1/12. Congenital malformations of the right atrium and the coronary sinus: an analysis based on 103 cases reported in the literature and two additional cases.STUDY OBJECTIVES: Congenital malformations of the right atrium (RA) and the coronary sinus (CS) are rare, and only sporadic cases have been reported. Little is known about the clinical relevance of this disorder. We report on two patients, one with a giant RA diverticulum, the other with a diverticulum of the CS, and review 103 cases of such malformations that have been reported previously. DESIGN: A medline search was performed to collect all cases of congenital malformations of the RA and the CS reported in the literature between 1955 and 1998. Cases were classified into the following categories: (1) congenital enlargement of the RA; (2) single diverticulum of the RA; (3) multiple diverticula of the RA; and (4) diverticulum of the CS. Clinical presentation and outcome of the different types of malformations were analyzed. RESULTS: The patients most frequently presenting with symptoms were those with diverticula of the CS (n = 28) followed by those with single diverticula of the RA (n = 13), multiple diverticula (n = 4), and congenital enlargements of the RA (n = 60). The percentages of symptomatic patients were 93, 84, 75, and 53%, respectively. Symptoms were frequently caused by arrhythmias. Supraventricular tachycardia (SVT) was found in 42 of the patients (40%) and was most common in patients with diverticula of the CS (24 of 28 patients) and multiple atrial diverticula (3 of 4 patients). Sudden cardiac death was reported more frequently in patients with diverticula of the CS (18%) compared to those with congenital enlargement of the RA (5%) or single or multiple diverticula of the RA (6%). All seven patients with diverticula of the CS who were not treated with catheter or surgical ablation eventually died. CONCLUSION: Congenital malformations of the RA and the CS frequently are associated with arrhythmias. SVT and sudden cardiac death have been reported in a significant percentage of patients with diverticula of the CS.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/12. Giant negative T waves during interferon therapy in a patient with chronic hepatitis c.interferon-alpha (IFN-alpha) has been widely used for treatment of chronic hepatitis c in japan. In general, cardiovascular adverse reactions are rare in association with IFN-alpha therapy. Here, a 64-year-old man with chronic active hepatitis c complained of fatigue, palpitation and depression, and developed atrial fibrillation with prominent negative T waves during IFN-alpha therapy. Echocardiogram showed septal and apical hypertrophy. Three days after discontinuation of IFN-alpha, subjective symptoms and atrial fibrillation subsided. It is unclear whether or not IFN-alpha induced the giant negative T waves with apical hypertrophy. We might observe the developing course of hepatitis c virus (HCV)-related myocardial hypertrophy by chance. Cardiovascular toxicity should be carefully monitored during IFN-alpha therapy even in patients with minor cardiac disease, such as premature ventricular contracture (PVC) and mild hypertension.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/12. Paroxysmal postural dyspnea related to a left atrial ball thrombus.We report herein an uncommon clinical observation of a 82-year-old woman with paroxysmal postural dyspnea related to a giant ball-thrombus located in the left atrium and partly protruding through the mitral orifice. No mitral stenosis was otherwise disclosed. The patient had a previous medical history of chronic atrial fibrillation without any anticoagulant therapy. The atrial mass was easily removed and the postoperative course was uneventful. disclosure of such a free-floating ball-thrombus in the left atrial cavity requires prompt surgical treatment because of high risks of acute hemodynamic decompensation due to obstruction of the left ventricular inflow or, more rarely, systemic embolic events.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/12. Giant multiperforated atrial septal aneurysm in a patient with paroxysmal atrial fibrillation.With the widespread use of transoesophageal echocardiography, atrial septal aneurysm (ASA) is frequently and easily recognized. Diagnostic criteria, however, remain arbitrary. A meticulous search for interatrial shunting (most often patent foramen ovale (PFO)) and associated cardiac diseases is important. ASA is considered a risk factor for cardioembolism, especially in association with patent foramen ovale. We describe a patient with a giant multiperforated ASA presenting with refractory paroxysmal atrial fibrillation. Resection of the aneurysm was performed in combination with a surgical Maze procedure.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
