Piotr Hendzel

An unexpected diagnosis in a patient with two left atrial pathological masses found by echocardiography

485 located opposite each other, both measuring ap‐ proximately 32 to 33 × 24 mm in size (FIGURE 1B). The first mass was oval, attached to the postero‐ lateral wall, and highly mobile (FIGURE 1C), and the other was irregular in shape and was local‐ ized next to the right upper pulmonary vein out‐ let (FIGURE 1D). The tumors did not originate from the interatrial septum. There was no evidence of valvular vegetations. Initially, cardiac myxo‐ mas or LA thrombi were suspected. Importantly, there was no sign of mitral stenosis or a formed thrombus in the LA appendage (FIGURE 1E). The le‐ sions excised from the LA (FIGURE 1F) were sugges‐ tive of thrombi. Histological examination revealed numer‐ ous colonies of Aspergillus fumigatus (mycelia). A 63 ‐year ‐old woman after kidney transplanta‐ tion, treated with immunosuppressive drugs, with permanent atrial fibrillation on acenocoumarol, was admitted for diagnostic workup of 2 abnor‐ mal structures detected in the giant left atrium (LA) by routine transthoracic echocardiography (FIGURE 1A). In recent weeks, she presented with fatigue and periodic chest pain. During hospi‐ talization, a recurrent fever reaching 39°C and an elevated C ‐reactive protein level of 154 mg/l were observed. Initially, empiric antibiotic ther‐ apy was ordered. Serial blood and urine cultures were negative. The international normalized ratio was within the therapeutic range on serial mea‐ surement. Transesophageal echocardiography confirmed 2 large abnormal masses in the LA, CLINICAL IMAGE

Usefulness of CorMatrix-based tricuspid valve repair in the treatment of infective endocarditis

A 34-year-old man addicted to heroin and mephedrone was transported to the cardiac surgery unit from the Isolation Hospital due to infective endocarditis (IE) of the tricuspid valve (TV) with severe regurgitation. Blood cultures indicated an increase in Staphylococcus aureus MSSA — a targeted antibiotic treatment with cloxacillin 6 × 2 g IV was added. The echocardiography revealed a large vegetation on the anterior leaflet of the TV, 31 × 20 mm in size, right atrium enlargement, and severe TV regurgitation (Fig. 1). Until recently, the only treatment options for IE causing significant damage to the TV were replacement of the valve with a biological or mechanical implant or advanced valvuloplasty. These methods, however, carry a risk of reinfection, dysfunction of the artificial prosthesis, as well as the potential complications inherent to aggressive treatment with vitamin K antagonists (VKA). Employing a CorMatrix patch may present an alternative method for treating IE. CorMatrix is an extracted extracellular matrix to which growth factors, matricellular proteins, glycosaminoglycans, and adhesion factors were applied. After implantation into human tissue, CorMatrix functions as a scaffold onto which the body’s own cells migrate, depending on the location of the implant. The material also promotes the migration of leukocytes — a crucial property when treating IE because it prevents further reinfection. Before opening the patient’s chest, the surgeon crafts a tubular CorMatrix patch, using the dimensions of the TV established during the pre-surgery cardiac echo as a template (the tricuspid annular diameter and the distance from the annulus to the papillary muscles in diastole). After sternotomy and removing the native TV, the surgeon implants the newly crafted valve to the native annulus and the papillary muscles. A CorMatrix-reconstructed TV (15 × 7 cm patch) was implanted. The intraoperative transoesophageal echocardiogram indicated the proper functioning of the CorMatrix prosthesis with only an insignificant regurgitation (Fig. 2). The patient was discharged from the intensive care unit two days after the surgery. During the following days, a gradual normalisation of biochemical parameters was observed. In good overall condition, the patient was transferred to the Isolation Hospital to continue intravenous antibiotic treatment. Six months after the surgery, a follow-up cardiac echo showed no tricuspid regurgitation and no reinfection. Until now, IE of the TV carried a high risk of reinfection. Additionally, there are no valves dedicated specifically to the tricuspid configuration available. The long-term outcomes of the implantation of a CorMatrix valve shed a new light on the treatment of IE of the TV. An additional advantage of the method is that it does not require any anticoagulant treatment with all abbreviation should be spelled out VKA, which often has a great impact on the quality of life of young patients.

Zasady kwalifikacji do ECMO u osób dorosłych

Extracorporeal Membrane Oxygenation (ECMO), is used in cases of extreme respiratory and/or circulatory insufficiency, resistant to conventional treatment methods. As science moved on and experience was gained, ECMO began to be used also in the treatment of the most serious stages of hypothermia, as well as during the preparation for a planned heart and/or lung transplant. Due to restrictive guidelines and an invasive character of treatment, ECMO is undertaken relatively rarely. However, it often constitutes an element of therapy critical for patients survival and further treatment possibilities.

Metabolomika — chemiczny „odcisk palca” i istotny element medycyny spersonalizowanej

Metabolomika jako cześc biologii systemowej zajmuje sie badaniem metabolomu, czyli związkow o malej masie cząsteczkowej (< 1,5 kDa). Metody, ktorymi posluguje sie metabolomika, to spektrometria mas (MS) i spektroskopia NMR. W ciągu ostatniej dekady obserwuje sie dynamiczny rozwoj technik „omicznych” jako narzedzi medycyny spersonalizowanej. Mozna rowniez zaobserwowac znaczny wzrost liczby publikacji z zakresu metabolomiki i lipidomiki w dziedzinie chorob ukladu krązenia. Nowe biomarkery mogą przyczynic sie do poprawy oceny ryzyka zaburzen kardio-metabolicznych.

Pulmonary artery aneurysm in an adult patient with idiopathic dilatation of the pulmonary artery

Idiopathic dilatation of the pulmonary artery (IDPA) is a rare congenital heart disease. It has been described for almost one hundred years, and numerous definitions have been proposed. The IDPA diagnostic criteria have not been updated for years. Secondary to primary disease, pulmonary artery aneurism was recognised as a lethal defect; however, long-term follow-up of patients with IDPA has not been well researched. Thus, indications to medical or surgical treatment are not evidence based. Here, we present a rare case of a 54-year-old patient with IDPA, who remained under observation for 36 years without surgical intervention.