A giant myxoma originating from the aortic valve causing severe left ventricular tract obstruction: a case report and literature review.

INTRODUCTION: The left ventricular localization of a myxoma is very rare, usually arising from the interventricular septum close to the left ventricular outflow tract, the mitral valve, the ventricular wall and extremely rarely the aortic valve. CASE PRESENTATION: A 13-year-old male was admitted due to dyspnea and angina. Transesophageal echocardiography revealed left ventricular outflow tract obstruction with a mean gradient of 58 mmHg, and a mobile mass measuring 65×25 mm originating from the ventricular surface of the aortic valve was identified. The patient underwent urgent surgical excision and aortic valve replacement. Histopathological examination of the mass confirmed the diagnosis of a myxoma. CONCLUSION: In conclusion, a myxoma originating from the aortic valve remains a very rare localization. Total resection associated with aortic valve replacement seems to offer an excellent outcome.

Does the St. Jude Regent 17-mm Offer Better Outcomes Than the Hemodynamic Plus 17-mm Aortic Valve Mechanical Prothesis?

OBJECTIVE: The aim of the present study is to report the early and mid-term clinical and hemodynamic results of a prospective trial investigating the clinical performance of the St. Jude Medical Regent 17 mm (SJMR-17) versus St. Jude Medical Hemodynamic Plus 17 mm (SJMHP-17). MATERIALS AND METHODS: Between January 2000 and August 2013, 20 patients (Group I) with aortic valve (AV) stenosis underwent first time AV replacement with a SJMR-17 and nine patients (Group II) underwent AV replacement with a SJMHP-17. The mean follow-up was 58 ± 31 months. RESULTS: There was one death in Group I. The end-diastolic IVS thickness and end-systolic posterior left ventricle (LV) wall thickness was reduced significantly in boths groups (p = 0.001 and p = 0.006 in Group I and p = 0.007 and p = 0.011 in Group II). The peak and mean transprosthesis gradients (P-TPG and M-TPG) were 29 ± 6.8 mmHg and 17.5 ± 4.5 mmHg in Group I, significantly lower than in Group II (55.2 ± 19.7 mmHg and 28.8 ± 7.7 mmHg). The postoperative left ventricular mass (LVM) and indexed left ventricular mass (LVMi) were reduced significantly in both groups versus the preoperative values. The postoperative LVMi was 114.5 ± 10.6 g/m(2) in Group I versus 127 ± 8 g/m(2) in Group II (p = 0.01). With dobutamine, heart rate, left ventricular ejection fraction, cardiac output, transprosthesis peak, and mean gradients increased significantly in both groups, however, the P-TPG and M-TPG were significantly higher in Group II (p = 0.026 and p = 0.022) despite a non-significant increase of the indexed effective orifice area. CONCLUSIONS: The SJMR-17 can be employed with satisfactory postoperative clinical and hemodynamic outcomes in patients with small aortic annulus, especially in elderly patients offering better outcome than SJMHP-17.

One and a half ventricle repair in association with tricuspid valve repair according to "peacock tail" technique in patients with Ebstein's malformation and failing right ventricle.

OBJECTIVES: The aim of this study was to evaluate the outcome in a series of patients with Ebstein's anomaly and a failing right ventricle (RV) undergoing tricuspid valve (TV) repair and bidirectional Glenn cavopulmonary anastomosis (BDG). MATERIALS AND METHOD: Between January 2006 and September 2013, 11 consecutive patients diagnosed with severe forms of Ebstein's anomaly and a failing RV underwent TV surgery and BDG. The mean age was 16.5 ± 7 years. Most frequently found symptoms were cyanosis, dyspnea, and arrhythmias. The azygos or hemiazygos veins were left open. The TV was repaired using the "peacock tail" technique, which consisted of total detachment of the anterior and posterior leaflets of the TV and rotation in both directions reimplanting them to the true annulus. The mean follow-up was 3.8 ± 2.4 years (range three months to six years). RESULTS: Hospital mortality was 9% (one patient). TV repair was possible in 10 patients. None of the patients had AV block postoperatively. At one year after surgery, the indexed RV and RA diameter were reduced significantly versus the preoperative data (p = 0.003 and p < 0.001). The mean TVR and indexed TV area were 1.2 ± 0.42 and 1.6 ± 0.6 (mm/m2), significantly lower than preoperatively (p = 0.001 and p = 0.008, respectively). The mean NYHA functional class, SaO2 , and cardiothoracic ratio were significantly improved. CONCLUSIONS: The peacock tail technique for TV repair in combination with BDG in patients with Ebstein's malformation and depressed RV function results in TV preservation, a low incidence of recurrent regurgitation, favorable functional status and RV function, and resolution of cyanosis.

Surgical treatment of a calcified, amorphous tumor of the right ventricle complicated with thrombosis of the right pulmonary artery in an adult male: a case report.

BACKGROUND: A calcified amorphous tumor of the heart is an extremely rare cardiac mass. CASE PRESENTATION: A 32-year-old Albanian man presented to our hospital with fatigue, shortness of breath, progressive dyspnea, and right congestive heart failure. Echocardiography and chest computed tomography revealed a giant, calcified right ventricular mass that originated between the papillary muscles and the trabeculae and extended to the pulmonary valve. The patient underwent surgery with excision of the mass, replacement of the pulmonary valve with a biological one, and repair of the tricuspid valve. His histopathological examination revealed that the mass was a calcified, amorphous tumor. His postoperative course was uneventful. CONCLUSIONS: The clinical presentation of the calcified amorphous tumor is similar to that of other cardiac tumors, so surgical excision is mandatory. Histopathological examination remains the gold standard for an accurate diagnosis.

