Asymptomatic Huge Cardiac Hydatid Cyst Located in the Interventricular Septum.

The cardiac involvement of hydatid cyst, which is rarely seen, with the location of asymptomatic huge cyst in the interventricular septum (IVS) is an extraordinary condition. We report an isolated cardiac hydatid cyst located in the IVS in an 18-year-old man diagnosed incidentally by transthoracic echocardiography. Cardiac magnetic resonance imaging confirmed a mass lesion of 47×74 mm in diameter located at the base of IVS. The cystic content and its germinative membrane were resected and the cavity was applicated under cardiopulmonary bypass. Postoperative course was uneventful and the patient was discharged on the 6th postoperative day, with oral albendazole therapy.

Asymptomatic huge cardiac hydatid cyst located in the interventricular septum

Abstract The cardiac involvement of hydatid cyst, which is rarely seen, with the location of asymptomatic huge cyst in the interventricular septum (IVS) is an extraordinary condition. We report an isolated cardiac hydatid cyst located in the IVS in an 18-year-old man diagnosed incidentally by transthoracic echocardiography. Cardiac magnetic resonance imaging confirmed a mass lesion of 47×74 mm in diameter located at the base of IVS. The cystic content and its germinative membrane were resected and the cavity was applicated under cardiopulmonary bypass. Postoperative course was uneventful and the patient was discharged on the 6th postoperative day, with oral albendazole therapy.

Do cardiac neuropeptides play a role in the occurrence of atrial fibrillation after coronary bypass surgery?

BACKGROUND: One of the potential mechanisms to explain the occurrence of postoperative atrial fibrillation (AF) is imbalance of autonomic nervous system tone. The myocardium is innervated not only by cholinergic and adrenergic nerves but also by peptidergic nerves that synthesize and secrete neuropeptides. To investigate the possible role of cardiac neuropeptides in the development of AF after coronary artery bypass grafting (CABG), we analyzed the plasma levels of substance P (SubP), neuropeptide Y (NPY), and angiotensin II (Ang II) in patients who underwent elective on-pump CABG. METHODS: This prospective study group included 83 consecutive patients scheduled for elective, on-pump CABG. Depressed left ventricular (LV) function (ejection fraction [EF] less than 0.30), concomitant cardiac procedures, history of atrial fibrillation, second or third degree atrioventricular block, implanted pacemaker, postoperative myocardial infarction, use of class I or III antiarrhythmic drug, and hemodynamic deterioration were exclusion criteria. Preoperative and postoperative serum levels of SubP, NPY, and AngII were measured by radioimmunoassay technique. RESULTS: Postoperative AF occurred in 27 patients (32.5%). Using multivariate logistic regression analyses, only a decrease in SubP level (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 0.767 to 0.99, p = 0.031) and an increase in AngII level (OR = 2.61, 95% CI = 1.002 to 1.021, p = 0.023) after CABG were found to be independently associated with AF. Increased age (p = 0.02), diabetes mellitus (p = 0.023), preoperative use of beta blocker (p = 0.024), proximal right coronary artery involvement (p = 0.024), low preoperative sodium levels (p = 0.023), low LVEF (p = 0.013), and increased mitral E wave deceleration time (p = 0.044) were also associated with AF. CONCLUSIONS: These results indicate that the increase in AngII and the decrease in SubP after CABG may play a role in the occurrence of postoperative AF. Further studies are needed to define the physiologic and pathologic relevance of these substances at the occurrence of AF in patients who undergo CABG.

Biocompatibility of heparin-coated cardiopulmonary bypass circuits in coronary patients with left ventricular dysfunction is superior to PMEA-coated circuits.

BACKGROUND: Several coating techniques for extracorporeal circulation have been developed to diminish the systemic inflammatory response during cardiopulmonary bypass (CPB). The aim of this study was to evaluate the clinical effectiveness and biocompatibility of heparin-coated and poly-2-methoxyethylacrylate (PMEA)-coated CPB circuits on coronary patients with left ventricular systolic dysfunction. METHODS: Thirty-six patients who underwent elective coronary artery bypass grafting were divided into two equal groups: group H (n = 18), heparin-coated; group P (n = 18), PMEA coated. Clinical outcomes, hematologic variables, cardiac enzymes, malondialdehyde (MDA), and acute phase inflammatory response (including myeloperoxidase (MPO), catalase, hsCRP, and IL-8) were analyzed perioperatively. RESULTS: Demographic, CPB, and clinical outcome data were similar for both groups. Plasma fibrinogen, total protein, albumin, and platelet count decreased, neutrophil count, MDA, IL-8, MPO, and catalase levels increased during CPB. During CPB, MPO and catalase values were significantly higher in group P (p = 0.02 and p = 0.01) and postoperative MDA concentration was lower in group H (p = 0.03). Platelet counts were better preserved in group H during and after CPB but neutrophil count and IL-8 level did not differ between the groups. Postoperative total protein, albumin, and fibrinogen levels were higher in group H (p < 0.05). The postoperative first day levels of troponin-I, CK-MB, and CRP increased in both groups without any significant differences between the groups. CONCLUSIONS: Heparin-coated circuit provided better suppression of perioperative inflammatory markers and exhibited more favorable effects on hematologic variables than PMEA-coated circuit.

