Transesophageal echocardiography was performed to evaluate the exact cause of severe mitral regurgitation in a 64-year-old man presented with hypotension and dyspnea after acute inferior wall myocardial infarction. In mid-esophageal two-and four-chamber view, the ruptured stump of papillary muscle could not be visualized. However, in transgastric two-chamber view, we could clearly visualize the ruptured head of the posteromedial papillary muscle as a separated mass attached by chorda tendinae, as well as the freely mobile stump of the ruptured papillary muscle within the left ventricle. So, the comprehensive transesophageal echocardiography, including transgastric imaging, is always indicated in patients with severe mitral regurgitation after acute myocardial infarction.
*Echocardiography, Transesophageal ; Heart Rupture, Post-Infarction/*ultrasonography ; Human ; Male ; Middle Aged ; Myocardial Infarction/complications/*ultrasonography ; Papillary Muscles/*ultrastructure

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and sudden cardiac death. The incidence, causes, pathogenesis, and treatment have not been defined clearly, but spontaneous coronary artery dissection should be considered in young patients without major cardiovascular risk factors or in patients in the peripartum period who present with acute coronary syndrome. The treatment is often challenging. Medical treatment is usually considered, and percutaneous coronary intervention or coronary artery bypass surgery may be possible in some patients. We herein report two cases of middle-aged males with myocardial infarction who were treated with percutaneous coronary angioplasty.
Adult ; Coronary Artery Disease/*complications/surgery/ultrasonography ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*etiology/surgery/ultrasonography ; *Percutaneous Coronary Intervention ; Rupture, Spontaneous/surgery/ultrasonography ; Ultrasonography, Interventional

Aged ; Angioplasty, Balloon, Coronary ; Heart Rupture, Post-Infarction ; complications ; diagnostic imaging ; Humans ; Male ; Myocardial Infarction ; therapy ; Papillary Muscles ; Shock, Cardiogenic ; etiology ; Systolic Murmurs ; etiology ; Ultrasonography

Chest trauma can lead to various cardiac complications ranging from simple arrhythmias to myocardial rupture. An acute myocardial infarction (AMI) is a rare complication that can occur after chest trauma. We report a case of 66-year-old male who suffered a blunt chest trauma from a traffic accident resulting in an AMI. The coronary angiography revealed an eccentric 50% narrowing of the ostium of left anterior descending artery (LAD) by a dissection flap with calcification. Intravascular ultrasonography (IVUS) revealed eccentric calcified plaque (minimal luminal diameter [MLD]=3.5 mm) with a dissection flap. Intervention was not performed considering the MLD and calcified flap, and he has been conservatively managed with aspirin and losartan for 2 years. The follow-up coronary angiography showed an insignificant luminal narrowing of the proximal LAD from the ostium without evidence of a dissection. An early coronary evaluation including an IVUS study should be considered for managing patients who complain of ongoing, deep-seated chest pain with elevated cardiac enzyme levels and an abnormal electrocardiogram (ECG) after a blunt chest trauma. Based on this case, some limited cases of traumatic coronary artery dissections can be healed with conservative management and result in a good prognosis.
Aged ; Aneurysm, Dissecting/diagnosis/*etiology ; Coronary Aneurysm/diagnosis/*etiology ; Coronary Angiography ; Human ; Male ; Myocardial Infarction/diagnosis/*etiology ; Radiography, Thoracic ; Thoracic Injuries/*complications ; Ultrasonography, Interventional ; Wounds, Nonpenetrating/*complications

Adult ; Aneurysm, False ; complications ; diagnosis ; Coronary Aneurysm ; complications ; diagnosis ; Coronary Angiography ; methods ; Coronary Vessels ; injuries ; Humans ; Male ; Myocardial Infarction ; etiology ; Tomography, X-Ray Computed ; methods ; Ultrasonography, Interventional ; methods

Objective: To compare the efficacy of intravascular ultrasound (IVUS) and coronary angiography guided drug eluting stent (DES) implantation for the treatment of left main coronary artery (LMCA) lesions. Methods: Randomized controlled trials (RCT) and observational studies, which compared IVUS with coronary angiography guided DES implantation for the treatment of LMCA lesions published before August 2021 were searched in PubMed, Embase and Cochrane Library databases. Baseline data, interventional procedures and endpoint events of each study were collected. The primary endpoint was major cardiovascular adverse events (MACE), and the secondary endpoints were all-cause death, cardiac death, myocardial infarction (MI), target lesion revascularization (TLR) and target vessel revascularization (TVR). The Newcastle-Ottawa Scale (NOS) and the Cochrane Collaboration Risk of Bias tool were used to evaluate the quality of the included studies. Results: Nine studies were included, including 3 RCT and 6 observational studies, with a total of 5 527 cases of LMCA. All the 6 observational studies had NOS scores≥6, and the 3 RCT had a low risk of overall bias. The results of meta-analysis showed that compared with coronary angiography guided group, MACE rate (OR=0.55, 95%CI 0.47-0.66, P<0.001), all-cause death (OR=0.56, 95%CI 0.43-0.74, P<0.001), cardiac death (OR=0.43, 95%CI 0.30-0.61, P<0.001), MI (OR=0.64, 95%CI 0.52-0.79, P<0.001), TLR (OR=0.49, 95%CI 0.28-0.86, P=0.013) and TVR (OR=0.77, 95%CI 0.60-0.98, P=0.037) were all significantly lower in the IVUS guided group. Conclusions: Compared with angiography guided, IVUS guided PCI with DES implantation in LMCA lesions could significantly reduce the risk of MACE, death, MI, TLR and TVR. IVUS is thus superior to coronary angiography for guiding PCI treatment among patients with LMCA.
Humans ; Coronary Artery Disease/complications* ; Coronary Angiography ; Drug-Eluting Stents/adverse effects* ; Treatment Outcome ; Percutaneous Coronary Intervention/methods* ; Ultrasonography, Interventional/methods* ; Risk Factors ; Myocardial Infarction/etiology*

