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1.
Article | WPRIM | ID: wpr-835398

ABSTRACT

Papillary fibroelastomas are the second most common primary cardiac tumor in adults. Over 80% of fibroelastomas occur on the cardiac valves, usually on the left side of the heart, while the remaining lesions are typically scattered throughout the atria and ventricles. Although the optimal timing for surgery is controversial and depends on tumor size and location, prompt surgical resection is warranted in patients at high risk of embolism. A tumor on the cardiac valve can be removed using the slicing excision technique without leaflet injury. Here we present two cases of papillary fibroelastomas occurring on the ventricular surface of the aortic valve and in the right ventricle.

2.
Yonsei Medical Journal ; : 535-541, 2019.
Article in English | WPRIM | ID: wpr-762082

ABSTRACT

PURPOSE: Whether cardiac rehabilitation (CR) improves clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) has not been thoroughly evaluated. Moreover, few studies have sought to identify patients who would benefit most from CR among STEMI patients. MATERIALS AND METHODS: Consecutively, 265 STEMI patients who underwent primary PCI with implantation of DESs and follow-up angiography were examined. Seventy-six patients (30%) who received CR were assigned to the CR+ group. Another 178 patients (70%) who did not participate in CR were assigned to the CR− group. Second generation DESs were implanted in 238 (94%) patients. RESULTS: Major adverse cardiovascular events (MACEs), including death, myocardial infarction, and revascularization, were compared. The CR+ group tended to have lower MACE than the CR− group at 3 years, although the difference was not statistically significant (9.9% vs. 18.3%, hazard ratio=0.54, p=0.138). Subgroup analysis revealed a significant interaction according to CR and preprocedural thrombolysis in myocardial infarction (TIMI) flow (p value for interaction=0.011). In patients with low preprocedural TIMI flow (TIMI flow ≤1, n=161), those in the CR+ group had significantly lower MACE than those in the CR− group (p=0.005), whereas MACE was not different among patients with higher TIMI flow (TIMI flow ≥2, n=93). CONCLUSION: CR including exercise training was associated with lower MACE, particularly in patients with lower preprocedural TIMI flow during primary PCI for STEMI in the current DES era.


Subject(s)
Angiography , Drug-Eluting Stents , Follow-Up Studies , Humans , Myocardial Infarction , Percutaneous Coronary Intervention , Rehabilitation
3.
Yonsei Medical Journal ; : 542-546, 2019.
Article in English | WPRIM | ID: wpr-762081

ABSTRACT

PURPOSE: The prevalence and clinical outcomes of asymptomatic carotid artery stenosis (CAS) in patients with coronary artery disease (CAD) have not been thoroughly studied. We examined the prevalence and predictors of asymptomatic CAS detected by carotid angiography and determined the impact of concomitant CAS on prognosis in patients undergoing coronary angiography (CAG) due to CAD. MATERIALS AND METHODS: Between January 2013 and July 2015, 395 patients who underwent carotid digital subtraction angiography to screen for CAS during CAG were analyzed. The presence of CAS was defined as angiographically significant stenosis (≥50%). Major adverse cardiac and cerebrovascular event (MACCE) rates were compared between patients with and without CAS. MACCEs included a composite of cardiac death, cerebrovascular death, acute myocardial infarction, and stroke. RESULTS: Of the 395 patients, 101 (25.5%) patients had significant CAS. The independent predictors of CAS were age, male sex, hypertension, diabetes, and multi-vessel disease. In patients with CAD, the presence of CAS was as an independent predictor for MACCEs after adjusting for confounding factors (hazard ratio 2.47, 95% confidence interval 1.16–5.24, p=0.018). CONCLUSION: Asymptomatic CAS was documented in up to 25% of patients with CAD. The presence of CAS in patients with CAD was associated with a higher rate of MACCEs. Therefore, detection of CAS by carotid angiography during CAG may be important for risk stratification for CAD patients, particularly those with multi-vessel disease.


