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Vascular Health and Risk Management 2024We aim to access the effect of pericardiectomy for constrictive pericarditis with or without cardiopulmonary bypass. (Review)
Review
AIM
We aim to access the effect of pericardiectomy for constrictive pericarditis with or without cardiopulmonary bypass.
METHODS
This was a review of pericardiectomy for constrictive pericarditis.
RESULTS
Cardiopulmonary bypass is actually an important maneuver to attain complete relief of the constriction. The short additional time of cardiopulmonary bypass during the procedure has very little effect on the risk of morbidity of the main operation.
CONCLUSION
Incomplete pericardiectomy perhaps was the cause of postoperative remnant constriction and high diastolic filling pressure leading to multiorgan failure. Complete pericardiectomy (removal of phrenic-to-phrenic and the postero-lateral and inferior wall pericardial thickening) using cardiopulmonary bypass should be the routine for total relief of the constriction of the heart.
Topics: Humans; Pericarditis, Constrictive; Pericardiectomy; Cardiopulmonary Bypass; Postoperative Complications
PubMed: 38348404
DOI: 10.2147/VHRM.S439292 -
Cureus Jan 2024A 70-year-old Japanese woman with hypertension, dyslipidemia, and diabetes mellitus complained of abdominal discomfort and vomiting and was brought to our emergency...
A 70-year-old Japanese woman with hypertension, dyslipidemia, and diabetes mellitus complained of abdominal discomfort and vomiting and was brought to our emergency department by ambulance two days later with impaired consciousness. Her vital signs suggested shock with a heart rate of 120 bpm. Electrocardiogram and initial transthoracic echocardiography suggested an inferior wall ST-elevation myocardial infarction, but the altered consciousness was inconsistent. Contrast-enhanced computed tomography was urgently performed to further clarify the cause. It revealed pericardial effusion and apparent extravasation from the left ventricular wall, confirming the early definitive diagnosis of left ventricular free wall rupture. The patient underwent successful emergent surgical repair without sequelae. Differential diagnosis of left ventricular free wall rupture is important in patients with ST-elevation myocardial infarction and impaired consciousness. Contrast-enhanced computed tomography allows early diagnosis and treatment of this life-threatening complication.
PubMed: 38344574
DOI: 10.7759/cureus.52127 -
Veterinarni Medicina Feb 2023This study aims to describe the most important cardiac structures in the through echocardiography and anatomical dissection. Echocardiographic and echo-Doppler...
This study aims to describe the most important cardiac structures in the through echocardiography and anatomical dissection. Echocardiographic and echo-Doppler measurements were performed on twenty healthy adult (10.10). The values of the ventricular length, aortic diameter, pulmonary trunk diameter, the mean thickness of the interventricular septum, and thicknesses of the wall of the (Cav. P) and (Cav. A), were measured. The aortic flow and pulmonary trunk flow were recorded. Two dead specimens (1.1) were dissected. The male's pulmonary trunk diameter was bigger compared to the female's in both the long and short axis. The reproductive ecology of has yet to be fully elucidated upon, however, male territorialism and dispersal from the hibernacula, and multiple male courtships toward a single female were described, hence, the more active reproductive activity of the male and the consequent sexual selection toward a higher aerobic performance can be hypothesised. A moderate interventricular right to left shunt was noticed in the Cav. V of all the specimens, which is considered normal and should not confuse the clinician. Congenital defects, cardiomyopathies, valvulopathies, and pericardial diseases are known to occur in ophidians and other reptiles. Reliable data and profound knowledge of the anatomy and physiology of the ophidian heart are fundamental for the diagnosis of cardiac diseases in snakes.
PubMed: 38332762
DOI: 10.17221/63/2022-VETMED -
Cureus Jan 2024Left ventricular pseudoaneurysm is a ventricular free wall rupture contained within the adjacent adherent pericardium or scar tissue. Myocardial infarction (MI), cardiac...
