Cor et Vasa Case Reports 2/2022

titulka_ico2-2022.jpgCor et Vasa Case Reports
Svazek | Volume 5 • Číslo | Number 2
Září | September 2022

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Raritní infekční endokarditida aortální chlopně 

P. Vojtěchová, A. Tomášek, J. Ničovský, P. Stibor, J. Štěrba, P. Němec

Infective endocarditis (IE) is an inflammation of the endocardium characterized by the presence of infectious vegetation (thrombus with microorganisms) on the valvular or even wall endocardium. IE occurs most often on a primarily damaged valve or in patients with reduced immunity. It is a very serious disease, which even today leads to death in 20–30% of cases. In the presented case report, we give an example of a patient who underwent an acute cardiac surgery for aortic dissection type A. Over the years he was subsequently treated for recurrent infections, fever, failure to thrive. As a part of the clinical manifestations, there was an atypical manifestation of infective endocarditis. Within the differential diagnosis, a vascular or infectious complication was considered. Based on the examinations performed, the presence of an extensive abscess cavity in the sternum area was confirmed in an already advanced stage of the disease.

Plicní embolie spojená s přítomností mobilních trombů v pravostranných srdečních oddílech se zaměřením na možnosti terapie 

M. Ryšavík, V. Kaučák, I. Horák

Pulmonary embolism is a very frequent diagnosis in patients in the cardiology department. In the following text treatment options for high-risk pulmonary embolism with the presence of thrombosis in the right-sided heart chambers are discussed. It is often associated with haemodynamic instability and higher mortality, furthermore, the possibilities of therapy, early administration of thrombolysis, and its contraindications, also the importance of early transthoracic echocardiographic examination in the determination of the final diagnosis in differential diagnosis of shortness of breath and chest pain, and finally in selected patients the need for surgical embolectomy or percutaneous mechanical thrombectomy as alternative methods to systemic thrombolytic therapy in patients that develop haemodynamic instability. These are case reports, both of them were before the SARS-CoV-2 pandemia. The role of extracorporeal membrane oxygenation (ECMO) in the therapy of high-risk pulmonary embolism is also mentioned.

Cor triatriatum sinistrum v těhotenství 

M. Pudová, T. Zatočil, L. Koc, A. Nečasová, D. Žáková, P. Janků, R.Gerychová, M. Kozák, P. Kala

Cor triatriatum sinistrum (CTS) is a rare congenital heart disease consisting of a fibromuscular membrane that subdivides the left atrium into two chambers. Most patients have onset of symptoms within the first year of life. Patients with isolated CTS and no restrictive orifice may be asymptomatic and accidentally diagnosed in adulthood. Depending upon the orifice size in membrane, the hemodynamics may mimic mitral stenosis. CTS limits the ability of the heart to respond to increased cardiovascular demands.

Parciální anomální návrat pravostranné plicní žíly jako neočekáváná překážka implantace biventrikulárního kardioverteru-defibrilátoru 

K. Fulínová, J. Honěk, J. Veselka

We present a case report of a patient with chronic heart failure admitted for implantation of a biventricular cardioverter defibrillator (CRT-D). As a result of undiagnosed anomalous pulmonary venous return, with a wide communication between the superior vena cava and the left atrium, the stimulation electrode was repeatedly penetrating into the left side chambers of the heart during the attempts to insert it into the coronary sinus. Therefore, due to technical challenges to achieve the correct placement of the lead, pacing of the left bundle branch was chosen as an alternative pathway to accomplish cardiac resynchronization therapy. Cardiac resynchronization therapy using biventricular pacing presents one of the treatment options for patients with advanced heart failure. In approximately 5% of all cases, it is not possible to insert the left ventricular electrode into the coronary sinus. In these cases, stimulation of the conduction system, such as left bundle branch pacing, provides an alternative pacing modality.

Izolované metastatické postižení srdce uroteliálním karcinomem 

M. Konečný, M. Špaček, F. Hemerka, K. Prokešová

Isolated metastatic involvement of the heart is rare. Except for malignant melanoma, only isolated case reports are described in the literature in clinical practice. The clinical symptomatology of these patients is absent or tends to be poor. Symptoms are often limited to pericardial involvement with a large pericardial effusion. Echocardiography is usually the first imaging test that is able to detect heart tumours. Computed tomography and cardiac MRI should follow. The final diagnosis is established histologically. Our case report describes the case of a patient whose primary diagnosis was established as a subacute myocardial infarction. Echocardiography proved expansive inhomogeneous masses in the region of the apex of the heart, the anterior and lateral walls of the left ventricle, and along the left atrium. Clinically, the patient had no cardiac symptoms. According to abdominal sonography, a urine bladder tumour was suspected. The patient dies of nosocomial complications with a multi-organ failure during the hospitalization. Subsequent autopsy and immunohistochemical examination demonstrate isolated metastatic involvement of the heart by the urothelial carcinoma of the urine bladder.