Dilatación idiopática de la aurícula derecha. Reporte de caso y revisión de la literatura / Idiopathic dilatation of the right atrium. Case report and literature review

Resumen La dilatación idiopática de la aurícula derecha (DIAD) es una malformación poco frecuente caracterizada por un crecimiento desproporcionado de la aurícula derecha en ausencia de una causa estructural o funcional que la justifique. Presentamos el caso de una paciente con DIAD con diagnóstico desde la etapa prenatal.

Abstract Idiopathic dilatation of the right atrium is a rare malformation characterized by disproportionate growth of the right atrium in the absence of a cause that justifies it. We present the case of a patient with idiopathic dilatation of the right atrium diagnosed since fetal life.

Transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation for Budd-Chiari syndrome complicated with liver cancer: a case report with surgical video / 器官移植

Objective To summarize clinical experience of transabdominal pericardial anastomosis of suprahepatic vena cava of the donor and right atrium of the recipient in liver transplantation for Budd-Chiari syndrome (BCS) complicated with liver cancer. Methods Clinical data of a BCS patient complicated with liver cancer undergoing transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation were retrospectively analyzed. Results The hepatic vein and suprahepatic vena cava were partially occluded in the patient. Liver transplantation was completed by transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium with beating-heart. In addition, due to pathological changes of the recipient's hepatic artery, splenic artery of the recipient was cut off, distal ligation was performed, and the proximal end was reversed and anastomosed with the common hepatic artery of the donor liver, and the reconstruction of hepatic artery was completed. The surgery was successfully performed. At approximately postoperative 1 week, the function of the liver allograft was gradually restored to normal, and no major complications occurred. The patient was discharged at postoperative 25 d. No signs of BCS recurrence was reported after 8-month follow-up. Conclusions It is safe and feasible to treat BCS by liver transplantation with transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium. BCS patients complicated with liver cancer obtain favorable prognosis.

A Case of Redo Ascending Aortic Replacement for Anastomotic Pseudoaneurysm through Right Thoracotomy in a Patient with Severe Coagulation Disorder / 日本心臓血管外科学会雑誌

A 51-year-old man presented to our hospital with general fatigue and lower extremity edema due to right heart failure with severe coagulation disorder. He had undergone ascending aortic and total arch replacement for type A acute aortic dissection when he was 49 years old and had diagnosed with anastomotic pseudoaneurysm in the ascending aorta by computed tomography 1 year after the operation. Preoperative computed tomography showed an enlargement of the pseudoaneurysm. Since re-median sternotomy seemed to be high risk strategy for bleeding due to severe coagulation disorder, we decided to perform ascending aortic replacement through right thoracotomy. We opened the pseudoaneurysm and found an aorto-right atrium fistula. Redo ascending aortic replacement with direct closure of the fistula was successfully performed. The postoperative course was uneventful.

Combined general and cardiac surgery for the treatment of pediatric tumors with supradiaphragmatic inferior vena cava and right atrium tumor thrombus / 中华实用儿科临床杂志

Objective:To investigate the feasibility and efficacy of combined general and cardiac surgery in the treatment of pediatric tumors with supradiaphragmatic inferior vena cava (IVC) and right atrium (RA) tumor thrombus.Methods:Retrospective analysis was performed on the clinical treatment of 8 pediatric tumor patients with supradiaphragmatic IVC and RA tumor thrombus treated by combined general and cardiac surgery in Children′s Hospital, Capital Institute of Pediatrics from June 2015 to May 2019.The operation was performed through a combined thoracoabdominal median incision.Cardiac surgeon opened the pericardium for cardiopulmonary bypass (CPB). Subsequently, general surgeon resected the primary abdominal tumor, cut open the subphrenic IVC, removed the subphrenic tumor thrombus, and made an attempt to remove the supradiaphragmatic tumor thrombus through the same incision of IVC.If the tumor thrombus cannot be completely removed through this incision, cardiac surgeon shall tighten the prefabricated pulmonary artery blocking band, establish CPB, and remove the supradiaphragmatic tumor thrombus in IVC or open RA to remove the atrial tumor thrombus.Results:In the 8 cases, there was hepatoblastoma in 4 cases, nephroblastoma in 3 cases, and adrenocortical carcinoma in 1 case.Among them, there was RA tumor thrombus in 4 cases, which was removed by right atrial thrombectomy under CPB; tumor thrombus in supradiaphragmatic IVC in 1 case, which was removed under CPB; subphrenic IVC in 3 cases, which was completely removed without the adoption of CPB.Among those 8 cases, 7 cases had complete resection of the tumor thrombus and 1 case had residual iliac vein tumor thrombus, and none of them developed pulmonary embolism.All the 8 cases underwent regular postoperative chemotherapy, and median follow-up time was 22.5 months (10-57 months), with 6 survived cases, 1 case died, and 1 case losing follow-up.Conclusions:Combined general and cardiac surgery can allow complete resection of the primary tumor and supradiaphragmatic and right a trial tumor thrombus in a single operation with reduced pain in patients, which could not only improve the rate of complete tumor resection but also reduce the risk of pulmonary embolism, thereby making the previously painful and risky surgery safer, more effective and more humane.

