Déjà vu: is your patient a twin?

Coronary artery disease is the leading cause of death worldwide. Hereditary and environmental factors have a strong impact on coronary artery disease development. The exact incidence of this disease and its characteristics among identical twins is unknown. Despite a limited amount of documented cases, several characteristics can be drawn: coronary artery disease is expressed at an early age, the onset of symptoms occurs within a short time span between the twins, the coronary pathology is often very similar and the metabolic and biochemical profiles are generally alike. We present a case of identical male twins with a near simultaneous clinical presentation of coronary artery disease, who initially underwent unsuccessful percutaneous coronary intervention due to chronic total occlusion and finally, coronary artery bypass grafting. In the case of identical twins, it is imperative to aggressively screen the asymptomatic twin of the symptomatic patient irrespective of young age or absence of symptoms.

Postpartal right ventricular thrombosis.

The discovery of an intracardial mass in patients presents a serious diagnostic dilemma. The differential diagnosis of this condition may seem abundant, but myxomas and intracardial thrombosis are the most frequent diagnoses. A connection between pregnancy and the presence of thrombosis has been documented frequently. Normal pregnancy leads to changes of the coagulative and fibrinolytic status toward a hypercoagulable condition which has its own physiological justification (the risk of blood loss decreases during labor). The case of a patient suffering from postpartal right ventricular thrombosis, which was successfully resolved by surgery as described in this contribution, demonstrates the value of a multidisciplinary approach.