το ΗΚΓ μετά την ανάταξη έδειξε φλεβοκομβικό ρυθμό 63 bpm με αριστερό άξονα, αρνητικά κύματα Τ στις απαγωγές D II, D III, aVF, V1-V6 και φυσιολογικά διαστήματα (PR: 160 ms, QRS: 100 ms, QT: 420 ms, QTc: 429 ms) (Εικόνα 2). Κατά τη διάρκεια της νοσηλείας της η ασθενής παρουσίασε θετική ενζυμική κίνηση (μέγιστη τιμή τροπονίνης T 1,62 ng/ml). Το σπινθηρογράφημα μυοκαρδίου με χορήγηση Th201 και διπυριδαμόλης έδειξε μικρής έκτασης ουλή στο κορυφαίο τμήμα της αριστερής κοιλίας, χωρίς αναστρέψιμη ισχαιμία και η στεφανιογραφία δεν ανέδειξε σημαντικές στενώσεις των επικαρδιακών στεφανιαίων αρτηριών. Στο υπερηχογράφημα καρδιάς η αριστερή κοιλία ήταν φυσιολογικών διαστάσεων με καλή συσταλτικότητα χωρίς τμηματικές υποκινησίες και με κλάσμα εξώθησης 65%, ενώ η δεξιά κοιλία παρουσίαζε διάταση του χώρου εξόδου και κρύπτη μικρού μεγέθους στην κορυφή και στη βάση της καθώς και εμφανή moderator band... (excerpt

Lipomatous hypertrophy of the interatrial septum and fibrosing mediastinal lymphadenopathy causing superior vena cava obstruction

Lipomatous hypertrophy of the interatrial septum (LHIS) is an uncommon cause of superior vena cava syndrome (SVCS). Fibrosing mediastinal lymphadenopathy is another cause of SVCS. We present a 65-year-old female patient with a history of tuberculosis (TB) and the coexistence of LHIS and fibrosing mediastinitis due to TB of the lung. Fibrosing or sclerosing mediastinitis is a rare entity with few cases published in the western literature. She presented with mild symptomatology of SVCS and she underwent on transthoracic and transesophageal echocardiography, computed tomography scan, magnetic resonance imaging, and venography. Due to the development of an abundant collateral venous system seen on venography and her negation for any treatment, she did not undergo yet on any intervention. To our knowledge, this is the first case reported in the international bibliography in which LHIS and sclerosing lymphadenopathy are simultaneously diagnosed in the same patient

Iatrogenic dissection of the descending aorta: Conservative or endovascular treatment?

Transcatheter aortic valve implantation (TAVI) is without any doubt a standard technique and the treatment of choice of severe aortic valve stenosis (AVS) in very high-operative risk patients. However, a number of complications may occur and has been described. Improper valve position, valve migration, paravalvular regurgitation, conduction disturbances, stroke and aortic dissection have been succeeded despite the perfection of the technique. For anyone of the complications above described, a solution may be invented. We present an interesting case of an 81-year-old woman with severe AVS treated through TAVI due to very high operative risk. This female, 12 days later presented with thoracic pain and shortness of breath and through the computed tomography of the chest performed was diagnosed a dissection of the descending aorta. She successfully underwent on thoracic endovascular aortic repair. In this report, we refer the bibliographic data and we discuss the treatment options in these cases

Aortic rupture during endovascular repair of a postoperative coarctation pseudoaneurysm in an adult: Emergency lifesaving stent graft implantation

We present a case with aortic rupture during an operation of thoracic endovascular aortic repair of an anastomotic pseudoaneurysm. This happened after the use of a low-pressure remodeling balloon inside the covered part of the deployed endografts. It was successfully treated with a second more centrally in the aortic arch-implanted endograft with full coverage of the left subclavian artery orifice. This patient had a history of surgically operated aortic coarctation

Current issues on simultaneous TAVR (Transcatheter Aortic Valve Replacement) and EVAR (Endovascular Aneurysm Repair)

Abstract Simultaneous EVAR and TAVR is technically feasible and is a reliable option in high‐risk patients