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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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Skific M, Golemovic M, Safradin I, Duric Z, Biocina B, Golubic Cepulic B. Cryopreserved human heart valve allografts: a ten-year single centre experience. Cell Tissue Bank 2022; 24:401-416. [PMID: 36222968 PMCID: PMC9555264 DOI: 10.1007/s10561-022-10043-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022]
Abstract
This study provides an overview of tissue banking activities at the Croatian Cardiovascular Tissue Bank (CTB) during past ten years and presents the outcomes of cryopreserved heart valve allografts (CHAs) use in different patient groups. From June 2011 until December 2021, 75 heart donations were referred to CTB: 41 recipient of heart transplant (RHT), 32 donors after brain death (DBD) and 2 donors after circulatory death (DCD) donations. Processing resulted in 103 valves of which 65 met quality requirements for clinical use. Overall tissue discard rate was 37%. The most frequent reasons for discard were inadequate morphology (12%) in RHT donations and microbiological contamination (19%) in DBD donations. Altogether, 38 CHAs were transplanted to 36 patients. Recipients were divided in three groups; infective endocarditis (IE), non-infectious heart disease and congenital heart disease group. In the IE group, the 30-day, 1-year and 3-year survival was 71%, 53% and 47%, respectively. Freedom from re-operation due to all graft-related causes was 76% and due to structural valve deterioration 88%. There were no cases of graft reinfection. In the congenital heart disease group CHAs were predominantly (94%) used for right ventricular outflow tract reconstruction and 88% of patients recovered without graft-related complications. At present, the number of demands for CHAs at CTB considerably outweighs their availability.
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Affiliation(s)
- Marijana Skific
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Mirna Golemovic
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Ivica Safradin
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Zeljko Duric
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.,University of Zagreb School of Medicine, Salata 3, 10000, Zagreb, Croatia
| | - Branka Golubic Cepulic
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.,University of Zagreb School of Medicine, Salata 3, 10000, Zagreb, Croatia.,University of Applied Health Sciences, Mlinarska 38, 10000, Zagreb, Croatia.,University of Split, University Department of Health Studies, Rudera Boskovica 35, 21000, Split, Croatia
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Petricevic M, Knezevic J, Samoukovic G, Bradaric B, Safradin I, Mestrovic M, Papestiev V, Hodalin A, Madzar T, Mihalj M, Rotim A, Biocina B. Diagnosis and Management of Acquired von Willebrand Disease in Heart Disease: A Review of the Literature. Thorac Cardiovasc Surg 2018; 68:200-211. [PMID: 30458570 DOI: 10.1055/s-0038-1673670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The incidence of acquired von Willebrand syndrome (AvWS) in patients with heart disease is commonly perceived as rare. However, its occurrence is underestimated and underdiagnosed, potentially leading to inadequate treatment resulting in increased morbidity and mortality.In patients with cardiac disease, AvWS frequently occurs in patients with structural heart disease and in those undergoing mechanical circulatory support (MCS).The clinical manifestation of an AvWS is usually characterized by apparent or occult gastrointestinal (GI) or mucocutaneous hemorrhage frequently accompanied by signs of anemia and/or increased bleeding during surgical procedures. The primary change is loss of high-molecular weight von Willebrand factor multimers (HMWM). Whereas the loss of HMWM in patients with structural heart disease is caused by increased HMWM cleavage by von Willebrand factor (vWF)-cleaving protease, ADAMTS13, AvWS in MCS patients is predominantly a result of a high shear stress coupled with mechanical destruction of vWF itself.This manuscript provides a comprehensive review of the evidence regarding both diagnosis and contemporary management of AVWS in patients with heart disease.
