Case reports issue of Cor et Vasa, number 4

Michael Aschermann

Cor Vasa 2017, 59(5):e419  

Transcatheter aortic valve implantation in patients with bicuspid aortic valve

Jiandong Ding, Jian Zhu, Jing Lu, Xiuxia Ding, Xiaoli Zhang, Genshan Ma

Cor Vasa 2017, 59(5):e420-e423  

Obstructive hypertrophic cardiomyopathy and aortic valve disease in elderly woman - a case for Cath lab or surgery?

Anna Chaloupka, Jan Krejčí, Ladislav Groch, Vladimír Horváth, Lenka Špinarová

Cor Vasa 2017, 59(5):e424-e429  

Aim: Hypertrophic cardiomyopathy (HCM) is a relatively common genetic cardiac disease (1 : 500) that is largely heterogeneous in its presentation, prognosis and treatment strategies. As such it often represents a dilemma to primary care clinicians as well as cardiovascular specialists. With widening possibilities of the management of the disease it is important to bring relevant clinical cases, which can help to clarify often difficult questions, which may arise.Methods/case presentation: We are reporting a case of 74-year-old woman with highly symptomatic obstructive hypertrophic cardiomyopathy (HOCM) in concomitance with mild and hemodynamically...

Fixed subaortic stenosis

Filip Kratochvíl, Tomáš Paleček, Tomáš Grus, Petr Kuchynka

Cor Vasa 2017, 59(5):e436-e440  

The authors present a case of a 40-year-old female patient with fixed subaortic stenosis (SAS). This defect is classified into a group of diseases characterized by the presence of obstruction in the left ventricular outflow tract, which collectively includes stenotic lesions located in the region extending from the anatomical outflow tract of the left ventricle distally to the descending aorta. Obstructions are named according to their relationship to the aortic valve (subvalvular, valvular, and supravalvular) and their common denominator is an increase in the left ventricular afterload. Fixed subaortic stenosis may be either a focal stenotic lesion...

Rapidly progressive heart failure in a patient with restrictive cardiomyopathy secondary to newly diagnosed multiple myeloma

Zuzana Jadvišová, Jiří Knot, Zuzana Moťovská

Cor Vasa 2017, 59(5):e430-e435  

Restrictive cardiomyopathy is a rare disease of the myocardium characterized by elevated filling pressures, limited left ventricular filling with usually normal systolic function. The most common cause in our geographic region is AL amyloidosis. This paper describes the case of a patient in whom multiple myeloma was diagnosed in an advanced stage of the disease, with organ damage and progressive heart failure, which was gradually reducing the quality of life and which despite the initiation of intensive treatment led to a patient's death.This case proves that the disease gets little attention, is diagnosed late, and therefore it is important to...

Accessory mitral valve tissue in association with bicuspid aortic valve and aortic coarctation

Tomáš Toporcer, Adrián Kolesár, Martin Ledecký, František Sabol

Cor Vasa 2017, 59(5):e441-e445  

Accessory mitral valve tissue (AMVT) is a rare congenital malformation of the heart. The first case of AMVT was described in 1842. The first surgical treatment of this lesion was published in 1963 and the first echocardiography diagnosis of AMVT was performed in 1985.A 50-year-old male with medical history of surgery of aortic coarctation 39 years ago was accepted to the hospital because of dyspnoea and repeated pain in the left thorax. Echocardiography revealed bicuspid aortic valve including progressive dilatation of an aortic root and ascending aorta with mild aortic regurgitation. Dilatation of mitral annulus with moderate regurgitation (without...

Unusual electrocardiographic changes during acute pancreatitis

Dante Antonelli, Ehud Rozner, Yoav Turgeman

Cor Vasa 2017, 59(5):e446-e449  

A 46-year-old man suffered from mild upper abdominal pain radiating to the back and nausea; after a week he began to complain also of chest discomfort radiating to the neck and presented to the emergency room. A 12-lead electrocardiogram showed large peaked T waves in leads II-III-AVF and giant T waves inversion in AVL, V1 through V6; half an hour later the chest discomfort and the electrocardiographic changes resolved. Serum biochemistry results showed elevated serum pancreatic enzymes; electrolytes, creatinine kinase and troponin T serum values remained normal. Coronary angiography showed normal coronary arteries. The patient was conservatively managed.Electrocardiographic...

