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Hydatid disease is a common health problem in sheep-farming countries including Iran. The liver and lungs are the most frequent primary sites of hydatid cysts in humans. Cardiac involvement is an uncommon manifestation and the right ventricle outflow tract is rarely involved. This is a case report of a 34-year-old man who presented to the Heart Clinic, Tehran, Iran, in 2019 with a history of dyspnea and fatigue. Following imaging study, the patient was diagnosed with a right ventricular outflow tract hydatid cyst. He underwent surgical resection of the cyst. The post-operative course was uneventful.Keywords: Hydatid cyst; Right ventricular; Outflow obstruction; case report; Iran.

Right atrial diverticulum is a very rare anomaly. It is an outpouching arising from the right atrial free wall. Clinical presentations vary widely but some cases are associated with supraventricular tachycardia and atrial flutter/fibrillation. The incidence/prevalence of this anomaly is not available because only a few cases have been reported. We report a 38-year-old female patient who presented to the Heart Clinic, Tehran, Iran in 2019 with a history of dyspnea and chest pain. Electrocardiography revealed left bundle branch block. Following a magnetic resonance imaging study, the patient was diagnosed with a right atrial diverticulum. She underwent surgical resection of the diverticulum. The post-operative course was uneventful and no recurrence of the arrhythmia was detected during the six months of follow-up. To the best of the authors’ knowledge, this combination has not been described in the literature. Keywords: Right Atrium; Diverticulum; Left Bundle Branch Block; Case Report; Iran.

We describe a 72-year-old woman, a known case of rheumatic heart disease with a history of mitral and aortic valve replacement 8 years previously, who underwent mitral valve-in-valve replacement supported by a transapically snared guidewire through septostomy.

OBJECTIVES: The aim of the present study was to ascertain whether the length of anterior mitral leaflet second-order chordae (SOC) could be considered as a predictor of the incidence of post-repair systolic anterior motion (SAM) and left ventricular outflow tract obstruction (LVOTO) in patients with myxomatous mitral valve disease. METHODS: With the implementation of preoperative transoesophageal echocardiography (TEE), the length of anterior mitral leaflet SOC, anterior leaflet (AL) and posterior leaflet (PL) as well as the distance from the coaptation point to the septum (C-S distance) before and after mitral valve repair (MVR) surgery were measured in 190 patients, comprising 12 who developed SAM and 178 who did not. RESULTS: The results revealed that, in patients who developed SAM, SOC were significantly higher (2.76 ± 0.15 vs 1.83 ± 0.32 mm, P< 0.001) and the C-S distance was significantly lower (2.18 ± 0.36 vs 2.91 ± 0.36 mm, P< 0.001) in comparison to the obtained results for those who did not develop SAM. SOC and the C-S distance were independent risk factors of developing SAM and had the largest area under the receiver operating characteristic (ROC) curve (P< 0.001). With application of a cut-off ROC curve analysis, the cut-offs selected for the two variables of C-S distance and SOC were 2.5 and 2.6, respectively. Sensitivity and specificity of SAM development were 100% [95% confidence interval (CI): 73.5–100] and 87.1% (95% CI: 81.0–91.4) for SOC ≥2.6 and 83.3% (95% CI: 51.6–97.9) and 73.6% (95% CI: 66.4–79.9) for the C-S distance ≤2.5. CONCLUSIONS: The two variables of the second-order chordae and the distance from the coaptation point to the septum were associated with an increased risk of the post-repair systolic anterior motion after mitral valve repair.

Background The ideal management of ischemic mitral regurgitation (MR) remains a clinical dilemma because of the suboptimal available therapeutic options. Recently, new concepts have emerged, pointing to the benefits of a patient selection approach when debating the management of moderate ischemic MR. We investigated the predictability of low-dose dobutamine stress echocardiography (DSE) in selecting candidates for CABG with moderate MR for valve repair. Methods From November 2002 to May 2010, 110 candidates for first-time CABG, who were admitted to the cardiac surgery department in Day General Hospital (Tehran, Iran), were enrolled in the present cross-sectional study. DSE was performed for each case before CABG. Those with positive findings underwent CABG alone and those with negative results underwent concomitant CABG and mitral valve repair. The patients were followed up for a minimum of 60 months. Results Of the 110 patients, 47 (42.72%) had positive test results and underwent CABG alone and 63 (57.28%) had negative DSE results and underwent concomitant CABG and mitral valve repair. The MR degree had decreased from 2.8 ± 0.3 preoperatively to 1.46 ± 0.6 early during the hospital stay and 1.9 ± 0.7 during late follow-up in the CABG group. It had decreased from 2.84 ± 0.4 preoperatively to 0.93 ± 0.65 postoperatively but then increased to 1.41 ± 0.9 during late follow-up, for a significant decrease in the combined group ( P Conclusions Despite its utility in selecting CABG patients with moderate ischemic MR for valve repair from a short-term perspective, the use of DSE cannot predict the long-term outcomes of these patients.

