Combination of a giant dissected ascending aortic aneurysm with multiple fistulae into the cardiac chambers caused by prosthetic aortic valve endocarditis

The combination of a dissected ascending aortic aneurysm [AA] with multiple fistulae to the periaortic root structures is a life-threatening complication that occurs rarely after infective endocarditis of the prosthetic aortic valve. Many risk factors are potentially associated with this complication, including aortic diameter, connective tissue disease of the aortic wall, hypertension and infection. We report a rare case of dissected ascending AA with fistulae to the left atrium and pulmonary artery and a paravalvular leak in a 47-year-old woman with a history of an aortic valve replacement. The patient had presented to the Imam Ali Hospital, Kermanshah, Iran, in January 2015 with clinical features of heart failure. After initially being treated for congestive heart failure, she underwent open-heart surgery via a classic Bentall procedure and double fistula closure. She was discharged 23 days after the operation in good condition. A six-month follow-up showed normal functioning of the composite conduit prosthetic valve and no fistulae recurrence

Right ventricular thrombus and cerebral artery aneurysm in a patient with Behcet's disease

We report a 35-year-old woman referred to the Imam Ali Hospital, Kermanshah, Iran, in July 2014 for evaluation of postoperative dyspnoea after neurosurgery performed seven days previously for a ruptured cerebral artery aneurysm. She was known to have Behçet's disease with a history of recurrent oral and genital aphthous ulcers and uveitis. At referral, her symptoms included vertigo, dysarthria, palpitations and chest pain. Transthoracic echocardiography [TTE] revealed a large thrombus in her right ventricle outflow tract and open-heart surgery was performed eight days after the previous surgery to remove the clot. The postoperative period was complicated by transient acute renal failure, which resolved spontaneously. The patient was discharged 13 days after the cardiac surgery on warfarin, prednisolone, azathioprine and cyclophosphamide. Cyclophosphamide and azathioprine were discontinued after three months as the symptoms had completely resolved; however, prednisolone was continued due to recurrent uveitis. A 10-month follow-up TTE scan revealed no thrombus recurrence and treatment with warfarin and prednisolone was continued

Milky pleural effusion, a rare complication of left atrial myxoma

We report a rare case of bilateral chylothorax, associated with huge left mass in a 45-year-old woman who presented with preoperative dyspnea, fever and weight loss. Transe esophageal echocardiography [TEE], gross, and microscopic features of the mass were consistent with myxoma. Biochemical analysis of bilateral effusion revealed chylothorax in pre - and post - operative periods. We conclude that myxoma-induced mitral stenosis and pulmonary hypertension should be included in the differential diagnosis of bilateral pleural effusion and chylothorax. In addition, pulmonary pressure should be monitored before and during diagnosis, in therapy of any effusion derived from myxoma

Cardiogenic shock and anterior papillary muscle rupture caused by blood supply to diagonal artery

Acute mitral regurgitation accounts for 9% cases of cardiogenic shock following myocardial infarction and results from papillary muscle infarction. This complication occurs early following myocardial infarction. The etiologies of this devastating complication include left ventricular failure, right ventricular failure and acute mitral regurgitation that mitral regurgitation usually results from papillary muscle rupture. We reported a 41 year old male with first diagonal branch stenosis and dominant left circumflex and complete transaction of anterolateral papillary muscle that had not been reported in literature

Anterolateral papillary muscle rupture caused by Brucella endocarditis

Brucellosis is a common zoonosis in Iran, transmitted to humans by direct contact with infected animal materials like fleece, animal excrement, leather, butchery or by the consumption of contaminated animal products [e.g. fresh cheese, unpasteurized milk or dairy products, and raw meat and raw liver that is consumed semi-roasted by kebab sellers in Iran. A 21-year-old woman presented with respiratory failure due to pulmonary edema from severe acute mitral valve regurgitation in the setting of acute Brucella endocarditis. She was found to have a ruptured anterolateral papillary muscle from necrosis caused by corroding large vegetations on the anterior mitral valve leaflet. This occurrence is an exceptionally rare phenomenon, in Brucella mitral endocarditis. Urgent transesophageal echocardiography [TEE] revealed large mobile vegetation on the anterior papillary muscle with severe mitral valve regurgitation. The patient underwent mitral valve replacement. During valve replacement surgery, anterior mitral valve vegetation and rupture of the AL-PM were confirmed. We also considered that prolonged post-operative antibiotic treatment was indicated in our patient to protect the newly implanted prosthetic valves

Off-pump repair of a post myocardial infarction ventricular septal defect

Refractory cardiogenic shock meant that traditional patch repairs requiring cardiopulmonary bypass would be poorly tolerated and external sandwich closure of post myocardial ventricular septal defect [VSD] appears to be simple and effective after initial myocardial infarction [MI]. The three cases presented with a VSD after of acute MI with or without thrombolysed with streptokinase during patient admission. The general condition of the three patients was poor with pulmonary edema, low cardiac output and renal failure. The heart was approached through a median sternotomy. Off-pump coronary artery bypass grafting of the coronary artery lesion was done first using octopus and beating heart surgery method and latero - lateral septal plication was performed using sandwich technique. Low cardiac output managed with intra-aortic balloon pump in these patients accompanied with inotropic drugs. Post-operative transesophageal echocardiography revealed that VSD was closed completely in one patient and in two patients small residual VSD remained. More experience is required to ascertain whether this technique will become an accepted alternative to patch repairs

A Giant Hydatid Cyst in the Interventricular Septum with Papillary Muscle Involvement

We present here a 44-year-old male patient with hydatid disease who was referred to our hospital due to dyspnea and chest pain for the last 2 month before admission. Using echocardiography and contrast-enhanced computed tomography the heart hydatid was diagnosed. However, hydatid disease of the interventricular septum is rare; particularly, the involvement of mitral apparatus with mitral regurgitation (MR) is an exceptionally rare presentation. Early diagnosis and an integrated treatment strategy are crucial. Surgical excision was performed and the patient had an uneventful recovery and follow-up at 3 months.

prevalence of cutaneous leishmaniases in patients referred to kermanshah hygienic centers

Cutaneous leishmaniases is the problem in our country. The aim of this study was determine of cutaneous leishmaniases in Kermanshah. This descriptive-analytic study was and the statical society includes individual information with diagnosis during the 2006-2008 in the county health department in combating communicable disease were registered. Most cases were in age group 20-29 year. Most patients had a wound on his body [52.36%] and most of them were on hands [52%].