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*

Double-chambered right ventricle (DCRV) is a congenital cardiac anomaly in which the right ventricle is divided into two chambers by anomalous hypertrophied muscle bundles that cross the right ventricular cavity. DCRV may be associated with other congenital cardiac anomalies, most commonly with ventricular septal defect. We report two cases of DCRV without other congenital cardiac anomalies with review of literatures. We performed echocardiography, cardiac catheterization and right ventricular angiogram to confirm the diagnosis.
Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Echocardiography ; Heart Septal Defects, Ventricular ; Heart Ventricles*

Myocardial calcification is usually classified as either dystrophic or metastatic. Dystrophic calcification is more common and usually occurs in the area of prior myocardial infarction. It is found in 8% of patients who have been survived longer than 6 years after myocardial infarction. The most common site of calcification is in the anterior wall of the left ventricle or apical and anterolateral aspect in the aneurysm of the left ventricle. We report the case of a 50-years old man with a typical dystrophic calcification of the endocardium in area of myocardial necrosis.
Aneurysm ; Calcinosis ; Echocardiography ; Endocardium ; Heart Ventricles ; Humans ; Middle Aged ; Myocardial Infarction* ; Necrosis

Intravenous leiomyomatosis is an uncommon benign tumor arising from either the uterine venous wall or uterine leiomyoma. Although this tumor is usually confined to the pelvic cavity, sometimes it can extend into the cardiac cavity and brings on sudden death. We report a case of intravenous leiomyomatosis extending into the right atrium, right ventricle and both pulmonary arteries by seeding. The tumor was detected with transthoracic echocardiography and appropriately diagnosed by transesophageal echocardiography and cardiac MRI. Entire tumor was successfully removed by one-stage radical surgery under cardiopulmonary bypass.
Cardiopulmonary Bypass ; Death, Sudden ; Echocardiography ; Echocardiography, Transesophageal ; Heart Atria* ; Heart Ventricles* ; Leiomyoma ; Leiomyomatosis* ; Magnetic Resonance Imaging ; Pulmonary Artery*

Fibrosing mediastinitis is a rare benign disorder caused by excessive proliferation of fibrous tissue within the mediastinum. Pulmonary artery stenosis is uncommon complication of fibrosing mediastinitis. We present a case of percutaneous stent deployment in a patient with severe pulmonary artery stenosis causing pulmonary hypertension secondary to fibrosing mediastinitis.
Constriction, Pathologic ; Humans ; Hypertension, Pulmonary* ; Mediastinitis* ; Mediastinum ; Pulmonary Artery* ; Stents*

BACKGROUND: Recognition of ischemic right ventricular (RV) dysfunction in the course of inferior wall left ventricular (LV) acute myocardial infarction is important in clinical practice. The Doppler Tei index is useful for estimating global cardiac function. However, the clinical usefulness of RV Tei index to diagnose subclinical RV dysfunction has not been investigated. The purpose of this study was to assess the clinical value of RV Tei index for diagnosis of subclinical RV dysfunction associated with inferior wall acute myocardial infarction who did not have definite ECG changes at right precordial leads. METHODS: The study population consisted of 22 consecutive patients (male 10, average age 57+/-12) with acute inferior myocardial infarction who did not have specific ST segment changes at right precordial leads. RV Tei index was measured by Doppler echocardiography and RV ejection fraction (EF) was measured by multigated blood pool (MUGA) SPECT. We defined subclinical RV dysfuntion as estimated RA pressure was > or =10 mmHg (group 1) by right heart catheterization. RESULTS: In patients with RV dysfunction, RV Tei index was significantly increased compared with those who did not have RV dysfunction (0.51+/-0.22 vs 0.35+/-0.18, p<0.05). RVEF by MUGA blood pool SPECT was significantly decreased in patients with RV dysfunction (35+/-11% vs 47+/-12, p<0.05). CONCLUSION: RV Tei index is simple and useful non-invasive method for diagnosis of subclinical RV dysfunction associated with inferior wall acute myocardial infarction who did not have typical ECG changes at right precordial leads.
Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Echocardiography, Doppler ; Electrocardiography ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Tomography, Emission-Computed, Single-Photon ; Ventricular Dysfunction, Right*

BACKGROUND: Aging is an important factor to determine transmitral inflow velocity pattern. Cardiac geometry such as left ventricular (LV) volume, mass and left ventricular outflow tract (LVOT) was also changed with age. The aim of this study was to assess the impact of geometric change of LVOT on transmitral inflow velocity pattern excluding a factor of age. METHODS: Healthy 115 (61 men, 37+/-15 years) individuals were enrolled. Echocardiography was performed to measure LV mass, thickness, left atrial (LA) size, aortoseptal angle (ASA), early (E) and late (A) transmitral inflow velocity, and deceleration time (DT). ASA was measured at mid-diastole in apical long-axis view according to a method as the open angle between the edge of the interventricular septum and axis perpendicular to the aortic annulus. The relation between transmitral inflow velocity pattern and LV geometric parameters was analyzed by regression analysis. RESULTS: Simple regression analysis demonstrated a significant correlation between transmitral inflow parameters with age and geometric parameters (ASA, LA size and LV mass index). Multiple regression analysis, taking into consideration age, ASA, LA size and LV mass index showed that only age was an independent predictor for E, A, DT, and E/A ratio (r2=0.210, Beta coefficient (beta)=0.459, p<0.001;r2=0.427, beta=0.654, p<0.001;r2=0.227, beta=-0.476, p<0.001;r2=0.436, beta=-0.661, p<0.001, respectively). But, excluding age, ASA was an independent predictor for E, A, DT, and E/A ratio (r2=0.151, beta=0.389, p<0.001;r2=0.294, beta=0.542, p<0.001;r2=0.227, beta=-0.476, p<0.001;r2=0.260, beta=0.509, p<0.001, respectively). CONCLUSION: ASA, a parameter of LVOT geometry, might be an important factor related to transmitral inflow velocity pattern excluding a factor of age.
Aging ; Axis, Cervical Vertebra ; Deceleration ; Diastole ; Echocardiography ; Heart Ventricles ; Humans ; Male

Functional mitral regurgitation (FMR) develops frequently in ischemic or dilated cardiomyopathy. It is clinically very important because it is strongly associated with the progression of the disease and its prognosis. Although the correct mechanism of the FMR is not fully understood, incomplete mitral leaflet closure area or tenting area is the most important determinant of the FMR. Regional or global remodeling, and the contractile dysfunction of the left ventricle could affect tenting area. However, there is still a debate about which is the most important factor among them to determine the tenting area. Also, new findings in histopathology of the mitral valve leaflets with the FMR suggest leaflet itself could be involved in the development of the FMR. For the treatment of the FMR, conventional mitral annuloplasty with or without ring is not always successful in some patients, and it may not prevent further remodeling of the left ventricle even in successfully repaired cases. Therefore, it needs more sophisticated and prospective study to evaluate the accurate mechanism of the FMR, and new treatment modality should be developed for the successful treatment of the functional mitral regurgitation.
Cardiomyopathy, Dilated ; Echocardiography* ; Heart Ventricles ; Humans ; Mitral Valve ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency* ; Prognosis