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

Postoperative Pain Trajectories in Cardiac Surgery Patients

Poorly controlled postoperative pain is a longstanding and costly problem in medicine. The purposes of this study were to characterize the acute pain trajectories over the first four postoperative days in 83 cardiac surgery patients with a mixed effects model of linear growth to determine whether statistically significant individual differences exist in these pain trajectories, and to compare the quality of measurement by trajectory with conventional pain measurement practices. The data conformed to a linear model that provided slope (rate of change) as a basis for comparing patients. Slopes varied significantly across patients, indicating that the direction and rate of change in pain during the first four days of recovery from surgery differed systematically across individuals. Of the 83 patients, 24 had decreasing pain after surgery, 24 had increasing pain, and the remaining 35 had approximately constant levels of pain over the four postoperative days

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

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

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

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

Case reportsPersistent left and absent right superior vena cava

Przetrwała żyła główna górna lewa (ŻGGL) występuje w 0,3–0,5% populacji ogólnej, ale zwykle współistnieje z żyłą główną prawą, natomiast obecność samej tylko ŻGGL jest anomalią występującą bardzo rzadko. Taką odmianę anatomiczną stwierdzono u 57-letniej chorej, która została przyjęta do szpitala w celu operacyjnego leczenia wady zastawkowej. Przedoperacyjna echokardiografia i tomografia komputerowa pozwoliły na prawidłowe rozpoznanie anomalii i wykonanie skutecznego zabiegu.Persistent left and absent right superior vena cava is a rare congenital anomaly, which is usually asymptomatic and discovered incidentally. A 57-year-old female patient was referred to this hospital for valvular surgery. Preoperative echocardiography and computed tomography revealed the diagnosis of persistent left and absent right superior vena cava. Mitral and aortic valve replacements were successfuly performed using aortic and single inferior vena cava cannulations with antegrade cardioplegic infusion. Cardiovascular surgeons or cardiologists should be aware of its presence in advance of a pertinent manoeuvre

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