Twin circumflex arteries: a rare coronary artery anomaly.

Dual origin of the circumflex artery is an extremely rare anomaly. We report a rare case of a left circumflex artery arising from the left mainstem and an anomalous circumflex artery from a separate ostium in the right coronary sinus. Both these arteries supplied the circumflex territory. The potential pathological significance of the anomaly and pitfalls of the misdiagnosis are also discussed.

Multiple pseudo-abscesses following aortic valve replacement.

Prosthetic aortic valve endocarditis is associated with valve ring abscess, conduction abnormalities and a grave prognosis. Aortic root abscess is a serious complication of infective endocarditis with high mortality. We report a case of a patient who had echocardiographic features resembling aortic root abscess along with severe aortic regurgitation, 6 weeks following aortic valve replacement. Valvular dehiscence led to perivalvular abscess like appearance. Infective endocarditis was exluded. He underwent a successful redo aortic valve surgery with slow recovery.

A rare case of multiple right heart myxomas.

Primary tumours of the heart are rare. Myxomas are the most common primary cardiac tumours with an estimated incidence of 0.5 per million population per year. Myxomas are most commonly found in left atrium and are solitary in more than 90% cases. Familial myxomas are rarer and tend to be multiple. We report a rare case of multiple myxomas in the right heart which occurred sporadically, presenting with an episode of pre-syncope.

Phaeochromocytoma presenting as dilated cardiomyopathy.

Phaeochromocytomas are rare endocrine tumours that secrete excessive amounts of catecholamines and can lead to myocarditis and cardiomyopathy. We report a 63-year-old man with long-standing hypertension and diabetes who presented with dilated cardiomyopathy, which was initially thought to be secondary to ischaemic heart disease. Subsequent coronary angiography was normal. Carvedilol therapy unmasked the characteristic features of phaeochromocytoma. Surgical resection of a right adrenal tumour cured his symptoms, hypertension and diabetes, as well as causing a substantial improvement in cardiac function. Phaeochromocytoma should be considered as a rare cause of dilated cardiomyopathy of uncertain aetiology.

Successful resuscitation of a patient with electrical storm.

A 41 year old woman with type 2 diabetes, hypertension, and hyperlipidaemia but no known heart disease received 130 DC shocks for repeated cardiac arrests due to ventricular tachyarrhythmias over 48 hours. She was stabilised by intravenous amiodarone and had a defibrillator implanted. Serial ECGs did not change, but raised troponin I confirmed myocardial infarction as the underlying cause. Electrical storm is an uncommon and dramatic but usually treatable syndrome of recurrent ventricular arrhythmias. Frequent precipitants of electrical storm include recent worsening heart failure, hypokalaemia, hypomagnesaemia and myocardial ischaemia. Amiodarone is the antiarrhythmic agent of choice and implantable cardioverter defibrillator improves long term outcome.

Morphological and anatomical studies on larval trematode of genus Brachylaima (Brachylaimidae) from the land snail, Monacha obstructa.

The metacercariae of genus Brachylaima were collected from the kidney of the land snail Monacha obstructa. About thirteen to fifteen metacercariae were collected from each snail. The metacercariae observed were elongated rather than oval. The gonads were no so developed inspite of the great similarity between this larval stage and the adults. No larval stages rather than the metacercariae were observed. The specimens were examined in fresh status and then stained with carmine and fast green as counter stain. The excretory system was developed to very great extent. This seems to be the first record of this larval stage in Egypt since 1899 when Looss collected the adult of B. aequans from Gerbillus aegyptiacus. The heavy infection of snails reflects the higher incidence of this parasite among land snails as intermediate host. Since, the life cycle of this parasite is not yet confirmed experimentally in Egypt, the species has not been identified.