Project description:A 69-year-old patient underwent an urgent aortic valve replacement because of Streptococcus agalactiae endocarditis of his native aortic valve. Since a rapid progression of the former abscess cavity into an aortic root pseudoaneurysm with increasing paravalvular regurgitation during postoperative follow-up, reoperation was performed. In the preoperative transesophageal echocardiography (TEE) images the pseudoaneurysm completely surrounds the left coronary artery (LCA) without any signs of myocardial ischemia.
Project description:Coronary artery fistula are anomalous connections with coronary vessels or cardiac chambers, potentially resulting in coronary dilatation and pseudoaneurysm formation. We present the case of a 68-year-old woman referred to our institution for a voluminous coronary pseudoaneurysm secondary to coronary artery fistula presenting as a nearly completely obstructive left atrial mass. (Level of Difficulty: Intermediate.).
Project description:Coronary artery aneurysm and pseudoaneurysm are rare and mainly result from atherosclerosis. We present a successfully treated case of a giant right coronary artery aneurysm and pseudoaneurysm with a coronary artery fistula, which might have developed after cardiac surgery for a right ventricular tumor 35 years earlier. (Level of Difficulty: Advanced.).
Project description:Coronary artery fistulas are rare congenital anomalies usually discovered incidentally on imaging studies. Coronary artery pseudoaneurysms are unusual complications of coronary artery fistulas, which can be due to atherosclerosis, inflammatory, traumatic or iatrogenic causes. We present a case of a 55 year old female with no known atherosclerotic risk factors, history of trauma or connective tissue disease referred because of recurrent palpitations. Work ups revealed a cardiac mass with an initial assessment of pericardial cyst. A multi modality approach of two dimensional echocardiography with Doppler studies, multidetector computed tomography and coronary angiogram revealed coronary artery fistula draining into a pericardial mass. The patient underwent surgical excision of the mass and ligation of the feeding vessel. Histopathology revealed features suggestive of a pseudoaneurysm. Postoperative course was uneventful and she was discharged stable and improved. Coronary artery fistula complicated by pseudoaneurysm is a rare clinical entity especially in patients without history of trauma or other risk factors. It can have an unusual presentation which can confound the diagnosis. Multimodality imaging is essential and adjunctive in order to determine a conclusive assessment. <Learning objective: Coronary artery pseudoaneurysm secondary to a congenital coronary artery fistula is an unusual cardiovascular pathology and can present as a rare diagnostic challenge for the clinician. This case emphasizes the importance of meticulous integration of both clinical assessment and complementary multimodality imaging approaches to better define the best therapeutic plan and facilitation of definitive surgical management.>.
Project description:The nuclear receptor joint Keystone meetings, formerly organized as 'Steroid Sisters' and 'Orphan Brothers', met this year under the banners, 'Signalling, Gene Regulation and Cancer' and 'Development, Physiology and Disease'. The change reflected both the excellent progress that has been made, as well as new directions that are now central to the field. The meeting covered all aspects of regulation by nuclear receptors and provided a good orientation for investigators new to the area, as well as a timely update for those with long tenure in the field.