Project description:BackgroundRuptured sinus of Valsalva (RSOV) is a rare disorder, which usually involves the right coronary sinus (RCS) or the non-coronary sinus (NCS) and ruptures usually into the right-sided chambers. Involvement of the left coronary sinus (LCS) and multiple sinuses, rupture into the left ventricle (LV), and dissecting aneurysm of the interventricular septum (IVS) have all been scarcely reported.Case summaryA 24-year-old male presented with complaints of exertional fatigue, palpitations, and chest pain with signs of aortic run-off like wide pulse pressure, collapsing pulse along with cardiomegaly, and a diastolic murmur. Echocardiography revealed sinus of Valsalva aneurysms (SOVAs) involving both the RCS and LCS with RCS aneurysm dissecting the IVS and rupturing into the LV and another multilobulated aneurysm from LCS rupturing into the LV. Findings were confirmed on computed tomography (CT) aortogram, and the patient underwent successful surgical repair.DiscussionSinus of Valsalva aneurysm is a rare disorder which usually ruptures into the right-sided chambers. The involvement of multiple sinuses and rupture into the IVS is extremely rare (<2%). Aneurysm dissecting the IVS can lead to complete heart block (CHB) and sudden death. Involvement of the LCS is reported in <5% cases of RSOV, and rupture of such an aneurysm into the pericardial space may lead to cardiac tamponade and can also lead to sudden death. Clinical examination, electrocardiogram, chest X-ray, 2D echocardiography, and CT all help in the diagnosis. Treatment involves surgical repair of the defect.
Project description:An unguarded atrioventricular orifice is an extremely rare congenital anomaly characterized by the absence of the atrioventricular valve in varying proportions. While atresia of the mitral or aortic valves are usually described as causes for hypoplastic left heart, our case highlights the role of free atrioventricular valve regurgitation and consequent volume loss of the left heart, giving rise to a small left ventricle. There was an associated double-outlet right ventricle and Type B aortic interruption. While we have attempted to discuss the complex management options in this scenario, the parents decided to withdraw further care.
Project description:Left ventricular (LV) pseudoaneurysm is a rare complication following free wall rupture post transmural myocardial infarction or left ventricular surgery. A lot of imaging modalities like echocardiography, computerised tomography and cardiac magnetic resonance imaging are available to diagnose it. Echocardiography plays a significant role in delineating the cavity, orifice and impact on the surrounding structures. We present a case of LV pseudoaneurysm recurrence following surgical repair.
Project description:Hydatid disease, Echinococcus granulosus, is a parasitic infection which is endemic in some countries. The liver and lungs are the most common sites of infection. Cardiac involvement is extremely rare. The most common localizations of cardiac involvement are the left ventricular free wall, right ventricle, and interventricular septum. Herein, we present a rare case of multiple cardiac hydatid cysts in the interventricular septum.
Project description:Crisscross heart is a rare congenital heart disease characterized by a twisted atrioventricular connection, as a result of rotation of the ventricular mass along its long axis. We report an asymptomatic 48-year-old woman referred to us for evaluation of a cardiac murmur. Further evaluation showed situs solitus, dextrocardia with normal atrioventricular and ventriculoarterial connection, and a crisscross relation of the atrioventricular valves. Unlike the usual case of crisscross heart, our patient had an intact ventricular septum.
Project description:BackgroundA multidisciplinary treatment approach is recommended for patients with extensive, advanced, or recurrent thymomas. However, detailed treatment strategies, such as chemotherapy regimens and optimal surgical procedures, are still under debate.Case presentationWe report a case of gigantic locally advanced thymoma. A 70-year-old male was referred to our hospital following the detection of abnormal chest shadows. Chest X-ray and computed tomography (CT) scans revealed a 21-cm mass in the anterior mediastinum, encircling the pulmonary hilum and extending into the left thoracic cavity. PET/CT showed increased 18F-fluorodeoxyglucose uptake at the tumor site. Based on a trans-percutaneous CT-guided needle biopsy, the tumor was diagnosed as a Type B2 thymoma at the clinical IIIA stage. The patient underwent four cycles of preoperative induction chemotherapy, including cisplatin, doxorubicin, and methylprednisolone (CAMP), resulting in a partial response; the tumor shrank to 12 cm and FDG uptake decreased. Considering the patient's age and comorbidities, we performed total thymectomy, along with partial resections of the parietal, mediastinal and visceral pleura, pericardium, and left upper lobectomy. This approach achieved complete histological resection, mitigating the risk of recurrence. Pathological analysis confirmed a thymoma, ypT3 (lung) N0M0 stage IIIA, with no malignancy in the pericardial or pleural effusions. No recurrence was detected 9 months post-surgery.ConclusionsWe report a case of giant thymoma successfully treated with multidisciplinary strategy. Surgical treatment alone may not have achieved complete resection, but after inducing significant tumor shrinkage with preoperative CAMP therapy, we were able to achieve complete resection. This treatment strategy may be effective in large thymoma cases.