In spite of advanced diagnostic teclmology and better antimicrpbial therapy, infective endocarditis is relatively common, life-threatening infection. Heart failure and systemic embolism are the common and serious complications associated with the infective endocarditis. Because embolic event caR result in irreversible organ dysfunction or death, prevention is a desirable goal. Identification of pltients who are in the high risk of embolism and who can be helped by early surgical intervenCion is very important. Echocardiography has been generally accepted as the technique of choice for noninvasive diagnosis of infective endocarditis because of its potential for direct visualization of endocarditis-induced lesions. We experienced a case of an aortic embolism and systemic embolism in infective endocarditis in 21 year old male patient. He adrnitted for abdominal pain and dark colored urine for 30 days. Diagnosis of infective endocarditiis was made by clinical manifestation and echocardiography. Abdominal CT showing a low density areas in the spleen and the right kidney suggestive of a splenic infarction and a renal infarction. Aortography revealed dilatation of the bifurcation site of the aorta into common iliac artery and nonvisualization of left common iliac artery. Aortoiliac bypass surgery and splenectomy were done. After antibiotics and anticoagulation therapy, the patient was discharged relatively good condition.
Abdominal Pain ; Anti-Bacterial Agents ; Aorta ; Aortography ; Diagnosis ; Dilatation ; Echocardiography ; Embolism* ; Endocarditis* ; Heart Failure ; Humans ; Iliac Artery ; Infarction ; Kidney ; Male ; Spleen ; Splenectomy ; Splenic Infarction ; Tomography, X-Ray Computed ; Young Adult

In the past 60 years the maternal mortality rate has declined rnarkedly. Nevertheless, death associated with childbirth is still a major public health problem. For women delivered of live infants, the leading causes of mortality are acute pulmonary embolism(mostly thromboembolic), pregnancy-induced hypertension, hemorrhage, and infection. Currently, the common cause of maternal rnortality are pulmonary embolisrn. Though acute pulmonary embolism is a potentially fatal disorder, when properly diagnosed and treated, clinically apparent pulmonary embolism was an uncommon cause of death. However, the diagnosis of acute pulmonary embolism is still a challenge for clinicians because of its nonspecific and variable clinical features. Pulmonary angiography, admittedly the 'gold standard' technique for this diagnosis, is costly, invasive, and not universally available. Noninvasive procedures such as lung scan has certainly simplified the diagnostic approach. However, lung scan is diagnostic in only 30 to 50% of patients, and many institutions lack nuclear medicine facilities. Thus, alternative imaging techniques are needed for the noninvasive diagnosis of pulmonary embolism. Echocradiography is rapid, practical and sensitive technique for the identification of right ventricular overload following acute pulmonary embolism. Echocardiographic identification of patients with right ventricular dysfunction is important because aggressive intervention with thrombolytics, certain inotropic and vasoactive agents, or embolectomy may improve outcome. We report herein two cases of acute pulmonary embolism after cesarean section. Certain clinical findings, hemodynamic values, and particularly, echocardiographic signs can indentify right ventricular dysfunction after pulmonary embolisrn. The patients was immediately treated mth intravenous heparin and inotropic support, which induced a rapid improvement of the clinical and hemodynamic parameters.
Angiography ; Cause of Death ; Cesarean Section* ; Diagnosis ; Echocardiography* ; Embolectomy ; Female ; Hemodynamics ; Hemorrhage ; Heparin ; Humans ; Hypertension, Pregnancy-Induced ; Infant ; Lung ; Maternal Mortality ; Mortality ; Nuclear Medicine ; Parturition ; Pregnancy ; Public Health ; Pulmonary Embolism* ; Ventricular Dysfunction, Right

Carcinoid tumors have been described in almost every organ and may affect virtually every body system. Cardiac involvement manifesting as right-sided valvular disease is characteristic of the carcinoid heart disease. Myocardial metastasis is an unusual manifestation of carcinoid heart disease and it was manifested as a mass lesion in the previous reports. We observed a myocardial metastasis of carcinoid tumor manifesting as diffusely infiltrative pattern.
Carcinoid Heart Disease* ; Carcinoid Tumor* ; Neoplasm Metastasis

Left ventricular pseudoaneurysm, in which a ventricular free wall rupture is locally contained by adherent pericardium, is a rare complication of myocardial infarction. Compared w'th a true left ventricular aneunsm, a pseudoaneurysm has a greater propensity to sudden rupture, with catastrophic sequelae. Pseudoaneurysm may be surgically curable, a prompt and accurate diagnosis is thus essential. Transthoracic echocardiography has been the procedure of choice in the diagnosis of pseu- doaneurysm. Transesophageal echocardiography can provide more accurate information than transthoracic echocardiography for the evaluation of ventricular pseudoaneurysm located in posterior and inferior wall. We experienced a case of pseudoaneurysm of left ventricle in a 75-year-old female who presented with dyspnea. A large pseudoaneurysm of left ventricle vith narrow neck was de- tected by transesophageal echocardiography.
Aged ; Aneurysm, False* ; Diagnosis ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart Rupture ; Heart Ventricles ; Humans ; Myocardial Infarction ; Neck ; Pericardium ; Rupture

