Lateral Wall Of Right Ventricle Research Articles

P172 Uncommon reason for right-sided heart failure

Abstract This paper outlines a case study 57 year old, female patient who was admitted in our institution due to severe sign and symptoms of right-sided heart failure. She complained on progressive fatigue, a shortness of breath and oedema of cruris for three months before. Initially she was hospitalized in regional hospital due to pericardial effusion and they excluded any malignancy and systemic tissue disease in that moment. Immediately after admission we have performed 2D transthoracic echocardiography which showed a large (6.7x4.9cm), oval tumours soft tissue formation in right atrium which compromise flow in Vena cava inferior and across tricuspid valve and make a gradient of 35 mmHg above it. Left and right ventricles had preserved dimensions and function, without pericardial effusion. 3D transoesophageal echocardiography (TEE) imaged confirmed huge, oval tumorous formation (8.2x7.9cm), which originated from lateral wall of right atrium and almost occupied it, compromising flow towards superior and inferior vena cava. We had detected an irregular free space, probably due to necrosis, in the middle part of that tumorous formation. Thorax MSCT revealed heterogeneous expansive mass (19x8x8 cm) in projection of right atrium with signs of active bleeding its central part, although MSCT couldn’t exclude extra cardiac origin. There were no signs of dissemination. Cardiac MR indicated that we had extra cardiac mass (12x9x10cm) close to lateral right atrial wall and basal part of lateral wall of right ventricle which compromise flow towards superior and inferior vena cava, with no changes on surrounding structures. The patient underwent almost complete tumour surgical resection, with a lot of bleeding complications due to its local invasiveness and central necrosis. Surgical findings completely were concordant with 3D TEE imagining which provided us very precise information about size, location and extension of tumour. Severe systemic inflammatory response syndrome (SIRS) occurred in the postoperative period, and the patient died due to multiple organ dysfunction. Patohistological analyses were conclusive of undifferentiated pleomorphic sarcoma diagnosis. Abstract P172 Figure.

Coronary artery stent infection presenting as coronary cameral fistula: a case report

IntroductionCoronary artery stent infection is a rare event. We report a case of delayed coronary artery stent infection with coronary cameral fistula presented as pyrexia of unknown origin, 1 year after coronary intervention.Case PresentationA 66-year-old man presented with paroxysmal low-grade fever of 2 years duration. He underwent percutaneous coronary intervention (PCI) with stent to right coronary artery (RCA) for inferior wall myocardial infarction in July 2014. He had non-ST-elevation myocardial infarction in December 2014. Repeat PCI with two stents to same vessel was done for total occlusion of stent. Repeated evaluations by family physician for fever did not yield any discrete diagnosis, and he was treated with empirical antibiotics. He had worsening of fever since last 2 months. Whole body positron emission tomography scan showed increased tracer uptake in RCA with perivascular abscess involving lateral wall of right ventricle. Coronary angiogram showed presence of small coronary cameral fistula from RCA draining into right atrium. Blood cultures grew Pseudomonas aeruginosa. He was taken for surgery and the infected portion of the RCA including the stents was removed.DiscussionThis case reports delayed coronary stent infection. Patient presented 1 year after procedure. Presence of bare metal stent increases risk of infection in presence of bacteraemia. Antiproliferative effects of drug eluting stents may predispose more to infection. This case was unique in its late presentation, presence of coronary cameral fistula and was successfully treated with surgery.

Radiofrequency Catheter Ablation of Ventricular Tachyarrhythmia Under Navigation Using EnSite Array

EnSite array (EA) provides virtual activation of ventricular tachycardia (VT) and premature ventricular contraction (PVC) on a beat-to-beat basis. Fifty-five consecutive patients (age 52+/-16 years) with 79 VTs/PVCs undergoing EA-guided radiofrequency catheter ablation (RFA) were studied, of whom 7 patients had organic heart diseases. A virtual activation map showed that 66 VTs/PVCs originated from the right ventricle (RV), including the RV outflow tract in 57, lateral wall of RV in 4, His bundle region in 3 and tricuspid annulus in 2. Ten VTs/PVCs originated from the left ventricle (LV), including the LV endocardium in 7 and aortic sinus cusp in 3. The origins of 3 PVCs, one each in 3 patients, were not identified. Six of 38 VTs were sustained and the remaining 32 VTs were non-sustained. RFA eliminated all but 3 focal PVCs, and all macroreentrant VTs at a critical conducting pathway, which was identified by the combined use of contact voltage and virtual activation maps. There were 11+/-9 applications, and the radiofrequency energy and fluoroscopy time were 11,354+/-13,360 J and 30+/-21 min, respectively. All patients with acute success were free of any symptoms during a follow up of 21+/-11 months. EA-guided RFA is safe and effective for VT/PVC, irrespective of its origin, mechanism, sustainability, hemodynamic condition, and underlying heart disease.