Left ventricular pseudoaneurysm is a ventricular free wall rupture contained within the adjacent adherent pericardium or scar tissue. Myocardial infarction (MI), cardiac surgery, and chest trauma are the common causes. The most common presenting symptoms of pseudoaneurysms are congestive heart failure, chest pain, and dyspnea, but a small percentage of patients may be asymptomatic. Early diagnosis and treatment are of prime importance because of the tendency of pseudoaneurysms to expand and rupture, with a high mortality rate, especially if left untreated. We present a case of a 65-year-old man who was found to have left ventricular pseudoaneurysm on a follow-up echocardiography within three weeks of an MI. He subsequently underwent patch repair and was discharged after medical optimization. Our case highlights the importance of maintaining a high clinical suspicion of pseudoaneurysm in a patient post-MI, as delayed diagnosis and treatment can be fatal.
PubMed: 38298290
DOI: 10.7759/cureus.51480 -
Frontiers in Cardiovascular Medicine 2024Echocardiography-guided percutaneous intramyocardial alginate-hydrogel implantation (PIMAHI) is a novel treatment approach for heart failure (HF). We validated PIMAHI...
BACKGROUND
Echocardiography-guided percutaneous intramyocardial alginate-hydrogel implantation (PIMAHI) is a novel treatment approach for heart failure (HF). We validated PIMAHI safety and efficacy in canine HF models.
METHODS
Fourteen canines with HF [produced by coronary artery ligation, left ventricular ejection fraction (LVEF) < 35%] were randomised to PIMAHI treatment ( = 8) or controls ( = 6). Echocardiography, two-dimensional speckle tracking echocardiography, and pathological examinations after a 6-month follow-up were performed. Repeated-measures analysis of variance was used for within-group comparisons.
RESULTS
At 6-month follow-up, PIMAHI treatment reversed LV dilation and remodelling, increasing LV free wall thickness (LVFW, = 0.002) and interventricular septum thickness (IVS, < 0.001) and reducing LV end-diastolic volume (EDV, = 0.008) and end-systolic volume (ESV, = 0.004). PIMAHI significantly improved LV systolic function, increasing LVEF (EF, = 0.004); enhanced LV myocardial contractility, including increased LV global longitudinal strain (GLS, < 0.001), global circumferential strain (GCS, = 0.006), and mitral annulus displacement (MAD, = 0.001). Compared with controls at 6-month, PIMAHI group significantly increased LVFW thickness (8.5 ± 0.3 vs. 6.8 ± 0.2 mm, = 0.002) and IVS (7.9 ± 0.1 vs. 6.1 ± 0.2 mm, < 0.001); decreased LVEDV (30.1 ± 1.6 vs. 38.9 ± 4.5 ml, = 0.049) and ESV (17.3 ± 1.2 vs. 28.7 ± 3.6 ml, = 0.004); increased LV systolic function (42.7 ± 1.5 vs. 26.7 ± 1.1% in EF, = 0.001); and enhanced LV myocardial contractility including GLS (13.5 ± 0.8 vs. 8.4 ± 0.6%, = 0.002), GCS (16.5 ± 1.4 vs. 9.2 ± 0.6%, = 0.001), and MAD (11.4 ± 3.5vs 4.6 ± 2.5 mm, = 0.003). During PIMAHI treatment, no sustained arrhythmia, pericardial, or pleural effusion occurred.
CONCLUSIONS
PIMAHI in canine HF models was safe and effective. It reversed LV dilation and improved LV function.
PubMed: 38287986
DOI: 10.3389/fcvm.2024.1320315 -
Cureus Dec 2023Chest pain is a common presentation that may represent a wide variety of underlying etiologies ranging from mild self-limiting conditions to immediately life-threatening...
