Adolescent ; Anemia, Iron-Deficiency ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Hemorrhoids ; Humans ; Klippel-Trenaunay-Weber Syndrome ; Male ; Polyps ; Port-Wine Stain ; Vascular Malformations

A 72-year-old man presented with incidentally found palpable abdominal mass of unknown duration. On admission, he had blood pressure of 120/80mmHg and pulse of 70 beats per minute. He consumed a pack of cigarettes per day for 45 years. He denied any prior chest pain episodes. The serum lipid profiles were within normal range. Electrocardiogram revealed sinus rhythm without ST-T wave change. Digital subtraction angiography revealed aneurysmal dilatation of both common iliac arteries to the proximal part of the external iliac arteries. Transthoracic echocardiography revealed normal left ventricular wall motion except a pseu-doaneurysm at the apex (Fig. 1). Color Doppler (Fig. 2) and intravenous contrast echocardiography (Fig. 3) showed free blood flow communication through the neck of the pseudoaneurysm. Coronary angiography revealed no significant luminal narrowing of coronary arteries. Left ventriculogram showed an aneurysm at the apex (Fig. 4). During the period of 8 months follow-up, the patient did not have any event or complain any symptom.
Aged ; Aneurysm ; Aneurysm, False* ; Angiography, Digital Subtraction ; Blood Pressure ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Dilatation ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Humans ; Iliac Artery ; Neck ; Phenobarbital ; Reference Values ; Tobacco Products

An important, albeit rare, cause of fetal bradycardia is long QT syndrome (LQTS). Congenital LQTS is an ion channelopathy caused by mutations in genes encoding cardiac ion channel proteins. Fetal onset of LQTS imposes high risk of life-threatening tachyarrhythmias and sudden cardiac death. Here, we report the case of a female newborn with fetal onset of bradycardia and a 2:1 atrioventricular (AV) block. After birth, a 12-lead electrocardiogram (ECG) revealed bradycardia with QT prolongation of a corrected QT (QTc) interval of 680 ms and pseudo 2:1 AV block. Genetic testing identified a heterozygous Gly402Ser (c.1204G>A) mutation in CACNA1C, confirming the diagnosis of LQTS type 8 (LQT8). The patient received propranolol at a daily dose of 2 mg/kg. Mexiletine was subsequently administered owing to the sustained prolongation of the QT interval and pseudo 2:1 AV block. One week after mexiletine inception, the ECG still showed QT interval prolongation (QTc, 632 ms), but no AV block was observed. There were no life-threatening tachyarrhythmias in a follow-up period of 13 months.

An important, albeit rare, cause of fetal bradycardia is long QT syndrome (LQTS). Congenital LQTS is an ion channelopathy caused by mutations in genes encoding cardiac ion channel proteins. Fetal onset of LQTS imposes high risk of life-threatening tachyarrhythmias and sudden cardiac death. Here, we report the case of a female newborn with fetal onset of bradycardia and a 2:1 atrioventricular (AV) block. After birth, a 12-lead electrocardiogram (ECG) revealed bradycardia with QT prolongation of a corrected QT (QTc) interval of 680 ms and pseudo 2:1 AV block. Genetic testing identified a heterozygous Gly402Ser (c.1204G>A) mutation in CACNA1C, confirming the diagnosis of LQTS type 8 (LQT8). The patient received propranolol at a daily dose of 2 mg/kg. Mexiletine was subsequently administered owing to the sustained prolongation of the QT interval and pseudo 2:1 AV block. One week after mexiletine inception, the ECG still showed QT interval prolongation (QTc, 632 ms), but no AV block was observed. There were no life-threatening tachyarrhythmias in a follow-up period of 13 months.

