Cardiac Vascular Hamartoma: Adult Diagnosis and Cardiac Reconstruction

Cardiac hamartoma is a rare benign tumor of the heart, and the vascular type is an extremely rare histologic diagnosis. A small number of cases have previously been described in childhood. We report the case of a 63-year-old woman with an incidentally detected cardiac mass that was finally diagnosed as vascular hamartoma. Approval for publication was obtained from the patient.

What if Valve-in-Valve TAVR fails? Is surgical re-replacement still an option in high-risk patients? A case report

Redo surgical aortic valve replacement has been the gold standard for the treatment of degenerated bioprostheses; however it carries an inherent risk associated with a reoperative open heart surgery. Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as an alternative approach. Few articles in literature review transcatheter aortic valve replacement's failure rates, complications (i.e., valve dislocation, paravalvular leaks) and their surgical management. The rate of reoperations after a percutaneous approach is expected to increase, with the currently rising number of transcatheter procedures worldwide even in patients with a longer life expectancy. Valve dislocation is a rare but serious complication that can severely impact on the outcome of patients. Paravalvular leaks and structural valve degeneration are the most common causes of surgical re-intervention. We present the case of a complex patient with previous surgical aortic valve and ascending aorta replacement who underwent a transfemoral valve-in-valve TAVI for bioprosthesis degeneration, complicated by valve dislocation requiring surgical reoperation.

Radial Artery Versus Saphenous Vein as Third Conduit in Coronary Artery Bypass Graft Surgery for Multivessel Coronary Artery Disease: a Ten-Year Literature Review

Coronary artery bypass grafting is the gold standard strategy for obtaining complete coronary revascularization in patients with multivessel coronary artery disease. The recent AHA and EACTS guidelines on myocardial revascularization recommend total arterial revascularization, especially in younger patients, whenever possible. However, the use of saphenous vein grafts in association with single or bilateral internal thoracic artery (SITA, BITA) instead of arterial grafts (radial arteries, right gastroepiploic artery and inferior epigastric artery) is widespread. We analyzed literature from the last ten years (January 2010 to December 2020) looking for evidence in favour of the use of a radial artery compared to a saphenous vein in association with BITA. We identified nine studies (4 Systematic Reviews and Meta-analyses and 6 large cohort observational studies with propensity score-matching) that compared arterial with saphenous grafts as third conduit. The main finding of the review is the higher rate of freedom from any cardiac adverse event in the population which reached Total Arterial myocardial Revascularization (TAR). A probable reason for the limited application of TAR as a strategy is the shortage of Randomized Controlled Trials (RCTs).

Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis

Background. Long-term outcomes of patients with infective endocarditis (IE) who received either a mechanical (MP) or biological prosthesis (BP) are conflicting. A meta-analysis of observational studies comparing the long-term outcomes of left-side IE with the use of MP versus BP was performed. Methods. Electronic databases from January 2000 to June 2021 were screened. Studies reporting long-term mortality were analyzed. The primary endpoint was long-term overall mortality. Secondary endpoints were in-hospital/.30-day mortality and freedom from both prosthesis reinfection and reintervention. The pooled hazard ratio (HR) with 95% confidence interval (CI) was calculated for survival according to the random effect model. Results. Thirteen retrospective observational studies reporting on 8645 patients (MP: 4688; BP: 4137) were included for comparison. Twelve studies reported data of long-term survival for a total of 8285 patients (MP: 4517; BP: 3768). The pooled analysis revealed that the use of MP was statistically associated with longer benefits compared to BP (HR 0.74; 95% CI 0.63–0.86; p < 0.0001). The median follow-up time ranged from 1 to 15.3 years. The pooled analysis of five studies reporting data on prosthesis reinfection in 4491 patients (MP: 2433; BP: 2058) did not reveal significant differences (HR 0.60; 95% CI 0.30–1.21; p = 0.15). Five studies reported data on prosthesis reintervention in 4401 patients (MP: 2307; BP: 2094). The meta-analysis revealed a significant difference in favor of MP (HR 0.40; 95% CI 0.29–0.55; p < 0.0001). Meta-regression reported no effect of male gender (p = 0.09) and age (p = 0.77) on long-term survival. Conclusions. In a meta-analysis of retrospective observational studies comparing the long-term outcome of patients who underwent surgery for left-sided IE, the use of MP compared to BP is associated with a significant longer-term survival and with a reduced incidence of late reoperation. The incidence of late reinfection is comparable between the two prostheses.

