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Journal of Cardiothoracic Surgery Jun 2024Left atrial appendage aneurysm is a rare cardiac mass, with only a few cases reported. There are usually no specific symptoms, and a few patients visit the doctor with...
BACKGROUND
Left atrial appendage aneurysm is a rare cardiac mass, with only a few cases reported. There are usually no specific symptoms, and a few patients visit the doctor with symptoms.
CASE PRESENTATION
A 20-year-old male presented to our hospital with a "pericardial cyst found by medical evaluation in another hospital for 2 years." Cardiac ultrasound performed at clinics of our hospital suggested a cystic dark area in the left ventricular lateral wall and the anterior lateral wall, consistent with a pericardial cyst and mild mitral regurgitation. After further relevant examinations and ruling out contraindications, an excision of the left atrial appendage aneurysm was performed under general anesthesia and cardiopulmonary bypass with beating-heart. The postoperative pathological results identified that: (left atrial appendage) fibrocystic wall-like tissue with a focal lining of the flat epithelium, consistent with a benign cyst.
CONCLUSION
Left atrial appendage aneurysms are rare and insidious. They are usually found by chance during medical evaluations. If the location is not good or the volume is too large, then compression symptoms or arrhythmia, thrombosis and other concomitant symptoms will occur. Surgical resection is presently the only effective radical cure for a left atrial appendage aneurysm.
Topics: Humans; Male; Atrial Appendage; Heart Aneurysm; Young Adult; Echocardiography; Cardiac Surgical Procedures
PubMed: 38849837
DOI: 10.1186/s13019-024-02629-7 -
Heart Failure Clinics Jul 2024Cardiac magnetic resonance represents the gold standard imaging technique to assess cardiac volumes, wall thickness, mass, and systolic function but also to provide... (Review)
Review
Cardiac magnetic resonance represents the gold standard imaging technique to assess cardiac volumes, wall thickness, mass, and systolic function but also to provide noninvasive myocardial tissue characterization across almost all cardiac diseases. In patients with cardiac amyloidosis, increased wall thickness of all heart chambers, a mildly reduced ejection fraction and occasionally pleural and pericardial effusion are the characteristic morphologic anomalies. The typical pattern after contrast injection is represented by diffuse areas of late gadolinium enhancement, which can be focal and patchy in very early stages, circumferential, and subendocardial in intermediate stages or even diffuse transmural in more advanced stages.
Topics: Humans; Amyloidosis; Cardiomyopathies; Magnetic Resonance Imaging, Cine; Contrast Media; Magnetic Resonance Imaging; Myocardium; Stroke Volume
PubMed: 38844300
DOI: 10.1016/j.hfc.2024.03.002 -
Cureus May 2024Cardiac involvement as the initial presentation of lymphoma is a rare occurrence. The most common type of cardiac lymphoma is diffuse large B-cell lymphoma (DLBCL),...
Cardiac involvement as the initial presentation of lymphoma is a rare occurrence. The most common type of cardiac lymphoma is diffuse large B-cell lymphoma (DLBCL), which often affects the right atrium. Cardiac lymphoma can either be mediastinal DLBCL invading the heart or primary cardiac lymphoma. We describe the case of an 84-year-old female who presented with an eight-week history of dyspnea. Computed tomography angiography (CTA) of the chest showed a right-sided pleural effusion with collapse of the right middle and lower lobes as well as a large mass-like density within the anterior pericardium, compressing the right atrium and right ventricle and encasing the right coronary artery. A transthoracic echocardiogram (TTE) showed a multilocular hypoechoic mass in the right atrium with invasion into the wall of the right atrium. The patient underwent diagnostic and therapeutic thoracentesis. Pleural fluid cytology revealed diffuse large B-cell lymphoma, with positive stains for CD20, PAX5, CD10, BCL6, and Mum-1. Fluorescence in situ hybridization (FISH) revealed an abnormality of BCL2/18q (16%). A staging positron emission tomography (PET) scan showed a large mediastinal mass involving the right pericardium, focal uptake in the left thyroid lobe, left skull base, and musculature around the proximal left femur. Chemotherapy was initiated with R-mini-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). PET scans after three cycles of chemotherapy showed a complete metabolic response with the resolution of previously noted hypermetabolic lesions. The patient completed all six cycles of chemotherapy without issues. The differential diagnosis of a right atrial cardiac mass should include lymphoma. TTE is usually the initial imaging test, and a tissue biopsy is required for a definitive diagnosis. DLBCL is highly aggressive and carries a poor prognosis if untreated. Early diagnosis and treatment with standard chemotherapy are crucial for favorable outcomes.
