Tommaso Acquaviva

A “strange cough”: 3D-echocardiography for diagnosis of late tricuspid valve endocarditis in a former drug addict with septic pulmonary emboli

Tricuspid valve endocarditis (TVE) is not an uncommon finding in intravenous drug addicts [1]. TVE with pulmonary septic embolization, however, is a less common finding [2]. Even more rare is the diagnosis of TVE mainly led by pulmonary signs. We report the case of a 40-year-old man, a former intravenous drug addict, referred to our institution for recurrent episodes of cough and fever mimicking episodes of pneumonitis since a couple of months. The patient was affected by chronic hepatitis C, without history of heart disease. At previous hospitalization, chest radiograph showed 2 parenchyma nodules within left lung (basal and apical). A pneumonitis was therefore hypothesized and the patient was administrated with levofloxacin and ceftriaxone for 2 weeks, without any symptom relief. At present hospitalization, chest X-ray confirmed the presence of a single nodule in the basal segment of the left lung. Physical examination, however, was unremarkable. Rest ECG showed sinus rhythm at 78 bpm without significant ST anomalies (Fig. 1). Systolic blood pressure was 120/80 mm Hg. Troponin was 0.03 ng/ml and N-terminal pro-brain natriuretic peptide 20.6 pg/ml, while C-reactive

GHOSTS AFTER LEAD REMOVAL: ETIOLOGY AND PROGNOSTIC IMPACT. A REPORT OF AN INTRACARDICAC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY

Ghosts are new mass lesions in the right cardiac chamber after leads extraction, whose clinical significance is not clear. Because we do not know the true origin of ghosts, prolonged hospitalization and antibiotic therapy are considered necessary. Sixteen patients scheduled for leads removal

Pulmonary Arterial Hypertension in Adults with Congenital Heart Disease: Can We Predict its Development?

Over the last decades, progress in pediatric cardiac surgery and interventional cardiology allowed reaching adulthood to a great number of children suffering from congenital heart diseases (CHD). Apart from corrected CHD patients, grownup congenital heart diseases (GUCH) also comprise adults with newly diagnosed cardiac defect. Ebstein’s anomaly, coarctation of the aorta, atrial septal defect and congenitally corrected transposition of the great arteries may remain undiagnosed for many years or occasionally identified on echocardiographic evaluation and at least manifest in adult life for the first time with infective endocarditis or effort dyspnea [1]. Therefore it is difficult to estimate the exact prevalence of CHDs in adults. The management of GUCH subjects requires particular expertise by physicians in order to provide the most appropriate treatments.

‘Broken-heart’ syndrome: ventricular septal perforation in a takotsubo cardiomyopathy

Takotsubo cardiomyopathy (TTC) is a form of acute left ventricular dysfunction usually reversible and with favorable prognosis. Ventricular septal perforation (VSP) is a very rare life-threatening complication. Percutaneous closure of VSP, despite being challenging, is a possible alternative to surgical repair. We present the first case of an 84-year-old patient with a TTC-related VSP treated by percutaneous approach. The case highlights the need of reconsidering the worldwide accepted consideration of TTC as benignant and allows some speculations on the optimal management of VSP in terms of timing, patient selection and possible alternative interventions.