Iatrogenic non-coronary leaflet perforation as a complication after robotic mitral valve repair.

Iatrogenic aortic regurgitation secondary to leaflet injury is a rare complication of mitral valve surgery. For the first time, we report a patient who had progressive aortic regurgitation due to non-coronary leaflet perforation after robotic mitral valve repair and required aortic valve repair 18 months after this initial surgery. As in our case, aortic regurgitation after mitral valve surgery may remain undiagnosed on intraoperative transesophageal echocardiography or undetected until the patient's discharge due to gradual enlargement of very small perforations over the postoperative course.

Short and oral antimicrobial therapy for diabetic foot infection: a narrative review of current knowledge.

Diabetic foot infection is a frequent complication in long-standing diabetes mellitus. For antimicrobial therapy of this infection, both the optimal duration and the route of administration are often based more on expert opinion than on published evidence. We reviewed the scientific literature, specifically seeking prospective trials, and aimed at addressing two clinical issues: (1) shortening the currently recommended antibiotic duration and (2) using oral (rather than parenteral) therapy, especially after the patient has undergone debridement and revascularization. We also reviewed some older key articles that are critical to our understanding of the treatment of these infections, particularly with respect to diabetic foot osteomyelitis. Our conclusion is that the maximum duration of antibiotic therapy for osteomyelitis should be no more than to 4-6 weeks and might even be shorter in selected cases. In the future, in addition to conducting randomized trials and propagating national and international guidance, we should also explore innovative strategies, such as intraosseous antibiotic agents and bacteriophages.

Takotsubo cardiomyopathy in a patient with multiple autoimmune disorders and hyperthyroidism.

Takotsubo cardiomypathy is a very rare cardiovascular syndrome leading to myocardial infarction and left ventricular dysfunction in the absence of a detectable coronary artery lesion. It is accepted as reversible left ventricular asynergy occuring typically after an intrinsic adrenergic hyperstimulation. In this report we present Takotsubo cardiomyopathy in a 75-year-old patient with multiple autoimmune disorders.

Giant floating thrombus localized in the ascending aorta.

We report the case of a 32-year-old male patient with symptoms of cerebrovascular accident manifesting with dysarthria. A transesophageal echocardiogram showed a floating mass localized in the ascending aorta, and a multislice computed tomography evaluation confirmed the diagnosis. With a comprehensive assessment of the mass, we decided on surgical intervention. A pedunculated and fragile mass was seen just near the right coronary ostium. The measured dimensions were 7.7 x 1.0 x 1.5 cm. The removed mass has been analyzed histopathologically and found to be the cause of the neurologic findings with an uncertain underlying etiology.