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stents (SES), as opposed to bare metal stents (BMS), have been shown to markedly reduce restenosis. However, many clinical trials have excluded the subset of patients (pts) with end-stage renal disease (ESRD). The aim of this study was to evaluate the clinical outcomes following SES implantation in ESRD pts. SUBJECTS AND METHODS: We analyzed the clinical outcomes in 50 pts from our registry following SES implantation, and compared the outcomes between those with ESRD receiving SES (SES-ESRD) and BMS (BMS-ESRD), and with non-ESRD pts following SES implantation (SES-non ESRD). RESULTS: A comparison of the SES-ESRD (50 pts, 72 lesions) with BMS-ESRD groups (42 pts, 45 lesions); those in the SES-ESRD group included; diabetes 78%, hypertension 94% and age 62+/-10 years. Those in the SES-ESRD group were more likely to have diabetes (diabetes of BMS-ESRD, 57%; p=0.04). The reference vessel diameters (RVD) of the SES-ESRD group were smaller (2.76+/-0.50 mm vs. 3.05+/-0.46 mm, p<0.001), but the lesion length was longer (25.6+/-7.0 mm vs. 19.1+/-8.8 mm, p<0.001) than those of the BMS-ESRD group. The SES-ESRD group had a lower 1-year major adverse cardiac events (MACE) rate than the BMS-ESRD group (6.0% vs. 33.3%; p<0.001). There were no differences in mortality and incidence of myocardial infarction between the two groups. The incidence of target vessel revascularization decreased significantly in the SES-ESRD group (2.0% vs. 19.0%, p=0.01). From a multivariate regression analysis, the use of SES was the only significant independent predictor of MACE (OR=0.054, 95% confidence interval 0.01 to 0.26, p<0.001). A comparison with SES-non ESRD group in our total registry (644 pts, 758 lesions); MACE in the SES-ESRD group (6.0%) was higher than in the SES-non ESRD group (3.1%), but there was no statistical significance (p=0.23). CONCLUSION: Compared with BMS, SES caused an improvement in the clinical outcomes in pts with ESRD.
Angioplasty* ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic* ; Mortality ; Myocardial Infarction ; Stents*

Multi-detector row coronary computed tomography (CT) angiography is an emerging noninvasive diagnostic tool for coronary artery disease. Because of the high negative predictive value of the test, coronary CT angiography is useful for ruling out significant coronary artery stenosis in patients with chest pain. Between 2003 and 2009, 2,148 (50%) of 4,337 patients who underwent coronary CT angiography had a normal coronary artery. Of the 2,148 patients, only two (0.09%) experienced cardiovascular events within three months of their index visit. One patient underwent invasive coronary angiography based on a positive exercise test result, while the second underwent invasive coronary angiography due to an episode of chest pain. Coronary angiographic examination of these two patients revealed significant luminal narrowing of the proximal left anterior descending artery; both patients underwent revascularization at the discretion of their physician.
Angiography ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Exercise Test ; Humans ; Phenobarbital

BACKGROUND AND OBJECTIVE: The purpose of this study was to develop a new type of coronary stent-graft, using surface modification of polymeric synthetic graft materials, to improve biocompatibility. MATERIALS AND METHODS: Three different polymers, Dacron, GoreTex and Teflon were tested. During the surface-modification process, hydroxybutyl acrylate (HBA) choline, an excellent blood-compatible phospholipid, was stably grafted onto the polymer surface. The optimal conditions for maximizing the amount of HBA choline grafted onto the polymeric surface were determined by quantitative analysis. The surface-modified polymers were then tested for their biocompatibility using an in vitro platelet adhesion test. Thereafter, stent-grafts were constructed with each of three different types of surface-modified polymer and implanted in porcine coronary arteries to compare their biocompatibility in vivo. RESULTS: In the platelet adhesion test, all the surface-modified polymers showed better biocompatibility than the control polymers. The in vitro biocompatibility correlated positively with the increasing quantity of grafted HBA choline. In the animal experiment, the surface-modified Teflon stent-graft showed the best biocompatibility. Whereas, all pigs implanted with the modified Dacron and GoreTex stent-grafts died within 48 hours of the implantation, five out of the six pigs with the Teflon stent-grafts remained alive at after the 4th week. In four of the five surviving pigs, angiography, intravascular ultrasound (IVUS) and histological evaluations demonstrated the patency of the stent-grafts, with a uniform neointima formation covering the entire stent-graft, without stent thrombosis or chronic inflammatory cells. CONCLUSION: The surface-modified Teflon coronary stent-grafts showed good in vitro and in vivo biocompatibility. Further animal and clinical studies will be required to validate the efficacy of the surface-modified polymer stent-grafts.
Angiography ; Animal Experimentation ; Animals ; Blood Platelets ; Choline ; Coronary Disease ; Coronary Vessels ; Neointima ; Polyethylene Terephthalates ; Polymers* ; Polytetrafluoroethylene ; Stents ; Swine ; Thrombosis ; Transplants ; Ultrasonography

