2.Paradoxical Heart Failure Precipitated by Profound Dehydration: Intraventricular Dynamic Obstruction and Significant Mitral Regurgitation in a Volume-Depleted Heart.
Dongmin KIM ; Jeong Beom MUN ; Eun Young KIM ; Jeonggeun MOON
Yonsei Medical Journal 2013;54(4):1058-1061
Occurrence of dynamic left ventricular outflow tract (LVOT) obstruction is not infrequent in critically ill patients, and it is associated with potential danger. Here, we report a case of transient heart failure with hemodynamic deterioration paradoxically induced by extreme dehydration. This article describes clinical features of the patient and echocardiographic findings of dynamic LVOT obstruction and significant mitral regurgitation caused by systolic anterior motion of the mitral valve in a volume-depleted heart.
Cardiac Volume
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Dehydration/*complications
;
Echocardiography/methods
;
Female
;
Heart Failure/*etiology/therapy
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Humans
;
Middle Aged
;
Mitral Valve Insufficiency/complications/*etiology
;
Pulmonary Edema/etiology
;
Ventricular Outflow Obstruction/*complications/etiology
3.The Unusual Suspect: Anemia-induced Systolic Anterior Motion of the Mitral Valve and Intraventricular Dynamic Obstruction in a Hyperdynamic Heart as Unexpected Causes of Exertional Dyspnea after Cardiac Surgery.
Jeong Beom MUN ; Ah Reum OH ; Hwa Sun PARK ; Chul Hyun PARK ; Kook Yang PARK ; Jeonggeun MOON
The Korean Journal of Thoracic and Cardiovascular Surgery 2013;46(6):457-460
Dynamic left ventricular (LV) outflow tract obstruction is a characteristic feature of hypertrophic cardiomyopathy; however, it can also occur in association with hyperdynamic LV contraction and/or changes in the cardiac loading condition, even in a structurally normal or near-normal heart. Here, we report a case of anemia-induced systolic anterior motion of the mitral valve and the resultant intraventricular obstruction in a patient who underwent coronary artery bypass grafting and suffered from anemia associated with recurrent gastrointestinal bleeding.
Anemia
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Cardiomyopathy, Hypertrophic
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Coronary Artery Bypass
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Dyspnea*
;
Echocardiography
;
Heart*
;
Hemorrhage
;
Humans
;
Mitral Valve*
;
Thoracic Surgery*
4.Fatal Renal Bleeding in a Patient Treated With Aggressive Antithrombotic Therapy After Recurrent Coronary Stent Thrombosis.
Jeonggeun MOON ; Sang Hak LEE ; Woo In YANG ; Young Guk KO ; Woong Kyu HAN ; Yangsoo JANG
Korean Circulation Journal 2010;40(7):348-351
Triple antiplatelet therapy has been known to be superior to the conventional dual regimen for preventing stent thrombosis after coronary stenting, and the addition of oral anticoagulation to antiplatelet therapy is also considered an option. However, the risks and benefits of a triple antiplatelet regimen plus additional oral anticoagulation must be taken into account. Here, we report a case of fatal renal bleeding in a patient treated with triple antiplatelet plus oral anticoagulant therapy for the prevention of recurrent stent thrombosis.
Coronary Thrombosis
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Drug Combinations
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Drug-Eluting Stents
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Hemorrhage
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Humans
;
Risk Assessment
;
Stents
;
Thrombosis
5.Feasibility and Applicability of Wireless Handheld Ultrasound Measurement of Carotid Intima-Media Thickness in Patients with Cardiac Symptoms
Albert Youngwoo JANG ; Jeongwon RYU ; Pyung Chun OH ; Jeonggeun MOON ; Wook Jin CHUNG
Yonsei Medical Journal 2020;61(2):129-136
0.9 between all observers). Receiver operating characteristic curve analysis showed that the predictive power for CAD was improved when max-CIMT and plaque information (plaque≥2) was added [area under the curve (AUC): 0.838] to the traditional clinical CV risk factors (AUC: 0.769). The cutoff values for CAD prediction with the standard device and the WHUS device were 1.05 mm (AUC: 0.807, sensitivity: 0.78, specificity: 0.53) and 1.10 mm (AUC: 0.725, sensitivity: 0.98, specificity: 0.27), respectively.CONCLUSION: max-CIMT measured by a WHUS device showed excellent agreement and repeatability, compared with standard ultrasound. Combined max-CIMT and plaque information added predictive power to the traditional clinical CV risk factors in detecting high-risk CAD patients.]]>
Carotid Artery, Common
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Carotid Intima-Media Thickness
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Coronary Angiography
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Coronary Artery Disease
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Humans
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Mass Screening
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Risk Factors
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ROC Curve
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Sensitivity and Specificity
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Ultrasonography
;
Wireless Technology
6.Prognostic Implications of Right and Left Atrial Enlargement after Radiofrequency Catheter Ablation in Patients with Nonvalvular Atrial Fibrillation.