Diagnóstico prenatal de dilatación idiopática de la aurícula derecha. Reporte de un caso / Prenatal diagnosis of idiopathic dilatation of the right atrium. A case report

La dilatación idiopática de la aurícula derecha es una entidad poco frecuente. Estimar la verdadera incidencia es dificultoso dado que muchos pacientes son asintomáticos y los síntomas reportados, tanto en niños como en adultos, presentan un amplio espectro de manifestaciones clínicas. Pocos pacientes con diagnóstico prenatal fueron publicados.Se presenta un caso de diagnóstico prenatal de dilatación auricular derecha con un seguimiento de 3 años y 8 meses. El paciente se encuentra asintomático, sin evidencia de trombosis auricular, medicado con ácido acetilsalicílico desde su nacimiento. El seguimiento se realizó con ecocardiogramas regulares; sin embargo, la confirmación diagnóstica fue a través de la resonancia magnética nuclear cardíaca.La importancia del reporte radica en describir una enfermedad rara, potencialmente grave, y cómo el diagnóstico prenatal permite tomar conductas anticipadas, como el monitoreo cardíaco, para la detección de arritmias y el inicio temprano de profilaxis primaria antitrombótic

Idiopathic dilatation of the right atrium is a rare condition. The real incidence of the disease is difficult to estimate since most patients are asymptomatic, although a wide spectrum of symptoms have been reported in children and adults. In the literature, prenatal diagnosis has been reported in few cases.We report a case of prenatally diagnosed right atrial dilation with a 3 years and 8 months follow up. The patient is on acetylsalicylic acid since birth and remained asymptomatic without any atrial thrombosis. We performed regular transthoracic echocardiograms during follow up, however was a cardiac magnetic resonance imaging the method for achieving diagnostic confirmation.The aim of this case report is to describe a rare, potentially serious disease and how prenatal diagnosis allows anticipated actions such as monitoring for cardiac arrhythmia detection and early starting of primary thrombosis prophylaxis.

Cor triatriatum dexter y comunicación interauricular tipo seno venoso: Una asociación infrecuente / Cor triatriatum dexter and sinus venosus atrial septal defect: An infrequent association

RESUMEN El cor triatriatum es una malformación congénita poco frecuente, con una prevalecia de un 0,1% entre todas las anomalías congénitas cardíacas, donde el corazón queda dividido en tres atrios o aurículas. En el cor triatriatum dexter la aurícula derecha queda dividida, por una membrana fibromuscular, en dos partes, una proximal y otra distal, que se comunican o no entre sí. En la evolución natural de la enfemedad, los pacientes pueden permanecer asintomáticos hasta su diagnóstico o presentar manifectaciones cardiovasculares secundarias a insuficiencia cardíaca derecha y trastornos del ritmo. En el caso particular de aquellos que se encontraran sintomáticos, el tratamiento de elección sería la corrección quirúrgica del defecto y, en ocasiones, la rotura percutánea de la membrana; mientras que en los que se encuentran asintomáticos, el seguimiento y tratamiento oportuno de sus complicaciones parecería la alternativa más viable.

ABSTRACT Cor triatriatum is a rare congenital condition with a 0.1% prevalence among all cardiac congenital anomalies in which the heart is partitioned into three atria. In cor triatriatum dexter the right atrium is divided by a fibromuscular membrane into two parts, a proximal and a distal one, which may or may not communicate with each other. In the natural course of the condition, patients may remain asymptomatic until diagnosis or present with cardiovascular manifestations secondary to right heart failure and rhythm disorders. In the specific case of symptomatic patients, the treatment of choice would be surgical correction of the anomaly and sometimes percutaneous rupture of the membrane; while in asymptomatic patients, timely follow-up and treatment of their complications would seem to be the best alternatives.

