Multimodality imaging in assessment of mitral valve tumors: An unusual papillary fibroelastoma?

Mitral valve masses are uncommon. These tumors and tumor-like lesions may have similar morphological and clinical characteristics, but different outcomes. Unlike valvular tumors, caseous calcification of the mitral annulus (CCMA) is a benign degenerative disorder, commonly misdiagnosed, thus differentiating it from other mitral valve masses is important to avoid unnecessary surgery. Multimodality imaging can prove a valuable tool for definitive diagnosis. We present a case of a 72-year-old female patient, with coronary artery disease, referred for angina symptoms. Echocardiography detected a mass in the mitral valve annulus. Cardiac magnetic resonance imaging showed a mobile mass respecting the myocardium suggestion an atypical papillary fibroelastoma and surgery was indicated. However, the definitive diagnosis, after histological examination, was CCMA. The aim of this case report is to illustrate the difficulty in differentiating between mitral valve masses and the repercussion on the subsequent management, emphasizing the pivotal role of multimodality imaging.

Catastrophic outcomes of thrombus 'bumper' ball in neglected severe rheumatic mitral stenosis: report of three cases.

Patients with rheumatic mitral stenosis (MS) often present complications such as atrial fibrillation and thrombus formation with significant morbi-mortality. Rarely, a free-floating 'ball thrombus' is found with possible catastrophic outcomes. We describe three cases of documented left atrial 'ping-pong' shaped 'thrombus ball' within MS: a 51 year old presented with acute heart failure with a fatal outcome due to the huge round thrombus closing the tight mitral valve, a 67-year-old and a 68-year-old male who were both urgently rushed to the operating room after accidental finding. The surgery was successful and consisted on mitral valve repair and thrombectomy. Our aim is to show that gigantic unattached thrombus ball within neglected rheumatism MS is a rare life-threatening entity, thus highlighting the importance of early diagnosis of such conditions present in endemic countries. A prompt surgery should be considered to avoid an eventual embolization and sudden death.

Giant circumflex artery with bilobed saccular aneurysm and right atrial fistula mimicking a bi-atrial hydatid cyst: a case report.

Coronary artery fistulas (CAF) are rare anomalies that pose a significant diagnostic and therapeutic challenge. Most of them originate from the right coronary artery and are congenital. They are often associated with coronary aneurysms. We report the case of a 38-year-old Black man who presented with exertion dyspnea. Transthoracic echocardiography found what was thought to be a bi-atrial hydatid cyst, alongside a right atrial shunt. Cardiac magnetic resonance imaging showed a cystic lesion hypointense on T1 and T2 sequences, located next to the left atrium as well as an aneurysmal circumflex artery shunting in the right atrium. Coronary angiography and computed tomography angiography confirmed the bilobed circumflex saccular aneurysm and CAF. The patient underwent a successful surgery, which consisted of closure of the fistula using two patches. He was discharged after an uneventful postoperative course. Our case report illustrates the diagnostic difficulty of CAF and the importance of multimodal imaging.

Isolated Right Juxtaposition of the Atrial Appendages in Adult With Bicuspid Aortic Valve Stenosis.

We report the case of a 30-year-old male who had symptomatic bicuspid aortic valve stenosis. Operative findings unexpectedly revealed right juxtaposition of the atrial appendages. This is a rare association, as juxtaposition of atrial appendages is generally associated with more complex forms of congenital heart disease. The patient underwent successful surgery with uneventful postoperative course.

Right atrial myxoma and severe left ventricular dysfunction: which explanations? Which management?

A 57 year-old woman with a large right atrial myxoma underwent emergency surgical resection in our institute. It is known that surgical management of such tumours is difficult regarding venous cannulation and embolic risk, but in our patient, the surgery was more challenging because of the severe left ventricular dysfunction. Thus, we aim on the one hand, to discuss the association between the left ventricular dysfunction and the right atrial myxoma, and, on the other hand, to describe the on-pump beating heart technique we used to remove this mass.

Surgical management of the left superior vena cava draining into the left atrium: a novel off-pump technique using the left atrial appendage.

The left superior vena cava is the most common congenital venous anomaly in the chest; however, its drainage into the left atrium is exceptional. The aim of the paper is to describe our novel technique to connect the left superior vena cava to the right cavities using the left atrial appendage, without cardiopulmonary bypass.

Textiloma mimicking a pericardial hydatid cyst: a case report.

Textiloma is unusual and uncommon diagnosis which is rarely considered. We report the case of a 13 year-old patient with Holt-Oram syndrome. He was operated on in 2006 for ostium secundum atrial septal defect. The postoperative course was uneventful until 2010 when the child presented paroxysmal dyspnoea. Investigations revealed para-cardiac mass which was thought to be a hydatid cyst, but operative findings showed textiloma.