Delayed post-traumatic tamponade together with rupture of the tricuspid valve in a 15 year old boy

With the increase in the number of high speed motor vehicle accidents, blunt, non-penetrating trauma to the heart has become an important health problem. An unusual case is reported of a 15 year old boy urgently referred with cardiac tamponade and a new systolic murmur four months after a car accident. The problems of the diagnosis and possible causes of late cardiac tamponade and tricuspid regurgitation following this type of accident are discussed.

Usefulness of low-dose dobutamine stress echocardiography in predicting recovery of poor left ventricular function in atrial fibrillation dilated cardiomyopathy

Assessment of contractile reserve was performed in 16 patients with dilated cardiomyopathy and chronic atrial fibrillation. In this prospective study, low-dose dobutamine echocardiography could predict recovery of left ventricular dysfunction and could identify tachycardiomyopathy before restoration of sinus rhythm.

Elective Wiktor GX stenting for symptomatic stenosis in old aortocoronary saphenous vein bypass grafts: the Antwerp experience

PURPOSE

We compared initial outcome, peri-procedural complications and long-term clinical follow-up of elective Wiktor GX stent implantation in severely narrowed vein grafts to a historic register of elective angioplasties in saphenous vein grafts in the same center.

METHODS

Eighty-one consecutive patients with angina and a history of coronary artery bypass grafting (CABG), all received elective angioplasty (PTCA) of the diseased graft; we described them as group P. The next 38 consecutive patients were treated with elective angioplasty and Wiktor Stent implantation, followed by one month ticlopidine; they were called group S.

CONCLUSION

This retrospective study suggests that elective Wiktor stenting in old saphenous vein graft stenosis, in combination with one month ticlopidine, leads to: 1) a better angiographic result, with reduction of peri-procedural complications; and 2) a lower incidence of recurrent angina, need for invasive or surgical re-intervention, myocardial infarction and death during follow-up.

Fetal ascites associated with an imperforate hymen: sonographic observation

We report a case of fetal ascites in which no abnormalities other than an imperforate hymen were noted. The ascites resolved after abdominal tap and incision of the hymen. A possible mechanism for an association between imperforate hymen and fetal ascites is proposed.

Benign ulcer in a hiatus hernia complicated with a pericardial fistula

Penetration of the pericardium by upper gastrointestinal lesions is uncommon. It usually results from trauma, perforation of foreign objects, perforation from gastric or thoracic neoplasm or spontaneous perforation. Unfrequently it is a complication of a benign peptic ulcer of the esophagus or the stomach. Survival from peptic ulcers penetrating to the heart is very rare. From a review of the English literature only 11 survivors have been described. We report the successful outcome of a 76 year old lady with a benign ulcus in a hiatus hernia perforating into the pericardium. Diagnosis of the fistula was established after methylene blue swallow. Treatment consisted of early pericardiotomy and drainage followed by surgical correction of the ulcer and fundoplication of the hiatus hernia.

Escherichia coli endocarditis of a native mitral valve with paravalvular pseudoaneurysm formation and fatal hemopericardium

Until recently only few cases have been described of acute infective endocarditis with E. Coli limited to a normal native mitral valve. Furthermore, mechanisms of so called abcess formation and rupture are still uncompletely understood. We report the case of an E. Coli endocarditis developing a rapidly progressive pseudoaneurysm of the mitral annulus. At necropsy diffuse infectious tissue weakening with pseudoaneurysm formation of the mitral ring and dissection into an hemorraghic pericard were seen. The authors further discuss the changing pattern of infectious agents causing acute infective endocarditis of the native mitral valve, transesophageal echocardiographic characteristics of paravalvular cavities and insights in mechanisms of pseudoaneurysm formation and dissection from clinicopathological findings.

Two siblings with midline field defects and Hirschsprung disease: variable expression of Toriello-Carey or new syndrome?

We describe 2 sibs with multiple congenital anomalies. The main manifestations include hypoplasia of the corpus callosum and/or cerebellar hypoplasia, Robin sequence, pharyngeal and laryngeal hypoplasia, abnormal ears, excessive neck skin, cardiac defect, and Hirschsprung disease. The presence in 2 sibs born to healthy, consanguineous parents suggests autosomal recessive inheritance. These anomalies must have arisen during blastogenesis; the syndrome resembles most the condition described in 1988 by Toriello and Carey.