Left ventricular thrombus (LVT) is a frequent complication in patients with acute large anterior myocardial infarction or dilated cardiomyopathy. The clinical importance of LVT lies in its potential for systemic embolization. We experienced a case of surgically treated LVT in a patient with acute myocarditis with embolic splenorenal infarction.
Cardiomyopathy, Dilated ; Heart Ventricles ; Humans ; Infarction ; Myocardial Infarction ; Myocarditis* ; Thrombosis*

Lipomatous hypertrophy of interartiral septum (LHIS) is a rare entity that is characterized by the excessive deposition of fat in the interatrial septum. The appearance of LHIS on echocardiogram is a bilobed or dumbbell-shaped in interatrial septum. We report a case of 56-years man with frequent premature ventricular contraction on holter monitoring which may related to his sudden cardiac death diagnosed lipomatous hypertrophy of interatrial septum by echocardiography.
Arrhythmias, Cardiac ; Death, Sudden, Cardiac ; Echocardiography ; Electrocardiography, Ambulatory ; Heart Septum ; Hypertrophy* ; Ventricular Premature Complexes

2D echocardiography (2DE) is a well established tool for the diagnosis of the mechanical complications after acute myocardial infarction (AMI) such as free wall and ventricular septal rupture. However, the extension of the rupture and the relationship with contiguous anatomic structures may not be clearly defined by 2DE. Real-time 3D echocardiography (RT3DE) is known to provide surgical enface view allowing complete visualization of the cardiac structures and comprehension of their spatial orientations to other anatomic structures. Obtaining such information with RT3DE before operation in AMI patient with mechanical complication may be essential for the optimal surgical treatment. We report a case of extensive ventricular wall rupture from the posterior wall to the ventricular septum after AMI demonstrated by RT3DE.
Comprehension ; Diagnosis ; Echocardiography ; Echocardiography, Three-Dimensional* ; Humans ; Myocardial Infarction* ; Rupture* ; Ventricular Septal Rupture ; Ventricular Septum*

Midventricular obstructive hypertrophic cardiomyopathy (MOHCM) is a rare variant of hypertrophic cardiomyopathy. Apical dilatation and myocardial infarction can be complicated without significant coronary artery disease. We report a case of apical dilatation in a patient with MOHCM without atherosclerotic coronary artery disease. A 76-year-old woman was admitted for recent cerebral infarction and consulted to cardiologist for abnormal electrocardiographic findings. She had been suffering from exertional dyspnea (NYHA II) for about four years. Two dimentional-echocardiography revealed midventricular obstructive hypertrophy with an apical dilatation and paradoxical jet flow from the apical aneurysm to the left ventricular outflow tract during early diastole. Cardiac catheterization demonstrated dyskinesia in the apical wall with midventricular obstruction and a peak-to-peak intraventricular pressure gradient of 110 mmHg during pull-back from the apical high-pressure chamber to the subaortic low-pressure chamber in the left ventricle. Coronary angiograms showed no significant stenotic lesion of the coronary arteries. She was prescribed oral beta-adrenergic antagonist to decrease the intraventricular pressure gradient.
Aged ; Aneurysm* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Cerebral Infarction ; Coronary Artery Disease ; Coronary Vessels ; Diastole ; Dilatation* ; Dyskinesias ; Dyspnea ; Electrocardiography ; Female ; Heart Ventricles ; Humans ; Hypertrophy ; Myocardial Infarction ; Ventricular Pressure

BACKGROUND: Severe tricuspid regurgitation (TR) may develop later after mitral valve replacement (MVR) in the absence of prosthetic mitral valve (MV) dysfunction and other causes of left heart failure. The aim of this study was to investigate the incidence and predictors of severe TR late after MVR for rheumatic MV disease. METHODS: From 309 patients who underwent MVR between 1995 and 1997 at Yonsei Cardiovascular Hospital, we selected 193 patients (M:F=52:141; mean age 48.5+/-11.3) who underwent MVR for rheumatic valvular disease [concomitant TAP (Tricuspid annuloplasty) group: 56, No TAP group: 137]. The mean follow up duration was 83.2+/-26.4 months. Primary end point was time to clinical events, such as death, reoperation for tricuspid valve, admission due to right heart failure and the development of severe TR without left side heart failure. Patients were classified into 3 groups based on the degree of TR at the time of MVR: Group I; patients with coexisting mild TR (Grade 0, trivial), Group II; mild to moderate TR (Grade I-II), Group III; severe TR (Grade III-IV). RESULTS: Twenty-one patients (10.9%) developed clinical events [Group I: 2/78 (2.6%), Group II: 8/76 (10.5%), Group III: 11/39 (28.2%)]. Event free survival rate was different during the follow-up period between groups. By Cox regression analysis, initial severe TR (Hazard Ratio: 5.2, 95%CI 2.2-12.3), old age (Hazard Ratio: 4.3, 95%CI 1.4-12.8), and TAP (Hazard Ratio: 4.3, 95%CI 1.8-10.5) were the risk factors for the development of late severe TR. CONCLUSION: The incidence of severe TR or right heart failure in the absence of prosthetic MV dysfunction was 10.9% in MVR patients. Despite of successful TAP, the severity of TR at the time of MVR was the most important factor for prediction of late severe TR. It can be suggested that initial TR grade and RV function rather than TAP, is the important factor for the recurrence of severe TR after MV surgery.
Disease-Free Survival ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Humans ; Incidence* ; Mitral Valve* ; Recurrence ; Reoperation ; Risk Factors ; Tricuspid Valve ; Tricuspid Valve Insufficiency*