Amac: Bu calismada cinsiyetin izole koroner arter baypas greftlemenin (KABG) erken cerrahi sonuclari uzerindeki muhtemel etkileri arastirildi. Ca­lis­ma­ pla­ni:­ Kalp hastalarini kapsayan mevcut veri tabaninin retrospektif incelemesine, Agustos 2007 ve Mart 2011 tarihleri arasinda Iran, Tahran Shariati Hastanesi’nde izole KABG yapilan 1390 ardisik olgu (393 erkek, 997 kadin; ort. yas 58.7±10.1 yil; dagilim 23-87 yil) alindi. Erkek ve kadin cinsiyetleri ameliyat oncesi ozellikler acisindan karsilastirildi. Cinsiyetin ameliyat sonrasi mortalite ve morbidite uzerindeki muhtemel etkilerini degerlendirmek uzere basamakli cok degiskenli lojistik regresyon analizi yapildi. Bul gu lar: Kadin hastalarin yasi daha ileriydi ve diabetes mellitus, hipertansiyon, hiperkolesterolemi ve hiperlipidemi prevalansi daha yuksekti. Mortalite orani, erkeklere kiyasla, kadinlarda anlamli duzeyde daha yuksekti (%2.3’e kiyasla %6.9; p

Despite huge progress in the surgical management of ischemic mitral regurgitation, there is still controversy regarding the ideal treatment option. Our study aimed to define an algorithmic approach in order to select those patients who will benefit the most from concomitant mitral valve procedure. Patients with mitral regurgitation (MR) who met the inclusion criteria were included in our study. Patients with structural MR including ruptured chordae or papillary muscle, abnormal leaflet thickening, annular calcification, or other valvular or congenital heart diseases, ventricular aneurysms and those who were candidates for other surgical procedures were excluded. A total of 350 patients (about 12 %) were classified as having ischemic mitral regurgitation (IMR) and were enrolled in our analysis. All the patients underwent coronary artery bypass grafting and by the designed algorithmic approach were also decided to have additive procedures for their concomitant IMR. Six months survival was 91.5 % among all the patients in this study. During the follow-ups 86.9 % of the patients survived . Overall mortality rate was 13.1 % (n = 46), of which 7.1 % (n = 25) occurred due to cardiac and 6 % (n = 21) as a result of a non-cardiac cause. Individualising methods to select patients suffering from IMR for concomitant mitral valve procedure and coronary artery bypass grafting (CABG) seems to serves more effectively by reducing unnecessary surgeries and at the same time not missing absolute indications for concomitant valve repairs. Our algorithm showed a promising efficacy to effectively select patients for CABG and concomitant mitral valve procedures.

Congenital aneurysmal dilatation of the left atrium is a rare anomaly that could be associated with supraventricular arrhythmias and life-threatening systemic embolization. We describe a 32-year-old man with a giant left atrial aneurysm diagnosed with new imaging modalities that underwent surgical resection with good results. Learning objective: Left atrial aneurysms are rare and characterized by their origin from an otherwise normal atrium, a clearly defined communication with the atrial cavity, and their intrapericardial location. Because of associated complications, early diagnosis and surgical excision are mandatory even in asymptomatic, otherwise healthy patients. The evaluations with cardiac imaging techniques should be considered in any patient with an unexplained abnormality on the chest radiograph or initial echocardiography.>

Objectives We used a modified technique of a composite graft by moving the valve prosthesis away from the end into the inside of the tube and compared the effectiveness of this surgical method with the standard valved conduits. Methods Through a prospective nonrandomized clinical study between March 2011 and June 2012, we performed replacement of the aortic valve and ascending aorta in 30 consecutive patients using a valved composite graft with a mechanical valve prosthesis. A modified self-assembled valved composite graft was employed in 20 patients (Modified group), while the remaining 10 patients received the standard composite graft (Control group). Results There was significantly less bleeding in the patients with modified grafts (184 vs. 415 mL, p