Subject(s)
Angiography , Angiography, Digital Subtraction , Carotid Arteries , Carotid Stenosis , Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease , Death , Humans , Hypertension , Male , Myocardial Infarction , Prevalence , Prognosis , Stroke
4.
Yonsei Medical Journal ; : 248-251, 2017.
Article in English | WPRIM | ID: wpr-126250

ABSTRACT

Most patients diagnosed with takotsubo cardiomyopathies are expected to almost completely recover, and their prognosis is excellent. However, complications can occur in the acute phase. We present a case of a woman with takotsubo cardiomyopathy with right ventricular involvement who developed a rupture of the right ventricular free wall following ventricular septal rupture, as a consequence of an acute increase in right ventricular afterload by left-to-right shunt. Our case report illustrates that takotsubo cardiomyopathy can be life threatening in the acute phase. Ventricular septal rupture in biventricular takotsubo cardiomyopathy may be a harbinger of cardiac tamponade by right ventricular rupture.


Subject(s)
Acute Disease , Aged , Female , Heart Ventricles/injuries , Humans , Prognosis , Takotsubo Cardiomyopathy/complications , Ventricular Septal Rupture/etiology
5.
Article in Korean | WPRIM | ID: wpr-221425

ABSTRACT

Epidemiological studies have demonstrated an increased risk for cardiovascular events in relation to both short- and long-term exposure to ambient particulate matter (PM). Several plausible mechanistic pathways have been described, including an enhanced propensity for arrhythmias, systemic inflammatory responses, and the chronic promotion of atherosclerosis. On the basis of this review, several new findings were reached, including the following: exposure to PM including PM <2.5 microm in diameter can trigger cardiovascular disease-related mortality; longer-term exposure (e.g., a few years) increases the risk for cardiovascular mortality; reductions in PM levels are associated with decreases in cardiovascular mortality within a period as short as a few years; and many credible pathological mechanisms have been elucidated that lend biological plausibility to these findings. It is the opinion of the writing group that the overall evidence is consistent with a causal relationship between PM exposure and cardiovascular morbidity and mortality. Finally, PM exposure is deemed a modifiable factor that contributes to cardiovascular morbidity and mortality. The purpose of this statement is to develop evidence-based practical guidelines for healthcare professionals and regulatory agencies with a comprehensive review of the literature on air pollution and cardiovascular disease and a specific focus on the clinical implications.


Subject(s)
Air Pollution , Arrhythmias, Cardiac , Atherosclerosis , Cardiovascular Diseases , Delivery of Health Care , Dust , Epidemiologic Studies , Mortality , Particulate Matter , Writing
6.
Article in Korean | WPRIM | ID: wpr-44726

ABSTRACT

Peripheral arterial disease is caused by atherosclerosis in the arteries causing an insufficient blood flow to the muscles and tissues. Peripheral arterial disease in the lower limbs is the main cause of intermittent claudication. Less commonly, the etiology of intermittent claudication can be extrinsic to vascular structures such as arterial aneurysm, arterial dissection, embolism, popliteal entrapment syndrome, and adventitial cystic disease. A 69-year-old man was referred to Sanggye Paik Hospital because of intermittent claudication. He had a history of diabetes mellitus and dyslipidemia and he was current smoker. His right ankle brachial index is 0.74. Lower extremity artery computed tomography scan was performed and it revealed the right popliteal cyst compressing the right popliteal artery. We performed the arthroscopic cyst drainage and after the procedure, intermittent claudication resolved completely.


Subject(s)
Aged , Aneurysm , Ankle Brachial Index , Arteries , Atherosclerosis , Diabetes Mellitus , Drainage , Dyslipidemias , Embolism , Humans , Intermittent Claudication , Lower Extremity , Muscles , Peripheral Arterial Disease , Popliteal Artery , Popliteal Cyst
7.
Korean Journal of Medicine ; : 728-732, 2014.
Article in English | WPRIM | ID: wpr-219254