Ebsteins anomaly is characterized by a downward displacement of the tricuspid valve into the right ventricle. Its anatomical abnormality is displacement of septal and posterior leaflets of tricuspid valve from atrioventricular ring into the body of right ventricle and therefore a portion of right ventricle is atrialized. The primary hemodynamic anomaly producing symptoms in Ebsteins malformation is tricuspid regurgitation. Its natural history and clinical features depend on the drgree of displacement of tricuspid leaflets from atrioventricular ring. Although most patients with Ebsteins anomaly are diagnosed in early children, some patients with a mildly deformed tricuspid valve may remain asympto- matic well into adulthood. Most common complaints adult-onset disease are exertional dyspnea, fatigue, palpitation and cyanosis. In rnost cases the physical exarnination, electrocardiogram, and roentgenogram are sufficiently to allow the diagnosis. But, recently echocardiography has played an important role in the recognition of Ebsteins anomaly because two-dimensional echocardiography provides direct visualization of the abnormally displaced tricuspid valve apparatus. So echocardiography has replaced angiography as the procedure of choice for diagnostic and morphologic assessrnent of patients with Ebsteins anomaly. We experienced a 67-year-old female patient with Ebstein's anomaly that was definitely diagnosed by two-dimentional echocardiography. We report this case with literature review.
Aged ; Angiography ; Child ; Cyanosis ; Diagnosis ; Dyspnea ; Ebstein Anomaly* ; Echocardiography ; Electrocardiography ; Fatigue ; Female ; Foramen Ovale, Patent* ; Heart Ventricles ; Hemodynamics ; Humans ; Natural History ; Tricuspid Valve ; Tricuspid Valve Insufficiency

BACKGROUND: Plaque rupture of the atherosclerotic plaque is an important pathophysiologic mechanism of acute coronary syndrorne(acute myocardial infarction or unstable angina). Plaque rupture and resulting thrombus formation could be identified by intravascular ultrasound (IVUS), even though the sensitivity was variable in previous reports. We sought to know the morphologic characteristics, incidence of plaque rupture and thrombus formation by ultrasound in patients with acute coronary syndrome. METHOD: Between April and Septernber 1997, 23 admitted patients who was diagnosed as unstable angina or acute rnyocardial infarction was included. We performed coronary angiography with IVUS examination within 2 weeks. Atherosclerotic plaque was classified into soft, fibrous, calcific, and mixed plaque, and plaque rupture was defined as rupture of fibrous cap with discontinuity and / or backflow into plaque. Thrombus was defined as a scintillating, movable mass or layering materials that could be distinguished from underlying plaque. RESULTS: Most of the plaques were soft and mixed types(14 and 6, out of 23 cases). Plaque rupture could be identified only in small portion(6 cases, 26%) of the cases. Thrombus was noted in 12 cases(52%). 4 cases showed both plaque rupture and thrombus. CONCLUSION: Soft plaque is the most frequent plaque pye in acute coronary syndrome. IVUS is a useful tool to identify the morphologic features of the plaque such as rupture and thrombus formation.
Acute Coronary Syndrome* ; Angina, Unstable ; Coronary Angiography ; Humans ; Incidence ; Infarction ; Myocardial Infarction ; Plaque, Atherosclerotic ; Rupture ; Thrombosis ; Ultrasonography*

Mixed Connective Tissue Disease(MCTD) is an overlap syndrome characterized by a combination of clinical features similar to those of systemic lupus erythematosus(SLE), scleroderma, polymyositis, and rheumatoid arthritis and unusually high titers of circulating antibody to a nuclear ribonucleoprotein antigen. The mean age of presentation is 37 years and 80% of patients are female. Cardiac involvement is less common in adults but may be more frequent in children. Pericarditis is the most common finding,' other findings include mitral valve prolapse, myocarditis and congestive heart failure. We experienced a case of pericarditis and asymmetric LV hypertrophy in a 33-yr-old postpartum woman with mixed connective tissue disease, who admitted to our hospital because of fever, dyspnea and chest discomfort, which was diagnosed by echocardiography and selorogic study. She was treated with oral prednisolone and aspirin and presented symptoms improved and pericardial effusion was disappeared.
Adult ; Arthritis, Rheumatoid ; Aspirin ; Child ; Connective Tissue ; Dyspnea ; Echocardiography ; Female ; Fever ; Heart Failure ; Humans ; Hypertrophy ; Mitral Valve Prolapse ; Mixed Connective Tissue Disease* ; Myocarditis ; Pericardial Effusion ; Pericarditis ; Polymyositis ; Postpartum Period* ; Prednisolone ; Ribonucleoproteins ; Thorax

