Supravalvar mitral ring: a case report

Supravalvar mitral ring is a rare congenital heart defect of surgical importance. The condition is characterized by an abnormal ridge of the connective tissue on the atrial side of the mitral valve. It often substantially obstructs the mitral valve inflow. We herein introduce a case of a supravalvar mitral ring in a 17-year-old male, who was admitted to our hospital with cardiac syncope. He had undergone a cardiac operation for ventricular septal defect [VSD] closure and mitral valve repair 15 years before. Transthoracic echocardiography, transesophageal echocardiography, and finally cardiac catheterization revealed a neglected supravalvular mitral ring. The ring was resected in a second operation, and the patient was discharged from the hospital symptom free

Correlation between blood levels of adhesion molecules ICAM-1 and VCAM-1 and thrombomodulin with coronary artery disease

The results of studies on coronary artery disease risk factors have demonstrated that some adhesion molecules could be risk factors for coronary artery disease. ICAM-1 and VACM-1 are the most important adhesion molecules. On the other hand, thrombomodulin is an anti-inflammatory factor and can reduce the risk for coronary artery disease. In this study, as well as evaluating these factors, we also studies the effect of the interaction between these factors on coronary artery disease. One hundred twenty-three patients between the ages of 45 and 70 years old who were admitted for coronary angiography in the cardiovascular center and met the inclusion criteria for the research, were selected in the first half of 2008. After recording their personal information and medical history in the questionnaires, blood samples were collected and after routine examination, the blood levels of these factors were measured. WE then entered the acquired results of the blood examination and the angiography in the patients' charts and analyzed the results using statistical methods. The angiography results in patient showed that 18 [14.7%] had normal coronary arteries, 5 [4%] had minimal coronary artery disease, 40 [32.5%] had single-vessel disease, 25 [20.3%] had two-vessel disease, and 35 [28.5%] had three-vessel disease. In laboratory tests, the mean soluble ICAM-1 level in patients with normal coronary arteries was 236 ngr/mL; however, in patients with coronary artery disease, the mean level was 274 ngr/mL. The average amount of VCAM-1 in patients with normal coronary arteries was 697 ngr/mL, whereas patients with coronary artery disase had an average of 108 ngr/mL. Thrombomodulin in the normal coronary artery group was 42 ngr/mL, but in patients with coronary artery disease the average level was 30 ngr/mL. The results in this research showed that increased levels of soluble ICAM-1 and also decreased levels of soluble thrombomodulin increased the risk and intensity of coronary artery disease, with statistical significance. The increase in soluble VCMA-1 also increased the risk of coronary artery disease; this was, however, not statistically significant. The important point is that increased levels of soluble ICAM-1 is a risk factor when the level of thrombomodulin is normal or below normal. When the levels of thrombomodulin and ICAM-1 have both increased, the increased risk and intensity of coronary disease is not statistically important

Fungal endocarditis: review of our cases over a four-year period

Over a 4-year period, we studied six cases of fungal endocarditis, four of which were caused by Aspergillus sp. And the other two were candidal in origin. Both sides of the heart showed involvement by these infections. The vegetations of infective endocarditis tend to vary in size, but fungal lesions are often large. Our youngest patient was four months old and the oldest one was 62 years old. A high index of clinical suspicion, together with histopathological and microbiological studies, can be used as tools to diagnose and treat such patient in due course. It is important to send fresh specimens for tissue culture studies in sterile normal saline and not in fixatives such as formaladehyde. Pathologically, not only are the special staining methods such as Periodic acid-Schiff useful in the demonstration of fungal elements in tissue or vegetation sections, but also the routine hematoxylin and eosin stain is capable of showing these structures clearly