Pitfalls in rate and rhythm control: Severe concomitant orthostatic hypotension unmasks after conversion to sinus rhythm

Nikolay Yu. Mironov, Shurat B. Gorieva, Sergey P. Golitsyn

Cor Vasa 2017, 59(5):e450-e453  

Rate control is an attractive strategy in management of patients with recurrent atrial fibrillation. Typically, it is more simple approach than rhythm control. Once optimal ventricular rate control is achieved patients with long-lasting atrial fibrillation commonly remain in good clinical status and do not require subsequent readmissions and change of prescribed drugs and their doses. We report a case of effective rate control strategy failure after relatively long period due to transformation of atrial fibrillation into atypical atrial flutter. Subsequent spontaneous conversion to sinus rhythm improved patient's hemodynamic but unmasked concomitant...

Junctional ectopic tachycardia and type 1 Brugada ECG in a pediatric patient: Casuality or causality?

Pasquale Crea, Lilia Oreto, Giuseppe Andò

Cor Vasa 2017, 59(5):e454-e456  

A 5-year-old male was admitted for tachycardia, toothache and fever. The 12-lead electrocardiogram showed a narrow QRS complex tachycardia. Following adenosine administration, the diagnosis of junctional ectopic tachycardia (JET) was established. Sinus beats showed a type 1 Brugada ECG. In the case herewith reported, JET presentation was unusual, occurring in a patient with no history of congenital heart disease or heart surgery. In the last years, Brugada Syndrome (BrS) was also correlated to various supraventricular arrhythmias. The peculiarity of the case is the first time reported association between JET and fever-induced type 1 Brugada ECG.

Bradycardic variant of sudden cardiac death in patient with left ventricle aneurysm

Oleg Libryk, Igor Vakaljuk, Elina Warenytsia, Andriy Vytryhovskiy

Cor Vasa 2017, 59(5):e457-e459  

A complicated diagnosis of constrictive pericarditis in a patient with atrial fibrillation - The importance of temporary pacing inducing regular heart rhythm during invasive hemodynamic study

Zuzana Rücklová, Josef Marek, Tomáš Paleček, Štěpán Jeřábek, Tomáš Grus, Aleš Linhart, Josef Kořínek

Cor Vasa 2017, 59(5):e460-e464  

Background: Constrictive pericarditis (CP) is a rare disease frequently with nonspecific initial clinical manifestations. Transthoracic echocardiography (TTE) is a key imaging method for the CP diagnosis. However, concomitant atrial fibrillation (AFib) may complicate the correct diagnosis, since some typical echocardiographic CP markers, especially those based on their respiratory changes may not be obvious or routinely evaluated.Case report: We present a case of initially asymptomatic 61-year-old male with elevated cholestatic enzymes of unclear etiology detected repeatedly over a period of 3 years, with chronic AFib but without signs of heart...

Novel pulmonary artery banding followed by transcatheter balloon dilatation in treatment of complex congenital heart defects

Laura Vazquez-Garcia, Zdenek Slavik, Hideki Uemura

Cor Vasa 2017, 59(5):e465-e467  

We present a novel technique of pulmonary arterial banding using a Gore-Tex strip secured by 7-0 Prolene suture as part of surgical treatment in 2 neonates with aortic coarctation and ventricular septal defects. Successful percutaneous balloon angioplasty of the main pulmonary artery in the area of pulmonary arterial band was performed at 12 and 26 months of age in one of the patients and at 3.5 months of age in the other patient. Peak systolic pressure drop across the area of previous pulmonary artery banding was 30 mmHg and 25 mmHg at 65 and 30 months of age, respectively.

Successfully treated contained circular rupture of the ascending thoracic aorta in a patient with a bicuspid aortic valve

Lucie Srncová, Magdalena Sionová, Róbert Petr, Hana Línková

Cor Vasa 2017, 59(5):e468-e473  

Stenting of the aortic arch and supra-aortic vessels, in a patient with DeBakey type I dissection

Ivo Petrov, Zoran Stankov, Galina Kozareva, Silvia A. Pavlova, Iv. Tasheva

Cor Vasa 2017, 59(5):e474-e476  

Background: Aortic dissection (AD) is a medical condition which requires emergent surgical intervention for dissection type I and II DeBakey. Despite advances in diagnostic and therapeutic modalities, mortality is still high. Additional tears, critical true lumen compression and obliteration with end-organ ischemia can compromise acute and chronic clinical outcomes after surgical intervention of AD. Endovascular treatment with non-covered stent implantation can be the treatment of choice for these cases. Thus the purpose includes closure of the proximal entry tear, depressurization of the false lumen, leading to its thrombosis, redirection of the blood...

