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

Malignant mesenchymomas by definition are composed of two or more cellular types that would ordinarily derive from primitive mesenchyme. They grow rapidly, recur frequently, metastasize, and can be found in a wide variety of locations. Malignant mesenchymomas as primary cardiac tumor are extremely rare with poor prognosis. Only 15 cases of cardiac malignant mesenchymoma were reported in worldwide literature in 1961-1992. We report a case of primary cardiac malignant mesenchymoma in 58 year-old female patient admitted due to hemoptysis and mild exertional dyspnea.
Dyspnea ; Female ; Heart Neoplasms ; Heart* ; Hemoptysis ; Humans ; Mesenchymoma* ; Mesoderm ; Middle Aged ; Prognosis

Ruptured aneurysm of sinus of Valsalva is an uncommon congenital lesion, which was first reported in 1840 by Thurman. Its incidence is representing up to 3.5% of patients undergoing congenital heart disease surgery. Predominant symptoms are dyspnea, palpitation, and chest pain, present above the half. An early diagnosis is helpful because of the favorable surgical prognosis. Echocardiography remains useful in detecting abnormalities, and provides important information prior to cardiac catheterization and surgery. Cardiac catheterization and angiography are necessary for diagnosis of receiving chamber and associated lesions such as ventricular septal defect, aortic regurgitation, and other congenital abnormalities. The effective treatment is surgery. Without operation, cause of death are heart failure or bacterial endocarditis. We report two cases of asymptomatic ruptured aneurysm of sinus of Valsalva, confirmed by transesophageal echocardiography, and cardiac catheterization. The corrective surgery was performed without complication.
Aneurysm, Ruptured* ; Angiography ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Cause of Death ; Chest Pain ; Congenital Abnormalities ; Diagnosis ; Dyspnea ; Early Diagnosis ; Echocardiography ; Echocardiography, Transesophageal* ; Endocarditis, Bacterial ; Heart Defects, Congenital ; Heart Failure ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Prognosis ; Sinus of Valsalva*

Acute mitral regurgitation associated with rupture of papillary muscle is a rare complication of blunt chest trauma. Echocardiographic information is very useful in the diagnosis of papillary muscle rupture, evaluation of left ventricular function and other abnoramlity of heart. The value of transthoracic echocardiography in blunt chest trauma is limited because patients with severe chest wall injury often have suboptimal echocardiographic fingings. But transesophageal echocardiography can provide high quality images when the transthoracic echocardiographic image quality is poor. We report 27 year-old female with papillary muscle rupture after blunt chest trauma in whom transthoracic echocardiography could not provide a prompt diangosis, but definitive evidence of papillary muscle rupture was demonstrated by transesophageal echocardiography.
Adult ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart ; Humans ; Mitral Valve Insufficiency ; Papillary Muscles* ; Rupture* ; Thoracic Wall ; Thorax* ; Ventricular Function, Left