Infrequently, patent foramen ovale or atrial septal defect act as a passage for the venous thrombi to reach the arterial circulation. These arterial thrombi can evoke tragic paradoxical embolisms. We report a case of impending paradoxical embolism due to a huge thrombus trapped through a patent foramen ovale in a 66-year-old man who presented with sudden dyspnea and chest discomfort in ten days after colon cancer surgery. The transthoracic echocardiogram demonstrated signs of acute right ventricular pressure overload and a huge linear mass wedged in a patent foramen ovale. On the intraoperative transesophageal echocardiography, the huge linear mass was freely floating in both right and left cardiac chambers passing through atrial septum. To prevent paradoxical embolism from this thrombus, he underwent emergent embolectomy and about 25 cm sized linear thrombus entrapped PFO was successfully removed.
Aged ; Atrial Septum ; Colonic Neoplasms ; Dyspnea ; Echocardiography, Transesophageal ; Embolectomy ; Embolism, Paradoxical* ; Foramen Ovale, Patent* ; Heart Septal Defects, Atrial ; Humans ; Pulmonary Embolism ; Thorax ; Thrombosis ; Ventricular Pressure

Atrial Septum ; Heart Neoplasms ; Humans ; Osteosarcoma

Partial anomalous pulmonary vein connection (PAPVC) is a rare congenital abnormal cardiac defect involving the pulmonary veins draining into the right atrium (RA) directly or indirectly by venous connection. Ninety percent of PAPVCs are accompanied by atrial septal defect (ASD). To our knowledge, there is no previous report of PAPVC with ventricular septal defect (VSD) without ASD in Korea, and in this paper, we report the first such case. A 2-day-old girl was admitted into the Chonnam National University Hospital for evaluation of a cardiac murmur. An echocardiogram revealed perimembranous VSD without ASD. She underwent patch closure of the VSD at 5 months of age. Although the VSD was completely closed, she had persistent cardiomegaly with right ventricular volume overload, as revealed by echocardiography. Three years later, cardiac catheterization and chest computed tomography revealed a PAPVC, with the right upper pulmonary vein draining into the right SVC. Therefore, correction of the PAPVC was surgically performed at 3 years of age. We conclude that it is important to suspect PAPVC in patients with right ventricular volume overload, but without ASD.
Atrial Septum ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Child ; Echocardiography ; Heart Atria ; Heart Murmurs ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Korea ; Pulmonary Veins ; Thorax

BACKGROUND: Intracardiac pathology resulting in embloic phenomena is a well-recognized cause of cerebral ischemia and infarction. Recently, the use of transesophageal echocardiography(TEE) has gained wide acceptance because of its superior resolution of basal structures such as the left atrium, left atrial appendage, mitral valvular apparatus, atrial septum, and aorta. The purposes of this study are to evaluate the effectiveness of TEE for detection of intracardiac source of cerebral emboli. METHOD: From 1991 to 1995, 215 patients were included in this study. All patients underwent both transthoracic and transesophageal imaging with saline contrast administration and Doppler color flow imaging. The study group consisted of 132 men and 83 women with a mean age of 51 years(range 15-74). We also reviewed TEE result of all patients according to two groups, which were divided by the presence of clinical cardiac abnormalities. RESULT: 1) TEE identified a potential cardiac source of embolism in 43.7%(94 to 215) of the overall study group compared with only 3.7%(8 to 215) by TTE. 2) Success rate of TEE was 93.5%(201 to 215). 3) Abnormalities noted by TEE included 23 patients with LA spontaneous echo contrast, 20 patients with patient foramen ovale, 16 patients with aortic atheroma, 16 patients with LA thrombi, 8 patients with atrial septal aneurysm, 5 patients with aortic valve prolapse, 4 patients with mitral valve prolapse, and 2 patients with LV thrombi. 4) In the 62 patients with cardiac disease, TEE identified 16 patients with LA spontaneous echo contrast, 12 patients with LA thrombi, 2 patients with patent foramen ovale, 1 patient with aortic atheroma, 1 patient with atrial septal aneurysm and 1 patients with aortic valve prolapse. In the 152 patients with no cardiac disease, TEE identified 18 patients with patent foramen ovale, 15 patients with aortic atheroma, 7 patients with artial septal aneurysm, 7 patients with spontaneous echo contrast, 4 patients with aortic valve prolapse, 1 patient with mitral valve prolapse and 1 patient LA thrombi. CONCLUSION: TEE was very useful method in investigating potential intracardiac source of cerebral emboli. Thus, the use TEE combined with TTE in patients with unexplained stroke should be recommended.
Aneurysm ; Aorta ; Aortic Valve Prolapse ; Atrial Appendage ; Atrial Septum ; Brain Ischemia ; Echocardiography, Transesophageal ; Embolism ; Female ; Foramen Ovale ; Foramen Ovale, Patent ; Heart Atria ; Heart Diseases ; Humans ; Infarction ; Intracranial Embolism ; Male ; Methods ; Mitral Valve Prolapse ; Pathology ; Plaque, Atherosclerotic ; Stroke

