MULTIDISCIPLINARY CARDIOVASCULAR ANNALS
Year:2017 | Volume:8 | Issue:1|Papers Count:6

Background: The recent trend of cardiac transplantation has been dramatic in our center, thus entailing the interpretation ofendomyocardial biopsies in such patients. Objectives: With this fact borne in mind, we decided to review the cases from the point of view of a certain diagnostic challenge, namely quilty lesion or effect. Methods: From April 2010 to December 2012, 42 patients with heart transplant have undergone endomyocardial biopsies and 63samples were acquired. Results: Mean age of the patients was 30 15. 7 years (male/female: 34/8). Quilty effect was seen in 8 out of 63 samples (12. 7%). Conclusions: The incidence of quilty lesion was within the range defined for this finding. When the lesion extends to the underlyingmyocardial tissue, it can be a diagnostic challenge. In the eyes of an inexperienced observer, ISHLT grade 2 rejection may bediagnosed instead of invasive quilty lesion. Therefore, experienced pathologists play an important role in this regard in all the cardiovasculartransplantation sites.

We present a 40-year-old man with a recurrent left atrial mass, previously diagnosed as cardiac myxoma elsewhere. His new admissionwasdueto a regrowth of the mass. Progressive exertional dyspnea washis major complaint. Alarge lobulatedtumorwasseen inechocardiography in the posterior wall of left atrium involving the posterior leaflet of mitral valve, and resulting in severe stenosisand diastolic protrusion of the mass into the left ventricle. Surgery showed a non-homogenous myxomatous mass which infiltratedthe posterior wall of the left atrium and parts of the inter-atrial septum. As a result, the surgeon excised parts of the septum andthe posterior wall and did a reconstruction with pericardial patches. The pathologic examination revealed soft creamy-brown tumoralfragments, m: 10  4 cm altogether. Contrary to his previous diagnosis, we observed a malignant neoplasm with cells thathad plump, round to oval nuclei, set in a myxoid and vascular background, but mitotic figures and necrosis were not conspicuous. Therefore, we made a diagnosis of recurrent myxoid round cell sarcoma and recommended immunohistochemical (IHC) studies. Multiple IHC and histopathological studies elsewhere favored a diagnosis of myxoma which was not compatible with our diagnosis. A second recurrent mass was soon found in the left atrium making further surgical attempts impossible. At last, a diagnosisof myxoid leiomyosarcoma confirmed our diagnosis, but the patient was not fortunate enough to survive and passed away beforeheart transplantation could be done as a remedy.

Background: There is concern about radiation dose in children during cardiovascular catheterization and many believe that theuse of computerized tomography is much better than conventional catheterization and angiography. The aim of this study is tocompare the radiation dose between diagnostic and therapeutic procedures in children. Methods: 178 patients with congenital heart disease enrolled in this study. Patients have been divided into 3 groups of CT angiography, conventional angiography and intervention. Data include: sex, age, weight, fluoroscopy time, total radiation dose of CT angiography, the amount of reference point air Kerma (Ka, r) (reference dose) and kerma area product (Pka) of fluoroscopy machine. Peak skin dose (PSD) was calculated for intervention and conventional angiography patients using the following formula: PSD = 249+ 5. 2 PKA. The data has been analyzed by SPSS version 20. In this study the P-value less than 0. 05 was considered meaningful. Results: The patients were similar in sex, age and weight in all the three groups. The mean reference point air kerma (ka, r) inintervention group was meaningfully higher than the other two groups (P < 0. 001), but in some patients of CT Angiography groupthe radiation dose was higher than conventional angiography group. The mean kerma area product (pka) in intervention group was higher than angiography group, although this difference is lessmeaningful statistically (P = 0. 049). The Fluoroscopy time (P = 0. 035) in intervention group was meaningfully higher than angiographygroup. The mean calculated pick skin dose (PSD) was 437 383 miligray and 213 508 miligray for intervention and conventionalangiography groups respectively (P < 0. 001). In intervention group, Fluoroscopy time (P = 0. 037), ka, r (P = 0. 17) ( and Pka (P =0. 02) are more about VSD closure than other procedures. Conclusions: Given the results of this study, the use of fluoroscopy for diagnosis and treatment of pediatric cardiovascular diseasesis safe but with due attention to sensitivity of children to some side effects of X-ray compared to adults, considering safety advicesin order to reduce fluoroscopy time, radiation dose and the use of standard protection to reduce X-ray absorption is necessary.

Visual loss after nonocular surgery is rare but devastating. Peak rates of perioperative visual loss are with heart and spine surgery. The two possible main causes of visual loss after cardiac surgery are ischemic optic neuropathy and retinal ischemia due to embolismand / or low perfusion secondary to hemodynamic changes through cardiopulmonary bypass within the retinal, optic nerveand choroidal circulation. Stable preservation of some hemodynamic factors during cardiac surgery seems to be the key to stopvisual loss. The purpose of this article is to briefly review perioperative visual loss after cardiac surgery.

Objectives: The current study tries to assess the causative factors of dysphagia and omit them to find the exact contribution of TEEfor this symptom among patients who suffer from elective open cardiac surgery in different age ranges in both sexes. Methods: In this observational study, 100 patients between 30-80 years of age with ASA < III and EF > 40% who were candidatefor elective open cardiac surgery in a referral hospital in Tehran in 2011 were recruited. The patients were divided into two groupsbased on TEE performance; patients who needed to perform TEE based on medical indication were considered the case group andthe other patients who did not have indication for TEE, formed the control group. Results: Total frequency of dysphagia was 13% in all patients disregarding TEE performance while 6 (12%) and 7 (14%) of controlsand cases showed this symptom respectively. Odynophagia was the other symptom to be assessed for its frequency in this studyand showed 13% total frequency considering all participants disregarding the groups. This symptom was reported exactly similarto dysphagia which was 6 (12%) in controls and 7 (14%) in cases. The participants’ gender was not effective on the distribution ofdysphagia where 6 (11. 3%) females and 7 (14. 9%) males were involved with no significant difference. Conclusions: Intraoperative trans-esophageal echocardiography during cardiac surgeries has greater usefulness than complicationsand is worth using in this case as well.

Introduction: Dilated pulmonary artery can increase the postoperative airway complications after the simultaneous repair of aorticarch anomaliesandcardiovascular lesions with large left to right shunt. It is claimed that the anterior translocation of pulmonaryartery will reduce the airway compression. Case Presentation: Here we report 3 cases including an 11-month-old infant with ventricular septal defect (VSD) and coarctation, a2-month-old infant with interrupted aortic arch (IAA) and VSD, and a neonate with aortopulmonary window (APW) in combinationwith coarctation in which all had a one stage repair of their lesions. Translocation of the right pulmonary artery (RPA) branch wasperformed in two patients, however with different postoperative courses that merit pondering over their fate. Conclusions: RPA anterior translocation could be considered as an additional palliation in some patients with coarctation repairfrom midsternotomy approach.