The aim of this study was to investigate the feasibility of performing papillary muscle repositioning (PMR) for subvalvular-sparing mitral valve replacement procedures in patients with ischemic mitral regurgitation and to determine the early and late effects of this procedure on the clinical outcome and left ventricular mechanics.We prospectively randomly allocated 50 patients with severe ischemic mitral regurgitation and left ventricle dysfunction who were candidates for coronary artery bypass graft surgery and mitral valve replacement into a total chordal-sparing mitral valve replacement group or a PMR group. Echocardiography was performed preoperatively, at discharge, and after 3 years to determine the left ventricular dimensions, shape, and function.The reduction in the left ventricle volumes and sphericity index in the PMR group was more significant than that in the other group. With regard to the left ventricular end-systolic and left ventricular end-diastolic volumes, sphericity index, and ejection fraction, the PMR group showed better results (p0.05), but the difference in New York Heart Association functional class after 3 years was not statistically significant between the two groups (p0.05).The PMR technique described herein can dramatically help ischemic patients by affecting the left ventricular shape and function more efficiently compared with the complete retention of the mitral subvalvular apparatus if the mitral valve is to be replaced.

Objective: The gold standard test in the diagnosis of heart transplant rejection is right ventricular (RV) myocardial biopsy, which is an invasive, time-consuming, expensive method. In an effort to find a reliable method to minimise the sequential use of myocardial biopsy, we assessed the main echocardiographic indices for the detection of allograft rejection. Materials and methods: Fifty myocardial specimens were examined in this prospective study, which assessed the prominent echocardiographic parameters propounded by previous studies as indicators of rejection. Prior to biopsy, all the patients underwent preoperative transthoracic echocardiography. The accuracy of the echocardiographic indices was compared with that of myocardial biopsy indices as the gold standard. At three myocardial segments, namely, RV base, interventricular septal (Sep) base and lateral left ventricular (Lat) base, peak systolic strain (RV-S, Lat-S and Sep-S) was measured. In addition, time to systole (TS) was measured at the same three segments, yielding the three variables of RV-TS, Sep-TS and Lat-TS. Results: Our logistic regression model revealed that the four factors of Lat-S (%), Sep-TS (ms), posterior wall thickness (PWT; mm) and left ventricular mass index (LVMI; g m � 2 ) could denote hearttransplantrejection.Wedeviseda newindex,theechorejectionscore,usingthefollowingformula: [(PWT + LVMI) � (Lat-S + Sep-TS)].This new formula has an area under a curve of 0.932 and a cut-off point of 0; it yields a sensitivity of 100.0%, specificity of 71.0%, positive predictive value of 67.9% and a negative predictive value of 100.0%. If the echo rejection score is >0, there is a 67.9% possibility that a cardiac transplant patient is presenting with allograft rejection, while a score � 0 denotes a 100% improbability of rejection. Conclusion: Our proposed method for screening patients at risk of acute cardiac rejection with echo rejection score showed a good sensitivity in detection of graft rejection. However, further study is required to determine if it can be used as an adjunct to the myocardial biopsy. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Behcet's disease is a multisystem disorder and classified as "vasculitic syndrome with a wide variety of clinical manifestations." Cardiac involvement is very rare but can occur with different presentations including: pericarditis, cardiomyopathy, endocarditis, endomyocardial fibrosis, intracavitary thrombosis, and coronary artery disease. Great vessel involvement is more common. Recurrent Phlebitis, commonly involving large vessels (superior vena cava, inferior vena cava, hepatic veins) and cerebral veins are the sole presentation in this regard. Arterial involvement is expressed by aneurysm or pseudoaneurysmal formation. Due to the wide variety of cardiovascular manifestations and the resulting high mortality, cardiac surgeons should be familiar with this disease. In this paper we review the articles and introduce our four cases presenting with aneurysm of ascending aorta with free aortic insufficiency, aneurysm of descending aorta, pulmonary artery aneurysm, and pseudoaneurysm of aortic arch.

ObjectiveIn patients with ischemic cardiomyopathy and substantial amounts of dysfunctional but viable myocardium, revascularization cannot always improve the left ventricular ejection fraction. We sought to investigate the interaction between the left ventricular volume and the amount of viable myocardium to predict the left ventricular ejection fraction increase after revascularization.MethodsEighty-five consecutive patients with a depressed left ventricular ejection fraction (mean: 27.3% ± 5.2%) underwent coronary artery bypass grafting after a dobutamine stress echocardiography had determined that they had at least 4 viable segments. Six months after coronary artery bypass grafting, left ventricular ejection fraction and regional wall motion were reassessed.ResultsAlthough the left ventricular ejection fraction was expected to recover more than 5% in all 85 patients after coronary artery bypass grafting, it did not improve in 15 patients (17.6%) despite the presence of viable segments. The likelihood of the left ventricular ejection fraction recovery decreased proportionally with an increase in the left ventricular end-systolic volume. The nonimprovers had a higher left ventricular end-systolic volume (164.2 ± 22.4 mL vs 125.6 ± 23.4 mL, P = .0001). In addition, the number of viable segments during the dobutamine stress echocardiography had a significant correlation with the ejection fraction increase after 6 months (P < .0001). Patients with 6 viable segments showed a good outcome irrespective of their left ventricular end-systolic volume. In patients with fewer than 6 viable segments, left ventricular end-systolic volume was a major factor in the prognosis: Patients with left ventricular end-systolic volume of 145 or more had a poor left ventricular ejection fraction increase and vice versa.ConclusionThe extent of left ventricular remodeling determines the rate of functional improvement after coronary artery bypass grafting. Patients with a high left ventricular end-systolic volume and fewer than 6 viable segments have a lower likelihood of improvement.

