Severe Aortic Coarctation in a 75-Year-Old Woman: Total Simultaneous Repair of Aortic Coarctation and Severe Aortic Stenosis

Aortic coarctation is usually diagnosed and repaired in childhood and early adulthood. Survival of a patient with an uncorrected coarctation to more than 70 years of age is extremely unusual, and management strategies for these cases remain controversial. We present a case of a 75-year-old woman who was first diagnosed with aortic coarctation and severe aortic valve stenosis 5 years ago and who underwent a successful one-stage repair involving valve replacement and insertion of an extra-anatomical bypass graft from the ascending to the descending aorta.

Stress-induced Cardiomyopathy Associated with Swine Influenza Infection Which Exacerbated Underlying Emphysema: A Case Report / 대한구급학회지

Stress-induced cardiomyopathy (SICM) is an acute cardiac condition that causes left ventricular apical ballooning which mimicks acute coronary syndrome. The risk of in-hospital mortality with SICM is generally low (1% to 3%) and supportive care is usually sufficient for resolution. Swine-origin influenza A (H1N1, S-OIV) is a recently spreading pandemic and a serious public health problem. Although most S-OIV infections have a mild, self-limited course, clinical cases resulting in fatalities and associated with variable co-morbidities remain as a serious concern in some individuals. Among such serious complications, there have been few reports of SICM caused by S-OIV infection. We herein report, for the first time in the literature, a case with fatal hemodynamic instability secondary to SICM caused by S-OIV infection with viral pneumonia.

The Meaning of Pathologic Q wave in Myocardial Infarction Assessed by Magnetic Resonance Imaging

BACKGROUND AND OBJECTIVES: The pathologic Q wave was once considered to be a sign of transmural myocardial infarction (MI), but the exact meaning of the pathologic Q wave remains to be elucidated. To evaluate the meaning of the pathologic Q wave using magnetic resonance imaging (MRI) investigations, which has recently emerged as a state-of-the-art diagnostic modality within cardiology. SUBJECTS AND METHODS: Thirty eight consecutive patients with acute myocardial infarction were enrolled in this study. MRI and coronary angiography were performed in all patients during their admission. A 32 segment model was used to analyze the MRI findings. Just before MRI, the electrocardiograms of all the patients were checked and the presence of the pathologic Q wave evaluated. The ischemic territories in each patient were quantified by the number of dysfunctional segments. Myocardial necrosis was determined by the area of delayed hyperenhancement in contrast enhanced MRI, and the myocardial necrosis index per segment was defined as the ratio of the hyperenhanced area to that of the entire segment. The total necrosis index was defined as the sum of all the myocardial necrosis indices in a patient, and the average necrosis index of dysfunctional segment (ANI) was calculated from the total necrosis index/number of dysfunctional segments in a patient. The transmurality of infarction was also assessed. RESULTS: Of all 38 patients, 26 showed a pathologic Q wave on ECG (Group A), whereas the other 12 did not (Group B). The number of dysfunctional segments, total necrosis index and frequency of transmural infarction (defined by infarct transmurality> or = 75% of wall thickness) were no different between the two groups. The infarct transmurality over 25 or 50% and ANI were significantly different between the two groups. In a multivariate analysis, an infarct transmurality over 50% and ANI were significant factors in determining the presence of a pathologic Q wave. CONCLUSION: By an in vivo analysis of myocardial necrosis, as determined by MRI in acute myocardial infarction, an infarct transmurality over 50% and average necrosis index of dysfunctional segments (ANI) might be significant factors in the genesis of a pathologic Q wave.

A Case of Primary Right Atrial Angiosarcoma Manifested with Cardiac Tamponade

Primary cardiac malignancy is very rare. Angiosarcoma is the most frequent malignant cardiac tumor and associated with a very unfavourable outcome. We report the case of an cardiac angiosarcoma complicated with cardiac tamponade revealed by echocardiography with pericardiocentesis and confirmed histopathologically in a 25 years old man.

