Not a Coincidental Concurrence of Breast Carcinoma and Cardiac Myxoma: Case Report

Background: Myxoma has been considered to undergo a simple and benign process but not always so. Case presentation: A female patient was admitted for evaluation of left breast nodule. Physical examination showed facial pigmentation, left breast nodule and 3/6 diastolic murmur at the mitral valve area. Preoperative echocardiography revealed a massive mobile left atrial mass attaching to the interatrial septum causing obstruction to mitral orifice. Histopathologic investigation confirmed the left atrial mass to be myxoma and left breast nodule to be cancer. Carney complex was considered and lifelong follow-up was advised. Conclusion: Cardiac myxoma may present as a part of a systematic disease entity. In patients with a combination of breast nodule and facial pigmentation, transthoracic echocardiography examination is advised to guide decision-making.

Morphometric Study of Mitral Valve in South Odisha - A Cadaveric Study

BACKGROUND The heart is a pair of valved muscular pumps combined in a single organ. For the proper functioning of the heart, all valves should be intact. Mitral valve (MV) prolapse and regurgitation is the main cause of MV replacement. The dimensions of mitral valve and the cusps vary from person to person. We wanted to measure the average size of the valve components with respect to the annulus in the cadavers of South Odisha region, which would help in the selection of prosthetic valve in cardiac surgery. METHODS This comparative study was carried out on 58 adult cadaveric human hearts. Left atrium was opened along the left border of heart so as to expose the mitral orifice. Parameters of different components ofthe valve were measured by using appropriate instruments. RESULTS The mean annular circumference of the mitral valve was found to be 8.84 ± 1.24 cm; The annular attachment and height of anterior cusp were 2.94 ± .81 cm and 2.55 ± 0.27 cm respectively. The annular attachment and height of posterior cusp were 4.52 ± 0.78 cm and 1.2 ± 0.17 respectively. The annular area was found to be 5.22 ± 1.13 cm2. The combined cusp area was found to be 9.38 ± 2.32 cm. CONCLUSIONS The size of mitral valve parameters in the South Odisha region were found to be less compared to other studies. This study might help cardio-thoracic surgeons as well as the prosthetic valve manufacturing companies for the rough estimation of the mitral valve size. KEY WORDS Mitral Valve, Anterior Cusp, Posterior Cusp, Annular Circumference, Annular Valve Area and Combined Cusp Area

POLYMORPHISM OF TOLL-LIKE RECEPTORS-2 IN PATIENTS WITH CHRONIC RHEUMATIC HEART DISEASE

Aim. To assess the contribution of TLR2 gene polymorphism to echocardiography and spirometry parameters in patients with chronic rheumatic heart disease (CRHD). Materials and Methods. A total of 128 patients with CRHD were examined – 15.6% of men and 84.4% of women. Genotyping by polymorphic markers Arg753Arg, Arg753Gln, Gln753Gln was performed by PCR with SNP-EXPRESS electrophoretic scheme (NPF Litekh, Russia) for detection of the result after extraction of DNA from leukocytes of venous blood. Echocardiography with evaluation of linear dimensions, left ventricular hypertrophy and mitral orifice area was performed on Philips Affinity 50 apparatus; respiration was evaluated using Spirolab II spirometer. Results. The distance of the 6-minute walk test in the groups did not differ significantly: (р=0.168): Arg753Arg–314.75±6.88 m, Arg753Gln–389.69±19.92 m, as well as mitral orifice area (p=0.182): Arg753Arg–1.73(1.66;1.80) cm2 and Arg753Gln–1/70(1.61;1.79) cm2. Echocardiography showed no differences in the size of the left ventricle, but in the group of Arg753Gln heterozygotes, dilatation of the left atrium was significantly higher 5.20(5.08;5.32) cm (Arg753Arg-4.98(4.83;5.13) cm) and of the right ventricle 3.10(2.90;3.30) cm (Arg753Arg-2.66 (2.59;2.72) cm) and less pronounced values of the left ventricular hypertrophy: interventricular septum thickness 1.018(0.92;1.12) cm (Arg753Arg-1.02(0.98;1.05) cm) and of the right atrium 4.40(4.10;4.70) cm (Arg753Arg-4.54(4.33;4.74) cm). In spirometry, values of both obstructive and restrictive parameters were significantly lower in the Arg753Arg homozygous group: forced lung capacity 71.04(66.15;72.94)% (Arg753Gln-84.16(79.68;88,65)%); forced expiratory volume in 1 sec 79,05(76,87;81,23)% (Arg753Gln-88,18(84,40;91.96)%); reserve inspiratory volume 84.88(81.60;88.17)% (Arg753Gln-96.45(86.73;106.18)%); reserve expiratory volume 21.29 (18.08;24.51)% (Arg753Gln-25.93(13.93;37.93)%). Conclusion. In patients with RHD, the contribution of single TLR2 nucleotide replacements to the parameters of echocardiography and spirometry is possible, which is manifested in a decrease in external respiration function in Arg753Arg homozygotes and dilatation of the left atrium and right ventricle in Arg753Gln heterozygotes.

