-
Traumatic Mitral Regurgitation From Intracardiac Bullet Fragments With Bullet Embolism to the Brain.JACC. Case Reports Jul 2024A 31-year-old man presented with multiple gunshot wounds. Mediastinal exploration revealed no signs of entry to the pericardium, but postoperative chest x-ray was...
A 31-year-old man presented with multiple gunshot wounds. Mediastinal exploration revealed no signs of entry to the pericardium, but postoperative chest x-ray was concerning for a bullet fragment within the left ventricle. Emergent transesophageal echocardiography showed traumatic perforation of mitral valve, and further imaging showed multiple bullet emboli.
PubMed: 38912317
DOI: 10.1016/j.jaccas.2024.102380 -
Cureus May 2024Pericardial angiosarcoma is an extremely rare malignant tumor originating from the endothelial cells of blood vessels within the pericardium. We present a case of a...
Pericardial angiosarcoma is an extremely rare malignant tumor originating from the endothelial cells of blood vessels within the pericardium. We present a case of a 49-year-old male who presented with symptoms of pericardial effusion and was subsequently diagnosed with pericardial angiosarcoma. This case report highlights the diagnostic challenges and management options associated with this rare entity.
PubMed: 38903323
DOI: 10.7759/cureus.60623 -
JTCVS Techniques Jun 2024The present study assessed the late results of the operation, which consisted of the construction of a stentless mitral valve using autologous pericardium and valve...
OBJECTIVES
The present study assessed the late results of the operation, which consisted of the construction of a stentless mitral valve using autologous pericardium and valve implantation.
METHODS
Between 2011 and 2018, among 1617 consecutive patients who underwent mitral valve operation at our institution, 15 adult patients (0.9%) with unrepairable mitral valves who wished to avoid conventional mitral valve replacement underwent this operation. Ten patients (67%) had a history of valve repair. After discharge, patients were prospectively followed-up with a echocardiographic evaluation up to the end point. The mean follow-up term was 70.8 ± 42.5 months.
RESULTS
There were no hospital deaths or thromboembolic events and only 1 late noncardiac death. Intraoperative transesophageal echocardiography of all patients revealed no or trivial mitral regurgitation. Eight patients (53.3%) underwent redo valve replacement within 12 years. Except 1 late death, the postoperative course was divided into 3 groups depending on the occurrence of redo surgery, as follows: an early reoperation group (reoperation within 4 years; n = 4), a late reoperation group (reoperation after 4 years; n = 4), and a free from reoperation group (n = 6). The latest transthoracic echocardiographic examination performed 7.2 ± 2.9 years after the operation revealed the grade of mitral regurgitation to be none in 2 patients, mild in 2 patients, mild to moderate in 1 patients, and moderate in 1 patient in the free from reoperation group.
CONCLUSIONS
Despite the high incidence of reoperation, Normo operation can be a viable option during valve replacement, especially for young patients.
PubMed: 38899115
DOI: 10.1016/j.xjtc.2024.02.020 -
JTCVS Techniques Jun 2024Aortic valve neocuspidization with autologous pericardium is gaining increasing attention as a surgical treatment option for aortic valve disease. However, little is...
OBJECTIVES
Aortic valve neocuspidization with autologous pericardium is gaining increasing attention as a surgical treatment option for aortic valve disease. However, little is known about midterm durability and valve-related events.
METHODS
Patients undergoing aortic valve neocuspidization between 2016 and 2021 were included. Transthoracic echocardiography was performed before the operation, at discharge, and annually thereafter. Data were analyzed for incidences of structural valve deterioration, bioprosthetic valve failure, survival, freedom from reoperation, and hemodynamic performance.
RESULTS
A total of 162 patients underwent aortic valve neocuspidization (mean age, 52.6 ± 16.6 years; range, 13-78 years); 114 (70.4%) were male. A total of 132 patients presented with a bicuspid aortic valve (81.5%) and 126 patients presented with aortic valve stenosis (77.8%). Concomitant procedures were performed in 63 patients (38.9%). Mean follow-up was 3.5 ± 1.2 years. At discharge, peak and mean pressure gradients were 15.6 ± 7.2 mm Hg and 8.4 ± 3.7 mm Hg, respectively, with a mean effective orifice area of 2.4 ± 0.8 cm. After 5 years, peak and mean pressure gradients were 14.5 ± 4.6 mm Hg and 7.5 ± 2.2 mm Hg, respectively, with a mean effective orifice area of 2.3 ± 0.8 cm. At 5 years, cumulative incidences of moderate and severe structural valve deterioration and bioprosthetic valve failure were 9.82% ± 3.87%, 6.96% ± 3.71%, and 12.1% ± 4.12%, respectively. Survival was 97.3% ± 1.4%, and freedom from reoperation was 91.3% ± 2.4%.
CONCLUSIONS
Aortic valve neocuspidization accomplishes low pressure gradients early after initial surgery and during follow-up. Survival in this young patient population is excellent. The main reason for reoperation is endocarditis, and rates for structural valve degeneration are low.