ABSTRACT

The benefit of thrombus aspiration during percutaneous coronary intervention in patients with acute myocardial infarction (AMI) is well established; however, the optimal management strategy for patients with a large thrombus burden after repeated thrombectomy (i.e., "failed" thrombectomy) is unknown. Here, we report the case of a 67-year-old male with polycythemia vera who was treated with intracoronary thrombolytic therapy in combination with mechanical thrombectomy. Repeated aspiration thrombectomy did little to reduce the coronary thrombus burden; thus, intracoronary urokinase infusions were applied to the thrombus-containing lesion. Repeat coronary angiography 4 days later revealed markedly improved antegrade flow in the infarct-related artery, and successful revascularization was performed. This case demonstrates the potential utility of intracoronary thrombolytic therapy for select AMI patients with a large thrombus burden who are in a hypercoagulable state.


Subject(s)
Aged , Arteries , Coronary Angiography , Humans , Male , Myocardial Infarction , Percutaneous Coronary Intervention , Polycythemia Vera , Thrombectomy , Thrombolytic Therapy , Thrombosis , Urokinase-Type Plasminogen Activator
9.
Article in English | WPRIM | ID: wpr-7439

ABSTRACT

OBJECTIVE: To confirm the improvement in arterial endothelial function by aerobic exercise training, flow-mediated dilation (FMD) was tested by ultrasonography. METHODS: Patients who received percutaneous coronary intervention due to acute coronary syndrome were included. The patients who participated in cardiac rehabilitation (CR) program were categorized as the CR group, and others who did not participate as the control. Both groups underwent initial graded exercise test (GXT) and FMD testing. Subsequently, the CR group performed aerobic exercise training sessions. Patients in control only received advice regarding the exercise methods. After six weeks, both groups received follow-up GXT and FMD testing. RESULTS: There were 16 patients in each group. There were no significant differences in the general characteristics between the groups. The VO2peak was 28.6+/-4.7 mL/kg/min in the CR group and 31.5+/-7.4 mL/kg/min in the control at first GXT, and was 31.1+/-5.1 ml/kg/min in the CR group and 31.4+/-6.0 ml/kg/min in the control at the follow-up GXT in six weeks. There was a statistically significant improvement in VO2peak only for CR group patients. FMD value was 7.59%+/-1.26% in the CR group, 7.36%+/-1.48% in the control at first and 9.46%+/-1.82% in the CR group, and 8.31%+/-2.04% in the control after six weeks. There was a statistically significant improvement in FMD value in the CR group. CONCLUSION: According to the results of GXT and FMD testing, six-week exercise-based CR program improved VO2peak and endothelial functions significantly. Thus, exercise-based CR program is necessary in patients with coronary artery disease.


Subject(s)
Acute Coronary Syndrome , Coronary Artery Disease , Endothelial Cells , Exercise Test , Exercise , Follow-Up Studies , Humans , Percutaneous Coronary Intervention , Rehabilitation , Ultrasonography
10.
Korean Circulation Journal ; : 776-780, 2012.
Article in English | WPRIM | ID: wpr-200134

ABSTRACT

Primary cardiac lymphoma (PCL) is a rare disorder, but the incidence is increasing and its clinical manifestations are various. We report a case of PCL, which mimics an acute coronary and aortic syndrome. A 51 year-old female was presented with chest pain radiating to the back. Her initial electrocardiogram revealed T wave inversion in the leads of V 5-6, II, III and aVF. Additionally, cardiac troponin-T was slightly elevated. Chest radiography showed marked mediastinal widening. Computed tomography scan showed a huge pericardial mass. The histopathologic findings of the mass were compatible with diffuse large B cell lymphoma. She died of refractory ventricular tachycardia, probably, due to an extensive infiltration of PCL to the myocardium.


Subject(s)
Acute Coronary Syndrome , Chest Pain , Electrocardiography , Female , Heart Neoplasms , Humans , Incidence , Lymphoma , Lymphoma, B-Cell , Myocardium , Tachycardia, Ventricular , Thorax , Troponin T
11.
Article in English | WPRIM | ID: wpr-85162

ABSTRACT

Acute total obstruction of the left main coronary artery (LMCA) is a serious emergency condition requiring prompt diagnosis and treatment. Unless properly treated, it will likely progress to cardiogenic shock and a high mortality rate. We report a case of acute LMCA total obstruction presenting with atypical momentary electrocardiogram (ECG) changes including right bundle branch block with left axis deviation, and ST-segment elevation in aVR and aVL. We focus on the unusual ECG changes associated with LMCA obstruction which should be noted in order to ensure revascularization without delay, especially when this condition is accompanied by cardiogenic shock.


