Multi-valve Libman-Sacks's endocarditis-related multiple, massive and fatal systemic embolization. A case report and a review of diagnostic work-up.

We reported a case of non-bacterial thrombotic endocarditis (NBTE) in a 37-year-old woman who presented with signs and symptoms of cardio-embolic cerebral stroke caused by a prothrombotic state due to underlying advanced uterine cancer. Multimodal imaging, including 3D-ecocardiography, as well as laboratory and cultural tests, were critical in making the diagnosis. After starting anticoagulation therapy with low molecular weight heparin (LMWH), the patient underwent surgical aortic valve replacement due to worsening aortic valve function, initial left ventricle enlargement, increasing dimensions, and mobility of vegetations. Unfortunately, vegetations relapsed on the aortic valve bio-prosthesis as well as the mitral leaflets, resulting in a final picture of multi-valve NBTE. The fatal outcome was due to a massive multiple limb embolism, which resulted in leg amputations and septical complications. Starting with the case, we present a brief overview of the pathology's presentation, treatment, management, and prognosis, as well as the diagnostic work-up.

[Primary cardiac lymphoma in an immunocompetent young adult: outcome with chemotherapy]. / Linfoma primitivo cardiaco in un giovane adulto immunocompetente: outcome positivo a medio termine con trattamento chemioterapico.

Primitive cardiac lymphoma (PCL) is a rare disease accounting for only 1-2% of primary cardiac tumors. Diffuse large B cell lymphoma is the most common type and shows a rapid progression with poor prognosis. The clinical presentation of PCL is nonspecific, and echocardiographic study is essential to the initial work-up. Magnetic resonance imaging and computed tomography scan are the methods of choice for the assessment of tumor extension. The definitive diagnosis is histopathology examination. Chemotherapy and radiotherapy represent the best treatment and should be started promptly after PCL diagnosis. We here report a case of PCL in a 59-year-old man complicated by pulmonary microembolism, atrial fibrillation and signs of right outflow tract obstruction.

[Temporary emergency cardiac pacing under continuous echocardiographic control. Feasibility and safety of the procedure without using fluoroscopy]. / Posizionamento ecoguidato di elettrostimolatore temporaneo endocavitario in emergenza. Fattibilità e sicurezza della procedura senza impiego di fluoroscopia.

BACKGROUND: Cardiac pacing often turns out to be the only effective treatment of severe brady-arrhythmias. Several invasive and noninvasive temporary pacing procedures are known, whose application is sometimes difficult or time-consuming. An alternative temporary cardiac pacing procedure is described in this article, which is based on echocardiographic control. METHODS: Fifty-four nonconsecutive patients were studied; they all were needing urgent cardiac pacing. A first choice attempt to perform an ultrasound-guided temporary cardiac pacing, by using a right jugular venous approach, was done. The catheter pathway was monitored by means of echocardiography performed by another operator. All data concerning time of execution, pacing parameters, acute or chronic complications and the in situ time duration of the catheter without needing to be repositioned were obtained. RESULTS: Ultrasound-guided cardiac pacing was not feasible in 3 patients (6%), because of a high thoracic acoustic impedance or failing to perform right jugular venous catheterization. Mean execution time was 680 +/- 179 s. Echocardiographic monitoring was performed in 50 patients by a cardiologist, in 1 patient by a non-cardiologist physician, and in 3 patients by a nurse, who had been previously trained to keep the transducer in the right position. No serious complications occurred. On 4 occasions (8%) the catheter had to be repositioned during the following hours. On 25 occasions (46%) permanent cardiac pacing was finally performed. CONCLUSIONS: Temporary ultrasound-guided cardiac pacing seems to be a safe and easy procedure; it can be performed in a broad range of clinical and logistic scenarios and does not require fluoroscopic monitoring. A limited number of human resources is needed, but technical skills in central venous catheterization are required. Further studies are needed to validate this procedure; however it shows several potential benefits as compared to the other temporary cardiac pacing techniques.