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Introduction: Percutaneous catheter, mostly radiofrequency (RF) ablation for supraventricular tachycardias (SVT) is an established way of treating symptomatic patients. Traditionally, essential tool for guiding intracardiac catheter manipulation was X ray fluoroscopy.1 The risks of exposing patients to ionizing, X ray radiation are well known and are of particular concern in pediatric cases or cases involving pregnant women. Recently, with the help of electroanatomical (3D) mapping systems, a possibility to perform these procedures without the use of X ray fluoroscopy, so called «zero fluoro», emerged. This is a case report with an overview of some intraprocedural aspects of «zero fluoro» RF ablation procedure performed in 26 years old pregnant women at University Hospital Centre Split. Case report: The patient was 26 years old primigravida, in sixth month of gestation, with the multiple symptomatic SVT episodes, uncontrolled under atenolol therapy. EP study was performed via right groin venous access and diagnostic catheters inserted in a coronary sinus and right ventricle without the use of X ray. Typical AVNRT was easily inducible and decision was made to proceed with the RF ablation with the intention of maintain «zero fluoro» principle. Couple RF applications (30-40W) were placed in AV nodal slow pathway region under only 3D mapping system guidance. RF application resulted in loss of continuous slow pathway conduction and thus rendered arrhythmia noninducible, even with isoproterenol provocation. Overall procedure time was 47 minutes, including 15 minutes waiting period for eventual tissue recovery. No complications occurred, and the patient had been discharged the day after. She stood arrhythmia free till her labour that had gone uneventful. Conclusion: Zero fluoro approach to RF ablation in patients with symptomatic SVT episodes is feasible. It should be preferred approach in vulnerable population such as pediatric cases or cases involving pregnant women. [ABSTRACT FROM AUTHOR]

Introduction: Pleuropulmonary synovial sarcomas are rare soft tissue malignancies.1-3 Additionally, pleuropulmonary synovial sarcoma metastasis with valvular involvement, which was the case with our patient, is even more rare. We present an unusual case of a 42-year-old female patient with metastatic pleuropulmonary synovial sarcoma prolapsing to the left ventricular cavity and causing mitral valve obstruction. Case report: 42-year-old female patient with a history of previously resected inguinal synovial sarcoma who underwent radical irradiation and remained stable for 3 years appeared with the following symptoms: cough, dyspnea and hemoptysis. Computed tomography (CT) scan showed a suspected tumor mass within the left inferior pulmonary lobe affecting the mediastinal pleura with infiltration of the left pulmonary vein. CT scan also revealed a 6 cm mass in the left atrium (LA) that prolapsed into the mitral valve. Immediate echocardiography was performed, which showed a left atrial mass measuring 60x27mm prolapsing into the mitral valve and causing valvular obstruction. Mean pressure gradient across the mitral valve was 6 mmHg. Echocardiography revealed normal ventricular systolic function but a dilatated right ventricle with severe pulmonary hypertension. MRI confirmed previous echo findings but showed a more prominent protrusion of the tumor mass to the right atrium through the atrial septal defect. Bronchial biopsy of the tumor mass revealed undifferentiated monomorphic blunt spindle cells with CD 99 positive expression which confirmed the diagnosis of metastatic monophasic synovial sarcoma. Due to a large tumor extension to almost all cardiac chambers, cardiothoracic surgery was not indicated. Patient is considered for further chemotherapy with ifosfamide/doxorubicin. Conclusion: The aggressive nature of synovial sarcoma makes its early detection difficult. Because of the small number of reported occurrences, there is no consensus regarding optimal therapy. Therefore, it seems worth investigating both optimal surgical procedures and additional chemo-radiotherapy protocols in order to improve the patient's survival. [ABSTRACT FROM AUTHOR]

Introduction: Diffuse large B cell lymphoma (DLBCL) is an aggressive and fast-growing type of lymphoma. Cardiac lymphoma is a rare cardiac tumor and an even more rare extranodal site of lymphoma, of which the most common type is DLBCL.1-3 We report a case of an 85-year-old female patient with pericardial lymphoma presenting with persistent effusions. Case report: 85-year-old female patient presented with sudden onset chest pain and dyspnea. A week before she was diagnosed with atrial fibrillation and warfarin and bisoprolol therapy was started. Echocardiography showed a circular pericardial effusion up to 20 mm thickness with no signs of impending tamponade. Thoracic, abdominal and pelvic CT showed no pathology, apart from the effusion. Laboratory tests showed a suspected M-protein and IgM/kappa through serum protein electrophoresis. A 3-week follow-up revealed a progression in effusion volume (29 mm) and symptoms exacerbation with ankle edema, chest pain and night sweats. Cytological analysis of an effusion sample verified DLBCL with plasma cell differentiation. The same was confirmed by bone marrow biopsy. Imaging showed no signs of lymphadenopathy or hepatosplenomegaly. Lymphoma was staged as Ann Arbour IVB and IRI 3. Therapy was initiated according to the R-CEOP protocol. After 4 therapy cycles echocardiography showed no signs of effusion. A total of 8 therapy cycles were administered and a control work-up showed total remission of the disease. Conclusion: New therapeutic protocols for this type of aggressive lymphoma have significantly improved patient survival rates. Clinical presentation is usually unspecific with a wide differential diagnosis. Given that extranodal and cardiac involvement is a negative prognostic sign for patient survival, efforts are warranted to improve the time to diagnosis and therapy initiation necessary for a favorable outcome. [ABSTRACT FROM AUTHOR]