RESPECT OR RESECT: A SINGLE STRATEGY DOES NOT FIT ALL

Mitral valve (MV) repair for mitral regurgitation (MR) due to posterior leaflet (PL) prolapse is achieved nowadays with a great success rate and a good survival, similar, in certain subgroups. In this paper, Sakaguchi et al describe their results in two groups of patients with PL prolapse. Some patients underwent resection (resection group) and others chordal replacement with/out limited resection (respect group). Results were similar in terms of survival and MR recurrence. Our goal is to eliminate, as much as possible, MR when a patient with degenerative MR is operated on. Reduction of the mitral orifice and consequently an increase of the transmitral gradient is the rule. MV repair for degenerative MR provides great results, but there is not a single surgical technique. A close evaluation of the anatomical findings will allow us to choose the best strategy for the individual patient. An open mind is the most important characteristic that a surgeon should have to repair a prolapsing PL without residual regurgitation and dangerous gradients.

Cor triatriatum sinister with left anomalous pulmonary venous drainage to innominate vein: what to do with the vertical vein?

We treated a surgical case of a 47-day-old male infant diagnosed with an unusual type of cor triatriatum sinister (CTS) with left anomalous pulmonary venous drainage to the innominate vein via a vertical vein. After preoperative hemodynamic assessment of pulmonary venous (PV) return, this patient underwent a resection of the fibromuscular membrane between the accessory and the true left atrial chambers, concomitant with vertical vein banding to facilitate a left PV return through a common pulmonary venous collector (CPVC). Catheterization three months after this surgery revealed no obstruction of the PV return to the mitral orifice as well as good growth of the CPVC as a left PV return pathway. The patient has been doing well on aspirin.

Congenital double mitral orifice with severe mitral regurgitation-associated rheumatoid arthritis: a case report

Background A double orifice mitral valve (DOMV) represents a rare congenital malformation characterized by two valve orifices with two separate subvalvular apparatus. Double orifice mitral valve is congenital anomaly of the subvalvular mitral valve apparatus consisting of an accessory bridge of fibrous tissue, which partially or completely divides the mitral valve into two orifices. Case summary A 30-year young male presented with dyspnoea and palpitation for 4 years, joint pain for 2 years and weakness of right upper limb and lower limb for 6 months. On clinical examination, Boutonniere, Swan neck, and Z-deformity of hand and foot metatarsal bone deformities are noted, on further evaluation, patient was diagnosed as a case of DOMV and was managed conservatively since patient was not willing for surgery. Discussion Two-dimensional echocardiography is the best detection method, the parasternal short-axis view being most useful to show DOMV.

Mechanisms and predictors of ischemic mitral regurgitation at rest and on exertion in patients at early stage of myocardial infarction

Aim. Determination of the mechanisms and predictors of ischemic mitral regurgitation (IMR) at rest and on exertion in patients at early stage of myocardial infarction (MI).Material and methods. Seventy-seven patients with inferoposterior MI and 79 patients with anteroseptal apical MI were examined on the 7th day at rest and after exertion. We determined the degree of IMR (according to the PISA method), posteromedial and anterolateral papillary muscle (PM) displacement, closure height of the mitral valve (MV), systolic and diastolic mitral valve orifice area, volume of the left ventricle (LV), LV contractility index, deformation of the infarction regions, general LV deformation, deformation and systolic dyssinchrony of the PM.Results. IMR was more common in inferior MI (42% vs 28%). LV volumes in cases with anteroseptal apical MI and IMR were greater and LV deformation was less than in patients without IMR. In inferoposterior MI and IMR, differences were observed in the index of local contractility and function of the posteromedial PM. The differences in MI of both localizations and IMR compared with MI without IMR were the areas of the mitral orifice and dyssinchrony of the PM. The degree of IMR after exertion did not depend on the degree of IMR at rest. Predictors of IMR at rest in MI of both localizations were the apical displacement of MV closure and the area of the mitral orifice. In inferoposterior, posteromedial PM displacement, deformation of the infarcted areas, PM dyssinchrony were also predictors. In anteroseptal apical MI, the area of the mitral orifice was the predictor of IMR. Predictors of anteroseptal apical MI after physical exertion after inferior MI were mitral orifice areas, contractility index, displacement and deformation of the posteromedial PM. In anteroseptal apical MI, the IMR predictors were MV closure height and systolic area of mitral orifice.Conclusion. The study confirms the significance of changing the spatial orientation of the MV structures in MI of both localizations, impaired regional contractility in inferoposterior MI and LV volume in anteroseptal apical MI at early stage of the disease.