Subject(s)
Axis, Cervical Vertebra , Bundle-Branch Block , Coronary Vessels , Dietary Sucrose , Electrocardiography , Emergencies , Shock, Cardiogenic
12.
Korean Journal of Medicine ; : 708-711, 2011.
Article in Korean | WPRIM | ID: wpr-201142

ABSTRACT

A 38-year-old man presented with typical squeezing-type anterior chest pain. An initial electrocardiogram (ECG) showed prominent ST-segment elevation (V1-V4 lead, 3 mm). Suddenly, the patient fell unconscious and had no pulse. At that time, the ECG showed polymorphic ventricular fibrillation (VT). After direct current (DC) cardioversion, the patient regained vital signs and defibrillation converted the VT into an accelerated idioventricular rhythm with resolution of the ST-segment elevation. The patient was referred to our hospital for close observation and further evaluation. At our hospital, an ECG showed normal sinus rhythms and cardiac enzymes were within normal limits. We diagnosed the patient with variant angina rather than ST elevation myocardial infarction (STEMI), because his clinical manifestations were quite distinct; ST-segment elevations disappeared slowly at the reperfusion stage. However, the patient's final diagnosis was STEMI because coronary angiography showed severe eccentric tubular stenosis (85%) with remnant thrombus in the middle left anterior descending artery. Defibrillation likely removed the thrombus, which led to STEMI.


Subject(s)
Accelerated Idioventricular Rhythm , Adult , Angina Pectoris, Variant , Arteries , Chest Pain , Constriction, Pathologic , Coronary Angiography , Electric Countershock , Electrocardiography , Humans , Myocardial Infarction , Myocardial Revascularization , Reperfusion , Thrombosis , Unconscious, Psychology , Ventricular Fibrillation , Vital Signs
13.
Article in English | WPRIM | ID: wpr-129428

ABSTRACT

BACKGROUND AND OBJECTIVES: Aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI) is an effective adjunctive therapy for ST-segment elevation myocardial infarction (STEMI). An elevated neutrophil count in STEMI is associated with microvascular dysfunction and adverse outcomes. We evaluated whether AT can improve microvascular dysfunction in patients with STEMI and an elevated neutrophil count. SUBJECTS AND METHODS: Seventy patients with STEMI undergoing primary PCI from August 2007 to February 2009 in our institution were classified by tertiles of neutrophil count on admission (7,600/mm3). The angiographic outcome was post-procedural thrombolysis in myocardial infarction (TIMI) flow grade. Microvascular dysfunction was assessed by TIMI myocardial perfusion (TMP) grade and ST-segment resolution on electrocardiography 90 minutes after PCI. The clinical outcome was major adverse cardiac event (MACE), defined as cardiac death, re-infarction, and target lesion revascularization at 9 months. RESULTS: There were no significant differences in the clinical characteristics and pre- and post-procedural TIMI flow grades between the neutrophil tertiles. As the neutrophil count increased, a lower tendency toward TMP grade 3 (83% vs. 52% vs. 54%, p=0.06) and more persistent residual ST-segment elevation (>4 mm: 13% vs. 26% vs. 58%, p=0.005) was observed. The 9-month MACE rate was similar between the groups. On subgroup analysis of AT patients (n=52) classified by neutrophil tertiles, the same tendency toward less frequent TMP grade 3 (77% vs. 56% vs. 47%, p=0.06) and persistent residual ST-segment elevation (>4 mm: 12% vs. 28% vs. 53%, p=0.05) was observed as neutrophil count increased. CONCLUSION: A higher neutrophil count at presentation in STEMI is associated with more severe microvascular dysfunction after primary PCI, which is not improved with AT.


