The Ratio Between the Percentage of Lymphocytes and Glucose Levels in Pericardial Fluid as a Method to Diagnose Tuberculous Pericarditis / 대한내과학회지

BACKGROUND/AIMS: Adenosine deaminase (ADA) is a valuable biochemical marker for pericardial effusion (PE) and may be useful for diagnosing tuberculous pericarditis (TPE) in patients with PE. However, no definite cut-off or borderline values for ADA currently exist to distinguish TPE from other PE etiologies. In this study, we identified other useful parameters and characterized their relationship with ADA as a method for diagnosing TPE. METHODS: From June 2004 to November 2011, 42 patients underwent pericardiocentesis due to moderate or severe PE, as confirmed by echocardiography or chest computed tomography (CT). Patients were subdivided into TPE and non-TPE (NTPE) groups. We analyzed ADA (p) (the pericardial ADA) and %Lymph (p)/Glucose (p) (the ratio between the percentage of lymphocytes and glucose levels in PE). RESULTS: We defined the cut-off value of ADA (p) as 48.5 IU/L, and that of %Lymph (p)/Glucose (p) as 0.678%.dL/mg. In a multivariate logistic regression analysis, an odds ratio (OR) of 44.24 and a 95% confidence interval (CI) of 2.85-686.97 were observed in patients with an ADA (p) > or = 48.5 IU/L (p = 0.023). An OR of 20.39 and a 95% CI of 1.06-392.93 were observed in patients with a %Lymph (p)/Glucose (p) > or = 0.678%.dL/mg (p = 0.046). The combination of ADA (p) and %Lymph (p)/Glucose (p) had a higher positive predictive value (PPV, 80.0%) and specificity (Sp, 93.8%) than either ADA (p) (PPV, 47.4%; Sp, 68.8%) or %Lymph (p)/Glucose (p) (PPV, 69.2%; Sp, 87.5%) alone. CONCLUSIONS: %Lymph (p)/Glucose (p) is a useful parameter for distinguishing TPE from other pericardial diseases if combined with an ADA (p) > or = 48.5 IU/L.

Sirolimus-Eluting Stent for the Treatment of In-Stent Restenosis: Comparision with Cutting Balloon Angioplasty

BACKGROUND AND OBJECTIVES: The use of drug-eluting stent implantation for in-stent restenosis (ISR) has shown some promising results. This study investigated the clinical and angiographic results of performing sirolimuseluting stent (SES) implantation for the treatment of patients with ISR as compared with treatment with cutting balloon angioplasty (CBA). SUBJECTS AND METHODS: Forty one patients with ISR (43 lesions) were treated with SES implantation and they were retrospectively compared with a group of patient with matched lesions that were treated with CBA (57 patients with 61 lesions). Routine angiographic follow-up was obtained at about 6 months after treatment and the incidence of major adverse cardiovascular events was evaluated. RESULTS: The baseline clinical characteristics, the patterns of ISR and the minimal luminal diameters (MLD) were not different between the two groups. There was no procedural failure and no immediate major cardiovascular adverse events (MACE) in the two groups. There were two target lesion revascularizations during the clinical follow-up in the CBA group and no MACE was found in the SES group (4% vs. 0%, respectively p<0.001). On the follow-up angiogram, the MLD and the stenosis diameter were significantly lower in the SES group than in the CBA group (2.82+/-0.33 vs. 1.80+/-0.82 mm, p<0.001; and 11.3+/-9.6 vs. 41.2+/-24.8%, p<0.001, respectively). The acute gain was significantly higher and the late loss was significantly lower in the SES group than in the CBA group (2.64+/-0.38 vs. 2.02+/-0.44 mm, p<0.001; and 0.21+/-0.28 vs. 0.71+/-0.73, p<0.001, respectively). CONCLUSION: The sirolimuseluting stent was safe, feasible and highly effective for treating the patients suffering with in-stent restenosis as compared with cutting balloon angioplasty.

