Case report: Diagnosis, management and evolution of a bulky and invasive cardiac mass complicated by complete atrioventricular block.

Introduction: Cardiac lymphoma is a rare but serious disease that is usually located in the right heart. The symptoms (dyspnea, respiratory distress, fatigue, syncope…) are not specific and depend on the mass location. Cardiac magnetic resonance has a crucial role in the diagnostic strategy but biopsy is mandatory to confirm the diagnosis. Case presentation: We report the case of a 63-yeart old man who presented with severe dyspnea and complete atrioventricular block (AVB). A bulky and invasive mass was found in the left atrium extending to the right atrium through the interatrial septum. A cardiac lymphoma was suspected by cardiac magnetic resonance (CMR) imaging and confirmed by transvenous biopsy. The patient was treated with urgent chemotherapy (R-CHOP) and pacemaker implantation. After 4 cycles of R-CHOP the patient was in complete remission with total disappearance of the mass and return of a spontaneous sinus rhythm. Conclusion: lymphoma is a therapeutic emergency as appropriate treatment can lead to complete remission even when the mass is extensive and invasive. Complete AVB is a potentially reversible complication of cardiac lymphoma, and the decision to implant a pacemaker must be carefully weighed.

Evaluation of a new invasive continuous cardiac output monitoring system: the truCCOMS system.

OBJECTIVE: To compare measurements of cardiac output using a new pulmonary artery catheter with those obtained using two "gold standard" methods: the periaortic transit time ultrasonic flow probe and the conventional pulmonary artery thermodilution. DESIGN: Prospective clinical trial. SETTING: Cardiac surgery operating room and surgical ICU in a university hospital. MATERIAL AND METHODS: In the operating room, a new pulmonary artery catheter (truCCOMS system) was inserted in eight patients. A periaortic flow probe was inserted in four of them. Measurements of cardiac output obtained with the truCCOMS catheter and with the flow probe were compared at different phases of the surgical procedure. In the intensive care unit, the cardiac output displayed by the truCCOMS monitor was compared with the value obtained after bolus injection performed subsequently. RESULTS: In the operating room (70 measurements), the coefficient of correlation between cardiac output measured by the flow probe and the truCCOMS system was r2 = 0.79, the bias was +0.11 l/min with a precision of 0.47 l/min, and limits of agreement -0.83 to +1.05 l/min. In the intensive care unit (108 measurements), the coefficient of correlation between cardiac output measured by thermodilution and the truCCOMS system was r2 = 0.56, the bias was -0.07 l/min, the precision was 0.66 l/min, and the limits of agreement were -1.39 to +1.25 l/min. CONCLUSION: The truCCOMS system is a reliable method of continuous cardiac output measurement in cardiac surgery patients.