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Affiliation(s)
- Mate Petricevic
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Jadranka Knezevic
- Department of Transfusion Medicine, University Hospital Center Mostar, Mostar, Bosnia and Herzegovina
| | - Gordan Samoukovic
- Divisions of Cardiac Surgery and Critical Care, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bozena Bradaric
- Merkur University Hospital, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Disease, Zagreb, Croatia
| | - Ivica Safradin
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marija Mestrovic
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Vasil Papestiev
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Alen Hodalin
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Mario Mihalj
- Department of Neurology, University of Split School of Medicine, University Hospital Center Split, Split, Croatia
| | - Ante Rotim
- University of Osijek School of Medicine, Osijek, Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
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Petricevic M, Biocina B, Milicic D, Lekic A, Safradin I, Gasparovic H. Multiple electrode aggregometry and prediction of bleeding and transfusion outcomes in adult cardiac surgery patients: methodological challenges and opportunities for future. Thorac Cardiovasc Surg 2013; 61:744-5. [PMID: 24265087 DOI: 10.1055/s-0033-1353533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mate Petricevic
- Department of Cardiac Surgery, University of Zagreb School of Medicine, Kispaticeva 12, 10000 Zagreb, Croatia
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Petricevic M, Biocina B, Safradin I, Gasparovic H. Preoperative aspirin discontinuation management and bleeding outcome in elective coronary artery surgery. Thorac Cardiovasc Surg 2013; 61:731-2. [PMID: 24265088 DOI: 10.1055/s-0033-1348318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mate Petricevic
- Department of Cardiac Surgery, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
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Safradin I, Cepulic BG, Golemovic M, Habekovic R, Borojevic M, Skific M, Jelasic D, Marekovic I, Ivankovic S, Biocina B. Cardiovascular tissue banking in Croatia. J Cardiothorac Surg 2013. [PMCID: PMC3846098 DOI: 10.1186/1749-8090-8-s1-p86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Ivankovic S, Borojevic M, Safradin I, Colak Z, Burcar I, Hodalin A, Belina D, Lekić A, Gasparovic H, Biocina B. Impact of preexisting cognitive decline in patients with diabetes mellitus type II on neurocognitive outcome after cardiac surgery. J Cardiothorac Surg 2013. [PMCID: PMC3844962 DOI: 10.1186/1749-8090-8-s1-p154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Petrunic M, Mestrovic T, Loncaric Y, Golubic-Cepulic B, Oberman B, Safradin I. In situ repair of a mycotic suprarenal aortic aneurysm using a cryopreserved aortic homograft and visceral debranching in a patient with spondylodiscitis and left psoas muscle abscess. Ann Thorac Cardiovasc Surg 2013; 19:394-8. [PMID: 23903708 DOI: 10.5761/atcs.cr.13-00084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present a patient with ruptured suprarenal aortic aneurysm, involving origins of visceral and renal arteries. Associated spondylodiscitis and left psoas muscle abscess were also diagnosed. The patient was initially treated with antibiotics. Diagnostic survey showed progression of the aneurysm diameter and enlargement of the psoas muscle abscess. Surgical treatment using a cryopreserved aortic homograft with debranching of visceral arteries was performed. Different modalities of surgical repair within the infected aortic segment and the rationale for usage of cryopreserved homografts are considered. The importance of optimal timing for surgery is emphasized as well.
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Affiliation(s)
- Mladen Petrunic
- Department of Surgery, Division for Vascular Surgery, University Hospital Center Zagreb - "Rebro", Zagreb, Croatia
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Borojevic M, Safradin I, Vrljic D, Biocina B. Rewarming strategy and neuromonitoring are significant details in neurological outcome after surgical repair of type A aortic dissection. Eur J Cardiothorac Surg 2013; 44:402. [PMID: 23404688 DOI: 10.1093/ejcts/ezt047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zrno M, Vojković J, Safradin I, Ivanković S, Corić V. [News in hemodynamic monitoring, resuscitation and intensive care of patients after cardiac surgery: "Guidelines for resuscitation in cardiac arrest after cardiac surgery" of the European Association for Cardio-Thoracic Surgery]. Lijec Vjesn 2010; 132 Suppl 1:32-35. [PMID: 20715719] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In order to simplify and to standardize procedures during cardiac arrest in patients after cardiac surgery and for professional medical staff education, working group of the European Association for Cardio-Thoracic Surgery issued in 2009 "Guideline for resuscitation in cardiac arest after cardiac surgery". There are several differences between these guidelines and guidelines for general population: in ventricular fibrillation, three sequential attempts at defibrillation should precede external cardiac massage; in asystole or extreme bradycardia, pacing should precede external cardiac massage. Where the above measures fail, and in pulseless electrical activity, early resternotomy is advocated. Adrenaline should not be routinely given. Also protocols for excluding reversible airway and breathing complications and for safe emergency resternotomy are given. These guidelines in very simple and professional way define rules for resuscitation of patients after cardiac surgery. It is a useful manual which will certainly find its place in daily work of professional medical staff involved in healthcare of these patients.
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Affiliation(s)
- Martina Zrno
- Klinika za kardijalnu kirurgiju Klinickog bolnickog centra Zagreb
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