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What’sthediagnosis?
PaulR.Vogt
EurAsiaHeartFoundation
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34ymRA,RV,PA„radicalresection“after1y,sametumour
PA:3yagoTeratomaradicalsurgeryretroperitonealLAE
1
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2ylatersametumourinnominateveinthoracicduct 1
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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
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64yoldpatient;dyspnoe
ADescendingthoracicaorticaneurysm
BCoronaryarteryCCircumflexfistulaDVenousaneurysm
3
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3
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a. FIBROELASTOMA
b. AVPROSTHESIS WITH
THROMBUS
c. THROMBUS OF NATIVE AVd. NORMAL AVPROSTHESISe. NONE OF ABOVE
56yearoldpatientwithmitralregurgitation
4
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4
Cageballprosthesisworkingfor40years
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556yoldpatient;haemoptysisA.PulmonaryembolismB.HypoplasialeftlungC.AbsentleftPAD.rightsidenormal
+leftsideEisenmenger
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6Diagnosis?
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6
Diagnosis?
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6
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6Ectopiacordis• complete• partial
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7Whatisthis?A.MyxomaB.LostballoontodilatemitralstenosisC.“Tumor”ofmitralvalveD.ifthisshouldbeatumour:whatkindof?
8
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936yoldman1.hugecongenitalsubpulmonaryVSD2.severeaorticregurgitation3.severepulmonaryregurgitation4.severetricuspidregurgitation5.AV+PVendocarditis6.suprasystemicpulmonarypressure
Isheoperable?
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9Yes!
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10
Whatisaboutthearterialpressurecurve?Howdoesthislooklike?
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• 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
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11
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12
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13 PatientcannotliedownforPM-implantationWhatistherealproblem?
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14Whichpatienthasananeurysm?
1.A2.B3.C4.AtoC5.AtoD
Ac
BD
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14
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14 What’sthediagnosis?
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15Whatisthediagnosis?
1.Lymphoma2.Rhabdomyoma3.Fibroma4.Echinococcus
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15
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16Whatisthis?1. Pericardialcyst?2. Fat3. Pulmonaryartery4. Leftauricle5. LV-aneurysm6. Rhabdomyoma
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16
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16
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16 LA-Thrombus...
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Asymptomaticseverenecktrauma...
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Patientveryrecentlydisturbedfromarterialbleedingfromtumour…
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1710yoldgirl,referredwithendocarditis1. Artefact2. Vegetation3. Tricuspidendocarditis4. Eustachianvalve5. Thebesianvalve
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189-yearoldboy• Dyspnoeonexertion,
atypicalchestpain• NohistoryofCHD,
normaldevelopment• Severetrafficaccident
with6years
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18
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18
“Pseudoaneurysm”oftheRA?posttraumatic?Congenital?Otheraetiology
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19 AnatomicalDx?Treatment?
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19
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20
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Resultate: Kinder-UniversitätSt.Petersburg38Missionenin3Jahren
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21• 11yoldboy• Headache• Surgerywasoffered
for5000USD1. Doesthismean
something?2. Diagnosis?3. Treatment?4. Prognosis?
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21CarotidTortuositySyndrome
• Adults:atherosclerosis• Children:3rd branchialarch
arterymalformation• Adults:TIA;stroke• Children:waitandsee• Follow-upofonechildfrom
Kazakhstanover15years:uneventful
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22 3monthsoldbabywithheartfailure
• Allheartchambersdilated
• Otherwisenormalanatomy
• Thrillabovetheposteriorcranialbase
• Diagnosis?
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22 Diagnosis?
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22 VenaGaleniMalformation
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23 DiagnosisisobviousWhatistheageofthe
patient?
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24 21yoldman
• Dyspnoe• Otherwisehealthy
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24 Diagnosis?Aetiology?
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24
Aetiology?A) Wedon’t
know?B) TuberculosisC) Congenital
LV-dysplasia
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YangonMedicalUniversity,Myanmar
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Tashkent,Uzbekistan
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RepublicanSpecializedCentreforCardiology,Tashkent• 30’000patientsperyear
PediatricUniversity,Tashkent• 700operations(PDA,CoA,ASD,VSD)
FerganaValley• 10millionpeoplewithoutcardiovascularcare
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TashkentAmbition for Central Asian
Cardiovascular Medical Centre
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25 Diagnosis?
