[Acute myocardial infarction--a possible complication in polycythemia vera. Case report]. / Infarctul miocardic acut--o posibila complicatie în policitemia vera. Prezentare de caz.

A 66-year-old woman with Polycythemia Vera suffered an postero-inferior acute myocardial infarction: this is a relative rare association. The association between primary coronary angioplasty with stent implantation and anti-aggregant and myelosuppressive treatment was followed by important clinical benefits for the patient. To our knowledge, there are rare reports in the literature relating the triad of Polycythemia Vera, acute myocardial infarction and primary coronary angioplasty with stent implantation.

[Morphologic study of cardiac myxomas]. / Studiul morfologic al mixoamelor cardiace.

The aim of the paper was the morphological study of the cardiac myxomas, admitted and operated at CCI, between 2000 and 2004. We evaluated the histology of the tumor, the incidence of the specific lesions, and we analysed the tumoral types on the basis of cardiac myxoma macroscopic appearance in correlation with clinical picture of tumor.

[Hypersensitivity myocarditis, a surprising diagnosis. Case report]. / Miocardita de hipersensibilizare--o surpriza diagnostica. Caz clinic.

Hypersensitivity myocarditis is a rare morphoclinical entity that may cause sudden death through arrhythmia and cardiogenic shock. The focus of the paper is the histological evaluation of the cases to identify the death cause of a 50-year-old patient, known to have suffered of hypertrophic cardiomyopathy, infective endocarditis and severe mitral regurgitation, case in which hypersensitivity myocarditis precipitated the evolution of the disease. The basis of the study was a complete cardiac evaluation including the morphological diagnosis on necropsy specimens. The paper shows that hypersensitivity myocarditis is a cause of sudden death through acute cardiac failure, and the setting of a precise morphological diagnosis is very important for an early targeted treatment.

[Subacute bacterial endocarditis due to Pasteurella pneumotropica. Case Report]. / Endocardita bacteriana subacuta determinata de Pasteurella pneumotropica. Studiu de caz.

Endocarditis due to Pasteurella pneumotropica are very rarely described. We report a new case of bacterial endocarditis in a 43 years-old patient with mitral stenosis. The patient was admitted to the hospital for lethargy, malaise and hemiparesis. On physical examination, a new systolic murmur was found. Transthoracic echocardiography revealed a vegetation on the mitral valve. Three blood culture sets were drawn and after 24 hours of incubation, the last two sets yielded Pasteurella pneumotropica and cell wall deficient forms (L-forms). The patient was successfully treated with gentamicin and ceftriaxone and underwent mitral valve replacement.

[Cardiac amyloidosis. A case report]. / Amiloidoza cardiaca. Prezentare de caz.

The paper presents the morphoclinical picture in cardiac amyloidosis to a 50 years old man admitted at Iasi Cardiology Center with progressive chronic cardiac failure, the patient having recent history of restrictive cardiomyopathy. It was made a complete cardiovascular evaluation including the right cardiac catheterization for endomyocardial biopsy. The biopsy specimens were fixed in buffered 10 % formalin, followed by routine paraffin embedding, and were stained with haematoxylin-eosin, elastic Van Gieson and sulphated blue Alcian for amyloid evaluation. The amyloid deposits were evidentiated in the interstitium and into vascular walls of the biopsy, pointing the importance of the morphological exam for amyloidosis diagnosis.

[Radiofrequency treatment of cardiac arrhythmias at the Cardiology Center in Iasi ]. / Tratamentul tahicardiilor prin radiofrecventa experienta Centrului de Cardiologie Iasi.

UNLABELLED: It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmias is effective and devoid of significant complications. However, in our country, the experience of this technique is not so large and requires more clinical studies to validate it. OBJECTIVES: The aim of this was to present our experience in the RFCA of cardiac tachycardias. METHODS: Between July 2002 and February 2003, in Iasi Cardiology Center, we performed a total of 79 diagnosis procedures. Of these 57 (72%) were radiofrequency ablation procedures at 51 patients, mean age 48 +/- 16 years (12-81), men majority 32 (63%). The electrophysiology diagnosis was: 22 (39%) common atrial flutter, 3 (5%) atrial tachycardias, 13 (23%) atrioventricular nodal reentrant tachycardia, 12 (21%) Wolff-Parkinson-White syndrome, 4 (7%) orthodromic tachycardia using concealed accessory pathway, 2 (3%) ventricular tachycardias and 1 (2%) ablation of the atrioventricular junction. RESULTS: The initial ablation procedure was effective in 44/ 51 patients (86%), with a total duration of 130 +/- 42 min, using 24 +/- 10 min of radioscopy. During follow-up 13 +/- 1.3 (11-16 months), recurrence occurred in 7 patients 14%. In 7 of them a second effective procedure was performed in 4 patients. Finally, radiofrequency ablation was effective in 48/51 of patients (94%), improving the procedural success rate at 95% (54/57 patients). No complications occurred during follow-up. CONCLUSION: The treatment of cardiac arrhythmias by radiofrequency catheter ablation is effective and safe and is the only way to cure the supraventricular and ventricular tachyarrhythmias.

Morphological evaluation of the surgically removed aortic and mitral valves.