Echocardiography is an important tool in investigation, re-evaluation of remained postoperative defect and follow-up for adult congenital heart disease, even though there are often a problem to obtain optimal echocardiogram. The usual systematic echocardiographic assessments should include special focus on 1) anatomic description of situs, concordance, discordance or valves; 2) chamber sizes and function; 3) valve appearance and function; 4) shunts; 5) pulmonary artery pressure; 6) flow and size of the arch; and 7) drainage of pulmonic veins. The major lesions are presented and echocardiographic features briefly discussed.
Adult* ; Drainage ; Echocardiography* ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Diseases* ; Heart* ; Humans ; Pulmonary Artery ; Veins

The importance of hypertension to the structure and function of the cardiovascular system has been well recognized for several decades. The relationship between BP and risk of CVD events is continuous, consistent, and independent of other risk factors. Worldwide prevalence estimates for hypertension may be as much as 1 billion individuals, and approximately 7.1 million deaths per year may be attributable to hypertension, which is the number one attributable risk for death throughout the world. Therefore, optimal evaluation and management of hypertensive patients are crucial in clinical practice. Diagnostic procedures for hypertensive patients should include; 1) to establish blood pressure levels, 2) to identify secondary causes of hypertension, and 3) to evaluate the overall cardiovascular risk by searching for other risk factors, target organ damage and concomitant diseases or accompanying clinical conditions. Echocardiography is a robust, noninvasive diagnostic technique that can be repeated many times and used to study large cohorts of patients. It has provided valuable clinical information regarding the geometry and function of the left ventricle including left ventricular mass, hypertrophy and systolic and diastolic function. Therefore, tons of data demonstrating the usefulness of various echocardiographic parameters as predictors of cardiac morbidity and mortality have been accumulated. Although technical variability and cost remain practical limitations, the clinical usefulness of information it has provided about hypertension should be understood by all physicians.
Blood Pressure ; Cardiovascular System ; Cohort Studies ; Echocardiography* ; Heart Ventricles ; Humans ; Hypertension ; Hypertrophy ; Mortality ; Prevalence ; Risk Factors

BACKGROUND: Cardiac involvement in Duchenne muscular dystrophy (DMD) is common, but usually latent without symptoms or signs in the initial period of disease. This study investigated the incidence and predictor of cardiac involvement in DMD patients. METHOD: From January 2000 to June 2005, we enrolled 45 patients with DMD (aged 20.2+/-3.0 years) who admitted to the Yongdong Severance Hospital. Electrocardiography and transthoracic echocardiography was done to evaluate the cardiac function. RESULT: Electrocardiographic abnormalities were present in 80.1% of patients. Sinus tachycardia was most common (50%). LVEF was decreased (46.7+/-13.8%), and 56% of the patients had diastolic dysfunction. Patients with pulmonary involvement were older (20.7+/-3.8 vs 17.6+/-2.8 years, p=0.028), and patients with reduced LVEF (<50%) had longer duration of disease (11.4+/-4.4 vs 14.3+/-2.4 years, p=0.04). However, on multivariate analysis, age, duration of disease, pulmonary involvement, dyspnea symptom, electrocardiographic abnormality was not an independent predictor for LV systolic dysfunction in adolescent and adult patients with DMD. CONCLUSION: Cardiac involvement in adolescent and adult patients with DMD was frequently observed independent of age, duration of disease, pulmonary involvement, and dyspnea symptom. Therefore, more active cardiac investigation is required in patients with DMD, even without clinical suspicion.
Adolescent ; Adult ; Dyspnea ; Echocardiography ; Electrocardiography ; Humans ; Incidence ; Lung Diseases ; Multivariate Analysis ; Muscular Dystrophy, Duchenne* ; Tachycardia, Sinus

Stroke, a sudden development of a focal neurologic deficit, remains as a frequent leading cause of death even in Korea. Five to 13% of strokes occur in patients with younger than 45 years of age; up to 40% of strokes occur in patients without occlusive cerebrovascular disease; and it is estimated that the source is cardiac origin in 15 to 20%. Another 30n to 40% are in the category of stroke of undetermined cause, also known as cryptogenic stroke. An increasing number of echocardiographic findings have been found in this group of cryptogenic stroke patients and in patients with embolic stroke. Cardiac tumors can be a source of emboli, but the most commonly implicated sources are thrombi from the left atrial appeadage or left ventricle, left atrial spontaneous contrast, atrial septal aneurysm associated with a patent foramen ovale (PFO), thrombi traversing a PFO, valve vegetations, protruding aortic atheroma of aortic arch, and emboli associated with mitral and aortic prostheses. Echocardiography is most helpful in defining the cause of cerebrovascular ischemia in patients without occlusive cerebrovascular disease. For complete evaluation of potential source of cardiac embolic sources, transesophageal echocardiography (TEE) is required because many of the entities such as left atrial appendage thrombus can be detected only with this technique.
Aneurysm ; Aorta, Thoracic ; Atrial Appendage ; Cause of Death ; Echocardiography* ; Echocardiography, Transesophageal ; Foramen Ovale, Patent ; Heart Neoplasms ; Heart Ventricles ; Humans ; Ischemia ; Korea ; Neurologic Manifestations ; Plaque, Atherosclerotic ; Prostheses and Implants ; Stroke* ; Thrombosis

Rupture of the interventricular septum is a serious complication of acute myocardial infarction, accounting for 5% of death due to acute myocardial infarction. The mortality with medical therapy alone exceeds 90%. Accurate diagnosis, urgent management, and early operative correction are necessary for survival. We report cases of 3 patients with ventricular septal rupture after acute myocardial infarction.
Diagnosis ; Humans ; Mortality ; Myocardial Infarction* ; Rupture ; Ventricular Septal Rupture*