Tumours of the heart: Diagnostic dilemma

Introduction Mitral annular calcification is a degenerative process of the fibrosus support structure of the mitral apparatus, usually spreading over the posterior mitral leaflet. Case Outline A 66-year-old woman with shortness of breath and palpitations was referred to our institution. Echocardiography showed a round, echo-dense mass, resembling a tumour, in the posterior mitral annulus, with the third degree mitral regurgitation. Based on the findings, surgical treatment was suggested involving removal of the tumour and correction of mitral valve insufficiency. During surgery the posterior annulus was incised, whitish caseous material was aspirated and the developed cavity was closed. A bioprosthetic valve was placed in the mitral position. The aspirated material was sent to bacteriological and histological analysis. Eight days after surgery control echocardiography and CT scan of the heart showed absence of the mass. Pathohistological finding was nonspecific. Bacteriology showed Staphylococus spp. Thirteen days after surgery the patient was discharged in stabile condition. Conclusion Mitral annular calcification is a common degenerative disorder particularly in elderly persons. As the diagnosis very often remains unrecognised imitating a tumor formation, precise diagnostics is necessary before possible surgery.

Procalcitonin-based therapeutic strategy to reduce antibiotic use in patients after cardiac surgery: A randomized controlled trial

Introduction. Procalcitonin (PCT) is a thyroid gland prohormone, and its serum concentration is elevated in systemic bacterial infections. The diagnostic cut-off value of PCT in patients early after cardiac surgery remains unclear. Objective. We investigated whether procalcitonin-guidance could reduce antibiotic usage safely. Methods. The prospective study included 205 patients who underwent open heart surgery. The patients were randomly assigned for procalcitonin-guided antibiotic treatment (PCT-group; n=102) or standard care (standard group; n=103). On the basis of serum procalcitonin concentrations, usage of antibiotics was encouraged (PCT≥0.5 ng/mL) or discouraged. Results. A relative risk of antibiotic exposure in the standard group compared with the PCT-group was 3.81 (95% CI=2.03-7.17; p<0.0001). The mean cost of antibiotics per patient in procalcitonin group was €193.3±636.6 vs. €372.1±841.1 (p=0.206) in the standard group, while the mean cost per hospital day was €8.0±18.4 vs. €17.8±36.3 (p=0.028). We found that non-infectious complications occurred in 40/102 vs. 41/103 (p=0.592) while infections appeared in 5/102 vs. 22/103 (p=0.001) cases. A statistically significant difference was observed in the treatment of urinary infections between PCT-group and standard group; 1/102 vs. 9/103 (p=0.016). In the PCT-group, the ICU stay was 5.74±11.49 days and in the standard group 6.97±11.61 (p=0.812). The hospital stay was 12.08±11.28 vs. 12.93±10.73 (p>0.05) days, respectively. Mortality rates were equal in both groups of patients (p=0.537). Conclusion. Procalcitonin-guided antibiotic treatment is safe and can significantly reduce the cost of postoperative care. Additionally, the antibiotic use during immediate postoperative course should be timely controlled and limited to documented bacterial infections