Mitral annulus calcification: current management and future challenges

Mitral annulus calcification is a chronic degenerative process in the fibrous base of the mitral valve. Assessment and treatment of mitral valve disease in patients with severe mitral annulus calcification is challenging, and a multimodal approach is helpful to delineate its severity and anatomic features, and to guide the therapeutic strategy. This article reviews the current literature to provide a clinically relevant description of mitral annulus calcification, analyze the diagnostic pathway of a patient with mitral annulus calcification, and summarize the therapeutic options.

The use of RemoweLL oxygenator-integrated device in the prevention of the complications related to aortic valve surgery in the elderly patient: Preliminary results

Background The effects of fat microembolization due to cardiopulmonary bypass are well known in cardiac surgery. Our aim is to evaluate the use of the RemoweLL device (Eurosets, Medolla, Italy) during elective aortic valve replacement in elderly patients (>70 years old) to rate its biochemical and clinical effects. The RemoweLL device is an oxygenator-integrated reservoir which combines two strategies for fat emboli and leucocytes removal: filtration and supernatant elimination. Methods Forty-four elderly patients were enrolled and assigned randomly to a Group A (standard device) and a Group B (RemoweLL). Biochemical effects were evaluated by blood samples, which were tested for white blood cells, neutrophils, protein SP-100 and interleukin 6 besides standard lab tests. Our clinical endpoints were any type of neurological, cardiac, respiratory, gastrointestinal or renal complications, and length of stay in the intensive care unit. Statistical analysis was carried out with chi square test for non-parametric data; t test and analysis of variance for repeated measures were used for parametric data. Results Group B showed lower levels of white blood cells, neutrophils, interleukin 6 and protein SP-100 immediately and 24 hours after the operation. Group B also showed a lower amount of neurocognitive type II dysfunction even if the length of stay in the ICU did not change. Conclusions The RemoweLL system is safe and effective in reducing inflammatory response to cardiopulmonary bypass and it could be a useful tool in minimizing negative effects of cardiopulmonary bypass; however, it does not seem to have any effect on elderly patients' hospital stay.

[Peripheral embolization and rapid growth of papillary fibroelastoma in a young woman]

Papillary fibroelastoma, a benign cardiac tumor, is a rare clinical condition. Before the echocardiography era, the diagnosis was often occasional, especially during other cardiac procedures; but nowadays it has improved with the advent of higher-resolution imaging technology. The clinical presentation can vary from asymptomatic to severe complications such as cerebrovascular or ischemic events due to tumor embolization.We present the case of a 33-year-old female with a papillary fibroelastoma on the anterior leaflet of the mitral valve undergoing clinical examination for claudicatio intermittens. An occlusion of the left common femoral artery was present. The diagnosis was made posteriorly after embolectomy. All cardiac imaging investigations were negative. The heart team decided a strict echocardiographic follow-up every 3 months, and after the first visit a pedunculated mass was detected on the anterior mitral leaflet. The surgical management included urgent resection of the tumor on cardiopulmonary bypass using a minimally invasive approach via a right anterior minithoracotomy. The postoperative course was uneventful. We emphasize the need for surgical treatment given the potential risk of relapse. When no mass is detected on imaging, a strict echocardiographic follow-up and antiplatelet therapy are mandatory.

Disseminated echinococcosis: follow your heart

: In this report, we present a rare case of cardiac echinococcosis presenting with cerebral haemorrhage due to rupture of a mycotic aneurysm in a peripheral branch of the media cerebral artery. Further investigations lead to discovery of multiple cysts in the heart and liver. The complementary use of transthoracic and transoesophageal echocardiography, MRI and computed tomography lead to the final diagnosis of disseminated echinococcosis and allowed precise evaluation of the anatomical and structural characteristics of the cardiac mass, its boundaries and its relationship with the surrounding anatomic structures.