Cor et Vasa Case Reports 3/2020

titulka_CEVCR3.jpgCor et Vasa Case Reports
Svazek | Volume 3 • Číslo | Number 3
Prosinec | December 2020

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Primární angiosarkom srdce 

Z. Marešová, P. Doškář, J. Matoušková, et al.

Cardiac angiosarcoma is the most common primary malignant cardiac tumor in adults. Due to nonspecific clinical symptoms its diagnosis is often late. A key role in diagnosis plays echocardiography and the cardiac biopsy; computed tomography and positron emission tomography (PET) can help in determining the presence of metastasis and the treatment strategy. Available methods of treatment are limited and based solely on individual case reports – surgical excision, chemotherapy, radiotherapy, or orthotopic heart transplantation have uncertain effect on survival. In this presented case, we report of a 52-year-old male who was admitted for palpitations...

Dilema v léčbě pacienta s akutním infarktem myokardu a vysokým rizikem recidivy masivního krvácení do gastrointestinálního traktu 

L. Prýmková, J. Kaňovský, R.Kroupa, S. Richter, P. Kala

Percutaneous coronary intervention (PCI) is a routine therapy in the setting of acute myocardial infarction. We report a case of a younger man without any common risk factors of coronary artery disease who was admitted to the cardiology department with non-ST-segment elevation myocardial infarction and history of gastrointestinal bleeding and anaemia. Acute coronarography revealed 80% stenosis of the left anterior descending artery as a single-vessel disease. Taking into account the ongoing ischemia we proceeded to acute coronary intervention with stent implantation despite a very high risk of massive gastrointestinal rebleeding that had not been objectified at the moment of PCI....

Infekční endokarditida prezentující se ložiskovým neurologickým postižením, které vedlo k dopravní nehodě 

K. Michalčíková, J. Plášek, M. Branny, R. Brát, B. Bortlíčková

A 39-year-old male with a history of bicuspid aortic valvuloplasty was admitted after a car accident for right-sided hemiparesis, cognitive slowing, and disorientation to the Teaching Hospital in Ostrava. Computed tomography (CT) at admission detected subarachnoidal bleeding in the temporoparietal region. Moreover, magnetic resonance imaging (MRI) detected small diffuse ischaemic lesions surrounded by microbleeds. Amongst other major injury, the patient suffered from splenic rupture, which led to urgent splenectomy. Major symptoms were of neurological origin, accompanied by forearm petechia and confirmed presence of Staphylococcus aureus in both blood samples and cerebrospinal fluid....

Tamponáda srdce jako první projev recidivy adenokarcinomu prostaty 

E. Lichnerová, M. Porzer, M. Branny

Secondary pericardial tumors are much more frequent than primary tumors of the pericardium. Very often the pericardial effusion is the first presentation of the disease. Often these tumors are present by a pericardial effusion as an unfavorable prognostic factor. The etiology or tumor origin of pericardial effusion can be difficult to determine. We present a case of 62-year-old patient with pericardial effusion and progression to cardiac tamponade as the initial presentation of metastatic affection of the pericardium by prostatic adenocarcinoma which appeared to be in remission during diagnosis process.

Kardioembolizační STEMI u pacienta s fibrilací síní a akutní plicní embolií 

E. Jančová, Z. Coufal, M. Slabák

Coronary embolization as a cause of myocardial infarction is rare but important entity in terms of both etiology and treatment. Cardioembolization from the left heart is most commonly manifested by central nervous system embolization and stroke or peripheral vascular embolization, rarely myocardial infarction. The cause of systemic embolization is most often the formation of thrombi in the left atrium during atrial fibrillation, from wall thrombi in the left ventricle after myocardial infarction, from vegetations on the valves in infectious endocarditis, but rarely from thrombi on native otherwise unaffected aortic valve. Rarely, paradoxical embolization can occur in the presence of a right-left short circuit, for example in the case of a persistent foramen ovale. Foramen ovale patens is a relatively common variant, which occurs in the general adult population in about 25–30%. Literary data of cardioembolizing myocardial infarctions are mostly casuistic, statistical data are not available. We present one of our cases: a case report of a 74-year-old man, who has urgent...

Nestandardní řešení recidivující ischemie myokardu při intermitentní obstrukci ústí kmene levé koronární tepny papilárním fibroelastomem 

J. Počarovský, A. Širáková, J. Ulman, J. Kroupa, V. Kočka

Papillary fibroelastomas are the second most common primary cardiac tumors, most frequently arising from the aortic valve. Fibroelastomas do not typically cause valvular dysfunction, but they may produce systemic embolization or coronary artery obstruction. The following case report describes a female patient with multiple comorbidities who was admitted in March 2018 to the Cardiology Department due to recurrent chest pain during acute myocardial ischemia followed by an episode of ventricular fibrillation. An emergent coronary angiography did not show any critical coronary artery stenosis, nevertheless, aortic dissection was suspected. Subsequent CT angiography revealed a mass in left coronary sinus of Valsalva, most likely consistent with fibroelastoma. Transesophageal echocardiography confirmed the diagnosis. Surgical resection was contraindicated due to high perioperative risk. Therefore, the patient underwent percutaneous intervention using the chimney technique – implantation of stent in the left main coronary artery (LMCA) with the proximal part of the stent extending above the edge of the aorta to prevent obstruction of LMCA orifice by the fibroelastoma. The patient has remained asymptomatic during the 27-month follow-up.