Misdiagnosis of Behçet's disease presented with intracardiac mass as inflammatory myofibroblastic tumor.

Behçet's disease is a chronic multisystem inflammatory disorder. There are limited data about cardiac involvement, but it is seen rarely. Herein, we present a 33-year-old male patient with heart failure secondary to a right ventricular mass. It was first diagnosed as inflammatory myofibroblastic tumor (IMT) histopathologically. During the postoperative follow-up, a thrombus was detected at the interatrial septum, and the patient was reevaluated. The diagnosis was possible Behçet's disease, and the mass, previously reported as IMT, was determined to be an organizing thrombus with a mixture of granulation tissue and thrombotic material.

Rapidly Progressive Malignant Fibrous Histiocytoma of Right Atrium: a Rare Case Report.

We are going to present a case of malignant fibrous histiocytoma in the right atrium, which is a very rare entity. The patient had a right atrial mass, which prolapsed through the tricuspid valve into the right ventricle, causing functional tricuspid valve stenosis. The tumor was completely resected and the patient had an uneventful postoperative period. Histopathological examination reported malignant fibrous histiocytoma. The patient presented to the emergency department five weeks after discharge with dyspnea and palpitation. Echocardiography and magnetic resonance imaging revealed recurrent right atrial tumor mass. His clinical status has worsened, with syncope and acute renal failure. On the repeated echocardiography, suspected tumor recurrence was observed in left atrium, which probably caused systemic embolization. Considering the aggressive nature of the tumor and systemic involvement, our Heart Council decided to provide palliative treatment by nonsurgical management. His status deteriorated for the next few days and the patient succumbed to a cardiac arrest on the 4th day.

Usefulness of the platelet-to-lymphocyte ratio in predicting long-term cardiovascular mortality in patients with peripheral arterial occlusive disease.

INTRODUCTION: Inflammation and increased platelet activation play a crucial role in the initiation and progression of atherosclerosis. Platelet-to-lymphocyte ratio (PLR) has recently been reported as a new independent predictor for major adverse cardiovascular events in cardiovascular diseases. AIM: To investigate the relation between PLR and cardiovascular mortality in patients with intermittent claudication or critical limb ischemia (CLI) or both. MATERIAL AND METHODS: In our retrospective study, 602 consecutive patients who were admitted to a large tertiary hospital with the diagnosis of symptomatic peripheral arterial occlusive disease (PAOD) were included. Patients were divided into two groups according to their PLR as follows: high PLR (PLR > 142) and low PLR (PLR ≤ 142) groups. RESULTS: During the follow-up period (median: 33.8 months (interquartile range: 21-45)), 131 deaths occurred out of 602 (21.8%) patients. Cardiovascular mortality was found to be significantly higher in the high PLR group compared to the low PLR group (31.6% vs. 17.2 %; p < 0.001). Even after adjustment for various risk factors, PLR > 142 and age were found to be independent predictors of long-term cardiovascular mortality in Cox regression analysis (hazard ratios (95% confidence interval): 1.03 (1.01-1.04) and 1.04 (1.02-1.06), p < 0.001 and p < 0.001, respectively). CONCLUSIONS: Platelet-to-lymphocyte ratio, which is one of the parameters of routine complete blood count, reflects increased inflammatory status, platelet activation and aggregation. PLR is a cheap and readily available marker that has the ability to improve risk stratification provided by conventional risk scores in predicting long-term cardiovascular mortality in PAOD.

Altered expression of micro-RNA 199a and increased levels of cardiac SIRT1 protein are associated with the occurrence of atrial fibrillation after coronary artery bypass graft surgery.

BACKGROUND: Postoperative atrial fibrillation (POAF) is a potentially life-threatening complication after coronary artery bypass graft (CABG) surgery. The expression of the cardioprotective SIRT1 protein with its antioxidant activity is increased in cardiac tissue of patients suffering from POAF. So far, information is lacking about the relationship between SIRT1 regulating micro RNAs (miRs), SIRT1 protein and the occurrence of POAF. METHODS: A total of 63 patients undergoing CABG were recruited, and biopsies were obtained from the right atrial appendage during cannulation. Postoperative, all patients were rhythm-monitored until discharge and randomized to POAF (n=20) or sinus rhythm (n=43). The expression of the micro RNAs miR-199a and miR-195 was quantified by real-time PCR. SIRT1 protein was detected by western blot analysis. RESULTS: The relative expression of miR-199a in the POAF group was significantly decreased compared to the control group (0.77±0.27 vs. 1.11±0.69, P=.022) Accordingly, SIRT 1 protein was significantly induced in tissue probes of patients with POAF (P<.001). CONCLUSION: Altered expression of the SIRT1 protein regulating miR-199a in human atrial tissue was found to be related to the occurrence of POAF, indicating its usefulness as a biomarker for cardiac surgery management.

Rapidly progressive malignant fibrous histiocytoma of right atrium: a rare case report

Abstract We are going to present a case of malignant fibrous histiocytoma in the right atrium, which is a very rare entity. The patient had a right atrial mass, which prolapsed through the tricuspid valve into the right ventricle, causing functional tricuspid valve stenosis. The tumor was completely resected and the patient had an uneventful postoperative period. Histopathological examination reported malignant fibrous histiocytoma. The patient presented to the emergency department five weeks after discharge with dyspnea and palpitation. Echocardiography and magnetic resonance imaging revealed recurrent right atrial tumor mass. His clinical status has worsened, with syncope and acute renal failure. On the repeated echocardiography, suspected tumor recurrence was observed in left atrium, which probably caused systemic embolization. Considering the aggressive nature of the tumor and systemic involvement, our Heart Council decided to provide palliative treatment by nonsurgical management. His status deteriorated for the next few days and the patient succumbed to a cardiac arrest on the 4th day.

Rupture of the NovaFlex balloon during transcatheter aortic valve implantation and subsequent dissection of the right iliac arteries.

We report a case with a very rare complication of transcatheter aortic valve implantation. Rupture of the NovaFlex balloon (Edwards transfemoral balloon catheter) occurred during the inflation of the Edwards SAPIEN valve, resulting in dissection of the right common and external iliac arteries during withdrawal of the balloon catheter. The NovaFlex balloon is a part of the Edwards NovaFlex XT transfemoral delivery system.