Masa auricular derecha: la importancia del ecocardiograma al momento del diagnóstico de fibrilación auricular en el enfoque terapéutico / Right atrial mass: The importance of cardiac ultrasound at the time of diagnosis of atrial fibrillation in the therapeutic approach

Resumen Se presenta el caso de un varón de 70 años de edad, quien debutó con fibrilación auricular no valvular, en quien, dos meses después y mediante ecocardiografía, se objetivaron dos masas contiguas en la aurícula derecha. Las masas eran dependientes de la válvula de Eustaquio, alcanzaban el septo interauricular y se asemejaban a un mixoma. Ambas fueron resecadas mediante cirugía, sin complicaciones intraoperatorias ni postoperatorias. El estudio anatomo-patológico concluyó que eran compatibles con trombos sin componente tumoral. Durante el seguimiento permaneció asintomático y en ritmo de fibrilación auricular.

Abstract The case is presented on a 70 year-old male who debuted with non-valvular atrial fibrillation. Two months later, and using cardiac ultrasound, two contiguous masses were observed in the right atrium. The masses were hanging from the Eustachian (inferior vena cave) valve, reached the interatrial septum and resembled a myxoma. Both were surgically resected, with no intra- or post-operative complications. The patient remained asymptomatic and in atrial fibrillation rhythm during follow-up.

Mixoma auricular derecho en la infancia / Right atrium myxoma in chilhood

Los tumores cardíacos primarios son poco frecuentes y representan solo el 5% de todos los tumores cardíacos. El 75% de estos tumores son benignos, y el mixoma es el tumor benigno más común en el adulto (50%). La mayoría de los mixomas cardíacos se localizan en la aurícula izquierda, solo el 18-20% se localizan en la aurícula derecha, y es aún más infrecuente la aparición de un tumor bilobulado, los signos y síntomas con los que se presentan son inespecíficos y varían de acuerdo a su comportamiento. Presentamos un caso con estas características en una paciente escolar de 9 años de edad que ingresó al Hospital del Niño Manuel Ascencio Villarroel

Primary cardiac tumors are rare and represent only 5% of all cardiac tumors. 75% of these tumors are benign, and myxoma is the most common benign tumor in adults (50%). Most cardiac myxomas are located in the left atrium, only 18-20% are located in the right atrium, and the appearance of a bilobed tumor is even more infrequent, the signs and symptoms with which they occur are nonspecific and they vary according to their behavior. We present a case with these characteristics in a 9-year-old school patient who was admitted to Manuel Ascencio Villarroel Children's Hospital.

Contemporary management and outcomes of infective tunnelled haemodialysis catheter-related right atrial thrombi: a case series and literature review

INTRODUCTION@#Infective haemodialysis catheter-related right atrial thrombus (CRAT) is a complication of tunnelled catheter use. Management recommendations are based mainly on published case series prior to 2011. We report our institution's recent experience in managing infective haemodialysis CRAT and correlate treatment with outcomes.@*METHODS@#We conducted a retrospective analysis of haemodialysis CRAT cases diagnosed on transthoracic echocardiography between 1 January 2011 and 31 December 2017. Clinical outcomes, including mortality at 180 days post diagnosis and thrombus resolution, were traced from electronic medical records.@*RESULTS@#There were 14 cases identified. The median age was 59 (range 47-88) years and 11 (78.6%) were male. Sepsis was the most common reason for hospitalisation (71.4%). Blood cultures identified Staphylococcus aureus in seven cases, of which two were methicillin-resistant. Three had coagulase-negative Staphylococcus. All cases received antibiotics with infectious disease physician input. Seven were treated with catheter removal alone, of which three died within 180 days. Both cases treated with catheter removal plus anticoagulation survived at 180 days. Of the two cases who had anticoagulation without catheter removal, one died within 180 days and the other did not have thrombus resolution. Three underwent surgical thrombus removal, of which two died postoperatively and the last required repeated operations and prolonged hospitalisation. Mortality at 180 days post diagnosis was 42.9%.@*CONCLUSION@#Catheter removal and anticoagulation are modestly effective. Surgery is associated with poor outcomes. Despite contemporary management, infective haemodialysis CRAT still results in high mortality. Prospective studies are needed to identify the optimal management.