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.
Acute Disease ; Aged ; Coronary Angiography ; Diagnosis, Differential ; Heart Atria/ultrasonography ; Heart Failure/diagnosis/etiology ; Humans ; Male ; Mitral Valve Insufficiency/ultrasonography ; Myocardial Infarction/complications/*diagnosis/therapy ; Pulmonary Edema/*diagnosis/etiology/therapy ; Shock, Cardiogenic/*diagnosis/etiology/therapy ; Tomography, X-Ray Computed

No abstract available.
*Aorta, Thoracic/ultrasonography ; Aortic Diseases/*complications/diagnosis ; Catheterization, Peripheral/*adverse effects ; Cerebral Angiography/*adverse effects ; Electrocardiography ; Fatal Outcome ; *Femoral Artery ; Heart Arrest/diagnosis/etiology ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis/*etiology ; Punctures ; *Sinus of Valsalva/ultrasonography ; Thrombosis/diagnosis/*etiology

Coronary artery injury rarely occurs after blunt chest trauma, but it can lead to extensive myocardial infarction and be frequently overlooked. A 16-yr-old man was presented with comatose mental state and rapid respiration rate. He ran into guard rail while riding a motorcycle. In routine examination, his electrocardiogram showed Q wave and 2 mm ST segment elevation in all precordial leads, I and aVL. The cardiac enzymes were also elevated: creatine kinase (CK)-MB was 300 U/L, and cardiac specific troponin I was 5.7 ng/mL. Two-dimensional echocardiography showed anteroseptal akinesia with severely depressed left ventricular function, ejection fraction of 28%. He could not receive any anticoagulation or thrombolytic therapy because of his brain lesion. Three weeks later, his mental state improved. A diagnostic coronary angiogram revealed total occlusion in the proximal left anterior descending artery (LAD) with collaterals from the right coronary artery and left circumflex artery. We successfully performed a percutaneous coronary intervention for the LAD lesion, and the final angiogram showed a good coronary flow without residual stenosis.
Adolescent ; Angioplasty, Transluminal, Percutaneous Coronary ; Brain/pathology ; Coronary Angiography ; Echocardiography ; Electrocardiography ; Human ; Male ; Myocardial Infarction/*etiology/therapy ; Thoracic Injuries/*complications/pathology/ultrasonography ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Left

OBJECTIVE: To quantitatively detect variation in regional myocardial systolic function in heart failure rat model induced by myocardial infarction by strain and strain rate imaging. METHODS: Seventy 2-month-old adult male SD rats were randomly assigned to 4 groups: a 4-week and a 8-week group after the operation (each n = 25) had thoracotomy, the pericardium opened and the anterior descending branch of left coronary artery ligated; a sham operation group (n = 10) had thoracotomy and the arcula cordis opened, but did not ligate the artery; a control group (n = 10) had no treatment. The changes of general state of health of the rats were observed and recorded every day. To assess the change of heart function, echocardiography was used at the end of the 4th week and 8th week after the surgery. To evaluate the change of heart function in heart failure rats, we quantitatively analyzed the regional myocardial systolic function in all rats by strain and strain rate imaging and myocardium to detect the level of MMP-9 at the end of the 4th week and 8th week. The repeatability and discrepancies of the results were all analyzed. RESULTS: Obviously objective signs of heart failure manifested themselves in the survived mice 10 to 14 days after the surgery. Compared with the control group and the sham operation group, the fraction shortening (FS) and ejection fraction (EF) of the 4-week group after the operation were lower (P < 0.05), the left ventricle index (LV index) of the 8-week group after the operation was higher, left ventricle posterior wall index (LVPW index), interventricular septum index (IVS index), FS, and EF of the 8-week group after the operation were lower (P < 0.05), EF and FS of the 8-week group after the operation were lower than those of the 4-week group. Except the mid-inferior wall and base-inferior wall, the systolic peak strain, systolic peak strain rate, the strain of end-systole in all segments of the operation group were lower than those of the other 2 groups (P < 0.05). The post-systolic strain index of the operation group was higher than that of the other 2 groups (P < 0.05). CONCLUSION Strain and strain rate imaging of echocardiography can quantitatively evaluate the changing of regional myocardial systolic function in the heart failure rat model induced by myocardial infarction, with good repeatability.
Animals ; Heart Failure ; diagnostic imaging ; etiology ; physiopathology ; Heart Ventricles ; diagnostic imaging ; Male ; Myocardial Infarction ; complications ; diagnostic imaging ; physiopathology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Systole ; Ultrasonography ; Ventricular Function, Left ; physiology