In 2001, of the 114 valves surgically excised at the Iasi Center of Cardiology from 59 men and 54 women (mean age 51 years; age range: 25 to 78 years), half were aortic and the other half mitral valves. The 57 aortic valves, from 20 women and 37 men (mean age 51.1; age range 25 to 78 years), had been surgically replaced. Functionally, 57.63 percent (30) were stenotic, 21.05 percent (12) were incompetent, and 26.31 percent (15) were both stenotic and incompetent (aortic disease). Pure stenosis was related to calcification of degenerative (73.3 percent), bicuspid (3.33 percent), post-inflammatory (20 percent), and undetermined (3.33 percent) causes. Pure regurgitation was not related to calcification and causes included infective endocarditis (50 percent), bicuspid valve (16.66 percent), postinflammatory (16.66 percent), aortic root dilatation (8.33 percent), and undetermined (8.33 percent). Aortic disease was secondary to postinflammatory etiologies (40 percent), degenerative calcification (33.33 percent), bicuspid and undetermined (13.33 percent each) causes. The reminder of 57 mitral valves, from 35 women and 24 men (mean age 45.5 years; age range 28 to 71 years), were surgically replaced. Functionally, 40.35 percent (23) were purely stenotic, 19.29 percent (11) were purely regurgitant, and 40.35 percent (23) both stenotic and regurgitant (mitral disease). The causes of pure stenosis were postinflammatory (presumably rheumatic) disease in 91.3 percent (21 cases) and degenerative disease in 8.7 percent (3 cases). Pure regurgitation etiology involved floppy valves in 45.45 percent (5 cases), degenerative disease in 27.27 percent (3 cases), postinflammatory disease in 18.18 percent (2 cases) and infective endocarditis 9.1 percent (1 case).

[Primary pulmonary hypertension--morphologic study]. / Hipertensiunea pulmonara primara--studiu morfologic.

Primary pulmonary hypertension is characterized by elevation of pulmonary arterial pressure over 25 mm Hg with increasing of pulmonary vascular resistance. Primary pulmonary hypertension is the result of idiopathic narrowing of pulmonary arteries and extensive remodeling of the pulmonary vasculature in case of lack of the pulmonary interstitial disease, cardiac diseases, and pulmonary thromboembolism. The morphological study revealed the histological vascular elements characteristic in arterial hypertension (intimal proliferation, medial hypertrophy, plexiform and dilatative lesions) associated with recent and organized arterial thrombosis secondary to intimal lesions through a recent infectious process. Our study revealed the necessity of morphological diagnosis in the view of accurate diagnosis and adequate cure. After all, the prognosis of primary pulmonary hypertension remain poor.

[Permanent cardiac pacing for chronic symptomatic atrioventricular block in uremic hemodialysed patients. A prospective study]. / Cardiostimularea electrica permanenta în insuficienta renala cronica terminala tratata prin hemodializa.

Though sudden cardiac death accounts for as much as 15% of all cause mortality in uremia, reports concerning advanced A-V block, requiring permanent cardiac pacing in end-stage renal disease (ESRD) hemodialysed (HD) patients are very few. This is the first long term prospective study reporting on systematic permanent pacemaker implantation, in a cohort of ESRD patients from a single HD unit. Between 01/06/1997 and 30/12/2001, 396 pacemakers were inserted for advanced, symptomatic A-V block in our institution, including 5 in ESRD, HD patients (M/F--4/1, age 47-73, M +/- SD--61 +/- 12 years) from a single dialysis center, treating 137 patients during the study period. Thus, the incidence and prevalence of A-V defects treated by permanent pacing in uremic patients was 0.81% and 3.65% respectively. Conversely, the incidence and prevalence of ESRD treated by hemodialysis, among patients with advanced A-V conduction disturbances, requiring permanent pacing were 0.28% and 1.26%. Mitral valve calcifications were present in all patients; 3 subjects also had extensive aortic valve calcifications. Left ventricular hypertrophy (echocardiographic Framingham criteria) was present in 4 patients, but the systolic function (ejection fraction and fractional shortening index) was normal in all cases, although a clinical picture of chronic heart failure was seen in 3 subjects preoperatively. A-V conduction defects were attributed to extensive metastatic calcifications, involving the cardiac squeleton, consecutive to severe hyperparathyroidism and inadvertent use of calcitriol and calcium carbonate as phosphate binders. No technical difficulties, short or long-term complications related to pacemaker implantation (4 VVI and 1 VVD devices) were encountered. Acute threshold and sensing values were similar with those of non-uremic patients. During follow-up, one patients died from a non cardiac death. If optimal hemodialysis is provided, benefits of permanent pacing are equal in uremic or non uremic patients and pacemaker implantation should be instituted as a prompt life-saving method in all dialysis patients with chronic symptomatic advanced A-V blocks.

Two cases of Marfan syndrome.

The early identification of the Marfan Syndrome should be essential for the prevention of the aortic dilatation and dissection, but the wide phenotypic expression of the disorder makes the clinical diagnosis very difficult. The aim of this study is to emphasise the necessity of a widely applicable method of morpho-clinical diagnosis. The diagnosis was confirmed on surgical biopsies from ascending aortic wall and aortic cusps, using routine morphological techniques. The macroscopical examination revealed a thin ascending aortic wall, presenting a transversal intimal tear, without secondary dissecting hematoma, and an aortic dilated annulus, producing aortic regurgitation. Microscopically, the diagnosis was supported by the identification of cystic medical necrosis, a specific degenerative lesion in the Marfan Syndrome, in patients with or without family history of aortic aneurysms. This study defines the morpho-clinical changes of the disease, emphasising the necessity of a permanent monitorization of the patient after surgery, due to the risk of late complications.