Wegener’s granulomatosis (WG) is a systemic necrotising vasculitis involving the respiratory and renal tracts. Dual valvular involvement in WG is uncommon. We describe a 52-year-old patient with aortic regurgitation and mitral stenosis due to WG requiring replacement of both valves. We also discuss a strategy for follow-up of asymptomatic WG patients with suspected heart valve involvement.
Aortic valve myxoma is an extremely rare cardiac tumour. We describe a 60-year-old woman found to have an aortic valve myxoma and a patent foramen ovale (PFO) presenting as a stroke. In view of the recurrent cerebral ischaemic events, the aortic valve myxoma was surgically removed and the PFO was closed. To the best of our knowledge, this is the first reported case of aortic valve myxoma with a PFO. We also highlight the importance of identifying a possible cardiac source of embolism in a stroke patient and considering this rare tumour as a cause in patients with a cryptogenic stroke.
A 67-year-old man was admitted to the coronary care unit with progressive dyspnoea, pedal oedema and presyncope. Relevant past medical history included a single-lead permanent pacemaker insertion for slow atrial fibrillation, mechanical mitral valve prosthesis and a recent left-sided hemiparesis. On examination, a blood pressure of 90/60 mmHg, pulse of 68 beats per min, peripheral oedema and elevated jugular venous impulse were noted. Precordial auscultation revealed a prosthetic first heart sound and a left parasternal pansystolic murmur.A large globular cardiac silhouette on chest X-ray ( Fig. 1) in the setting of hypotension and distended neck veins prompted an urgent transthoracic echocardiogram to rule out cardiac tamponade. This revealed severe dilatation of all four chambers of the heart (Fig. 2), spontaneous echo contrast in the left ventricle (video 1 in the electronic supplementary material), severe tricuspid regurgitation and a competent mitral prosthesis. The pericardial space was devoid of fluid. Following diuretic therapy and optimisation of anticoagulation to an INR of 3.0-3.5, the patient was transferred to a stroke rehabilitation unit.Pericardial effusions on chest radiographs are typically seen as rounded, enlarged globular cardiac silhouettes without specific chamber enlargement [1]. The cardiac contour is very clearly demarcated, due to the static outer margin of the distended pericardial sac. In our patient, however, the entire cardiac silhouette was comprised of the grossly dilated heart with no trace of pericardial fluid on echocardiography. It is unusual for dilated cardiomyopathy to cause such a spherical cardiac silhouette, which is more typically described in large pericardial effusions. We believe that the severe biatrial enlargement, especially that Fig. 1 Chest radiograph shows gross cardiomegaly with a spherical cardiac silhouette. A small pleural effusion is seen at the left costophrenic angle. A single-lead permanent pacemaker device, sternal wires and a prosthetic heart valve in the mitral position are also noted Electronic supplementary material The online version of this article (
Therefore, in conclusion it is necessary to formalise a pathway for reviewing echos and acting on findings. This should be through formal echo MDT meetings. There should also be a Review of echo protocol to include LV and RV detailed serial measurement.
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