Resumo Objetivo: O problema da cicatrizacao de feridas e comumente observado apos procedimentos de revascularizacao do miocardio. Nosso objetivo e determinar a prevalencia e os indicadores de complicacao na dissecacao da veia safena apos procedimentos de revascularizacao coronaria. Metodos: Apos revisao e aprovacao pelo comite de etica da instituicao, uma revisao retrospectiva de 4029 procedimentos de revascularizacao foi realizada com enxerto da veia safena durante um periodo de seis anos. Treze fatores de risco para aqueles que desenvolveram complicacoes extensas nas feridas da perna foram analisados e comparados com toda a coorte de pacientes submetidos a procedimentos de revascularizacao semelhantes durante o mesmo periodo. Resultados: Complicacoes nas feridas do membro inferior ocorreram em 68 pacientes (1,7%), 43 deles precisaram de intervencao cirurgica adicional. Foram realizados 17 desbridamentos de feridas, nove transplantes de pele, uma angioplastia, 11 fasciotomias, tres procedimentos vasculares e duas transferencias livre de tecidos. Das treze variaveis analisadas pela analise multivariada, sexo feminino, IMC, uso de enxerto de veia toracica interna, doenca vascular periferica, o uso de balao intra-aortico no pos-operatorio e hiperlipidemia pre-existente foram identificados como indicadores independentes significativos de complicacoes extensas nas feridas a perna (p

There is still controversy about the influence of gender on hospital mortality after coronary artery bypass grafting. We analyzed various risk factors in 1,258 patients undergoing isolated on-pump coronary artery bypass, of whom 19 (1.5%) died in hospital. There were 937 men (74.5%) and 321 women (25.5%). Compared to men, women were older with a higher mean body mass index, twice as many were hypertensive and diabetic, and they had higher serum cholesterol and triglycerides. Men smoked more, had lower ejection fractions, more myocardial infarctions and poorer functional status. Female sex, congestive heart failure, low ejection fraction, diabetes, previous percutaneous interventions and chronic lung disease were more prevalent among the patients who died. These factors were used to form a logistic regression model in which sex did not have an independent influence on hospital mortality. The difference between men and women can be explained by differences in risk factor profile.

Background Ischemic mitral regurgitation (IMR) is a complex lesion to repair, and its successful management requires an understanding of its mechanism and severity. Ring annuloplasty, currently the surgical treatment of choice for IMR, has failure rates as high as 30% in patients with functional IMR. We sought to study the variables that can predict IMR recurrence after ring annuloplasty. Methods This is a prospective study of 114 patients with 3+ to 4+ IMR who underwent coronary artery bypass grafting and mitral valve annuloplasty with acceptable results at an approximately 2-year follow-up. Variables were compared in a failure group, comprising patients with 2+ or higher MR and a nonfailure group, consisting of those with less than +2 MR. Results There were five postoperative in-hospital deaths. During follow-up, 14 patients died and 95 patients were evaluated. After a mean follow-up of 22.2 ± 4.6 months for the nonfailure group and 18.6 ± 5.6 months for the failure group, 23 patients (24.4%) exhibited annuloplasty failure. Some variables had an effect in our univariate analysis, but only interpapillary muscle distance had a relationship with recurrent MR in the multivariate analysis. Mean preoperative interpapillary muscle distance was 15.0 ± 4.0 and 26.5 ± 2.9 in the nonfailure group and failure group, respectively ( p Conclusions Interpapillary muscle distance, as a reliable index of dysfunctional subvalvular apparatus in patients with IMR, can predict late postrepair MR and indicate the need for a procedure complementary to annuloplasty.

