Tertiary syphilis and cardiovascular disease: the united triad: case report.

Background: Syphilis, owing to its natural course, can lead to long-term damage to the aortic valve, such as insufficiency and rarely stenosis, ostial coronary stenosis, and syphilitic aortitis. Cardiovascular involvement alongside neurological involvement dominates the prognosis. This should no longer be seen, thanks to awareness and prevention programmes, medical treatment, and antibiotics. Case summary: We report a case of a 54-year-old chronic smoker with no previous history, admitted for respiratory distress amid an impaired general condition. An electrocardiogram was performed, which showed sinus rhythm with lateral ST depression and T-wave inversion. Coronary angiography revealed an ostial stenosis of the left coronary artery. Echocardiography displayed a globular dilated left ventricle with a left ventricular ejection fraction of 40% and severe aortic insufficiency (AI). Computed tomography angiography of the aorta showed a dilation of the thoracic aorta and suprarenal abdominal aorta. Syphilitic serology was positive. The patient underwent angioplasty, resulting in a satisfactory outcome, and subsequently received optimal treatment. Following a consultation with a cardiovascular surgeon and vascular team, it was decided to proceed with mechanical aortic valve replacement and aorto-coronary double bypass surgery, but vascular surgery of the ascending aortic aneurysm was not possible at once. Discussion: Tertiary syphilis should always be considered when faced with isolated coronary ostial involvement, aortic aneurysm, and/or AI. What makes our case special is that the patient had almost all the cardiovascular complications of tertiary syphilis. Primary syphilis should always be prevented, diagnosed early, and treated appropriately with antibiotic therapy.

Three-Dimensional (3D) Mapping and Catheter Ablation for Simultaneous Reverse Typical and Atypical Atrial Flutter: A Case Report.

Atrial flutter, a common cardiac arrhythmia, is characterized by rapid and regular atrial contractions that result in a characteristic sawtooth pattern on the electrocardiogram. It emerges due to the formation of reentrant electrical circuits within the atria, giving rise to structured, sawtooth-patterned atrial waves as observed on electrocardiography. We present the case of a 52-year-old female with a medical history of ankylosing spondylitis, dyslipidemia, and a previous surgical closure of an atrial septal defect. The patient developed a rare form of atrial flutter, characterized by two distinct mechanisms: a clockwise isthmus-dependent flutter and an atypical scar-related flutter around the atriotomy scar. In order to effectively address this complex condition, a successful ablation procedure was performed to target both mechanisms. This case report offers valuable insights into the complexities surrounding the diagnosis and treatment of a complex case characterized by the coexistence of multiple mechanisms of atrial flutter within a single patient. While catheter ablation has demonstrated improved success rates for typical and atypical atrial flutters when occurring in isolation, predicting the prognosis of complex cases continues to pose challenges.

Unmasking Idiopathic Brugada ECG Pattern: Inducible Type 1 Brugada Pattern in a Young Patient and Clinical Implications.

Brugada syndrome is a rare inherited channelopathy associated with an increased risk of ventricular tachycardia and ventricular fibrillation, leading to syncope and sudden cardiac death. We present a case report of a young patient with an inducible type 1 Brugada pattern on an electrocardiogram (ECG), accompanied by a comprehensive literature review. The 19-year-old patient presented with dizziness and exhibited a type 2 Brugada pattern on admission ECG, which converted to a type 1 pattern following an Ajmaline test. Based on the absence of symptoms, inducible arrhythmias, or cardiac events in the patient's history, implantable cardioverter-defibrillator insertion was deemed unnecessary. Genetic testing was recommended, and screening ECGs were advised for the patient's first-degree relatives. The discussion explores the different types of Brugada patterns, their diagnostic significance, and the controversies surrounding risk stratification and management strategies. The case underscores the importance of maintaining clinical suspicion for Brugada syndrome in young patients and tailoring treatment approaches based on individual characteristics and risk factors.

Anomalous origin of right coronary artery with interarterial course revealed by effort angina: case report.

Anomalous origin of coronary artery with interarterial course is recognized as a rare congenital heart disease. Its main manifestation is myocardial ischemia related to systolic compression of coronary arteries positioned between the great arteries. We report a case of a middle-aged man admitted in our department for an effort angina during nordic walking. A coronary angiography was performed showing an anomalous coronary artery with a birth defect giving a right common trunk of the circumflex artery and the right coronary artery. We proceeded to a multidetector computed tomography coronary angiography (MDCTCA) to describe this variant of an anomalous coronary arteries which revealed a birth defect in the left anterior sinus of the right coronary and the circumflex artery from a right common trunk passing between the aorta and the trunk of the pulmonary arteries. Magnetic resonance imaging (MRI), exercise stress test and myocardial perfusion scintigraphy were performed in order to objectify an ischemia. Despite the positivity of myocardial scintigraphy, we recommended to our patient to limit exercise with a regular follow-up since he is only symptomatic during a major effort. There are many types of anomalous coronary arteries and the anatomic variant of a right coronary artery that course between the great vessels represents a risk of adverse event and sudden death in young athletes. The choice of therapy is controversial and depends especially on the variant of anomalous coronary artery and the symptoms.

