(18)F-fluorodeoxyglucose uptake by positron emission tomography in patients with IPAH and CTEPH

Pulmonary arterial hypertension (PAH) is driven by pathologies associated with increased metabolism such as pulmonary revascularization, vasoconstriction and smooth muscle cell proliferation in pulmonary artery wall. 18-fluorodeoxyglucose positron emission tomography (18FDG-PET) is an imaging technique sensitive to glucose metabolism and might be considered as a non-invasive method for diagnosis due to significant role of inflammation in idiopathic pulmonary artery hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The present study aimed to investigate the role of PET/CT imaging of patients with IPAH and CTEPH as an alternative diagnosis method. Demographic characteristics, FDG uptake in lungs, pulmonary artery and right ventricle (RV) of 17 patients (10 IPAH, 7 CTEPH), and 30 controls were evaluated. PET scanning, 6-min walk test, pro-BNP level, right heart catheterization of patients were performed both at the onsert and after 6-month PAH specific treatment. IPAH and CTEPH patients had significantly higher left lung FDG (p = 0.006), right lung FDG (p = 0.004), right atrial (RA) FDG (p < 0.001) and RV FDG (p < 0.001) uptakes than controls. Positive correlation was detected between the RV FDG uptake and the mean pulmonary artery pressure (mPAP) (r = 0.7, p = 0.012) and between the RA FDG uptake and the right atrial pressure (RAP) (r = 0.5, p = 0.02). Increased RV FDG and RA FDG uptakes predicts the presence of pulmonary hypertension and correlates with mPAP and RAP, respectively, which are important indicators in the prognosis of PAH. Further studies are required whether FDG PET imaging can be used to diagnose or predict the prognosis of pulmonary hypertension.

[Diagnosis and therapy of aortic stenosis in older age. When does it become critical?]

Together with mitral valve insufficiency, aortic stenosis is the most common heart defect in adulthood. The two major forms are degenerative senile aortic stenosis of old age, and secondary degenerated bicuspid valve manifesting in middle age. A typical feature is a lengthy asymptomatic course due to compensating ventricular hypertrophy with a constant systolic wall tension. With the aid of Doppler echocardiography aortic stenosis can be accurately quantified. Although effective drug treatment is not available, evidence is mounting that statins are capable of slowing the progression of valvular sclerosis, presumably on the basis of pleiotropic, anti-inflammatory effects. As a rule, the onset of symptoms (dyspnea, angina, syncope) is an indication for surgery. As a result of rising life expectancy, the proportion of elderly and very old patients with degenerative senile aortic stenosis is increasing appreciably, and presents a challenge in terms of deciding appropriate individual therapy. Advances in valvular surgery in high old age, however, can offer many of these patients the option of a procedure with an acceptably low risk and longer-term prognostic and symptomatic benefits following successful surgery.

[Clinical, anatomical-pathological and therapeutic correlates of benign intracavitary heart tumors]

Benign intracavitary cardiac tumors lead to "malignant" complications, so early diagnosis and adequate treatment are of vital importance. Our investigation summarizes a 10-year experience after surgical treatment of 29 patients suffering from benign intracavitary cardiac tumors. The postoperative histological examination revealed a myxoma in 27 cases; in 2 cases a papillary fibroelastoma was diagnosed. The main symptom in 19 patients was dyspnea. In 8 cases an embolic event occurred. All patients underwent extirpation of the tumor. Early mortality was 10%, while late mortality was 4%. The treatment of choice of benign intracavitary cardiac tumors is extirpation, which, due to unpredictable embolic complications, is to be carried out immediately should the tumor have a lobulated tuberous surface. In such cases the descriptive function of echocardiography is of considerable importance.

[Surgical treatment of acute pericardial tamponade in an infestation of the heart by Echinococcus]

HISTORY AND CLINICAL FINDINGS

A 56-year-old turkish patient, previously in good health, was admitted because of pain suggesting myocardial infarction. Physical examination of the heart, lungs and abdomen was unremarkable.

INVESTIGATIONS AND DIAGNOSIS

The concentrations of myocardium-specific enzymes were not elevated and the ECG showed no signs of ischaemia. Echocardiography and magnetic resonance imaging ruled out acute aortic dissection, but demonstrated a round cystic space-occupying mass over the anterior wall of the heart. Hydatid cyst was suspected from the imaging results and the patient's origin from area endemic for Echinococcus. The diagnosis was confirmed by a titre of 1:6,400 (normal: 1: < 100) for Echinococcus antibodies.

TREATMENT AND COURSE

Albendazole administration was initiated. Planned elective surgical removal of the hysatid cyst had to be performed urgently because of acute pericardial tamponade. Cyst rupture was suspected but an actually undamaged cyst was subtotally removed under cardiopulmonary bypass. The postoperative course was uneventful and albendazole treatment was continued.

CONCLUSION

Because of the high incidence of fatal complications urgent surgical removal under cardiopulmonary bypass is the treatment of choice for hydatid cyst involving the heart. Perioperative albendazole administration is also essential.