Late diagnosis of Kawasaki disease with major cardiovascular complications: a case report.

Background: Kawasaki disease (KD) is an acute systemic vasculitis syndrome, mostly targeting children under 5 years old. If untreated, coronary artery abnormalities develop to approximately one out of four patients who suffered from KD. As KD might be easily missed in childhood, managing cardiovascular complications might become a real challenge at an advanced age. Case summary: A 25-year-old woman was presented to a skying resort hospital with discomfort in chest, shortness of breath, cold sweat, and dizziness after skiing. Based on increased troponin level and ECG findings, the specialists diagnosed myocarditis and initiated treatment with non-steroidal anti-inflammatory drugs. After the symptoms recurred in half a year, there was a need for further clarification of the diagnosis of myocarditis. The patient received a comprehensive cardiac imaging evaluation at Vilnius University Santaros Clinic to differentiate the cause of the recurrent chest pains. Coronary artery computed tomography revealed presence of aneurysm with wall calcification in left anterior descending artery S6-10 mm in diameter and aneurysm of circumflex artery S11-7 mm in diameter as well as occlusion of calcified right coronary artery. After taking a detailed medical history, a presumption about a former case of KD has been made. Discussion: Coronary artery aneurysm is a cardiovascular sequelae of KD if it is left untreated. Due to atypical presentation, it might be overlooked, while the key of successful KD management is an early diagnosis and therapy.

Predictors of ischaemic mitral regurgitation recurrence in patients undergoing combined surgery: additional value of cardiovascular magnetic resonance imaging.

OBJECTIVES: We aimed to evaluate (i) the effectiveness of combined surgery (coronary artery bypass grafting with restrictive mitral valve annuloplasty) and (ii) the late gadolinium enhancement cardiovascular magnetic resonance-based predictors of ischaemic mitral regurgitation (IMR) recurrence. METHODS: The prospective analysis included 40 patients with multivessel coronary artery disease, IMR >II° and left ventricular (LV) dysfunction undergoing combined surgery. The degree of IMR and LV parameters were assessed preoperatively by transthoracic echocardiography, 3D transoesophageal echocardiography and cardiovascular magnetic resonance and postoperatively by transthoracic echocardiography. The effective mitral valve repair group (n = 30) was defined as having recurrent ischaemic mitral regurgitation (RIMR) ≤II° at the end of follow-up (25 ± 11 months). RESULTS: The surgery was effective: freedom from RIMR >II° at 1 and 2 years after surgery was 80% and 75%, respectively. Using multivariable logistic regression, 2 independent predictors of RIMR >II° were identified: ≥3 non-viable LV segments (odds ratio 22, P = 0.027) and ≥1 non-viable segment in the LV posterior wall (odds ratio 11, P = 0.026). Using classification trees, the best combinations of cardiovascular magnetic resonance-based and 3D transoesophageal echocardiography-based predictors for RIMR >II° were (i) posterior mitral valve leaflet angle >40° and LV end-systolic volume index >45 ml/m2 (sensitivity 100%, specificity 89%) and (ii) scar transmurality >68% in the inferior LV wall and EuroSCORE II >8 (sensitivity 83%, specificity 78%). CONCLUSIONS: There is a clear relationship between the amount of non-viable LV segments, especially in the LV posterior and inferior walls, and the recurrence of IMR after the combined surgery.

[Follow-up results after left ventricular geometry and volume restoration operations in patients with postinfarctic aneurysm]. / Kairiojo skilvelio geometrijos ir turio atkurimo operaciju velyvieji rezultatai.

UNLABELLED: Fifty patients underwent surgery due to reconstruction of the left ventricular volume and geometry together with heart revascularisation since 1999.02 till 2002.05 of Clinic of Heart Surgery, Vilnius University and Vilnius Heart Surgery Center. Forty eight patients were evaluated in late postoperative period at 3-44 months after the surgery. The functional status of patients improved and the mean NYHA functional class went down from 3.75 till 2.31 (p<0.01). The mean left ventricular ejection fraction significantly raises after operation from 31.8 to 37.8%. Twelve patients in late postoperative period had symptoms of congestive heart failure. These patients had a large asynergy and most intraventricular conductivity disturbances preoperatively. The left ventricular ejection fraction after operation for these patients had no changes and compared with good filling patients they still had larger asynergy. CONCLUSIONS: 1. The functional status of most patients improved after the operation. 2. The left ventricular ejection fraction became better after operation. 3. The stability of good results after 3 years was 65%. 4. Long- term survival after 3 years was 89%.

[Early and late postoperative results of mitral and tricuspid valve insufficiency surgical treatment using edge-to-edge central coaptation procedure]. / Mitralinio ir triburio voztuvu nesandarumo korekcijos centrines buriu koaptacijos metodu ankstyvieji ir velyvieji rezultatai.

Edge-to-edge approximation of the mitral leaflets and creation of a double-orifice mitral valve (Jatene-Alfieri procedure), for mitral regurgitation surgical treatment was effective in most cases, especially for patients who had rheumatic and degenerative valve disease, traumatic or ischemic mitral valve insufficiency. Positive results of double-orifice technique encourages to use this method to correct some forms of tricuspid insufficiency. Triple-orifice repair procedure is a lot more effective to correct central prolapses in all of the three leaflets (extraordinary elongated chordaes) and/or degenerative tricuspid annular dilation than the ordinary routine procedures. This study aims to evaluate early and long-term postoperative outcomes for 29 patients after mitral double-orifice and/or triple orifice repair procedures. It also determines clinical and echocardiographic results at follow-up period for more than two years.