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Parentic M, Podolski E, Korda M, Katic B, Kajs FJ, Krzelj K, Belina D, Gasparovic H, Tokic T, Duric Z. Penetrating injury to the left ventricle caused by attempted suicide-a case report. J Surg Case Rep 2024; 2024:rjae159. [PMID: 38505331 PMCID: PMC10948745 DOI: 10.1093/jscr/rjae159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Penetrating cardiac injuries are rare but are one of the most urgent emergencies because they require early intervention in order to prevent death. The mortality rate of such injuries, including pre-hospitalization deaths, goes up to 90%. The most commonly injured heart chamber is the right ventricle since it takes over half of the anterior thoracic wall. The left ventricle is injured less often, but these patients usually have worse prognoses and higher mortality rates because such injuries lead to hemodynamic instability faster. We present a unique case of a suicide attempt in which the patient stabbed himself with a knife, penetrated the left ventricle, and survived even though he transected the second diagonal branch of the left anterior descending coronary artery and pulled the knife out of his chest.
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Affiliation(s)
- Mara Parentic
- University of Zagreb, School of Medicine, Zagreb 10000, Croatia
| | - Eva Podolski
- University of Zagreb, School of Medicine, Zagreb 10000, Croatia
| | - Marin Korda
- University of Zagreb, School of Medicine, Zagreb 10000, Croatia
| | - Borna Katic
- University of Zagreb, School of Medicine, Zagreb 10000, Croatia
| | - Fran Juraj Kajs
- University of Zagreb, School of Medicine, Zagreb 10000, Croatia
| | - Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Drazen Belina
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Tomislav Tokic
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Zeljko Duric
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
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Krzelj K, Lekic A, Luksic VR, Milicic D, Ilic I, Simetic L, Dzepina ZS, Gasparovic H, Biocina B, Safradin I. Successful clinical approach to the metastatic uterine leiomyosarcoma to the epicardium-a case report. BMC Cardiovasc Disord 2024; 24:49. [PMID: 38218764 PMCID: PMC10787998 DOI: 10.1186/s12872-023-03689-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/24/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Uterine leiomyosarcoma is a rare and aggressive tumour with a poor prognosis. Its metastases to the heart are even rarer, especially to the epicardium. The majority of reported cardiac metastases of uterine leiomyosarcoma were in the cardiac chambers or intramyocardial. Surgical resection of the uterine leiomyosarcoma in the early stages is the only definitive treatment for this disease. However, in the cases of cardiac metastasis, surgery is recommended only in emergencies and patients with expected beneficial outcomes. CASE PRESENTATION Our patient was a 49-year-old female referred to the Department of Cardiac Surgery for scheduled surgery of pericardial neoplasia. The patient underwent a hysterectomy and adnexectomy three years prior owing to the uterine leiomyosarcoma. A regular follow-up magnetic resonance imaging of the abdomen and pelvis discovered neoplasia in the diaphragmic portion of the pericardium. No other signs of primary disease relapse or metastases were found. The patient was asymptomatic. The multidisciplinary team concluded that the patient is a candidate for surgery. Surgery included diastolic cardiac arrest achievement and resection of the tumour. Macroscopically, a parietal layer of the pericardium was completely free from the tumour that invaded only the apical myocardium of the left ventricle. Completed histopathology confirmed the diagnosis of leiomyosarcoma of the uterine origin. Three months after surgery, the patient received adjuvant chemotherapy with doxorubicin and dacarbazine. One year after surgery, there are no signs of new metastases. CONCLUSIONS Strict surveillance of patients with uterine leiomyosarcoma after successful treatment of the early stage of the disease is of utmost importance to reveal metastatic disease to the heart in a timely manner and to treat it with beneficial outcomes. Surgery with adjuvant chemotherapy might be a good approach in patients with a beneficial prognosis. From a surgical point of view, it is challenging to assess the appropriate width of the resection edges to be radical enough and, at the same time, sufficiently conservative to ensure the satisfactory postoperative function of the remaining myocardium and avoid repetitive tumour growth. Therefore, intraoperative histopathology should always be performed.
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Affiliation(s)
- Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia.
| | - Ante Lekic
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Vlatka Reskovic Luksic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Davor Milicic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Ivana Ilic
- Department of Pathology and Cytology, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Luka Simetic
- Department of Oncology, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Zrinka Starcevic Dzepina
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Ivica Safradin
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
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Krzelj K, Gasparovic H, Duric Z. Right ventricular dissection after arterial switch operation. Cardiol Young 2023; 33:2466-2468. [PMID: 37555257 DOI: 10.1017/s1047951123002998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Herein we present the right ventricular dissection and describe its successful management after arterial switch operation in a full-term male neonate. There are no evidence-based recommendations for the management of this rare complication. Our management included veno-arterial extracorporeal membrane oxygenation placement and delayed surgical evacuation of the dissecting haematoma with beneficial outcomes.
