1/57. Histologic changes in three explanted native cardiac valves following use of fenfluramines.Use of fenfluramines, either alone or co-administered with phentermine ("fen-phen") as anorexic agents in obesity, has been associated with the development of clinically significant cardiac valve disease. We present the macroscopic and histologic findings in cardiac valves explanted from three patients who presented with valvular disease after fenfluramine or fenfluramine-phentermine use and underwent single valve replacement surgery. paraffin sections were prepared with hematoxylin and eosin, trichrome, elastic-van Gieson, and Giemsa stains, as well as immunostains using antibody to CD3 and CD20. All three patients (two females, ages 37 and 43, and a 49-year-old male) developed progressively symptomatic mitral (2 patients) or aortic (1 patient) valvular insufficiency following dexfenfluramine (2 patients) or fenfluramine-phentermine (1 patient) use. Macroscopic changes included irregular leaflet thickening, accompanied by chordal fusion in the mitral valves, but without vegetations, commissural fusion, or evidence of annular dilation. Histologically, fibromyxoid plaques and nodules just below the valve surface, superficial to a generally intact elastic fiber layer, were associated with CD3-positive lymphocytes. Valves from all three patients had central myxoid degenerative changes, which were focal/mild in one mitral valve, diffuse/moderate in one mitral valve, and diffuse/marked in one aortic valve. Focal areas of superficial fibromyxoid change or intimal thickening may also be seen in cardiac valves from patients with drug-unrelated processes leading to symptomatic or asymptomatic valvulopathy. Therefore, when valve tissue is available for histopathologic examination, valvular disease can be attributed to use of fenfluramines only if the following criteria are satisfied: (i) the macroscopic and microscopic features are consistent with fenfluramine-related valvulopathy, (ii) clinical, echocardiographic, and intraoperative findings support the diagnosis, and (iii) the history of drug exposure predates the development or exacerbation of valvular dysfunction.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/57. Successful treatment of prosthetic aortic valve mucormycosis.Mucor endocarditis after cardiovascular surgery is rare and usually fatal. We report the first known case of prosthetic aortic valve mucormycosis in a patient without predisposing risk factors who was successfully treated using a combination of early antifungal drug therapy and surgical removal of infected material.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
3/57. The postpericardiotomy syndrome as a cause of pleurisy in rehabilitation patients.Pleuritic chest pain in patients on a rehabilitation unit may be caused by several conditions. We report 2 cases of postpericardiotomy syndrome (PPS) as a cause of pleuritic pain. PPS occurs in 10% to 40% of patients who have coronary bypass or valve replacement surgery. The syndrome is characterized by fever, chest pain, and a pericardial or pleural friction rub. Its etiology is believed to be viral or immunologic. The syndrome can be a diagnostic challenge, and an increase in length of hospitalization because of it has been documented. Identified risk factors for PPS include age, use of prednisone, and a history of pericarditis. A higher incidence has been reported from May through July. Many patients undergo a battery of expensive procedures before PPS is diagnosed. The pain is sharp, associated with deep inspiration, and changes with position. Pleural effusions may be present and tend to occur bilaterally. Pericardial effusions are a documented complication. A pericardial or pleural rub may be present and is often transient. Serial auscultation is important. Laboratory work provides clues with a mild leukocytosis and an elevated erythrocyte sedimentation rate. However, this does not provide the definitive diagnosis. Cardiac enzymes are not reliably related to the syndrome. An electrocardiogram will show changes similar to those associated with pericarditis. The patient may have a fever, but it is rarely higher than 102.5 degrees F. Complications include pericardial effusions, arrhythmias, premature bypass graft closure, and cardiac tamponade. Treatment consists of a 10-day course of nonsteroidal anti-inflammatory drugs.- - - - - - - - - - ranking = 1.3345694740801keywords = closure, drug (Clic here for more details about this article) |
4/57. Persistent hypoxemia occurring as a complication of tricuspid valve endocarditis.A 33-year-old woman had intravenous drug-associated tricuspid valve infective endocarditis. Despite resolution of septic pulmonary emboli, hypoxemia persisted. We report a case of right-to-left shunting across a previously insignificant patent foramen ovale documented by contrast transesophageal echocardiography. Although a rare complication of tricuspid endocarditis, clinicians should be aware of this potential correctable complication.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