PubMed: 38840985
DOI: 10.7759/cureus.59755 -
JACC. Case Reports Jul 2024An 87-year-old man developed delayed cardiac tamponade 55 min after leadless pacemaker implantation and recurrent pericardial effusion 20 days later....
An 87-year-old man developed delayed cardiac tamponade 55 min after leadless pacemaker implantation and recurrent pericardial effusion 20 days later. Electrocardiogram-gated enhanced cardiac computed tomography revealed that the leadless pacemaker tines on the lateral side had penetrated the right ventricular free wall. He underwent off-pump hemostatic surgery.
PubMed: 38827267
DOI: 10.1016/j.jaccas.2024.102378 -
Journal of Personalized Medicine Apr 2024The right heart catheterisation constitutes the gold standard for pulmonary hypertension (PH) diagnosis. However, echocardiography remains a reliable, non-invasive,... (Review)
Review
The right heart catheterisation constitutes the gold standard for pulmonary hypertension (PH) diagnosis. However, echocardiography remains a reliable, non-invasive, inexpensive, convenient, and easily reproducible modality not only for the preliminary screening of PH but also for PH prognosis. The aim of this review is to describe a cluster of echocardiographic parameters for the detection and prognosis of PH and analyse the challenges of echocardiography implementation in patients with suspected or established PH. The most important echocardiographic index is the calculation of pulmonary arterial systolic pressure (PASP) through the tricuspid regurgitation (TR). It has shown high correlation with invasive measurement of pulmonary pressure, but several drawbacks have questioned its accuracy. Besides this, the right ventricular outflow track acceleration time (RVOT-AT) has been proposed for PH diagnosis. A plethora of echocardiographic indices: right atrial area, pericardial effusion, the tricuspid annular plane systolic excursion (TAPSE), the TAPSE/PASP ratio, tricuspid annular systolic velocity (s'), can reflect the severity and prognosis of PH. Recent advances in echocardiography with 3-dimensional right ventricular (RV) ejection fraction, RV free wall strain and right atrial strain may further assist the prognosis of PH.
PubMed: 38793056
DOI: 10.3390/jpm14050474 -
The Egyptian Heart Journal : (EHJ) :... May 2024Perforation by pacemaker leads, although rare, is a complication reported since the introduction of pacemaker therapy. Although historically reported frequencies were as...
BACKGROUND
Perforation by pacemaker leads, although rare, is a complication reported since the introduction of pacemaker therapy. Although historically reported frequencies were as high as 5%, recent reports have cited frequencies ranging from 1 to 2%. We report a case where a screw-type atrial lead slightly penetrated the right atrial wall, causing chronic abrasion of the ascending aorta, resulting in shock.
CASE PRESENTATION
A 54-year-old male presented with dilated cardiomyopathy diagnosed at 40 years of age when he developed decompensated heart failure. Despite ongoing treatment, his heart failure worsened, leading to hospitalization at the age of 54. During his hospital stay, he experienced cardiac arrest that required cardiopulmonary resuscitation, followed by a return of spontaneous circulation. He was subsequently transferred to our institution after initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and an intra-aortic balloon pump (IABP). Echocardiography revealed an ejection fraction of 25%, left ventricular end-diastolic diameter of 60 mm, and severe mitral regurgitation (MR). Transcatheter mitral valve repair was performed to treat severe MR, followed by implantation of a cardiac resynchronization therapy defibrillator (CRT-D). Three months later, the patient was brought to our emergency department by ambulance because of hypotension. Contrast-enhanced computed tomography revealed pericardial effusion causing cardiac tamponade, necessitating emergency pericardial decompression via left fourth intercostal mini-thoracotomy and drain placement. Upon transfer to the intensive care unit, 1200 mL of blood was drained from the chest tube, prompting a return to the operating room for a median sternotomy. It was discovered that the pacemaker lead on the left side of the right atrium had slowly eroded into the aorta, leading to perforation. The ascending aorta was repaired and hemostasis was achieved; the patient recovered uneventfully and was discharged on postoperative day 18.
CONCLUSIONS
The pacemaker lead perforated the right atrium; chronic abrasion of the lead against the ascending aorta resulted in bleeding from the ascending aorta 3 months later.