BACKGROUND AND OBJECTIVES: Intracardiac pathology results in 15 - 20% of ischemic stroke, but transthoracic echocardiography (TTE) has a number of limitations because of suboptimal precordial windows or ultrasound interference with prosthetic materials. Transesophageal echocardiography (TEE) provides superior resolution of basal structures such as the left atrium, left atrial appendage, mitral valvular apparatus, atrial septum, and aorta. The purpose of this study was to describe the various TEE findings which were sources of cerebral emboli. MATERIALS AND METHOD: The study population was comprised of 122 patients (mean age:54.5, male 83, female 39) who were admitted to Severance Hospital because of ischemic stroke from 1991 to 1997. All patients underwent TEE with agitated saline contrast administration. Patients without a definitive cardiac source of embolism underwent Holtor monitoring, internal carotid and cerebral angiography, as well as transcranial Doppler. RESULTS: 1) The number of patients diagnosed as cardioembolic stroke was 55 (45.1%). Atrial fibrillation was noted in 31 patients of cardioembolic stroke and it was the most frequent finding. Among these patients, 16 did not have any other cardiac problem. 2) We were able to find the possible source of embolism in 49 (40.2%) patients with TEE. Among these patients, 12 did not have dysrhythmia or any known previous heart problem. We found spontaneous echo contrast in the left atrium and left atrial appendage in 33 cases. There were 8 patients who had intracardiac thrombus. Among these patients, 6 patients had thrombi in the left atrial appendage, 1 in left atrium and 1 in left ventricular apex. We found patent foramen ovale in 3 cases and atrial aneurysm in 1 case. We found atheromatous plaque and/or thrombi of the aorta in 16 cases, while there were 4 cases where lesions located in the ascending aorta and aortic arch and which were considered as the source of embolism. Small thrombi in the left atrial appendage and left atrium were only detectable with TEE. CONCLUSIONS: We described TEE findings in ischemic stroke patients. And we assert TEE is a useful diagnostic tool in detecting the source of cardioembolic stroke and it may be used as a primary diagnostic tool in patients who are being evaluated for ischemic stroke.
Aneurysm ; Aorta ; Aorta, Thoracic ; Atrial Appendage ; Atrial Fibrillation ; Atrial Septum ; Cerebral Angiography ; Dihydroergotamine ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Female ; Foramen Ovale, Patent ; Heart ; Heart Atria ; Humans ; Intracranial Embolism ; Male ; Pathology ; Stroke* ; Thrombosis ; Ultrasonography

BACKGROUND: Primary cardiac tumors are known to be rare. We studied the surgical results for primary cardiac tumors. MATERIAL AND METHOD: Between August 1980 and December 2003, we classified 86 patients who had operation for primary cardiac tumors in our center into 3 groups; myxoma, nonmyxoma benign tumors, and malignant tumors. The mean age was 44.3+/-20.8 years and 59 patients (66.3%) were female. In postoperative pathologic diagnosis, there were 81 cases (94.2%) of benign tumors in which myxoma was the most common tumor (70 cases, 78.7%); 5 fibroma (5.6%), 3 rhabdomyoma (3.4%), and 5 malignant tumors (5.8%). RESULT: 86.4% of benign tumor was myxoma and the mean age was 50.4+/-15.4 (range 7~80) years. Tumor was more common in females (49 cases) and most common preoperative symptom was dyspnea (62.9%). 57 cases were located at left atrial septum and only one case, which was located at right ventricular septum, was resected incompletely. There were no hospital deaths and one patient had mitral valve replacement on the first operative day due to newly developed postoperative mitral regurgitation. The mean follow up period was 109.3+/-71.8 months and there was no evidence of recurrence in this period. 11 cases (12.8%) were nonmyxoma benign tumors; 5 fibromas, 3 rhabdomyomas, etc. There were two hospital deaths and the causes of death were fungal endocarditis and hypoxia. There were no reoperations in nonmyxoma benign tumors. Malignant tumors were in 5 cases (5.8%); undifferentiated sarcoma in 2, rhabdomyosarcoma in 1, etc. Although there were no hospital mortalities, 3 patients who were followed up died from complications of tumors. CONCLUSION: Myxomas showed very excellent prognosis after complete resection and nonmyxoma benign tumors showed relatively good results for relief of symptoms. Surgery helped to relieve symptoms for malignant tumors, but the prognosis was poor.
Anoxia ; Atrial Septum ; Cause of Death ; Diagnosis ; Dyspnea ; Endocarditis ; Female ; Fibroma ; Follow-Up Studies ; Heart Neoplasms* ; Hospital Mortality ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Myxoma ; Prognosis ; Recurrence ; Rhabdomyoma ; Rhabdomyosarcoma ; Sarcoma ; Ventricular Septum

OBJECTIVETo observe the incidence of ventricular desynchronization in patients with or without pacemaker syndrome (PMS).