PubMed: 38899113
DOI: 10.1016/j.xjtc.2024.02.011 -
Animals : An Open Access Journal From... Jun 2024An 8-month-old intact male domestic shorthair cat was referred to the Emergency Service of the Veterinary Teaching Hospital (VTH) of the Department of Veterinary Science...
An 8-month-old intact male domestic shorthair cat was referred to the Emergency Service of the Veterinary Teaching Hospital (VTH) of the Department of Veterinary Science of the University of Parma (Italy) from the Parma municipal multi-cat shelter, during the winter season (January 2023), for lethargy, anorexia, hypothermia, and hypoglycemia. At the VTH, upon cardiologic examination, an increase in heart rate, under normal blood pressure conditions, was detected. Signalment, clinical history, basal metabolic panel (BMP), ultrasound investigations, and cytological findings were all consistent with a diagnosis of feline infectious peritonitis (FIP). FIP was confirmed in the effusive abdominal fluid by a molecular genetic test (real-time PCR for feline coronavirus RNA). The molecular genetic investigation also detected an FCoV gene single-nucleotide mutation: biotype M1058L. At necropsy, an effusive collection was recorded in the abdomen, thoracic cavity, and pericardium sac. White parenchymal nodules, of about 1 mm diameter, were found on the surface and deep in the lungs, liver, kidneys, and heart. Histopathology revealed the typical FIP pyogranulomatous vasculitis and IHC confirmed the presence of the FIP virus (FIPV) antigen. The most relevant histopathological finding was the myocarditis/myocardial necrosis associated with the presence of the gene-mutated FCoV (M1058L biotype). This is the first case of myocarditis in a cat positive for the FCoV/FIP M1058L biotype. Further studies are necessary to support the mutated FCoV M1058L biotype, as an uncommon, but possible, causative pathogen of myocarditis in FCoV/FIP-positive cats. Studies including several FCoV/FIP M1058L-positive cases could allow us to make a correlation with heart gross pathology, histopathology, and immunolocalization of the FCoV/FIP M1058L biotype in the myocardium. The investigation will potentially allow us to determine the effective tropism of the FCoV/FIP M1058L biotype for myocardiocytes or whether myocardiocyte lesions are evident in the presence of concomitant causes related to the patient, its poor condition, or external environmental distress such as cold season, and whether the aforementioned concomitant events are correlated.
PubMed: 38891720
DOI: 10.3390/ani14111673 -
EJVES Vascular Forum 2024Primary aorto-enteral fistula (PAEF) is a connection between the gastrointestinal tract and the aorta that occurs without previous aortic surgery. The aetiological...
OBJECTIVE
Primary aorto-enteral fistula (PAEF) is a connection between the gastrointestinal tract and the aorta that occurs without previous aortic surgery. The aetiological factors include, but are not limited to, aneurysm, infection, and tumours. It is a life threatening condition if untreated and requires emergency vascular surgical repair. A secondary aorto-enteric fistula (AEF) can occur to a previously reconstructed aorta. This case report presents a unique case of a male patient who developed a primary AEF and subsequent secondary AEF with successful surgical outcomes, suggested to be due to tuberculous aortitis.
REPORT
The patient was diagnosed and treated for tuberculosis and developed a saccular aneurysm within six months. The PAEF was surgically corrected with a tube graft using a bovine pericardial patch, the defect in duodenum was sutured, and a retrocolic omental flap was created between the duodenum and aorta. He developed a small stable pseudoaneurysm during follow up, and then a secondary AEF two and a half years later, in which a connection between the pseudoaneurysm and duodenum was corrected using a new bovine aorto-aortic interposition graft using a bovine pericardium patch. The defect in the duodenum was also sutured in two layers and a new omental flap was created.
DISCUSSION
The mortality rate of AEF is high and it is very unlikely that a patient will survive two AEFs without major complications. It is believed that there are extremely few double AEF cases described in the literature. The aetiological factor in the development of PAEF in this case was most likely the patient's aortic aneurysm, which was most likely of mycotic origin due to tuberculosis. The patient developed a pseudoaneurysm during follow up and it is uncertain whether the pulsatile pressure of the pseudoaneurysm led to the recurrence of the AEF.
PubMed: 38884073
DOI: 10.1016/j.ejvsvf.2024.05.005 -
ARYA Atherosclerosis Jul 2023Chronic constrictive pericarditis results in the signs and symptoms of heart failure due to the chronic compression of the myocardium. When the pericardium becomes... (Review)
Review
Chronic constrictive pericarditis results in the signs and symptoms of heart failure due to the chronic compression of the myocardium. When the pericardium becomes thickened and fibrosed, surgery is the sole curative management strategy. Surgery leads to an improvement in functional status and survival, but it is associated with significant mortality and morbidity. Over the years, the surgical approach to this pathology has largely remained unchanged, but there has been a shift in the etiological mechanism of constrictive pericarditis from predominantly tuberculous to post-cardiac surgery and idiopathic pathologies. This review offers an overview of the surgical management of constrictive pericarditis.