Incidence of and Risk Factors for Bundle Branch Block in Adults older than 40 years

BACKGROUND: In the general population, the incidence of bundle branch block (BBB) is relatively low, and its effects on long-term prognosis have not been established. Previous studies on the incidence and correlation of BBB to clinical factors have produced conflicting results. However, the incidence of BBB was strongly related to age. This study aimed to describe the incidence of and risk factors for BBB in Korea. METHODS: In this study, 14, 540 adults (male 6, 573/female 7, 967) > or=40 years old received screening tests for general health between April and December 2000. Participants answered questionnaires and underwent examinations, which included blood pressure, electrocardiogram (ECG), total cholesterol and fasting glucose. The data analysis was performed using SPSS 10.0 for windows. RESULTS: The incidences of complete right bundle branch block (CRBBB) were 1.5 and 2.9% in people older than 40 and 65 years, respectively. Approximately 38.0% of individuals with CRBBB were older than 65 years. The incidence of CRBBB was higher in men than women at all age groups was highest in those aged 75-79 years. Males, advancing age (> or=65 years), hypertension and diabetes mellitus (DM) were associated with an increased risk of CRBBB. The incidences of complete left bundle branch block (LBBB) and bifascicular bundle branch block (BBBB) were 0.1 and 0.08% and 0.3 and 0.2% in those older than 40 and 65 years, respectively. Approximately 71.4 and 58.3% of individuals with LBBB and BBBB, respectively, were older than 65 years. Advancing age and cardiac disease were associated with an increased risk of LBBB. Advancing age was associated with an increased risk of BBBB. The most potent risk factor for BBB in this study was advancing age. CONCLUSION: The incidences of BBB were 1.7 and 3.4% in those older than 40 and 65 years respectively. Bundle branch block correlates strongly with age, and is common in the older ages groups. These findings support the theory that bundle branch block is a marker of slowly progressing degenerative diseases.

The Safety of Tirofiban Therapy in Patients with Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Recent randomized studies have shown a significant reduction in the rate of recurrent cardiac events with adjunctive pharmacotherapy, using Glycoprotein IIb/IIIa inhibitors (GPI), in patients undergoing percutaneous coronary intervention (PCI) procedures. However, in Korea, there is a paucity of data concerning complications of tirofiban therapy in patients with acute coronary syndrome (ACS). Therefore, this study was performed to evaluate the safety of tirofiban therapy. SUBJECTS AND METHODS: ACS patients who underwent tirofiban administration between May 2002 and October 2003 were reviewed. The rates of bleeding, transfusion, and thrombocytopenia were analyzed, and the rates of complications by ages, gender and PCI compared with medical treatment, renal function and vascular access route. RESULTS: A total of 261 ACS patients (male/female=150/111) underwent tirofiban therapy. The mean ages of the subjects was 64.5 years, the rates of minor bleeding, major bleeding, transfusion and thrombocytopenia were 8.1% (n=21), 2.3% (n=6), 4.6% (n=12) and 1.2% (n=3), respectively. Minor bleeding occurred at similar rates in both sexes (8 vs. 8.1%) and to a greater extent in old age (> or =65) (12.5 vs. 2.6%, p=0.093), but major bleeding occurred to a greater extent in females and old age (5.4 vs. 0% and 4.2 vs. 0%, p=0.25 and 0.093, respectively). The rates of thrombocytopenia and transfusion were greater in old age (2.1 vs. 0% and 8.3 vs. 0%, p=0.052 and 0.087, respectively). In-hospital days were greater in old age (14.7+/-9.5 vs. 11.9+/-4.4 days, p=0.065). The rates of complications were similar in both groups when compared by PCI or medical treatment and vascular access route. The serum creatinine was 3.3 mg/dL in those with major bleeding, which was higher than in the other groups (p=0.000). CONCLUSION: The tirofiban therapy in patients with ACS did not induce an increase in the bleeding rates, in-hospital days and it was safe and well tolerated in old age.

