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What’sthediagnosis?
PaulR.Vogt
EurAsiaHeartFoundation
34ymRA,RV,PA„radicalresection“after1y,sametumour
PA:3yagoTeratomaradicalsurgeryretroperitonealLAE
1
2ylatersametumourinnominateveinthoracicduct 1
1:Diagnosis:a. NEOINTIMA FORMATION
b. ORGANIZED THROMBUS
c. BENIGN TERATOMA
d. NECROSIS
e. PERSISTENT NSGCTf. SARCOMATOUS DEGENERATIONg. CARCINOMATOUS DEGENERATIONh. REGRESSIVE NON-MALIGN “TERATOMA”
2:Treatment:a. SURGERY ALONE
b. RADIOTHERAPYc. CHEMOTHERAPY
d. ALL TREATMENT OPTIONS
1
2
64yoldpatient;dyspnoe
ADescendingthoracicaorticaneurysm
BCoronaryarteryCCircumflexfistulaDVenousaneurysm
3
3
a. FIBROELASTOMA
b. AVPROSTHESIS WITH
THROMBUS
c. THROMBUS OF NATIVE AVd. NORMAL AVPROSTHESISe. NONE OF ABOVE
56yearoldpatientwithmitralregurgitation
4
4
Cageballprosthesisworkingfor40years
556yoldpatient;haemoptysisA.PulmonaryembolismB.HypoplasialeftlungC.AbsentleftPAD.rightsidenormal
+leftsideEisenmenger
6Diagnosis?
6
Diagnosis?
6
6Ectopiacordis• complete• partial
7Whatisthis?A.MyxomaB.LostballoontodilatemitralstenosisC.“Tumor”ofmitralvalveD.ifthisshouldbeatumour:whatkindof?
8
936yoldman1.hugecongenitalsubpulmonaryVSD2.severeaorticregurgitation3.severepulmonaryregurgitation4.severetricuspidregurgitation5.AV+PVendocarditis6.suprasystemicpulmonarypressure
Isheoperable?
9Yes!
10
Whatisaboutthearterialpressurecurve?Howdoesthislooklike?
• Two months ago: explosion while working with a battery
• Unconscious for 5 minutes• Developed hoarseness• Severe respiratory distress• Lack of any exercise capacity• Referred due to pericardial
effusion
Diagnosis?
A. Traumatic aortic rupture (“loco classico” =
distal to the left subclavian artery)
B. Mycotic aneurysm of the aortic arch
C. Traumatic rupture of the ascending aorta
D. Chronic effusive pericarditis with
tamponade, e.g. infectious
E. Aneurysm of the proximal descending aorta
F. Aneurysm of the aortic arch
G. Double aortic arch
11
11
12
13 PatientcannotliedownforPM-implantationWhatistherealproblem?
14Whichpatienthasananeurysm?
1.A2.B3.C4.AtoC5.AtoD
Ac
BD
14
14 What’sthediagnosis?
15Whatisthediagnosis?
1.Lymphoma2.Rhabdomyoma3.Fibroma4.Echinococcus
15
16Whatisthis?1. Pericardialcyst?2. Fat3. Pulmonaryartery4. Leftauricle5. LV-aneurysm6. Rhabdomyoma
16
16
16 LA-Thrombus...
Asymptomaticseverenecktrauma...
Patientveryrecentlydisturbedfromarterialbleedingfromtumour…
1710yoldgirl,referredwithendocarditis1. Artefact2. Vegetation3. Tricuspidendocarditis4. Eustachianvalve5. Thebesianvalve
189-yearoldboy• Dyspnoeonexertion,
atypicalchestpain• NohistoryofCHD,
normaldevelopment• Severetrafficaccident
with6years
18
18
“Pseudoaneurysm”oftheRA?posttraumatic?Congenital?Otheraetiology
19 AnatomicalDx?Treatment?
19
20
Resultate: Kinder-UniversitätSt.Petersburg38Missionenin3Jahren
21• 11yoldboy• Headache• Surgerywasoffered
for5000USD1. Doesthismean
something?2. Diagnosis?3. Treatment?4. Prognosis?
21CarotidTortuositySyndrome
• Adults:atherosclerosis• Children:3rd branchialarch
arterymalformation• Adults:TIA;stroke• Children:waitandsee• Follow-upofonechildfrom
Kazakhstanover15years:uneventful
22 3monthsoldbabywithheartfailure
• Allheartchambersdilated
• Otherwisenormalanatomy
• Thrillabovetheposteriorcranialbase
• Diagnosis?
22 Diagnosis?
22 VenaGaleniMalformation
23 DiagnosisisobviousWhatistheageofthe
patient?
