Large Tricuspid Valve Myxoma in an Asymptomatic Patient with Uterine Myoma: An Uncommon Case.

Tricuspid valve myxomas are very uncommon tumors that could be found after the occurrence of pulmonary thromboembolism, symptomatic tricuspid obstruction, and right-sided heart failure. Herein, we describe a 42-year-old woman evaluated for an abdominal mass. In preoperative consultation, a tricuspid valve mass was detected in echocardiography. She underwent the removal of a benign uterine myoma and a myxoma of the tricuspid valve. Tricuspid valve myxomas constitute a scarce diagnosis. They could be asymptomatic, occurring in unusual locations and in association with benign tumors in other organs. Our patient was asymptomatic, underscoring the significance of the early diagnosis of this type of tumor to prevent further catastrophic events.

Alterations in the echocardiographic variables of the right ventricle in asymptomatic patients with breast cancer during anthracycline chemotherapy.

BACKGROUND: Anthracycline-induced cardiotoxicity can reach an irreversible phase; therefore great efforts are made to diagnose it early. As the right ventricle (RV) is smaller than the left, the right side of the heart is probably influenced by anthracycline to a greater extent and in a shorter time. The purpose of the present study was to investigate the early effects of chemotherapy on the right side of the heart. METHODS: This cross-sectional study was performed in Isfahan University hospitals from August 2014 to December 2015. Subjects were 67 patients with breast cancer who were planned to receive anthracycline for the first time. Echocardiography was performed before administration of anthracycline and 6 months later. Variables included right heart measures (RV end-diastolic dimensions, right atrium length and diameter), RV fractional area change (RVFAC), index of myocardial performance (Tei index), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure, lateral tricuspid annular early and late diastolic velocities, and tissue Doppler diastolic and systolic velocities. RESULTS: Forty-nine of the subjects completed the study. RV end-diastolic diameters and Tei index (0.31 to 0.37) were significantly increased (p<0.001). RVFAC (49.83% to 43.59%) and TAPSE (18.8 to 17.7 mm) were significantly decreased (p<0.001). There was a significant reduction in E (57.06 to 46.59 cm/s, p<0.001), E/A ratio (1.42 to 1.18, p<0.001), E' (16.73 to 12.4 cm/s, p<0.001), E'/A' ratio (1.21 to 0.9, p<0.001) and S' (12.59 to 10.57 cm/s, p<0.001). Systolic pulmonary arterial pressure (20.63 to 22.24 mm Hg, p=0.04) was significantly increased. CONCLUSIONS: This study shows a significant decrease in RV systolic and diastolic function during chemotherapy for 6 months. These reductions are in the normal range and can probably be considered an early indicator of anthracycline-induced cardiotoxicity.

Comparison between theophylline, N-acetylcysteine, and theophylline plus N-acetylcysteine for the prevention of contrast-induced nephropathy.

BACKGROUND: Few studies compared the efficacy of theophylline with N-acetylcysteine or evaluated the efficacy of combination therapy in the prevention of contrast-induced nephropathy (CIN). We compared the efficacy of theophylline, N-acetylcysteine, and the combination of these agents in the prevention of CIN. METHODS: This randomized controlled trial was conducted on 96 patients referring consecutively to the Shahid Chamran University Hospital in Isfahan, Iran, for elective coronary angiography (with our without angioplasty). Patients with at least moderate risk for CIN were included and were randomized to receive theophylline (200 mg), N-acetylcysteine (600 mg), or theophylline + N-acetylcysteine, twice a day, from 24 h before to 48 h after administration of the contrast material. A non-ionic, low-osmolar contrast material was used. Serum creatinine was measured before and 48 h after contrast material injection. RESULTS: Serum creatinine was increased by 6.83 ± 15.32% with theophylline, 13.09 ± 14.63% with N-acetylcysteine, and 5.45 ±1 3.96% with theophylline + N-acetylcysteine after contrast material injection (between group P = 0.072). Controlling for Mehran risk score, baseline serum creatinine, and contrast volume, the change in serum creatinine level was lower with theophylline compared with N-acetylcysteine (F = 4.79, P = 0.033), and with theophylline + N-acetylcysteine compared with N-acetylcysteine (F = 5.78, P = 0.020). CIN (increase in creatinine of ≥ 0.5 mg/dl or ≥ 25% from the baseline) was occurred in 20%, 21.9%, and 7.1% of patients in the theophylline, N-acetylcysteine, and theophylline + N-acetylcysteine groups, respectively (P = 0.260). CONCLUSION: Theophylline is superior to N-acetylcysteine in preventing contrast-induced renal dysfunction, but the combination with N-acetylcysteine is not superior to theophylline alone in this regard. Further trials with larger sample of patients are warranted.

An observational study on infective endocarditis: a single center experience.

BACKGROUND: Cloning of microorganisms on heart endothelium can lead to infective endocarditis (IE). The prototypic lesion of infective endocarditis, the vegetation is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. OBJECTIVES: The aim of this study was to evaluate patients with IE and also focusing on echocardiographic data and comparison between TTE (transthoracic echocardiography) and TEE (transesophageal echocardiography) of native and prosthetic valve endocarditis and the final impact of IE (infective endocarditis) in these patients with endocarditis. PATIENTS AND METHODS: All patients with IE admitted to our center between 2007 and 2010 were studied. All echocardiographies were performed by the same echocardiographer. Echocardiography and lab tests were performed for all patients. We used SPSS 16 for data analysis. RESULTS: We studied 35 patients, 45% male and 55% female with a mean age of 56.36 ± 12.44 years. Fever (80%) and chills (65.7%) were the most common symptoms. There was only a positive blood culture and enterococci sensitive to vancomycin and amoxicillin. The most involved valve was mitral (54.2%) and then aortic valve (48.5%) (two patients had vegetation on both aortic and mitral valves). In this study, specificity and sensitivity of TEE were 100% and 88.6%. Six patients (17.1%) died and six patients needed surgery. CONCLUSIONS: Endocarditis is an important disease with a high mortality rate if not treated appropriately. Therefore, these patients need more attention. In echocardiography, vegetation and complications of IE such as abscess and paravalvular leakage can be detected.