PubMed: 38789703
DOI: 10.1186/s43044-024-00494-2 -
European Heart Journal. Case Reports May 2024Secondary cardiac tumours are much more common compared with primary (100-1000 times). The majority of the primary cardiac tumours are benign; however, almost a quarter...
BACKGROUND
Secondary cardiac tumours are much more common compared with primary (100-1000 times). The majority of the primary cardiac tumours are benign; however, almost a quarter are malignant, and 95% of these are sarcomas. The rarest type of primary malignant cardiac sarcoma is intimal (spindle cell) sarcoma.
CASE SUMMARY
A 37-year-old woman presented with episodes of breathlessness. Initially treated for a chest infection, however, the patient continued to deteriorate and presented to the emergency department. A large pericardial effusion was discovered and drained, with samples sent for analysis. A repeat interval echo confirmed the resolution of the pericardial effusion with preserved left ventricular (LV) systolic function. The computed tomography (CT) of the thorax showed suspicious lesions in the heart and lung while the repeat echo raised suspicion of an infiltrative disease. A cardiac magnetic resonance imaging scan was performed, which suggested evidence of an undifferentiated sarcoma involving the posterior wall of the LV and an overlying thrombus. Computed tomography of the abdomen and pelvis did not show any evidence of abdominal metastasis. A CT-guided lung biopsy was arranged. On histological analysis, the report was overall strongly supportive of a diagnosis of intimal sarcoma. She underwent chemotherapy until recently.
DISCUSSION
Cardiac intimal sarcomas are the least reported type of primary malignant tumours of the heart. They are encountered more commonly in the large arterial blood vessels, including the pulmonary artery and aorta, and are extremely rare in the heart. A prompt diagnosis is essential as they are considered extremely aggressive.
PubMed: 38770404
DOI: 10.1093/ehjcr/ytae072 -
World Journal of Clinical Cases May 2024This study presents an evaluation of the computed tomography lymphangiography (CTL) features of lymphatic plastic bronchitis (PB) and primary chylothorax to improve the...
BACKGROUND
This study presents an evaluation of the computed tomography lymphangiography (CTL) features of lymphatic plastic bronchitis (PB) and primary chylothorax to improve the diagnostic accuracy for these two diseases.
AIM
To improve the diagnosis of lymphatic PB or primary chylothorax, a retrospective analysis of the clinical features and CTL characteristics of 71 patients diagnosed with lymphatic PB or primary chylothorax was performed.
METHODS
The clinical and CTL data of 71 patients (20 with lymphatic PB, 41 with primary chylothorax, and 10 with lymphatic PB with primary chylothorax) were collected retrospectively. CTL was performed in all patients. The clinical manifestations, CTL findings, and conventional chest CT findings of the three groups of patients were compared. The chi-square test or Fisher's exact test was used to compare the differences among the three groups. A difference was considered to be statistically significant when < 0.05.
RESULTS
(1) The percentages of abnormal contrast medium deposits on CTL in the three groups were as follows: Thoracic duct outlet in 14 (70.0%), 33 (80.5%) and 8 (80.0%) patients; peritracheal region in 18 (90.0%), 15 (36.6%) and 8 (80.0%) patients; pleura in 6 (30.0%), 33 (80.5%) and 9 (90.0%) patients; pericardium in 6 (30.0%), 6 (14.6%) and 4 (40.0%) patients; and hilum in 16 (80.0%), 11 (26.8%) and 7 (70.0%) patients; and (2) the abnormalities on conventional chest CT in the three groups were as follows: Ground-glass opacity in 19 (95.0%), 18 (43.9%) and 8 (80.0%) patients; atelectasis in 4 (20.0%), 26 (63.4%) and 7 (70.0%) patients; interlobular septal thickening in 12 (60.0%), 11 (26.8%) and 3 (30.0%) patients; bronchovascular bundle thickening in 14 (70.0%), 6 (14.6%) and 4 (40.0%) patients; localized mediastinal changes in 14 (70.0%), 14 (34.1%), and 7 (70.0%) patients; diffuse mediastinal changes in 6 (30.0%), 5 (12.2%), and 3 (30.0%) patients; cystic lesions in the axilla in 2 (10.0%), 6 (14.6%), and 2 (20.0%) patients; and cystic lesions in the chest wall in 0 (0%), 2 (4.9%), and 2 (4.9%) patients.
CONCLUSION
CTL is well suited to clarify the characteristics of lymphatic PB and primary chylothorax. This method is an excellent tool for diagnosing these two diseases.
