Mario Udovičić

Tetralogy of Fallot with Cor Triatriatum Dexter in an Adult Patient: A Case Report

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect with only approximately 3% of uncorrected patients surviving past age 40. In this case report, we present a 48-year-old mentally retarded man suffering from congenital spastic quadriplegia who was diagnosed with a unique combination of symptomatic TOF and cor triatriatum dexter (CTD). Reduced preload because of CTD with spastic quadriplegia that prevented physical exertion is believed to have facilitated this patients unusually long survival.

Rapid progression of left main disease in a patient with anterior ST-segment elevation myocardial infarction

2. Liang JJ, Hodge DO, Mehta RA, Russo AM, Prasad A, Cha YM. Outcomes in patients with sustained ventricular tachyarrhythmias occurring within 48 h of acute myocardial infarction: when is ICD appropriate? Europace. 2014 Dec;16(12):1759-66. https://doi.org/10.1093/europace/euu138 Case report: 43-year old male patient, with a positive family history for coronary artery disease, was admitted to hospital in Jul 2017 with acute ST-segment elevation myocardial infarction presenting with rhythmic instability (VT/VF) and cardiogenic shock. Angiography revealed occlusion of the proximal left anterior descending artery as the culprit lesion and intermediate stenoses of the distal segment of the right coronary artery (RCA) and OM branch of the circumflex artery. Percutaneous coronary intervention (PCI) of the culprit lesion was performed with an optimal angiographic result. Echocardiography showed dilation of the left ventricle with significant reduction of ejection fraction (EFLV 35%) and mild mitral regurgitation. He was discharged with optimal medical therapy. In Oct 2017 repeat angiography was performed to evaluate the aforementioned residual coronary lesions. Intravascular ultrasonography showed nonsignificant lumen stenosis of the left main artery (MLA 8 cm2), RCA and OM branch. Medical therapy was modified with introduction of sacubitril/valsartan. In Dec 2017 the patient was admitted to hospital with rhythmic instability (VT/VF) and elevated cardiac biomarkers. Angiography revealed significant ostial stenosis of left main artery with ventriculization of blood pressure curves and fall in BP during catheterization. After stabilization, an implantable cardioverter defibrillator was implanted for secondary prevention followed by PCI of the left main with implantation of one everolimus-eluting stent. On follow up visits the patient remains symptom-free, without clinical signs of heart failure or evidence of malignant ventricular arrhythmias.

Cor triatriatum sinister u trudnice.

Cor triatriatum sinister rijetka je priroena srËana greπka, koja obiËno biva otkrivena u djetinjstvu. Dijagnoza i praÊenje cor triatriatum sinister u potpunosti je moguÊe s minimalno invazivnim metodama, kao πto su transtorakalna i transezofagusna 2D te 3D ehokardiografija. Ove metode su stupovi praÊenja ove rijetke priroene srËane greπke, Ëija rijetkost moæe doprinijeti njezinom neprepoznavanju, no kada je ispravno prepoznata i lijeËena, ishod je izvrstan. Donosimo prikaz sluËaja mlade bolesnice kojoj je cor triatriatum sinister otkriven u odrasloj dobi te njegovo praÊenje tijekom trudnoÊe i uspjeπno konzervativno lijeËenje sve do poroda.

Three-dimensional echocardiography in unicuspid mitral valve

Cardiologia CROATICA Congenital malformation with absence of posterior mitral leaflet is extremely rare. A case of a 27-year-old woman with congenital malformation of unicuspid mitral valve is reported. To our knowledge, this is the first case of unicuspid mitral valve reported in Croatia. This report demonstrates that real-time three-dimensional (3D) echocardiography can be an optimal tool to evaluate congenital malformation of the mitral valve. Real-time 3D echocardiography is important in diagnosing heart valve diseases because it enhances the evaluation of morphologic abnormalities and improves understanding of complex relationships through more precise imaging and presentation of interrelations of different parts of the mitral apparatus. The downside of real-time 3D echocardiography is that it extends the time required for diagnostic procedure and it demands higher level of training of the examiner. In our patient, real-time 3D echocardiography revealed a complete absence of the posterior mitral leaflet. In absence of the posterior leaflet, the image was dominated by an elongated and thickened anterior mitral valve leaflet, accompanied with trivial mitral regurgitation. The subvalvular apparatus was anatomically normal, with appropriate chordal attachments and papillary muscles. There was no evidence of chamber enlargement or valvular dysfunctions. The patient was asymptomatic with normal function of unicuspid mitral valve. The prognosis of asymptomatic patients with unicuspid mitral valve is uncertain. As an example, annular dilatation can progressively impatr mitral regurgitation. For this reason such patients should undergo annual examination with transthoracic echocardiography to monitor progression of mitral regurgitation.

A familial cluster of idiopathic dilatation of the right atrium—A two-case report

We report two cases of idiopathic atrial dilatation in two adult siblings, a brother and a sister. The first patient was a 36-year-old man who was referred to our institution for evaluation of atrial fibrillation and syncopes. Transthoracic echocardiography revealed an enlarged right atrium accompanied by a severe tricuspid regurgitation associated with annular dilatation. The diagnosis of idiopathic atrial enlargement was made after all other lesions known to produce it have been excluded. The patient did not consent to the proposed cardiothoracic surgical treatment so he remained on conservative therapy. On electrocardiography, atrial standstill was noted, resulting in the implantation of a VVI cardiac pacemaker one year later. After an asymptomatic period, the patient suffered sudden death at the age of 40 years. His 45-year-old sister suffering from the same symptoms was also referred for examination, also to be diagnosed with idiopathic atrial dilatation and severe tricuspid regurgitation. Idiopathic dilatation of the right atrium, although a rare disorder, should not be forgotten as differential diagnosis for enlarged right atrium. Transthoracic echocardiography is the most commonly used technique and in our cases it was sufficient for establishing the diagnosis.