Effects of posterior pericardiotomy on the incidence of pericardial effusion and atrial fibrillation after coronary revascularization.

BACKGROUND: The aim of this prospective, randomized study was to assess the efficacy of posterior pericardiotomy in decreasing the prevalence of pericardial effusion and postoperative atrial fibrillation (AF). MATERIAL/METHODS: The study was performed in 100 patients who underwent elective coronary artery bypass grafting surgery (CABG) between October 2003 and July 2005. They were randomized to receive posterior pericardiotomy (Group A) or no posterior pericardiotomy (Group B). A 4-cm longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in group A patients. Posterior pericardiotomy was not performed in group B patients. RESULTS: Early pericardial effusion developed in 6 patients (12%) of group A and 21 patients (42%) of group B; no late pericardial effusion developed in group A, but did in 3 patients (6%) of group B. The number of patients who developed postoperative AF was significantly lower in the fenestration group compared with the control group (10% vs. 30%, p < 0.010). The overall incidence of supraventricular tachycardia in patients with early pericardial effusion was significantly higher than in patients without early pericardial effusion (18 patients vs. 9 patients). CONCLUSIONS: These findings suggest that posterior pericardiotomy reduces the prevalence of early pericardial effusion and related AF by improving pericardial drainage in patients undergoing coronary artery bypass surgery.

Mitral annular tumors: report of two cases in childhood.

Primary tumors of the mitral valve are extremely rare especially in the pediatric age group; only a few cases have been reported previously. The clinical appearance of the tumor may mimic other pathological findings of heart structures or remain asymptomatic. We describe two different benign primary cardiac tumors, which were hemangioma and myxoma originating from the anterior annulus of the mitral valve and presenting with an unusual clinical course in two children. Both tumors were resected successfully with mitral valve conservation and there was no recurrence at 6-month and 1-year follow-ups.

Chronic pseudoaneurysm of the aortic arch: a case report.

Pseudoaneurysm of the thoracic aorta is a rare condition and usually occurs following blunt trauma. It is almost fatal in the absence of prompt surgical treatment. We describe the case of a 56-year-old male suffering from intermittent non-massive hemoptysis, mild dysphagia, and atypical chest pain for 1 month who has no history of trauma. A saccular aneurysm at the aortic arch between left common carotid artery and left subclavian artery was diagnosed by magnetic resonance imaging. Intraoperatively, compression of surrounding structures including trachea and esophagus by the aneurysmal sac (6 x 8 cm in diameter) was seen. Pseudoaneurysm adherent to the upper lobe of the left lung was resected and entire aortic arch replacement with a prosthetic graft was performed. Postoperative course was uneventful and neither specific changes on histologic examination nor any evidence of infection could be detected.

Intracardiac extension of intravenous leiomyoma.

Intravenous leiomyoma with intracaval and intracardiac extension is a rare benign neoplasm affecting women. We report a case in which an intravenous leiomyoma originated from the right iliac vein and extended through the inferior vena cava into the right atrium. The correct diagnosis was made intraoperatively, after resection of the intracardiac extension of the tumor, which was 28 cm in length. At the 2nd stage of the operation, a right common iliac venotomy enabled the removal of all residual tumor from the inferior vena cava.

Absence of right superior vena cava and aortic annular hypoplasia in a patient with Turner's syndrome.

Cardiovascular abnormalities are frequently encountered in patients with Turner's syndrome. These include coarctation of the aorta, bicuspid aortic valve, aortic root dilatation, atrial and ventricular septal defects, but absence of the right superior vena cava (SVC) in visceroatrial situs solitus is extremely rare. We report absence of the right SVC and congenital aortic annular hypoplasia with bicuspid aortic valve stenosis in a patient with Turner's syndrome. Aortic root extension with prosthetic valve replacement was performed and absent right SVC, which was detected incidentally during operation, is confirmed by postoperative venous angiogram.

