Although untreated, 2+ TR significantly improved after mitral valve surgery, it then progressed again in the mid- to long term. Therefore, concomitant TVS should be considered in patients with 2+ TR who have dilated tricuspid annulus or atrial fibrillation, if feasible.
Cardiac fibromas are rare benign tumors usually seen in the pediatric population. Generally, long-term survival after surgical resection is favorable, and recurrence of fibroma has been hardly reported. Herein, we report a case of a 34-year-old woman who presented with ventricular tachycardia 21 years after resection of a cardiac fibroma and was found to have a recurrent giant cardiac fibroma. We performed a complete resection of the recurrent fibroma. At the 2-year follow-up, she remains asymptomatic with no evidence of ventricular tachycardia or recurrence of fibroma.
BackgroundSymptomatic anterior mediastinal mass in pregnancy is rare, and cesarean section for such patients poses a risk of cardiopulmonary collapse.Case presentationA 30-year-old woman at 40 weeks’ gestation complained of breathlessness and cough, and she was not able to lie supine because of respiratory distress. Computed tomography scan revealed a large anterior-superior mediastinal mass severely compressing the trachea, bilateral main bronchus, and superior vena cava. Because clinical symptoms and computed tomographic findings suggested imminent respiratory catastrophe, urgent cesarean section was planned. The patient was able to lie in the semi-recumbent position with minimal symptoms; therefore, we considered it safe to perform cesarean section with combined spinal epidural anesthesia. In the event of cardiopulmonary collapse, emergent intubation and extracorporeal membrane oxygenation were also planned. The operation was performed successfully with combined spinal epidural anesthesia. The infant was healthy, and the postoperative hospital course was uneventful.ConclusionsCombined spinal epidural anesthesia is preferable in the anesthetic management of cesarean section with symptomatic anterior mediastinal mass. A well-designed preoperative strategy can lead to favorable outcomes even in this complicated situation.
A 5-year-old girl with right atrial isomerism, complete atrioventricular septal defect, hypoplastic left ventricle, double outlet right ventricle, and mixed-type total anomalous pulmonary venous connection with totally occluded left pulmonary veins presented at our center for fenestrated total cavo-pulmonary connection with an extra cardiac conduit at the age of 3 years. Eleven months after the Fontan completion, she developed protein-losing enteropathy (PLE). Spontaneously closed fenestration was thought to be the cause of the PLE, and she underwent revision of fenestration at the age of 5 years. After the operation, PLE did not improve, and newly developed hypoxemia impaired her systemic ventricular function, leading to the initiation of veno-arterial extracorporeal membrane oxygenation (ECMO) with the Endumo(®) system 18 days after the operation to treat her hemodynamic instability. Although the ECMO circuit was changed three times during the first 8 days, the fourth circuit could be used for 74 days without hemolysis and serum leakage, until the patient unfortunately died 82 days after the operation due to multi-organ failure.
A n 82-year-old woman who had undergone ascending aorta and aortic valve replacement 4 years earlier presented with worsening recurrent episodes of sudden-onset dyspnea, all while in the seated position. In the emergency room, significant hypoxia was confirmed when the patient was seated and lying on her right side. When the patient rolled to her left side, her oxygenation suddenly improved.Initial workup was negative for pulmonary embolism, interstitial lung disease, or pulmonary hypertension. Transesophageal echocardiography was then performed with the patient in multiple positions.As shown in Online Videos 1, 2, and 3, the foramen ovale (A, yellow arrow) was wide open, with a right-to-left shunt across the defect while the patient was sitting and in the right lateral decubitus position (A, B) but improved while in the supine (C) and the left lateral decubitus (D) positions. The partial pressure of oxygen in arterial blood was similarly improved when the patient was moved from the former to the latter position.
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