Multimodality imaging in assessment of mitral valve tumors: An unusual papillary fibroelastoma?

Mitral valve masses are uncommon. These tumors and tumor-like lesions may have similar morphological and clinical characteristics, but different outcomes. Unlike valvular tumors, caseous calcification of the mitral annulus (CCMA) is a benign degenerative disorder, commonly misdiagnosed, thus differentiating it from other mitral valve masses is important to avoid unnecessary surgery. Multimodality imaging can prove a valuable tool for definitive diagnosis. We present a case of a 72-year-old female patient, with coronary artery disease, referred for angina symptoms. Echocardiography detected a mass in the mitral valve annulus. Cardiac magnetic resonance imaging showed a mobile mass respecting the myocardium suggestion an atypical papillary fibroelastoma and surgery was indicated. However, the definitive diagnosis, after histological examination, was CCMA. The aim of this case report is to illustrate the difficulty in differentiating between mitral valve masses and the repercussion on the subsequent management, emphasizing the pivotal role of multimodality imaging.

The silent invader: a case of intrapericardial hydatid cyst with exceptional pulmonary artery involvement.

A 70-year-old woman was referred to our cardiology department for the management of dyspnoea. Cardiovascular examination revealed a loud P2, with no sign of right-sided heart failure. Chest X-ray showed a convex left medium cardiac border and a double contour along the right cardiac border. Transthoracic echocardiogram revealed a cystic mass attached to the right ventricle apex. Computed tomography scan showed cyst with fluid density on the apex of the right ventricle; and a honeycomb-like aspect cyst with partial occlusion in the left pulmonary artery. Cardiac magnetic resonance imaging revealed the presence of hydatic intrapericardial cyst that compresses the right ventricular apex; associated with intraluminal left pulmonary artery cyst. Hydatic serology was positive. The patient refused surgery and was discharged on a regimen of Albendazole. She has been followed up closely with a good outcome.

Abnormal Origin of the Left Coronary Artery From the Pulmonary Artery Discovered at Age 67: What to Do?

Anomalous left coronary artery from the pulmonary artery (ALCAPA) was described by Abbott in 1908. In most cases, it is an isolated lesion, being the most common cause of myocardial ischemia in children. The associated mortality rate without intervention reaches 90% during childhood. We report the case of a 67-year-old woman, who underwent coronary angiography for investigation of atypical chest pain and was found to have ALCAPA. The patient refused surgery and has remained asymptomatic on a medical regimen.

Transposition of the great arteries in situs inversus totalis.

A rare case of a newborn with situs inversus totalis associated with simple transposition of the great arteries is reported. A successful anatomical surgical repair was accomplished on day 10 of life, consisting of an arterial switch operation with reimplantation of the coronary arteries.

Congenital native interruption of aortic arch in an adult: extra-anatomic approach by right-side thoracotomy.

We outline the case of an 18-year-old male patient with a congenital nonoperated interruption of the aortic arch. A right thoracotomy without cardiopulmonary bypass facilitated repair through an extra-anatomic bypass between the ascending and the supradiaphragmatic descending aorta. Results for the immediate and 2-year radiologic and clinical check-up were satisfactory. The most common complications in anatomic correction are stroke under selective cerebral perfusion, risk of paraplegia, and hemorrhage. We present a new technique for repair of interruption of the aortic arch in adults that avoids the need for extended dissection of the aorta and a partial occlusion clamp during anastomosis and allows for cerebral and medullar perfusion.