Bilateral lung lesions: when the eyes deceive the brain!

We report a clinic case of patient in whom angiosarcoma of the heart presents as bilateral pulmonary nodular infiltrates. The cardiac tumor was clinically silent, the electrocardiogram was normal and the cough was the only symptom. Chest CT scan (Fig. 1) showed bilateral diffuse nodular infiltrates ranging. Clinical clues, the results of laboratory tests and all of the cultures obtained excluded an infectious etiologies; the findings of CT-guided needle biopsy was inconclusive for a definitive diagnosis. Thus, the patient was scheduled for a thoracoscopic biopsy. Surprisingly, the pre-operatory echocardiogram showed a soft tissue mass fixed to the posterior wall of the right atrium. On retrospective reviewing of chest CT scan, a tumor was evident in the right atrium, but it was missed initially. In theory, the lung lesions attract the attention of the observer who had not taken into account anything else as to say: "the brain knows what the eyes want". The diagnosis of pulmonary metastases was obtained by means of pleural biopsy during right thoracoscopy. Immunoistochemical staining revealed a CK(-), CK7(-), EMA(-), ESA(-), CEA(-), TTF1(-), Vimentina(+), CD31(+), CD117(+) lesion. Because at the time of diagnosis our patient already had lung metastases, he underwent chemotherap

Clozapine-related Sudden Pericarditis in a Patient Taking Long Acting Aripiprazole and Valproate: A Case Report

Clozapine may be associated with cardiovascular adverse effects including QTc prolongation and, more rarely, with myocarditis and pericarditis. Although rare, these latter cardiovascular adverse effects may be life-threatening and must be immediately recognized and treated. Several cases of clozapine related-pericarditis have been described and often it has a subtle and insidious onset with symptoms that may be often misdiagnosed with psychiatric manifestations (e.g. anxiety, panic or somatization) leading to a delayed correct diagnosis with potential fatal consequences. In the present report we describe the case of a 27-year-old girl with schizoaffective disorder taking long acting aripiprazole and valproate who developed a sudden onset clozapine-related pericarditis during titration phase that resolved with immediate clozapine discontinuation and indomethacin administration. We underline the importance of an early diagnosis of clozapine-related pericarditis and the need to have monitoring protocols to prevent this potentially fatal adverse effect especially when polypharmacy is administered to patients taking clozapine

Clozapine-related Sudden Pericarditis in a Patient Taking Long Acting Aripiprazole and Valproate: A Case Report

Clozapine may be associated with cardiovascular adverse effects including QTc prolongation and, more rarely, with myocarditis and pericarditis. Although rare, these latter cardiovascular adverse effects may be life-threatening and must be immediately recognized and treated. Several cases of clozapine related-pericarditis have been described and often it has a subtle and insidious onset with symptoms that may be often misdiagnosed with psychiatric manifestations (e.g. anxiety, panic or somatization) leading to a delayed correct diagnosis with potential fatal consequences. In the present report we describe the case of a 27-year-old girl with schizoaffective disorder taking long acting aripiprazole and valproate who developed a sudden onset clozapine-related pericarditis during titration phase that resolved with immediate clozapine discontinuation and indomethacin administration. We underline the importance of an early diagnosis of clozapine- related pericarditis and the need to have monitoring protocols to prevent this potentially fatal adverse effect especially when polypharmacy is administered to patients taking clozapine

Outcome of redo surgical aortic valve replacement in patients 80 years and older: Results from the multicenter RECORD initiative