Minimally invasive left thoracotomy and prosthetic valve mini skirt for recurrent mitral paravalvular regurgitation

Sathappan Kumar, Vinod Namana, Israel J. Jacobowitz, Gregory A. Crook, Greg H. Ribakove

Cor Vasa 2017, 59(5):e477-e480  

Paravalvular leaks still occur following prosthetic valvular replacement. When the paravalvular leaks are significant and causing symptoms or hemolysis, they require closure. Numerous operative techniques, including transcatheter interventions, hybrid approach are described in the literature to treat paravalvular leaks. We describe a minimally invasive left thoracotomy surgical technique that can secure closure of recurrent mitral paravalvular leak in a patient undergoing open-heart surgery for the fifth time.This surgical technique involves the minimally invasive left thoracotomy, sewing a piece of prosthetic material (bovine pericardium or synthetic...

Acute arterial occlusions of the extremities as only one manifestation of cardiac myxoma

František Nehaj, Michal Mokáň, Juraj Sokol, Stanislav Mizera, Michal Hulman, František Kovář, Marián Mokáň

Cor Vasa 2017, 59(5):e481-e484  

Cardiac myxoma is the most common benign tumor of the heart that occurs in adult population. It can cause several specific and nonspecific symptoms, especially depending on localization and size of the tumor. The disease may take many months and years being unrecognized and asymptomatic. The echocardiography is the golden standard in diagnostic process of cardiac tumors, but in many cases the finding is incidental and the diagnosis is often challenging. We present a case report of the left atrial myxoma manifesting with multiple acute limb ischemia. After urgent thrombectomy and embolectomy a sample of thrombus was sent for histology. The conclusion...

Type II complex regional pain syndrome resulting in a persistent contracture of the left hand: A severe side effect of ambulatory blood pressure monitoring

Jiří Pudich, Jiří Plášek, Miroslav Homza

Cor Vasa 2017, 59(5):e485-e487  

In this paper, we report a case of a 64-year-old woman who developed a type II complex regional pain syndrome (CRPS, also known as Sudeck's dystrophy, Reflex sympathetic dystrophy, shoulder-hand syndrome) as a result of a routine ambulatory blood pressure monitoring in a patient on anticoagulation therapy with renal insufficiency probably aggravated by an episode of a respiratory tract infection immediately preceding the ABPM. However, as such, a severe complication of this procedure was not expected, and as CRPS is not routinely encountered by cardiologists, the correct diagnosis was unfortunately established late and the patient developed a permanent...

A rare case of multiple aneurysms in ilio-femoro-popliteal segment with rupture of deep femoral artery

L. Beshev, T. Andreev, A. Marinov, N. Totsev, V. Velikov, B. Tsankov, B. Ignatov

Cor Vasa 2017, 59(5):e488-e492  

Introduction: Aneurysms of the deep femoral artery (DFA) are extremely rare. The diagnosis is difficult due to the anatomical location of the artery. Generally, the aneurysm presents itself with its complications - compression, rupture.Presentation of case: We present a case of 78-year-old man admitted in state of emergency in Vascular Surgery department, presenting with suddenly appearing pain and big pulsatile mass in the femoral triangle of the left thigh. The performed ultrasonography and CTA confirmed the presence of ruptured DFA aneurysm with big hematoma on the left side. CTA established also aneurysms of both iliac, femoral and popliteal...

Ventricular fibrillation in rheumatoid arthritis

Marek Matyášek, Martin Fiala, Martin Pleva, Marian Branny

Cor Vasa 2017, 59(5):e493-e495  

We present a case of a young female with rheumatoid arthritis resuscitated from sudden cardiac death due to ventricular fibrillation. Extensive subacute ischemic damage to the interventricular septum by cardiac magnetic resonance suggested ventricular fibrillation associated with acute myocardial infarction. In the absence of coronary artery stenosis on coronary angiography, other rheumatoid arthritis-specific causes of acute myocardial necrosis with unpredictable evolution and risks encouraged implantation of cardioverter-defibrillator.

Ulnar artery aneurysm - A rare cause of mass on wrist

Cenk Conkbayir, Ozan Emiroğlu, Hasan Birtan, Levent Cerit

Cor Vasa 2017, 59(5):e496-e498  

In this article we are going to discuss a patient with ulnar aneurysm due to atherosclerosis which is very rare in the literature. Among its reasons, trauma, infection, peripherial embolism, immunologic reasons, Ehlers-Danlos Syndrome and arteriosclerosis play role, its diagnosis and treatment is important since it can cause ischemia of finger. The diagnosis of peripheral embolism should also be excluded in such cases with physical examination, ultrasound and angiographic tests. For the treatment of ulnar artery aneurysm surgical procedures as resection and reconstruction may be performed.

