No abstract available.
Anesthesia* ; Takotsubo Cardiomyopathy*

We present a case of successful surgical resection of a giant left ventricular (LV) pseudoaneurysm that developed 5 yr after mitral valve replacement (MVR). A 59-yr-old female was admitted with exertional chest pain radiating to left arm and back. 64-slice multidetector computed tomography (MDCT) revealed significant stenosis on the ostium of the first diagonal branch of the left anterior descending coronary artery and also a huge pseudoaneurysm compressing the right atrium and the inferior vena cava. She underwent resection of the pseudoaneurysm, and the pseudoaneurysm tunnel was repaired from the inside of LV cavity by removing the previously inserted prosthetic valve, followed by redo MVR together with coronary arterial bypass grafting (CABG) for a single-vessel disease. At the 6-month follow-up, the patient continued to do well without any complications.
*Aneurysm, False/etiology/pathology/surgery ; Female ; *Heart Aneurysm/etiology/pathology/surgery ; Heart Valve Prosthesis Implantation/*adverse effects ; Heart Ventricles/pathology/*surgery ; Humans ; Middle Aged ; Mitral Valve/*surgery ; Postoperative Complications/*surgery ; Treatment Outcome

Klippel-Trenaunay syndrome is a rare congenital mesodermal abnormality characterized by varicose veins, cutaneous hemangiomas, soft tissue and bony hypertrophy of limb. Potential complications such as deep venous thrombosis and pulmonary thromboembolism have not been reported in Korea to date. We demonstrate the case of a 48-year-old woman with Klippel-Trenaunay syndrome with extensive varicose veins on right lower limb, hypertrophy of left big toe and basilar artery tip aneurysm, complicated with acute submassive pulmonary thromboembolism treated successfully with intravenous thrombolytic therapy.
Aneurysm ; Basilar Artery ; Extremities ; Female ; Heart Failure ; Hemangioma ; Humans ; Hypertrophy ; Intracranial Aneurysm ; Klippel-Trenaunay-Weber Syndrome* ; Korea ; Lower Extremity ; Mesoderm ; Middle Aged ; Pulmonary Embolism* ; Thrombolytic Therapy* ; Toes ; Varicose Veins ; Venous Thromboembolism ; Venous Thrombosis

Takotsubo cardiomyopathy (TC) is a transient form of acute heart failure that most often occurs in postmenopausal women, typically triggered by a preceding emotional or physical stressor. A 74-year-old woman who suffered from chronic psychiatric stress visited National Medical Center for dyspnea. Acute emotional or physical stress could not be identified despite careful history taking. An electrocardiogram showed diffuse T-wave inversions with prolonged QT interval, and the echocardiogram showed akinesia of mid and apical segments of the left ventricle with hyperkinesia at the base. There was no significant stenosis on coronary angiography. Differing from the typical case of TC, which follows acute stress triggers, our case indicates that underlying chronic psychiatric illness exacerbation can lead to TC. We suggest that cardiologists and psychiatrists be aware of this predisposition to TC, especially in the circumstances of acute heart failure.
Aged* ; Cardiomyopathies ; Constriction, Pathologic ; Coronary Angiography ; Depressive Disorder, Major* ; Dyspnea ; Electrocardiography ; Female ; Heart Failure ; Heart Ventricles ; Humans ; Hyperkinesis ; Psychiatry ; Takotsubo Cardiomyopathy*

Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy, is caused by emotional or physical stressors and mimics acute myocardial infarction. Stress-induced cardiomyopathy is characterized by acute, reversible left ventricular apical ballooning without significant coronary artery stenosis. New variants of stress-induced cardiomyo pathy with localized wall motion abnormalities or an inverted pattern with a hyperdynamic apex have been reported. We present a rare case of a sudden cardiac arrest due to atypical stress-induced cardiomyopathy (mucosal packing and the injection of epinephrine) in an elderly male patient during elective endoscopic sinus surgery with septoplasty under local anesthesia. In this case, only the basal and midportions of the left ventricle were affected, whereas the apex was completely spared. The patient rapidly and completely recovered without sequelae.
Aged* ; Anesthesia, Local ; Cardiomyopathies* ; Coronary Stenosis ; Death, Sudden, Cardiac ; Epinephrine ; Heart Ventricles ; Humans ; Male* ; Myocardial Infarction ; Takotsubo Cardiomyopathy

We report a case of partial anomalous pulmonary venous return where the right upper and lower pulmonary veins drain into the coronary sinus with right-to-left shunt via patent foramen ovale. To our knowledge, this is the uncommon case where the interatrial septum is intact. The diagnosis was initially made by transthoracic echocardiography and transesophageal echocardiography with the infusion of agitated saline and confirmed by pulmonary artery angiography. Curative operation could not be performed because of the irreversible pulmonary hypertension.
Angiography ; Atrial Septum* ; Coronary Sinus* ; Diagnosis ; Dihydroergotamine ; Echocardiography ; Echocardiography, Transesophageal ; Foramen Ovale, Patent ; Hypertension, Pulmonary ; Pulmonary Artery ; Pulmonary Veins ; Scimitar Syndrome*