An unusual cause of multiple embolic strokes: cardiac myxoma, about a case.

Cardiac myxomas are the most common primary intracardiac tumors, accounting for 50% of all cardiac neoplasms, with an estimated frequency of 0.5/million/inhabitants/year. Presenting symptoms are related to cerebral or peripheral embolism, and/or intracardiac obstruction. Thus, urgent management of myxoma is mandatory due to embolism's risk. Herein, we report the case of an 82-year-old woman with a myxoma of the left atrium, revealed by a multiple ischemic strokes, to raise awareness of this entity.

Use of neocords in the treatment of mitral valve prolapse: about 6 cases.

INTRODUCTION AND IMPORTANCE: Mitral insufficiency is a common valve disease with a prevalence of 2% and increases after the age of 65. This is the second valvulopathy operated after aortic stenosis. The surgical management of mitral insufficiency has been completely changed in recent years. The mitral valvular replacement with was the gold standard; is currently preceded by conservative surgery thanks to the emergence of reproducible and durable surgical techniques. The aim of our study is to highlight the place of Neogortex in the treatment of mitral valvular prolapse. METHODS: This is a retrospective study that includes 6 adult patients operated on for mitral insufficiency by prolapse of the large valve between October 2016 and June 2018 in the Cardiovascular Surgery Department A of the Ibn Sina Hospital in Rabat, Morocco. RESULTS: We collected 6 patients. The average age is 56 years. The clinical presentation was made of dyspnea in the 6 patients. On the echocardiographic level, all patients had mitral insufficiency due to prolapse of the large mitral valve in 2 patients and a restriction of the play of the valve by shortening of the ropes in 2 patients. The 6 patients were operated. The technique was the installation of a prosthetic ring with neogortex fixation between the free edge and the abutment and a tricuspid plasty type Devega. The operative sequences were simple. CONCLUSION: Mitral valve repair gives satisfactory results in terms of survival and symptomatic improvement with a low operative risk.

COVID 19 Myocarditis: Myth or Reality?

COVID 19 so far is not a known cardiotropic virus, and the term "myocarditis" should be exclusively used after EMB or autopsy proven diagnosis. We report a case of 26-year-old man admitted for COVID 19 infection and symptoms leading to myocarditis. We describe the workup that led to the potential diagnosis.

Primary cardiac hydatid cyst presenting with massive pericardial effusion: a case report.

BACKGROUND: Cardiac hydatidosis is a rare manifestation of Echinococcus infection. It represents 0.5 to 2% of hydatic disease (Mustafa et al., Can J Cardiol 22:2, 2006). The most common localization is the myocardium of the left ventricle but can also touch the right ventricle, atrium, pericardium, interventricular septum, and pulmonary artery. Clinical presentation is varied ranging from clinical latency or minor symptoms to cardiogenic shock and sudden death. The present case describes a primary pericardial hydatid cyst, a very exceptional localization of cardiac hydatidosis, which can lead to a delayed diagnosis or to an erroneous treatment that can expose the life of the patient to complications and death if it is not considered. Diagnosis can be established by cardiac imaging and hydatid serology. Therapy management should combine both surgery and medical treatment by albendazole or mebendazole. CASE PRESENTATION: We report a 70-year-old woman from Sale, who was admitted for dyspnea New York Heart Association (NYHA) class IV evolving in a febrile context with signs of right heart failure related to a rupture of a primary pericardial hydatid cyst with pre-tamponade. The diagnosis was confirmed by echocardiography, computed tomography scan (CT scan), and hydatic serology, and the patient was operated and put on albendazole for 3 months with favorable clinical course. CONCLUSIONS: The aims of this article are to consider the diagnosis of cardiac hydatid cysts in the presence of pericardial effusion, especially if there is a prior history of hydatid disease, a contact with animals, or when it occurs in an endemic country, and to be able to make a differential diagnosis with cardiac imaging in order to avoid its complications and to guide the management.

Surgicel mimicking early onset prosthetic valve endocarditis: case report.

BACKGROUND: Surgicel is one of the commercial forms of oxidized regenerated cellulose used as a bioabsorbable topical haemostatic agent during surgical procedures. However, its presence can mimic an abscess, tumour, lymph node or retained foreign body on imaging studies. The challenge in cardiac surgery is to differentiate the haemostatic material from an abscess that might be mistaken for an early onset prosthetic valve endocarditis. CASE SUMMARY: A 56-year-old woman was admitted to our department for a suspicion of early onset prosthetic valve endocarditis after an aortic valve replacement. An early clinical and biological improvement, features on a chest computed tomography scan, as well as a surgical correlation were able to rectify the diagnosis. The acute fever was linked to urinary tract infection, whereas the periaortic echogenic mass shown at the transoesophageal echocardiography corresponded to Surgicel. DISCUSSION: Oxidized regenerated cellulose can mimic an abscess on cardiac imaging, especially when used in excess during cardiac surgery. Fortunately, some radiographic features can help differentiate the haemostatic material from an abscess. Hence, sharing the use and location of Surgicel between the surgeon, radiologist, and cardiologist is very important and necessary to make the correct diagnosis.