Cor et Vasa Case Reports 3/2018

cevcr_3-2018-titulka-190px.jpgCor et Vasa Case Reports
Svazek | Volume 1 • Číslo | Number 3
Prosinec | December 2018

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Transapikální valve-in-valve TMVI: Nestandardní přístup k řešení periprocedurální komplikace 

D. Nešpor, P. Němec, P. Kala, M. Třetina, R. Ňorek, P. Pokorný, K. Puszkailer

We present the case of 73-year-old woman, 9 years after complex open heart surgery. Because of structural deterioration of mitral bioprosthesis, she was indicated to transapical valve-in-valve implantation (ViV TMVI) of transcatheter biological prosthesis. The procedure was complicated by impossibility of passage of the Edwards Sapien XT valve through stenotic mitral bioprosthesis. With in situ intrumentarium, we inserted the dilatation balloon through the pure string suture on the heart apex and predilated the degenerated mitral bioprothesis. Following TMVI was without complications.

Rekurentní fulminantní kardiogenní šok léčený emergentním VA ECMO s dvojnásobným úplným obnovením kardiální funkce 

J. Šmalcová, O. Šmíd, J. Rulíšek, M. Balík, J. Dušková, J. Bělohlávek

Pheochromocytoma is one of the rarest and potentially lethal causes of cardiogenic shock. The symptoms may not always be obvious, which puts the patient at risk of delayed diagnosis of the disease. As a result, the possibilities to deal with the situation are quite limited and often highly increase the risk of death because of cardiovascular complications. Urgent implantation of VA ECMO can be a life-saving treatment in cases of cardiac and respiratory failure. Recurrent episodes of refractory shock with full cardiac recovery in the same patient are quite rare and the presented case report stresses the importance of the right indication and early implantation of circulatory support to patients in cardiogenic shock.

Postižení srdce u pacienta s p-ANCA negativní eosinofilní granulomatózou s polyangiitidou 

Š. Volovár, P. Mukenšnabl, R. Rokyta

Eosinophilic granulomatosis with polyangiitis (EGPA) is a condition classified as systemic vasculitis affecting vessels with small to moderate diameter. Annual incidence is 1–3 cases per million. The heart is affected in 15–60% of cases and is associated with the negativity of p-ANCA. Cardiac involvement progresses from eosinophilic myocarditis through fibroplastic endocarditis to endomyocardial fibrosis, causing a restrictive cardiomyopathy. In addition to medical history, physical examination, and ECG, echocardiography, cardiac MRI and endomyocardial biopsy are used for the diagnosis. Early initiated immunosuppressive therapy can lead to almost complete regression of cardiac involvement. In this case report, we present a patient who has been diagnosed with EGPA in cardiology department. During the diagnostic process there was a rapid progression of the disease. It was possible to document particular stages of cardiac involvement in hypereosinophilia. Combined immunosuppressive therapy was initiated and led to almost complete regression of cardiac involvement and disappearance of the patient’s symptoms.

Recidivující pravostranný pleurální výpotek jako projev idiopatické konstriktivní perikarditidy 

T. Patočková, V. Kaučák, Z. Sekanina, V. Kiš, K. Novobílský, R. Kryza

In the article we present a clinical case of a fifty-eight-year-old patient with repeated hospitalizations from September 2015 for progressive dyspnea with the right pleural effusion, which was evacuated several times. Etiology of the pleural effusion was not specified despite complex investigation. In the later course signs of progressive right heart failure dominated and suspicion of constrictive cardiomyopathy on repeated echocardiography was raised. Invasive hemodynamic catheterization and cardiac magnetic resonance was performed and diagnosis of constrictive pericarditis was verified. In March 2016 surgical pericardiectomy was performed with significant improvement of symptoms, signs of right heart failure disappeared without recurrence of pleural effusion. During further follow-up the patient was completely asymptomatic. In our case report we highlight the necessity of putting constrictive pericarditis on comprehensive differential diagnosis of pleural effusion with unclear origin and diagnostic difficulties we had to establish idiopathic constrictive pericarditis diagnosis especially when typical risk factors (status post cardiovascular surgery, acute pericarditis, actinotherapy, tuberculosis) in medical history were missing.