Asymptomatic giant lipoma of the right ventricular outflow tract: a case report

Cardiac lipomas are extremely rare tumors of the heart. They are usually symptomatic and rarely may be found incidentally in autopsies. Here we describe a 23-year-old healthy man, in whose physical examination for employment a murmur was found incidentally. Transthoracic and then transesophageal echocardiographic examination showed a 4-cm oval-shaped mass in the right ventricular outflow tract. He underwent elective surgery, during which the tumor was removed under cardiopulmonary bypass and aortic-cross clamping via right atriotomy. The postoperative course was uneventful, and the patient was in good condition at 1 year's follow-up

effect of amlodipine and sildenafil on the NT-ProBNP level of patients with COPD-induced pulmonary hypertension

Pulmonary hypertension [PH] is an important cause of heart failure in chronic obstructive pulmonary disease [COPD]. The pro brain natriuretic peptide N-terminal [NT-proBNP] has been suggested as a noninvasive marker to evaluate ventricular function. However, there is no evidence to support the use of NT-proBNP in monitoring the benefits of vasodilators in COPD induced PH. Thus, we used NT-proBNP as a biomarker to evaluate the effect of oral vasodilators on cardiac function in COPD-induced PH. Forty clinically-stable PH patients were enrolled with history of COPD, normal left ventricular ejection-fraction [LVEF], right ventricular systolic pressure [RVSP] > 45 mmHg and baseline blood NT-proBNP levels >100 pg/mL. Patients were randomized into two groups, one group received sildenafil and second group were given amlodipine for two weeks. NT- proBNP and systolic pulmonary arterial pressure [systolic PA-pressure] were measured at the beginning and the end of study. Mean NT-proBNP level in the first group was 1297 +/- 912 pg/mL before therapy and 554 +/- 5 pg/mL after two weeks drug therapy, respectively. Similarly, in second group NT- proBNP level was 1657 +/- 989 pg/mL and 646 +/- 5 pg/mL before and after treatment. Amlodipine or sildenafil significantly reduced NT-proBNP levels in COPD-induced PH patients [p < 0.05]. Our study shows that amlodipine and sildenafil have a similar effect on NT-proBNP levels. In both groups NT- proBNP levels were significantly reduced after treatment. Therefore, our findings support the potential benefits of treatment with vasodilators in COPD induced PH

Successful surgical intervention in an unusual case of Aspergillus endocarditis with acute myeloid leukemia

Endocarditis due to Aspergillus infection is a rare complication in patients with hematological malignancies. Here, we present a case of aspergillus endocarditis in a patient with acute myeloid leukemia [AML] successfully treated with antifungal therapy and surgical treatment. The patient was a 51 years old male, a known case of AML who was admitted to our medical center for evacuating his valvular vegetations and repairing his atrial septal defect. He underwent an open heart surgery to relinquish his thromboses and also received an antifungal regimen. The patient tolerated the procedure well and eight months after his surgery, the patient remains asymptomatic. Successful treatment of this severe case of aspergillus endocarditis justifies a multidisciplinary method to be as a safe and effective approach to manage these patients

Different histopathological appearances of cardiac tuberculosis: presentation of a rare case with review of literature

Tuberculosis is caused by a mycobacterium and is a multipotential, omnipresent infectious disease. Generally, two major categories, pulmonary and extrapulmonary exist. Whereas pericardial involvement is relatively common, myocardial tuberculosis has been reported in not more than 0.3% of all tuberculosis patients post-mortem. A 21-year-old woman sought medical attention due to progressive dyspnea upon exertion, weight loss, and general weakness. She underwent a heart operation and a well-circumscribed, solid, and creamy egg-shaped mass with a lobulated surface was seen in the right atrium. The histopathological study showed multiple well-formed granulomas with multinucleated giant cells and extensive caseous necrosis. These were compatible with a diagnosis of tuberculoma; however, the Ziehl-Neelsen stain failed to reveal the acid-fast bacilli. Her postoperative course was uneventful and soon she was discharged with advice to continue her medical therapy

Mulibrey nanism in a 35 year-old iranian female with constrictive pericarditis

Mulibrey nanism is a rare autosomal recessive disorder characterized by severe growth retardation and pericardial constriction associated with muscle, liver, brain, and eye abnormalities. More than 80% of previously reported cases are Finnish. We report a 35-year-old Iranian female who presented with classic phenotypic features of Mulibrey nanism with symptomatic constrictive pericarditis and underwent pericardiectomy .Our case is one of the rare examples of Mulibrey nanism outside Finland that has been reported so far

Correlation between the pulmonary artery pressure measured in echocardiography and pulmonary artery diameter in the ct-scan of patients suffering from interstitial lung disease

