LEFT ATRIAL, LEFT ATRIAL APPENDAGE AND PULMONARY VEINS ANATOMICAL VARIANTS IN PATIENTS WITH ATRIAL FIBRILLATION VERSUS PATIENTS IN SINUS RHYTHM.

The aim of the study is to evaluate by multidetector computed tomography (MDCT) the prevalence, location and size of LA (left atrial) diverticula and accessory appendages, the prevalence of PVs anatomical variants and LAA (left atrial appendage) shapes in patients with atrial fibrillation (AF) compared to patients in sinus rhythm (SR). Images obtained by MDCT in a group of 100 patients with <1 year paroxysmal or persistent AF prior to radiofrequency catheter ablation and in a group of 100 patients in SR with unconfirmed or insignificant (<50%) coronary arteries stenoses were compared. The prevalence of LA diverticula (22% in AF group, 19% in SR group) and accessory appendages (6% in AF group, 5% in SR group) was not significantly different between the two groups. Similar sizes of LA diverticula and accessory appendages were registered in patients with AF and in SR. The prevalence of a common left venous trunk was significantly higher in patients with AF (30%) compared to patients in SR (18%) (p=0.047) and proved to be an independent predictor for AF (odds ratio (OR) 1.32; 95% confidence interval (CI) 0.93-1.51; p=0.002) at multivariate logistic regression. LAA had a complex shape but no significant differences concerning the prevalence of the 4 major types were registered between the groups. In conclusion, the only parameter associated with AF was the presence of a left common trunk suggesting that it is either a consequence or a predisposing factor for the development of AF.

Subacute fungal endocarditis due to Acremonium spp: a case study and review of the literature.

A 52 years old patient is hospitalized in June 2007 in the Cardiology Clinic of Cardiovascular Diseases Medical Institute in Iasi with suspected subacute infectious endocarditis. Echocardiography shows mobile vegetation on the pulmonary valve. Acremonium spp is isolated from blood cultures after 2 weeks of incubation. The patient was treated with fluconazole, but died after 3 months due to renal failure.

Aortocoronary bypass graft patency assessed by coronary computed tomography angiography--unicentric study.

UNLABELLED: Coronary artery bypass graft (CABG) surgery is used to revascularize ischemic myocaydium affected by coronary artery obstruction. Conventional coronary angiography (CCA) is an invasive method used for graft evaluation. Nowadays, in post CABG patients grafts can be assessed noninvasively by using coronary computed tomography angiography (CCTA). AIM: To determine the late patency rate in coronary bypass grafts using CCTA. METHODS: To assess graft patency, sixty post CABG patients (51/60 males and 9/60 females) were evaluated using dual source computed tomography (DSCT) angiography. All patients underwent a primary isolated CABG surgery between January 2000 and December 2004, performed by a single surgeon, at the Dartment of Cardiovascular Surgery, "Prof. Dr. George I. M. Georgescu" Institute for Cardiovascular Diseases, Iasi, Romania. The grafts were classified as patent, occluded and stenotic (stenosis >50%). RESULTS: The mean age of patients was 68.05-7.59 years and the mean time after graft implantation was 129.53-16.74 months. The number of assessed grafts was 200, including 146 saphenous vein grafts (SVG) and 54 in situ left internal mammary artery (LIMA) grafts. A total number of 105/146 (71.92%) venous grafts and 52/54 (96.3%) arterial grafts were patent. CONCLUSION: Nowadays, computed tomography angiography is a modern noninvasive imaging modality used to evaluate the aortocoronary graft patency in early and late postoperative settings. In our study, the late saphenous graft patency rate was superior to that found in earlier angiographic studies.

Pathological comparative assessment of two cases of thymic cyst and cystic thymoma and review of the literature.

Cystic changes of the thymus are rare lesions. In addition to their appearance in non-neoplastic congenital and acquired conditions, they have been seen in association with certain malignancies of the thymus. Our aim is to highlight the possibility of confusing between benign and malignant thymus cysts having different cure approach. We report two thymic cyst cases, one congenital ectopic condition, and the other one, a cystic thymoma. Investigations included blood counts, echograms, and computed tomography. The cysts were excised by mediastinal route and examined pathologically. The final diagnosis was made only after histopathological examination of the surgery biopsy revealing two types of cystic thymic lesions: congenital and tumoral. Because thymic cysts may present malignant transformation, they represent a diagnostic challenge that is resolved only by surgical excision and histological examination. Due to cystic changes masking tumoral features in these cases, thorough sampling is required to ensure that a malignancy is not overlooked.