Subject(s)
Death , Electrocardiography , Humans , Myocardial Infarction , Neutrophils , Percutaneous Coronary Intervention , Perfusion , Thrombectomy , Thymidine Monophosphate
14.
Article in English | WPRIM | ID: wpr-129413

ABSTRACT

BACKGROUND AND OBJECTIVES: Aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI) is an effective adjunctive therapy for ST-segment elevation myocardial infarction (STEMI). An elevated neutrophil count in STEMI is associated with microvascular dysfunction and adverse outcomes. We evaluated whether AT can improve microvascular dysfunction in patients with STEMI and an elevated neutrophil count. SUBJECTS AND METHODS: Seventy patients with STEMI undergoing primary PCI from August 2007 to February 2009 in our institution were classified by tertiles of neutrophil count on admission (7,600/mm3). The angiographic outcome was post-procedural thrombolysis in myocardial infarction (TIMI) flow grade. Microvascular dysfunction was assessed by TIMI myocardial perfusion (TMP) grade and ST-segment resolution on electrocardiography 90 minutes after PCI. The clinical outcome was major adverse cardiac event (MACE), defined as cardiac death, re-infarction, and target lesion revascularization at 9 months. RESULTS: There were no significant differences in the clinical characteristics and pre- and post-procedural TIMI flow grades between the neutrophil tertiles. As the neutrophil count increased, a lower tendency toward TMP grade 3 (83% vs. 52% vs. 54%, p=0.06) and more persistent residual ST-segment elevation (>4 mm: 13% vs. 26% vs. 58%, p=0.005) was observed. The 9-month MACE rate was similar between the groups. On subgroup analysis of AT patients (n=52) classified by neutrophil tertiles, the same tendency toward less frequent TMP grade 3 (77% vs. 56% vs. 47%, p=0.06) and persistent residual ST-segment elevation (>4 mm: 12% vs. 28% vs. 53%, p=0.05) was observed as neutrophil count increased. CONCLUSION: A higher neutrophil count at presentation in STEMI is associated with more severe microvascular dysfunction after primary PCI, which is not improved with AT.


Subject(s)
Death , Electrocardiography , Humans , Myocardial Infarction , Neutrophils , Percutaneous Coronary Intervention , Perfusion , Thrombectomy , Thymidine Monophosphate
15.
Korean Journal of Medicine ; : 624-629, 2010.
Article in Korean | WPRIM | ID: wpr-162421

ABSTRACT

Right atrial (RA) thrombi are rarer than left atrial thrombi; they are frequently associated with major pulmonary embolism and carry a very high risk of mortality, requiring prompt diagnosis and treatment. In particular, multiple, mobile right atrial thrombi have a very poor prognosis because of the high incidence of massive pulmonary embolism. Echocardiography is useful in the diagnosis of RA thrombi. The treatment options for RA thrombi are anticoagulation, thrombolysis, and thrombectomy. Here, we report a case of multiple, mobile right atrial thrombi and pulmonary embolism that presented as cardiogenic shock during arthroscopic lavage of a septic knee. It was diagnosed using transthoracic echocardiography and treated successfully with thrombolytics and anticoagulants.


Subject(s)
Anticoagulants , Echocardiography , Heart Atria , Incidence , Knee , Prognosis , Pulmonary Embolism , Shock, Cardiogenic , Therapeutic Irrigation , Thrombectomy , Thrombosis
16.
Article in English | WPRIM | ID: wpr-27394

ABSTRACT

Primary cardiac angiosarcoma is a very rare disease with a poor prognosis. We report a case of a patient with a primary cardiac angiosarcoma who presented with cardiac tamponade; the angiosarcoma was successfully resected surgically.