A rare and independent association of Right Atrial Myxoma with Immune Thrombocytopenic Purpura

Primary tumours of the heart are rare and the most common benign ones are myxomas.  The clinical features are varied and include a myriad of presenting symptoms like embolic, constitutional, cardiac and also symptoms due to obstruction. Right atrial myxomas are very rarely seen when compared with left atrium. Such myxomas independently co existing with Immune Thrombocytopenic Purpura (ITP) is even rarer and we now present one such case in with right atrial myxoma was associated with ITP and was managed surgically. This case emphasises the fact that ITP can co-exist with myxoma and should be borne in mind when treating such patients surgically.

Rapidly progressive malignant fibrous histiocytoma of right atrium: a rare case report

Abstract We are going to present a case of malignant fibrous histiocytoma in the right atrium, which is a very rare entity. The patient had a right atrial mass, which prolapsed through the tricuspid valve into the right ventricle, causing functional tricuspid valve stenosis. The tumor was completely resected and the patient had an uneventful postoperative period. Histopathological examination reported malignant fibrous histiocytoma. The patient presented to the emergency department five weeks after discharge with dyspnea and palpitation. Echocardiography and magnetic resonance imaging revealed recurrent right atrial tumor mass. His clinical status has worsened, with syncope and acute renal failure. On the repeated echocardiography, suspected tumor recurrence was observed in left atrium, which probably caused systemic embolization. Considering the aggressive nature of the tumor and systemic involvement, our Heart Council decided to provide palliative treatment by nonsurgical management. His status deteriorated for the next few days and the patient succumbed to a cardiac arrest on the 4th day.

Long-term Disease-free Survival after Trimodality Treatment of Recurrent Hepatocellular Carcinoma Involving the Inferior Vena Cava and Right Atrium

Hepatocellular carcinoma (HCC) involving the inferior vena cava (IVC) and/or right atrium (RA) is a rare and intractable disease. A standard treatment has not been established yet, owing to the rarity of disease and difficulties in the therapeutic treatment. Herein, we report the case of a patient who had recurrent HCC (after a prior lobectomy) involving both IVC and RA and underwent multimodality treatments including external beam radiotherapy and transarterial chemotherapy, followed by sorafenib treatment. The disease was well controlled with local treatments and sustained for 7 years until last follow-up after the systemic treatments. Our case shows a possibility of long-term survival for patients affected by HCC involving IVC and/or RA, after a rigorous multimodality treatment strategy.

Study on the measurement of cardiac CT in patients with acute pulmonary embolism / 中华急诊医学杂志

Objective To measure and analyze cardiac ventricular sizes of acute pulmonary embolism patients,and compared with normal group,to investigate the morphological changes of heart in patients with acute pulmonary embolism.Methods 75 patients with acute pulmonary embolism were analyzed retrospectively and were divided into two groups according to the score of embolism index:more than or equal to 50％ (group c,33 cases) and less than 50％ (group b,42cases) and compared with normal group (group a,56 cases) to analyze the changes of cardiac ventricular transversal diameter(LR) and anteroposterior diameter (AP).Results The group c compared with group a and b,the right ventricular LR and AP,and the right atrium LR increased significantly (P＜0.05),the left ventricular LR decreased significantly (P＜0.05).The group b compared with the group a,the right ventricular LR and the right atrium AP increased significantly (P＜0.05),the left atrium LR decreased significantly (P＜0.05).The left atrial AP,group b was larger than that of group a and group c (P＜0.05).The left ventricular AP,there was no significant difference between the three groups.The atrial ratio (RA/LA) and the ventricle ratio (RV/LV)of the three groups were significantly different (P＜0.05).According to the product of two lines of the same heart cavity (RL × AP),compared with group a and b,the left atrium and ventricle of group c decreased (P＜0.05),the right atrium and ventricle enlarged (P＜0.05).Compared with group a,the left ventricular angle of group c decreased significantly (88.97±5.47 vs 97.91±7.66,P＜0.001),there was no significant difference between the group b and c (P＞0.05).After the treatment of acute pulmonary embolism,the right ventricular RL × AP is significantly reduced(4 209.57±844.63 vs 5 090.58±1312.69,P=-0.002),the ventricle ratio (RV/LV) is significantly reduced(0.80±0.13 vs 0.93±-0.19,P=0.003.Conclusions The size and shape of heart cavity varied with different pulmonary embolism index,and we can make preliminary observation and evaluate treatment efficacy by using chest CT scan.

