Myxom je spojen s nespecifi ckými symptomy podobnými jiným srdečním onemocněním. Pozdní resekce myxomu zhoršuje další vývoj onemocnění, například rozvoj městnavého srdečního selhání, vznik arytmií, srdeční embolie, případně náhlé srdeční smrti. Diagnózu je nutno stanovit a chirurgickou excizi srdečních myxomů, zvláště těch s klky na povrchu, provést co nejdříve. Aby se zabránilo komplikacím, bylo nutno provést další diagnostické vyšetření umožňující defi novat typy myxomů pro časné zahájení léčby. Popisujeme případ síňového myxomu, který byl diagnostikován a odstraněn dříve, než byl medián doby uváděné ve starší studii. Tento článek upozorňuje na význam časného stanovení diagnózy a defi nování typů myxomů.
Purpose: This study aimed to compare postoperative ejection fraction (EF) in response to coronary artery bypass grafting (CABG) among patients with preoperative EF <35% and >35%.
Methods: A retrospective study was conducted in a single institution using clinical data of 660 patients undergoing elective on-pump CABG in 2018-2019. Patients were classified into two groups based on preoperative left ventricle ejection fraction (<35% and >35%). The primary endpoint was the change of postoperative ejection fraction.
Results: In this study, 72 patients had preoperative left ventricle ejection fraction <35% (group A) while the other 588 patients had ejection fraction >35% (group B). Among both groups, the duration of cardiopulmonary bypass (CPB) and aortic clamp (AxC) were not significantly different (P > 0.05). The transformation of pre- and postoperative EF in groups A and B was significantly different (2.91+10.31 vs. -0.14+4.57, P < 0.001). There was a significant difference in the duration of ICU stay (73.42+112.55 vs. 34.43+64.99, P < 0.001) and postoperative ventilatory support (25.54+43.92 vs. 16.42+45.87, P < 0.008) between group A and B.
Conclusion: Low preoperative EF showed better improvement in cardiac function after surgery. We concluded that the result could be affected by revascularization of hibernating myocardium.
Lutembatcher syndrome is a rare cardiac condition characterized by a combination of the atrial septal defect (ASD; congenital or iatrogenic) and mitral stenosis (MS; congenital or acquired). Patients with Lutembatcher syndrome and adults with congenital heart disease (ACHD) in general may be at high risk when accompanied by coronavirus disease 2019 (COVID-19). Since there is no published study on the impact of COVID-19 on ACHD, little is known about management strategies in this subset of patients. Herein, we report a young adult female presented with abdominal discomfort, swollen legs, fever, cough, and dyspnea. The patient had developed palpitation and exercise intolerance five years ago but paid it no attention. Echocardiography revealed large secundum type ASD with severe MS (Wilkins score of eight) and a nasopharyngeal swab confirmed SARS-COV-2 infection. The patient was diagnosed with Lutembacher syndrome and COVID-19. Intensive treatment was given to relieve symptoms due to heart failure and to treat COVID-19 pneumonia. Patients with Lutembatcher syndrome are at a higher risk of being infected with COVID-19 and manifest into severe infections. Therefore, determining the risk of infection and the severity of COVID-19 in ACHD patients are required during the pandemic.
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