scholarly journals Lone Atrial Flutter in Children and Adolescents: Is It Really “Lone”?

2020 ◽  
Author(s):  
Jana-K. Dieks ◽  
David Backhoff ◽  
Heike E. Schneider ◽  
Matthias J. Müller ◽  
Ulrich Krause ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Atrial Flutter ◽  
Clinical Course ◽  
Histopathological Examination ◽  
Electrophysiological Study ◽  
Conduction Block ◽  
Current Application ◽  
Premature Ventricular Contractions ◽  
The Right

Abstract Atrial flutter (AFL) in children and adolescents beyond the neonatal period in the absence of any underlying myocardial disease (“lone AFL”) is rare and data is limited. Our study aims to present clinical and electrophysiological data of presumed “lone AFL” in pediatric patients and discuss the role of endomyocardial biopsy (EMB) and further follow-up. Since July 2005, eight consecutive patients at a median age of 12.7 (range 10.4–16.7) years presenting with presumed “lone AFL” after negative non-invasive diagnostic work-up had electrophysiological study (EPS) and induction of cavotricuspid isthmus (CTI) conduction block by radiofrequency (RF) current application. In 6/8 patients EMB could be taken. Induction of CTI conduction block was achieved in all patients. Histopathological examination of EMB from the right ventricular septum exhibited myocarditis or cardiomyopathy in 4/6 patients, respectively. During follow-up, 4/8 patients had recurrent arrhythmia (AFL n = 2, wide QRS complex tachycardia n = 1, monomorphic premature ventricular contractions n = 1) after the ablation procedure. 3/4 patients with recurrent arrhythmia had pathological EMB results. The remaining patient with recurrent arrhythmia had a negative EMB but was diagnosed with Brugada syndrome during further follow-up. Taking together results of EMB and further clinical course, only 3/8 patients finally turned out to have true “lone AFL”. Our study demonstrates that true “lone AFL” in children and adolescents is rare. EMB and clinical course revealed an underlying cardiac pathology in the majority of the individuals studied. EMB was very helpful in order to timely establish the diagnosis of myocarditis or cardiomyopathy.

Peritricuspid annular prostate pellet

2021 ◽  
Vol 14 (2) ◽  
pp. e238076
Author(s):  
Bryan O'Sullivan ◽  
Richard Tanner ◽  
Peter Kelly ◽  
Gerard Fahy
Keyword(s):  
Right Ventricle ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Prostate Adenocarcinoma ◽  
Left Ventricular ◽  
Premature Ventricular Contractions ◽  
Left Ventricular Outflow ◽  
Metallic Object ◽  
The Right

A 75-year-old was treated for prostate adenocarcinoma with brachytherapy in September 2018. A routine follow-up chest radiograph 3 months later revealed a metallic object of the same dimensions as a brachytherapy pellet located in the right ventricle. Further imaging showed the brachtherapy pellet was located in the anterobasal right ventricular endocardium close to the tricuspid valve. Frequent asymptomatic premature ventricular contractions were observed with likely origin from the left ventricular outflow tract, an area remote from the site of the pellet. The patient remains asymptomatic and subsequent imaging shows that the position of the pellet has not changed.

scholarly journals Feasibility and efficacy using the KODEX-EPD imaging system in right atrial flutter ablation: a single center experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Schillaci ◽  
G Stabile ◽  
G Shopova ◽  
A Arestia ◽  
A Agresta ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Imaging System ◽  
Conduction Block ◽  
Right Atrial ◽  
Atrial Pacing ◽  
Funding Sources ◽  
Single Center Experience ◽  
Typical Atrial Flutter ◽  
Procedural Time

Abstract Background Isthmus-dependent right atrial flutter is the most frequently encountered atrial flutter in clinical practice (80–90% of atrial flutters). Purpose The aim of our study was to assess as first experience the feasibility and safety of radiofrequency catheter ablation (RFCA) of cavo-tricuspid isthmus (CTI) guided by KODEX-EPD imaging system in patients presenting with typical atrial flutter (AFL). Methods 16 consecutive patients (mean age 68,46±7,8 years, 80% males) with diagnosis of AFL underwent RFCA guided by KODEX-EPD imaging system. In 15 patients the analysis performed during tachycardia showed a counter-clockwise activation. In 1 patient no tachycardia could be induced and the ablation was performed in sinus rhythm with fixed pacing from the coronary sinus. The KODEX-EPD imaging system was also used to guide ablation and to confirm persistent bidirectional block after ablation. Results Mean procedural time was 37,6±8,2 min, mean radiofrequency ablation time was 7,8±3,4 min, and mean fluoroscopy time was 2,1±1,2 min. All procedures were acutely successful with interruption of AFL during RFCA along the inferior CTI in 15 patients and achievement of the bidirectional conduction block in 16 patients proven by atrial pacing medial and lateral to the ablation line. There were no major procedural and 30-day complications. Over a mean follow-up of 18 months, we observed no recurrence of arrhythmia and no complications. Conclusions Our study shows that RFCA for AFL using the KODEX-EPD imaging system is feasible, safe, and effective. FUNDunding Acknowledgement Type of funding sources: None.