Pulmonary hypertension [PH] is a significant cause of morbidity and mortality in patients suffering from pulmonary parenchymal diseases. Diagnosis of PH has always been a major clinical dilemma due to its non-specific clinical manifestations. However, diagnosing PH and determining its severity are essential for the prognosis and treatment planning in PH patients. This study aimed at evaluating the correlation between the pulmonary artery diameter [PAD] in the CT-scan and pulmonary artery pressure [PAP] in echocardiography of patients. PAD was evaluated in the CT-scan of 117 patients suffering from interstitial lung disease [ILD] and the correlation between PAD and PAP was studied. A receiver operating characteristic curve [ROC curve] which is indicative of the precision of the diagnostic test was drawn to find the cut off point for the MPAD representing PH. The area under the curve was also calculated in order to define the discriminative power of the test. PAP higher than 25 mmHg was considered as PH. PAD over 29 mm reported in the CT-scan for the diagnosis of PH in ILD patients had sensitivity of 63% and specificity of 41.5%. No significant linear correlation was found between PAD and PAP [P-value=0.17, r=0.15]. The area under the ROC curve was calculated to be 0.49 in the cutoff point of 29 mm for determining PH [CI 95%=0.38-0.60, P=0.89]. ROC curve showed a weak discriminative power. PAD had low sensitivity and specificity in the CT-scan for the diagnosis of PH. Therefore, we conclude that CT-scan alone is not helpful in finding PH cases and further examinations are required

Unusual presentation of ruptured sinus of valsalva aneurysm

Sinus of Valsalva Aneurysm [SVA] is caused by dilation, usually of a single sinus of Valsalva, from a separation between the aortic media and the annulus fibrosus. Indeed, a deficiency of normal elastic tissues and abnormal development of the bulbus cordis have been associated with the development of SVA. We report a 31-year-old man with unusual presentation of ruptured sinus of valsalva aneurysm

Myocardial infarction after blunt chest trauma in two young men

Traumatic myocardial injury occurs in up to 55% of patients sustaining blunt chest trauma. We report two cases of myocardial infarction following blunt chest trauma in two young men due to a car accident. They were both suffering multiple trauma and were hospitalized in ICU. Diagnostic and therapeutic procedures performed for these patients are presented in this article

Evaluation of patients with infective endocarditis in a pulmonary referral centre

Despite the decreased incidence of rheumatic fever and use of prophylactic antibiotic the incidence rate of infective endocarditis has not declined. In this research, we have studied the clinical feature and therapeutic response of patients with infective endocarditis presenting with pulmonary manifestations to a pulmonary referral center. All patients with diagnosis of endocarditis that had pulmonary manifestations [based on Duke Criteria] as their primary clinical presentation were entered in this study. Data in regard to individual information, clinical features, laboratory finding and therapeutic responses were noted. All data were analysed using SPSS software [version 11.5]. A total number of twenty patients here entered the study. Mean age was 34.8 +/- 11.6 yr. The commonest clinical features included: fever [95%], cough [65%] and dyspnea [65%]. Also the commonest signs were cardiac murmurs [65%], hepatomegaly [35%] and splenomegaly [35%]. Clubbing was seen in 10%. Sixty percent of the cases were intravenous drug users and 25% were infected with HIV. Also 50% of the patients did not have any background of valvular diseases. However, there was vegetations on one valve in 75% and multiple valves were involved in 25%. The commonest valves affected were trocuspid [50%], mitral [30%] and pulmonic valve [10%]. Staphylococcus aureus [47.3%] and Streptococcus viridans [27.3%] were the commonest microorganisms detected. Pericardial effusion was present in 30% which was higher in IV drug users [p. value=0.042]. Total mortality rate in hospital was 5%. Infective endocarditis should be considered in the list of differential diagnosis in patients suffering from pulmonary symptoms especially in IV drug users

Effect of major lung resection on pulmonary artery pressure

Background: Major lung resection is one of the surgical procedures which its significant physiologic and hemodynamic effects on the right heart have been recently studied. This study has been implemented to review the effects of this surgery on the most important echocardiographic index of the right heart that is pulmonary artery pressure [PAP]

Materials and Methods: 29 patients were consecutively studied during 2 years. Each patient underwent a single transthoracic echocardiography before the operation and another echo study within one week after the operation. Background variables [age and sex] and echocardiographic indices [EF for global left heart function and PAP] were recorded. Analysis of data after review of distribution was done by paired-t-test and Wilcoxon signed rank test

Results: In this study 18 men and 11 women with mean +/- SD age of 52 +/- 21 were included. Mean +/- SD of EF and PAP before the operation were 57.1 +/- 3.9 and 26.8 +/- 9.9 respectively. After the operation no significant changes in EF [p?1] was observed while PAP changed to 29.7 +/- 11.3 [p <0.086]

Conclusion: The results showed that reduced pulmonary vascular bed after lobectomy and pneumonectomy did not affect left sided EF, while right sided index [PAP] was slightly elevated although not statistically significant. We can deduce that major lung resection does not affect cardiac outcome and PAP significantly; future studies with more patients and longer follow-ups will clarify this issue

Echocardiographic evaluation in mediastino-pulmonary malignancy

As any cardiac involvement may worsen the prognosis of mediastino-pulmonary tumors, this study was designed to evaluate the function and anatomy of heart by ehocardiography in this group of patients. Medical records of 76 patients were reviewed for age, sex, type of malignancy, and cardiac consultation report. The patients underwent transthoracic echocardiography. Moreover, descriptive statistical methods were used for data analysis. The study population included 58 males and 18 females, with the mean [