Myxomas are the most common primary benign cardiac tumor. In general, myxoma has a benign growth and chronic entity, so symtoms of myxoma are vague and mild. Therefore the association of an atrial myxoma with acute pulmonary edema and syncope appears to be very rare. Even though very rare, detection of myxoma is important because it is usually fatal in several cases if unrecognized and untreated. We experienced a case of left atrial (LA) myxoma presenting as acute pulmonary edema and syncope of unknown cause in 47 years old female patient. A mass located on left atrium was excised en bloc, and the patient recovered uneventfully. We report the case along with literature review.
Female ; Heart Atria ; Heart Neoplasms ; Humans ; Middle Aged ; Myxoma* ; Pulmonary Edema* ; Syncope

Systemic amyloidosis is an uncommon disease characterized by deposits of fibrillar aggregates of monoclonal immunoglobuloin light chains in vital organs. This amyloid deposit cause cardiac or renal dysfunction and ultimately, death. Cardiac amyloidosis may be asymptomatic or important causes of progressive heart failure and refractory arrhythmia. Cardiac involvement from AL amyloidosis is rapidly fatal. The amyloidoses are classified according to the biochemical nature of the fibril-forming protein. Cardiac amyloidosis is common in primary (AL) and heterofamilial amyloidosis and very rare in the secondary (AA) form. As we experienced a case of systemic amyloidosis affected heart, liver and kidney, which was confirmed by histology. We present a 57-year-old female case with literature review.
Amyloidosis* ; Arrhythmias, Cardiac ; Female ; Heart ; Heart Failure ; Humans ; Kidney ; Liver ; Middle Aged ; Plaque, Amyloid

BACKGROUND: Adriamycin (doxorubicin) is one of the widely used drugs in the treatment of a variety of solid and hematologic malignancies. However, the adriamycin-induced cardiomyopathy limits the prolonged use of this effective drug. Transthoracic echocardiography is the excellent tool in early detection and follow-up studies of adriamycin-induced cardiomyopathy. The aim of this study was to assess the cardiac function and morphology using a 15 MHz high-frequency imaging in rats. METHODS: Adriamycin was administrated intraperitoneally by six equal injections at a dose of 2.5 mg/kg over a period of 2 weeks for total cumulative dose of 15 mg/kg body weight in 12 male Sprague-Dawley rats (weight 367+/-39 g). Transthoracic echocardiography with a 15 MHz linear-array transducer was performed at baseline and additionally at 3 weeks to measure the left ventricular wall thickness and dimension from the parasternal short axis view with 2D guided M-mode and pulsed Doppler signals of mitral inflow. Within 2 days of echocardiography, the heart was harvested for electron microscopic evaluation after potassium-induced cardiac arrest. RESULTS: 1) The mortality rate during the experimental period was 0%. 2) Transthoracic echocardiography provided adequate 2D guided M-mode images and pulsed Doppler signals of mitral inflow in all rats. 3) In follow-up echocardiography, pericardial effusion was detected in 7out of 12 rats (58%). 4) Compared to baseline, end-diastolic dimensions were increased from 7.01+/-0.69 to 7.74+/-1.25 mm (p<0.001), end-systolic dimensions were increased from 4.13+/-0.69 to 5.22+/-1.12 mm (p<0.05), and interventricular septal and posterior wall thickness at end-systole and end-diastole were significantly decreased (p<0.05, respectively). 5) Fractional shortening was decreased from 43.0+/-6.8 to 32.7+/-8.0%, compared to baseline (p<0.05). 6) E/A ratio of mitral inflow changed significantly from 1.63+/-0.36 to 2.78+/-1.0, compared to baseline (p<0.05). CONCLUSION: Adriamycin administration at total cumulative dose of 15 mg/kg body weight over 2 weeks creates a reliable model of non-ischemic dilated cardiomyopathy in rats with a high success rate. Transthoracic echocardiography using a 15 MHz transducer provides adequate images for assessing the cardiac function and morphology in follow-up studies in adriamycin-induced cardiomyopathy of rats. These results suggest that transthoracic echocardiography using a 15 MHz Transducer is a promising tool for an assessment of adriamycin-induced cardiomyopathy in small animals.
Animals ; Axis, Cervical Vertebra ; Body Weight ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Doxorubicin ; Echocardiography* ; Follow-Up Studies ; Heart ; Heart Arrest ; Hematologic Neoplasms ; Humans ; Male ; Mortality ; Pericardial Effusion ; Rats* ; Rats, Sprague-Dawley ; Transducers*