Atrial Fibrillation after Rheumatic Heart Valve Surgery: Incidence, Predictors, and Outcomes.

BACKGROUND: Atrial fibrillation after cardiac surgery (AFACS) impacts 10 to 65% of patients. AFACS is associated with stroke and other systemic embolic manifestations. METHODS: Patients at our hospital who underwent rheumatic valve surgery procedures including aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG were included in this study in the period from 2002 to 2017. RESULTS: In total, 346 patients were included in the current analysis, with a mean age of 51.6 ± 16.1 years, and 51% were males. AFACS was documented in 102 patients (29.9%) .: Univariate predictors of AFACS included age, gender, body mass index (BMI), operation type, left ventricular ejection fraction (EF), left atrial (LA) diameter, previous history of AF, use of aldosterone antagonists more than a month before surgery, use of diuretics more than a month before surgery, length of ICU stay, total length of stay, cross-clamp time more than 90 minutes, pump time more than 120 minutes, postoperative acute kidney injury, left ventricular dimensions.By multivariate analysis, only age (p = 0.028, AOR = 10.6), male gender (p = 0.021, AOR = 3.4), type of surgery (p = 0.034, AOR = 7.12), history of AF (p = 0.018, AOR = : 2.32), BMI (p < 0.001, AOR = 3.91), EF before surgery (p ≤ 0.001, AOR = 3.91), and LA diameter (p = 0.0051, AOR = 18.23) were independent predictors of AFACS. CONCLUSION: This study identifies risk factors associated with the development of atrial fibrillation after rheumatic valve heart surgery. Older patients, male gender, type of surgery, preoperative AF, BMI, EF before surgery, and LA diameter are independent predictors of AF after cardiac valve surgery.

Sinus of valsalva aneurysm with fistula to the right atrium presented as acute heart failure in a young man.

PATIENT: Male, 23 FINAL DIAGNOSIS: Sinus of valsalva aneurysm (SVA) Symptoms: Chest pain • low O2 saturation • short of breath MEDICATION: - Clinical Procedure: - Specialty: Cardiology. OBJECTIVE: Rare disease. BACKGROUND: Sinus of valsalva aneurysm (SVA) is a rare cardiac anomaly. It may be congenital or acquired; a coexisting cardiac lesion might be present. Rupture of the aneurysm, where it usually occurs in the right atrium, can cause acute symptoms of heart failure. Echocardiography (particularly TEE) can provide all necessary diagnostic data for safe surgical treatment. Treatment of choice is surgery. CASE REPORT: A 23-year-old male, previously healthy, presented to the emergency room (ER) with shortness of breath for the last 10 hours after lifting a heavy object. The patient had central chest pain. His O2 sat was 88%. ECG showed ischemic changes. Diagnosis of AMI was made, but auscultation revealed a murmur followed by a TTE and TEE, which revealed a ruptured sinus of valsalva aneurysm. CONCLUSIONS: This case report highlights the superiority of TEE over TTE in diagnosis and in planning adequate surgical treatment for patients with ruptured SVA, as well as the importance of ultrasonographer experience in the diagnosis. The optimal management for a ruptured SVA is surgical repair, with an acceptably low operative risk and good long-term outcome.