Novel treatment approach to ascending aorta pseudoaneurysms: a case report

The pseudoaneurysm of the aorta is rarely due to trauma and infection but usually is a late complication of previous surgical procedures like coronary artery bypass graft surgery. We describe a 65-year-old woman with the pseudoaneurysm of the ascending aorta due to coronary artery bypass graft surgery. It was revealed in coronary artery angiography after nonspecific symptoms. It was confirmed by multidetector computed tomographic angiography. The patient refused open cardiac surgery, so we decided to use an atrial septal defect occluder device in off-label way to seal the pseudoaneurysm orifice. In a hybrid operating room setting, the procedure was done successfully and patient's hospitalization course was eventless. In multidetector computed tomographic angiography after 3 months, the device was in the appropriate position without endoleak and in the yearly visit the patient was asymptomatic and healthy

Ruptured sinus of valsalva aneurysm accompanied by aortic and tricuspid valve endocarditis: a case report

A ruptured sinus of Valsalva aneurysm rarely accompanies the aortic and tricuspid valve endocarditis. A 36-year-old woman presented with low-threshold dyspnea on exertion and fever. Transthoracic and transesophageal echocardiography showed a ruptured noncoronary sinus of Valsalva aneurysm with large vegetations on the tricuspid and aortic valves, resulting in moderately severe tricuspid regurgitation and severe aortic regurgitation. Blood culture was negative. The patient was initially treated with antibiotics and then subjected to the surgical repair of the sinus of Valsalva aneurysm and the tricuspid and aortic valve replacement. The patient's postoperative period was uneventful, and she was discharged healthy

Incidentally detected tricuspid papillary fibroelastoma

A 56-year-old man was admitted to our hospital for coronary artery bypass graft surgery. Preoperative transthoracic echocardiography revealed thickening of the anterior leaflet of the tricuspid valve, and transesophageal echocardiography showed oval and irregular-shaped masses, featuring well-demarcated borders and a homogenous texture, attached to the atrial side of the anterior leaflet of the tricuspid valve with a small, tiny, mobile stalk. In the operating room, this mass was resected and gross anatomical examination showed multiple finger-like fronds attached to the stalk. When it was placed in saline, the mass revealed typical Sea anemone','suggestive of papillary fibroelastoma. Although echocardiography had been previously conducted for routine preoperative evaluation, this incidental finding significantly changed the surgical plan

Fragmented QRS complex in acute anterior myocardial infarction and coronary sinus blood flow: is there any relevance?

Patients with QRS fragmentation following myocardial infarction [MI] are at greater risk of cardiac death. Transthoracic echocardiography [TTE] can be used as a method for evaluating the coronary sinus blood flow [CSBF] and coronary sinus velocity time integral [CSVTI]. The present study reports measurement of CSBF and CSVTI by TTE in 100 acute anterior MI cases, half of them with fragmented QRS. Our study included 100 patients with acute anterior MI in whom CSBF and CSVTI were measured by the use of TTE. Fifty of all the patients had fragmented QRS complex and 50 patients were without fragmented QRS complex, while there was no difference in terms of LVEF in both groups of study. CSBF [303 +/- 126 ml/min vs. 258 +/- 121 ml/min; p-0.001] and CSVTI [14.45 +/- 2.85 ml vs. 10.85 +/- 2.69 ml; p=0.003] were significantly lower in the acute anterior MI patients with fragmented QRS in comparison with the patients with acute anterior MI without fragmented QRS. We conclude that CSBF and CSVTI can be measured by TTE in acute MI patients and these variables are reduced in acute anterior MI patients with fragmented QRS