Congenital combined atresia of the left main coronary with supravalvar aortic stenosis

Congenital atresia of the left main coronary artery (LMCA) is an exceedingly rare phenomenon, and in the most of them, coronary artery bypass graft is required. We here describe a rare case of this anomaly that concomitantly was associated with supravalvar aortic stenosis and coronary–pulmonary fistula without the presence of conventional collateral circulation in a 16-year-old boy. The patient was admitted to our center with chest pain and dyspnea. Echocardiographic examinations showed supravalvar aortic stenosis with normal function of the aortic valve. Coronary angiography revealed atresia of LMCA with poorly developed left anterior descending coronary artery and well-developed circumflex coronary artery and diagonal artery that perfused by dominant and lengthy right coronary artery. The patient underwent coronary artery bypass grafting with repair of supravalvar aortic stenosis. The postoperative course was uneventful. The 6-month follow-up revealed normal diameter of the ascending aorta with symptomatic relief of preoperative chest complaint.

Right atrial fibroma in an adult patient

Left atrial fibroma as a benign tumor is an exceedingly rare left atrial mass. It has various clinical signs and symptoms and sometimes leads to serious complications such as lethal arrhythmia and death. We report a case of right atrial fibroma in a 40-year-old male who presented with dyspnea and atrial fibrillation. Transthoracic echocardiography revealed a large sessile mass attached to interatrial septum near the coronary sinus valve in the right atrium. The patient underwent surgical resection of tumor through the right atrium. The postoperative course was unremarkable. Histopathological examination showed that it was a fibroma. The 6-month follow-up revealed that the patient was in well condition with no evidence of tumor recurrence.

Ostium secundum atrial septal defect endocarditis caused by brucella infection.

The most common cardiovascular presentation of brucellosis (a zoonotic infection) in Iran is aortic valve endocarditis. Brucellosis is a systemic infection and may involve any congenital heart defect with various clinical signs and symptoms. We report brucella endocarditis in an atrial septal defect (ASD) in a 55-year-old man who presented with fever and hemiplegia. Echocardiography showed a secundum ASD with large vegetations of 0.5×1 cm arising from the rim of the ASD. Serological analysis was positive for Brucella agglutinin, thus confirming the diagnosis. The brain CT scan revealed a large ischaemic zone in the left hemisphere. At surgery, large vegetations were excised and the defect was closed with fresh pericardium. After surgery the patient was treated with a 4- week course of antibiotics. His recovery was uneventful except for the neurological deficit (hemiplegia); he was discharged on postoperative day 35. Natl Med J India 2016;29:146–7

Right ventricular hydatid cyst ruptured to pericardium.

Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43‑year‑old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.

Prevalence of Giardiasis among children in childcare centers in Kermanshah, Iran.

Background: Giardia is a common and widespread intestinal protozoan parasite which occurs in of both humans and animals. The aim of this study is determining the prevalence rate of Giardiasis in children, Kermanshah childcare centers (2012). Methods: This cross-sectional study was performed on 632 children (330 were female and 302 were male) with an average of 0-6 years in children, Kermanshah childcare centers (2012). Three stool samples were obtained on three consecutive days and were tested for the detection of trophozoites, and/or cysts, using both direct laboratory methods and Formalin-Ether concentration. Informations were collected by a questionnaire. Results: Of the 632 cases in this study, the prevalence rate of gut parasite infection was 169 (26.74%), so that Giardia lamblia with 13.93%, Entamoeba histolytica with 3.48%, and Entamoeba coli with 2.53 were the most predominant isolate. The prevalence rate ranged in rural residents (15.67%) was more than urban residents (11.07%). The age group 4-6 years had the highest rate (14.24%) and 0-2 years the lowest (1.74%); boys with 16.29% had a higher rate than girls (10.45%). Parasitic infection was more prevalent in children whose parents had no high education (17.25). The maximum percentage of infections was in August with 5.86%. Conclusion: With attention to the above findings, it seems that in order to decrease, control and prevent of parasitic infection we should have the necessary public education to teachers and parents of children.

Prevalence of cysticercus of Taenia saginata in cattle slaughtered.

Background: Taenia saginata is a parasite infecting cattle. Human and cattle are as definitive hosts and intermediate hosts, respectively. Humans infected by eating raw or undercooked beef containing larval cysts. The aim of this study was to determine the prevalence rate of T. saginata in cattle in the slaughterhouse of Bistoons Kermanshah (Iran) in 2010-2011. Methods: In order to determine the infection in cattle slaughtered, 100,040 carcasses were observed and inspected along 24 months, from January 2010 until December 2011. Organs like heart, masseter muscles, tongue, triceps muscles, diaphragm, thigh, back ribs, kidney and liver were cut and inspected by eye-and-knife method. Results: In 2010, 29 cases (0.06%) from 48171 and in 2011, 20 cases (0.03%) from 51869 of carcasses were infected. According to the result of this study, the most contaminated organs were heart and tongue. Conclusion: Eye-and-knife method was also less sensitive than standard method (the method used in South Africa, Germany and England) for diagnosis of T. saginata in carcasses.

Adult patent Ductus Arteriosus complicated by endocarditis and hemolytic anemia / Conducto arterioso patente complicado por endocarditis y anemia hemolítica en un adulto

An adult with a large patent ductus arteriosus may present with fatigue, dyspnea or palpitations or in rare presentation with endocarditis. The case illustrated unique role of vegetation of endocarditis in hemolytic anemia in adult with patent ductus arteriosus (PDA). Despite treatment of endocarditis with complete course of appropriate antibiotic therapy and normality of C- reactive protein, erythrocyte sedimentation rate and leukocytosis and wellness of general condition, transthoracic echocardiography revealed large vegetation in PDA lumen, surgical closure of PDA completely relieved hemolysis, and fragmented red cell disappeared from peripheral blood smear. The 3-month follow-up revealed complete occlusion of PDA and abolishment of hemolytic anemia confirmed by clinical and laboratory examination.

Un adulto con un gran ductus arterioso permeable puede presentar fatiga, disnea y palpitaciones y menos frecuentemente presentar endocarditis. El caso muestra el papel de la vegetación de la endocarditis en la anemia hemolítica con el conducto arterioso patente (CAP) en adultos. A pesar del tratamiento de la endocarditis con la terapia antibiótica completa, la normalidad en la proteína C-reactiva, la tasa de sedimentación globular y leucocitaria, y un estado de bienestar general del paciente, la ecocardiografía trans torácica reveló gran vegetación en el lumen de CAP y el cierre completo quirúrgico de PDA, sin hemólisis y la desaparición de glóbulos rojos fragmentados en frotis de sangre periférica. Los 3 meses de seguimiento revelaron oclusión completa de CAP y la desaparición de la anemia hemolítica confirmada por examen clínico y laboratorio.