14noneBackground Octogenarians undergoing surgical aortic valve replacement (AVR) after prior cardiac surgery are expected to be at high risk of adverse events. This finding has recently popularized transcatheter AVR in this cohort. Methods This multicenter study includes 744 patients (99 were 80 years or older) who underwent surgical AVR after prior cardiac surgery. The outcome of octogenarians was compared with younger patients in the entire cohort and in a propensity score-matched population. Results Octogenarians and younger patients had similar immediate outcome (in-hospital mortality, 3.0% versus 5.9%; p = 0.34; stroke, 5.1% versus 6.7%; p = 0.66; dialysis, 9.1% versus 6.5%; p = 0.34), as confirmed also in 84 propensity score-matched pairs. Octogenarians and younger patients had similar late survival (5-year survival, 83.1% versus 78.0%; p = 0.68; propensity score-adjusted relative risk [RR], 0.23; 95% confidence interval [CI], 0.59 to 1.88). Octogenarians and younger patients had similar freedom from heart failure episodes (at 5 years, 84.5% versus 89.2%; p = 0.311; propensity score-adjusted RR, 1.37; 95% CI, 0.62 to 3.04) and from reoperation (at 5 years, 94.9% versus 97.9%; p = 0.51; propensity score-adjusted RR, 1.93; 95% CI, 0.35 to 10.56). However, octogenarians had poorer freedom from late stroke (at 5 years, 89.8% versus 97.5%; p = 0.016; propensity score-adjusted RR, 6.137; 95% CI, 1.776 to 21.208) and peripheral thromboembolism (at 5 years, 90.0% versus 98.2%; p = 0.003; propensity score-adjusted RR, 4.00; 95% CI, 1.07 to 15.00). Conclusions Octogenarians undergoing surgical AVR after prior cardiac surgery have similar immediate postoperative outcome as younger patients, and their 5-year outcome is excellent. These data suggest that indications to undergo transcatheter AVR should not rely only on coexistence of advanced age and history of prior cardiac surgery. © 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc.Onorati, Francesco; Biancari, Fausto; De Feo, Marisa; Mariscalco, Giovanni; Messina, Antonio; Santarpino, Giuseppe; Santini, Francesco; Beghi, Cesare; Nappi, Giannantonio; Troise, Giovanni; Fischlein, Theodor; Passerone, Giancarlo; Heikkinen, Jeuni; Faggian, GiuseppeOnorati, Francesco; Biancari, Fausto; De Feo, Marisa; Mariscalco, Giovanni; Messina, Antonio; Santarpino, Giuseppe; Santini, Francesco; Beghi, Cesare; Nappi, Giannantonio; Troise, Giovanni; Fischlein, Theodor; Passerone, Giancarlo; Heikkinen, Jeuni; Faggian, Giusepp

Surgery for prosthetic valve endocarditis: a retrospective study of a national registry\u2020

We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design

Corrigendum to \u201cA predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE\u201d. [Int. J. Cardiol. 241 (Aug 15 2017) 97\u2013102](S0167527317309877)(10.1016/j.ijcard.2017.03.148)

The authors regret that the first name and last name of the author Sandro Sponga was published incorrectly in the original version and this has now been corrected

A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE

Background The aim of this large retrospective study was to provide a logistic risk model along an additive score to predict early mortality after surgical treatment of patients with heart valve or prosthesis infective endocarditis (IE). Methods From 2000 to 2015, 2715 patients with native valve endocarditis (NVE) or prosthesis valve endocarditis (PVE) were operated on in 26 Italian Cardiac Surgery Centers. The relationship between early mortality and covariates was evaluated with logistic mixed effect models. Fixed effects are parameters associated with the entire population or with certain repeatable levels of experimental factors, while random effects are associated with individual experimental units (centers). Results Early mortality was 11.0% (298/2715); At mixed effect logistic regression the following variables were found associated with early mortality: age class, female gender, LVEF, preoperative shock, COPD, creatinine value above 2\ua0mg/dl, presence of abscess, number of treated valve/prosthesis (with respect to one treated valve/prosthesis) and the isolation of Staphylococcus aureus, Fungus spp., Pseudomonas Aeruginosa and other micro-organisms, while Streptococcus spp., Enterococcus spp. and other Staphylococci did not affect early mortality, as well as no micro-organisms isolation. LVEF was found linearly associated with outcomes while non-linear association between mortality and age was tested and the best model was found with a categorization into four classes (AUC\ua0=\ua00.851). Conclusions The following study provides a logistic risk model to predict early mortality in patients with heart valve or prosthesis infective endocarditis undergoing surgical treatment, called \u201cThe EndoSCORE\u201d