Aortic Valve Myxoma Presenting with a Stroke: A case report and review of the literature

Myxomas originating from the aortic valve are rare. We report a 40-year-old male patient who presented to the King Fahd Hospital of the University, Khobar, Saudi Arabia, in 2017 with a stroke. Transoesophageal echocardiography indicated a mobile mass measuring 6 × 2 mm attached to the right coronary cusp of the aortic valve and a mobile interatrial septum with a small patent foramen ovale (PFO). The patient underwent surgical excision of the mass and direct closure of the PFO. Histopathology confirmed the mass to be a myxoma. Despite their rarity, the recognition and treatment of valvular myxomas is very important; moreover, clinicians should be aware that affected patients may present with an embolic stroke.Keywords: Aortic Valve; Myxoma; Patent Foramen Ovale; Stroke; Transesophageal Echocardiography; Case Report; Saudi Arabia.

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Infective endocarditis of an aortic bioprosthesis causing life-threatening incessant junctional tachycardia: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa446 ◽

2020 ◽

Author(s):

Quentin Chatelain ◽

Andrea Carcaterra ◽

Florian Rey ◽

Haran Burri

Keyword(s):

Case Report ◽

Infective Endocarditis ◽

Aortic Valve ◽

Electrophysiological Study ◽

Atrioventricular Node ◽

Transoesophageal Echocardiography ◽

Junctional Ectopic Tachycardia ◽

First Case ◽

Intravenous Amiodarone ◽

The Right

Abstract Background Infective endocarditis with paravalvular abscess can be complicated by atrioventricular block (AVB), but junctional ectopic tachycardia (JET) has as yet never been described. Case summary A 68-year-old male recently admitted with Staphylococcal aureus endocarditis of his aortic valve bioprosthesis, presented with a regular tachycardia at 240 b.p.m. with a pre-existent right bundle branch block pattern. Haemodynamic collapse necessitated electrical cardioversion, following which high-grade AVB was observed. Multiple recurrences of the same tachycardia required repeated electrical cardioversions and emergent electrophysiological study, which indicated JET. The tachycardia was unresponsive to overdrive pacing, adenosine and intravenous amiodarone, and external cardioversions. Radiofrequency catheter ablation of the atrioventricular node was performed emergently with interruption of the tachycardia. A temporary external pacemaker was implanted via a jugular route. The tachycardia recurred after 48 h at a slower rate, and the patient underwent redo ablation. Transoesophageal echocardiography revealed a pseudoaneurysm of the right sinus of Valsalva probably corresponding to an evacuated abscess. A permanent pacemaker was implanted after active infection had been ruled out. At 3 months of follow-up, the patient had complete AVB, without arrhythmia recurrence. Discussion This is the first case report of JET complicating a paravalvular abscess of the aortic valve with concomitant AVB. Junctional ectopic tachycardia is very rare arrhythmia which is usually seen in children as a congenital arrhythmia or following surgical correction of paediatric heart disease. The differential diagnosis is discussed in detail in the article.

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Patent Foramen Ovale—A Not So Innocuous Septal Atrial Defect in Adults

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd8060060 ◽

2021 ◽

Vol 8 (6) ◽

pp. 60

Author(s):

Veronica Romano ◽

Carlo Maria Gallinoro ◽

Rosita Mottola ◽

Alessandro Serio ◽

Franca Di Di Meglio ◽

...

Keyword(s):

Atrial Septal Defect ◽

Patent Foramen Ovale ◽

Septal Defect ◽

Adult Population ◽

Interatrial Septum ◽

Foramen Ovale ◽

Gestational Week ◽

Clinical Risks ◽

The Right ◽

Systemic Arteries

Patent foramen ovale (PFO) is a common congenital atrial septal defect with an incidence of 15%–35% in the adult population. The development of the interatrial septum is a process that begins in the fourth gestational week and is completed only after birth. During intrauterine life, the foramen ovale allows the passage of highly oxygenated blood from the right to the left atrium and into the systemic arteries, thus bypassing the pulmonary circulation. In 75% of the general population, the foramen ovale closes after birth, and only an oval depression, called fossa ovalis, remains on the right side of the interatrial septum. Patent foramen ovale can be associated with various clinically important conditions, including migraine and stroke, or decompression illness in divers. The aim of this review is to summarize the PFO developmental and anatomical features and to discuss the clinical risks associated with this atrial septal defect in adults.