A foreign body in heart is rare, but it is more frequently encountered than the past as iatrogenic causes are increasing. Clinicians should be aware that foreign body could be mistaken for normal structure of heart. In order for accurate diagnosis, multi-imaging modalities should be used for information of exact location, mobility and hemodynamic effects. A decision to intervene should be made based on potential harms harbored by foreign bodies. Endovascular retrieval should be considered as an option. However, when fatal complications occur or when foreign bodies are embedded deeply, a surgical removal should be attempted.
Cardiac Surgical Procedures/*methods ; Echocardiography ; Female ; Foreign Bodies/*radiography/*surgery ; Foreign-Body Migration/radiography ; Heart Injuries/diagnosis/etiology/*surgery ; Humans ; Iatrogenic Disease ; Middle Aged ; *Needles ; Treatment Outcome

A foreign body in heart is rare, but it is more frequently encountered than the past as iatrogenic causes are increasing. Clinicians should be aware that foreign body could be mistaken for normal structure of heart. In order for accurate diagnosis, multi-imaging modalities should be used for information of exact location, mobility and hemodynamic effects. A decision to intervene should be made based on potential harms harbored by foreign bodies. Endovascular retrieval should be considered as an option. However, when fatal complications occur or when foreign bodies are embedded deeply, a surgical removal should be attempted.
Cardiac Surgical Procedures/*methods ; Echocardiography ; Female ; Foreign Bodies/*radiography/*surgery ; Foreign-Body Migration/radiography ; Heart Injuries/diagnosis/etiology/*surgery ; Humans ; Iatrogenic Disease ; Middle Aged ; *Needles ; Treatment Outcome

PURPOSE: We wanted to evaluate the utility of multi-slice computerized tomography (MSCT) for assessing coronary artery bypass graft patency and/or occlusion. MATERIALS AND METHODS: For 24 patients, both conventional angiography and CT angiography with 4-MSCT were performed within seven days of one another in order to evaluate the accuracy of MSCT with regard to graft patency and/or occlusion. A follow-up CT angiogram was performed in patients with and without symptoms (n=11, n=34, respectively) with 4- or 16-MSCT. We retrospectively compared the results of MSCT to those of conventional coronary graft angiography. RESULTS: Sixty-five grafts were evaluated for the accuracy of MSCT. Six of those 65 were occluded. The sensitivity, specificity, positive predictive value and negative predictive values of MSCT for the diagnosis of graft occlusion were 100% (6/6), 98% (58/59), 86% (6/7) and 100% (58/58), respectively. Patency could not be determined by angiography in two grafts; however, the grafts proved to be patent on MSCT. On follow-up, new graft occlusions in the asymptomatic patients were detected by MSCT in 8.2% of the previously patent grafts at the two years post-op, and in 15.2% at the three years post-op. CONCLUSION: MSCT is a practical and accurate noninvasive diagnostic tool for following up coronary artery bypass grafts.
Angiography ; Coronary Artery Bypass* ; Coronary Vessels* ; Diagnosis ; Follow-Up Studies* ; Humans ; Retrospective Studies ; Sensitivity and Specificity ; Transplants