Elektra Bartha

Permanent Left Atrial and Left Ventricular Single‐Lead DDD Pacing with a Coronary Sinus Electrode

MERKELY, B., et al.: Permanent Left Atrial and Left Ventricular Single‐Lead DDD Pacing with a Coronary Sinus Electrode. This report describes a patient with drug refractory severe chronic congestive heart failure, first‐degree AV block, and wide QRS complexes of 175‐ms duration with left bundle branch block who was successfully treated by a left‐sided dual chamber pacemaker system using a single‐lead coronary sinus electrode. Left atrial and ventricular signal amplitudes, left atrial and ventricular pacing thresholds were 2.5 mV, 13 mV, 1.8 V and 0.7 V (0.5ms), respectively. Using DDD pacing with an optimal 120‐ms AV delay the QRS duration decreased to 150 ms and the mitral filling pattern improved. Three months after implantation the patients functional status improved from NYHA Class III‐IV to Class II.

Uncommon presentation of a rare tumour - incidental finding in an asymptomatic patient: case report and comprehensive review of the literature on intrapericardial solitary fibrous tumours

BackgroundA solitary fibrous tumour is a rare, mainly benign spindle cell mesenchymal tumour most commonly originating from the pleura. An intrapericardial location of a solitary fibrous tumour is extremely unusual. We present a case of an asymptomatic patient with a slow-growing massive benign cardiac solitary fibrous tumour.Case presentationA 37-year-old asymptomatic female patient was referred to our hospital with an enlarged cardiac silhouette found on her screening chest X-ray. The echocardiographic examination revealed pericardial effusion and an inhomogeneous mobile mass located in the pericardial sac around the left ventricle. Cardiac magnetic resonance (MRI) examination showed an intrapericardial, semilunar-shaped mass attached to the pulmonary trunk with an intermediate signal intensity on proton density-weighted images and high signal intensity on T2-weighted spectral fat saturation inversion recovery images. First-pass perfusion and early and late gadolinium-enhanced images showed a vascularized mass with septated, patchy, inhomogeneous late enhancement. Coronary computed tomography angiography revealed no invasion of the coronaries. Based on the retrospectively analysed screening chest X-rays, the mass had started to form at least 7 years earlier. Complete resection of the tumour with partial resection of the pulmonary trunk was performed. Histological evaluation of the septated, cystic mass revealed tumour cells forming an irregular patternless pattern; immunohistochemically, the cells tested positive for vimentin, CD34, CD99 and STAT6 but negative for keratin (AE1-AE3), CD31 and S100. Thus, the diagnosis of an intrapericardial solitary fibrous tumour was established. There has been no recurrence for 3 years based on the regular MRI follow-up.ConclusionIntrapericardial SFTs, showing slow growth dynamics, can present with massive extent even in completely asymptomatic patients. MRI is exceedingly useful for characterizing intrapericardial masses, allowing precise surgical planning, and is reliable for long-term follow up.

Prophilactic aortic-root reconstruction in Marfan syndrome

of these excellent results is even more contrasted the 49% five year survival rate in the AAD group, not mentioned it’s 21% hospital lethality. The only conclusion might be taken out of these results: the prophylactic aortic root reconstruction is a safe and useful method, connected with excellent long term survival to prevent the occurrence of AAD.

Successful heart transplantation as third cardiac operation in a 12 year-old Marfan patient

Background Approximately 300.000 patients might be treated in Hungary because of heart failure. Out of this 900-1000 might be affected by end stage heart failure. These patients should be potentially treated by heart transplantation (HTX). The etiologic reasons of heart failure among transplanted patient are mainly cardiomyopathic or ischemic in origin (48%-44%). The valvular or congenital origin is rear (4%-2%). The prevalence of Marfan syndrome is 1-2/ 10.000; it means that we can calculate with 1000-2000 Marfan patients (MP) in Hungary. As it is mentioned in the literature MPs are often affected by a left ventricle dysfunction due to the characteristic Marfan cardiomyopathy, which may show a rapid progression in case of concomitant longstanding aortic or/and mitral regurgitation.