1.Acute Myocardial Infarction Caused by Coronary Artery Dissection Following Blunt Chest Trauma.
Se Jung YOON ; Hyuck Moon KWON ; Dong Soo KIM ; Bum Kee HONG ; Dong Yeon KIM ; Yun Hyeong CHO ; Byung Seung KANG ; Hyun Seung KIM
Yonsei Medical Journal 2003;44(4):736-739
Chest trauma can lead to various cardiac complications ranging from simple arrhythmias to myocardial rupture. An acute myocardial infarction (AMI) is a rare complication that can occur after chest trauma. We report a case of 66-year-old male who suffered a blunt chest trauma from a traffic accident resulting in an AMI. The coronary angiography revealed an eccentric 50% narrowing of the ostium of left anterior descending artery (LAD) by a dissection flap with calcification. Intravascular ultrasonography (IVUS) revealed eccentric calcified plaque (minimal luminal diameter [MLD]=3.5 mm) with a dissection flap. Intervention was not performed considering the MLD and calcified flap, and he has been conservatively managed with aspirin and losartan for 2 years. The follow-up coronary angiography showed an insignificant luminal narrowing of the proximal LAD from the ostium without evidence of a dissection. An early coronary evaluation including an IVUS study should be considered for managing patients who complain of ongoing, deep-seated chest pain with elevated cardiac enzyme levels and an abnormal electrocardiogram (ECG) after a blunt chest trauma. Based on this case, some limited cases of traumatic coronary artery dissections can be healed with conservative management and result in a good prognosis.
Aged
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Aneurysm, Dissecting/diagnosis/*etiology
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Coronary Aneurysm/diagnosis/*etiology
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Coronary Angiography
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Human
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Male
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Myocardial Infarction/diagnosis/*etiology
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Radiography, Thoracic
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Thoracic Injuries/*complications
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Ultrasonography, Interventional
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Wounds, Nonpenetrating/*complications
3.A Case of Behcet's Disease with Pericarditis, Thrombotic Thrombocytopenic Purpura, Deep Vein Thrombosis and Coronary Artery Pseudo Aneurysm.
Chang Mo KWON ; Seung Hyun LEE ; Jin Ho KIM ; Kyu Hyung LEE ; Hyun Do KIM ; Yeong Hoon HONG ; Choong Ki LEE
The Korean Journal of Internal Medicine 2006;21(1):50-56
Behcet's disease with concomitant thrombotic thrombocytopenic purpura (TTP), coronary artery stenosis and coronary artery pseudo aneurysm is rare. Here we report a case of Behcet's disease with several cardiovascular complications, namely: pericarditis, deep vein thrombosis (DVT), TTP, coronary artery stenosis, and a coronary artery pseudo aneurysm. A 37-year-old female presented with sudden dyspnea and syncope at our emergency room and underwent pericardiectomy and pericardial window formation for the diagnosis of cardiac tamponade with acute hemorrhagic pericarditis. Thereafter, TTP and DVT complicated her illness. After confirmation of Behcet's disease on the basis of a history of recurrent oral and genital ulcers and erythema nodosum, remission was achieved after treatment with methylprednisolone pulse therapy, colchicine, catheter directed thrombolysis and thrombectomy. However, whilst maintaining anticoagulation therapy, a newly developed pericardial aneurysmal dilatation was noted on follow-up radiologic evaluation. Further evaluation revealed right coronary artery stenosis and a left coronary artery pseudo aneurysm; these additional problems were treated with the nonsurgical insertion of an endovascular graft stent . At the time of writing three months later after stent insertion, the aneurysm has continued to regress and no additional complications have intervened with combined immunosuppressive therapy.
Venous Thrombosis/diagnosis/*etiology
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Purpura, Thrombotic Thrombocytopenic/diagnosis/*etiology
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Pericarditis/diagnosis/*etiology
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Humans
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Female
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Echocardiography
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Coronary Vessels/*physiopathology
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Coronary Stenosis/diagnosis/*etiology
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Cardiac Tamponade/diagnosis/*etiology
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Behcet Syndrome/*complications/diagnosis
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Aneurysm, False/diagnosis/*etiology
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Adult
6.Percutaneous Transluminal Coronary Angioplasty for Coronary Artery Stenosis in a Young Patient with Long Term Kawasaki Disease.
Seok In HONG ; Pum Joon KIM ; Ki Bae SEUNG ; Jung Hyun KWON ; Ju Yeal BEAK ; Chang Dong YEO ; Kyu Bo CHOI
The Korean Journal of Internal Medicine 2005;20(2):187-190
Kawasaki Disease (KD) is an acute, febrile, multisystem disease of children. More severe complications in 15~25% of cases include, the development of coronary aneurysms, ischemic heart disease, and sudden cardiac death. The standard treatment for significant coronary artery stenosis has generally been aortocoronary bypass surgery, although percutaneous transluminal coronary angioplasty (PTCA) has been described in a small number of patients. This report describes a 14 year old boy with a history of KD who developed multiple coronary aneurysms and stenosis. We performed PTCA, which was successful in relieving the stenosis of the left circumflex artery.
