A recidivant primary cardiac osteosarcoma: the role of bone scans.

Primary cardiac tumors are infrequent, less than 15-20% are malignant, and most of them are sarcomas. Primary recidivant cardiac osteosarcomas are extremely rare, only a few cases have been reported, and the prognosis is ominous. We report a case of a primary cardiac osteosarcoma in a 70-year-old woman who was admitted to the hospital for evaluation of congestive heart failure. Despite the wide resection of the tumor, a local and metastatic recurrence was diagnosed. In this report, we illustrate the utility of image techniques for the diagnosis and the monitoring of primary cardiac tumors, especially the role of bone scintigraphy. This technique is not a routine procedure for the cardiologist, but it has been very useful in this case in order to decide the optimal treatment.

Infective endocarditis of unusual location following surgical correction of a complex congenital heart disease.

A 40-year-old woman from Ecuador diagnosed with a complex congenital heart disease was admitted complaining of fever chills, night sweats, and productive cough 6 months after surgical correction of the anomalies. An echocardiography showed vegetations located on the interatrial pericardium patch. To the best of our knowledge, this is the first reported case of postoperative infective endocarditis on this location.

Aspergillus aortitis after cardiac surgery.

OBJECTIVES: The aim of this study was to describe the clinical characteristics of Aspergillus aortitis in a small series of consecutive patients. BACKGROUND: Aspergillus infection of the ascending aorta after cardiopulmonary bypass surgery has rarely been reported and has always resulted in death. METHODS: Aspergillus aortitis was confirmed by pathologic and microbiologic analysis in eight men (61 +/- 8 years) of 9,375 consecutive patients who underwent cardiac surgery between 1975 and 2000. RESULTS: Patients presented with Aspergillus aortitis after aortic valve replacement (n = 5), coronary revascularization (n = 2), or both (n = 1). Initial symptoms appeared between the immediate postoperative period and up to two years after surgery. All patients had prolonged fever. Ante-mortem diagnosis was established in only three patients for whom transthoracic echocardiography was suggestive of aortic pseudoaneurysm and was confirmed by thoracic computed tomography or aortography. All patients had negative peripheral blood cultures. Seven patients died at short-term follow-up, and the one surviving patient was promptly treated by surgery and antifungal drugs. Pathologic examination confirmed Aspergillus aortitis with multi-organ dissemination without heart involvement in all patients except for two, in whom aortic valve endocarditis was found. Fungal cultures confirmed the presence of Aspergillus fumigatus in all patients. CONCLUSIONS: Aspergillus aortitis is typically found after aortic valve or coronary surgery. It commonly leads to lethal multi-organ dissemination without involvement of the intracardiac structure. This entity should be considered in patients with persistent fever and negative blood cultures after open-heart surgery involving significant aortic wall damage, irrespective of the postoperative period.

Endocarditis por coxiella burnetii: evolución a largo plazo de 20 pacientes / Coxiella burnetii endocarditis: Long term follow up of 20 patients

Introducción y objetivos. Coxiella burnetii es una causa cada vez más frecuente de endocarditis infecciosa de evolución subaguda asociada a una elevada morbimortalidad. Nuestro objetivo fue analizar, en una serie de 20 pacientes, la evolución clínica, serológica y terapéutica a largo plazo. Métodos. Se estudiaron retrospectivamente 20 pacientes ingresados (13 varones y 7 mujeres con una edad media de 42 ñ 10 años) entre 1982 y 1996, que cumplían criterios de Duke modificados por Raoult para endocarditis por fiebre Q. Resultados. La endocarditis asentó sobre prótesis valvular en 14 pacientes y sobre válvula nativa en 6. Todos excepto uno recibieron tratamiento antibiótico, presentando la doxiciclina en monoterapia peor resultado que combinada con otros fármacos. Fueron sometidos a recambio valvular 15 pacientes, siendo la causa más frecuente la disfunción protésica. La mortalidad global fue del 40 por ciento (8 pacientes). Actualmente, todos los pacientes mantienen valores de anticuerpos antifase I elevados tras un seguimiento entre 19 y 156 meses (media de 74 ñ 47 meses). En 5 pacientes se suspendió el tratamiento antibiótico, dada la negatividad microbiológica valvular, permaneciendo asintomáticos tras 15-65 meses (32 ñ 30) de seguimiento. Conclusiones. La endocarditis por fiebre Q se asocia a un alto índice de complicaciones severas que requieren cirugía de sustitución valvular. Todos los pacientes mantienen títulos serológicos elevados de forma crónica, sin otros datos de infección activa, lo que plantea la posibilidad de retirar el tratamiento en algún enfermo con negatividad valvular microbiológica y cuestiona el valor de la persistencia de una serología anormal como monitorización del tratamiento (AU)