In this article we present brief overview of the subject of amyloidosis and involvement of the cardiovascular system, the criteria for diagnosis, principles of treatment, and the clinical case of cardiac amyloidosis.
Aim. To perform a comparative analysis of multislice computed tomography (MSCT), echocardiography and single photon emission computed tomography (SPECT) in the evaluation of left ventricular end-diastolic volume (LV EDV) and left ventricular ejection fraction (LVEF). Methods. The study included 44 patients (15 female, 29 male) aged of 21 to 73 years (mean age 55±11 years). LV EDV and LVEF were assessed by noninvasive MSCT coronary angiography. echocardiography and SPECT were also performed. Results. There was a statistically significant difference found between the LV EDV medians for the following pairs: MSCT vs Quantitative Gated SPECT (QGS), MSCT vs SPECT using 4D MSPECT regimen, MSCT vs echocardiography. There was no statistically significant difference determined for the following pairs: echocardiography vs SPECT, QGS SPECT vs 4D MSPECT. Difference between the LV EDV were calculated using the Bland-Altman method as following: MSCT vs echocardiography - 55±33 ml, MSCT vs QGS SPECT - 38±29 ml, MSCT vs 4D MSPECT - 30±33 ml. Differences in the LVEF evaluation methods were: MSCT vs echocardiography - 2,5±7,2%, MSCT vs QGS SPECT - 0,9±8,3%, MSCT vs 4D MSPECT - 1,2±8,1%. The highest LV EDV values were registered by MSCT, the lowest - by echocardiography, with the values registered by SPECT lying in between MSCT and echocardiography volumes. Conclusion. MSCT, echocardiography and SPECT present different left ventricular volume and similar LVEF data.
Introduction Inflammatory myofibroblastic tumor (IMT), also known as plasma granuloma, is a very rare tumor with varying biological behavior, from completely benign to malignant. IMT can occur in virtually every organ, but cardiac origin is extremely rare. IMT occurs mainly in children and young people. The mainstay of treatment is complete surgical resection of the tumor. We present a case of 28 year old white woman with no contributory medical and family history, who was admitted to hospital because of dyspnea and cough. The transthoracic echocardiography (TTE) showed elevated pulmonary artery systolic pressure up to 61 mm Hg and mild dilation of right chambers. Further assessment by computed tomography showed thrombosis of the main pulmonary artery (PA), narrowing its lumen by 90%, with spread to the lobar and segmental arteries of the left lung - signs of massive pulmonary embolism. During thromboendarterectomy revealed a mass, about 4,1 x 3,1 x 1,8 cm in size, with thrombotic overlays, locating at the right ventricular outflow tract (RVOT) and the pulmonary trunk. Histological examination and Immunohistochemistry studies was consistent with IMT with an intermediate potential of malignancy. A year after the operation, the patient became pregnant. Routine TTE showed low density mobile mass narrowing the pulmonary trunk. The transvalvular blood flow velocity was 2.4 m/s. Cardiac magnetic resonance (CMR) was consistent with echo findings. The pregnancy has been preserved, and after 36 weeks it was decided to perform the birth of a girl by means of a Cesarian section. After 2 months, due to an increase in the size of the tumor and the dyspnea, a reoperation was performed to remove the tumor lining the RVOT and intimately connected with the PA valve, excision of the PA valve. A bioprosthesis was installed. The tumor had an identical morphological picture. Conclusion This case report describes a rare recurrent cardiac inflammatory myofibroblastic tumor involving RVOT and PA. The prognosis after surgical treatment of IMT is usually favorable, but it is known that some tumors recur, and rarely they can even metastasize. The long-term outcome is not well established due to the rarity of these tumors. Abstract P1700 Figure.
Aim. To perform a comparative analysis of multispiral computed tomography, echocardiography and myocardial perfusion scintigraphy in the evaluation of left ventricular mass. Methods. The study included 44 patients (15 female, 29 male) aged of 21 to 73 years (mean age was 55±11 years). Left ventricular mass was assessed by noninvasive multispiral computed tomography coronary angiography using the 64-slice «Aquillon 64» (Toshiba, Japan) scanner. Echocardiographic evaluation was performed on the «Vivid-7» (GE, USA) ultrasound system. Scintigraphic analysis of left ventricular mass was performed on the single-detector gamma camera «Millenium-MPR» (GE, USA) using the «4-D MSPECT» (University of Michigan Medical Center) software. Results. A comparative analysis of left ventricular mass showed that the differences in median values were statistically significant between all the methods presented. The differences in left ventricular mass calculated using the Bland-Altman method were as follows: between multispiral computed tomography and echocardiography -32±41 gr, between multispiral computed tomography and myocardial perfusion scintigraphy «4-D MSPECT» 34±48 gr. Conclusion. Multispiral computed tomography, echocardiography, myocardial perfusion scintigraphy assess left ventricular mass differently, with myocardial perfusion scintigraphy giving the lowest and echocardiography giving the highest mass. Results gained at multispiral computed tomography lies in between the myocardial perfusion scintigraphy and echocardiography.
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