Faculty Bibliography

Background: Hemodialysis (HD) is capable of inducing Left ventricular dysfunction, which may persist even after hemodynamic or clinical status has returned to normal. Repeated episodes of myocardial depression result in myocardial hibernation, remodeling, and some degree of irreversible loss of contractile function. Objectives: Our goal is to highlight the impact of this phenomenon, sometimes not considered an important risk factor for cardiovascular morbidity. Methods: Review of literature, identifying predisposing factors, diagnostic approaches and therapeutic options. Discussion: Predisposing factors include dialysis-related, cardiac and medical. The most important are: * Large volume of fluid removal. * Hemodialysis-related hypotension. * Small cardiac chamber size or chamber hyperthrophy. * Microvascular endothelial dysfunction. * Overmedication with antihypertensive agents * Reduced fluid intake or volume loss. Symptoms occur during HD and include chest discomfort, palpitations, and general fatigue as well as ECG changes. Echocardiography is ideally suited to diagnose transient reversible regional wall motion abnormalities (RWMA) that are hallmark to this condition. Increase in troponin T levels is also related with presence and severity of myocardial dysfunction. The therapeutic approach is aimed to reduce the episodes of intradialytic hypotension and avoid large UF volumes. Biofeedback dialysis, reduced dialysate temperatures, frequent dialysis sessions, switch peritoneal dialysis and use of beta-blockers are some options. Conclusions: Cardiac dysfunction occurs in two-thirds of HD patients and predicts a substantial increase in mortality. As shown, HD-related myocardial ischemia with recurrent ischemic insults leads to structural and functional changes resulting in systolic dysfunction. Preliminary evidence has shown that modifications of dialysis technique may reduce the myocardial perturbation

Cardiac Teratoma is a tumor of very rare occurrence in adult population. Here we report a case in a Caucasian male with history of Human immunodeficiency virus infection where the symptom as presentation was recurrent episodes of tachycardia. The chest radiograph showed a lesion in the right heart border and subsequent investigation revealed an intrapericardial lesion, which was demonstrated to be a pericardial teratoma diagnosed by histopathology. In this case the initial differential diagnosis included lymphoma or an infectious organism as possible causes in a immunocompromised patient. Cardiac teratomas are among the less common types of cardiac tumors being more frequent in child population and around 1% of all the cardiac tumors in adults. Imaging studies are very helpful. CT and MRI are the best due to their resolution and ability to assess the relationship of the mass with the surrounding structures. Echocardiogram in also helpful determining the presence of pericardial effusion because cardiac teratomas are most of the time present in the pericardium. The final diagnosis is mostly made after surgical excision and this is the most effective treatment because they are relatively resistant to chemotherapy and radiotherapy. The authors have no funding, financial relationships, or conflicts of interest to disclose.

The incidental diagnosis in adult age is very unusual and the presence of clinical symptoms is related to its location, which is most commonly intrapericardial. The presence of intramyocardial teratoma lesions is even rarer and has been reported in few publications. The recommendations for the diagnosis and management of a cardiac teratoma depends upon the imaging studies and the pathological report after surgical excision. The prognosis of surgically treated patient is very good and a complete surgical excision is preferred in order to avoid complications.

Myxomas are the most common primary cardiac tumors, most frequently found in the left atrium. We present a case of an atrial myxoma. An in-depth review of atrial myxoma is presented, examining the important clinical symptoms and diagnostic indicators. The treatment of atrial myxoma is then discussed, with an emphasis on current therapies. An extensive literature review has been performed to present a comprehensive review of the causes, pathophysiology of atrial myxoma.

OBJECTIVES: The purpose of this study was to determine the importance of nondiagnostic fine-needle aspiration biopsy results for post-thyroidectomy bed lesions in patients with thyroid cancer. METHODS: The Institutional Review Board approved this retrospective Health Insurance Portability and Accountability Act-compliant study with a waiver for informed consent. Twenty-one patients with nondiagnostic fine-needle aspiration biopsy of a thyroid bed lesion after thyroidectomy with at least 1 year of follow-up with neck imaging were retrospectively enrolled in our study. The tumor type, local staging, radiotherapy, serum thyroglobulin levels, and imaging characteristics of the thyroid bed lesions were recorded. All patients underwent sonographically guided fine-needle aspiration biopsy of the thyroid bed lesion. RESULTS: The mean imaging follow-up +/- SD was 46.3 +/- 28.7 months. Lesions in 20 patients (95.2%) were stable on imaging. Most thyroid bed lesions were hypoechoic (80.9%), and none showed calcifications. The mean thyroid bed mass maximum diameter was 1.17 +/- 0.6 cm (range, 0.3-2.9 cm). CONCLUSIONS: Thyroid bed lesions with nondiagnostic fine-needle aspiration biopsy results after thyroidectomy can be managed with imaging follow-up; 1-year imaging is a reasonable interval after biopsy.

Kommerell diverticulum (KD) is an aortic arch diverticulum at the origin of an aberrant subclavian artery. It is a rare anatomical anomaly that can be associated with a double aortic arc, a left aortic arch, and anomalous origin of the right subclavian artery or a right aortic arch with anomalous left subclavian artery. We present a case of KD presenting initially as syncope, as well as a review of the literature of this rare syndrome, including diagnosis, imaging techniques, and current surgical treatments.

Heparin Induced Thrombocytopenia (HIT) is an adverse effect of heparin therapy with possibly devastating consequences. We present a case of HIT Type II. An in-depth review of HIT is presented, examining the important clinical symptoms and diagnostic indicators. The treatment of HIT is then discussed, with an emphasis on current therapies. An extensive literature review has been performed to present a comprehensive review of the causes, pathophysiology and treatment of HIT. KEYWORDS: Heparin induced thrombocytopenia; Anticoagulation; PF4; HIT.