5/57. Nonsurgical closure of a patent foramen ovale in a patient with carcinoid heart disease and severe hypoxia from interatrial shunting.We report the percutaneous transcatheter closure of a patent foramen ovale using an Amplatzer septal occluder in a rare patient with carcinoid heart disease involving both the right and left heart who presented with severe hypoxemia secondary to intra-atrial shunting. We believe this is the first report of this technique being utilized in a patient with carcinoid heart disease and it may represent an alternative to surgical closure in these patients at high risk for surgical complications.- - - - - - - - - - ranking = 5.0074168444804keywords = closure (Clic here for more details about this article) |
6/57. Hypocomplementemic urticarial vasculitis, jaccoud's arthropathy, valvular heart disease, and reversible tracheal stenosis: a surfeit of syndromes.We describe a patient who, during 29 years of observation, manifested polyarthralgia and polyarthritis leading to progressive deformity of the joints of hands and feet (without loss of cartilage or erosion of bone); persistent urticaria made worse by cold and accompanied by hypocomplementemia; and progressive cardiac valvular disease with mitral and aortic stenosis and regurgitation. In 1996, she developed subglottic tracheal stenosis that resolved by the end of 1997 without a change in treatment, which has consisted of low dose azathioprine, glucocorticoid, and nonsteroidal antiinflammatory drugs. Tests for cryoprecipitable protein, antineutrophil cytoplasmic antibodies, antinuclear antibody, and rheumatoid factor were negative. skin biopsy was consistent with "leukocytoclastic vasculitis." The pathogenesis of this remarkable combination of syndromes is unknown.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
7/57. Fibroelastoma of the mitral valve as a cause of transient ischemic stroke.A 44-year-old woman had a transient ischemic stroke, fibroelastoma of the mitral valve being the source of the embolus. The patient evolved with neutropenia induced by ticlopidine after 10 days of treatment. We report the major clinical features, therapeutical options, and medicamentous toxicity resulting from the use of antiplatelet drugs.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
8/57. Accessory mitral valve tissue causing left ventricular outflow tract obstruction: case reports and literature review.Accessory mitral valve (AMV) tissue is a rare congenital malformation causing left ventricular outflow tract obstruction (LVOTO). We present three patients with AMV tissue undergoing surgery. A 60-year old man presented with an AMV leaflet, mild LVOTO and coronary artery disease and underwent accessory leaflet excision and coronary revascularization. A 24-year old man presented with an AMV leaflet, LVOTO and interatrial septal defect and underwent defect closure and accessory leaflet resection. An 8-month-old girl underwent interventricular septal closure and AMV leaflet resection but died on postoperative day 5 from progressive heart failure. Another 87 cases with AMV tissue were identified in the literature The anomaly was classified as: Type I (fixed: A = nodular, B = Membranous), and type II (mobile: A = pedunculated, B = leaflet like). Type IIB was further subdivided as rudimentary chordae and developed chordae. patients with AMV tissue causing LVOTO may undergo mass removal with acceptable postoperative outcome. Prophylactic removal of AMV tissue should not be attempted in patients with no or mild LVOTO and no other associated heart defects. These patients should be followed and observed periodically by Doppler echocardiography to identify any progression in LVOTO.- - - - - - - - - - ranking = 1.6691389481601keywords = closure (Clic here for more details about this article) |
9/57. Extensive left atrial endoatriectomy for infective endocarditis.The technique of extensive endoatriectomy of the left atrium and reconstruction with autologous pericardium for infective endocarditis is described. endocardium of the left atrium with vegetations was completely excised from the valvular annulus to normal endocardium, and autologous pericardium was used to reinforce the endocardial defect and to allow less tension in the closure. This technique permits complete removal of infectious lesions and facilitates mitral valve replacement reinforcing the mitral annulus.- - - - - - - - - - ranking = 0.83456947408006keywords = closure (Clic here for more details about this article) |
10/57. Cases from the osler medical service at Johns Hopkins University.PRESENTING FEATURES: A 29-year-old woman with a history of rheumatic heart disease and one episode of endocarditis as an adolescent was admitted to the hospital after 1 week of headache, fever, and myalgia. Her past medical history was otherwise unremarkable and did not include illicit drug use. On physical examination, she had a previously noted 3/6 holosystolic murmur at the apex, which radiated to her back; a previously noted 1/4 diastolic murmur at the right upper sternal border; diminished strength in her right upper extremity; multiple painful erythematous nodules on her fingers (Figure 1); and red streaks under her nails (Figure 2). magnetic resonance imaging of the brain demonstrated multiple lesions; the largest was in the right frontal lobe with associated hemorrhage (Figure 3).What is the diagnosis?- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
| | Next -> |