Medzi najčastejšie primárne nádory pulmonálnej chlopne a pulmonálnej artérie patrí schwanóm, myxóm, papilárny fi broelastóm, primárny choriokarcinóm a sarkóm. Výskyt týchto histologických typov nádorov je veľmi raritný. Medzi najčastejšie klinické manifestácie tumorov pulmonálnej artérie patrí dýchavica, bolesť na hrudi, kašeľ a hemoptýza. Prezentovaná je kazuistika 44-ročného muža s anamnézou zhoršujúcej sa dýchavice, febrilít, kašľa a straty hmotnosti. Vyšetrenia zobrazovacími metódami poukázali na veľkú nasadajúcu embóliu výtokovej časti pravej komory, pulmonálnej chlopne a kmeňa pulmonálnej artérie. Pacient bol prijatý do nemocnice za účelom antikoagulačnej terapie. Vzhľadom na neúspešnosť konzervatívnej terapie bol pacient indikovaný k operácii. Peropečne bol zistený tumor pulmonálnej chlopne vypĺňajúci takmer celý lumen pulmonálnej artérie a viaceré menšie tumory výtokového traktu pravej komory a pulmonálnej artérie. Histologické vyšetrenie tumoru poukázalo na leiomysarkóm high grade 3. Prezentovaná kazuistika zdôrazňuje, že tumor pulmonálnej artérie by mal byť stále zahrnutý do diferenciálnej diagnostiky pulmonálnej embólie. To platí najmä v prípade zvýraznenia symptómov i pri adekvátnej antikoagulácii a absencii rizikových faktorov hlbokej žilovej trombózy. Vzhľadom na neskorú diagnostiku ostáva prognóza pacientov so sarkómom pulmonálnej chlopne hrozivá.

Objectives: The primary aim of this retrospective study was to evaluate short-term (one-to-six months) and mid-term (six-to-forty-eight months) results of aortic valve-sparing procedures. The second endpoint was to compare the results with the group of patients undergoing mechanical aortic valve replacement during the same period. Methods: Between April 2008 and May 2012 at our institution, we treated 76 patients either with ascending aorta/root aneurysm/dissection or with isolated aortic regurgitation. A total of seventy-six patients undergoing aortic valve surgery. Results: Analyzed parameters were divided into two parts as function of time. In the fi rst part, i.e. during hospitalization, the mortality, duration of hospitalization, duration of extra corporeal circulation (ECC), and duration of cardiac arrest (CA) were compared and assessed. In the second part, i.e. during monitoring of the patients after their discharge from hospital (one-to-six months, and six-to-forty-eight months), the grade of postoperative AR aimed mainly at the group of aortic valve-sparing operations (subgroups A1, A2, A3), postoperative peak gradient, presence of thromboembolic and bleeding complications, postoperative endocarditis and need for reoperation or hospitalization due to cardiac reasons were analyzed. Conclusion: Based on our fi rst experience, we believe that in spite of higher technical diffi culty, the aortic valvesparing operations can be possibly performed with the same or respectively lower rate of postoperative morbidity and mortality. Presented results show that compared with the aortic valve replacement, the aortic valve-sparing operation is a promising method, and an interesting therapeutic alternative for patients. After proper indications, we consider it to be a method of choice (Tab. 6, Fig. 7, Ref. 28).

Abstract:Background: Aortic coarctation in adults is sometimes associated with concomitant cardiovascular pathologies which require intervention. The optimal operative approach for such patients remains unsettled. An extra-anatomic aortic bypass from the ascending aorta to the descending aorta via median sternotomy allows simultaneous performance of repair of complex aortic coarctation and concomitant cardiac operation. Case report: We present herein an adult female with coarctation of the aorta combined with an ascending aortic aneurysm associated with concomitant aortic valve regurgitation. We performed a single-stage operation which consisted of Bentall's procedure and extra-anatomic bypass from the ascending to the descending aorta. The patient's postoperative period was uneventful and twelve months after the surgery she is doing well. The conclusions of our work resulted in one essential experience, namely that clinically serious, previously almost intractable conditions can be successfully resolved in unusual ways. Extra-anatomic reconstruction of aorta coarctation that for various reasons could not have been solved by resection of the affected aortic segment allowed us to achieve a structurally as well as functionally excellent outcome. Therefore, we recommend to consider this option in appropriate patients and/or incorporate it into the therapeutic armamentarium of cardiosurgical centers (Fig. 5, Ref. 11 Coarctation of the aorta is a common congenital defect which, unless primarily detected and surgically corrected in childhood, may remain undiagnosed until adulthood. In most patients it is then discovered during examination of systemic hypertension (1). Moreover, coarctation is commonly associated with concomitant cardiac congenital or acquired pathology that may require surgical intervention. In addition, 5 % to 30 % of patients with previous coarctation repair have recoarctation and require reintervention (2).Aortic coarctation is a serious pathology which requires surgical or endovascular treatment. About 50 % of cases of uncorrected isolated aortic coarctation are lost up to the age of 10; only 10 % may reach the age of 50. The most common reason for death from untreated aortic coarctation is the rupture of aortic aneurysm or side branches with a rate of 23 % (3).The management of aortic coarctation associated with other cardiac pathology in adults appears to be a great surgical challenge. Insuffi cient clinical data due to the small number of these patients on the one hand and a large variety of complicating factors on the other are the reasons why there is no consensus on the optimal approach. Debates exist not only as to which lesion should be corrected fi rst but also in regard to the type and timing of the procedure. Surgery can be one-or two-staged (4). An alternative surgical approach is an anatomic left-sided short aortic bypass from the arcus aorta to the descending aorta via median sternotomy, which allows a simultaneous repair of a complex aortic coarctation and concomitant cardiac operat...

In this article, we report the autopsy findings of a 48-year-old man who sustained blunt trauma to the thorax. A medical record review revealed no history of cardiac disease. He presented to the hospital with a computed tomography–verified fracture of the left fourth and fifth ribs, and pulmonary and cardiac contusion. He was released from the hospital in stable condition at his own request 7 days later. Because of sudden deterioration, he was readmitted to the hospital the next day. Electrocardiogram detected cardiac arrhythmia on the 15th day after chest trauma. Electrocardiography detected pericardial effusion and severe mitral insufficiency resulting in left ventricular failure. Death was attributed to diffuse alveolar damage–complicating pneumonia due to cardiac contusion with mitral insufficiency occurring 25 days after hospital admission. Internal examination revealed diffuse fibrinous pericarditis, left atrial tear right above the anterior mitral valve leaflet with intrapericardial granulation tissue, and no sign of myocardial damage. Immunohistochemistry showed significantly more CD68-positive macrophages within tissue taken from the heart, a finding indicative of previous atrial and ventricular myocardial contusion. This case report demonstrates that routine hematoxylin and eosin staining may not always reveal significant myocardial damage.

This article reports the autopsy findings of a 1.5-year-old girl with no history of previous hospital admission who suddenly collapsed at home. After 45 minutes of resuscitation efforts, the cardiac activity was restored. During hospitalization, she had ventricular arrhythmia and extremely elevated cardiac troponin levels. Internal examination and immunohistochemistry revealed cardiac fibromas of the right and left ventricles and extensive hypoxic myocardial damage. The right ventricular fibroma demonstrated interdigitating and entrapped myocardium visible at the edges and within the central portion of the tumor. The left ventricular fibroma originated in the subepicardial region and propagated towards the endocardium.