Adolescent
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*Angioplasty, Transluminal, Percutaneous Coronary
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Coronary Aneurysm/diagnosis/etiology/therapy
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Coronary Angiography
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Coronary Stenosis/diagnosis/etiology/*therapy
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Coronary Vessels/ultrasonography
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Endosonography
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Follow-Up Studies
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Humans
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Male
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Mucocutaneous Lymph Node Syndrome/*complications/diagnosis
7.Angiographic and intravascular ultrasonographic features of Kawasaki coronary artery disease.
Kiang Wei LOW ; Kian Keong POH ; Huay Cheem TAN
Singapore medical journal 2012;53(5):e87-9
We report a 38-year-old man with previous Kawasaki disease who presented with exertional dyspnoea and was found to have multivessel coronary aneurysm and stenoses on coronary angiography. Coronary artery bypass surgery was subsequently performed. This case highlights the angiographic and intravascular ultrasonographic imaging features of this relatively uncommon condition presenting to an adult general cardiology service in Singapore.
Adult
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Coronary Aneurysm
;
diagnosis
;
etiology
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Coronary Angiography
;
methods
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Coronary Stenosis
;
diagnosis
;
etiology
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Coronary Vessels
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diagnostic imaging
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Diagnosis, Differential
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Humans
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Male
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Mucocutaneous Lymph Node Syndrome
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complications
;
diagnosis
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Ultrasonography, Interventional
;
methods
8.Review and analysis of 283 cases of Kawasaki disease.
Li WANG ; Yi LIN ; Ying-Zi SU ; Yun WANG ; Di ZHAO ; Tie-Ji WU
Chinese Journal of Pediatrics 2004;42(8):609-612
OBJECTIVEThe aim of the study was to review the cases of Kawasaki Disease (KD) and analyze the clinical features especially their cardiac complications.
METHODSTotally 283 patients with KD were hospitalized from 1992 to 2002. Their clinical features and factors associated with increased risk of coronary artery aneurysms were reviewed.
RESULTS(1) Among the 283 KD patients, 186 were male and 97 were female. The male-female ratio was 1.9:1. Most of them (71%) were younger than 3 years old. Seasonal peak was in spring and summer (from May to Aug). Depending on the criteria of KD, 228 (81%) were diagnosed as typical KD and 55 (19.4%) were atypical KD. All patients had fever, lasting for 6.1 days. The most common clinical features were oral mucosal changes (97.5%) and cervical lymphadenopathy (95.4%), conjunctivitis (91.2%). And changes in the extremities (89.8%) and rash (81.5%) were also noted. (2) Before the treatment, coronary artery abnormalities were seen in 103/279 (36.9%), which occurred within 4 - 30 days of fever onset. Two weeks after intravenous gamma globulin (IVIG) treatment, the new cases of coronary artery abnormalities were 28/211 (13.3%). The prevalence of coronary artery aneurysms (CAA) with KD was 4.7%. The risk factors of CAA were male cases (P < 0.05) and fever lasting longer than 9 days (P < 0.05). Other cardiac abnormalities in acute phase included left atrial and ventricular enlargement (40/279, 14.3%) and changes in ECG (57/274, 20.8%). The pericardial effusions were found in 11 cases (3.9%).
CONCLUSIONSCardiac complications of KD occurred in the early period of KD. The new cases of coronary artery abnormalities were 13.3% after IVIG treatment. The risk factors of CAA included male cases and fever lasting for longer time.
Child, Preschool ; Coronary Aneurysm ; epidemiology ; etiology ; Female ; Heart Diseases ; diagnosis ; etiology ; Humans ; Immunoglobulins, Intravenous ; administration & dosage ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnosis ; drug therapy ; Prevalence ; Risk Factors
10.Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy Associated with an Apical Aneurysm: Evaluation of Possible Causes of Aneurysm Formation.
Yuichi SATO ; Naoya MATSUMOTO ; Shinro MATSUO ; Shunichi YODA ; Shigemasa TANI ; Yuji KASAMAKI ; Tadateru TAKAYAMA ; Satoshi KUNIMOTO ; Satoshi SAITO
Yonsei Medical Journal 2007;48(5):879-882
Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare type of cardiomyopathy, associated with apical aneurysm formation in some cases. We report a patient presenting with ventricular fibrillation, an ECG with an above normal ST segment, and elevated levels of cardiac enzymes but normal coronary arteries. Left ventriculography revealed a left ventricular obstruction without apical aneurysm. There was a significant pressure gradient between the apical and basal sites of the left ventricle. Cine magnetic resonance imaging (MRI), performed on the 10th hospital day, showed asymmetric septal hypertrophy, mid-ventricular obstruction, and an apical aneurysm with a thrombus. The first evaluation by contrast-enhanced imaging showed a subendocardial perfusion defect and delayed enhancement. It was speculated that the intraventricular pressure gradient, due to mid- ventricular obstruction, triggered myocardial infarction, which subsequently resulted in apical aneurysm formation.
Cardiomyopathy, Hypertrophic/complications/*diagnosis
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Coronary Angiography
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Echocardiography, Doppler
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Heart Aneurysm/*diagnosis/etiology
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Humans
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Hypertrophy, Left Ventricular/complications/*diagnosis
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Magnetic Resonance Imaging, Cine
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Male
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Middle Aged
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Myocardial Ischemia/complications/diagnosis