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Abstract

Stem cells are undifferentiated cells that can divide and become differentiated. Hematopoietic stem cells cannot transform into new stem cells such as cardiomyocytes or new heart valves, but they act through paracrine effects, by secreting cytokines and growth factors that lead to an increase in contractility and overall improved function. In this case report, we present how autologous stem cell transplantation can bring two major benefits: the first refers to hematological malignancy and the second is about the improvement of the heart condition. We present the case of a 60-year-old patient diagnosed with multiple myeloma suffering from a bi-valve severe condition in which autologous stem cell transplantation led to the remission of the patient’s malignant disease and also improved the heart function.

Abstract

Impedance cardiography (ICG) is a non-invasive tool for assessing the hemodynamic parameters. It has been used for diagnosing several cardiovascular diseases, such as heart failure, cardio-myopathy, and valvular diseases. Particularly, the valvular heart disease is characterized by the damage in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary valves. The mitral valve insufficiency and the aortic valve stenos are the most frequent valve diseases in the world. In this paper, we propose to diagnosis the mitral valve insufficiency using the impedance cardiography technique. The study group consisted of 40 subjects (20 control subjects and 20 patients with mitral insufficiency). A parameter “I” is calculated from the impedance cardiogram waveform and it is used to differentiate control subjects from patients with mitral insufficiency. The parameter “I” was related significantly to the abnormalities of the impedance cardiogram waveform. For patients with mitral insufficiency, “I” was higher than for the healthy subjects with a difference ratio of 89% (p<0.001). To improve the diagnosis, we determined the stroke volume, cardiac output, and other hemodynamic parameters for the two groups of subjects. Finally, we concluded that we could identify, easily, patients with mitral insufficiency based on the abnormalities of the impedance cardiogram tracings and a characteristic parameter “I”.

Abstract

Bicoronary - pulmonary artery fistulae are rare conditions. Their association with mitral valve prolapse is even rarer and randomly reported. This association is important to be recognized in clinical practice because of the differential diagnose problems. Closing the coronary fistulae and mitral valve replacement during the same surgical procedure is probably the optimal management of these patients. We report a case involving the correction of congenital bicoronarypulmonary artery fistulae and mitral valve replacement within the same surgical procedure in a 56 years old female patient with angina and clinical signs of left ventricular failure associating the fistulae to severe mitral regurgitation due to mitral valve prolapse. Past medical history revealed autoimmune thyroiditis, atrial fibrillation, mitral and tricuspid valve regurgitation. At admission physical examination revealed stable vital signs, irregular tachycardia with significant pulse and a mitral regurgitation systolic murmur. ECG showed atrial fibrillation, no ischemia. Echocardiography revealed severe mitral regurgitation, prolapse of anterior and posterior mitral leaflets, moderate tricuspid valve regurgitation, and mild pulmonary hypertension. Coronary angiogram showed no significant lesions of the epicardial vessels but high flow congenital bicoronary-pulmonary fistulae (right coronary artery and left coronary artery to main pulmonary artery). Surgical correction of the congenital bicoronarypulmonary fistulae was performed simultaneously with mitral valve replacement in the same session. Postsurgical evolution was uneventful. Post-procedural ECG showed atrial fibrillation with a controlled heart rate, postoperative echocardiography showed normal functional and normal positioned prosthetic mitral mechanical valve, and rather normal left ventricle function. Coexistence of bicoronary-pulmonary fistulae and mitral valve insufficiency due to prolapse in a symptomatic patient with angina pectoris is a very rare clinical entity. Solving both abnormalities within the same surgical procedure was the optimal management for this patient.

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