[Diagnosis and therapy of aortic stenosis in older age. When does it become critical?]. / Diagnostik und Verlaufsbeobachtung der Aortenstenose im höheren Alter. Wann wird's kritisch?

Together with mitral valve insufficiency, aortic stenosis is the most common heart defect in adulthood. The two major forms are degenerative senile aortic stenosis of old age, and secondary degenerated bicuspid valve manifesting in middle age. A typical feature is a lengthy asymptomatic course due to compensating ventricular hypertrophy with a constant systolic wall tension. With the aid of Doppler echocardiography aortic stenosis can be accurately quantified. Although effective drug treatment is not available, evidence is mounting that statins are capable of slowing the progression of valvular sclerosis, presumably on the basis of pleiotropic, anti-inflammatory effects. As a rule, the onset of symptoms (dyspnea, angina, syncope) is an indication for surgery. As a result of rising life expectancy, the proportion of elderly and very old patients with degenerative senile aortic stenosis is increasing appreciably, and presents a challenge in terms of deciding appropriate individual therapy. Advances in valvular surgery in high old age, however, can offer many of these patients the option of a procedure with an acceptably low risk and longer-term prognostic and symptomatic benefits following successful surgery.

[Surgical treatment of acute pericardial tamponade in an infestation of the heart by Echinococcus]. / Chirurgische Behandlung der akuten Perikardtamponade bei Echinokokkusbefall des Herzens.

HISTORY AND CLINICAL FINDINGS: A 56-year-old turkish patient, previously in good health, was admitted because of pain suggesting myocardial infarction. Physical examination of the heart, lungs and abdomen was unremarkable. INVESTIGATIONS AND DIAGNOSIS: The concentrations of myocardium-specific enzymes were not elevated and the ECG showed no signs of ischaemia. Echocardiography and magnetic resonance imaging ruled out acute aortic dissection, but demonstrated a round cystic space-occupying mass over the anterior wall of the heart. Hydatid cyst was suspected from the imaging results and the patient's origin from area endemic for Echinococcus. The diagnosis was confirmed by a titre of 1:6,400 (normal: 1: < 100) for Echinococcus antibodies. TREATMENT AND COURSE: Albendazole administration was initiated. Planned elective surgical removal of the hysatid cyst had to be performed urgently because of acute pericardial tamponade. Cyst rupture was suspected but an actually undamaged cyst was subtotally removed under cardiopulmonary bypass. The postoperative course was uneventful and albendazole treatment was continued. CONCLUSION: Because of the high incidence of fatal complications urgent surgical removal under cardiopulmonary bypass is the treatment of choice for hydatid cyst involving the heart. Perioperative albendazole administration is also essential.

[Clinical, anatomical-pathological and therapeutic correlates of benign intracavitary heart tumors]. / Klinische, anatomopathologische und therapeutische Korrelate benigner intrakavitärer Herztumoren.

Benign intracavitary cardiac tumors lead to "malignant" complications, so early diagnosis and adequate treatment are of vital importance. Our investigation summarizes a 10-year experience after surgical treatment of 29 patients suffering from benign intracavitary cardiac tumors. The postoperative histological examination revealed a myxoma in 27 cases; in 2 cases a papillary fibroelastoma was diagnosed. The main symptom in 19 patients was dyspnea. In 8 cases an embolic event occurred. All patients underwent extirpation of the tumor. Early mortality was 10%, while late mortality was 4%. The treatment of choice of benign intracavitary cardiac tumors is extirpation, which, due to unpredictable embolic complications, is to be carried out immediately should the tumor have a lobulated tuberous surface. In such cases the descriptive function of echocardiography is of considerable importance.