Positive family history as the single traditional risk factor for developing extensive very premature coronary artery disease: a case report

Although coronary artery disease [CAD] is not common among individuals younger than 40-45 years of age, a small percentage of this age group needs to undergo surgical revascularization because of CAD. Why some people are at higher risk of developing premature CAD is not clearly known. Increased number of traditional risk factors or genetic predisposition may play significant roles in this regard. A 22-year-old man with a negative history for all traditional risk factors except for a family history of premature CAD referred to our center due to an episode ofmyocardial infarction of one month s duration. He had no congenital heart disease and no hypercoagulable state, and there was a negative history of drug abuse. His coronary angiography showed extensive CAD. He underwent coronary artery bypass grafting and he left the hospital in good healthy condition. One year after surgery, his follow-up showed that he was symptom free and he still had no new traditional risk factor. It seems that a positive family history of premature CAD is an important and independent risk factor for developing premature CAD and individuals with this type of history should be treated more cautiously

Safety of recombinant human deoxyribonuclease as a rescue treatment for persistent atelectasis in newborns

Pulmonary problems are vitally important in newborns. Increased intense and mucoid secretions may lead to atelectasis, pulmonary infections, respiratory distress, prolonged mechanical ventilation or even death. The aim of this study was to evaluate the safety of recombinant human deoxyribonuclease [rhDNase] in the management of persistent atelectasis in term and preterm newborns, unresponsive to the conventional treatment. Prospective study of patients admitted to a general community setting of a neonatal intensive care unit between December 2007 and December 2009. The study included 22 patients [12 premature and 10 term] who were admitted to the neonatal intensive care unit because of respiratory distress and developed atelectasis, and were unresponsive to conventional treatment. Nebulized rhDNase was administered to all patients at a dose of 1 mg/m[2] twice daily for 3 days. In patients who did not respond to 3 days of treatment, endotracheal rhDNase was administered at a dose of 1 mg/m[2]. We assessed the clinical [respiratory rate and oxygen requirement] and radiologic responses [chest radiographic score], recurrence of atelectasis, the need for a repetitive treatment, and mortality rate. A clinical and radiologic improvement of atelectasis was observed in 18 of 22 patients following 3 days of nebulized rhDNase treatment. Atelectasis relapsed in 4 patients. Following the administration of combined endotracheal and nebulized rhDNase treatment, an improvement of atelectasis was noted in all four recurrent cases. No adverse events were observed in patients because of the rhDNase treatment. rhDNase treatment is a safe option and may be used as an effective method for the management of persistent atelectasis in newborns, which is resistant to other conventional treatment methods

Solitary coronary artery nourishing the entire heart

Coronary artery anomalies are being more frequently diagnosed these days both because increasing numbers of patients are undergoing diagnostic studies and because advanced radiographic imaging methods are now commonly available. An isolated single coronary artery giving rise to the main coronary branches is a rare congenital anomaly. In this report we present a patient with a solitary coronary ostium, with both the left and right coronary artery systems arising from it, and then following their usual courses. This case was diagnosed incidentally during conventional angiography

Repair of idiopathic rupture of mitral chordae tendinea by triangular resection and annuloplasty

Major causes of rupture of chordae tendinea are myocardial infarction, trauma, hypertension, myxomatous degeneration, endocarditis and rheumatic heart disease. We describe an idiopathic rupture of the chordae tendinea of the posterior mitral leaflet in a 67 years old patient who had no evidence of coronary artery disease, rheumatic disease or other etiologies. The defect was repaired with triangular resection and annuloplasty. He had an uneventful postoperative course for 5 months