Surgical excision of a giant calcified amorphous tumour of the right ventricle and right pulmonary artery.

A cardiac calcified amorphous tumour (CCAT) is a rare non-neoplastic intracavitary mass with unknown causes. We describe a 32-year old male presenting with progressive dyspnoea, cough and oedemas. The transthoracic echocardiography and contrast-enhanced angio-computed tomography demonstrated a 4 × 10 cm calcified mass into the right ventricle and total occlusion of the right pulmonary artery. The patient underwent successful total removal of the mass through a transverse right ventriculotomy, and right pulmonary embolectomy. Histopathological examination of mass confirmed the diagnosis of a CCAT. The postoperative course was uneventful. To our knowledge, this is the first reported case with a confirmed diagnosis of CCAT at two different locations and the third undergoing a combined approach aiming at total mass excision.

Coil embolization of an anomalous bronchial artery originating from the left subclavian artery following arterial switch operation: a case report.

INTRODUCTION: Bronchial arteries originate from the descending aorta at the level of the T5-T6 vertebrae following an intrapulmonary course along the major bronchi. When bronchial arteries take off from a vessel other than the descending aorta, the anatomy is defined as an anomalous origin of the bronchial artery. CASE PRESENTATION: A 3-day-old boy from Kosovo with dextro-transposition of the great arteries who developed progressive heart failure required an emergency arterial switch operation. Because of persistent pulmonary edema after completion of the arterial switch operation at our institution, the patient could not be weaned off mechanical ventilation. Transthoracic echocardiography revealed an anomalous accelerated flow, indicating an anomalous systemic pulmonary shunt. Arterial catheterization revealed an abnormal bronchial artery originating from the left subclavian artery and bifurcating to both lungs. The anomalous ectatic bronchial artery was successfully occluded by coil embolization. The improvement of the patient's hemodynamic status resulted in an uneventful post-operative course. CONCLUSION: A coil embolization procedure was successfully performed to treat an anomalous bronchial artery originating from the left subclavian artery after a switch operation in a patient with transposition of the great arteries. When clinically indicated, catheter-based therapy with coil embolization can be performed to successfully treat anomalous bronchial arteries by reducing as such the pulmonary overflow.

Hemodynamics of 17-mm vs. 19-mm St. Jude Medical Regent and annulus enlargement.

OBJECTIVE: We aimed to compare early and midterm clinical and hemodynamic outcomes of 17-mm vs. 19-mm St. Jude Medical Regent valves with concomitant aortic annulus enlargement. METHODS: Between 1999 and 2012, 20 patients (group 1) underwent first-time aortic valve replacement with a 17-mm St. Jude Medical Regent valve, and 35 patients (group 2) had a 19-mm valve and concomitant aortic annulus enlargement. The mean follow-up was 81 ± 37 months (range 20-110 months). RESULTS: There was one death in group 1 vs. 4 in group 2 (p > 0.05). The mean postoperative transprosthetic gradient was 17.5 ± 4.5 in group 1 and 17 ± 6.4 mm Hg in group 2 (p = 0.83), and 37 ± 10.7 and 32 ± 13 mm Hg, respectively, under stress (p = 0.17). Left ventricular mass and left ventricular mass index were reduced and similar in both groups. Postoperative effective orifice area index was higher in group 2 (0.85 ± 0.17 cm(2 )m(-2)) than group 1 (0.76 ± 0.2 cm(2 )m(-2); p > 0.05). A multivariate Cox model identified a 19-mm valve with aortic annulus enlargement (p = 0.032), functional class (p = 0.025), reoperation (p = 0.04), ejection fraction < 35% (p = 0.042), and combined surgery (p = 0.04) as strong predictors of poorer overall event-free survival. CONCLUSIONS: The 17-mm St. Jude Medical Regent valve may be employed with satisfactory postoperative clinical and hemodynamic outcomes in patients with a small aortic annulus, as an alternative to a larger prothesis with aortic annulus enlargement.

Perventricular device closure of a large residual perimembranous interventricular septal defect after previous surgical correction.

A 21 years albanian patient was referred with important residual left to right shunt. He was undergone 7 years before conventional surgical correction of a perimembranous ventricular septal defect (VSD). The patient underwent sternotomy and perventricular device closure of the residual employing a 16 mm multifenestrated atrial septal defect occlude, which was positioned through the anterior wall of the right ventricle. across the defect. The previous autologous pericardial patch was compressed into the double umbrella device. We may conclude that perventricular device closure can employed successfully in patients with residual perimembranous VSD after previous surgical repair as an alternative to the conventional surgery with excellent hemodynamic and postoperative outcome. Such a technique should be part of the surgical armamentarum.

The peacock tail technique: a modified reconstruction technique for tricuspid valve repair in Ebstein's malformation.

The "peacock tail" technique is a modification of the cone reconstruction technique for Ebstein's malformation and failing right ventricle and is performed simultaneously with a bidirectional cavopulmonary shunt. The technique consists of total detachment of the posterior and anterior tricuspid valve leaflets, which are rotated simultaneously clockwise and counterclockwise and sutured at the midseptal leaflet level, forming a new tricuspid valve (TV). The constructed cone-shaped valve is then attached in its entire circumference to the true tricuspid annulus.