IHJ Cardiovascular Case Reports (CVCR)最新文献

Background

Coronavirus disease 2019 COVID-19 still remains a major cause of morbidity and mortality worldwide, mainly due to Acute Respiratory Distress Syndrome (ARDS). Nevertheless, other extra-pulmonary pathological aspects of COVID-19, notably cardiovascular, were disclosed as the global understanding of the pathogen agent advanced.

Objectives

To detect and evaluate acute myocarditis in patients with active and symptomatic COVID-19 infection.

Materials and methods

In this prospective analysis, patients presented with active COVID-19 illness and meeting the inclusion criteria were identified at the University Hospital Complex of Rabat between January and September 2021.

Results

Fifteen patients (8 males and 7 females) aged from 17 to 52 were included during the analysis period, the average delay between the confirmation of COVID-19 and the onset of myocarditis symptomatology was 17 days. The symptomatology was dominated by chest pain, unexplained cardiogenic shock and palpitations. The ECG showed essentially diffuse repolarization disorders. The inflammatory markers were significantly disturbed with an elevation of ultra-sensitive cardiac troponin I in all patients. Cardiac MRI showed impaired global longitudinal strain (GLS) myocardial edema, early and late subepicardial Gadolinium enhancement, compared to the control group (p < 0,01).

Conclusion

Cardiac involvement was detected in a proportion of patients with active COVID-19. Age, gender, clinical and electrical presentations didn't seem to influence the diagnosis. Cardiac MRI played an essential role for detecting and evaluating active myocarditis. Patients who presented myocardial injury had to have a longer follow-up as current understanding of long-term prognosis is still lacking.

Mitral regurgitation (MR) is the leading cause of heart valve disease worldwide. In aging population, the incidence of mitral regurgitation (MR) has gradually surpassed that of aortic valve stenosis. We present a report of 5 cases,with history of rheumatic heart disease and old malfunction bioprosthetic valve, presenting with dyspnea, poor ejection fraction.Investigations revealed severe mitral stenosis and regurgitation. TMVR (trans catheter mitral valve replacement) was done with successful outcome.

Post-cardiac injury syndrome is an immune-mediated inflammatory process involving the pericardium and, to a lesser extent, the pleura, epicardium, and myocardium. It usually happens following cardiac surgery, myocardial infarction, or cardiac trauma, but can also develop after interventional procedures like transvenous pacemaker implantation. We present the case of an 83-year-old patient who underwent pacemaker upgradation(from VDD to DDR) with fixation of a new atrial screwing lead following the end of the life of the pulse generator. He presented to the emergency department within one week of the procedure with fever, chest pain, worsening respiratory difficulty, new onset pericardial and bilateral pleural effusion, and raised blood inflammatory markers. The patient responded well to anti-inflammatory medication and therapeutic pleural tapping and was subsequently discharged.

66yrs old, Male, presented to our hospital with history of low-grade fever of one month duration. Only significant past history was right coronary artery (RCA)stenting done a year ago. Physical examination no localizing signs of fever. Blood culture identified pseudomonas aeruginosa. Electrocardiogram (ECG) showed old inferior wall myocardial infarction changes. Echocardiography (ECHO) detected myocardial abscess along the right atrioventricular groove and vegetation on tricuspid valve. Coronary angiogram showed totally occluded and infected RCA stent with formation of coronary cameral fistula, draining into right atrium. A positron emission tomography (PET) scan and a computed tomography (CT) scan showed increased tracer uptake in RCA stent, peri-stent abscess. Infected stent, artery, and vegetation removed surgically, then graft given to distal RCA. The multi-diagnostic modality helped in identifying this condition early. Timely surgical intervention helped the patient to recover in otherwise life-threatening complication.

The overall morbidity and mortality rates of cardiogenic shock are high. The Impella 5.5 is a temporary mechanical circulatory support device that treats cardiogenic shock by supporting a failing ventricle. It is used as a bridge to advanced therapy, decision, or recovery. We report our initial experience with this device.

Background

Mucormycosis is an invasive fungal infection most commonly seen in immune compromised patients. Diabetic ketoacidosis, haematopoietic transplantation, iron overload states, and deferoxamine therapy are considered to be some of the classical risk factors. While cutaneous and rhino-sinusoidal forms may be seen in immune competent individuals, cardiac and mediastinal involvement is rare. In this report, we describe a young patient with disseminated Mucormycosis who presented as rhino orbital Mucor mycosis with pericardial involvement.

Case summary

A 17-year-old female presented with intermittent high-grade fever of 1 month duration. She was diagnosed as Rhino orbital Mucormycosis as evidenced by MRI brain and orbits and biopsy of maxillary sinus. Patient underwent left endoscopic debridement of sinuses and left endoscopic Denker's procedure with left orbital decompression and was treated with Amphotericin B subsequently. During the course of hospitalisation, patient developed large pericardial effusion with cardiac tamponade secondary to invasive mucor infection as evidenced by pericardial fluid culture.

Conclusion

Disseminated Mucor mycosis is a rare condition that involves two or more non-contiguous organ systems. Disseminated Mucor mycosis is the least common and the worst prognosis type, and it mostly starts with lesions in the lungs and then disseminates to other sites. Cardiac dissemination of rhino orbital Mucor mycosis, like in our case, is unusual and often diagnosed post-mortem; an antemortem diagnosis is very rare. Cardiac involvement is a rare, yet fatal, complication that can occur in disseminated disease and a strong index of suspicion is necessary for prompt treatment, especially in high-risk patients.