A Case of Native Valve Infective Endocarditis Caused by Staphylococcus lugdunensis / 대한내과학회지

A 37-year-old woman presented to our hospital with a 1-month history of fever. She also complained of lower leg pain. Transthoracic echocardiography showed large vegetations on the mitral valve leaflets. Staphylococcus lugdunensis was isolated from blood cultures. She was diagnosed with infectious endocarditis due to S. lugdunensis and was treated with antibiotics and surgery. Infective endocarditis caused by S. lugdunensis can be invasive and often resembles endocarditis due to Staphylococcus aureus. Thus, whenever this organism is found in patients with endocarditis, early surgical treatment of the infected valve should be considered.

A Case of a Right Atrial and Inferior Vena Caval Thrombus Resembling a Right Atrial Myxoma

A right atrial and inferior vena caval thrombus in a structurally normal heart is a very rare condition. We report a case of such a thrombus in a 66-year-old woman. She was admitted to our hospital with recent onset dyspnea. Based on echocardiography, we suspected that she had myxoma. We performed an excision of a mass, which was found, by pathologic examination, to be an organized mural thrombus.

Papillary Fibroelastoma Presenting as a Left Ventricular Mass

Cardiac papillary fibroelastoma (CPF) is a benign cardiac tumor that usually affects cardiac valves. It is usually discovered incidentally on routine echocardiography. However, left ventricular CPF is rare. This report describes the case of a 73-year-old female, referred to a cardiology department for evaluation of a mass of the left ventricle. The mass was found routine echocardiography. The transthoracic echocardiography revealed a 2.2x1.3 cm highly oscillating mass, attached by stalk on the inferior wall of the left ventricle. Cardiac magnetic resonance imaging demonstrated a non-enhanced, 1.8x1.0 cm mass on the inferior wall of the left ventricle. The patient underwent surgical resection of the mass, histopathologic examination of the mass confirmed the diagnosis of a CPF.

Successful Percutaneous Coronary Intervention for Acute Coronary Syndrome in a Patient With Severe Hemophilia A

Patients with hemophilia generally have a reduced frequency of coronary artery disease compared to the general population. As advances in the management of hemophilia have increased their life expectancy, the prevalence of coronary artery disease also has increased. However, there are no standard treatment guidelines for coronary artery disease in patients with hemophilia, especially in the field of coronary intervention. We report the case of a patient with severe hemophilia A who presented with acute coronary syndrome and was successfully treated with percutaneous coronary intervention.

Huge Aneurysm of the Sinus of Valsalva Compressing the Left Atrium

Sinus of Valsalva aneurysms are rare cardiac anomalies. They can be congenital or acquired, and mainly involve the right or non-coronary sinuses. Unruptured aneurysms are usually asymptomatic unless they compress other structures or produce thrombi. A sinus of Valsalva aneurysm can also produce myocardial infarction through thrombus formation secondary to the turbulent flow in the Valsalva aneurysm. We report a case of a huge sinus of Valsalva aneurysm involving the noncoronary sinus, which was diagnosed as the presumed source of acute myocardial infarction.

Impact of ST segment deviation in patients with acute myocardial infarction and left ventricular systolic dysfunction / 대한내과학회지

BACKGROUND/AIMS: Although the impact of ST segment elevation in patients with acute myocardial infarction (MI) has been studied, little information is available on the impact of ST segment elevation in the patients with acute MI and left ventricular systolic dysfunction. METHODS: We retrospectively analyzed the baseline clinical and angiographic characteristics and the in-hospital and 1- year clinical outcomes of 117 consecutive patients who were diagnosed with acute MI and who had a left ventricular ejection fraction of less than 40%, and these patients were treated from January 2004 to June 2006 at Busan Paik Hospital. Coronary angiography at the index hospitalization and the major adverse cardiac events (MACEs), including cardiac death, non-fatal reinfarction, target vessel revascularization (TVR), and heart failure, were compared between the 77 patients with ST segment elevation myocardial infarction (STEMI) and the 40 patients with non-ST segment elevation myocardial infarction (NSTEMI). RESULTS: Overall, the baseline clinical characteristics were similar between the two groups. On the coronary angiography, thrombolysis in myocardial infarction 0 flow was more common in the STEMI group as compared to the NSTEMI group (p<0.01) and the NSTEMI group had more frequent multivessel disease compared to the STEMI group (p=0.01). However, the in-hospital cardiac deaths and MACEs were not different on comparison between the two groups (p=0.66, p=0.81, respectively). The one-year cardiac deaths and MACEs were not significantly different on comparison between the two groups (p=0.37, p=0.68, respectively). CONCLUSIONS: This study demonstrated that ST segment elevation had no influence on in-hospital and the long term outcomes of patients with acute MI and left ventricular systolic dysfunction.

Effects of Cilostazol on the Drug-Eluting Stent in Native Coronary Arteries

BACKGROUND AND OBJECTIVES: Cilostazol is an antiplatelet drug with antiproliferative properties when administered after coronary bare metal stent implantation. However, its effect on clinical and angiographic outcomes after sirolimus-eluting stent (SES) implantation in native coronary arteries has not been established. SUBJECTS AND METHODS: Two hundred patients who had undergone successful SES implantation were randomly assigned to receive, in addition to aspirin, 75 mg clopidogrel daily or 100 mg cilostazol twice daily after one month of triple oral therapy (aspirin, clopidogrel, and cilostazol). The medications were continued until the follow-up coronary angiography, which was performed after six months. RESULTS: There were no significant differences in the minimal luminal diameters before and immediately after the coronary intervention, and at the follow-up angiography. The late loss of minimal luminal diameter was 0.26+/-0.40 mm in the cilostazol group and 0.28+/-0.41 mm in the clopidogrel group (p=0.773). Other quantitative coronary angiography variables were also similar in the two groups. Restenosis, determined by quantitative coronary angiography at six months and defined as > or =30% narrowing, occurred in 11.4% of the clopidogrel group and 8.7% of the cilostazol group (p=0.478). However, in-stent restenosis was focal (100% vs 23.1% in the clopidogrel group, p<0.001), and shorter in the cilostazol group (6.26+/-2.42 vs 14.5+/-6.55 mm, p=0.001). CONCLUSION: Cilostazol was not inferior to clopidogrel in terms of clinical anti-coagulation effect, and had an antiproliferative effect in native coronary arteries after SES implantation.

A Case of Gastritis Cystica Profunda Suspiciously Caused by Gastric Foreign Body / 대한소화기내시경학회지

Gasritis cystica profunda (GCP) is a rare disease in which hyperplasia of mature glandular epithelium extends into the tissues beneath the submucosa. It shows multiple small cysts in the mucosa and submucosa of the stomach. It was firstly reported by Littler and Gleibermann on 1972. GCP is mainly observed at the site of gastroenterostomy but, it may occur in the stomach without a previous history of surgery. The proposed pathogenesis of the these abnormalities are related to ischemia, chronic inflammation and the presence of a foreign body. GCP may present not only as a submucosal tumor or as solitary or diffuse polyps but also as a giant gastric mucosal fold rarely. It should be differentiated from Menetrier's disease, Zollinger-Ellison syndrome, inflammatory disease and malignancy. We present a case of gastritis cystica profunda without having had any previous surgery, suspiciously caused by gastric foreign body. We made a diagnosis based on findings from the esophagogastroduodenoscopy, endoscopic ultrasonography and histologic findings after surgery.