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Journal of Community Hospital Internal... 2023A left ventricular pseudoaneurysm (LVP) is defined as an outpouching contained by the surrounding pericardium. Clinical presentation is often unspecific with patients...
A left ventricular pseudoaneurysm (LVP) is defined as an outpouching contained by the surrounding pericardium. Clinical presentation is often unspecific with patients presenting with chest pain, dyspnea, symptoms consistent with heart failure, and post-myocardial infarction. Cardiac magnetic resonance imaging represents an important tool for differentiating a pseudoaneurysm from a true aneurysm. Furthermore, multiple imagining modalities are available, including transesophageal and transthoracic echocardiogram and contrast ventriculography, which remains the gold standard diagnostic technique. Early recognition and prompt surgical management are of utmost importance in patients with acute and symptomatic LVP. On the other hand, medical management may be considered in patients with chronic and small pseudoaneurysms. Here, we are presenting a 74-year-old lady who presented with chest pain and was found to have a chronic and small LVP which was managed conservatively.
PubMed: 38596559
DOI: 10.55729/2000-9666.1240 -
Acute Medicine & Surgery 2024Penetrating cardiac injuries are usually fatal and associated with poor survival rates.
BACKGROUND
Penetrating cardiac injuries are usually fatal and associated with poor survival rates.
CASE PRESENTATION
A 69-year-old man was injured in a motor vehicle accident and suffered from left hemothorax and multiple rib fractures near the heart. A comprehensive assessment raised suspicions of lacerated pericardium and myocardial injury. Consequently, a thoracoscopy was performed 9 h after injury. A penetrating cardiac injury was detected and surgically treated via video-assisted thoracoscopic surgery. The patient recovered uneventfully and was discharged on postoperative day 16.
CONCLUSION
Exploratory video-assisted thoracoscopic surgery may play a key role in the primary diagnosis of patients with high-energy chest traumas with cardiac injury and simultaneously allow for the appropriate surgical interventions.
PubMed: 38596161
DOI: 10.1002/ams2.938 -
JPMA. the Journal of the Pakistan... Mar 2024A 5 year old boy with acute ly mphoblastic leukaemia on chemotherapy presented with chest pain and vomiting for two days after an elective procedure under general...
A 5 year old boy with acute ly mphoblastic leukaemia on chemotherapy presented with chest pain and vomiting for two days after an elective procedure under general anaesthesia. H is ches t x-ray was remarkabl e for a promin ent halo sign, an air gap surrounding the he art indicat ing a large pneumope ricardium. Alth ough the pneu mo pericardium could not be appre ciated on an echocardiogram, the child developed clinical sig ns of cardiac t amponade. Attem pts to evacu ate the pneumopericardium were unsuccessful leading to death.
Topics: Male; Child; Humans; Child, Preschool; Pneumopericardium; X-Rays; Radiography; Pericardium; Chest Pain
PubMed: 38591303
DOI: 10.47391/JPMA.9393 -
Europace : European Pacing,... May 2024
Topics: Humans; Catheter Ablation; Arrhythmias, Cardiac; Epicardial Mapping; Pericardium; Electrophysiologic Techniques, Cardiac; Treatment Outcome
PubMed: 38590179
DOI: 10.1093/europace/euae086 -
Acta Biomaterialia May 2024A plethora of biomaterials for heart repair are being tested worldwide for potential clinical application. These therapeutics aim to enhance the quality of life of... (Review)
Review
A plethora of biomaterials for heart repair are being tested worldwide for potential clinical application. These therapeutics aim to enhance the quality of life of patients with heart disease using various methods to improve cardiac function. Despite the myriad of therapeutics tested, only a minority of these studied biomaterials have entered clinical trials. This rapid scoping review aims to analyze literature available from 2012 to 2022 with a focus on clinical trials using biomaterials for direct cardiac repair, i.e., where the intended function of the biomaterial is to enhance the repair of the endocardium, myocardium, epicardium or pericardium. This review included neither biomaterials related to stents and valve repair nor biomaterials serving as vehicles for the delivery of drugs. Surprisingly, the literature search revealed that only 8 different biomaterials mentioned in 23 different studies out of 7038 documents (journal articles, conference abstracts or clinical trial entries) have been tested in clinical trials since 2012. All of these, intended to treat various forms of ischaemic heart disease (heart failure, myocardial infarction), were of natural origin and most used direct injections as their delivery method. This review thus reveals notable gaps between groups of biomaterials tested pre-clinically and clinically. STATEMENT OF SIGNIFICANCE: Rapid scoping review of clinical application of biomaterials for cardiac repair. 7038 documents screened; 23 studies mention 8 different biomaterials only. Biomaterials for repair of endocardium, myocardium, epicardium or pericardium. Only 8 different biomaterials entered clinical trials in the past 10 years. All of the clinically translated biomaterials were of natural origin.
