Prosthetic heart valve thrombosis

Prosthetic heart valve thrombosis is one of the most dreaded complications of mechanical heart valves. Suboptimal anticoagulation is the major risk for developing prosthetic heart valve thrombosis. Prosthetic heart valve thrombosis usually presents with dyspnea or embolic events1. We present patient with prosthetic heart valve thrombosis without any symptoms, diagnosed via transthoracic echocardiography twenty days after mitral valve replacement during regular echocardiograph follow-up. In the medical history we obtained the information that the patient didn’t take anticoagulation drugs for five days after hospital discharge. Transthoracic echocardiography control revealed reduced leaflet mobility and high transvalvular gradients: MV maxPG 22mmHg, MV meanPG 12mmHg (Figure 1). Transesophageal echocardiography showed the presence of thrombus on prosthetic valve measuring 11x7 mm. Patient was readmitted to the hospital and treated with thrombolytic drug alteplase. According to the American College of Cardiology/American Heart Association Guidelines fibrinolysis can be considered in a thrombosed left-sided prosthetic heart valve, which is of recent onset (<14 days) with class I-II symptoms and a small thrombus on transesophageal echocardiography. Control echocardiography after treatment (Figure 2) showed MV meanPG 3.9mmHg and normal mobility of mitral valve. Successful thrombolytic therapy was followed by warfarin and intravenous unfractionated heparin until the INR is 3-4. Current American College of Cardiology/American Heart Association Guidelines assign Class I recommendation to transthoracic echocardiography or transesophageal echocardiography imaging in patient with prosthetic valve only in the presence of clinical symptoms or sings of valve dysfunction. Pathological studies and observational registries indicate that the risk of valve thrombosis highest in the first 3 month after surgical implantation of prosthetic valve, suggesting that anticoagulant thromboprophylaxis in this time frame may be beneficial.2 Early follow up after surgical implantation is important because early detection and treatment of thrombus formation may lead to shortterm reduction in the risk of TE events and long-term prevention of prosthetic valve degeneration

Pseudoaneurysm of the ascending aorta and superior vena cava syndrome after aortic valve replacement

Introduction: Ascending aortic pseudoaneurysm is a rare, sometimes fatal complication after aortic surgical procedures. Contrast computed tomographic scan is the investigation of choice. Transesophageal echocardiography is helpful before, during and after treatment of pseudoaneurysm. Surgical treatment of pseudoaneurysm is often considered like treatment of choice but is associated with high morbidity and mortality. Sometimes transcatheter closure may be an effective treatment in selected patients.1,2 We describe the successful management of a pseudoaneurysm of the ascending aorta which was united with fistula between superior vena cava and aortic pseudoaneurysm. Case report: 71-year-old male came to hospital with superior vena cava syndrome which manifested in facial swelling, neck distension, and enlarged veins of the upper chest, which developed two days before admission. One year ago, he had aortic valve replacement with biological valve, mitral valve repair, plastic of tricuspidal valve and implantation of the pacemaker. Chest computed tomography showed pseudoaneurysm dimension 85x57x65 mm on right lateral contour of the ascending aorta. The neck of pseudoaneurysm was 17 mm in diameter. In the area of dorsal contour of pseudoaneurysm sachets was communication with a vena cava superior in the sense of fistula. A transesophageal echocardiography exam shows pulsatile flow between aorta and pseudoaneurysm. After a heart time discussion, the percutaneous approach was undertaken. In the Hybrid operating room under transesophageal echocardiography and fluoroscopic guidance the Amplatzer duct occluder device was placed in the neck of pseudoaneurysm, but day after procedure control transesophageal echocardiography showed flow right next to device between pseudoaneurysm and aorta. The high velocity blood flow move Amplatzer device. Next day patients has open chest surgery with pseudoaneurysmectomy, reconstruction of ascending aorta and reparation defect of the superior vena cava. Several days after surgery the facial and neck swelling was disappeared, and patient felt better