24 21yoldman
• Dyspnoe• Otherwisehealthy
24 Diagnosis?Aetiology?
24
Aetiology?A) Wedon’t
know?B) TuberculosisC) Congenital
LV-dysplasia
YangonMedicalUniversity,Myanmar
Tashkent,Uzbekistan
RepublicanSpecializedCentreforCardiology,Tashkent• 30’000patientsperyear
PediatricUniversity,Tashkent• 700operations(PDA,CoA,ASD,VSD)
FerganaValley• 10millionpeoplewithoutcardiovascularcare
TashkentAmbition for Central Asian
Cardiovascular Medical Centre
25 Diagnosis?
25 MediastinalTeratoma
• Healthyman• Nosymptoms• Incidentalfinding• Routinechestx-ray
beforebirthofchild
Donezk...untilMay2014
SubaorticVSD
263months 5years
12yearsoldgirlwithsubaorticVSDDyspnoeSlightlyblueCardiologistasksfor“urgent”surgerySystemic=pulmonarypressureExaminations:
• Chestx-ray• Echo:subaorticVSD
Operable?Forwhatkindofsurgery?• Pulmonarybanding• Totalcorrection:VSDclosure• Assistdeviceasbridgetodecision• Heart-lung-transplantation
26
MediansternotomyPressureaorta:87mmHgPressurePA:70mmHg100%oxygen:
Pressureaorta:85mmHgPressurePA:67mmHg
Operable?
26
26
Uneventfulpostoperativecourse
26
Willthepulmonaryarterypressurecomedown?Probablyyes.Because…:• …thechildisgrowing…• …andnewpulmonaryvesselsandnewalveoliwillgrow…
27
50yoldladyPartialAV-canaldefect
Operable?
• Yes
• no
28
31yoldman25ymedicaltreatmentforbronchialasthma
28Diagnosis?
CreationofunroofedcoronarysinusintotheLAAtrialpatch;tricuspidannuloplasty
28
53yoldwomanNegativehistoryReferredwithpericardialtamponadeduetoacutetypeAdissectionInfero-posteriorinfarctionwithleftventricularrupturePerforationsuturedBypassgraftingnotpossible
29
DevelopedmitralregurgitationMitraClip2y:severetricuspidregurgitation
Operable?
29
Tricuspidvalvereplacement:27mmCERevatio,Levosimendan,preoperativeIABP
1ylater:gradeIItoIIIregurgitationofbioprosthesisValve-in-valveTAVI;actuallyNYHAII 2
9
64yoldwomanOpenmitralcommissurotomy15yagoSeveretricuspidrepairEROdiameter1.4cm168cm;146kg;onlymobileinsmallroomTreatment:4differentdiuretics
30
Elephantiasis?Lymphaticproblem?Duetotricuspidregurgitation
Indicationfortricuspidvalvesurgery?
YesNo
TricuspidrepairwithreductionannuloplastyComplexpostoperativecourseAnuriaè prolongeddialysisDifficultweaningfrommechanicalventilation
Whatwastheresult?A)Bodyweightincreased•Patientlost:B)15kgC)30kgD)50kgE)75kg
30
30Tricuspidvalvesurgery:beneficialEveninworstcases…
3164yearoldpatient• 25yischemicheartdisease
• LVAD
• Hearttransplantation
• 4weeksafterhearttransplantation
• Sternumdehiscence+sternumosteomyelitis
• Mycoticaneurysmoftheascendingaortawith
impendingruptureofaorto-aorticanastomosis
• InfectedresidualLVADarterialreturnprosthesis
31
Diagnosis?Chylothorax?Infection?Fattydegeneration?Pusbonumet
laudabile?Tuberculosis
31 Diagnosis?
≈120 people involved in EAHF
3429 operations / interventions
13’552 patients consulted
6 million CHF in material donations
>275 million CHF: value of operations in CH
What EAHF has done so far
• Klinik Im Park, Zürich, Schweiz• UniversitätsSpital Zürich, Schweiz• Universitäts-Kinderspital Zürich, Schweiz• Universitätsspital Bern, Schweiz• Kantonsspital Aarau, Schweiz• Krankenhaus Hietzing, Wien, Österreich• Medizinische Universität AKH Wien, Österreich• Universitätsklinikum Münster, Deutschland• Ukrainian Children’s Cardiac Centre, Kiev, Ukraine• The Harley Street Clinic, London, UK• Yale School of Medicine, Hew Haven, USA• Universitätsspital St. Marina, Varna, Bulgarien• Military Medical Academy, St. Petersburg, Russland• St. Petersburg State Pediatric University, Russland• Kinderherzchirurgie Tomsk, Russland
International Network
WhereEAHFisactive
...tolate...
„...not all have the same opportunities...“
TodesursachenSchweiz
…esgibtimmernochvielzutun...
EurAsia Heart: Science and Research (1)
8168Patients:Switzerland,Austria,Russia,BulgariaAmericanSocietyforHospitalEpidemiologyandInfectionControl
EurAsia Heart: Science and Research (2)
EisenmengerEnd-stageheartfailure• Acuteanimalstudy• Chronicanimalstudy
...esgibtimmernochvielzutun...
• Irkutsk• Wladiwostok• Voronezh• MedSiMoskau• Ulaanbator• Jakarta• Surabaya
SchweizerischeGesellschaftfürKardiologieSchweizerischeGesellschaftfürHerz- undGefässchirurgie
UniversitätsSpitalZürich:EAHFalsManagingDirectorforInternationalRelationsandStrategicProjects