Effects of giant left atrium on thromboembolism after mitral valve replacement.

The aim of this study was to evaluate the incidence of thromboembolic events in patients with giant left atrium ( > 6.5 cm) after mitral valve replacement. From January 2000 to September 2002, a total of 126 patients who had undergone mitral valve replacement were divided into two groups according to the presence or absence of giant left atrium. Group A comprised 34 patients with left atrium over 6.5 cm without compression symptoms and Group B comprised 92 patients. The preoperative variables did not distinguish the patients in each group, except for atrial fibrillation; Group A 85.2% and Group B 61.9% ( p < 0.01). After mitral valve replacement, left atrium mean diameter was significantly decreased in Group A from 8.1 +/- 1.3 mm to 6.2 +/- 1.6 mm ( p < 0.01). There were no significant differences in thrombosis, hemorrhage and thromboembolism rates in both groups. Postoperative clinical and hemodynamic parameters demonstrated a positive clinical response to mitral valve replacement in patients with giant left atrium. During follow-up no direct relationship between thromboembolism and giant left atrium was evident.

Aortic root replacement for reoperation of dissecting aneurysm of the interventricular septum.

Dissection of the interventricular septum due to an aneurysm of the left sinus of Valsalva is a very rare cardiac condition. We report a case in which we used a modified Bentall procedure for aortic root replacement in reoperating on a sinus of Valsalva aneurysm that had dissected into the interventricular septum.

Surgical repair of postoperative left sinus of Valsalva aneurysm dissecting into the interventricular septum.

We describe the dissection of the interventricular septum by unruptured aneurysm of the left sinus of Valsalva in a patient who had undergone aortic valve replacement for rheumatic aortic valve insufficiency 5 years previously. The patient had worn a permanent pacemaker for 1 year to manage complete atrioventricular block. Sufficient information was provided by echocardiography and aortography to confirm the diagnosis. Operative correction consisted of obliteration of the aneurysm sac and closure of the outward orifice with a Dacron patch from the side of the aortic sinus.

Rupture of the abdominal aorta in a 13-year-old girl secondary to Behçet disease: a case report.

Behçet disease is a multisystemic vasculitis of unknown origin. The vascular complications as a result of the disease are rare in the pediatric age group. We report a 13-year-old patient with vasculo-Behçet disease with a ruptured abdominal aortic aneurysm without a formerly known history of Behçet disease. Urgent aortoiliac bypass with a polytetrafluoroethylene graft was performed with success, and the patient has also received corticosteroid and immunosuppressive drug therapy.

Management of primary venous aneurysms.

OBJECTIVE: Venous aneurysms are a relatively rare abnormality. Unlike arterial aneurysms, venous aneurysms are a much less frequent abnormality. The purpose of our study was to review our experience in the management of venous aneurysms. METHODS: Nine patients with venous aneurysms, who had undergone operation in the Department of Cardiovascular Surgery, Yuzuncu Yil University Medical School, Van, Turkey, during the period September 1997 through to May 2003, were included in this study. There were 5 female and 4 male patients, ranging in age from 16-47-years with a mean age of 31 +/- 7 years. They were diagnosed by color flow duplex imaging. Eight patients had saccular aneurysm; the remaining one patient with basilar vein aneurysm, had fusiform aneurysm. RESULTS: Aneurysms were located the lower extremities in 4 cases, the upper extremity in 4, and external jugular vein in one. Aneurysms size ranged from 2, 3 to 5, 5 cm (mean 3, 6 cm). There were no symptoms in 2 patients (cephalic vein aneurysm in one patient, short saphenous vein aneurysm in one). These patients were operated on for cosmetic purposes. Six patients complained of pain associated with a subcutaneous swelling. The remaining one patient with popliteal vein aneurysm complained of extremity pain, associated with deep venous thrombosis. All patients underwent surgery under local anesthesia. In 7 patients, aneurysms were resected and venous continuity with a graft was found unnecessary. End to end anastomosis was performed in 2 patients (popliteal vein aneurysm in one and axillary vein aneurysm in one). During follow up period, there were no recurrences. CONCLUSION: Venous aneurysms may cause thrombophlebitis, thrombus formation, pulmonary embolism and theoretical complication of spontaneous rupture. Varicose veins, hemangiomas, lymphocele, hernias, hygromas, arteriovenous fistulas and similar subcutaneous swellings located subcutaneous venous spaces should be considered in the differential diagnosis. Consequently, we suggest that surgical treatment be performed to prevent subsequent complications in all cases.