Laparoscopic myotomy with partial fundoplication is a safe operation. The long-term outcome is extremely effective and approximately one-third of patients have no evidence of persistent symptoms at follow-up. Furthermore, those who have persistent symptoms rarely have severe or very frequent complaints. Patients older than age 65 years tend to have a better outcome.
Primary Intracardiac thrombosis in the absence of indwelling catheters or pacemaker etc. is an uncommon complication.Although cases of primary coronary sinus thrombosis are reported, most cases occur due to endothelial damage following invasive cardiac procedures involving the right atrium, such as Central Venous Pressure (CVP) placement, Right Ventricle (RV) pacing, cardiac resynchornising therapy and cardiac transplant.We report the case of a 31 yr -old woman, who was admitted with chest discomfort and exertional dyspnea and was found by investigation to have Systemic Lupus Erythematosus (SLE) with secondary antiPhospholipid antibody syndrome. Subsequent 64 slice spiral computerised tomography showed pulmonary embolism. In addition, Trans-Thoracic Echocardiography (TTE) and Trans-Esophageal Echocardiography (TEE) revealed an hyperechoic signal highly suggestive of tumor/thrombus at an unusual site, namely the coronary sinus. The patient underwent surgery under cardiopulmonary bypass and moderate hypothermia. The organized calcified tumor/thrombus was removed through trans-atrial approach and an 8mm Polytetrafluoroethylene (PTFE) graft was placed at the coronary sinus opening. Histological examination of the specimen obtained from the coronary sinus showed an organised, partiallycalcified thrombus. In our patient, pre-operative investigations could not differentiate a thrombus from a mass and the definitive diagnosis was made post-operatively.Keywords Thrombosis . Cardiac . Cardiopulmonary bypass Case reportIn May 2009, a 31 year-old woman presented at the emergency room of our hospital with sudden-onset chest discomfort and exertional dyspnoea of class III severity (New York Heart Association criteria). The patient was a known hypothyroid for last 2 years, for which she had been on supplementary dose of thyroxine (100 μg/day). She was recently diagnosed to have hypertension and was on medical treatment.At the time of presentation in May 2009, physical examination revealed a blood pressure of 160/100 mm Hg, heart rate of 100/min and respiratory rate of 24/min. The jugular venous pressure was not elevated. First and second heart sounds were regular, but the pulmonic component of 2nd heart sound (P2) was accentuated. The lungs were clear and the abdomen was soft; no peripheral oedema was found. Acanthosis nigricans and livedo reticularis, markers of autoimmunity, were noted. A chest radiograph showed a normal-sized heart with a relative decrease in right-sided bronchovascular markings, a finding suggestive of segmental pulmonary artery occlusion. Electrocardiogram (ECG) showed sinus tachycardia with right-axis deviation (mean frontal plane QRS axis of 105 degrees) and symmetrical 'T' inversion in right sided precordial leads (V1, V2, and V3). Colour Doppler and duplex scan ultrasonogram of the lower limbs excluded deep vein thrombosis.Two dimensional Echocardiography (Philips HD7 ultrasound system, 2-5 MHz transducer) revealed normal left ventricular and left atrial dimensions. Aortic and mitral
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