Topics: Humans; Biocompatible Materials; Animals
PubMed: 38588997
DOI: 10.1016/j.actbio.2024.04.008 -
Europace : European Pacing,... May 2024Pericardiocentesis is usually completed under fluoroscopy. The electroanatomic mapping (EAM) system allows visualizing puncture needle tip (NT) while displaying the...
AIMS
Pericardiocentesis is usually completed under fluoroscopy. The electroanatomic mapping (EAM) system allows visualizing puncture needle tip (NT) while displaying the electrogram recorded from NT, making it possible to obtain epicardial access (EA) independent of fluoroscopy. This study was designed to establish and validate a technique by which EA is obtained under guidance of three-dimensional (3D) EAM combined with NT electrogram.
METHODS AND RESULTS
3D shell of the heart was generated, and the NT was made trackable in the EAM system. Unipolar NT electrogram was continuously monitored. Penetration into pericardial sac was determined by an increase in NT potential amplitude and an injury current. A long guidewire of which the tip was also visible in the EAM system was advanced to confirm EA. Epicardial access was successfully obtained without complication in 13 pigs and 22 patients. In the animals, NT potential amplitude was 3.2 ± 1.0 mV when it was located in mediastinum, 5.2 ± 1.6 mV when in contact with fibrous pericardium, and 9.8 ± 2.8 mV after penetrating into pericardial sac (all P ≤ 0.001). In human subjects, it measured 1.54 ± 0.40 mV, 3.61 ± 1.08 mV, and 7.15 ± 2.88 mV, respectively (all P < 0.001). Fluoroscopy time decreased in every 4-5 cases (64 ± 15, 23 ± 17, and 0 s for animals 1-4, 5-8, 9-13, respectively, P = 0.01; 44 ± 23, 31 ± 18, 4±7 s for patients 1-7, 8-14, 15-22, respectively, P < 0.001). In five pigs and seven patients, EA was obtained without X-ray exposure.
CONCLUSION
By tracking NT in the 3D EAM system and continuously monitoring the NT electrogram, it is feasible and safe to obtain EA with minimum or no fluoroscopic guidance.
Topics: Humans; Male; Female; Animals; Pericardium; Middle Aged; Imaging, Three-Dimensional; Needles; Aged; Electrophysiologic Techniques, Cardiac; Epicardial Mapping; Pericardiocentesis; Punctures; Predictive Value of Tests; Adult; Swine; Models, Animal; Action Potentials; Sus scrofa; Fluoroscopy
PubMed: 38587311
DOI: 10.1093/europace/euae089 -
BMC Cardiovascular Disorders Apr 2024IgG4-related disease is a fibro-inflammatory disorder with an unknown etiology, which can affect multiple organ systems, including the cardiovascular system. While most... (Review)
Review
BACKGROUND
IgG4-related disease is a fibro-inflammatory disorder with an unknown etiology, which can affect multiple organ systems, including the cardiovascular system. While most reported cases of cardiovascular involvement are primarily associated with the aorta, there have been sporadic reports of isolated cardiac involvement.
CASE PRESENTATION
This paper presents a documented case of IgG4-related systemic disease with symptoms indicative of restrictive cardiomyopathy. Subsequent Cardiac Magnetic Resonance imaging revealed diffuse myopericardial involvement, characterized by pericardial thickening and enhancement, accompanied by subepicardial and myocardial infiltration. Considering the rarity of cardiac involvement in our case, we conducted a thorough review of the existing literature pertaining to various patterns of cardiac involvement in IgG4-related disease, as well as the diagnostic modalities that can be employed for accurate identification and assessment.
CONCLUSIONS
This case report sheds light on the importance of recognizing and evaluating cardiac manifestations in IgG4-related systemic disease to facilitate timely diagnosis and appropriate management.
Topics: Humans; Immunoglobulin G4-Related Disease; Pericardium; Magnetic Resonance Imaging; Immunoglobulin G
PubMed: 38582827
DOI: 10.1186/s12872-024-03874-3 -
Internal and Emergency Medicine Jun 2024Epicardial adipose tissue is a novel cardiometabolic risk factor and indicator of subclinical atherosclerosis. We aimed to evaluate the epicardial adipose tissue...