5/12. Large aneurysms of the ascending aorta and major coronary arteries in a patient with hereditary hemorrhagic telangiectasia.We describe a 50-year-old man with a history of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) who presented with chest pain, atrial fibrillation, and congestive heart failure. echocardiography revealed a large ascending aortic aneurysm accompanied by severe aortic regurgitation and giant coronary artery aneurysms involving the right, left main, left anterior descending, and circumflex coronary arteries. coronary angiography clearly defined multiple aneurysms involving the aorta and coronary arteries. The patient underwent complex and successful surgical repair of the aneurysms. To our knowledge, this is the first reported case of extensive cardiac involvement in a patient with this uncommon genetic disorder.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
6/12. Solitary pericardial hydatid cyst.Hydatid cyst of the heart is an uncommon presentation of human echinococcosis which may lead to life-threatening conditions. diagnosis should be suspected in every case of cyst-like mass in persons coming from areas where echinococcus granulosus is endemic. echocardiography, computed tomography and magnetic resonance imaging can help in the differential diagnosis of the lesion. Even if some reports of successful therapy with benzimidazoles have been described, the treatment of choice is the surgical excision of the cyst. pericardiectomy with cyst removal is feasible with low morbidity and mortality rates even in elder patients. The authors describe the successful surgical management of a single giant pericardial hydatid cyst in a 78-year-old woman from North africa.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/12. Minimal invasive endoscopic resection of a giant left atrial appendage aneurysm.We report a case of a 35-year-old male patient who presented with chronic atrial fibrillation secondary to a massive congenital left atrial appendage aneurysm. Minimal invasive endoscopic resection of the left atrial aneurysm with cryoablation was performed. The patient was discharged home in sinus rhythm.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
8/12. mitral valve replacement in a patient with a collapsed lung and a giant abscess.mitral valve replacement was performed on a 75-year-old man with a history of pulmonary tuberculosis. Computed tomography showed a collapsed left lung and counterclockwise rotation of the heart due to a hard abscess. Surgery was performed through a median sternotomy, and extensive pericardial suspension was useful for obtaining an adequate view. Despite poor pulmonary function, the patient was extubated on the day of surgery and had an uneventful postoperative course. Cardiac surgery can be performed in patients with a single functional lung if their preoperative respiratory function is good enough to have daily life without dyspnea.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
9/12. Ocular ichemia syndrome - a malignant course of giant cell arteritis.PURPOSE: To call attention to a malignant course of ocular ischemic syndrome in patients with giant cell arteritis (GCA). methods/PATIENT: A 84-year-old woman developed severe headache for about 3 (1/2) months prior to myocardial infarction and visual disturbances. RESULTS: An anterior ischemic optic neuropathy (AION) in the right eye with a distinct reduction in visual acuity was found. The retina revealed several cotton-wool spots in both eyes. Serologic examinations showed inflammatory signs. Despite treatment with prednisolone, eye pressure decreased to 2 mm Hg in the right eye and 4 mm Hg in the left eye in a few days. An ischemic iritis developed in the right eye. visual acuity worsened to detection of hand motions in the right eye and to 0.1 in the left eye. Approximately 8 (1/2) months after her initial headache, a biopsy was carried out. The patient was treated continuously with corticosteroids. histology of the superficial temporal artery indicated inflammatory cells in the vessel wall. - The patients daughter developed symptoms of GCA at the age of 54 years. CONCLUSION: An ocular ischemic syndrome points to a malignant course of the disease. A cardiac infarction can develop in GCA. A biopsy of the temporal artery can reveal inflammatory changes even after 8 (1/2) months.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
10/12. Giant aortic aneurysm 18 years after repair of double-outlet right ventricle with pulmonary stenosis.Substantial long-term morbidity after a successful operation in complex congenital heart defects is a matter of concern. We present a patient with a giant ascending aortic aneurysm 18 years after repair of a double-outlet right ventricle with pulmonary stenosis. Our report emphasizes the need for ongoing follow-up into adulthood.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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