PubMed: 38765753
DOI: 10.12998/wjcc.v12.i14.2350 -
Cureus May 2024Introduction Epicardial adipose tissue (EAT) is an emerging cardiovascular biomarker. Subclinical left ventricular (LV) systolic dysfunction is common in rheumatoid...
Introduction Epicardial adipose tissue (EAT) is an emerging cardiovascular biomarker. Subclinical left ventricular (LV) systolic dysfunction is common in rheumatoid arthritis (RA). The aim of this study was to assess LV systolic function using two-dimensional speckle tracking echocardiography (2D-STE) and investigate its association with EAT in RA patients without clinical cardiovascular disease (CVD). Methods 60 RA patients without manifestations of CVD and 60 age- and gender-matched healthy controls have been recruited for the study. We assessed LV systolic function and EAT in all subjects using conventional echocardiography and 2D-STE. EAT was measured as the relative echo-free region between the free wall of the right ventricle and the visceral layer of the pericardium at end-systole. Results Global longitudinal strain (GLS) was decreased and EAT was increased in the RA group compared to the control group. GLS was reduced as EAT increased in RA patients (r=-0.273, P=0.035). After adjusting for confounders, multivariate linear regression analysis revealed a weakened correlation between EAT and GLS.Age and disease activity scores28 were independent factors influencing GLS in RA. Conclusion RA patients have significantly thickened EAT compared with controls. 2D-STE can detect early LV myocardial systolic dysfunction in RA, as shown by lower GLS. Accumulation of EAT is associated with lower GLS, but older age and higher disease activity may play a greater role in LV myocardial systolic dysfunction in RA.
PubMed: 38764705
DOI: 10.7759/cureus.60495 -
ESC Heart Failure May 2024Systemic amyloidosis represents a heterogeneous group of diseases resulting from amyloid fibre deposition. The purpose of this study is to establish a differential...
AIMS
Systemic amyloidosis represents a heterogeneous group of diseases resulting from amyloid fibre deposition. The purpose of this study is to establish a differential diagnosis algorithm targeted towards the two most frequent subtypes of CA.
METHODS AND RESULTS
We prospectively included all consecutive patients with ATTR and AL evaluated between 2018 and 2022 in two centres in a score derivation cohort and a different validation sample. All patients had a complete clinical, biomarker, electrocardiographic, and imaging evaluation. Confirmation of the final diagnosis with amyloid typing was performed according to the current international recommendations. The study population included 81 patients divided into two groups: ATTR (group 1, n = 32: 28 variant and 4 wild type) and AL (group 2, n = 49). ATTR patients were younger (50.7 ± 13.9 vs. 60.2 ± 7.3 years, P = 0.0001), and significantly different in terms of NT-proBNP [ATTR: 1472.5 ng/L (97-4218.5) vs. AL 8024 ng/L (3058-14 069) P = 0.001], hs-cTn I [ATTR: 10 ng/L (4-20) vs. AL 78 ng/L (32-240), P = 0.0002], GFR [ATTR 95.4 mL/min (73.8-105.3) vs. AL: 68.4 mL/min (47.8-87.4) P = 0.003]. At similar left ventricular (LV) wall thickness and ejection fraction, the ATTR group had less frequently pericardial effusion (ATTR: 15% vs. AL: 33% P = 0.0027), better LV global longitudinal strain (ATTR: -13.1% ± 3.5 vs. AL: -9.1% ± 4.3 P = 0.04), RV strain (ATTR: -21.9% ± 6.2 vs. AL: -16.8% ± 6 P = 0.03) and better reservoir function of the LA strain (ATTR: 22% ± 12 vs. AL: 13.6% ± 7.8 P = 0.02). Cut-off points were calculated based on the Youden method. We attributed to 2 points for parameters having an AUC > 0.75 (NT-proBNP AUC 0.799; hs-cTnI AUC 0.87) and 1 point for GFR (AUC 0.749) and TTE parameters (GLS AUC 0.666; RV FWS AUC 0.649, LASr AUC 0.643). A score of equal or more than 4 points has been able to differentiate between AL and ATTR (sensitivity 80%, specificity 62%, AUC = 0.798). The differential diagnosis score system was applied to the validation cohort of 52 CA patients showing a sensitivity of 81% with specificity of 77%.
CONCLUSIONS
CA is a complex entity and requires extensive testing for a positive diagnosis. This study highlights a series of non-invasive checkpoints, which can be useful in guiding the decision-making process towards a more accurate and rapid differential diagnosis.
PubMed: 38757395
DOI: 10.1002/ehf2.14852