Background The aim of this study was to investigate the feasibility of performing papillary muscle repositioning for mitral valve replacement procedures in patients with left ventricular dysfunction and to determine the early and late effects of this procedure on clinical outcome and left ventricular mechanics. Methods One hundred patients with ejection fraction less than 40, who were candidates for isolated surgical correction of mitral insufficiency, had mitral valve replacement and were prospectively randomly assigned to either total chordal-sparing or papillary muscle repositioning. Fifty subjects underwent papillary muscle repositioning (PMR group), and the remaining 50 had complete preservation of all chordal structures with mitral valve replacement (CMVR group). Echocardiography was performed preoperatively, at discharge, and after 2 years to determine dimensions, left ventricular shape, and function. Results End-diastolic and -systolic volumes decreased in both groups initially and continued to decline. Decreasing volumes, however, were more significant in the PMR group, in which the significant decrease in the sphericity index continued for another 2 years. In contrast, the sphericity index in the CMVR group had no significant changes at discharge and at 2 years. In terms of systolic performance, ejection fraction had no significant changes in the CMVR group, whereas ejection fraction significantly increased in the PMR group. Conclusions Papillary muscle repositioning may result in more favorable left ventricular remodeling compared with complete retention of the mitral subvalvular apparatus during mitral valve replacement. It confers a significant early and late advantage by causing significant reductions in the left ventricular chamber volume, sphericity index, and systolic performance.

The harmful effects of smoking on the postsurgical wound healing disturbances have been widely investigated across various surgical procedures. These effects after coronary artery bypass graft (CABG) surgery have been less explored. We aimed to investigate the association of smoking and the wound healing problems in post-CABG patients.We compared the incidence of wound complications in 405 smokers and 405 nonsmokers who underwent an elective CABG surgery. The incidence of leg and sternal wound complications was evaluated during the first 7 d as well as at a 6-wk postoperative visit.One hundred fifty-six leg wound complications were noted in 132 patients (16.3%). The overall rate of leg wound healing disturbances was significantly higher in smokers than those in nonsmokers (odds ratio, 1.47; 95% confidence interval, 1.109-4.019; P = 0.010). The incidence rates of leg wound edge necrosis and dehiscence were significantly higher in smokers compared with those in nonsmokers (3.7% versus 0.7%, P = 0.004 and 6.6% versus 0.7%, P0.0001, respectively). We found no significant differences between the incidence of postoperative leg wound infection, hematoma, wound edema, and seroma in active smokers and those who never smoked. Thirty-seven postsurgical sternal wound complications (4.6%) were developed in 33 patients (4.1%). The overall rate of sternal wound healing disturbances was similar between smokers and nonsmokers. There was a trend between the sternal wound dehiscence and smoking (P = 0.03); however, the other sternal wound complications were not associated with smoking.Smoking may contribute to the disturbances of wound healing, especially wound dehiscence, in post-CABG patients.

Ascending aorta and aortic arch thrombosis is rare in a young man with no risk factor. Here, we report the case of a young male patient with factor V Leiden mutation who developed ascending aorta and aortic arch thrombosis and subsequent emboli.

We present a practical and accurate way to measure artificial chordae length in mitral valve repair. During preoperative transesophageal echocardiography, the distance between the head of the posterior papillary muscle and the mitral annulus plane at the coaptation of the leaflets is measured; this is the length of the new chorda. Every millimeter of braided 4-0 Gore-Tex (W.L. Gore & Assoc, Flagstaff, AZ) contains two tight reverse knots; therefore, the number of the knots determines the accurate length of the artificial chorda.

We report the case of a 48-year-old woman with a history of transient ischaemic attacks (TIA). The patient was diagnosed with a large patent foramen ovale (PFO), for which she underwent percutaneous PFO closure. Two years postprocedurally, the patient suffered frequent TIA and assessment showed the displacement of the device. The device was surgically removed, and the septum was repaired with a pericardial patch. Afterward, however, the patient experienced repeat TIA. It was discovered that the patient had a pulmonary arteriovenous fistula (PAVF), and a diagnosis of a trauma was made. The PAVF was later coil embolised. This case illustrates the importance of evaluating PFO closure patients for the associated causes of right-to-left shunting.

A 21-year-old man who had suffered an episode of complete heart block 2 months earlier and thus undergone pacemaker implantation presented with syncope. Echocardiography showed cardiac tamponade and raised the suspicion of lead penetration. The effusion was drained. Multi-sliced CT scan confirmed that the right aspect of the pacemaker wire was extracardiac, causing the cardiac tamponade.

Transcatheter aortic valve implantation has become an established alternative treatment method for patients with symptomatic aortic stenosis who are at high risk for conventional aortic valve replacement. Problems, however, persist when using this technique in patients with associated coronary artery disease. We describe a successful case of valve implantation via the transaortic route with simultaneous full revascularization.

