Cor et Vasa Case Reports 1/2020

CVCR_1_20_titulka.jpgCor et Vasa Case Reports
Svazek | Volume 3 • Číslo | Number 1
Březen | March 2020

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Vzácný případ primárního vysoce agresivního tumoru perikardu 

M. Košťál, T. Zatočil, O. Savka, T. Ostřížek, P. Kala, O. Toman

Primary pericardial tumors are an extremely rare disease with poor prognosis. Initially they are clinically mute and their growth and dissemination to surrounding structures lead to a development of often unspecific health problems. The presented case report describes the case of a patient with highly undifferentiated malignant sarcomatoid pericardial tumor, refers to the difficult diagnostics of pericardial tumors and emphasizes the need of the earliest initiation of the therapy as possible. In the presented patient, the illness started with progressing dyspnea and chest pain. During the standard examination, atrial fibrillation with rapid ventricular response was detected. Also pericardial effusion, progressing and eventually leading to the necessity of pericardiocentesis. After repeated examinations using a range of imaging methods, a malignant pericardium disorder was suspected. Subsequently, this was verified histologically through mini-thoracotomy, which confirmed the suspicion. The patient’s health condition rapidly deteriorated and resulted in death before possible treatment.

Nestabilní angina pectoris jako první projev subclavian steal fenoménu u pacientky po kardiochirurgické revaskularizaci – kazuistika 

A. Kažimírová, M. Hudec, M. Kamarád, R. Miklík

Angina pectoris is a type of ischemic heart disease with a prevalence of 20 000–40 000 per 1 million inhabitants. Its cause is a disparity between myocardial oxygen supply and consumption. The most common cause of angina pectoris is coronary atherosclerosis.1 The development of a cardiac surgery with an increasing number of patients undergoing aortocoronary bypass surgery using the left internal mammary artery graft leads to an increasing number of clinical manifestations of the rare cause of angina pectoris, namely coronary-subclavian steal syndrome. We present a case report of a patient with a chronic coronary artery disease by whom this syndrome developed sixteen years since the artery bypass grafting was received and subsequently was successfully treated by a complex percutaneous revascularization in our department.

Akutní mitrální regurgitace jako příčina jednostranného plicního edému 

E. Polaková, M. Horn, J. Veselka

Unilateral pulmonary edema accounts for 2% of cardiogenic pulmonary edemas. Etiology is variable, severe mitral regurgitation being the most common. In the majority of cases, pulmonary edema occurs in the right upper lobe. Due to unusual presentation, the initiation of appropriate treatment tends to be delayed. We present a case of a very dramatic and rare mechanical complication of a small myocardial infarction. The patient’s condition was initially incorrectly described as pneumonia. He was admitted due to severe respiratory insufficiency, his condition required mechanical ventilation, later V-V ECMO was initiated. Afterwards, echocardiography revealed acute severe mitral regurgitation with flail posterior leaflet and eccentric jet directed towards right pulmonary veins. Selective coronarography revealed severe stenosis of the left circumflex artery and plain old balloon angioplasty was performed. Subsequently, surgical valve replacement took place. The objective of this paper is to present an unusual case and its pathophysiology.

Akutní končetinová ischemie při konkomitantní systémové a plicní embolizaci 

L. Šujaková, J. Pařenica, J. Hlásenský, M. Keřkovský, T. Andrašina, Z. Šilhart, P. Kala

Acute limb ischemia due to paradoxical embolization is considered a rare event. It occurs under specific circumstances when a patient with persistent foramen ovale / atrial septal defect suffers from arterial embolism by vein thrombosis. In this report we demonstrate a case of a 28-year-old woman hospitalized for dyspnea and severe pain in both lower limbs. She was diagnosed with massive pulmonary embolism and multiple occlusions in the arterial bed of both lower limbs. The patient was successfully treated with systemic thrombolysis followed by surgical thromboembolectomy which led to a complete recovery of the affected limbs. Furthermore, other feasible treatment strategies and therapeutic interventions of acute limb ischemia, as well as the long-term preventive measures of recurrent embolization events in this context, are discussed.

Multiorgánová paradoxní embolizace u pacientky s akutní plicní embolií a tranzientním trombem v mezisíňovém septu 

M. Ráchela, A. Staňková, J. Málek, J. Matějka, J. Večeřa

Paradoxical embolism refers to the clinical form of thromboembolism, where a thrombus originating in venous system traverse through an intracardiac or pulmonary shunt into the systemic circulation. The most frequently, it is being associated with patent foramen ovale (PFO), however, an entrapped thrombus is rare. We present a case of 87-year-old patient with acute pulmonary embolism, transient thrombus in interatrial septum and multiorgan paradoxical embolism. Surgical thromboembolectomy is a preferred treatment in acute phase, but anticoagulation and thrombolysis may be an acceptable option in relation to hemodynamic state, comorbidities and surgical risk. Considering the coincidence of acute myocardial infarction, ischemic stroke, and pulmonary embolism, our treatment option was thrombolysis. Anticoagulation therapy was chosen for the secondary prevention.

Postižení levé komory u arytmogenní kardiomyopatie 

J. Hrečko, M. Solař, K. Mědílek, P. Solařová, M. Hujňáková

Abstract Arrhythmogenic cardiomyopathy (ACM) is genetically determined cardiac disease with high risk of malignant arrhythmias. We present the case of young woman with ventricular tachycardia in whom we diagnosed ACM with extensive left ventricular disease. The aim of this case report is to show actual diagnostic modalities and to remind specific features of left ventricular involvement in ACM.