Case of Left Atrium Myxoma with Inferior Vena Caval Thrombus and Pulmonary Embolism Complicated with Budd-Chiari Syndrome

Primary tumors of the heart are rare, three-quarters of the tumors are benign, and nearly half of the benign heart tumors are myxomas. Cardiac myxoma usually originate in the left atrium about 75 percent, but, only 3 to 4 percent of myxoma are detected in the left ventricle. Cardiac myxoma is histologically benign, but may be lethal because of their position. We reported a case of 65-year-old man with left atrium myxoma associated with inferior vena caval thrombi and pulmonary embolism. After the operation of myxoma, the Budd-Chiari syndrome developed and the patient died due to hepatic failure.

A Case of Embolism of Left Posterior Tibial Artery after Successful Pregnancy and Delivery in a Patient with a Mechanical Valve Replacement Using Subcutaneous Injection of Low Molecular Weight Heparin

Low molecular weight heparin (LMWH) demonstrated the safety and efficacy in patients with valve prosthesis and successfully prevented or treated venous thromboembolic events in large series of pregnant women. Subcutaneous injection of LMWH at home was done for whole gestational period (39 weeks) in 29 year-old female patient with mechanical prosthetic valves in the aortic (St. Jude 21 mm) and mitral (St. Jude 29 mm) position. aPTT and echocardiography were regularly monitored once a month. Dosage of LMWH was used in a steady state. On delivery day, use of LMWH was stopped and full-term vaginal delivary of a healthy baby could be obtained without fetal loss, thromboembolic episodes. Warfarin was combined with LMWH for 3 days after delivery. One week later, left posterior tibial artery embolism developed.

The Influence of Changes in Preload on Tei index

BACKGROUND: Tei index is a Doppler-derived index of combined systolic and diastolic myocardial performance proposed to be a promising noninvasive measurement of overall cardiac function, calculated as the sum of isovolumic contraction (ICT) and isovolumic relaxation times (IRT) divided by ejection time (ET). This study aimed to investigate the effect of changes in preload on Tei index. SUBJECTS AND METHOD: The study population was 10 patients with chronic renal failure who are on regular hemodialysis (HD). They were 3 men and 7 women with a mean age of 45.3+/-12.4 years old. The complete 2-dimensional and Doppler echocardiography including recordings of mitral inflow and left ventricular outflow were performed using HP SONOS 1500 equipment before and after HD. Body weight was measured using electric scale before and after HD. Blood pressure and pulse rate were measured by an automated cuff measurement every 1 hour throughout HD. Hematocrit was monitored noninvasively and continuously using the Crit-Line instrument (In-Line Diagnostics, Riverdale, UT, USA) during HD. RESULTS: There were no significant changes in systolic and diastolic blood pressure, RR interval, left ventricular end-diastolic and end-systolic dimension, left atrial dimension, and left ventricular ejection fraction during HD. The mean body weight loss during HD was 2.1+/-0.65 kg. The percentage of reduction of body weight was 4.1+/-1.56%. Changes in total blood volume at the end of HD were compared with that of baseline -11.79+/-5.51%. The percent change in total blood volume during the HD correlated significantly with the amount of change in body weight (r=0.678, p<0.05) and percent change in body weight (r=0.835, p<0.01), respectively. ICT before HD and at the end of HD were 39+/-13.0, 42+/-24.1 msec (p=NS). IRT before HD and at the end of HD were 76+/-29.1, 95+/-28.5 msec (p<0.01) and , ET before HD and at the end of HD were 317+/-18.1, 289+/-9.0 msec (p<0.01), respectively. Tei index before HD was 0.36+/-0.10, and the index at the end of HD were 0.47+/-0.13 (p<0.001). CONCLUSION: When there is a change in preload during a short period, it seems that the effect of change in preload should be considered when using Tei index to assess ventricular function.

Effect of a Meal on Cardiac Performance in Patients with Coronary Artcry Disease

BACKGROUND: It has been well recognized that exercise tolerance and angina threshold in patients with coronary artery disease (CAD) are reduced after a meal. But precise mechanism leading to the postprandial worsening of angina has yet to be adequately defined. This study was undertaken to determine the effect of a mixed meal on cardiac performance and heart rate variability (HRV) in patients with CAD. METHODS: 24 patients with angina or myocardial infarction were studied. Echocardiographic examination and heart rate variability test were performed in the fasting state and the other 40-60 minutes after a 600-800 kcal mixed meal. RESULTS: In the postprandial state, resting heart rate was significantly increased by 5.2% from 64.8+/-10.69 beats/min to 68.2+/-10.2 beats/min (p<0.01), stroke volume by 8.1% from 59.6+/-17.3 ml to 64.4+/-18.1 ml (p<0.01), cardiac output by 14.2% from 3.8+/-1.06 to 4.3+/-1.21 (p<0.01). E wave and A wave of mitral filling flow and E/A ratio were not significantly different in the fasting and postprandial tests. But DT and IVRT were significantly increased in the postprandial state (p<0.05, p<0.01 respectively). HRV was not different in the fasting and postprandial state. CONCLUSIONS: In patients with CAD, a 600-800 kcal mixed meal significantly increased resting heart rate, stroke volume, cardiac output, DT and IVRT.