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BackgroundThe reoperation for isolated tricuspid regurgitation in rheumatic population is rare and still unclear and controversial because of the rarity of publications. The aim of this study was to analyze short and long-term results and outcome of tricuspid valve surgery after left-sided valve surgery in rheumatic patients.MethodsTwenty six consecutive rheumatic patients who underwent isolated tricuspid valve surgery after left-sided valve surgery between January 2000 and January2017 were retrospectively registered in the study. The mean age was 48.2 ± 8.6 years with 8.3% as sex-ratio (M/F). EuroSCORE was 6.1 ± 5 (range 2.5 to 24.1). The mechanism of tricuspid regurgitation was functional and organic in respectively 14 (53.8%) and 12 cases (46.2%). Ten patients (38.5%) had previous tricuspid valve repair. Surgery consisted of 15 ring annuloplasty and 11 tricuspid valve replacement (5 bioprostheses and 6 mechanical prostheses). Follow-up was 96.1% complete, with a mean follow-up of 55.6 ± 38.8 months (range 1 to 165).ResultsThe operative mortality rate was 15.4% (n = 4) and the cumulative survival at 1, 5 and 10 years was respectively 80% ± 8%, 75.6% ± 8.7% and 67.2% ± 11.1% with no significant difference at 8 years between tricuspid valve replacement (80% ± 12.6%) and repair (57.6% ± 16.1%) (p = 0.5). Multivariable Cox regression analysis revealed that ascites (HR, 5.8; p = 0.01), and right ventricular dysfunction (HR, 0.94; p = 0.001) were predictors of major adverse cardiac events. There were no recurrence of tricuspid regurgitation and no structural or non-structural deterioration of valvular prostheses.ConclusionThe reoperation of rheumatic tricuspid regurgitation should be considered before the installation of complications such as right ventricular dysfunction and major signs of right heart failure. Despite the superiority of repair techniques, tricuspid valve replacement should not be banished.

Giant cell tumors originating from the sternum are rare. We report a case of a giant cell tumor of the sternum with radiological evidence of aggressiveness. A 34 year-old woman noted a mass in the anterior chest wall that had been slowly growing over 1 year. After incision biopsy revealed a diagnosis of a giant cell tumor she was treated by surgical resection (subtotal sternectomy) and reconstruction with methylmethacrylate. The tumor was 14×9×8 cm, and histological study confirmed that it was a giant cell tumor. Although giant cell tumors are benign, they are locally aggressive lesions and must be considered in the differential diagnosis in patients with a sternal mass.

BackgroundThe diagnosis of constrictive pericarditis continues to be a clinical challenge. Magnetic resonance imaging provides excellent visualization of the pericardium. The aim of our study is to clarify the contribution of this non invasive exploration in the diagnosis of constrictive pericarditis in our center.Methodswe conducted a prospective study over a period of two years, since 2008, covering a series of patients (n = 11), mean age 44 ± 15 years, in whom constrictive pericarditis was suspected clinically and on transthoracic echocardiography. We studied its characteristics on magnetic resonance imaging.ResultsMagnetic resonance imaging confirmed the diagnosis showing pericardial thickening in all cases, measuring 8.2 +/- 2.6 mm on average, circumferential in 64%, and localized in 36%. The imaging data, particularly pericardial thickening and its topography, were confirmed by surgical exploration, and results were concordant in all cases.ConclusionMagnetic resonance imaging is a powerful tool to establish constrictive pericarditis diagnosis.

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Congenital left atrial appendage aneurysm is a rare condition caused by dysplasia of the atrial muscles. We report a case of a 14-year-old boy, with a 5-month history of cough and in sinus rhythm. Transthoracic echocardiography and computerized tomographic angiography confirmed the aneurysm of the left atrial appendage which was resected through median sternotomy on cardiopulmonary bypass. This case is presented not only for its rarity but also for its atypical clinical presentation.

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