Massive cardiac vegetation and cardiomyopathy in a 23-year-old rancher with brucellosis.

Key clinical massage: A 23-year-old rancher was admitted with the diagnosis of brucellosis. In evaluations, a massive vegetation in the aortic valve was seen. A combination of antibiotic therapy and cardiac surgery were performed, it seems this approach reduces mortality and complications. Abstract: Brucellosis (also known as "undulant fever," "Mediterranean fever," or "Malta fever") is a zoonotic infection transmitted to humans from infected animals (cattle, sheep, goats, camels, pigs, or other animals) by ingestion of food products (such as unpasteurized dairy products) or by contact with tissue or fluids. It is the most frequent zoonosis globally and a major public health issue in many resource-poor nations. Endocarditis is one of the rarest and most dangerous consequences of brucellosis. Additionally, the combination of endocarditis with cardiomyopathy increases its rarity. This condition is usually treated with a high level of suspicion Serological, clinical, and epidemiological data can all be used to make a diagnosis. The use of echocardiography aids in the early diagnosis. Due to the high risk of recurrence and the extent of tissue destruction brought on by Brucella, the majority of experts advise an early surgical intervention; nevertheless, other writers assert that low-risk patients also require cautious therapy. In this article, we discuss the situation of a patient who underwent surgery and had Brucella endocarditis and heart failure. In conclusion, a combination of antibiotic therapy and cardiac surgery, reduces mortality and complications associated with Brucella endocarditis and improves patient quality of life.

Huge aneurysmal fistula from left main artery to right atrium in a man with atypical chest pain and dyspnea on exertion.

We present a 33-year-old man with atypical chest pain and with no significant past medical history. The patient was finally diagnosed as a case of huge fistula from the left main coronary artery to the right atrium, a very rare condition with challenging diagnostic and therapeutic approaches. The majority of cases of coronary artery fistula are small, asymptomatic and clinically undetectable; they frequently do not cause any complications and can spontaneously resolve. However, larger fistulas are frequently three times the size of a typical caliber of a coronary artery and may or may not cause symptoms or complications.

Rescue thrombolysis partial failure in massive PE complicated with in-transit thrombus.

A 58-year-old man who presented with syncope, dyspnea, and hemodynamic compromise was found to have large free-floating right atrial thrombuses on echocardiogram. Decision was made to transfer the patient for emergent atriotomy. Cardiothoracic surgeons declared the patient as inoperable and recommended to use a lytic agent. Alteplase was administered with subsequent near-complete resolution of symptoms and near-normalization of echocardio-graphic parameters. The post-thrombolytic course was complicated by saddle pulmonary emboli requiring embolectomy. Catheter embolectomy was not available and cardiothoracic surgeon in other center considered the patient to be very high risk for transferring between hospitals and surgical intervention. Ultimately, the critical decision was made, despite the patient having been administered thrombolytic therapy within the previous 48 hours. Alteplase was given, but was not effective and the patient required surgical intervention. Surgical embolectomy was done successfully in another hospital and the patient was discharged with warfarin.

Surgical treatment of primary intracardiac myxoma: 20-year experience in "Shahid Modarres Hospital"--a tertiary university hospital--Tehran, Iran.

UNLABELLED: Although cardiac tumors are not common they may vary in terms of race and surgical approach in different countries. METHOD: Patients data of 20 years was collected and evaluated in the "Shahid Modarres Hospital"--a tertiary university hospital--Tehran, Iran. RESULTS: 42 patients with cardiac myxoma (all cases in 20 years) were included in study, 17 males and 25 females, age difference: 13 to 76 years (mean 50.6). Most of patients were in functional classes I, II. 35 patients complained of dyspnea and 3 patients had embolic events. 97.6% of tumors were primary (41 patients) and one tumor was recurrent (2.4%), 85.7% of tumors (36 cases) were located in LA, and 88.1% of tumors (37 cases) were pediculated. 40 patients (95%) had one tumor. In 22 patients (52.3%) after tumor resection septal defects were repaired primarily while in 18 patients (42.8%) the defects were repaired with pericardial patch and In one patient, tumor resected without any septal defect. Mean tumor size was about 5.22 cm (range of 2.2 to 8.2 cm). Postoperatively, 33 patients discharged from hospital without any complication. DISCUSSION: The research reveals that patients' age and gender were similar to that of other studies in other countries while tumor's incidence seems to be higher. 3 patients were diagnosed after remote embolic event and one patient was diagnosed after MI reflecting relatively high tumor complications and late diagnosis. CONCLUSION: In our study mean time from diagnosis to operation was too long. The patients had more preoperative embolic events and complication. However, size of myxoma and location of that was as same as its rate in the other literature. As recommendation we suggested that in all patients with vague chest pain or remote embolic events cardiac myxomas should be ruled out.

Application of intra-aortic balloon pump in resection and anastomosis of trachea.

The intra-aortic balloon pump (IABP) is a mechanical device used to assist cardiac circulatory function in patients suffering from cardiogenic shock, congestive heart failure, refractory angina and complications of myocardial infarction. While using IABP in cardiac surgery is well established, there are few studies on the utility of IABP support in high-risk cardiac patients undergoing non-cardiac surgery. Major non-cardiac surgeries are associated with high rates of cardiac complications in patients with advanced coronary disease. Recent case studies have reported favorable outcomes with the use of IABP support in non-cardiac surgery in patients with severe cardiac compromise. Using IABP may reduce cardiac complications by providing hemodynamic stability. Here, we present five cases of IABP use in high-risk cardiac patients undergoing resection and anastomosis of the trachea. IABP was inserted prior to induction of anesthesia in four of the cases, while IABP insertion was withheld in one case. In the four cases where IABP support was utilized, the IABP was removed between 6-48 hours postoperatively with no complications. The patient who did not undergo IABP insertion died on the 8th postoperative day due to uncontrollable pulmonary edema and progressive myocardial infarction. We also review the literature and discuss the role of IABP use in non-cardiac surgery.

Asymptomatic pediatric pulmonic valve myxoma involving the right ventricular outflow tract: a case report and review of the literature.

Asymptomatic pediatric pulmonic valve myxoma involving the right ventricular out flow tract (RVOT) is very rare. The case is presented of 13-year-old asymptomatic boy who was referred to the cardiology clinic for evaluation of murmur, and was found to have a large mobile mass (3 x 2 cm) in the RVOT that protruded into the pulmonary artery across the pulmonary valve during systole, and relocated in the right ventricle in diastole. The patient underwent successful surgical excision of the tumor, which had a short stalk attached to the pulmonary valve. Macroscopic examination revealed a typical myxoma without any evidence of malignancy. This case elaborates the importance of early recognition and surgical excision of these tumors in order to prevent thromboembolic complications.