PubMed: 38881993
DOI: 10.48305/arya.2023.41472.2882 -
BMC Oral Health Jun 2024Horizontal ridge augmentation of a deficient alveolar bone site is performed either simultaneously with implant placement or in a staged approach prior to implant...
Double layer graft technique for horizontal alveolar ridge augmentation with staged implant placement: radiographic histological and implant stability analysis-a case report.
INTRODUCTION
Horizontal ridge augmentation of a deficient alveolar bone site is performed either simultaneously with implant placement or in a staged approach prior to implant insertion. There are several available strategies for the augmentation of alveolar ridge deficiencies, including guided bone regeneration (GBR) through the use of barrier membranes. The success of the GBR approach mainly depends on the exclusion of soft tissue cells during bone remodeling.
CASE PRESENTATION
A healthy 25-year-old male patient presented with a missing upper left central incisor after clinical and radiographic examination, the site showed a class III defect horizontal atrophy. The procedure performed was the horizontal alveolar ridge augmentation using resorbable pericardium membrane with double layer graft technique (DLT) where autogenous bone placed as a first layer of the graft followed by xenograft as a second layer, the membrane was fixed with titanium pins. A cone beam computed tomography (CBCT) was performed before, immediately and 6 month following the surgery. After 6 months during implant placement, a core biopsy specimen was retrieved, stored and prepared for histological evaluation, with assessment of primary implant stability. The radiographic analysis showed a horizontal width gain of about 4 mm, at 6 month following implant placement, the implant was successfully osteointegrated with stability assessment also done after 6 months from placement.
CONCLUSION
DLT was successfully used for horizontal alveolar ridge augmentation, thus allowing a prosthetically driven implant placement. More cases assessing implant survival and success are needed to confirm the results of this case report.
Topics: Humans; Male; Alveolar Ridge Augmentation; Adult; Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Bone Transplantation; Incisor
PubMed: 38872190
DOI: 10.1186/s12903-024-04416-1 -
The Annals of Thoracic Surgery Jun 2024In this invited expert review, we focus on evolving lifetime management strategies for adolescents and young adults with congenital aortic valve disease, acknowledging... (Review)
Review
In this invited expert review, we focus on evolving lifetime management strategies for adolescents and young adults with congenital aortic valve disease, acknowledging that these patients often require multiple interventions during their lifetime. Our goal is to preserve the native aortic valve when feasible. Leveraging advanced multimodality imaging, a detailed assessment of the aortic valve and root complex can be obtained, and a surgical approach tailored to an individual patient's anatomy and pathology can be employed. In turn, aortic valve repair and reconstruction can be offered to a greater number of patients, either as a definitive strategy or as a component of a staged strategy to delay the need for aortic valve replacement until later in life when more options are available. In adolescents and young adults with unrepairable aortic valve disease, our preferred strategies are aortic valve replacement with pulmonary autograft (Ross procedure) or autologous pericardium (Ozaki procedure). Aortic valve replacement with a bioprosthetic or mechanical valve is a safe and reproducible option reserved as a "last resort" in adolescents and young adults due to the cumulative lifetime risk of valve-related complications and ongoing attrition of these patients during follow-up.
PubMed: 38871162
DOI: 10.1016/j.athoracsur.2024.04.038 -
Journal of Investigative Medicine High... 2024Constrictive pericarditis (CP) presents as a pathophysiological state where the pericardium becomes inelastic due to fibrotic changes, most commonly secondary to a...
Constrictive pericarditis (CP) presents as a pathophysiological state where the pericardium becomes inelastic due to fibrotic changes, most commonly secondary to a protracted inflammatory process. The disease is characterized by compromised diastolic cardiac function due to loss of pericardial compliance. Immunoglobulin G4 (IgG4)-related disease, an entity marked by the insidious proliferation of IgG4-positive plasma cells and subsequent fibrosis within various organs, is an infrequent but recognized cause of CP. A case of a 55-year-old male patient with clinical manifestations of dyspnea and edema in the lower extremities elucidates the diagnostic complexity inherent to CP. Echocardiography revealed a constellation of signs, including annulus reversus, septal bounce, and a congested inferior vena cava; cardiac magnetic resonance imaging (MRI) demonstrated diffuse pericardial thickening with delayed gadolinium enhancement, suggestive of a long-term inflammatory state; and right heart catheterization confirmed the hemodynamic hallmark of CP-equalization of diastolic pressures across the cardiac chambers. The serological analysis elicited elevated serum levels of IgG4 and IgE, pointing to the differential diagnosis of IgG4-related disease. Given the nonspecific clinical presentation of IgG4-related CP, a heightened index of suspicion combined with a systematic approach to imaging and serological evaluation is paramount.
Topics: Humans; Pericarditis, Constrictive; Male; Middle Aged; Immunoglobulin G; Multimodal Imaging; Echocardiography; Magnetic Resonance Imaging; Immunoglobulin G4-Related Disease; Diagnosis, Differential
PubMed: 38869103
DOI: 10.1177/23247096241248969