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Abstract TP221: A Novel Ultrasound Probe Attached to the Cervix Can Precisely Detect Large Patent Foramen Ovale

Stroke ◽

10.1161/str.47.suppl_1.tp221 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Hidetaka Mitsumura ◽

Ayumi Arai ◽

Kenichi Sakuta ◽

Kenichiro Sakai ◽

Yuka Terasawa ◽

...

Keyword(s):

Temporal Bone ◽

Patent Foramen Ovale ◽

Valsalva Maneuver ◽

Interatrial Septum ◽

Center Frequency ◽

Foramen Ovale ◽

Ultrasound Probe ◽

Diagnostic Ability ◽

Bone Window ◽

The Right

Introduction: We developed a novel probe (paste-able soft ultrasound probe; PSUP) attached to the cervix for detection of right-to-left shunt (RLS), because insufficient temporal bone window interrupts the precise examination for diagnosis of RLS. Hypothesis: We assessed the hypothesis that diagnostic ability of PSUP for RLS detection is equal to those of transesophageal echocardiography (TEE). Methods: Subjects were patients with ischemic stroke and transient ischemic attack who underwent TEE. PSUP was a 2.0-MHz center frequency, which had an equal property with TCD, and the shape was thin, soft, and square modified for attachment to the neck. At first, we performed TEE with the echoscope at the level of the fossa ovalis after injection of saline agitated with air in the right antecubital vein. The procedure was performed with and without Valsalva maneuver. Visualization of microembolic signals (MES) induced contrast agent within the right atrium and crossing the interatrial septum was considered as positive patent foramen ovale (PFO). We divided PFO into two groups according to number of MES, such as small PFO (1-29 of MES) and large PFO (≥30 of MES). Then, monitoring using PSUP was performed at unilateral common carotid artery (CCA) using similar preparation and procedure to TEE. RLS by PSUP diagnosed when we found 1and more MES in CCA. We compared detectable rate by size of PFO between TEE and PSUP, and calculated accuracy of PSUP against TEE. Results: From May 2014 to July 2015, 62 patients (46 male, mean age of 61 years) were included in this study. We diagnosed 26 of 62 patients (42%) as PFO by TEE, whereas PSUP detected in 17 of them (27%). As a reference of TEE findings, diagnostic ability of PSUP was 58% of sensitivity, 94% of specificity, and 79% of accuracy. In TEE examination, large PFO was 11 patients and small was 15 patients. PSUP could evaluate large PFO (9 of 11 patients) more accurately than small one (6 of 15, 82% vs. 40%, p=0.05). Conclusion: PSUP should have a considerable accuracy of large PFO diagnosis. For patients with insufficient temporal bone window, PSUP may play an important role of detecting large PFO.

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A case report of a triad causing platypnoea–orthodeoxia syndrome

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab236 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Laura Fuertes-Kenneally ◽

Juan Quiles-Granado ◽

Jessica Sánchez-Quiñones ◽

Juan Gabriel Martínez-Martínez

Keyword(s):

Tricuspid Regurgitation ◽

Patent Foramen Ovale ◽

Early Recognition ◽

Systolic Function ◽

Rare Condition ◽

Transoesophageal Echocardiography ◽

Interatrial Septum ◽

Foramen Ovale ◽

Surgical Closure ◽

Bubble Test

Abstract Background Platypnoea–orthodeoxia syndrome (POS) is a rare condition characterized by hypoxaemia and dyspnoea when changing from a recumbent to an upright position. Diagnosis requires a high clinical suspicion and is often underdiagnosed. Case summary We report a case of POS in a 50-year-old woman with dyspnoea and new-onset atrial fibrillation. Oxygen saturation and dyspnoea worsened as she changed from a supine to a sitting position (96 vs. 86%, respectively). Transoesophageal echocardiography demonstrated enlargement of both atria and right ventricle with reduced systolic function and a large Chiari network (CN). Colour Doppler discovered severe tricuspid regurgitation with tenting and tethering of the valve leaflets. Finally, a bubble test revealed the cause of POS to be a patent foramen ovale along with the severe tricuspid regurgitant jet moving into the left atrium and favoured by the CN. Surgical closure of the foramen ovale resulted in the resolution of symptoms. Discussion Platypnoea–orthodeoxia syndrome is most commonly caused by a right-to-left shunt through an anatomical defect of the interatrial septum, typically a patent foramen ovale, combined with elevated right atrium pressure. This case illustrates an uncommon cause of POS in the absence of elevated atrium pressure due to the interplay of three key elements: a patent foramen ovale, tricuspid regurgitation, and the CN. Our aim is to alert physicians to the possibility of an intracardiac shunt as the cause of unexplained and/or refractory hypoxaemia related to position changes. Early recognition of this syndrome promotes timely treatment, greatly improving patient outcomes.

