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INTRODUCTION: Left ventricular pseudoaneurysm is a rare but serious clinicopathologic entity. MATERIALS AND RESULTS: This article describes a case report of 51-year-old man who experienced recurrence of chest pain and dyspnea 4 months later after anterior ST elevation myocardial infarction of first diagonal branch. Anterior basal left ventricular pseudoaneurysm was diagnosed and successful surgical treatment was performed. One year after operation, patient has no cardiovascular events and remains in NYHA class II. CONCLUSION: Cardiac magnetic resonance should be performed, if there is a suspicion of left ventricular pseudoaneurysm from transthoracic echocardiography. Surgery is the treatment of choice in case of left ventricular pseudoaneuryms because untreated lesions carry a significantly high risk of rupture.
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Background: This study aims to evaluate the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on cardiac surgery in a single cardiac surgery center in Lithuania. Methods: Between November 2018 and March 2021, the data of male COVID-19-negative patients (n=81; mean age: 65.5±8.5 years; range, 46 to 87 years) operated during the pandemic were compared with the data of male COVID-19-positive patients operated during the same period (n=14; mean age: 65.2±10.6 years). The number of patiets, demographic and perioperative data were compared between the patients operated during the pandemic (2020/2021 years; pandemic group) and the prepandemic period (2018/2019 years; control group). Results: A statistically significant difference between the COVID-19-positive and COVID-19-negative patients was found in terms of the frequency of wound infection (n=3, 21.4% vs. n=12, 14.8%; p=0.013), resternotomy due to bleeding (n=2, 14.3% vs. n=0, 0%; p=0.018), and duration of hospitalization after surgery (26.4±20.4 days vs. 15.3±8.9 days; p=0.008). Comparing data of patients who had surgery before and during the pandemic, a significant decrease in the number of cardiac operations (166 vs. 95) was observed. There was significantly increased body mass index (p=0.01) and incidence of diabetes mellitus type 2 (p=0.021) in the pandemic group. Conclusion: Despite a significantly higher rate of complications in patients infected with COVID-19, planned cardiac surgery with the utilization of adequate protective measures during quarantine is still a better option than a complete cessation of elective cardiac surgery.
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BACKGROUND: The main goal of this manuscript was to evaluate the diagnostic value of the global and regional postsystolic shortening (PSS) parameters, assessed by two-dimensional (2D) speckle-tracking echocardiography, at rest and during dobutamine stress for the detection of functionally significant coronary artery stenoses in patients with moderate pretest probability of stable coronary artery disease (CAD). METHODS: Dobutamine stress echocardiography (DSE) and adenosine stress myocardial perfusion imaging by cardiac magnetic resonance (CMR-MPI) were performed on 83 patients with moderate pretest probability of stable CAD and left ventricle ejection fraction ≥55%. CAD was defined as ≥50% diameter stenoses on invasive coronary artery angiography (CAA) validated as hemodynamically significant by CMR-MPI. According to invasive CAA and CMR-MPI results, patients were divided into two groups: Nonpathologic CAD (-) group: 38 (45.8%) and pathologic CAD (+) group: 45 (54.2%). RESULTS: There were no significant differences in clinical characteristics, conventional 2D echocardiography between the two groups at rest and during low dobutamine dose. Regional postsystolic index (PSI) during recovery phase had the highest area under the receiver operating characteristic curve (AUC) (AUC 0.882, sensitivity 87%, specificity 92%) for the detection of functionally significant one-vessel disease. During high dobutamine dose, regional PSI had sensitivity 78% and specificity 81% (AUC 0.78) to detect significant CAD. Regional PSI remained the same tendency remains for the detection of multiple-vessel CAD. Other myocardial deformation parameters were less sensitive and specific during high dobutamine dose and recovery phase. CONCLUSIONS: PSS parameters showed to be sensitive and specific in detecting hemodynamically significant coronary artery stenosis in patients with stable CAD with moderate pretest probability. The study revealed that the assessment of regional PSI performed during recovery improves the diagnostic accuracy of DSE for the detection of functionally significant CAD.
