1/10. Redo Bentall operation for the aortitis syndrome.The aortitis syndrome is a chronic inflammatory arterial disease with an unknown etiology that may present as a variety of vascular lesions. The surgical treatment of aortitis syndrome is associated with many potential difficulties due to the inflammatory nature of the disease. A patient with the aortitis syndrome underwent the Bentall operation for annulo-aortic ectasia and aortic regurgitation 11 years prior to presentation. The operation was not performed during the active inflammatory phase. An anastomotic dehiscence required reoperation, which was performed with Piehler's method. In the aortitis syndrome, the exclusion technique, Carrel patch repair of the coronary arteries and pledgeted anastomoses should be performed for aortic root reconstruction.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. aortic valve replacement in a patient with factor xii deficiency: case report.Congenital factor xii deficiency is a rare condition. We report a case of aortic valve replacement (AVR) in a 63-year-old man with factor xii deficiency. On admission, the patient's activated partial thromboplastin time (aPTT) was prolonged (271 s), and activated clotting time was 500 s. His factor XII level was <3%. The Sonoclot signature showed an abnormal pattern. AVR with a prosthetic valve (St. Jude Medical) was performed safely after the normalization of aPTT and the Sonoclot signature by frozen plasma transfusion. The perioperative management in patients with factor xii deficiency is discussed.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
3/10. giant cell arteritis presenting with annuloaortic ectasia.Four cases of giant cell arteritis causing severe aortic regurgitation secondary to an aneurysm of the ascending aorta are described. In two cases, the nature of the aortic pathology could be suspected considering the past clinical evidence of temporal arteritis and/or polymyalgia rheumatica. In the two other cases, the cardiothoracic manifestations represented the onset of Horton disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. The "surreptitious Staphylococcus": staphylococcus lugdunensis endocarditis in a child.A child with congenital heart disease developed infective endocarditis caused by staphylococcus lugdunensis. Despite an apparent excellent response to initial antibiotic treatment in clinical, inflammatory and echocardiographic indices, the patient's valve damage progressed silently and surgical intervention was required. This case highlights the potential for misidentification of S. lugdunensis, its usual susceptibility to penicillin and in particular the aggressive nature of endocarditis caused by this coagulase-negative staphylococcus. The epidemiology and treatment of endocarditis caused by this organism are reviewed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. Recurrent acute rheumatic fever: a forgotten diagnosis?The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve. This culminated in her undergoing urgent aortic valve replacement during a phase of the illness that should have been treated with high dose anti-inflammatory medication. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patient with a previous history of rheumatic fever. We briefly discuss the diagnostic dilemma of patients suffering from this condition and in differentiating it from acute endocarditis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. Three cases of destructive native valve endocarditis caused by staphylococcus lugdunensis.Described here are three cases of acute native valve endocarditis due to the coagulase-negative pathogen staphylococcus lugdunensis with serious complications. Two of the three patients died despite optimal antibiotic therapy and cardiovascular surgery. These cases demonstrate the aggressive nature of S. lugdunensis and emphasize the importance of identifying coagulase-negative staphylococci to the species level and not considering the isolation of S. lugdunensis from normally sterile body fluids as contamination. On the contrary, when this organism is found in patients with endocarditis, early surgery should be considered. The possibility that this organism could be misidentified as S. aureus because of "autocoagulation" and that commercial identification systems may misidentify it as S. haemolyticus, S. hominis or S. warneri should also be remembered.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. Iatrogenic left main coronary artery stenosis following PTCA or valve replacement.We report three patients who developed iatrogenic severe left main coronary artery stenosis. In two, it was secondary to coronary cannulation during aortic valve replacement and in one it followed distention of the artery during balloon dilatation of a proximal lesion in the left anterior descending artery. In all three, the stenosis was clinically manifest a few months after the intervention. All were successfully treated by aortosaphenous coronary bypass. A common mechanism for the three cases may be mechanical distention of the left main coronary artery resulting in intimal damage with secondary fibrosis and stenosis. The percutaneous transluminal coronary angioplasty-related stenosis is, to our knowledge, the first reported case of this nature, and represents a previously unrecognized complication of this procedure.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. corynebacterium endocarditis. Difficult diagnosis in an elderly woman.physicians have been reminded repeatedly of the many faces of bacterial endocarditis. In this case, corynebacterium endocarditis presented as an occult malignancy and eluded diagnosis for six months. The coryneform isolates found in cultures are often considered to be contaminants because of their ubiquitous nature, sometimes causing a delay in diagnosis. patients with culture-negative endocarditis or corynebacterium "contamination" should be treated as having corynebacterium endocarditis pending results of microbiologic isolation tests.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. Aortic regurgitation and sinus of valsalva-right atrial fistula after blunt thoracic trauma.Non-penetrating chest trauma commonly causes a wide variety of cardiac injuries. Disruption of the aortic valve with resultant aortic regurgitation is not uncommon; conversely, a sinus of valsalva-right atrial fistula, in the absence of a congenital sinus of valsalva aneurysm, has been reported only once previously. This report describes the detection by preoperative cardiac catheterisation of both aortic regurgitation, and a sinus of valsalva-right atrial fistula after blunt chest trauma, and its surgical management. The need for preoperative cardiac catheterisation in patients suffering from non-penetrating cardiac trauma is emphasised, even when the diagnosis appears cleas, because of the diverse nature and possible multiplicity of cardiac lesions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. Calcific stenosis of a glutaraldehyde-treated porcine bioprosthesis in the aortic position.The porcine xenograft bioprosthesis is used widely at the present time, although its long-term durability is still being evaluated. Calcification resulting in stenosis of the glutaraldehyde-treated bioprosthesis has been reported infrequently. In the patient described herein, severe calcific stenosis of a porcine xenograft in the aortic position occurred 45 months after implantation. This report emphasizes the life-threatening and rapidly progressive nature of this complication in the long-term survivor after valve replacement.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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