Intraluminal ascending aorta fibroma

Primary cardiac tumors are quite rare, especially in the pediatric age group, and their atypical presentation often prevent a timely diagnosis. Most primary cardiac tumors in the pediatric age group are benign. Fibromas are generally reported as the second most common primary cardiac tumors in the pediatric age group. These neoplasms are often intramural and involve the left ventricular free wall or the interventricular septum. Although benign, fibromas may become life-threatening by causing arrhythmias or obstruction to the blood flow. A case of supravalvular intraluminal ascending aorta fibroma in a 23-month-old girl, presenting with syncope, is described here; the location is rare and the presentation atypical for this type of tumor. Transesophageal echocardiography helped us to evaluate the anatomic details of the tumor and plan surgery

Correlation between blood levels of CRP, TNT-alpha [as inflammatory factors], and IL-10 [as anti-inflammatory factor] and coronary artery disease

The results of a great amount of research done the world over in recent years have indicated that atherosclerosis is an inflammatory disease. Most of these investigations were conducted on the correlation between inflammatory factors such as CRP, Il- and Il-1 and atherosclerosis. In this study, we evaluated inflammatory factors such as CRP and TNF-alpha as well as anti-inflammatory factor IL-10 and analyzed the correlation between the balance of these factors with atherosclerosis. In total, 135 patients between the ages of 45 and 70 years who were admitted for coronary angiography were selected. All of the selected patients met the inclusion criteria for the research. After recording personal information, medical history, and any previous treatment in the questionnaire, blood samples were collected and levels of CRP [high-sensitive quantitative test], TNF-alpha, and IL-10 were measured in all the samples. We entered the acquired results, the routine blood examination, and the angiography results in the patients' charts and analyzed the results using statistical methods. The angiography results in the 135 patients were as follows: 19 [14.1%] cases had normal coronary arteries, 6 [4.4%] had minimal CAD, 43 [31.8%] had single-vessel disease, 29 [21.5%] two-vessel, and 38 [28.1] had three-vessel disease. In the laboratory tests, the mean CRP level in patients with normal coronary arteries was 6 +/- 4 mg/l, however in patients with CAD it was 17 +/- 9 mg/l. Also, the mean IL=10 level in cases with normal coronary arteries was 4.4 pgr/mL, while in patients with CAD it was 2.6 pgr/mL, and serum level of TNF-alpha in patients with CAD was 6.2 +/- 3.8 pgr/mL, whereas in cases with normal coronary arteries, the average serum level of TNF-alpha was 4.5 +/- 2.2 pgr/mL. The obtained results in this research showed a direct correlation between the blood levels of CRP and TNF-alpha with the existence and intensity of coronary artery disease. In addition, we found a reverse significant correlation between blood levels of IL-10 and existence of coronary artery disease. Although we found a correlation between reduced levels of IL-10 and intensity of coronary artery disease, it was not statistically significant. Furthermore, in patients with elevated blood levels of inflammatory and antiinflammatory factors, the intensity of the coronary artery disease was far less than that in patients with high levels of inflammatory factors and reduced levels of antiinflammatory factors. Therefore, we concluded that high levels of CRP and TNF-alpha and low levels of IL-10 had a significant correlation with the intensity of coronary artery disease and also the balance between these factors had a significant correlation with the intensity of the coronary artery disease

Congenital left ventricular diverticulum associated with ASD, VSD, and epigastric hernia

Congenital left ventricular diverticulum is a rare cardiac malformation. Two categories of congenital ventricular diverticulum have been identified with regard to their localization: apical and non-apical. Apical diverticula are always associated with midline thoraco-abdominal defects and other heart malformations. Non-apical diverticula are always isolated defects. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging, or left ventricular angiography. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities, and possible complications. We report a 10-month-old girl with left ventricular apical diverticulum, large atrial septal defect, two small muscular ventricular septal defects, and pulmonary hypertension, associated with epigastric hernia. This patient underwent total surgical repair for intra-cardiac defects as well as diverticular resection

Modified Blalock-Taussig shunt and giant perigraft reaction

This is a case of a modified Blalock-Taussig shunt, which was complicated by perigraft transudative, fibrinous fluid accumulation and recurrence after surgical intervention. Follow-up and expectant management of the patient was successful. Our experience regarding this complication is presented