OBJECTIVE One of the mechanisms of development of functional mitral regurgitation after myocardial infarction is the increased papillary muscle distance which results due to ventricle remodeling. The aim of this study was to investigate the long-term effect of papillary muscle approximation (PMA) on the cardiac function of patients with ischemic cardiomyopathy and increased papillary muscle distance. METHODS Thirty patients (22 males; mean age: 57.0 ± 7.4 years) selected for coronary artery bypass grafting (CABG) underwent ventriculoplasty. Additionally, 50% of the study population also underwent PMA (group 1). All the patients had preoperative grade 3 or 4 mitral regurgitation with an inter-papillary muscle distance > 2.5 cm. In group 1, the papillary muscles were drawn together using an encircling loop. Mitral annuloplasty and the Dor procedure were performed in all the patients. Follow-up time was 41.5 ± 5.8 months and 42.7 ± 3.3 months in groups 1 and 2, respectively (p-value=0.49). RESULTS The two groups had no significant difference regarding the annulus diameter, ring size, number of grafts, and concavity area. There was one case of in-hospital mortality in each group, and one patient in group 2 had expired by the last follow-up. Postoperative echocardiography revealed significant changes in the concavity area, ejection fraction, and sphericity index in the PMA group by comparison to group 2 (p-value < 0.05). CONCLUSIONS In patients with ischemic mitral regurgitation and increased papillary muscle distance, PMA as an adjunct to CABG results in better left ventricle function and shape, even at long-term follow-up.

Background. Zygomycosis is an opportunistic fungal infection mainly affecting patients with diabetes mellitus, immunodeficiency, and malignancies. The majority of cases in which it has been reported as a posttransplantation complication have been after renal or liver transplantation. There are few instances of rhino-sinusitis and orbital mucormycosis complicating heart transplantation. Case Report. A 38-year-old diabetic man who had undergone heart transplantation returned to the transplantation follow-up clinic 20 days after a successful operation with unilateral periorbital swelling, nasal discharge, and multiple cranial nerve dysfunctions. Multidisciplinary investigations resulted in detection of mucormycosis in the paranasal sinuses and the orbital space, as well as a thrombosis of the cavernous sinus. Surgical ablation of the infected parts, along with antifungal treatment and adjustment of immunosuppressive maintenance, restricted extension of the craniofacial involvement. Allograft function remained undisturbed. Conclusion. Early detection of opportunistic infections in transplant recipients plays a big role in preventing dissemination. Fungal infections, including zygomycosis, should be considered for recipients, especially those with risk factors, such as diabetes, who present with local unusual manifestations. Sinonasal and orbital mucormycosis, if diagnosed in timely fashion, can be managed to reduce mortality. Although devastation of one-side facial and ophthalmic structures was inevitable in this case, the overall outcome was acceptable.

ObjectiveCommonly used procedures to repair functional tricuspid regurgitation have a high failure rate. The present study was designed to lower this failure rate by reducing leaflet tethering via pericardial patch augmentation when the preoperative probability of recurrence was high.MethodsBetween 2001 and 2007, 210 patients with severe functional tricuspid regurgitation underwent tricuspid valve repair at the Day General Hospital. With respect to the type of repair, the patients were randomly divided into 4 groups: (1) De Vega in 52 patients; (2) ring annuloplasty in 53 patients; (3) De Vega and, if indicated by the preoperative tethering index (tethering distance > 8 mm or tethering area > 16 mm2), pericardial patch augmentation in 53 patients; and (4) ring annuloplasty and, if indicated by the preoperative tethering index (tethering distance > 8 mm or tethering area > 16 mm2), pericardial patch augmentation in 52 patients. The results of 1-month and 1-year postoperative tricuspid regurgitation were evaluated.ResultsFifteen patients in group 3 and 15 patients in group 4 met the criterion for the complementary procedure. Postoperative tricuspid regurgitation was different between the groups (P < .05): 16.0% and 28.0% of patients in the De Vega group, 8.0% and 14.0% of patients in the ring annuloplasty group, 4.0% and 10.0% of patients in the De Vega + pericardial patch augmentation group, and 2.0% and 8.0% of patients in the ring annuloplasty + pericardial patch augmentation group had postoperative tricuspid regurgitation at 1-month and 1-year follow-up, respectively.ConclusionAn assessment of preoperative tricuspid valve tethering to select patients suitable for augmentation contributes to a good surgical outcome in patients with severe functional tricuspid regurgitation.

