The effect of open-chest cardiac resuscitation on mitral regurgitant flow: an on-line transesophageal echocardiographic study in dogs.

INTRODUCTION: We sought to determine the effect of cardiac massage on a pre-existing regurgitant mitral valve during open-chest cardiopulmonary resuscitation (OCCPR) in an animal experiment. METHODS: Our study included 29 dogs that were used as experimental models. We anesthetized them and inserted a transesophageal echocardiographic (TEE) probe. Then we performed a transverse thoracotomy, attempting to produce acute mitral regurgitation (MR). In models that showed cardiac arrest we initiated OCCPR to restore cardiac function. The regurgitant area of mitral jet and left ventricular (LV) diameters and volumes were calculated before and during OCCPR using TEE. RESULTS: Ventricular fibrillation and/or electromechanical dissociation occurred in 13 animals (45%). In 4 models without preexisting MR, no additional regurgitation was detected during OCCPR, while in another 5 with preexisting MR we noticed a slight increase in the regurgitant flow. The regurgitant flow area changed from 0.62 +/- 1 cm2 before to 1.1 +/- 0.36 cm2 during OCCPR (p<0.008). In the 4 animals that had severe damage to the mitral apparatus after the attempts, the regurgitant flow increased from 4.01 +/- 0.93 cm2 to 7.7 +/- 2.6 cm2 (p<0.002). The LV transverse diameter decreased from 4.39 +/- 0.62 cm to 1.54 +/- 0.5 cm and its volume from 60.5 +/- 7.14 cm3 to 17.02 +/- 4.14 cm3 (both p<0.001), thus showing the effectiveness of OCCPR. CONCLUSIONS: Given the presence of preexisting mitral regurgitation, direct cardiac massage during OCCPR would probably be less effective than expected, because of an increase in the amount of the regurgitant.

Chest pain and ST-segment elevation in a patient with polymyositis: a case report.

BACKGROUND: Cardiac involvement in patients with polymyositis is well-documented and includes myocarditis, coronary arteritis, pericarditis, valvular dysfunction and arrhythmias. CASE REPORT: There are only few reports of acute myocarditis in patients with polymyositis and, although it usually follows a chronic, mild course, it may occasionally become life-threatening. We describe the case of a 36-year-old young woman suffering from polymyositis who presented with clinical signs and symptoms mimicking an ST Elevation Acute Coronary Syndrome. The atypical features of the pain, the young age of the woman, the lack of significant cardiovascular risk factors and the medical history of an autoimmune disease, led us to reconsider our initial diagnosis towards the presence of focal myocarditis. CONCLUSION: We describe our diagnostic approach and comment on our speculations and decisions about the treatment of such a life threatening event.

Multiple cardiac metastases from a malignant melanoma.

Metastatic tumors in the pericardium or the heart are more common than primary tumors and their incidence has increased during the last decades due to the prolonged survival of patients with cancer and the increased prevalence of the disease in the general population. We present the case of a 36-year-old patient admitted to our hospital due to fatigue, dyspnea, and episodes of dizziness and fainting during the last month. He had a history of a malignant skin melanoma surgically removed 4 years ago. The echo study identified multiple metastases in the heart involving the pericardium, the myocardium and the right atrium, where the tumor was mobile creating mechanical tricuspid valve stenosis. Malignant metastasis was confirmed by pericardiocentesis and, although treatment with chemotherapy was promptly initiated, the patient died 4 months later. Despite the difficulty in clinical diagnosis of cardiac melanoma, early detection has important therapeutic and prognostic implications. Echocardiography is the most common diagnostic modality and transesophageal approach may be the technique of choice to image intracardiac metastatic tumors.

Follow-Up of an Unresectable Hemangioma in the Heart.

We present the case of a patient with a hemangioma, a benign heart tumor, that is revealed incidentally during cardiac catheterization. The patient had coexisting coronary artery disease. This rare tumor remained unchanged in size, and the patient has been asymptomatic for a period of 20 years.