METHODSThe systolic peak velocity, the acceleration and the time to peak velocity of the interventricular septum (IVS), left ventricular (LV) and right ventricular (RV) lateral wall were detected by tissue Doppler imaging (TDI) in 14 atrial fibrillation patients without pacemaker implantation (control), 18 atrial fibrillation patients without PMS and 16 atrial fibrillation patients with PMS. All patients were free of valve disease, myocardial infarction, severe pulmonary hypertension, low left ventricular eject fraction (< or = 50%), significant segmental hypokinesis of ventricular wall or complete bundle branch block.

RESULTSCompared to the control patients, the systolic peak velocity and the accelerations on lateral walls of the LV and RV reduced significantly in patients with implanted pacemakers (P < 0.05). The intervals to peak velocity of the IVS and LV lateral walls were significantly prolonged [PMS group (80.13 +/- 26.92) ms vs. (25.60 +/- 4.30) ms, P < 0.01; without PMS group (76.22 +/- 23.32) ms vs. (25.60 +/- 4.30) ms, P < 0.01] and the intervals to peak velocity of the IVS and RV lateral walls significantly shortened [PMS group (16.33 +/- 6.85) ms vs. (40.70 +/- 7.60) ms, P < 0.01; without PMS group (21.20 +/- 7.34) ms vs. (40.70 +/- 7.60) ms, P < 0.01]. The systolic peak velocities, the accelerations of the IVS and bilateral walls and the intervals to peak velocity of the IVS and LV lateral wall were similar in patients with and without PMS (P > 0.05), however, the intervals to peak velocity of the IVS and RV lateral wall was significant shorter in patients with PMS compared to that of patients without PMS [(16.33 +/- 6.85) ms vs. (21.20 +/- 7.34) ms, P < 0.01].

CONCLUSIONRV desynchronization but not LV desynchronization might play an important role in patients with PMS.

Adult ; Aged ; Aged, 80 and over ; Atrial Fibrillation ; therapy ; Cardiac Pacing, Artificial ; adverse effects ; Echocardiography, Doppler, Pulsed ; Female ; Heart Ventricles ; diagnostic imaging ; physiopathology ; Humans ; Male ; Middle Aged ; Ventricular Septum

BACKGROUND: Ebstein anomaly is a rare congenital disease distinguished by its unique deformity in tricuspid valve and right ventricle & atrium. In its surgical treatment , tricuspid valve reconstruction and valve replacement are well known method, but various surgical methods were suggested. MATERIAL AND METHOD: From January 1984 to December 1995, 8 patients with Ebstein anomaly underwent surgical correction. Age and sex distribution, clinical symtoms, radiologic findings, preoperative studies, operative findings, operative methods and its results were analyzed. RESULT: The sex ratio was 5 to 3(male : female). Patients' ages were averaged 17.6(2-28) years. In all cases, it showed typical deformities of the tricuspid valve. Associated anomalies were permenant foramen ovale, atrial septum defect, pulmonary stenosis. Surgical procedures included tricuspid valve replacement(n=4) and tricuspid valve reconstuction(n=4). Two cases of sinus tachycardia and complete AV block occured postoperatively. There were two hospital death and no late death. All survivors are in NYHA class I or II with median follow up of 64.8 months. 2-D echocardiogram disclosed improvement tricuspid regurgitation during the follow up period. CONCLUSION: Even though operative method of Ebstein anomaly should be decided according to each anatomical characteristics, we recommended that tricuspid valvuloplasty and plication can be one of the good methods method in the selective cases.
Atrial Septum ; Atrioventricular Block ; Congenital Abnormalities ; Ebstein Anomaly* ; Follow-Up Studies ; Foramen Ovale ; Heart Ventricles ; Humans ; Pulmonary Valve Stenosis ; Sex Distribution ; Sex Ratio ; Survivors ; Tachycardia, Sinus ; Tricuspid Valve ; Tricuspid Valve Insufficiency

A right atrial thrombus in structurally normal heart is very rare. A 66-year-old woman was admitted with chest discomfort and dyspnea. She was diagnosed of right atrial myxoma on echocardiography and chest computed tomography. We performed an excision of the mass attached to atrial septum, which was found to be an organized mural thrombus by pathologic examination. We report this rare case with a review of literature.
Aged ; Atrial Septum ; Dyspnea ; Echocardiography ; Female ; Heart ; Heart Atria ; Humans ; Myxoma* ; Thorax ; Thrombosis*

A 70-year-old man with aphasia due to ischemic cerebral events by thromboemboli was admitted. The cause of thromboemboli was investigated, and transesophageal echocardiography and chest MRI revealed an encapsulated cystic mass in the right atrium, not circulating. It was a homogeneous cystic mass suggesting a tumor (Myxoma) rather than thrombus. Right atrial mass was resected together with partial atrial septum under the normothermic cardiopulmonary bypass. Histologically it was an atrial septal aneurysm, closed on itself, filled with blood. We report this rarely seen case with a review of the literatures.
Aged ; Aneurysm* ; Aphasia ; Atrial Septum ; Cardiopulmonary Bypass ; Echocardiography, Transesophageal ; Heart Atria ; Heart Neoplasms ; Heart Septum ; Humans ; Magnetic Resonance Imaging ; Thorax ; Thrombosis