Mitral Valve Prolapse and Athletic Participation in Children and Adolescents

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 789-790
Author(s):  
Keyword(s):  
Mitral Valve ◽  
Children And Adolescents ◽  
Mitral Valve Prolapse ◽  
Holter Monitoring ◽  
Premature Ventricular Contractions ◽  
Benign Condition ◽  
Migraine Headaches ◽  
Asymptomatic Patients ◽  
Vascular Accidents

Mitral valve prolapse (MVP) is generally a benign condition characterized by the protrusion of the mitral valve leaflets into the left atrium during systole. The prevalence of MVP in individuals under the age of 18 years is estimated to be 5% but is higher in those with Marfan's syndrome and other collagen vascular disorders.1 A midsystolic nonejection click with or without a late systolic murmur is the auscultatory hallmark of this syndrome. The diagnosis of MVP in children and adolescents should be based primarily on auscultatory findings and not on minor echocardiographic findings.1 The prognosis in children and adolescents with isolated MVP appears to be excellent and complications are rare. In 553 children, aged 15 days to 18 years, who were involved in studies with a follow-up period of 6 to 9 years, the following were reported: subacute bacterial endocarditis (one case), cerebral vascular accidents (two cases), migraine headaches (four cases), and chest pain (12 cases).2,3 Only four cases of sudden death have been reported in patients younger than 20 years of age.1-4 In a study of 103 patients with MVP, 16% were found to have premature ventricular beats during exercise electrocardiography (ECG) (exercise test).3 Thirty-eight percent were found to have premature ventricular contractions (PVCs) on 24-hour ECG (Holter) monitoring. This study, however, does not report the true prevalence of dysrhythmias because all these subjects had been referred to a pediatric cardiologist for evaluation. It is likely that these reported numbers are high because asymptomatic patients are less often referred.

scholarly journals Paravertebral Well-Differentiated Liposarcoma with Low-Grade Osteosarcomatous Component: Case Report with 11-Year Follow-Up, Radiological, Pathological, and Genetic Data, and Literature Review

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Nicolas Macagno ◽  
Stéphane Fuentes ◽  
Gonzague de Pinieux ◽  
André Maues de Paula ◽  
Sébastien Salas ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Soft Tissue Sarcomas ◽  
Fish Analysis ◽  
Low Grade ◽  
Central Mass ◽  
Divergent Differentiation ◽  
Paravertebral Muscles ◽  
Well Differentiated ◽  
The Right

Despite being one of the most frequent soft-tissue sarcomas, well-differentiated liposarcoma has never been reported near the spine. The authors present the case of a 67-year-old man with progressive history of back pain. Physical examination revealed a mass located within the right paravertebral muscles. MR and CT imaging showed a heavily ossified central mass surrounded by a peripheral fatty component. No connection with the underlying bone was detected on imagery and during surgery. After surgical resection, histopathological examination revealed a tumor harboring combined features of well-differentiated liposarcoma and low-grade osteosarcoma. Tumor cells displayed overexpression of MDM2, CDK4, and P16 by immunohistochemistry and CGH revealed amplification of 12q13-15 as the only genetic imbalance. MDM2 FISH analysis was performed but was inconclusive. The pathological, immunohistochemical, and genetic features, the differential diagnoses, and the therapeutic management of this unusual tumor are discussed. No complementary treatment was performed initially. Following first treatment, two recurrences occurred 6 and 9 years later, both displaying histological features similar to the first occurrence. Radiotherapy was started after the second recurrence. Follow-up shows no evidence of disease 11 years after initial diagnosis. This case was unusual due to the paravertebral location of the tumor and its divergent differentiation.

scholarly journals Calcified Right Ventricular Fibroma in an Adult: A Case Report

2021 ◽  
Author(s):  
Huanhuan Gao ◽  
Shuai Yuan ◽  
Zhiqiang Hu ◽  
Zhelan Zheng ◽  
Shengjun Wu
Keyword(s):  
Right Ventricular ◽  
Histopathological Examination ◽  
Tumor Resection ◽  
Anterior Wall ◽  
Benign Tumors ◽  
Troublesome Symptom ◽  
History Of ◽  
The Right ◽  
Operative Recovery

