Saso Rafajlovski

THERAPEUTIC APPROACH IN PATIENTS WITH A FLOATING THROMBUS IN THE RIGHT HEART

BACKGROUND The occurrence of a floating thrombus in the right heart, although rare, is a life-threatening condition requiring a specific approach. In most cases, these thrombi are a result of embolization from deep venous thrombosis, and have lodged temporarily in the right heart. The management of this condition is variable, depending on whether or not there is a thrombus entrapped within a foramen ovale (FO). OBJECTIVES To present the management of 2 patients with a free-floating thrombus in the right heart, and a third patient with an entrapped thrombus in the FO. CASE REPORTS Two patients with a free-floating thrombus in the right atrium who were treated with thrombolytic therapy had an immediate excellent outcome. The patient with a thrombus entrapped within the FO was scheduled for surgical removal of the thrombus due to an unacceptable risk of systemic embolization if treated with thrombolytic and anticoagulant therapy. Unfortunately, he developed an ischemic stroke on the fifth day of presentation, just a few hours before the scheduled surgery, despite meticulous monitoring of continuous heparin infusion with activated partial thromboplastin time. CONCLUSION Thrombolytic therapy is recommended in patients with a free-floating thrombus in the right heart. However, in patients with a thrombus entrapped within an FO, delaying surgical removal of the thrombus may be deleterious due to unpredictable systemic embolization.

Myocardial Perfusion Imaging in Diagnosis of Culprit Lesion in Patients Undergoing Elective Percutaneous Coronary Intervention

Myocardial perfusion imaging (MPI) was developed in the 1970s and has been used increasingly in clinical cardiology since the 1980s (Underwood et al., 2004). Technical developments that have fuelled this recent increases are single-photon emission computed tomography (SPECT) imaging, pharmacological stress and ECG-gated SPECT imaging. MPI comprises the only widely available method of assessing myocardial perfusion directly and many previously published reports support its evidence in the diagnosis of myocardial ischemia and necrosis. Moreover, the prognostic value of this method for patients’ risk stratification has already been extensively reported, with an incremental prognostic value after clinical assessment, exercise electrocardiography and even above coronary angiography. Thus, MPI is an established imaging technique that is already an integral part of the management of coronary artery disease (CAD) (diagnosis, prognostication, selection for revascularization and assessment of acute coronary syndromes) and is included in a number of professional guidelines. (1, 2) In the past two decades, a great body of literature has established the use of nuclear imaging for risk stratification in patients with known or suspected CAD. Risk stratification is of crucial importance for the practice of contemporary medicine. Extending the paradigm of noninvasive cardiac testing beyond the detection of disease is especially important, may risk assessment permits patients who are identified as being at a high risk for subsequent cardiac events should receive aggressive management, possibly including cardiac catheterization for potential revascularization procedures that may improve their outcome. Conversely, the management focus in patients with low future event rate should be shifted toward risk factor modification and aggressive medical therapy, reserving invasive procedures for

Asymmetry and sexual dimorphism of the medial frontal gyrus visible surface in humans

BACKGROUND/AIM Studies of visible (extrasulcal) surface of the brain hemispheres are not feasible for measurements of the brain size, but are valuable for analysis and quantification of sexual dimorphism and/or asymmetries of the human brain. Morphological and morphometric investigations of the brain may contribute in genetic studies of the human nervous system. The aim of this study was to determine and to quantify sexual dimorphism and the right/left morphological asymmetry of the visible surface of medial frontal gyms (gyrus frontalis medialis - GFM). METHODS Measurements and analysis of the visible surface of GFM were done on 84 hemispheres (42 brains from the persons of both sexes: 26 males and 16 females, 20-65 years of age). After fixation in 10% formalin and dissection, digital morphometric measurements were performed. We studied these in relation to the side of the hemisphere and the persons sex. Standardized digital AutoCAD planimetry of the visible surface of GFM was enabled by the use of coordinate system of intercommissural line. RESULTS In the whole sample, the visible surface of the right GFM (21.39 cm2) was statistically significantly greater (p < 0.05) than the left GFM (18.35 cm2) indicating the right/left asymmetry of the visible surface of GFM. Also, the visible surface of the right GFM in the males (22.66 cm2) was significantly greater (p < 0.05) than in the females (19.35 cm2), while the difference in size of the left GFM between the males and the females was not significant (p > 0.05). CONCLUSION Morphological analysis of visible surface of GFM performed by digital planimetry showed sexual dimorphism of the visible surface and the presence of right/left asymmetry of GFM.

Echocardiographic findings of mitral valve prolapse

Prolaps mitralnog zalistka predstavlja najcescu urođenu srcanu manu kod odraslih osoba. Ehokardiografski nalaz ima kljucnu ulogu prilikom postavljanja dijagnoze, ustanovljavanja lokalizacije zahvacenih segmenata i procene obima bolesti. Takođe, omogucuje identifikaciju bolesnika sa najvecim rizikom za pojavu komplikacija i daje kljucne podatke pri donosenju odluke o rekonstrukciji mitralnog zalistka.