Jeonggeun MOON ; Hye Jeong LEE ; Jong Youn KIM ; Hui Nam PAK ; Moon Hyoung LEE ; Young Jin KIM ; Boyoung JOUNG
Korean Circulation Journal 2015;45(4):301-309
BACKGROUND AND OBJECTIVES: The prognostic role of the right atrium (RA) compared with that of the left atrium (LA) is unclear in patients with atrial fibrillation (AF). We assessed structural changes in both atria and determined their association with recurrence of AF after radiofrequency catheter ablation (RFCA). SUBJECTS AND METHODS: All 111 patients with nonvalvular AF (87 men; mean age, 57+/-11 years; 68 with paroxysmal AF) who underwent RFCA were enrolled consecutively. Three-dimensional volumes of both atria measured from computed tomography images were compared between subjects with and without recurrence of AF during the follow-up. RESULTS: Early (<3 months), 6-month, and 1-year recurrence was documented in 26 (24%), 30 (27%), and 36 (32%) patients, respectively. Significantly larger RA and LA volume indices (RAVI and LAVI) were observed in the early, 6-month, and 1-year recurrence groups (p<0.05 for all). In multivariate analysis, Early recurrence was independently associated with RAVI (for each 10 mL/m2 increase; odds ratio [OR], 1.31; 95% confidence interval [CI], 1.03-1.66, p= 0.03), but not with LAVI. However, both RAVI and LAVI failed to predict 6-month outcomes independently. LAVI was the only independent predictor of 1-year recurrence (for each 10 mL/m2 increase; OR, 1.36; 95% CI, 1.08-1.71, p=0.009). CONCLUSION: RA enlargement was more closely related to early recurrence of AF after RFCA than LA size. However, LA size, rather than RA volume, was a determinant of long-term AF prognosis after RFCA. These findings suggest a temporal pattern in the prognostic implication of enlargement in each atrium that switches over time after RFCA for AF.
Atrial Fibrillation*
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Catheter Ablation*
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Follow-Up Studies
;
Heart Atria
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Humans
;
Male
;
Multivariate Analysis
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Odds Ratio
;
Prognosis
;
Recurrence
7.Unusual Diaphragmatic Hernias Mimicking Cardiac Masses.
Si Hun KIM ; Myoung Gun KIM ; Su Ji KIM ; Jeonggeun MOON ; Woong Chol KANG ; Mi Seung SHIN ; Wook Jin CHUNG
Journal of Cardiovascular Ultrasound 2015;23(2):107-112
Hiatal hernia and Morgagni hernia are sorts of diaphragmatic hernias that are rarely detected on transthoracic echocardiography. Although echocardiographic findings have an important role for differential diagnosis of cardiac masses, we often might overlook diaphragmatic hernia. We report three cases of diaphragmatic hernias having specific features. The first case is huge hiatal hernia that encroaches left atrium with internal swirling flow on transthoracic echocardiography. The second case is a hiatal hernia that encroaches on both atria, incidentally detected on preoperative echocardiography. The third case is Morgagni hernia which encroaches on the right atrium only. So, we need to consider possibility of diaphragmatic hernia when we find a cardiac mass with specific echocardiographic features.
Diagnosis, Differential
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Echocardiography
;
Heart Atria
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Hernia
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Hernia, Diaphragmatic*
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Hernia, Hiatal
8.Transient Right Ventricular Dysfunction After Pericardiectomy in Patients With Constrictive Pericarditis.
