What Do We Know So Far About Ventricular Arrhythmias and Sudden Cardiac Death Prediction in the Mitral Valve Prolapse Population? Could Biomarkers Help Us Predict Their Occurrence?

PURPOSE OF THE REVIEW: To summarize currently available data on the topic of mitral valve prolapse (MVP) and its correlation to the occurrence of atrial and ventricular arrhythmias. To assess the prognostic value of several diagnostic methods such as transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance, cardiac computed tomography, electrocardiography, and electrophysiology concerning arrhythmic episodes. To explore intra and extracellular biochemistry of the cardiovascular system and its biomarkers as diagnostic tools to predict rhythm disturbances in the MVP population. RECENT FINDINGS: MVP is a common and mainly benign valvular disorder. It affects 2-3% of the general population. MVP is a heterogeneous and highly variable phenomenon with three structural phenotypes: myxomatous degeneration, fibroelastic deficiency, and forme fruste. Exercise intolerance, supraventricular tachycardia, and chest discomfort are the symptoms that are often paired with psychosomatic components. Though MVP is thought to be benign, the association between isolated MVP without mitral regurgitation (MR) or left ventricle dysfunction, with ventricular arrhythmia (VA) and sudden cardiac death (SCD) has been observed. The incidence of SCD in the MVP population is around 0.6% per year, which is 6 times higher than the occurrence of SCD in the general population. Often asymptomatic MVP population poses a challenge to screen for VA and prevent SCD. Therefore, it is crucial to carefully assess the risk of VA and SCD in patients with MVP with the use of various tools such as diagnostic imaging and biochemical and genetic screening.

Coronary anomalies diagnosed with transesophageal echocardiography: complementary clinical value in adults.

INTRODUCTION: Coronary arteriography remains a gold standard for the evaluation of coronary anatomy. In the case of anatomical anomalies, understanding of vessel course based upon a coronary angiogram may be difficult. Transesophageal echocardiography is a noninvasive method allowing tomographic visualization of proximal coronary arteries. Experience concerning its usefulness for the assessment of anomalous coronary arteries is limited. MATERIAL: Eleven patients with confirmed coronary anomalies studied between 1993-96 were identified in the cohort of those undergoing transesophageal echocardiography. RESULTS: Transesophageal echocardiography revealed potentially serious anomalies (origin of left or right coronary artery from contralateral aortic sinus) in 3 patients and benign in 8. Coronary ostia and proximal course could be delineated in all patients. Anatomical information was consistent between methods, except for a separate origin of the left anterior descending and circumflex artery, where the angiogram missed a very short common left main coronary artery in 2 patients. The relationship between the coronary arteries, aorta and pulmonary trunk was better defined by the echocardiogram. Doppler flow analysis allowed us to exclude anomaly-related flow disturbances. CONCLUSIONS: Transesophageal echocardiography can be considered as a noninvasive technique with the potential for anatomical and functional evaluation of anomalous proximal coronary arteries and deserves a routine use whenever such a condition is suspected. This approach may simplify invasive procedures in this patient group.

[Constrictive pericarditis in a patient following prosthetic aortic valve replacement caused by postpericardiotomy syndrome]. / Zaciskajace zapalenie osierdzia u chorego po wszczepieniu sztucznej zastawki aortalnej powiklanym zespolem po perikardiotomii.

A case of a 53-year old man is presented who developed postpericardiotomy syndrome and subsequently constrictive pericarditis following prosthetic aortic valve replacement due to severe aortic stenosis. The diagnosis was based on clinical picture and confirmed invasively. Nearly total excision of thickened fibrous pericardium resulted in a slow but full disappearance of constriction signs.

[Dissecting aortic aneurysm complicated by rupture of the right coronary artery and acute myocardial infarction--in a person treated with fibrinolysis]. / Tetniak rozwarstwiajacy aorty wstepujacej powiklany odwarstwieniem prawej tetnicy wiencowej i zawalem serca--u osoby laczonej fibrynolitycznie.

A case report of 45-year-old woman with acute inferior wall and right ventricle myocardial infarction treated with i.v. Streptokinase is presented. Few days later acute aortic dissection involving right coronary artery was detected. After six days the patient was successfully operated. She is in good condition 10 months afterwards.