In our previous study, we defined a cut-off point of 120 ms for atrial electromechanical interval (AEMi) to determine the risk of atrial fibrillation (AF) occurrence. Accordingly, the present study sought to investigate whether or not a prophylactic perioperative administration of amiodarone could reduce the incidence of AF in a high-risk group (AEMi >120 ms) undergoing coronary artery bypass grafting (CABG). In this prospective, randomized study, 100 patients with AEMi >120 ms received either amiodarone (n=50) or placebo (n=50). The endpoints were AF occurrence after CABG and hospital and intensive care unit (ICU) lengths of stay after CABG. The incidence of postoperative AF was significantly higher in the placebo group than that of the amiodarone group (88% of patients in control group vs. 16% of patients in amiodarone group, P

Background: Postoperative blindness has been mentioned as a rare complication of heart surgery. The majority of reported cases are caused by retinal artery occlusion or ischemic optic neuropathy. We report a case of transient visual loss due to cortical ischemia after coronary artery bypass grafting (CABG). Case Report: A 52-year-old nondiabetic man developed complete bilateral visual loss immediately after CABG. He had been normotensive throughout the operation. An ophthalmologic exam detected no causative ocular damage. The results of a Doppler study of the carotid, vertebral, and ophthalmic arteries were completely normal, and an echocardiography examination showed no left ventricular clot. Magnetic resonance imaging of the brain, however, showed several ischemic plaques in watershed areas and a small subacute infarct in the occipital lobe. Recovery began on postoperative day 4, and the patient's vision was restored in 6 months. Conclusion: Although most cases of visual loss after open heart surgery have been caused by injuries to the peripheral optic system, cortical blindness may occur following open heart surgery in the absence of any preexisting risk factor. Fortunately, the course of recovery is promising one, as it was for our patient.

The successful removal of a sewing needle from the heart of a 36-year-old female one year after penetration.

Recent studies define functional mitral regurgitation (MR) and worsened left ventricular (LV) systolic indices as the widening of the dimension between papillary muscle heads; consequently, narrowing this distance may improve the mitral valve and LV function. Thirty (22 males; mean age: 57+/-7 years) candidates for CABG underwent ventriculoplasty and in 50% of them papillary muscle approximation was also performed (group 1). All the patients had grade 3 to grade 4 MR with an interpapillary muscle distance of more than 2.5 cm. In group 1 the papillary muscles were drawn together by an encircling loop using a 4-mm Gore-Tex tube or umbilical tape. Mitral annuloplasty and Dor procedures were performed in all the patients. Postoperative echocardiography revealed significant changes in systolic and diastolic sphericity indices in the PMA group. There was one hospital death in each group, and within a short mean follow-up period of 9 months, there were no late deaths. Improvement of NYHA class and MR were significantly better in the PMA group. Papillary muscle approximation in selected patients has a clear effect on the mitral valve and LV shape by reducing tethering and sphericity due to the displacement of the papillary muscles.

INTRODUCTION: Low-grade endometrial stromal sarcoma (LG-ESS) is a malignant intrauterine tumor that rarely presents with distant metastasis. Simultaneous lung and cardiac metastases from LG-ESS is also an extremely rare event. CASE PRESENTATION: A 42-year-old woman presented with dyspnea and exercise intolerance. She had a history of hysterectomy and left salpingoophorectomy. She underwent second laparotomy as well as right oophorectomy after new finding of vaginal mass with histopathologic diagnosis of LG-ESS. Cardiac imaging techniques demonstrated tumoral process in the right atrium and ventricle, coronary sinus, and pulmonary outlet tract as well as multiple metastases in the lung fields. Successful complete surgical resection of the metastatic tumor in the right side of the heart and then radiotherapy were done. After 28 months, follow-up examination revealed no abnormality. CONCLUSIONS: We describe the first documented case of isolated intracardiac and lung metastases of a LG-ESS without concurrent abdominal or caval metastasis.

Background Behçet's disease is a collagen-vascular disease most commonly seen in Asia and Mediterranean area. Different organs and systems including cardiovascular system could be involved. Pseudoaneurysm is the most common form of arterial involvement in Behçet's disease; however, cardiac pseudoaneurysm is rare. Case Presentation A rare case of 13 years old boy with a 4-year history of Behçet's disease with development of a huge left ventricular pseudoaneurysm is reported who had been admitted because of cough, chills, fever, and chest pain. Findings obtained on echocardiography, magnetic resonance imaging, chest computed tomography and coronary angiography confirmed a left ventricular pseudoaneurysm. There was no complication for next 24 months follow up period after surgical treatment. Conclusion Considering its fatality and nonspecific manifestations, one should consider cardiac pseudoaneurysms as a potential risk in any patient with Behçet's disease.