Background: Cardiac fibromas are rare benign tumors of the heart composed of fibroblasts and collagen. They are common among children and adolescents but are rarely present in adults. Case presentation: We here report the case of a fifty-seven-year-old man who complaining of a 2-year history of chest tightness at rest. Transthoracic echocardiography detected a severe calcified mass protruding outside the right ventricular anterior wall near the apex. The patient was referred for tumor resection. The calcified mass was determined to be a cardiac fibroma with postoperative histopathological examination. The patient experienced an unremarkable post-operative recovery and was discharged 8 days later. Subsequent follow-up has shown complete freedom from his troublesome symptom. Conclusions: Preoperative diagnosis with various imaging modalities and early surgery are the keys to improve prognosis of patients with cardiac fibromas.

scholarly journals Trichilemmal cyst of the neck: case report and review of the literature

2021 ◽  
pp. 13-17
Author(s):  
Othman El Houari ◽  
Amal Hajjij ◽  
Ilias Tahiri ◽  
Mohamed Said Anajar ◽  
Loubna Taali ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Neck Surgery ◽  
Cervical Region ◽  
Malignant Degeneration ◽  
Review Of The Literature ◽  
Rare Presentation ◽  
Follicular Cyst ◽  
Trichilemmal Cyst ◽  
The Right

Introduction: Trichilemmal cysts are lesions originating in the isthmus of the hair follicle. They are more common in women and occur in 90% on the scalp. Presentation of case: A 10-year-old female patient presented with a hard, slightly painful, nonexophytic mass in the right cervical region (Ia). After surgical resection in healthy margins, the diagnosis of trichilemmal cyst was made on histopathological examination. Discussion: The age of the patient as well as the cervical location of this type of lesion is an extremely rare presentation of trichilemmal cyst. Follow-up is rigorous in search of a triad: ichthyosis, keratosis, deafness, particularly in this patient. Conclusion: Close follow-up in this clinical case is indicated because the risk of malignant degeneration and development of similar lesions is present. Keywords: Follicular cyst; KID syndrome; Trichilemmal cyst; Neck surgery; Trichilemmal carcinoma

P95412 lead Holter monitoring in Brugada syndrome

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Carvalho ◽  
C Gravinese ◽  
A Previti ◽  
G P Varalda ◽  
L Montagna
Keyword(s):  
Brugada Syndrome ◽  
Electrophysiological Study ◽  
Right Ventricular Outflow Tract ◽  
Holter Monitoring ◽  
The Other ◽  
Drug Induced ◽  
Premature Ventricular Contractions ◽  
Bundle Branch Block ◽  
The Right

Abstract Background 12 lead-Holter monitoring is commonly used for the assessment  of type 1 Brugada repolarization"s burden. However, data considering the prevalence and morphology of premature ventricular contractions (PVC) in these patients is lacking. Purpose. We investigated the prevalence of PVCs in subjects with Brugada syndrome (BRs) phenotype during 24-hour 12 lead-Holter monitoring (12-L Holter), trying to identify their origin according to morphology.  Methods. From January 2013 to September 2018, a total of 156 patients with type 1 BRs phenotype (spontaneous or drug induced) were screened for PVCs. In these patients we placed the right precordial leads at the second (V1-V2) and the forth (V3-V4) intercostal spaces.  Results. 83 subjects (53%) displayed PVCs. Their mean age was 50 years (range 21-73) and 63 (76%) were male. 14 subjects (17%) had a spontaneous type 1 repolarization whereas 69 (83%) presented a drug induced type 1. One patient had implanted an ICD as secondary prevention after an aborted sudden cardiac death. The others were mostly asymptomatic as only five of them (6%) had history of suspected cardiac syncope. 17 subjects (20%) had performed an electrophysiological study, which resulted positive in 3 cases (4%). The population without PVCs had similar baseline characteristics. In 59 (71%) patients PVCs were monomorphic, in the other 29% we analyzed the prevalent morphology. PVCs were classified according to their morphology as follows (i) left bundle branch block (LBBB)/inferior axis suggesting an origin from the right ventricular outflow tract (RVOT), that was shown in 40 (48%) subjects; (ii) right bundle branch block (RBBB)/left axis suggesting an origin close to the posterior fascicle of the left bundle branch in 36 (43%). The other 7 patients presented several morphologies. According to their number during the 24-hour monitoring, PVCs were arbitrarily classified as follows: (i) 1-59,present in 62 patients (75%); (ii) 60-749, present in 16 patients (19%); (iii) 750-9000, present in 4 patients (5%); (iv) >9000, in only one patient (1%).  Conclusions. In our population of subjects with BRs phenotype the prevalence of PCVs is similar to that of the general population. Their morphologies suggest an origin from the RVOT or close to the posterior fascicle of the left bundle branch.