Angina Pectoris and Physiological Coronarographic Findings

Angina pectoris may be associated with normaln coronary arteries. Normal coronary arteries status is defined as absence of visible disease or the irregu-larity of lumen (less than 50%) as assessed visually on the interventional cardiologists. In our retrospective study among 1130 patients we have identified 181 patients with normal angiographic findings with various risk factors, as male sex, body mass index (BMI), lipid disorders, smoking, hypertension, diabetes mellitus type 2. The analysis results suggest that 56.3% patients of 181 verified normal coronary findings involve female patients with high BMI, unregulated hypertension and lipid disorders. In order to find real causes of chest pain, patients with normal coronary status need careful examination and treatment. The reduction of risk factors and adequate medications are important precon-ditions for the good quality of life in these patients

Postoperative Glycaemia in Patients Following the CABG Surgery

In this study we analyzed patients glucose levels taken before and after coronary artery bypass surgery. The data are taken from University of Sarajevo Clinics Centre-medical documentation of Heart Center from January 1st, 2007 to October 31st, 2007. Therefore, the entire study is done retrospectively. The patients considered in this analysis were divided into three groups. The patients in the first group were treated with peroral antidiabetics. The second group included patients treated with insulin while the third group consisted of patients without diabetes and acted as control group. All the patients had increased BMI. In the first two groups glucose levels were elevated before the surgery. Data analysis showed that three patients from the first group changed from peroral antidiabetics to insulin during postoperative period, and they were dismissed from hospital with this therapy. In the control group, peroral antidiabetis were introduced in four patients. The study results show that all the three groups have had high glycaemia on the first postoperative day. This may be caused by a number of reasons: inadequate pre-operative antidiabetic therapy, the impact of stress during surgery, inadequate pre-operative treatment of glycaemia or avoidance of the proscribed therapy by patients themselves. Stress during operation and administration of several medications after operation may also cause increased insulin resistance and distort glycaemia control

Postoperative Glycaemia in Patients Following the CABG Surgery

In this study we analyzed patients glucose levels taken before and after coronary artery bypass surgery. The data are taken from University of Sarajevo Clinics Centre-medical documentation of Heart Center from January 1st, 2007 to October 31st, 2007. Therefore, the entire study is done retrospectively. The patients considered in this analysis were divided into three groups. The patients in the first group were treated with peroral antidiabetics. The second group included patients treated with insulin while the third group consisted of patients without diabetes and acted as control group. All the patients had increased BMI. In the first two groups glucose levels were elevated before the surgery. Data analysis showed that three patients from the first group changed from peroral antidiabetics to insulin during postoperative period, and they were dismissed from hospital with this therapy. In the control group, peroral antidiabetis were introduced in four patients. The study results show that all the three groups have had high glycaemia on the first postoperative day. This may be caused by a number of reasons: inadequate pre-operative antidiabetic therapy, the impact of stress during surgery, inadequate pre-operative treatment of glycaemia or avoidance of the proscribed therapy by patients themselves. Stress during operation and administration of several medications after operation may also cause increased insulin resistance and distort glycaemia control

Angina Pectoris and Physiological Coronarographic Findings

Angina pectoris may be associated with normaln coronary arteries. Normal coronary arteries status is defined as absence of visible disease or the irregu-larity of lumen (less than 50%) as assessed visually on the interventional cardiologists. In our retrospective study among 1130 patients we have identified 181 patients with normal angiographic findings with various risk factors, as male sex, body mass index (BMI), lipid disorders, smoking, hypertension, diabetes mellitus type 2. The analysis results suggest that 56.3% patients of 181 verified normal coronary findings involve female patients with high BMI, unregulated hypertension and lipid disorders. In order to find real causes of chest pain, patients with normal coronary status need careful examination and treatment. The reduction of risk factors and adequate medications are important precon-ditions for the good quality of life in these patients