Chest pain is a common presentation that may represent a wide variety of underlying etiologies ranging from mild self-limiting conditions to immediately life-threatening emergencies. The combination of "cardiac-sounding chest pain" and elevated troponin levels would raise suspicion of an acute ischemic event. An acute coronary syndrome is a diagnosis that may be straightforward; however, oftentimes, patients with elevated troponin levels and chest pain may bring about a state of diagnostic uncertainty. Alternative diagnoses to consider would be inflammatory or infectious conditions of the myocardium and pericardium. We present the case of a young gentleman in his twenties who presents with cardiac chest pain, elevated troponin, and non-specific changes on his electrocardiogram who was treated for an alternative cause of elevated troponin and chest pain, myopericarditis. We present the case of a 24-year-old male who presented with a six-hour history of debilitating retrosternal chest pain. Initial workup showed a Troponin I level greater than 15,000 ng/L, D-Dimer greater than 1,000 mcg/L with no overt ischemic features on electrocardiogram. The patient had no high-risk features in his medical history & denied the use of recreational drugs. A formal same-day echocardiogram revealed normal biventricular systolic function and no evidence of regional wall motion abnormality (RWMA). He was eventually treated clinically for myopericarditis. A Cardiac MRI (CMR) imaging was done to confirm the diagnosis and rule out, most importantly, ischemic heart disease or any other underlying pathology. The main dilemma in this case was working out whether there was indeed peri-myocardial inflammation, or an acute coronary event (such as spontaneous coronary artery dissection) given his age and clinical history. Patients presenting with a very high troponin level, particularly in young patient cohorts, should raise suspicion of a myocardial or pericardial inflammatory process. In addition to a thorough history and in the absence of ischemic changes on the electrocardiogram, subtle findings such as PR segment depression may point to a diagnosis of pericardial inflammation. While urgent echocardiography is useful to quickly assess ventricular function and for RWMA, CMR imaging is the Gold Standard modality of investigation to provide detailed structural information of the heart.
PubMed: 38213369
DOI: 10.7759/cureus.50391 -
Surgical Case Reports Jan 2024Lung abscess treatment results the treatment results improved with the development of antibiotics; however, surgical treatment is indicated when pyothorax is present,...
BACKGROUND
Lung abscess treatment results the treatment results improved with the development of antibiotics; however, surgical treatment is indicated when pyothorax is present, surgical treatment is indicated. When a lung abscess ruptures, pyothorax and fistula occur, which are difficult to treat.
CASE PRESENTATION
A 74-year-old woman who experienced exacerbated dyspnea and left back pain for 10 days was diagnosed with a lung abscess caused by an odontogenic infection. The patient's medical history included hypertension, angina pectoris, untreated dental caries, and periodontitis. Despite administration of meropenem for 5 days, inflammatory markers increased. Chest radiography revealed pleural effusion exacerbation; therefore, the patient immediately underwent chest drainage and surgery was planned. Thoracic debridement and parietal and visceral decortication were performed. However, the lung abscess in the lateral basal segment ruptured during visceral decortication. As the tissue was fragile and difficult to close with sutures, free pericardial fat was implanted in the ruptured abscess cavity and fixed with fibrin glue, and sutured to the abscess wall. No signs of postoperative air leakage or infection of the implanted pericardial fat were observed. All drainage tubes were removed by postoperative day 9. The patient was discharged on postoperative day 12 and underwent careful observation during follow-up as an outpatient. At 1 year and 2 months after surgery, empyema recurrence was not observed.
CONCLUSIONS
A lung abscess that ruptured intraoperatively was successfully and effectively treated by implantation of free pericardial fat in the abscess cavity.
PubMed: 38200276
DOI: 10.1186/s40792-024-01814-z -
Heart Views : the Official Journal of... 2023Acute coronary syndromes (ACSs) present most frequently with chest pain, but angina equivalents such as dyspnea, diaphoresis, and fatigue are not uncommon. Atypical...