Increased epicardial adipose tissue thickness as a sign of subclinical atherosclerosis in patients with rheumatoid arthritis and ıts relationship with disease activity ındices.
Epicardial adipose tissue is a novel cardiometabolic risk factor and indicator of subclinical atherosclerosis. We aimed to evaluate the epicardial adipose tissue thickness in rheumatoid arthritis (RA) patients and its association with disease activity scores. A total of 81 rheumatoid arthritis patients and 70 age- and sex-matched healthy individuals were recruited for this cross-sectional study. Epicardial adipose tissue thickness (EATT) was measured by transthoracic two-dimensional echocardiography. Tender and swollen joint counts were recorded at the time of inclusion. The laboratory tests included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, anti-citrullinated protein antibodies, and serum lipid levels. Disease activity was calculated based on Disease Activity Scores for 28 joints (DAS-28) ESR and CRP, the Simple Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI). Epicardial adipose tissue thickness was significantly higher in the RA patients compared to the healthy controls (p < 0.001). We found statistically significant correlations of EATT with all disease activity indices (p < 0.001) and CRP (p = 0.002). According to a cut-off value of 6.4 mm determined for epicardial adipose tissue thickness, the RA patients with thickness ≥ 6.4 mm had higher disease activity scores and CRP levels. In the multivariable regression analysis, only SDAI score was found as an independent risk factor for increased EATT (OR, (95%CI), 13.70 (3.88-48.43), p < 0.001). Epicardial adipose tissue thickness measurement by echocardiography is a reliable method for assessing subclinical atherosclerosis in rheumatoid arthritis patients, and a higher disease activity score is an independent risk factor for coronary artery disease.
Topics: Humans; Arthritis, Rheumatoid; Female; Male; Adipose Tissue; Middle Aged; Cross-Sectional Studies; Pericardium; Atherosclerosis; Echocardiography; Adult; C-Reactive Protein; Case-Control Studies; Risk Factors; Aged; Epicardial Adipose Tissue
PubMed: 38578429
DOI: 10.1007/s11739-024-03542-6 -
Frontiers in Medicine 2024One of the exceptionally rare forms of non-Hodgkin's lymphoma (NHL) is primary cardiac lymphoma (PCL). The principal clinical manifestation in patients with PCL involves...
BACKGROUND
One of the exceptionally rare forms of non-Hodgkin's lymphoma (NHL) is primary cardiac lymphoma (PCL). The principal clinical manifestation in patients with PCL involves cardiac symptoms resulting from myocardial infiltration by lymphoma, including arrhythmias, heart failure, and chest pain. F-FDG PET/CT serves as a reliable and indispensable imaging modality for assessing clinically staging NHL.
CASE REPORT
We present a rare case involving a 72-year-old woman diagnosed with primary intracardiac diffuse large B-cell lymphoma. For further staging, the patient underwent F-FDG PET/CT, revealing multiple nodular soft tissue density lesions in the heart and pericardium exhibiting increased FDG metabolism (SUVmax = 12.1). The supradiaphragmatic and infradiaphragmatic segments of the inferior vena cava exhibited irregular morphology with localized nodular changes and increased FDG metabolism in the surrounding area (SUVmax = 9.7). Additionally, multiple enlarged lymph nodes were identified in the left axilla, mediastinum, and adjacent to the abdominal aorta, displaying heterogeneous FDG uptake with an SUVmax of 9.3, indicating lymphoma involvement. The above imaging findings suggested that the mass was a PCL. Hence, the patient underwent a combination of chemotherapy and immunotherapy using R-CDOP (rituximab, cyclophosphamide, liposomal doxorubicin, vincristine, and prednisone). Following two courses of treatment within a span of 2 months, there was a partial remission observed in the cardiac lymphoma and the enlarged lymph nodes.
CONCLUSION
The case elucidated in this report contributes to an enhanced understanding of the disease for clinicians, with F-FDG PET/CT providing comprehensive insights into the extent of cardiac involvement, as well as the engagement of extracardiac organs and pathologic lymph nodes. The F-FDG PET/CT examination not only visually delineates the lesion's location and extent but also serves as a cornerstone for clinical tumor staging, offering valuable support for treatment monitoring and subsequent follow-up.
PubMed: 38576712
DOI: 10.3389/fmed.2024.1373773