RESUMEN
Non-bacterial thrombotic endocarditis (NBTE) is a rare, often asymptomatic, condition. A 55-year-old woman presented with hemiparesis, facial palsy and chest pain. After urgent investigation, she was referred as a case of type A aortic dissection complicated by tamponade, myocardial infarction and stroke. Review of her imaging identified haemopericardium but no dissection, and emergency surgery proceeded considering her unstable condition. She underwent an emergency repair of left-ventricular free-wall rupture and excision of an aortic valve vegetation. Postoperative investigations confirmed a diagnosis of NBTE in the setting of a plexiform neurofibroma, and she was discharged 9 weeks later with residual neurological symptoms. This case poses a previously unreported acute presentation of NBTE and highlights the complexities in its diagnosis and management.
Asunto(s)
Endocarditis no Infecciosa , Infarto del Miocardio , Accidente Cerebrovascular , Humanos , Femenino , Persona de Mediana Edad , Endocarditis no Infecciosa/etiología , Infarto del Miocardio/etiología , Válvula Aórtica , Accidente Cerebrovascular/etiologíaRESUMEN
Unilateral right pulmonary edema has been reported as a potential life-threatening complication after minimally invasive mitral valve surgery. Nearly 2% of these cases in the immediate postoperative period have been reported to require extra-corporeal membrane oxygenation support as a rescue therapy for severe hypoxia. The exact pathophysiology of this condition remains unclear, but has been assumed to be related to ischemia-reperfusion injury and re-expansion pulmonary edema. We present in this report the successful use of extra-corporeal membrane oxygenation to manage two cases of severe hypoxia and multiorgan dysfunction secondary to unilateral right pulmonary edema.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Oxigenación por Membrana Extracorpórea/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Válvula Mitral/cirugía , Edema Pulmonar/etiología , Edema Pulmonar/terapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Fibroelastomas are rare, primary cardiac tumours with a predilection for valvular endothelium and a propensity to embolise. We present the case of a 72-year-old male with multiple cerebrovascular events (CVA) despite oral anticoagulation. Transoesophageal echocardiography (TOE) revealed a small highly mobile left atrial mass with frond-like projections attached by a stalk to the orifice of the LAA. The mass was surgically excised and confirmed to be a fibroelastoma on histological examination. This case report describes a rare but treatable source of multiple cerebrovascular events and highlights the utility of TOE in the assessment of cardiac embolic source. LEARNING POINTS: Fibroelastomas are most commonly found on left-sided heart valves (aortic > mitral) and have the potential to cause systemic emboli associated with significant morbidity and mortality.A left atrial appendage (LAA) mass in a patient presenting with cerebrovascular events does not always represent thrombus. Uncommon aetiologies such as a cardiac tumour should be considered in the differential diagnosis.Transthoracic echocardiography (TTE) does not provide an accurate assessment of the LAA and should not be used to detect pathology within this structure. Transoesophageal echocardiography (TOE) is superior to TTE in imaging the LAA and provides a complete delineation of its anatomy. In addition, TOE can detect very small highly mobile lesions (as described in this case), which may be missed on other imaging modalities.
RESUMEN
We report a patient admitted with acute pulmonary edema 3 months after mitral valve repair, with no history of inter-current febrile illness. Transesophageal echocardiography (TEE) demonstrated severe mitral regurgitation (MR) and an abnormally positioned annuloplasty ring, suggestive of dehiscence. The extreme extent of ring dehiscence was visualized on 3-dimensional TEE (3D), with near-complete separation of the ring. Strept.Mitis and Cristatus were isolated from the ring following redo mitral valve surgery, confirming endocarditis as the mechanism for dehiscence. This report highlights the additive role and superior ability of 3D TEE in the identification and anatomic delineation of mitral ring dehiscence.
Asunto(s)
Ecocardiografía Tridimensional/métodos , Ecocardiografía Transesofágica/métodos , Endocarditis/complicaciones , Anuloplastia de la Válvula Mitral , Válvula Mitral/diagnóstico por imagen , Dehiscencia de la Herida Operatoria/complicaciones , Anciano , Endocarditis/diagnóstico por imagen , Endocarditis/cirugía , Prótesis Valvulares Cardíacas , Humanos , Masculino , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Reoperación/métodos , Dehiscencia de la Herida Operatoria/diagnóstico por imagen , Dehiscencia de la Herida Operatoria/cirugíaRESUMEN
The St. Jude aortic connector system (St. Jude Medical, Inc, St. Paul, MN) is being increasingly used for the construction of vein proximal anastomosis in coronary artery bypass grafting. We suggest a possible use of the connected vein as temporary shunt during open endarterectomy of the innominate artery and at the same time as graft for coronary artery bypass grafting.