Cor et Vasa Case Reports
Svazek | Volume 1 • Číslo | Number 2
Říjen | October 2018
Marek Hozman, Petr Peichl, Alexandr Schee
Difficult radiofrequency ablation of typical atrial flutter is usually caused by anatomical variants of the cavo-tricuspid isthmus. We report a case of 66-year-old patient with recurrent typical atrial flutter despite previous repeated ablations. Intracardiac echocardiography revealed close relationship between the right ventricular pacemaker lead and the cavo-tricuspid isthmus as the probable causeof repeat reconductions. A successful radiofrequency ablation guided by intracardiac echocardiography was performed.
Eva Hlavinová, Tomáš Zatočil, Anna Nečasová, Tomáš Brychta, Šárka Bohatá, Václav Vybíhal, Adéla Mitášová,Markéta Hanslianová
The incidence of cerebral abscess (CA) at normal population isvery rare, the general mortality ofCA in present conditions is very low. Onthe contrary, the patients with cyanotic heart defect, due to thealteredsystemic circulation and higher cerebral vulnerability, present a specialgroup of patients with a lot higherCA incidence.CA is considered a severecomplication with high mortality at these patients, especially wheninitially misdiagnosed. There are no general recommendations for therapymanagement of CA. In this case report, a 28-year-old patientwithpulmonary atresia with ventricular septal defect, arterial duct andsignificant aortopulmonary collaterals, accompanied with severe pulmonaryhypertensionand cyanosis, is presented. CA isdiagnosed by initial cranialCT scan, proceeded though thereis a lack of specific neurological signs andabsence of elevated inflammatory markers at the patient. Early diagnosticsand intense antibiotical therapy, accompanied by miniinvasive neurosurgical intervention – by the puncture aspiration of CA at this patient, is a vitalfactor improvingprognosis of patients with CA. The cyanotic heart defects,with or without pulmonary hypertension, are associated with high morbidity.One out of many life threatening diagnoses at these patients, furthermorebeyond standard cardiological diagnostics,presents CA.
Petr Doškář, Martin Mates, Petr Neužil, Petr Ošťádal
The most important task in coronary artery anomalies is to evaluate their prognostic significance and to assess for the risk of myocardial ischemia and sudden cardiac death. Individually tailored treatment strategy is set based on the grounds of thorough risk stratification process. We present a case of a 59-year-old female with an anomalous left coronary artery (LCA) arising from the proximal part of the right coronary artery and running in between the large arteries. In the literature, this variant is described as malignant. However, to date there are no prospective trials available to determine the optimal management of patients suffering from such anomaly. Therefore, surrogate risk factors are used for prognostication; such are symptoms of myocardial ischemia, sharp angulation or intramural course of proximal part of LCA, or its compression between the aorta and the pulmonary artery. In this case, having evaluated all risk factors, we chose conservative approach – mainly due to patient’s age, her low physical demands and absence of major symptoms. During the next few years the patient remained asymptomatic regarding coronary ischemia. In the discussion we further elaborate chosen strategy and we review published work on the topic.
