INTRODUCTION

Sinus of Valsalva aneurysms (SOVA) are rare conditions in which a portion of the aortic root dilates due to weakness of the aortic wall, which can eventually lead to rupture, leading to a shunt from the aorta into any one of the cardiac chambers. Some patients can present asymptomatically and are diagnosed incidentally, while others can present with precipitous courses with symptoms of chest pain, palpitations and heart failure. When left untreated, these patients have poor prognosis.

CASE DESCRIPTION

A total of six patients are presented in this case series. These patients were seen in a national tertiary hospital from 2018 to 2024. The patients had varied characteristics, with ages ranging from 24-57 years old. Most of the patients were males. The presenting symptoms are also varied, with dyspnea being the most common symptom and a murmur being the most common sign. The most commonly involved sinus was the right coronary sinus draining into the right ventricle, with half of the patients presenting with concomitant ventricular septal defects. Five out of the six patients underwent successful open repair of their ruptured SOVAs and were eventually discharged.

DISCUSSION

Early identification of the cardiac lesion is important to clinch the diagnosis and plan for eventual definitive management. Imaging studies such as transthoracic echocardiogram are needed to visualize the defect, which is classically described as a windsock deformity. Transesophageal echocardiography may present clearer images to assess the anatomy better preoperatively. Medical management is usually done to bridge the patient to more definitive therapy, either through endovascular closure if the anatomy permits it or through surgical repair. Urgent and timely repair is needed to ensure improved survival in these patients.

Human ; Sinus Of Valsalva ; Aneurysm ; Rupture ; Chest Pain ; Heart Failure

INTRODUCTION: Cardiac hemangiomas are rare benign primary tumors.We present the successful management of a patient with a hemangioma causing significant right ventricular outflow tract (RVOT) obstruction.
CLINICAL PRESENTATION: A 54-year-old  female  with  no  co-morbidities  presented  with  progressive  right-sided  heart failure  symptoms.Examination  revealed  a  prominent right  ventricular  heave,  irregular  cardiac  rhythm,murmurs  consistent  with  pulmonic  stenosis  and  tricuspid regurgitation,  ascites,  and  bipedal  edema.  Given the echo features of the mass and the patient's clinical course,we  favored  a  benign  cardiac  tumor  over  malignancy.Differentials included  myxoma,  fibroma,  and  papillary fibroelastoma. Medical management included enoxaparin and carvedilol as anticoagulation and rate control for the atrial flutter, respectively. Surgical treatment consisted of tumor excision and tricuspid valve annuloplasty.
RESULTS: Intra-operatively, the stalk was indeed attached to the RV free wall. Histopathology was consistent with primary cardiac hemangioma. The patient's post-operative course was complicated by pneumonia, acute kidney injury, and tracheostomy, but she was eventually discharged improved after a month in the ICU.
SIGNIFICANCE: This report highlights a rare primary cardiac tumor in an unusual location. While there have been several reports in the world literature on cardiac hemangiomas, less than ten cases have been shown to have significant RVOT obstruction as in our patient.
CONCLUSION: Cardiac hemangiomas should be part of the differential diagnosis for an intracardiac mass in the right ventricle.  Meticulous  echocardiography  can  be  a  non-invasive and inexpensive aid to diagnosis and pre-operative planning.

Human ; Female ; Middle Aged ; Tricuspid Valve ; Carvedilol ; Enoxaparin ; Tricuspid Valve Insufficiency ; Heart Ventricles ; Tracheostomy ; Myxoma ; Heart Neoplasms ; Propanolamines ; Hemangioma ; Pulmonary Valve Stenosis

OBJECTIVE: To determine high sensitivity C-reactive protein (hsCRP) levels of patients admitted for myocardial infarction (MI) and determine its association with existing traditional cardiovascular (CV) risk factors and future cardiovascular events.

METHODS: This was a prospective cohort study involving two centers, the Makati Medical Center and the University of the Philippines-Philippine General Hospital (UP-PGH). A total of 49 acute Ml patients who fulfilled the inclusion and exclusion criteria were enrolled in the study. Levels of hs-CRP were taken within 6 hours of admission. Demographic data, in-patient outcomes and 30-day clinical outcomes were observed. A univariate analysis with Fisher's Exact Test was done to determine if there was an association between hs-CRP levels and traditional CV risk factors, and clinical outcomes.

RESULTS: There was a significantly higher difference in the primary composite endpoint of all-cause mortality, Ml, unstable angina and revascularization among patients with hs-CRP> 10 mg/dL(CI: 95%, p=0.045)

CONCLUSION: The study shows that elevated levels of hs-CRP can be utilized for cardiovascular risk stratification and prognostication among patients with acute myocardial infarction.

Human ; Male ; Female ; Young Adult ; Adolescent ; Child ; Infant ; Infant Newborn ; C-reactive Protein ; Cardiovascular Diseases ; Philippines ; Angina, Unstable ; Myocardial Infarction ; Cardiovascular System