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Affiliation(s)
- Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Zeljko Duric
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia
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Mihaljevic MZ, Petricevic M, Konosic S, Svetina L, Urlic M, Starcevic Z, Krzelj K, Milosevic M, Kalamar V, Gasparovic H, Biocina B. The Association between Glycosylated Hemoglobin Level and Platelets Reactivity in Patients with Diabetes Mellitus Undergoing Elective Coronary Artery Bypass Grafting. Thorac Cardiovasc Surg 2023; 71:469-482. [PMID: 35752164 DOI: 10.1055/s-0042-1748768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Diabetic patients tend to have increased platelet reactivity after coronary artery bypass grafting (CABG). The aim of this study was to determine the association between hemoglobin A1c (HbA1c) values and platelet reactivity and to evaluate the consequent impact on clinical outcomes in patients undergoing CABG. METHODS This prospective observational trial consecutively enrolled 225 diabetic patients undergoing CABG, between February 2014 and October 2018. HbA1c levels and platelet function (multiple electrode aggregometry [MEA]) were analyzed the day before surgery and on postoperative day 4 (POD 4). Patients were divided into two groups according to the HbA1c value: HBA1c < 7% and HbA1c ≥ 7%. RESULTS Significantly higher postoperative ASPI (platelet function test based on arachidonic acid) and ADP (platelet function test based on adenosine diphosphate) test values were observed at POD 4 compared with preoperative values (ASPI test: p < 0.001; ADP test: p < 0.001). The prevalence of preoperative aspirin resistance (AR) was 46.4% relative to 57.2% after surgery showing consistent increase in postoperative AR by approximately 10%. In addition, the prevalence of AR in the HbA1c < 7% group was higher by 10% compared with the HbA1c ≥ 7% group, both before and after surgery. We did not demonstrate differences in clinical outcomes between the HbA1c groups. CONCLUSION Perioperative assessment of platelet reactivity in diabetic patients detects those with AR who may be at increased risk of adverse ischemic events. A personalized approach guided by MEA and administration of early and more potent antiaggregation therapy after CABG can be beneficial in this group of patients.
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Affiliation(s)
- Martina Zrno Mihaljevic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Mate Petricevic
- Department of Cardiac Surgery, University Department of Health Studies, University of Split, UHC Zagreb, Split, Croatia
| | - Sanja Konosic
- Department of Anesthesiology, University Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Lucija Svetina
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Marjan Urlic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Zrinka Starcevic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Milan Milosevic
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Viktor Kalamar
- Department of Thoracic Surgery, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery, University Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
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Krzelj K, Anic D. Aortic Dissection and COVID-19 Pneumonia in a Pregnant Woman at 34 Weeks of Gestation. Tex Heart Inst J 2023; 50:490619. [PMID: 36735917 PMCID: PMC9969779 DOI: 10.14503/thij-22-7854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Between 0.1% and 0.3% of all aortic dissections occur during pregnancy. Arterial hypertension, connective tissue disorders, and congenital cardiovascular anomalies-including bicuspid aortic valves-are well-known risk factors. The causality between pregnancy and aortic dissection is unclear, but there have been some observations that COVID-19 illness may increase the risk. This report describes a pregnant woman at 34 weeks of gestation who had a bicuspid aortic valve and experienced an acute aortic dissection while ill with COVID-19 pneumonia. Computed tomography confirmed a type A aortic dissection and bilateral patchy pulmonary opacities. Cesarean delivery was performed, followed by replacement of the aortic valve with a mechanical aortic prosthesis and reconstruction of the ascending aorta and hemiarch. The intraoperative course was uneventful, and the patient was successfully weaned from mechanical ventilation after 51 hours. COVID-19 during pregnancy seems to increase the risk for aortic dissection, although there is no evidence base for an association. Because guidelines for diagnosis and treatment in such complex cases are lacking, care from a multidisciplinary team is crucial for successful outcomes.
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Affiliation(s)
- Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darko Anic
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
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Krzelj K, Duric Z, Situm I, Karmelic D, Erceg A, Kljajic K, Mazar M, Gasparovic H, Lovric D. Management of tracheo-innominate artery fistula in the challenging environment of an improvised COVID-19 intensive care unit. Anaesthesiol Intensive Ther 2023; 55:310-312. [PMID: 38084578 PMCID: PMC10691458 DOI: 10.5114/ait.2023.132916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zeljko Duric
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivan Situm
- Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dora Karmelic
- Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ante Erceg
- Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Kristina Kljajic
- Department of Paediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirabel Mazar
- Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Daniel Lovric
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
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Krzelj K, Petricevic M, Gasparovic H, Biocina B, McGiffin D. Ventricular Assist Device Driveline Infections: A Systematic Review. Thorac Cardiovasc Surg 2021; 70:493-504. [PMID: 34521143 DOI: 10.1055/s-0041-1731823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Infection is the most common complication in patients undergoing ventricular assist device (VAD) implantation. Driveline exit site (DLES) infection is the most frequent VAD infection and is a significant cause of adverse events in VAD patients, contributing to morbidity, even mortality, and repetitive hospital readmissions. There are many risk factors for driveline infection (DLI) including younger age, smaller constitution of patients, obesity, exposed velour at the DLES, longer duration of device support, lower cardiac index, higher heart failure score, DLES trauma, and comorbidities such as diabetes mellitus, chronic kidney disease, and depression. The incidence of DLI depends also on the device type. Numerous measures to prevent DLI currently exist. Some of them are proven, whereas the others remain controversial. Current recommendations on DLES care and DLI management are predominantly based on expert consensus and clinical experience of the certain centers. However, careful and uniform DLES care including obligatory driveline immobilization, previously prepared sterile dressing change kits, and continuous patient education are probably crucial for prevention of DLI. Diagnosis and treatment of DLI are often challenging because of certain immunological alterations in VAD patients and microbial biofilm formation on the driveline surface areas. Although there are many conservative and surgical methods described in the DLI treatment, the only possible permanent solution for DLI resolution in VAD patients is heart transplantation. This systematic review brings a comprehensive synthesis of recent data on the prevention, diagnostic workup, and conservative and surgical management of DLI in VAD patients.
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Affiliation(s)
- Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Mate Petricevic
- Division of Health Studies, Department of Cardiac Surgery, University of Split, University Hospital Center Zagreb, Zagreb, Croatia
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - David McGiffin
- Department of Cardiothoracic Surgery and Transplantation, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Clayton, Victoria, Australia
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