Stanko Biočić

Pulmonary valve papillary fibroelastoma diagnosed by echocardiography: a case report

Papillary fibroelastomas (PFEs) are rare cardiac valve tumours with reported incidence of <0.03% according to autopsy studies. Among them, pulmonary valve PFEs are extremely rare. With wider use of echocardiography, they are being increasingly recognized premortem. We describe a case of a 32-year-old Caucasian woman with PFE of pulmonic valve diagnosed by echocardiography. The patient underwent surgery due to high mobility of the tumour and high risk of embolic complications. The surgery was done with complete tumour resection and total preservation of valve function. This case report discusses diagnostics of PFEs, their characteristic echocardiographic and histological features, and possible complications and suggests treatment options in this rare cardiac tumour.

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.

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.

Fibroelastoma or atheromatous plaque: a case report

Cardiologia CROATICA Cardiac fibroelastoma is a rare, benign cardiac tumor. Usually, they arise from valvular endocardium and non-valvular location is rare. Although transthoracic echocardiography is sufficient for diagnosis of most cardiac tumors, small tumors may be missed. We describe an adult female patient who was clinically asymptomatic, but was submitted for the echocardiocraphic evaluation because of the high blood pressure. Transthoracic echocardiography showed a small lesion that was attached to the aortic wall near the aortic valve. In such a case, differential diagnosis consists of tumor, thrombus or atheromatous plaque and usually relies on localization of the structure and clinical presentation. In conclusion, echocardiography represents an invaluable diagnostic tool for the detection of intracardiac masses while it simultaneously provides information about their size, location, mobility and attachment site as well as the presence and extent of any consequent hemodynamic effects. However, it is almoust impossible to define tissue character using echocardiography alone, as in our case. Magnetic resonance imaging excels at making a differential diagnosis of various soft tissues and organs becuse of its high revolving power. According to the proper diagnosis the adequate treatment including conservative or surgical approach could be provided.

Ruptured aneurysm of the noncoronary sinus of Valsalva into the right atrium

2. Galicia-Tornell MM, Marin-Solis B, Mercado-Astorga O, Espinosa-Anguiano S, Martinez-Martinez M, Villalpando-Mendoza E. Sinus of Valsava aneurysm with rupture. Case report and literature review. Cir Cir. 2009;77:441-5. Aneurysms of sinus of Vasalva are rare cardiac abnormalities, with an incidence of less than 0.15%, and marked male predominance. They are dilatations of the aortic sinuses, and are classified as congenital or acquired. The congenital aneurysms are more common and often caused by weakness at the junction of the aortic media and the annulus fibrosus. They commonly coexist with other malformations such as ventricular septal defect, anomalies of the aortic valve and coarctaton of the aorta. Acquired aneurysms are caused by conditions affectng the aortic wall, such as infections, trauma, or connective tissue disorders. It may be asymptomatic, or it may present as angina, or with symptoms of valvular insufficiency. Once ruptured, it often produces hemodynamic instability. The frequency of ruptured sinus Valsalva aneurysm varies according to the location: 60% are located in the right sinus, 42% in the noncoronary sinus and 10% in the left sinus. According to the location and frequency, rupture of a sinus Valsalva aneurysm occurs principally in the right ventricle (60%) or in the right atrium (29%). Extracardiac ruptures are rare. When rupture is suspected, immediate diagnosis should be pursued with transthoracic echocardography. We present a case of 33-year-old man admitted to our emergency departament with symptoms of abdominal pain, abnormal liver function tests and new diagnosed heart murmur. On physical examination his blood pressure was 120/60 mmHg and heart rate of 95 bpm. Jugular venous distension was present. There were no pulmonic rales or signs of peripheral edema. On auscultation, there was continuous systolic-dyastolic murmor of grade III/IV, best heard at the apex. Chest X-ray showed cardiomegaly. Transthoracic echocardography showed dilatation of the left ventricle, reduced systolic function, dilatation of the right ventricle and left atrium, and noncoronary sinus Valsalva aneurysm ruptured in the right atrium. The aortic valve was three-leaflet, and had no insufficiency, no ventricular septal defecte was present. The patient underwent corrective surgery, confirming the aneurysm of noncoronary sinus valsava ruptured in the right cardiac chambers. The patient has been followed-up in our cardiology clinic with complete recovery.

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.