Anesthetic Consideration in Case of Large Lymphangioma in Right Atrioventricular Groove: A Case Report

Background Cardiac tumor is a rare disease but it causes various hemodynamic changes depending on location and size. Compression of the right sided heart can lead to impaired venous return and consequent systemic and coronary vascular collapse. Case A 62-year-old male who had cardiac lymphangioma on right atrio-ventricular groove. Upon entering the operating room, he was admitted to the tamponade physiology with tachycardia and hypotension. Opioid based anesthesia was performed to minimize myocardial depression, and myocardial function was continuously monitored through Transesophageal echocardiography and pulmonary artery catheter to safely wean the cardio pulmonary bypass (CPB) machine. Conclusion Anesthesiologists should be able to predict and respond appropriately to physiological hemodynamic changes according to the location and size of cardiac tumor.

Left atrial ıntramural hematoma after radiofrequency catheter ablation of left lateral accessory pathway

We report a case of left atrial hematoma after ablation of left lateral concealed accessory pathway. A 46-year-old male patient experienced chest pain after radiofrequency ablation. Transthoracic echocardiography and computed tomography revealed the intramural mass consistent with hematoma in the left atrium. He was hemodynamically stable, and conservative approach was decided. Atrioventricular groove is a vulnerable part of left atrium, and ablation of left free wall accessory pathway may require targeting both atrial and ventricular surfaces of the mitral annulus. Avoidance of forceful catheter manipulation during the electrophysiological procedure is important for prevention of this complication. Optimal periprocedural anticoagulation might reduce the risk of procedure-related thromboembolic complications, but electrophysiologists should always pay attention to an intramural hematoma that may occur after radiofrequency catheter ablation.

Absence of Both Right and Left Main Coronary in a COVID Survivor

The prevalence of isolated right coronary artery (RCA) absence ranges from 0.014% to 0.066% in the general population, but its combination with an absent left main (dual ostium left anterior descending [LAD] and super-dominant left circumflex [LCx]) has not been previously described. We report the case of a rare coronary artery anomaly: an absent RCA with LAD and LCx coronary arteries arising separately from the left coronary sinus. A 53-year-old male with recent COVID-19 infection was referred to our service for coronary computed tomography angiography (CCTA) due to the recent onset of atypical chest pain. The RCA was absent, with no vessel leaving the right or non-coronary sinus. The LAD and LCx emerged from the left coronary sinus, with a “double-barrel” appearance. The LAD was unremarkable, with small, non-stenosed calcified plaque. The LCx had a 3 mm diameter, arching downward in the left atrioventricular groove, passing through the crux cordis, continuing into the right atrioventricular groove, and ending as a left acute artery and sinonodal artery. No significant stenosis was found on any of the vessels, ruling out atherosclerotic coronary disease.

Results and outcomes for patients with atrioventricular groove disruption after mitral valve surgery

Background: Atrioventricular groove disruption (AVGD) is a rare and severe complication of mitral valve surgery (MVS). Current literature is limited to several case reports and series. Our aim was to analyze outcomes of patients with AVGD after MVS from our tertiary cardiac surgery center. Methods: Between June 2010 and January 2019, 18 patients suffering AVGD were identified in our institutional database and included in our retrospective observation. Preoperative, intraoperative and outcome data were analyzed using IBM SPSS Statistics. Late survival was estimated by using the Kaplan–Meier survival analysis. Results: The mean age of the study population was 76 ± 5 years. Most common indication for MVS was an isolated mitral valve insufficiency (67%). Severe annular calcification was present in four patients (22%). Majority of implanted valves were biological prosthesis (78%). Due to the location, 72% suffered type I rupture. External repair was performed in 94% of all patients. Second look operation in regard of excessive mediastinal hemorrhage was necessary in 67% of patients. Mean hospital stay of the presented collective was 13 ± 11 days with an intra-hospital mortality of 56%. Late follow-up was obtained in eight patients at an average of 3.1 (1.6–5.7) years postoperatively. Conclusion: Mortality rates for AVGD after MVS are high. However, way of managing AVGD depends on the underlying type of rupture and should be evaluated in regard of the myocardial damage. Due to the rare occurrence, registry data might help to address more scientific value concerning therapeutic measures and outcomes of this severe complication.

Hybrid Double Valve Replacement for Multivalvular Disease With Severe Mitral Annular Calcification

Severe mitral annular calcification poses a significant challenge, particularly in higher risk, frail, elderly patients with multivalvular disease. Both surgical and transcatheter options exist but remain fraught with risks of paravalvular leak, atrioventricular groove disruption, patient prosthesis mismatch, and left ventricular outflow tract obstruction. We present an innovative hybrid surgical approach to manage severe aortic and mitral valve disease in a Jehovah’s Witness patient with severe circumferential mitral annular calcification.

Pericardial pseudocyst along atrioventricular groove

Cystic lesions in relation to the pericardium are a rare congenital lesion with an estimated incidence of 1 per 100,,000. Pericardial cysts may be classified as congenital or acquired. Here, we present a case of a pericardial pseudocyst having a horseshoe configuration along the atrioventricular groove in a middle-aged subject with no previous relevant medical history. The patient underwent open surgery for the same with histopathological diagnosis being established. This paper highlights the differentials for a cystic pericardial lesion in imaging in addition to the histopathological entity of a pericardial pseudocyst.