Surgical treatment of a giant unruptured aneurysm of the noncoronary sinus of Valsalva: a case report

BACKGROUND: A sinus of Valsalva aneurysm is a rare cardiac anomaly which may be acquired or congenital. The main associated symptoms are conduction disturbances, myocardial ischemia, and syncopes. CASE PRESENTATION: In this report we describe a 52-year-old Albanian woman from Kosovo with an unruptured aneurysm of 74×60 mm of the noncoronary sinus of Valsalva presenting dyspnea, jugular distension, and tachycardia due to cardiac compression. She underwent successful closure of the orifice and sinus remodeling with a Dacron patch. CONCLUSION: To the best of our knowledge this is the largest reported isolated unruptured aneurysm of the coronary sinus causing severe compression of the cardiac chambers undergoing successful surgical correction

European society of cardiology: Cardiovascular disease statistics 2019

peer reviewedAims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are and results drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index >_30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.523.1%] vs. 15.7% (IQR 14.521.1%)}, diabetes [7.7% (IQR 7.110.1%) vs. 5.6% (IQR 4.87.0%)], and among males smoking [43.8% (IQR 37.448.0%) vs. 26.0% (IQR 20.931.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.010.8) vs. 16.7% (IQR 13.919.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 56558115)] compared with high-income [2235 (IQR 18963602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest. © The Author(s) 2019

Modified Port-Access Technique for the Treatment of Aortic Dissection after Previous Cardiac Surgery

One of the most challenging conditions to manage after previous cardiac surgery is chronic dissection of the ascending aorta. We operated on a 54-year-old man who had aortic dissection in addition to large aortic dimensions very close to the sternum, severe aortic regurgitation, and a false lumen in the descending aorta. We used a combination of perfusion and myocardial protection techniques, arising from port-access technology, that enabled antegrade flow into the aorta, endoclamping of the ascending aorta, the administration of cardioplegic solution before opening the sternum, and left ventricular venting to prevent ventricular distention. Our technique resulted in minimal blood loss, shorter circulatory-arrest and operative times, the ability to operate on a decompressed heart and descending aorta, good myocardial protection, and easier and safer access to the heart. Three years postoperatively, our patient was doing well. Other patients might benefit from this approach; however, the surgeon must ensure that an aortic segment is suitable for endoclamping.</jats:p

Early Clinical Outcome of Acute Poisoning Cases Treated in Intensive Care Unit

INTRODUCTION: A variety of factors have influenced the significant incidence of morbidity and mortality of acute poisoning and the timely recognition and properly management of critically ill poisoned patients is a key component. The aim of this study is to reveal the reasons for ICU admission of acutely poisoned patients, the main factors influencing the course and outcome of patients in relation with clinical approaches applied, available resources and infrastructure of treatment. MATERIALS AND METHODS: This is a retrospective study based on most reachable variables extracted from patients’ medical records and ED registers of patients admitted at the medical ICU of “Mother Teresa” University Hospital in Tirana over two (2012-2013) years. Demography, time of exposure, etiology and circumstances of poisonings, assessment and treatment, reasons for ICU admission, course and outcome were duly obtained. RESULTS: The number of ICU treated patients was 118, consisting in 47.4% (56) males and 52.5% (62) females which represented 10.2% of poisoned patients admitted during this two-year-period in ED and 9.2% of other etiology ICU admitted patients. Mean was 42.6 years for males, and 38 years for females. About 55.9% were urban residents and 44% rural ones. The elapsed time from toxic exposure to treatment initiation had varied between 2-6 hours, 44% arrived in the hospital <4 hours. The toxic exposures were intentional in 87.2% of cases, with a male:female ratio was 0.8:1. Agrochemicals such as Aluminum phosphide and organophosphates were involved in 77.1% of cases. Cardiovascular collapse and respiratory failure were the main clinical syndromes encountered. Mechanical ventilation was required in 31.4% of patients. The length of ICU stay was 2.73 (0.96) days and the mortality was 54.2%. CONCLUSION: This study evidenced that highly lethal toxicants used in poisoning acts such as agrochemicals, high rate of suicide, notwithstanding the infrastructure and resources available employed for ICU patients’ treatment, all had played a role in the very high rate of mortality in this cluster of patients

Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation

AbstractIntroductionThe papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the mostly frequently found tumor occurring in cardiac valves.Case presentationWe describe a 52 year old female presenting a history of 2 weeks of fever due to wound infection after breast’s surgery. A preoperative echocardiography demonstrated a mass >1cm2 originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. The histologic evaluation demonstrated a PFE.DiscussionWith the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. PFE have been found most often on valve leaflets, chordae tendineae, and both ventricles. The differential diagnosis of PFE includes other cardiac tumors, thrombus, vegetation, and Lambl’s excrescences.ConclusionTo summarize, we report a PFE of the anterior leaflet of the mitral valve. The diagnosis was confirmed by histopathological examination after surgical removal. Finally, careful echocardiographic analyses during evaluation of valvular masses are strongly recommended for differential diagnosis