Background: Matrix metalloproteinases (MMPs) constitute a family of zinc-dependent proteases (endopeptidases) whose catalytic action is the degradation of the extracellular matrix components. In addition, they play the major role in the degradation of collagen and in the process of tissue remodeling. The present clinical study investigated blood serum levels of metalloproteinases-1, -2, -3 and -9 in patients with acute and chronic aortic dissection, thoracic aortic aneurysm and acute myocardial ischemia compared to healthy individuals.

This report shows that serum CRP, IL-6 levels and the ratio CRP/IL-6 are associated with descending aortic aneurysmal dimensions. Also values of the ratio CRP/IL-6 above 0.8 are associated with aneurysmal dimensions for both ascending and descending aortic aneurysms. It is still early to establish the clinical significance of those findings, and further studies with larger groups of patients with longer follow-up are required in order to truly assess the usefulness of the serum CRP and IL-6 as markers in relation to the progression of the disease.

Synchronous cholecystectomy and open heart surgery can be performed safely in selected patients.

Percutaneous placement of an Amplatzer occluder was safe and effective with use of local anesthesia and fluoroscopy alone. There were no recurrent strokes over >4 years. Migraine relief was reported by >80% of patients.

Background: Atypical cardiac myxomas are a rare occurrence and may present with a variety of clinical manifestations depending on the morphology and location.

Presenting in AdulthoodCongenital heart diseases that cause obstruction of the right ventricular outflow tract are often difficult to diagnose. We report the case of a 49-year-old Congenital heart diseases that cause obstruction of the right ventricular outf low tract (RVOT) are diff icult to diagnose precisely, especially in older patients.1 Obstruction of the RVOT can be the result of abnormalities at the mid-right ventricle (RV), the infundibulum, the pulmonary valve, the supravalvular region, or at the branch or peripheral pulmonary arteries. These lesions are usually congenital, but can be iatrogenic as a result of previous cardiac surgery. 1,2 Right-sided aortic arch is a congenital anomaly that affects approximately 0.1% of the general population.3 Right-sided aortic arch results from involution of part of the left dorsal aorta and persistence of the right dorsal aorta. In situs solitus, right-sided aortic arch is typically associated with cardiac malformations in the outflow tract, as found in cases of tetralogy of Fallot (TOF), pulmonary atresia, or common arterial trunk. 3 We report a case of a middle-aged man with isolated RVOT obstruction caused by double-chambered right ventricle. Case ReportIn August 2012, a 49-year-old man presented at the Evangelismos General Hospital with long-standing shortness of breath on exertion (New York Heart Association functional class II). His medical history included hypertension and dyslipidemia, both controlled with medication. Three years previously, he had undergone endovascular stent-grafting of the lower descending thoracic aorta for type B aortic dissection. At that time, he was also found to have a right-sided aortic arch with an aberrant left subclavian artery. His childhood records were said to have reported a supracristal ventricular septal defect (VSD), but this had not been confirmed. The patient had a 20-pack-year history of smoking but had stopped smoking 3 years before. He had a family history of coronary artery disease.On admission, the patient was in sinus rhythm with a blood pressure of 120/75 mmHg. His electrocardiogram displayed negative T-wave deflection in leads II, III, and aVF, and in precordial leads V 1 through V 5 , together with signs of RV overload. Chest radiographs revealed the endovascular stent-graft in the descending aorta, but no signs of pulmonary dilation.Both transthoracic (TTE) and transesophageal (TEE) echocardiography revealed diffuse RV hypertrophy and severe obstruction at the RV infundibulum (Fig. 1); however, there were no signs of right-sided heart failure. The left ventricle was

We describe a case of severe acute aortic regurgitation in a 60-year-old woman due to spontaneous avulsion of an aortic valve commissure. She presented with spontaneous bleeding and a platelet count of 4 000/microl caused by idiopathic thrombocytopenic purpura and developed acute heart failure and respiratory insufficiency. Preoperative transesophageal echocardiography was not diagnostic for the exact mechanism of aortic regurgitation. She received a 2-day course of intravenous immunoglobulin (0.5 mg/kg/d) to increase platelet count. At operation detachment (avulsion) of the commissure between the left and the right coronary cusp was evident. Aortic valve repair was performed with resuspension of the commissure. The postoperative course was uneventful. During a 24-month follow-up period, the patient has remained in NYHA class I.

Prosthetic valve thrombosis (PVT) represents a serious and potentially lethal complication. It can be attributed more frequently to inadequate anticoagulant therapy. We present a case of acute aortic mechanical valve thrombosis six months after implantation. The patient discontinued oral anticoagulation after being discharged following the primary operation. Two days after reinitiating warfarin as an outpatient, he developed acute valve thrombosis presenting with symptoms and signs of cardiac failure. He was managed with intravenous thrombolysis with a recombinant plasminogen activator which resulted in immediate resolution of thrombus and clinical improvement. A paradox procoagulant effect of warfarin is evident on the first one or two days after initiation of therapy. A 'bridging' protocol with unfractionated or low molecular weight heparin (LMWH) should be considered, according to recently published guidelines, until warfarin reaches therapeutic levels and exerts an antithrombotic effect.