An adult asymptomatic pulmonary artery sling / 영남의대학술지

A pulmonary artery sling is a very rare congenital abnormality in which the left pulmonary artery rises from the posterior surface of the right pulmonary artery and then passes between the trachea and the esophagus, causing tracheal compression. It is associated with tracheo-bronchial abnormalities (50%) and cardiovascular abnormalities (30%). It may produce respiratory symptoms through the airway compression of the abnormal left pulmonary artery and congenital abnormalities associated with it. Because most (90%) pulmonary artery sling patients present symptoms during infancy, their condition is often diagnosed in the first year of life. However, a pulmonary artery sling is occasionally found in adults. It is usually asymptomatic and found incidentally. This is a very rare case of an asymptomatic pulmonary artery sling in an adult. A 38-year-old man presented symptoms of mild exertional dyspnea. His spiral computed tomography showed a pulmonary artery sling. He was discharged without specific treatment because his symptoms improved without specific treatment and might not have been associated with a pulmonary artery sling. We report an adult case of an asymptomatic pulmonary artery sling diagnosed via spiral computed tomography, accompanied by a literature review.

A Case of Unruptured Aneurysm of the Right Sinus of Valsalva with Right Ventricular Outflow Obstruction

A 66-year-old man presented with exertional dyspnea. He was found to have an unruptured aneurysm of the right sinus of Valsalva causing significant right ventricular outflow obstruction. This aneurysm was diagnosed by transthoracic two-dimensional echocardiography, transthoracic three-dimensional echocardiography, transesophageal echocardiography, contrast echocardiography and 64-slice multidetector cardiac computed tomography. Because unruptured aneurysms of the sinus of Valsalva are rarely symptomatic, they can be difficult to detect. However, the unruptured aneurysm of the right sinus of Valsalva in this case caused significant right ventricular outflow tract obstruction, resulting in exertional dyspnea.

Effects of Percutaneous Coronary Intervention on Depressive Symptoms in Chronic Stable Angina Patients

OBJECTIVE: Depression is present in 1 of 5 outpatients with coronary artery disease (CAD), and a well-documented risk factor for recurrent cardiac events and mortality. We examined the impact of percutaneous coronary intervention (PCI), on depressive symptoms, in chronic stable angina (CSA) patients. METHODS: On prospective and non-randomized trial, consecutive CSA patients (n=171), who had undergone coronary angiography from January 2006 to December 2007, were included. Patients were subdivided into PCI and non-PCI groups, and then completed 21-item the Beck Depression Inventory II (BDI-II), at the baseline and pre-discharge, to assess the depressive symptoms. RESULTS: A total of 108 (63%) patients were assigned to the non-PCI group, and 63 (37%) patients to the PCI group. Using an independent t-test, we found that patients with PCI were significantly older (non-PCI vs. PCI; 57+/-11 vs. 64+/-10, years, p<0.001), had more joint disease (12.0 vs. 27.0%, p=0.013), more stroke history (5.6 vs. 17.5%, p=0.012) and higher incident of family history of cardiovascular disease (28.7 vs. 46.0%, p=0.025), but less religion (54.6 vs. 36.5%, p=0.002) and private health insurance (43.5 vs. 20.6%, p=0.002). The mean difference of BDI-II score between the baseline and pre-discharge was higher in patients with PCI (OR: 1.266; 95% CI: 1.146-1.398, p<0.001). CONCLUSION: In conclusion, PCI contributes independently to higher risk of developing depressive symptoms in CSA patients during hospitalization; Routine assessment and management of PCI related depressive symptoms are justified.

Effects of Percutaneous Coronary Intervention on Depressive Mood in Elderly Patients

BACKGROUND: Depression is a common comorbid condition in patients with coronary artery disease and a well-documented risk factor for recurrent cardiac events and mortality. We examined the impact of percutaneous coronary intervention (PCI) on depressive mood in elderly patients with chronic stable angina. METHODS: Consecutive patients with chronic stable angina (n=171) who had undergone elective PCI from January 2010 to May 2010 were included in this study. Patients were divided into elderly (> or =65 years) and non-elderly groups (<65 years) and then completed the 21-item Beck Depression Inventory I (BDI-I) at baseline and prior to discharge to assess for depressive symptoms. RESULTS: Seventy-three (43%) patients were assigned to the elderly group and 98 (57%) to the non-elderly group. Using multivariate regression analysis, we found that the elderly group had a higher prevalence of joint, lung, and gastrointestinal diseases; were less religious and less likely to be employed; had lower rates of private health insurance; and were, less frequently, users of regular alcohol, current smokers, and regular exercisers compared to the non-elderly patients. The mean difference in BDI-I scores at baseline and pre-discharge was higher in elderly patients. CONCLUSION: Our study showed a correlation between the extent of depression and elective PCI, especially in elderly patients. This population should be assessed routinely for depressive symptoms and managed accordingly.

Case of Takotsubo Cardiomyopathy following Pacemaker Implantation

Takotsubo cardiomyopathy, also called apical ballooning syndrome or stress-induced cardiomyopathy, is a unique reversible cardiomyopathy that is frequently precipitated by a stressful event, and is described as a typical form of acute transient left ventricular dysfunction. The classic situation is postmenopausal women presenting with chest pain or dyspnea. The overall prognosis is favorable. We report a case of a 75-year-old female patient who came to our hospital with dizziness, which was found to be caused by transient apical ballooning following permanent pacemaker implantation.