Anomalous Origin of the Left Coronary Artery from the Right Sinus of Valsalva, which Presented as Acute Myocardial Infarction

Among all the congenital coronary anomalies, an anomalous origin of the left coronary artery (LCA) from the right sinus of Valsalva is rare. A 48-year-old male patient suffering with lateral acute myocardial infarction was referred for primary percutaneous coronary intervention. The initial angiogram failed to show the LCA, which originated from the right coronary sinus. A critical stenotic lesion was observed in the distal left circumflex artery. The lesion was treated successfully with stenting. We report here on a case of an anomalous origin of the left coronary artery from the right sinus of Valsalva, and the patient presented as acute myocardial infarction. He was successfully treated with primary percutaneous intervention.

A Case of Acute Myocardial Infarction and Multiorgan Involvement Secondary to Rheumatoid Vasculitis

Rheumatoid arthritis patients have an increased risk of subclinical cardiovascular disease, and they also have a high prevalence of carotid disease and peripheral arterial disease as a form of vasculitis. Rheumatoid arthritis patients have an increased cardiovascular mortality rate and an increased premature death rate, and they have a higher incidence of atherosclerosis. Myocardial infarction due to vasculitis is a rare complication for patients with rheumatoid vasculitis. We report here on a case of a patient with multiorgan involvement who developed myocardial infarction, right carotid artery occlusion and left renal artery occlusion secondary to his rheumatoid vasculitis.

A Case of Primary Cardiac Fibroma

Primary cardiac tumors in infancy and childhood are rare, with fibromas being the second most common tumor after rhabdomyomas. Although cardiac fibromas are characteristically benign intramural tumors, they may exhibit expansile growth resulting in obstruction, valvular dysfunction, as well as other problems so early diagnosis and successful surgical excision are important. We experienced a case of cardiac fibroma in right ventricle that diagnosed by transthoracic echocardiography, chest CT, open heart tissue biopsy etc.

A Clinical Review of Primary Pulmonary Hypertension

BACKGROUND AND OBJECTIVES: Primary (idiopathic) pulmonary hypertension is a rare, progressive and fatal disease. It has been defined, by the World Health Organization, as a mean pulmonary arterial pressure greater than 25 mmHg at rest, or greater than 30 mmHg during exercise, without the apparent cause of secondary pulmonary hypertension. This study was performed to better understanding the clinical presentation, natural history and prognosis of primary pulmonary hypertension. SUBJECTS AND METHODS: A total of 18 patients, who were diagnosed as primary pulmonary hypertension, at three University Hospitals, were retrospectively reviewed. All patients had undergone echocardiography and cardiac catheterization. RESULTS: With the patients there was a male: female ratio of 1:8, ranging in age between 10 and 50 years. The most common presenting symptom was dyspnea on exertion, with other symptoms comprising of fatigue in 11, chest pain in 5, syncope in 3 and hemoptysis in 2. The ECG & echocardiography reflected the presence of right-sided heart enlargement. The average right ventricular systolic pressure, from Doppler echocardiography, was 73.6+/-18.8 mmHg. The mean pulmonary artery pressure and pulmonary capillary wedge pressure were 52.9+/-18.4 and 9.2+/-3.1 mmHg, respectively. The survival times were within 30 and 21 to 60 months in 9 and the remaining patients, respectively. CONCLUSION: We conclude that primary pulmonary hypertension is common in female patients in their third to fifth decades. This study also showed a poor prognosis, as in other reports.

Angiographic Outcomes and Predictors of Recurrent Restenosis after Cutting Balloon Angioplasty for the Treatment of In-Stent Restenosis