Mechanical intravascular hemolysis after percutaneous closure of perioaortal pseudoaneurysm

Aleš Benák, Veronika Čapková, Tomáš Marek, Jana Vrbská, Michael Želízko, Josef Kautzner

Cor Vasa 2017, 59(5):e499-e502  

Mechanical intravascular hemolysis is a rare complication after implantation of Amplatzer occluder. We report a case of transient hemolysis after percutaneous closure of perioaortal pseudoaneurysm in a 45-year-old male who underwent previous bypass surgery with replacement of ascending aorta.

A rare cause of acute limb ischemia of both upper and lower limbs caused by prolonged vasospasm

Sylvie Kuchynková, Miroslav Chochola, Petr Vařejka, Dana Kautznerová, Pavel Procházka, David Ručka, Samuel Heller, Aleš Linhart, Jean-Claude Mukonkole Lubanda

Cor Vasa 2017, 59(5):e503-e506  

Acute limb ischemia is a life-threatening condition caused by various etiologies including atherothrombosis and peripheral embolization. However, in young adults other etiologies should also be considered. We report a rare case of a 19-year-old man developing acute limb ischemia of both upper and lower limbs due to prolonged vasospasm.

Acute myocardial infarction as the manifestation of the thoracic aorta pseudoaneurysm

Václav Hanák, Petr Šantavý

Cor Vasa 2017, 59(5):e507-e511  

We present the case of the 56-year-old Caucasian man, with the 30-month history of previous Yacoub operation, reported to the complex cardiovascular center because of the acute coronary syndrome with new LBBB ECG changes. Coronary angiogram proved the atypical affection of the left main coronary artery, transesophageal echocardiography clarified a large aortic pseudoaneurysm repressed both of coronary arteries, as the cause of symptoms. The surgical correction (Bentall procedure) was successfully performed and the patient was discharged 23 days after redo surgery with no complications.

Giant cardiac lipoma - Potentially deceptive entity in differential diagnostic imaging

Miroslav Koňařík, Jiří Malý, Jan Pirk, Marek Kollár, Ondrej Szárszoi

Cor Vasa 2017, 59(5):e512-e514  

Unexpected echocardiographic findings in one vessel coronary artery disease

Olga Nedeljković-Arsenović, Bosiljka Vujisić-Tešić, Olivera Ninković-Mrđenovački, Marija Boričić-Kostić, Ivana Nedeljković, Biljana Parapid, Marko Banović

Cor Vasa 2017, 59(5):e515-e519  

Introduction: Left ventricular aneurysm is one of the most significant complications of myocardial infarction and it is thought to develop in 5-10% of all patients with acute myocardial infarction.Case report: A 50-year-old male patient with a history of chronic alcohol abuse and risk factors for coronary heart disease was treated twice in the regional hospital center because of heart failure. Initially, echocardiography was not performed. Three years later he was admitted to the Urgent Center with a chief complaint of chest pain. He was evaluated by echocardiography, which showed a scar affecting the inferior wall of the left ventricle with an...

Penetrating injury to the heart

Monika Mikolášková, Ondřej Ludka, Petra Ondříková, Vladimír Horváth, Petr Němec, Jindřich Špinar

Cor Vasa 2017, 59(5):e520-e523  

We report a rare case of penetrating cardiac injury. Management of the unique life-threatening condition is described. The successful outcome of treatment of this severe group of patients could be achieved by maintenance of the following fundamental principles: rapid transport of patients to the nearest hospital, maximum rapidity in establishment of the diagnosis and highly qualified urgent surgical intervention. Echocardiography is the most informative as well as quick method of noninvasive diagnostics of penetrating cardiac injuries.

Pavel Jansa, Michael Aschermann a kol.: Chronická plicní hypertenze - patofyziologie, klinický obraz, diagnostika, terapie

Prof. MUDr. Jan Petrášek, DrSc.

Cor Vasa 2017, 59(5):604  

Prof. MUDr. Zbyněk Straka, CSc. (3. 5. 1961-12. 8. 2017)

Petr Widimský, Jan Pirk

Cor Vasa 2017, 59(5):600  

Blahopřání k sedmdesátinám profesora MUDr. Jaromíra Hradce, CSc., FESC

Jiří Král

Cor Vasa 2017, 59(5):601  

Profesor MUDr. Jaromír Hradec, CSc., FESC, sedmdesátníkem

Michael Aschermann

Cor Vasa 2017, 59(5):602  

Jubilant doc. MUDr. Václav Chaloupka, CSc.

Jiří Vítovec, Jindřich Špinar

Cor Vasa 2017, 59(5):603  

Editorial Board

Editorial board

Cor Vasa 2017, 59(5):i