Acute coronary syndromes (ACSs) present most frequently with chest pain, but angina equivalents such as dyspnea, diaphoresis, and fatigue are not uncommon. Atypical presentations are especially seen in women, the elderly, and diabetics. Cardiac evaluation using a transthoracic echocardiogram is almost always done before or immediately after someone undergoes left heart catheterization for ACS. It provides information valuable information regarding wall motion, left ventricular systolic function, diastolic function, right ventricular involvement, pulmonary pressures, incidental valvular disease, pericardial fluid, or any other unsuspected abnormality. We describe a novel case where an atypical presentation of ACS was suspected based on the lack of intravenous contrast administered, to enhance endocardial border resolution. The use of contrast during echocardiography has been used during stress protocols to assess microcirculation during perfusion assessment studies. However, we described a reduced uptake during the acquisition of resting myocardial echocardiogram images and it was very useful to direct therapy.
PubMed: 38188711
DOI: 10.4103/heartviews.heartviews_32_23 -
Romanian Journal of Morphology and... 2023Pericardial cysts (PCs) or pleuropericardial cysts are rare congenital mediastinal lesions with an approximate incidence of one in 100 000 persons. Usually, they are...
Pericardial cysts (PCs) or pleuropericardial cysts are rare congenital mediastinal lesions with an approximate incidence of one in 100 000 persons. Usually, they are asymptomatic, being incidentally discovered during a routine chest imaging examination or an autopsy exam. The study involved a retrospective evaluation of clinicopathological findings in a 6-year series of PCs, treated in the Clinic of Pulmonary Diseases, Iaşi, Romania. A group of five cases of PCs, four females and one male, were evaluated. All patients displayed different symptoms, such as dyspnea, chest pain, chronic cough, fatigue, palpitation, and epigastric pain. The cystic lesions were located in the right and left cardiophrenic angle, in four cases, and in the central mediastinum in a single case. The lesions had a fluid content and a maximum diameter that ranged between 35 and 95 mm. The microscopic examination of the surgical resection tissues revealed a thin connective tissue wall without any associated smooth muscle cells. The loose connective tissue band was lined by a layer of mesothelial cells with no cellular atypia, which displayed discrete papillary projections, in one case. Although PCs are rare incidental findings, they should be considered in differential diagnoses of mediastinal cysts, especially as they are associated with non-specific symptoms. Furthermore, considering the possibility of development of severe complications, PCs should be thoroughly explored for suitable patients' management.
Topics: Female; Humans; Male; Mediastinal Cyst; Retrospective Studies; Diagnosis, Differential; Autopsy; Chronic Cough
PubMed: 38184832
DOI: 10.47162/RJME.64.4.08 -
BMJ Case Reports Dec 2023Malignant peritoneal mesothelioma (MPeM) is a rare malignancy with historically poor prognosis. Recent research has started to reveal increasingly prevalent genetic...
Malignant peritoneal mesothelioma (MPeM) is a rare malignancy with historically poor prognosis. Recent research has started to reveal increasingly prevalent genetic mutations seen in this malignancy. Here, we report a case of complete clinical remission of unresectable, metastatic MPeM with systemic chemotherapy. Immunohistochemistry of our patient's malignant cytology sample showed loss of Breast Cancer Gene 1-associated protein-1 expression (BAP1). The patient had synchronous diagnoses of primary squamous cell carcinoma of the anus, benign schwannoma and meningioma. Following the completion of 18 cycles of pemetrexed and bevacizumab, the patient has remained in clinical remission for 8 months. We examine the unusual susceptibility of unresectable MPeM to systemic chemotherapy and attribute susceptibility to the molecular milieu created by mutations in multiple DNA repair pathways. We encourage increased testing for and analysis of mutations in DNA repair pathways to improve future treatment outcomes in this rare malignancy.
Topics: Humans; Bevacizumab; Pemetrexed; Lung Neoplasms; Mesothelioma, Malignant; Mesothelioma; Peritoneal Neoplasms; Mutation; Ubiquitin Thiolesterase; Tumor Suppressor Proteins
PubMed: 38142057
DOI: 10.1136/bcr-2023-255916