[Postoperative upper gastrointestinal bleeding in patients with cardiovascular surgery]. / Hemoragia digestiva superioara postoperatorie la pacientii cu interventie chirurgicala cardio-vasculara studiu prospectiv.

UNLABELLED: Patients with cardio-vascular surgery are at risk for upper digestive bleeding due to several factors. AIM: To determine the utility of medication and endoscopy in preventing gastrointestinal bleeding (GB) after cardiovascular surgery. MATERIAL AND METHOD: 79 patients (60 males and 19 women, mean age 61 +/- 16.1 years) were prospectively included in the study from the 850 patients operated in the period 2004 - 2006. Inclusion criteria were: patients with digestive symptoms (dyspepsia) and with risk for GB (personal history of peptic ulcer, gastroduodenitis, esophagitis, hiatus hernia, gastric cancer, gastric surgery and GB). All patients with symptoms and partially patients with risk were evaluated by endoscopy. Patients received standard medication for prevention of GB. RESULTS: Prophylactic medication was partially efficient in GB prophylaxis vs. no prophylaxis (7% vs. 11% p < 0.05). Patients with endoscopy examination before surgery had significantly lower incidence of bleeding (6.6% vs. 10.9%, p < 0.05%). CONCLUSIONS: Gastrointestinal bleeding may occur despite prophylactic medication. Gastrointestinal endoscopy prior surgery may be useful in preventing the bleeding.

[A primary undifferentiated pleomorph cardiac sarcoma. Case report]. / Sarcomul cardiac primar pleomorf nediferentiat. Prezentare de caz.

The aim of the study was to characterize the clinical and histological picture of a malignant cardiac tumor, to assess the prognosis and to develop a management strategy. We described a primary cardiac sarcoma, located in the right ventricle. Minimal invasive right thoracotomy was used and a partial surgical excision of the malignant cardiac tumor was made as a palliative procedure. The malignant cardiac tumour continues to have a poor prognosis despite of the individualization of the approach.

[Morphologic study of cardiac myxomas]. / Studiul morfologic al mixoamelor cardiace.

The aim of the paper was the morphological study of the cardiac myxomas, admitted and operated at CCI, between 2000 and 2004. We evaluated the histology of the tumor, the incidence of the specific lesions, and we analysed the tumoral types on the basis of cardiac myxoma macroscopic appearance in correlation with clinical picture of tumor.

[Morphologic and clinical correlations in medullar thymoma]. / Corelatii morfoclinice în timomul medular.

The medullar thymoma is a rare and distinctive epithelial thymoma, a thymic tumor characterized histologically by a mixture of spindle epithelial cells and lymphoid cells. We are presenting this tumor to a 68 years old man, admitted at CCI, for a mediastinal tumor, treated by tumorectomy, for revealing the cytological, histological and immunohistochemical characteristic features. The surgical biopsy was prepared by using usual histological techniques and haematoxilin eosin and Van Gieson stainings. We are discussing the relation between the thymoma clinicopathological and prognostic features, resulting a clear correlation between histological type and clinical study. We also pointed the Muller-Hermelink thymoma histological subtypes and their correspondence with OMS histological types, reflecting realistically the thymoma clinical behavior.

Two cases of Marfan syndrome.

The early identification of the Marfan Syndrome should be essential for the prevention of the aortic dilatation and dissection, but the wide phenotypic expression of the disorder makes the clinical diagnosis very difficult. The aim of this study is to emphasise the necessity of a widely applicable method of morpho-clinical diagnosis. The diagnosis was confirmed on surgical biopsies from ascending aortic wall and aortic cusps, using routine morphological techniques. The macroscopical examination revealed a thin ascending aortic wall, presenting a transversal intimal tear, without secondary dissecting hematoma, and an aortic dilated annulus, producing aortic regurgitation. Microscopically, the diagnosis was supported by the identification of cystic medical necrosis, a specific degenerative lesion in the Marfan Syndrome, in patients with or without family history of aortic aneurysms. This study defines the morpho-clinical changes of the disease, emphasising the necessity of a permanent monitorization of the patient after surgery, due to the risk of late complications.