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25 MediastinalTeratoma
• Healthyman• Nosymptoms• Incidentalfinding• Routinechestx-ray
beforebirthofchild
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Donezk...untilMay2014
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SubaorticVSD
263months 5years
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12yearsoldgirlwithsubaorticVSDDyspnoeSlightlyblueCardiologistasksfor“urgent”surgerySystemic=pulmonarypressureExaminations:
• Chestx-ray• Echo:subaorticVSD
Operable?Forwhatkindofsurgery?• Pulmonarybanding• Totalcorrection:VSDclosure• Assistdeviceasbridgetodecision• Heart-lung-transplantation
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MediansternotomyPressureaorta:87mmHgPressurePA:70mmHg100%oxygen:
Pressureaorta:85mmHgPressurePA:67mmHg
Operable?
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Uneventfulpostoperativecourse
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Willthepulmonaryarterypressurecomedown?Probablyyes.Because…:• …thechildisgrowing…• …andnewpulmonaryvesselsandnewalveoliwillgrow…
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50yoldladyPartialAV-canaldefect
Operable?
• Yes
• no
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31yoldman25ymedicaltreatmentforbronchialasthma
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28Diagnosis?
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CreationofunroofedcoronarysinusintotheLAAtrialpatch;tricuspidannuloplasty
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53yoldwomanNegativehistoryReferredwithpericardialtamponadeduetoacutetypeAdissectionInfero-posteriorinfarctionwithleftventricularrupturePerforationsuturedBypassgraftingnotpossible
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DevelopedmitralregurgitationMitraClip2y:severetricuspidregurgitation
Operable?
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Tricuspidvalvereplacement:27mmCERevatio,Levosimendan,preoperativeIABP
1ylater:gradeIItoIIIregurgitationofbioprosthesisValve-in-valveTAVI;actuallyNYHAII 2
9
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64yoldwomanOpenmitralcommissurotomy15yagoSeveretricuspidrepairEROdiameter1.4cm168cm;146kg;onlymobileinsmallroomTreatment:4differentdiuretics
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Elephantiasis?Lymphaticproblem?Duetotricuspidregurgitation
Indicationfortricuspidvalvesurgery?
YesNo
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TricuspidrepairwithreductionannuloplastyComplexpostoperativecourseAnuriaè prolongeddialysisDifficultweaningfrommechanicalventilation
Whatwastheresult?A)Bodyweightincreased•Patientlost:B)15kgC)30kgD)50kgE)75kg
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30Tricuspidvalvesurgery:beneficialEveninworstcases…
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3164yearoldpatient• 25yischemicheartdisease
• LVAD
• Hearttransplantation
• 4weeksafterhearttransplantation
• Sternumdehiscence+sternumosteomyelitis
• Mycoticaneurysmoftheascendingaortawith
impendingruptureofaorto-aorticanastomosis
• InfectedresidualLVADarterialreturnprosthesis
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Diagnosis?Chylothorax?Infection?Fattydegeneration?Pusbonumet
laudabile?Tuberculosis
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31 Diagnosis?
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≈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
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• 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
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WhereEAHFisactive
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...tolate...
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„...not all have the same opportunities...“
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TodesursachenSchweiz
…esgibtimmernochvielzutun...
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EurAsia Heart: Science and Research (1)
8168Patients:Switzerland,Austria,Russia,BulgariaAmericanSocietyforHospitalEpidemiologyandInfectionControl
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EurAsia Heart: Science and Research (2)
EisenmengerEnd-stageheartfailure• Acuteanimalstudy• Chronicanimalstudy
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...esgibtimmernochvielzutun...
• Irkutsk• Wladiwostok• Voronezh• MedSiMoskau• Ulaanbator• Jakarta• Surabaya
SchweizerischeGesellschaftfürKardiologieSchweizerischeGesellschaftfürHerz- undGefässchirurgie
UniversitätsSpitalZürich:EAHFalsManagingDirectorforInternationalRelationsandStrategicProjects
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