P1013Biannular atrial flutter: clinical and electrophysiological characterization by activation and entrainment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Martinez Cossiani ◽  
S Castrejon ◽  
C Escobar ◽  
M Ortega ◽  
M Batlle ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Electrophysiological Study ◽  
Mitral Annulus ◽  
Interatrial Septum ◽  
The Other ◽  
Right Atrial ◽  
Av Conduction ◽  
Isthmus Block ◽  
Electrophysiological Characterization ◽  
The Right

Abstract Introduction re-entry mechanisms around mitral and tricuspid annuli are frequent causes of left and right atrial flutter (AFt) respectively in patients with ipsilateral atrial pathology. However, clinical and electrophysiological characteristics of other types of atrial re-entries that could involve both AV annuli are less known. Purpose characterize biannular atrial flutters. Methods 4 patients with AFt were submitted for ablation (aged 30, 31, 58 and 61 yo; 2 females). All had a cardiac congenital disease with a prior surgical procedure: 3 atrial septal defects (ASD) with surgical repair and 1 with transposition of the great arteries (TGA) with Senning repair. The AFt had a cycle length (CL) of 290, 315, 330 y 340 ms respectively and 1:1 AV conduction in 3 of them. For the electrophysiological study, a multipolar catheter (20 or 24 poles) was placed in the right atrium (RA) in every patient, showing counterclockwise and clockwise activation in 1 and 3 patients, respectively. Coronary sinus (CS) activation was proximal to distal in one patient and distal to proximal in the other 2. No CS activation could be obtained in the patient with Senning repair. Results each AFt was mapped by entrainment from different sites of the RA, showing post-pacing intervals (PPI) similar to the CL of the AFt around the tricuspid annulus in all of them and also from proximal and distal CS in the 3 patients with ASD. Access to the native left atrium (LA) was achieved in the patient with Senning repair, showing PPIs around the mitral annulus that were similar to the LC of the tachycardia. In 2 patients the attempt to get to the LA through the interatrial septum (IAS) could not be achieved and was unattempted in the other one. Recordings and PPIs of the LA roof were obtained from the right branch of the pulmonary artery in 2 patients. Counterclockwise AFt and clockwise AFt by single biannular perimitrotricuspid rotation in 1 and 3 patients respectively. The AFt was ended and no reinduction was possible after radiofrequency application that achieved cavotricuspid isthmus block in all of the patients. Conclusions reentry around both AV annuli is possible as a single loop, counterclockwise or clockwise, of simultaneous rotation as a clinical mechanism of Aft. This type of AFt seems to be associated to absence or severe damage in the IAS.

Endometrial tumour as a cause of mechanical bowel obstruction – a case report

Nowa Medycyna ◽  
2018 ◽  
Vol 25 (4) ◽  
Author(s):  
Sławomir Glinkowski ◽  
Daria Marcinkowska
Keyword(s):  
Bowel Obstruction ◽  
Histopathological Examination ◽  
Positive Family History ◽  
Child Bearing ◽  
Surgical Ward ◽  
Fluid Supplementation ◽  
Uterine Ligaments ◽  
Mechanical Bowel Obstruction ◽  
The Right

Endometriosis is a disease that involves the presence of physiologically active uterine tissue beyond the uterus. It is classified as a non-malignant disease that typically develops within the reproductive system: in the ovaries, fallopian tubes, or uterine ligaments. These changes tend to occur also beyond the reproductive structures, usually within the digestive system, where the most common sites are the peritoneum, postsurgical scars or umbilicus. Moreover, the disease can occur in the intestine, usually in the large bowel, and particularly in the caecum. The literature reports that endometriosis may affect even 10% of women of child-bearing age. The authors present a case of a patient admitted to the surgical ward due to mechanical bowel obstruction. Intraoperatively, an endophytic tumour, completely occluding the ileum, was found. Due to its location, i.e. approximately 15 cm from the Bauhin’s valve, it was resected together with the ascending colon and the right half of the transverse colon. Based on the morphology of the lesion and a positive family history, cancer was thought to be the most probable cause of the patient’s symptoms. The result of the histopathological examination did not confirm this, however. The specimen showed endometriosis. On the day of surgery, the patient was administered antibiotics, total parenteral nutrition and essential fluid supplementation. The wound healed normally, and abdominal pain did not return as diet was being extended. The patient was discharged on the 6th day after the operation with recommended follow-up in a surgical clinic.

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