Subject(s)
Cardiac Tamponade , Heart Neoplasms , Hemangiosarcoma , Humans , Pericardial Effusion , Prognosis , Rare Diseases
17.
Article in English | WPRIM | ID: wpr-27392

ABSTRACT

Primary cardiac lymphomas (PCL) are extremely rare. Clinical manifestations may be variable and are attributed to location. Here, we report on a case of PCL presenting with atrioventricular (AV) block. A 55 year-old male had experienced chest discomfort with unexplained dyspnea and night sweating. His initial electrocardiogram (ECG) revealed a first degree AV block. Along with worsening chest discomfort and dyspnea, his ECG changed to show second degree AV block (Mobitz type I). Computed tomography (CT) scan showed a cardiac mass (about 7 cm) and biopsy was performed. Pathologic finding confirmed diffuse large B-cell lymphoma. The patient was treated with multi-drug combination chemotherapy (R-CHOP: Rituximab, cyclophoshamide, anthracycline, vincristine, and prednisone). After treatment, ECG changed to show normal sinus rhythm with complete remission on follow-up CT scan.


Subject(s)
Antibodies, Monoclonal, Murine-Derived , Atrioventricular Block , Biopsy , Drug Therapy, Combination , Dyspnea , Electrocardiography , Follow-Up Studies , Heart Neoplasms , Humans , Lymphoma , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , Male , Sweat , Sweating , Thorax , Vincristine , Rituximab
18.
Korean Circulation Journal ; : 618-621, 2008.
Article in English | WPRIM | ID: wpr-192087

ABSTRACT

Pulmonary thromboembolism (PTE) originating from a renal vein thrombosis (RVT) is very rare, especially in relatively healthy young women. The patient described herein presented with a syncope-associated massive PTE. She was previously healthy, except for termination of an ectopic pregnancy with methotrexate 4 months before. The only medication she was taking was an oral contraceptive (OC), which was started 3 months before the PTE. She had no family history of venous thromboembolism (VTE) or any other underlying risk factors. We report the case of a woman who had a PTE originating from a RVT associated with OC use after an ectopic pregnancy.


Subject(s)
Contraceptives, Oral , Female , Humans , Methotrexate , Pregnancy , Pregnancy, Ectopic , Pulmonary Embolism , Renal Veins , Risk Factors , Thrombosis , Venous Thromboembolism
19.
Korean Circulation Journal ; : 453-457, 2007.
Article in English | WPRIM | ID: wpr-200812

ABSTRACT

Ventricular perforation is a rare complication of permanent cardiac pacemaker implantation. We report here on a 68-year-old woman with a dual chamber permanent pacemaker that had been implanted one month earlier, and she suffered cardiac perforation from the pacemaker lead. Frequent follow-up via12-lead surface electrocardiography and chest radiography and the proper work-up for pacemaker implantation are needed for detecting rare complications after pacemaker implantation.


Subject(s)
Aged , Electrocardiography , Female , Follow-Up Studies , Heart Ventricles , Humans , Radiography , Thorax
20.
Article in Korean | WPRIM | ID: wpr-723814

ABSTRACT

OBJECTIVE: To evaluate the dynamics of autonomic nervous activity at rest and immediately after maximum exercise using heart rate variability (HRV) in coronary artery disease (CAD) and to assess the long-term effect of exercise. METHOD: Time and frequency domain of HRV was measured in 18 normal subjects, 37 CAD patients with percutaneous transluminal angioplasty and 10 CAD patients with coronary artery bypass graft at rest and 1 hour after peak graded treadmill exercise. Nineteen CAD patients were exercised with moderate intensity during 4 month and HRV was measured. RESULTS: At rest, the standard deviation of the NN interval (SDNN) and low frequency was significantly lower in both CAD groups than in normal subjects. At recovery stage after maximum exercise, low frequency and low frequency/high frequency ratio was significantly lower in both CAD groups than in normal subjects. SDNN at recovery stage in normal subjects remained significantly below the baseline. There was no significant change in HRV after long-term exercise even though maximum oxygen uptake had improved. CONCLUSION: This study demonstrated the reduced control of autonomic nervous activity in CAD patients at rest and immediately after peak exercise. There was no change in HRV after long-term exercise.


Subject(s)
Angioplasty , Coronary Artery Bypass , Coronary Artery Disease , Coronary Vessels , Heart Rate , Heart , Humans , Oxygen , Transplants
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