Hee Tae YU ; Jong Won HA ; Sak LEE ; Chi Young SHIM ; Jeonggeun MOON ; In Jeong CHO ; Min Kyung KANG ; Woo In YANG ; Donghoon CHOI ; Namsik CHUNG
Korean Circulation Journal 2011;41(5):283-286
Pericardiectomy is the standard treatment in patients with chronic constrictive pericarditis who have persistent symptoms. However, myocardial atrophy with prolonged pericardial constriction and abrupt increase in venous return can lead to heart failure with volume overload after pericardial decompression, especially in the right ventricle (RV). We experienced a 44 year old male patient who developed transient RV failure after pericardiectomy for constrictive pericarditis. Echocardiography revealed a markedly dilated RV with decreased peak systolic velocity of the tricuspid annulus, suggesting severe RV dysfunction. After treatment with inotropics and diuretics, a follow-up echocardiography revealed an improved systolic function with decreased RV chamber size. This case demonstrates the importance of volume overload and RV dysfunction in patients with constrictive pericarditis undergoing pericardiectomy.
Atrophy
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Constriction
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Decompression
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Diuretics
;
Echocardiography
;
Follow-Up Studies
;
Heart Failure
;
Heart Ventricles
;
Humans
;
Male
;
Pericardiectomy
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Pericarditis, Constrictive
;
Ventricular Dysfunction, Right
9.Newly Developed Aortic Dissection After Aorta Cannulation During Mitral Valve Surgery in a Patient With Marfan Syndrome.
Jeonggeun MOON ; Mi Seung SHIN ; Hun Jin LEE ; Wook Jin CHUNG ; Chul Hyun PARK ; Kook Yang PARK
Korean Circulation Journal 2012;42(6):437-440
We report a case of newly developed aortic dissection after aorta cannulation during mitral valve surgery in a patient with Marfan syndrome. An unexpected fatal complication of cardiac surgery detected on postoperative imaging survey in Marfan syndrome patient and its surgical finding are described.
Aorta
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Catheterization
;
Echocardiography
;
Humans
;
Marfan Syndrome
;
Mitral Valve
;
Thoracic Surgery
10.The Impact of Diabetes Mellitus on Vascular Biomarkers in Patients with End-Stage Renal Disease.
Jeonggeun MOON ; Chan Joo LEE ; Sang Hak LEE ; Seok Min KANG ; Donghoon CHOI ; Tae Hyun YOO ; Sungha PARK
Yonsei Medical Journal 2017;58(1):75-81
PURPOSE: Diabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD) and an important risk factor for cardiovascular (CV) disease. We investigated the impact of DM on subclinical CV damage by comprehensive screening protocol in ESRD patients. MATERIALS AND METHODS: Echocardiography, coronary computed tomography angiogram, 24-h ambulatory blood pressure monitoring, and central blood pressure with pulse wave velocity (PWV) were performed in 91 ESRD patients from the Cardiovascular and Metabolic disease Etiology Research Center-HIgh risk cohort. RESULTS: The DM group (n=38) had higher systolic blood pressure than the non-DM group (n=53), however, other clinical CV risk factors were not different between two groups. Central aortic systolic pressure (148.7±29.8 mm Hg vs. 133.7±27.0 mm Hg, p= 0.014), PWV (12.1±2.7 m/s vs. 9.4±2.1 m/s, p<0.001), and early mitral inflow to early mitral annulus velocity (16.7±6.4 vs. 13.7±5.9, p=0.026) were higher in the DM group. Although the prevalence of coronary artery disease (CAD) was not different between the DM and the non-DM group (95% vs. 84.4%, p=0.471), the severity of CAD was higher in the DM group (p=0.01). In multivariate regression analysis, DM was an independent determinant for central systolic pressure (p=0.011), PWV (p<0.001) and the prevalence of CAD (p=0.046). CONCLUSION: Diabetic ESRD patients have higher central systolic pressure and more advanced arteriosclerosis than the non-DM control group. These findings suggest that screening for subclinical CV damage may be helpful for diabetic ESRD patients.
Aged
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Aorta
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Biomarkers
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Blood Pressure/physiology
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Blood Pressure Monitoring, Ambulatory
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Coronary Artery Disease/diagnostic imaging/*physiopathology
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Diabetes Mellitus/*physiopathology
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Diabetic Nephropathies/physiopathology
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Echocardiography
;
Female
;
Humans
;
Kidney Failure, Chronic/*physiopathology
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Male
;
Middle Aged
;
Pulse Wave Analysis
;
Regression Analysis
;
Risk Factors
;
Systole/physiology