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Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations

Cardiovascular & Hematological Agents in Medicinal Chemistry ◽

10.2174/1871525718666200203111641 ◽

2020 ◽

Vol 18 (2) ◽

pp. 135-150

Author(s):

Harsha S. Nagarajarao ◽

Chandra P. Ojha ◽

Archana Kedar ◽

Debabrata Mukherjee

Keyword(s):

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Narrow Channel ◽

Paradoxical Embolism ◽

Current Evidence ◽

Foramen Ovale ◽

The Right ◽

The Relationship ◽

Current Guidelines

: Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. : In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO’s for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.

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Intrascrotal lipoblastoma in adulthood

BMJ Case Reports ◽

10.1136/bcr-2019-231320 ◽

2019 ◽

Vol 12 (12) ◽

pp. e231320

Author(s):

Mário José Pereira-Lourenço ◽

Duarte Vieira-Brito ◽

João Pedro Peralta ◽

Noémia Castelo-Branco

Keyword(s):

Case Report ◽

Magnetic Resonance ◽

S100 Protein ◽

Surgical Excision ◽

Large Mass ◽

Histological Diagnosis ◽

Physical Exam ◽

Nodular Lesion ◽

Inferior Portion ◽

The Right

This case report describes the case of a 37-year-old man that noticed an intrascrotal right mass with 1 month of evolution. During physical exam presented with a large mass at the inferior portion of the right testicle, clearly separated from the testicle, with a tender consistency and mobile. An ultrasound was performed that showed a solid and subcutaneous nodular lesion, extra testicular, heterogeneous, measuring 7.2 cm. Pelvic magnetic resonance imageMRI showed a lesion compatible with a lipoma. The patient was subjected to surgical excision of the lesion by scrotal access, having histology revealed a lipoblastoma (LB) of the scrotum. Histological diagnosis was obtained by microscopic characteristics (well-circumscribed fatty neoplasm) and immunohistochemistry (stains for CD34, S100 protein and PLAG1 were positive; stains for MDM2 and CDK4 were negative). LB is extremely rare after adolescence in any location, being this first described case of intrascrotal LB described in adulthood.

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Transcatheter closure for decompression sickness with a patent foramen ovale: A case report

Journal of Interventional Medicine ◽

10.1016/j.jimed.2021.05.004 ◽

2021 ◽

Author(s):

Fenglin Jiang

Keyword(s):

Case Report ◽

Patent Foramen Ovale ◽

Transcatheter Closure ◽

Decompression Sickness ◽

Foramen Ovale

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Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt following pneumonectomy

BMJ Case Reports ◽

10.1136/bcr-2021-245699 ◽

2021 ◽

Vol 14 (10) ◽

pp. e245699

Author(s):

Matthew Steward ◽

Anthony Hall ◽

Ross Sayers ◽

Christopher Dickson

Keyword(s):

Patent Foramen Ovale ◽

Transoesophageal Echocardiography ◽

Foramen Ovale ◽

Success Rates ◽

Interatrial Communication ◽

Population Prevalence ◽

Contrast Enhanced ◽

High Index Of Suspicion ◽

Interatrial Shunt

A 62-year-old man presents with breathlessness 6 months following right pneumonectomy for lung adenocarcinoma. Previous investigations had not yielded a diagnosis and his symptoms were progressing. The patient described worsened symptoms when stood up (platypnoea), with profound hypoxia until laid supine (orthodeoxia). Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt was diagnosed on contrast-enhanced transoesophageal echocardiography with the patient undergoing successful percutaneous patent foramen ovale closure. Patent foramen ovale is often asymptomatic with a population prevalence of around 20%–30%. Anatomical shifts postpneumonectomy can open, or worsen a previously closed interatrial communication leading to right-to-left shunting of blood. Platypnoea-orthodeoxia is under-recognised, impairing quality of life and patient outcome. Investigations can be falsely reassuring, or poorly sensitive for the causative pathology. Percutaneous closure is safe with high success rates and this case highlights the need for a high index of suspicion for shunts, particularly in postpneumonectomy patients.

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