A 62-year-old woman was admitted to our hospital because of increasing dyspnoea, limited exercise tolerance and a dry hacking cough. She denied upper respiratory tract infection. The patient had been regularly treated for severe hypertension for the previous 20 years. The patient was admitted in an unnstable condition. Her physical examination revealed aortic murmur and tachycardia, and blood pressure was increased. Transthoracic echocardiography revealed communication between ruptured aneurysm of the noncoronary sinus of Valsalva and the right atrium. The diagnosis was confirmed in transoesophageal echocardiography (Fig. 1). The patient was operated upon with cardiopulmonary bypass, hypothermia (30°C) and cardioplegic arrest. Intraoperatively, we found ruptured aneurysm of the noncoronary sinus of Valsalva with fistulous tract between the noncoronary sinus and the right atrium (Fig. 2). Surgical findings also included atrial septal defect type secundum. The fistula was closed with plasty of the sinus of Valsalva (Dacron 3 × 2 cm) and the atrial septal defect was repaired (Fig. 3). The early postoperative period was uneventful. The patient was discharged from the hospital in good condition on the ninth day of treatment. Aneurysm of the sinus of Valsalva is a rare cardiac anomaly. It is usually an asymptomatic disease, but when it ruptures, symptoms appear and the patient's condition deteriorates rapidly. This aneurysm ruptured in the right atrium, causing haemodynamic complications. The diagnosis was obtained by transthoracic and transoesophageal echocardiography. The prognosis of ruptured aneurysm of sinus of Valsalva is always serious and surgery is the treatment of choice. A left-to-right shunt to the right atrium may cause an increase of haemodynamic loading of the heart, and the patient will require urgent surgery. This was indeed the treatment used for our patient.
We present a rare case of a native aortic valve fungal endocarditis in a young obese woman. Our patient had undergone a bariatric surgery followed by numerous local complications associated with further surgical procedures and multiple antibiotic treatment. Six months later, she was admitted to our centre with signs of septicaemia. In echocardiography a massive tumour on the aortic valve was revealed. An urgent cardiosurgery operation was performed -the tumour was resected and an artificial valve was implanted. Microbiological analysis of the tumour and blood samples confirmed fungal infection (Candida albicans). Intensive antifungal therapy was continued for 4 weeks. However, during the hospitalization serious embolic complications were observed. Finally, the patient responded well on implemented treatment and was discharged in a good clinical condition. Our case presents an exceptionally rare form of cardiac infection, unexpected in immunocompetent patients. We associate this condition with an unfavourable course of the previous bariatric therapies. StreszczeniePrzedstawiamy niezwykły przypadek grzybiczego zapalenia wsierdzia na natywnej zastawce aortalnej u młodej otyłej kobiety. Nasza pacjentka przebyła zabieg chirurgii bariatrycznej powikłany serią miejscowych komplikacji, które były przyczyną kolejnych operacji oraz stosowania licznych antybiotyków. Sześć miesięcy później pacjentka została przyjęta do naszego ośrodka z objawami sepsy. W echokardiografii stwierdzono dużą zmianę guzowatą związaną z zastawką aortalną. Wykonano pilny zabieg kardiochirurgiczny -wycięto guza wraz z zastawką i wszczepiono protezę mechaniczną w ujście aortalne. W badaniach mikrobiologicznych guza i posiewów krwi potwierdzono zakażenie grzybicze (Candida albicans). Przez 4 tygodnie kontynuowano intensywne leczenie przeciwgrzybicze. Mimo to w trakcie hospitalizacji wystąpiły powikłania zatorowe w ośrodkowym systemie nerwowym oraz oku. Ostatecznie pacjentka dobrze odpowiedziała na stosowane leczenie i została wypisana do domu w stanie dobrym. Nasz przypadek przedstawia wyjątkowo rzadką formę infekcji serca, niespodziewaną szczególnie u immunokompetentnych pacjentów. Łączymy ten stan z niekorzystnym przebiegiem wcześniej stosowanego leczenia bariatrycznego.
We report an unusual localisation of myxoma, the most common primary cardiac neoplasm. A 58-year-old woman was admitted to surgery department with exacerbation of abdominal discomfort and symptoms of lower limb claudication.The abdominal CT showed embolism in the upper mesenteric artery arms with intestinal ischemia, in the minor renal arteries with kidney infarcts and in the minor arteries of lower extremities. She was urgently, succesfully operated and partial resection of the small intestine was performed. The chest angio-CT conducted three days after the operation revealed additional structure in the aortic arch. Local aortic arch dissection with a thrombus was initially suspected. Echocardiography showed homogenous tumor on the minor curvature of the aortic arch, with a base of 11 mm of width, reaching down with the blood stream towards the descending aorta. The aortic wall was linear, with no signs of dissection or atherosclerotic lesions, echogenicity indicated rather solid mass. The patient was operated cardiosurgically and tumor of a myxoma type was confirmed intraoperatively. Another, small tumor of the same type was found below isthmus, in a descending aorta. Partial resection of aortic arch, alloplasty of aortic arch with the use of a dacron prosthesis were performed. The tumor below the isthmus was removed, without resection of aortic wall, due to the high risk associated with the widening of the procedure. Multimodality imaging with the essential role of echocardiography is useful especially in differential diagnostics of the atypically localized tumors causing diffuse peripheral embolization. Abstract P680 Figure. Aortic arch myxoma tumor
We present 59-year-old patient, with acute, severe mitral regurgitation due to papillary muscle rupture in the course of non-ST-elevation myocardial infarction. Signs of heart failure occurred in subacute phase of myocardial infarction, 7 days after primary PCI. Repeated clinical examination, confirmed by immediate echocardiography, led to intensive pharmacological treatment and subsequent urgent surgical valve replacement.
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