Darko Anić

Surgical excision of a hemangioendothelioma of the left ventricle

Primary intracardiac neoplasms are most commonly histologically benign with only 30% exhibiting signs of malignancy. Metastatic tumors of the heart are 30 times more common than primary cardiac tumors. Patients with intracardiac masses may present with dyspnea on exertion, thromboembolic events, pericarditis, arrhythmias, or congestive heart failure. In many, however, the diagnosis is made upon discovering a murmur in an otherwise asymptomatic patient. Hemangioendotheliomas are very rare tumors of the heart characterized by capillary-sized vessels lined by rounded and often multilayered endothelial cells. Cardiac muscle cells are found compressed between proliferating vascular channels. We present a patient with this unusual cardiac tumor with no previous cardiac history and a new systolic murmur.

Impact of reduced creatinine clearance on early heart transplantation outcomes: A propensity score adjusted analysis

We aimed to determine the independent effect of preoperative creatinine clearance (CrCl) on HTx outcomes. Patients and Methods: 220 patients underwent HTx in Croatia from 2008 to 2014. Four patients were excluded due to missing data. Patients were dichotomized according to a CrCl cut-off value of 50 ml/ min (Group A: CrCl≤50 ml/min; Group B: CrCl>50 ml/min). Sixty-three patients (29%) had a CrCl≤50 ml/ min. Propensity score (PS) adjustment was performed by accounting for recipient age and gender, AF, smoking, ischemic time, CPB time, BMI, mechanical circulatory assistance (MCS) and reoperation. Results: Patients in Group A were older (56±11 vs. 49±12 years, P<0.001) and had longer donor ischemic times (197±65 vs. 162±62 min, P<0.001). No significant differences were noted in recipient gender (48/63 (76%) vs. 125/153 (82%) male, P=0.355), donor age (39±13 vs. 39±12 years, P=0.875), donor gender (46/63 (73%) vs. 100/153 (65%) male, P=0.338), PVR (213±107 vs. 188±96 dyn*s*cm −5 , P=0.145), diabetes (18/63 (29%) vs. 34/153 (22%), P=0.382), reoperation (18/63 (29%) vs. 34/153 (22%), P=0.382), CPB duration (175±62 vs. 158±56 min, P=0.06) or preoperative MCS (6/63 (10%) vs. 17/153 (11%), P=0.813). Six-month mortality was higher in patients with a CrCl≤50 ml/min (18/63 (29%) vs. 19/153 (12%); unadjusted OR 2.82 [95% CI 1.36-5.84]; P=0.009). Similarly, group A patients were more likely to require renal replacement therapy (RRT) (16/63 (25%) vs. 17/153 (11%); OR 2.72 (1.28-5.82); P=0.012). After PS adjustment these differences remained significant for both 6-month mortality and RRT (OR 2.44 [95% CI 1.09-5.49]; P=0.030 and OR 3.36 [95% CI 1.43-7.92]; P=0.005, respectively). Con Clusions: Patients with a CrCl≤50 ml/min undergoing isolated HTx had inferior 6-month survival and required RRT more commonly. The impact of CrCl remained significant after adjustment for multiple perioperative covariates. Hrvoje Gasparovic 1

The case of 28 year-old female after Senning procedure with persistent atrial flutter and severe triscuspid regurgitation.

E-mail: jbulum@gmail.com Transposition of the great vessels (TGA) is a rare condition with incidence of 1:5,000. The most common variant is dtransposition or complete transposition. Pivotal surgical procedure (Senning, 1957) has dramatically improved survival. However, typical long term complications include pressure overload of the systemic right ventricle with tricuspid regurgitation and atrial arrhythmias. Most of the patients are in NYHA I-II functional status 30 years after the operation but only 40-50% of them remain in sinus rhythm, while 30% of patients had minimally one episode of atrial flutter. A 28 year-old female was admitted to our Department in November 2011. When she was 9 months old, she underwent Senning procedure because of d-TGA. She was asymptomatic on beta-blocker until the age of 26 when she experienced palpitations and reduced effort tolerance. In addition, she was planning a pregnancy. Echocardiography showed the dilated and hypertrophic systemic right ventricle with reduced systolic function, and moderate to severe tricuspid regurgitation. Atrial conduits have a normal function. Cardiovascular magnetic resonance imaging showed a right ventricular hypertrophy without signs of fibrosis, and preserved Proπireni saaeetak / Extended abstract