Efrosina Kajo

A giant myxoma originating from the aortic valve causing severe left ventricular tract obstruction: a case report and literature review

IntroductionThe left ventricular localization of a myxoma is very rare, usually arising from the interventricular septum close to the left ventricular outflow tract, the mitral valve, the ventricular wall and extremely rarely the aortic valve.Case presentationA 13-year-old male was admitted due to dyspnea and angina. Transesophageal echocardiography revealed left ventricular outflow tract obstruction with a mean gradient of 58 mmHg, and a mobile mass measuring 65 × 25 mm originating from the ventricular surface of the aortic valve was identified. The patient underwent urgent surgical excision and aortic valve replacement. Histopathological examination of the mass confirmed the diagnosis of a myxoma.ConclusionIn conclusion, a myxoma originating from the aortic valve remains a very rare localization. Total resection associated with aortic valve replacement seems to offer an excellent outcome.

Surgical excision of a giant calcified amorphous tumour of the right ventricle and right pulmonary artery

A cardiac calcified amorphous tumour (CCAT) is a rare non-neoplastic intracavitary mass with unknown causes. We describe a 32-year old male presenting with progressive dyspnoea, cough and oedemas. The transthoracic echocardiography and contrast-enhanced angio-computed tomography demonstrated a 4 × 10 cm calcified mass into the right ventricle and total occlusion of the right pulmonary artery. The patient underwent successful total removal of the mass through a transverse right ventriculotomy, and right pulmonary embolectomy. Histopathological examination of mass confirmed the diagnosis of a CCAT. The postoperative course was uneventful. To our knowledge, this is the first reported case with a confirmed diagnosis of CCAT at two different locations and the third undergoing a combined approach aiming at total mass excision.

Hemodynamics of 17-mm vs. 19-mm St. Jude Medical Regent and annulus enlargement

Objective We aimed to compare early and midterm clinical and hemodynamic outcomes of 17-mm vs. 19-mm St. Jude Medical Regent valves with concomitant aortic annulus enlargement. Methods Between 1999 and 2012, 20 patients (group 1) underwent first-time aortic valve replacement with a 17-mm St. Jude Medical Regent valve, and 35 patients (group 2) had a 19-mm valve and concomitant aortic annulus enlargement. The mean follow-up was 81 ± 37 months (range 20–110 months). Results There was one death in group 1 vs. 4 in group 2 (p > 0.05). The mean postoperative transprosthetic gradient was 17.5 ± 4.5 in group 1 and 17 ± 6.4 mm Hg in group 2 (p = 0.83), and 37 ± 10.7 and 32 ± 13 mm Hg, respectively, under stress (p = 0.17). Left ventricular mass and left ventricular mass index were reduced and similar in both groups. Postoperative effective orifice area index was higher in group 2 (0.85 ± 0.17 cm2 m−2) than group 1 (0.76 ± 0.2 cm2 m−2; p > 0.05). A multivariate Cox model identified a 19-mm valve with aortic annulus enlargement (p = 0.032), functional class (p = 0.025), reoperation (p = 0.04), ejection fraction < 35% (p = 0.042), and combined surgery (p = 0.04) as strong predictors of poorer overall event-free survival. Conclusions The 17-mm St. Jude Medical Regent valve may be employed with satisfactory postoperative clinical and hemodynamic outcomes in patients with a small aortic annulus, as an alternative to a larger prothesis with aortic annulus enlargement.

Surgical treatment of a calcified, amorphous tumor of the right ventricle complicated with thrombosis of the right pulmonary artery in an adult male: a case report

BackgroundA calcified amorphous tumor of the heart is an extremely rare cardiac mass.Case presentationA 32-year-old Albanian man presented to our hospital with fatigue, shortness of breath, progressive dyspnea, and right congestive heart failure. Echocardiography and chest computed tomography revealed a giant, calcified right ventricular mass that originated between the papillary muscles and the trabeculae and extended to the pulmonary valve. The patient underwent surgery with excision of the mass, replacement of the pulmonary valve with a biological one, and repair of the tricuspid valve. His histopathological examination revealed that the mass was a calcified, amorphous tumor. His postoperative course was uneventful.ConclusionsThe clinical presentation of the calcified amorphous tumor is similar to that of other cardiac tumors, so surgical excision is mandatory. Histopathological examination remains the gold standard for an accurate diagnosis.

Coil embolization of an anomalous bronchial artery originating from the left subclavian artery following arterial switch operation: a case report.

IntroductionBronchial arteries originate from the descending aorta at the level of the T5-T6 vertebrae following an intrapulmonary course along the major bronchi. When bronchial arteries take off from a vessel other than the descending aorta, the anatomy is defined as an anomalous origin of the bronchial artery.Case presentationA 3-day-old boy from Kosovo with dextro-transposition of the great arteries who developed progressive heart failure required an emergency arterial switch operation. Because of persistent pulmonary edema after completion of the arterial switch operation at our institution, the patient could not be weaned off mechanical ventilation. Transthoracic echocardiography revealed an anomalous accelerated flow, indicating an anomalous systemic pulmonary shunt. Arterial catheterization revealed an abnormal bronchial artery originating from the left subclavian artery and bifurcating to both lungs. The anomalous ectatic bronchial artery was successfully occluded by coil embolization. The improvement of the patient’s hemodynamic status resulted in an uneventful post-operative course.ConclusionA coil embolization procedure was successfully performed to treat an anomalous bronchial artery originating from the left subclavian artery after a switch operation in a patient with transposition of the great arteries. When clinically indicated, catheter-based therapy with coil embolization can be performed to successfully treat anomalous bronchial arteries by reducing as such the pulmonary overflow.