The Diagnostic Usefulness of Cardiovscular Magnetic Resonance Imaging for Non-Ischemic Myocardial Injury : The Value of the Endocardial Sparing Pattern on Delayed Enhancement

BACKGROUND AND OBJECTIVES: Cardiovascuar MR using contrast enhancement has recently been reported to be useful for diagnosing myocarditis. It is also well known that irreversible myocardial injury by epicardial coronary artery flow obstruction spreads from the endocardium to the epicardium in a wave-front pattern with a time-dependent manner. We investigated characteristics of the patterns of contrast-enhanced MR imaging according to the underlying myocardial injury mechanism. SUBJECTS AND METHODS: Of all 275 patients who underwent coronary angiogram at our hospital due to cheat pain and elevated cardiac enzymes between October, 2002 and August, 2003, 48 patients who underwent cardiac MR were enrolled in this study. We retrospectively analyzed the pattern of delayed hyperenhancement according to presence or absence of a documented infarct related artery. Endomyocardial biopsies were done in selected patients. RESULTS: Contrast MR images of all patients showed delayed hyperenhancement. The study group was divided into 2 groups according to whether the areas of hyper-enhancement were involved in the sub-endocardial portion (endocardial sparing pattern, ESP) or not. In 8 patients (Group A, 17%) who showed the endocardial sparing pattern on contrast MR, the findings of coronary angiogram were all normal. In 40 patients (Group B, 83%), who did not show the endocardial sparing pattern on contrast MR, 39 patients (97.5 %) had an infarct related artery on coronary angiogram (p=0.001). Endomyocardial biopsies were performed in 3 patients of group A. The findings of the 3 biopsies were 2 cases of definite myocarditis and 1 case of myocardial degeneration. CONCLUSION: The endocardial sparing pattern of myocardial injury demonstrated by delayed enhancement MR imaging was very useful to predict the presence of an infarct related artery in patients with myocardial necrosis that has been determined by elevated cardiac enzymes. This result can be a useful clue to determine the nature of the underlying injury mechanism such as ischemic or non-ischemic.

Biochemical Analysis of Serum and Pericardial Fluid in Patients with Hemorrhagic Pericardial Effusion

BACKGROUND AND OBJECTIVES: Since echocardiography became a routine diagnostic tool, pericardial effusion has become a common clinical finding. The major causes of hemorrhagic pericardial effusion are malignancy and tuberculosis. However, it was unknown to the use of biochemical analysis of pericardial fluid and serum, for differentiation of malignancy from tuberculosis. To evaluate this, we investigated the biochemical analysis of pericardial fluid and serum in relation to the causes of pericardial tamponade. SUBJECTS AND METHODS: 46 patients who were admitted to Pusan National University Hospital from January 1, 1995, to April 30, 2002, and underwent both a pericardiocentesis and a pericardiostomy for the relif of cardiac tamponade, were included in this study. the pericardial fluid was routinely analyzed for the following: gross appearance, cell count, glucose, total protein(P), lactate dehydrogenase(LDH), cytology, gram stain, cultures for bacteria and mycobacterium, pericardial fluid to serum ratios of total protein and lactate dehydrogenase,(p/s TP, p/s LDH, respectively). RESULTS: f the 46 patients who underwent both pericardiocentesis and pericardiostomy, for the relief of cardiac tamponade, 33 patients(71.7%) had hemorrhagic pericardial effusion. The common causes of hemorrhagic pericardial effusion were malignancy(51.5%) and tuberculosis(33.3%) but, those of nonhemorrhagic pericardial effusion were idiopathic (38.5%). Cell counts were higher in hemorrhagic than nonhemorrhagic group(p=.029). Serum LDH(sLDH) was higher in malignant than tuberculous group(p=.001) but, serum total protein(sTP) was higher in tuberculous group(p=.004). Compared malignant group with tuberculosis group in patients with hemorrhagic pericardial effusion, p/s ratio of LDH and sTP were higher in tuberculous group (p=.029, p=.017), but sLDH was higher in malignant group(p=0.002). CONCLUSION: It is difficult to differentiate tuberculosis from malignancy only on the basis of the biochemical analysis of pericardial fluid in hemorrhagic pericardial effusion. However, the analysis of both pericardial fluid and serum may make it possible to evaluate the cause of pericardial effusion.