Perioperative management of critical right ventricular inflow obstruction from right atrial rhabdomyoma

Rhabdomyoma is the most common cardiac tumor in infancy and commonly located in the ventricles causing outflow obstruction or arrhythmias. We report a rare pediatric (7 month old) case of a right atrial rhabdomyoma presenting with severe cyanosis and low cardiac output from significant tricuspid inflow obstruction with right to left shunt across a stretched patent foramen ovale. We present an emergency cardiac surgery for right atrial tumor resection, and the management of separating the patient with failing right ventricle from cardiopulmonary bypass using a Glenn shunt, since extracorporeal membrane oxygenation (ECMO) or nitric oxide was not available.

Sorafenib Treatment in Advanced Hepatocellular Carcinoma with Tumor Thrombus Nearly Occupying the Entire Right Atrium

Advanced hepatocellular carcinoma (HCC) with tumor thrombus extending through the hepatic veins, inferior vena cava, and right atrium (RA) is very rare. However, whether active treatments such as radiation, transcatheter arterial chemoembolization, and sorafenib in advanced HCC with RA involvement prolong survival is uncertain. We present a rare case of advanced HCC with tumor thrombus nearly occupying the entire RA that was treated with sorafenib. The patient received 400 mg sorafenib twice daily. However, her liver enzyme levels continued to increase and abdominal computed tomography showed an increase in the tumor size in the liver and RA. In the present case, active treatment with sorafenib was ineffective; thus, palliative care may be more beneficial in advanced HCC with extensive RA involvement.

Diagnosis of congenital malformations of the right atrium by echocardiography / 中华超声影像学杂志

Objective To review the imaging characteristics and evaluate the diagnostic value of echocardiography for congenital malformations of the right atrium(CMRA).Methods Doppler echocardiography was performed and these images were compared with operative findings in 1 1 children with CMRA.Results CMRA was characterized by idiopathic dilation of the right atrium and right heart appendage,congenital diverticulum of the right atrium and coronary sinus.CMRA consisted of idiopathic dilation of the right atrium(4 cases),congenital diverticulum of the right atrium(3 cases),idiopathic dilation of the right heart appendage(2 cases),and congenital diverticulum of the coronary sinus(2 cases).The associated malformations included patent foramen ovale(6 cases),atrial septal defect(3 cases),pulmonary hypertension(3 cases),and hypoplastic tricuspid valve(2 cases).Eight of 1 1 cases were diagnosed correctly,and other 3 cases were misdiagnosed,in which 1 case with idiopathic dilation of the right atrium misdiagnosed as Ebstein's anomaly,1 case with congenital diverticulum of the right atrium misdiagnosed as congenital enlargement of the right atrial appendage,and 1 case with congenital diverticulum of the coronary sinus misdiagnosed as coronary sinus stenosis.Conclusions CMRA could be diagnosed accurately by Doppler echocardiography,but it is prone to be misdiagnosed and must be distinguished from Ebstein's anomaly.

Nursing of one patient under went thoracoabdominal surgery for recurrent pelvic intravenous leiomyoma involving right atrium / 中华护理杂志

To summarize the nursing experience on recurrent intravenous leiomyomatosis with right atrial invasion in one case undergoing thoracoabdominal joint surgery.The key points were muhidisciplinary consultation and collaboration,detailed personalized surgical program and reasonable arrangements.A comprehensive preoperative assessment and psychological counseling was carried out.In the process of operation nosocomial infection was strictly controlled.The patient underwent an 8-hour procedure with 1 000ml intraoperative blood loss and was in good recovery right now.

Nursing of one patient under went thoracoabdominal surgery for recurrent pelvic intravenous leiomyoma involving right atrium / 中华护理杂志

To summarize the nursing experience on recurrent intravenous leiomyomatosis with right atrial invasion in one case undergoing thoracoabdominal joint surgery.The key points were muhidisciplinary consultation and collaboration,detailed personalized surgical program and reasonable arrangements.A comprehensive preoperative assessment and psychological counseling was carried out.In the process of operation nosocomial infection was strictly controlled.The patient underwent an 8-hour procedure with 1 000ml intraoperative blood loss and was in good recovery right now.