RESUMO
Ebstein anomaly is a congenital heart disease that is considered rare and mostly found in pediatrics population. Symptoms in adults vary depending on the degree of the valve displacement and include difficulty breathing, palpitations, stroke, or even fatigue. However, if it occurs in the elderly, they end up with a good prognosis. A novel calcium sensitizer "levosimendan" has been used perioperatively in heart valve replacement to improve the long-term prognosis of patients. The use of the drug has been shown to reduce postoperative mortality in patients with reduction in ejection fraction. We present the case of a 62-year-old female, a known case of hypothyroidism, bronchial asthma, gastroesophageal reflux disease, and recent diagnosis of Ebstein anomaly, who underwent tricuspid valve repair and atrial septal defect repair on being symptomatic, in addition to the successful use of a novel positive inotropic drug with decrease in the intensive care unit stay.
RESUMO
BACKGROUND: Cardiac myxomas (CM) are the most prevalent type of primary cardiac tumour. The majority of primary cardiac tumours, including CM, are found to be benign. In the context of this study, the objective was to investigate and analyse the experience of CM over a period of 10 years, specifically in Bahrain. By examining this particular subset of cardiac tumours, valuable insights can be gained regarding their prevalence, clinical presentation, diagnostic methods, treatment approaches, and outcomes in the Bahraini population. METHODS: We retrospectively evaluated the medical records of 20 patients who presented with CM at the Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre in the Kingdom of Bahrain from January 2010 to January 2021. All patients had transthoracic echocardiography to establish a preoperative diagnosis. All of the patients underwent an operation using the median sternotomy, and a histopathology examination confirmed the final diagnosis. RESULTS: The mean age at the time of presentation was 57 (± 18.1) years, ranging from 17 to 80 years, and 55% (12 patients) were female. Dyspnea (n=8, 40%) and peripheral embolism (n=4, 20%), which include cerebrovascular accidents and acute monocular vision loss, were the most frequently observed symptoms. The largest diameter of the myxoma was 5.1 cm (±1.7). The left atrium was the predominant location for myxoma formation (n=16, 80%), with the majority of the myxomas attached to the atrial septum. CONCLUSION: CM poses a significant risk of cardiac and systemic complications. Early detection and timely gross-complete resection result in excellent early and long-term outcomes.
RESUMO
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure that is considered a good alternative to surgical aortic valve replacement (sAVR) in selected patients. Our aim is to determine the baseline, procedural characteristics and one-year clinical outcomes of our TAVI registry. METHODS: This study is a retrospective observational analysis of a prospectively designed cohort comprising 81 consecutive patients treated at Mohammed bin Khalifa Cardiac Centre (MKCC) who were enrolled in Bahrain TAVI registry from February 2014 to February 2019. The clinical endpoints were defined according to the updated Valve Academic Research Consortium-2 (VARC-2) consensus document. RESULTS: Out of the 81 patients included in our study, there were 37 (45.7%) males. The mean age was 76.4 ± 8.9 years with a mean Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE II) of 4.1 ± 2.5 and a mean Society of Thoracic Surgery (STS) Risk Score of 4.2 ± 3.5. Evolute-R valve was used for 36 (44.4%) patients, Edward Sapien for 26 patients (32.1%), and Core valve for 19 patients (23.5%). At one year follow up, all-cause death was reported in three (3.7%) patients; none of them was cardiovascular mortality. As per VARC-II criteria, no cases fulfilled the criteria of valve dysfunction but TAVI-related complications (i.e., TAV-in-TAV deployment) were reported in four (4.9%) cases. One (1.2%) case of major bleeding was encountered but no patient experienced life-threatening bleeding. Major vascular complications were documented in two patients (2.5%) only. Significant Acute Kidney Injury (AKI) occurred in two (2.5%) patients, both classified as stage-2 but no one deteriorated to stage-3 or hemodialysis. Seven (8.6%) patients required permanent pacemakers, and all were implanted during the index admission for TAVI. One patient (1.2%) had stroke and all survivors completed one-year follow up. CONCLUSION: The TAVI program in Bahrain is encouraging and corresponds to the finest international centers outcomes in terms of procedural success and complications rate.