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