This paper presents a case of cardiac tamponade with idiopathic hemorrhagic pericarditis as the initial symptom of human immunodeficiency virus (HIV) infection. A 29-year-old male came to the emergency room with a sudden onset of dizziness. Upon arrival, he was hypotensive although not tachycardic, and his jugular venous pressure was not elevated. His chest X-rays revealed a mild cardiomegaly. Transthoracic echocardiography revealed a large amount of pericardial effusion with a diastolic collapse of the right ventricle, a dilated inferior vena cava with little change in respiration, and exaggerated respiratory variation of mitral inflow velocities, representing echocardiographic evidence of cardiac tamponade. After pericardiocentesis, his blood pressure improved to 110/70 mmHg without inotropics support. Serial 12-lead electrocardiograms during hospitalization revealed upwardly concave diffuse ST-segment elevation followed by a T-wave inversion suggestive of acute pericarditis. Pericardial fluid cytology and cultures for bacteria, mycobacteria, adenovirus, and fungus were all negative. HIV enzyme-linked immunosorbent assay (ELISA) was positive and confirmed by Western blot. The CD4 cell count was 168/mm3. Finally, the diagnosis of cardiac tamponade due to HIV-associated hemorrhagic pericarditis was made. It was concluded that HIV infection should be considered in the diagnosis of unexplained pericardial effusion or cardiac tamponade in Korea.
Acquired Immunodeficiency Syndrome/*diagnosis/*pathology ; Acute Disease ; Adult ; Cardiac Tamponade/*complications/*diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Male ; Pericarditis/*complications/*diagnosis

Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.
Aged, 80 and over ; Angina Pectoris/chemically induced ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*adverse effects ; Calcium Channel Blockers/administration & dosage ; Colonic Neoplasms/*drug therapy ; Coronary Angiography ; Coronary Vasospasm/*chemically induced/diagnosis/therapy ; Drug-Eluting Stents ; Electrocardiography ; Fluorouracil/administration & dosage/*adverse effects ; Humans ; Leucovorin/administration & dosage/adverse effects ; Male ; Nifedipine/administration & dosage ; Nitroglycerin/administration & dosage ; Organoplatinum Compounds/administration & dosage/adverse effects ; Percutaneous Coronary Intervention/instrumentation ; Recurrence ; Severity of Illness Index ; Treatment Outcome ; Vasodilator Agents/administration & dosage

A 68 year-old woman was admitted due to chest pain with dyspnea. Transthoracic echocardiography showed isolated right ventricular dysfunction. Coronary angiogram was normal. Cardiac enzyme was elevated persistently. Under the supposed diagnosis of acute idiopathic myocarditis, she was treated with supportive care but symptom and cardiac enzyme was not improved. After steroid pulse therapy, symptom was improved and cardiac enzyme was normalized. She was discharged with improvement of symptoms.
Aged ; Chest Pain ; Diagnosis ; Dyspnea ; Echocardiography ; Female ; Humans ; Myocarditis* ; Ventricular Dysfunction, Right

BACKGROUND: New stent implantation during intracoronary brachytherapy is discouraged due to the high risk of late thrombosis. However, new stent implantation is inevitable in some cases due to the inadequate ballooning or major dissections. Long-term follow-up results of newly implanted stents during brachytherapy are not well-known. We performed this study to evaluate the long-term clinical outcomes of newly implanted stents during intracoronary brachytherapy. METHODS: In the Seoul national university Post-Angioplasty RhEnium irradiation (SPARE) trial, patients were treated with conventional catheter-based technique and then randomized to either beta- radiation (RG) or control group (CG). Radiation was performed with 188 -rhenium-filled conventional balloon catheter system. From 1999 to 2001, new stent implantation was performed in 58 and 56 patients in RG and CG, respectively. Clinical and angiographic follow up data were analyzed. RESULTS: In RG, short-term angiographic restenosis rate was lower than CG (28.6% vs 53%, p=0.03). In RG, late thrombosis was found in 3 patients. However, there was no late thrombosis in CG. Two year major cardiac event rates were not different between the 2 groups (RG: 25.9% vs CG: 28.3%). Independent predictors for major cardiac event in RG were major dissections (>or=type C) after stent implantation (beta=70, p=0.01) and longer administration of dual antiplatelets (aspirin+clopidogrel/ ticlopidine, >6 months, beta=0.07, p=0.04). CONCLUSION: Stenting during intracoronary brachytherapy seems to be ineffective in reducing long-term event rates. When new stent implantation is inevitable during brachytherapy, extreme attention is required not to make a dissection and long-term dual antiplatelet treatment should be followed after stent implantation.
Angioplasty ; Brachytherapy ; Catheters ; Follow-Up Studies ; Humans ; Rhenium ; Seoul ; Stents* ; Thrombosis ; Ticlopidine