ABSTRACT Accidental detachment of mechanical valve leaflet during implantation is a rare and potentially serious complication. When the lost leaflet cannot be found by direct visualisation, additional diagnostic procedures are necessary to detect it. Computer tomography is the best detection method, but the patient needs reoperation. We presented a patient in whom the detached leaflet migrated and became trapped into the left inferior pulmonary vein. The computed tomography (CT) scan was used to reveal leaflets, and successful extirpation was performed in the second operation.

Abstract We presented a case of a 56-year-old man with giant pulmonary artery aneurysm caused by a misdiagnosed patent ductus arteriosus, severe multivalvular disease and active aortic valve endocarditis successfully treated by surgery. The correct diagnosis was missed despite preoperative diagnostics because the small patent ductus arteriosus was located at the distal part of common pulmonary trunk and a huge regurgitant signal overlapped its Doppler signal. Thorough evaluation of every patient, regardless of age, is necessary to recognize and treat this congenital anomaly.

RESUMO Objetivo: A DPOC é uma das principais causas de morbidade e mortalidade em todo o mundo. Os provedores de cuidados de saúde deveriam aconselhar seus pacientes fumantes com DPOC a parar de fumar como primeiro passo de tratamento. Entretanto, em países com altas prevalências de tabagismo, os profissionais de saúde também podem ser fumantes. O objetivo deste estudo foi determinar a frequência de DPOC e sua gravidade em profissionais de saúde que fumam. Métodos: Trata-se de um estudo transversal. Todos os profissionais de saúde fumantes de nove centros de saúde na Sérvia foram convidados a participar do estudo e realizar espirometria. O diagnóstico de DPOC baseou-se em VEF1/CVF pós-broncodilatador < 0,70. Todos os pacientes preencheram o COPD Assessment Test e o Fagerström Test for Nicotine Dependence. Resultados: Participaram do estudo 305 indivíduos, e 47 (15,4%) eram do sexo masculino. A média de idade dos participantes foi de 49,0 ± 6,5 anos. A espirometria revelou defeito ventilatório obstrutivo em 33 indivíduos (10,8%), defeito ventilatório restritivo em 5 (1,6%) e doença das vias aéreas pequenas em 96 (31,5%). O diagnóstico de DPOC foi feito em 29 pacientes (9,5%), 25 (86,2%) dos quais foram recém-diagnosticados. Com base nas diretrizes da Global Initiative for Chronic Obstructive Lung Disease, a maioria dos pacientes com DPOC ficou no grupo A ou B (n = 14; 48,2%, para ambos); 1 ficou no grupo D (3,6%) e nenhum ficou no grupo C. Um grau muito alto de dependência de nicotina foi mais comum nos indivíduos com DPOC que naqueles sem a doença (20,7% vs. 5,4%; p = 0,01). Conclusões: Nesta amostra de profissionais de saúde, a frequência de DPOC foi comparável à observada na população geral. A presença de DPOC em profissionais de saúde que fumam relacionou-se com maior dependência de nicotina.

ABSTRACT Objective: COPD is one of the major causes of morbidity and mortality worldwide. Health care providers should counsel their smoking patients with COPD to quit smoking as the first treatment step. However, in countries with high prevalences of smoking, health care workers may also be smokers. The aim of this study was to determine the frequency and severity of COPD in health care workers who smoke. Methods: This was a cross-sectional study. All health care workers who smoke, from nine health care centers in Serbia, were invited to participate in the study and perform spirometry. The diagnosis of COPD was based on a post-bronchodilator FEV1/FVC ratio of < 0.70. All patients completed the COPD Assessment Test and the Fagerström Test for Nicotine Dependence. Results: The study involved 305 subjects, and 47 (15.4%) were male. The mean age of the participants was 49.0 ± 6.5 years. Spirometry revealed obstructive ventilatory defect in 33 subjects (10.8%); restrictive ventilatory defect, in 5 (1.6%); and small airway disease, in 96 (31.5%). A diagnosis of COPD was made in 29 patients (9.5%), 25 (86.2%) of whom were newly diagnosed. On the basis of the Global Initiative for COPD guidelines, most COPD patients belonged to groups A or B (n = 14; 48.2%, for both); 1 belonged to group D (3.6%); and none, to group C. Very high nicotine dependence was more common in those with COPD than in those without it (20.7% vs. 5.4%, p = 0.01). Conclusions: In this sample of health care workers, the frequency of COPD was comparable with that in the general population. The presence of COPD in health care workers who smoke was associated with higher nicotine dependence.