A 53-year-old woman presented to our center with progressive fatigue and dyspnea on exertion (New York Heart Association functional class III). The patient's medical history was significant for multiple cardiac interventions: open mitral commissurotomy for the treatment of rheumatic mitral stenosis

Surgical treatment of mitral regurgitation, especially when compounded by ventricular aneurysm, remains a challenge. Several procedures have been developed to repair the mitral valve and reduce regurgitation. We describe a technique of intraventricular annuloplasty which is much less time-consuming than mitral valve repair through a left atriotomy. This procedure is considered technically easy and useful.

A 30-year-old man was kicked in the chest during a fight and developed chest pain. He presented to the hospital the same day, but it was thought that the pain was due to a broken rib and he was discharged with nonsteroidal antiinflammatory drugs. The pain was intermittent and continued; after three days he was referred to our hospital for a possible cardiac source of the pain. An electrocardiogram showed extensive anteroseptal myocardial infarction, and ST segment was elevated in leads V1 to V6. Cardiac enzymes were elevated. Echocardiography demonstrated akinesia in all left anterior descending artery territory. The patient underwent angiography, which demonstrated that the left anterior descending artery was totally occluded at the proximal portion. The other coronary arteries were completely normal (Figs 1 and 2). A stent was placed in the left anterior descending artery, and the blood flow was restored (Fig 3). After 3 months, the patient developed ischemic cardiomyopathy. He had a left ventricle ejection fraction of 15 and right ventricle ejection fraction of 15. He is being treated medically for heart failure. Fig 1.

© 2011 by The Society of Thoracic Surgeons Published by Elsevier Inc large paravalvular leak for which he had undergone Amplatzer closure 5 months prior. Laboratory tests confirmed hemolysis, and echocardiography and fluoroscopy showed restricted motion of prosthetic valve leaflet. The patient underwent surgery, which revealed the interference of the Amplatzer in valve mobility (Figs 1 and 2). The Amplatzer was thereafter removed, Fig 2.

We read with interest the case report titled ‘Intra-atrial implantation of a mitral valve prosthesis in a heavily calcified mitral annulus’ by Atoui et al. [1]. As noted in the article, in cases of severe mitral valve annulus calcification there is always difficulty implanting the prosthetic valve. We agree that the presented technique can be life saving; however, it should be remembered that there remains the risk of dehiscence due to the weakness of the left atrial wall and paravalvular leak is an important and common complication. In a similar patient who had presented to our centre with severe congenital mitral regurgitation in childhood, due to impossibility of implanting the prosthetic valve in the annulus, the valvewas placed in the left atrialwall. Thepatient presented2 years laterwith severe paravalvular leak and the next surgeon considering this as only a paravalvular leak proceeded with closing the leak. Unfortunately, the patient developed paravalvular leak and dehiscence again as a result of the left atrial wall weakness. In such cases, we recommend using a two-layered Dacron patch to reduce tension to the left atrial wall. A hole is made in the centre of the patch where the valve is to be placed and sutured. Then the Dacron with the prosthetic valve implanted in its centre is sutured to the left atrial wall. With this technique the chance of dehiscence from the left atrial wall is reduced.

A 50-year-old man with a history of left ventricular aneurysmectomy was evaluated with a 64-multislice computed tomogram, which demonstrated left ventricular enlargement and a pseudoaneurysm at the apicolateral side. The images were critical to our management. We resected the pseudoaneurysm with an excellent outcome.

This recently published article by Albertini et al. [1] beautifully depicts the modified Bentall operation: the double sewing ring technique. We have made use of a similar technique for years, but unfortunately it does not mean that it renders the use of bioprosthetic valves any easier. We had two patients with prosthetic valve malfunction, which necessitated valve replacement. Surgery proved problematic, however, because even utilizing a Valsalva tube did not reduce the probability of the dehiscence of the coronary ostia or the whole graft. The present manuscript states that neither patient required reoperation, but we are inclined to believe that the patients in question will refer to the hospital in the near future for the same problem. We employ this technique for patients with small aortic annuluses or for patients who need root enlargement because, as the manuscript itself attests, not only does this independent selection of graft and valve size minimize the chance of valve-to-graft mismatch but also the use of smaller size sutures decreases the probability of bleeding. In conclusion, although this technique is suitable for small or calcified annuluses, we fear that an extensive use of this technique with bioprosthetic valves could beget trouble. Consequently, it is advisable that this technique not be recommended for the time being until the patients’ followup is complete. Reference