The coronavirus disease 2019 (COVID-19) has revolutionised the healthcare system and has had a profound impact on the clinical practice and on the management of cardiovascular (CV) diseases.
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Infectious aortic aneurysm leads to poor prognosis and high mortality rate as high as 50% due to delayed/missed diagnosis. Early use of appropriate antibiotics and adequate surgical debridement would improve outcome of patients which is dependent on diagnosis on time. It takes as long as 7 days before a certain bacterium could be isolated/biochemical identified. It is difficult to differential these bacteria by the isolation/biochemical identification on time. Direct detection of a certain bacterium using molecular diagnostic assays such for PCR with specific primers is a preferred option for rapid diagnosis but requires sophisticated laboratories. A high degree of clinical suspicion should be the key for a diagnosis of infectious aortic aneurysm in endemic areas.
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Introduction: In the heart failure population, overweight individuals are associated with lower mortality, termed the obesity survival paradox. The influence of body mass index (BMI) on outcomes in cardiac amyloidosis has not been characterized. We sought to determine the association between BMI and mortality, and hematologic and cardiac response in patients with light chain (AL) amyloidosis. Methods: We conducted a retrospective study of patients with cardiac AL amyloidosis referred between 1/1/2009 and 09/30/2018. We collected baseline demographics including BMI and recorded mortality and hematologic and cardiac response. Cox proportional hazards model and logistic regression models were constructed to examine the association between BMI and outcomes. Results: Of the 78 patients, 17 patients had a BMI of 17-22.5, 19 a BMI of 22.6-25, 23 a BMI of 25.1-29.9, and 19a BMI of ≥ 30kg/m2. The median follow-up was 51 months. There was no relationship between BMI as a continuous variable and mortality (adjusted HR 0.98, 95% CI 0.91-1.05, p=0.54).While there was no relationship between high BMI ( 25 kg/m2) and hematologic response (adjusted OR 0.97, 0.34-2.76, p=0.96), there was a relationship between high BMI and a lower likelihood of achieving cardiac response (adjusted OR 0.23, 0.07-0.71, p=0.011). Conclusions: In this cohort of patients with AL cardiac amyloidosis, there was no significant relationship between BMI and mortality. Patients with a higher BMI were significantly less likely to achieve a cardiac response. These findings highlight the importance of a multidisciplinary approach involving oncologists, cardiologists, and nutritionists in the treatment of this very complex multi-organ disease.
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Aorto-Left Ventricular Tunnel (ALVT) is a rare congenital heart disease (CHD) that is worth studying, specifically when considering the differential diagnosis in other pathologies such as coronary artery fistulas (CAF), sub arterial VSD with aortic insufficiency, ductus arteriosus and the like. We present a case of a child who was asymptomatic until the age of 12 and was diagnosed of ALVT during the study of a heart murmur. We found two interesting associations: a unique coronary artery and a sub aortic VSD. After attempting to close the tunnel and VSD, aortic regurgitation was detected, which required reintervention. Authors highlight the importance of the echocardiogram and catheterization to reveal details of the malformation as well as the need for constant follow up after surgery to monitor the possibility of later complications.
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