BACKGROUND AND OBJECTIVES: The optimal treatment for in-stent restenosis(SR) s controversial, although intracoronary radiation therapy(CRT) as provided the most consistent results to date. This study was designed to assess the early and late angiographic results, and to find independent predictors of recurrent restenosis, following cutting balloon angioplasty(BA) or ISR. SUBJECTS AND METHODS: Eighty patients(7 lesions) ith first time ISR underwent CBA and systematic follow-up(U) ngiography. A conventional balloon was used before, or after, the CBA, if required. ICRT was used in 18 lesions(1%). A multivariate logistic regression analysis was performed.(why?) RESULTS: he ISR was focal(n=2, 37%), diffuse or proliferative(n=1, 58%) nd occlusive(n=4, 5%). Procedural success was achieved in all 87 lesions(00%). No significant edge dissection occurred. The pre- and post-procedural diameter stenoses(S) ere 81.5+/-10.8% and 6.7+/-6.0%, respectively, and the pre- and post-procedural MLD(efine MLD?) .71+/-0.44 mm and 2.85+/-0.32mm, respectively, with 2.14+/-0.44mm of acute gain. A FU angiography was performed in 54(8%) f the 69 lesions treated with CBA alone. The overall angiographic restenosis rate was 24%(3/54), with 9%(/22) n the focal ISR and 34%(1/32) n the diffuse or occlusive ISR. The FU DS and MLD were 32.0+/-23.4% and 2.1+/-0.7mm, respectively, with 0.79+/-0.69mm of late loss. The length of a restenotic lesion(R 12.2, 95% CI:1.3-115.2, p=.0286) as an independent predictor of recurrent restenosis. CONCLUSION: CBA is a simple and efficient first line treatment for ISR, with an acceptable restenosis rate, and the length of a restenotic lesion is an independent predictor of recurrent restenosis. In diffuse or occlusive ISR, more definite treatment modalities, such as ICRT combined with CBA or debulking techniques, might be required to reduce recurrent restenosis.

A Case of Congenital Left Atrial Appendage Aneurysm

No abstract available.

Clinical Study of Myocardial Bridge

BACKGROUND AND OBJECTIVES: Myocardial bridge is congenital coronary anomaly and cause myocardial ischemia by milking effect. The general study of myocardial bridge is to be weak, so we examined a clinical study of myocardial bridge. MATERIALS AND METHOD: This study included 36 bridge cases out of 1048 patients who underwent coronary angiography due to chest pain from Jan. 1993 to Jul. 1998. Angiographic film, medical records and interview by telephone were reviewed retrospectively. Total follow-up duration was mean 27 months (1 month to 62 months). RESULTS: Incidence of myocardial bridges diagnosed by angiography was 3.4%. Angiography showed normal in 32, 1 vessel disease in 3 and 2 vessel disease in one patient. Mean reference diameter was 2.97+/-0.36mm, bridge diameter was 2.75+/-0.33mm in diastole, 1.12+/-0.47mm in systole. Myocardial bridge length was 12.50+/-7.44mm, mean % diameter stenosis was 59.26+/-17.7%. Myocardial bridge location was 80.6% in mid LAD and 13.9% in mid & distal LAD and 5.5% in distal LAD. There was no statistically significant correlation with sex, risk factor of coronary heart disease, resting electrocardigraphy, treadmill test, diameter and angulation of coronary artery, clinical symptom in the severity of myocardial bridge. But the severity of myocardial bridge correlated with bridge length(r=.5033). CONCLUSION: Clinical outcomes of bridge patients were relatively good during the mean follow up periods of 27 months. Myocardial bridge was more severe in younger age and longer bridge length.

Cerebral Infarction Caused by Floating Thoracic aortic Thrombus in Young Male

A case of embolic episode resulting in cerebral infarction from an unknown source is reported. This occured in a young male. He had no cardiovascular risk factors. Diagnostic evaluation for identifying the source of embolism revealed a large, pedunculated and mobile thrombus arising from a nonaneurysmatic and nonatheroslerotic descending aorta. The thrombus was identified by transesophageal echocardiography, and was successfully removed by aortic thromboendarterectomy. We emphasize the importnace of transesophageal echocardiography as a reliable method for the diagnosis of thoracic aorta diseases and for identification of aortic thrombi. An aggressive surgical approach is recommended in the low-risk parient to prevent further embolic episodes.

A Case of 51 Year Old Woman with Quadricuspid Aortic Valve Associated with Regurgitation

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. A case is reported of a 51 year old woman with quadricuspid aortic valve associated with regurgitation. In the past, quadricuspid aortic valve was recognised at surgery or necropsy, but now transthoracic and transesophageal echocardiography play a pivotal role in diagnosing this rare valve malformation. On occasion the transthoracic echocardiogram cannot show the quadricuspid nature of the aortic valve, and transesophageal echocardiography must be performed.