11/169. Triscuspid annular dilatation causing severe valvular incompetence and associated with dystrophic calcification of the left ventricular myocardium.We report on a case of severe tricuspid regurgitation (TR) in a young patient with no history of chest trauma and with an anatomically normal tricuspid valve (TV) apparatus and a dilated TV annulus associated with dystrophic calcification of the left ventricular myocardium. The possibility of congenital pathology as well as the possibility of this being a limited inflammatory or restrictive myocardial disease is discussed.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
12/169. D-2-Hydroxyglutaric aciduria in a patient with a severe clinical phenotype and unusual MRI findings.We report an infant with intermittent urinary excretion of D-2-hydroxyglutaric (D-2-OHG) acid who died at the age of 10 months from cardiogenic shock due to cardiomyopathy. High urinary concentrations of D-2-OHG and succinic acid, as well as increased levels of lactic acid were detected on three different occasions, whereas a normal urinary profile of organic acids was found on one occasion. The clinical findings of our patient consisted of generalized hypotonia, irritability, developmental delay, generalized tonic seizures, lethargy, cardiomyopathy, and respiratory distress. Cerebral MRI revealed bilateral lesions in the substantia nigra, the periaqueductal area, the medial part of the thalamus, the hypothalamus, the caudate nucleus, putamen and globus pallidus. This pattern is suggestive of a mitochondriopathy. However, respiratory chain enzyme activities were normal in fibroblasts. Exogenous supplementation of D-2-OHG acid strongly inhibited cytochrome-c oxidase activity in fibroblasts from the patient and from normal controls in vitro. The results suggest that our patient has an unusual form of D-2-hydroxyglutaric aciduria (D-2-OHGA), different from the patients published so far, and that the increase of lactic acid and some citric acid cycle intermediates encountered in some patients with D-2-OHGA may be due to a functional defect of the respiratory chain caused by D-2-OHG acid.- - - - - - - - - - ranking = 0.027379535220744keywords = area (Clic here for more details about this article) |
13/169. Six-month follow-up of takotsubo cardiomyopathy with I-123-beta-metyl-iodophenyl pentadecanoic acid and I-123-meta-iodobenzyl-guanidine myocardial scintigraphy.A 69-year-old man with a history of transient chest pain was diagnosed takotsubo cardiomyopathy. In I-123-beta-metyl-iodophenyl pentadecanoic acid myocardial scintigraphy, decreased uptake of apex was seen in the acute phase, and it recovered in 3 months. In I-123-meta-iodobenzyl-guanidine myocardial scintigraphy, decreased uptake of apex persisted for 6 months, and there was a discrepancy between apical and total washout rate in the acute phase and after 3 months, which disappeared after 6 months. We speculate that the discrepancy of sympathetic innervation between the apical and basal region is the cause of the characteristic left ventricular apical akinesia of takotsubo cardiomyopathy.- - - - - - - - - - ranking = 27.526077569824keywords = chest pain, chest, pain (Clic here for more details about this article) |
14/169. Giant hydatid cyst in the interventricular septum of a pregnant woman.A 25-year-old woman, pregnant for 38 weeks, was admitted to our clinic with dyspnea. Transthoracic echocardiography revealed a large cyst that originated from the left side of the interventricular septum, decreasing left ventricular volume and almost entirely obstructing the left ventricular outflow tract. Cardiac magnetic resonance imaging confirmed a grade 1 hydatid cyst, which measured 61 x 59 x 66 mm. The cyst was excised after cesarean section. Extirpation required the creation of a small septal defect, which we closed without a patch, by suturing the septum directly to the left ventricular wall. The patient was discharged without symptoms. The case reported here is of particular interest not only because a hydatid cyst is rarely seen in the interventricular septum, but because a giant hydatid cyst obstructing the left ventricular outflow tract is very rare in pregnancy.- - - - - - - - - - ranking = 0.027379535220744keywords = area (Clic here for more details about this article) |
15/169. Ethical issues in the management of geriatric cardiac patients.A 69-year-old woman dying of severe ischemic cardiomyopathy and peripheral arterial disease is developing gangrene of her toes without pain or overt signs of infection. Should you perform an arteriogram, attempt repeat angioplasty of either or both limbs?- - - - - - - - - - ranking = 0.085025735032478keywords = pain (Clic here for more details about this article) |
16/169. MR imaging of myocardial haematoma after blunt chest injury.Myocardial contusion after a chest trauma is a frequently under-diagnosed injury. We report two cases of myocardial contusion in which MR imaging, thanks to its contrast capability, was able to assess the presence of a haematoma and in one case to demonstrate the recovery of the lesion.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
17/169. fistula from the aortic sinus of valsalva to the right ventricle--case report.The authors report a case of a 42-year-old male, with the incidental finding of a fistula from the aortic root (sinus of valsalva) to the right ventricle in the diagnostic work-up of atypical chest pain. The images and results of the exams are presented and the therapeutic options are discussed after the final diagnosis.- - - - - - - - - - ranking = 27.526077569824keywords = chest pain, chest, pain (Clic here for more details about this article) |
18/169. Centronuclear myopathy and cardiomyopathy requiring heart transplant.Centronuclear myopathy has been extremely rarely associated with cardiomyopathy, which can lead to heart failure and premature death. We report the case of a 3.5-year-old girl with early-onset dilated cardiomyopathy, biventricular hypertrophy and histologic features suggestive of centronuclear myopathy. After unsuccessful medical treatment for heart failure, she underwent cardiac transplantation at the age of 4.5 years. Results of a skeletal muscle biopsy showed increased central nuclei and perinuclear vacuolations with aggregates of mitochondria. Examination of the heart at the time of transplantation confirmed a diagnosis of dilated cardiomyopathy. Histologic results revealed hypertrophic myocardiocytes, focal areas of infarction and endocardial fibroelastosis, most prominently in the left ventricle. Although cardiomyopathy is commonly associated with other childhood myopathies, to our knowledge, this is the youngest patient reported with centronuclear myopathy presenting with heart failure caused by cardiomyopathy, and the first patient to successfully undergo cardiac transplantation. One year after the heart transplant, there were no signs of rejection. We recommend detailed cardiac assessment with regular follow-up for children with histologic features consistent with centronuclear myopathy.- - - - - - - - - - ranking = 0.027379535220744keywords = area (Clic here for more details about this article) |
19/169. Peripartum cardiomyopathy and thromboembolism; anesthetic management and clinical course of an obese, diabetic patient.PURPOSE: To describe the anesthetic management and clinical course of a patient with peripartum cardiomyopathy. We highlight the frequent occurrence of thromboembolic morbidity in this group of parturients, emphasizing the need for early consideration of prophylactic anticoagulation. Clinical features: A 38-yr-old, diabetic, obese parturient was admitted with pulmonary edema and severe orthopnea at 31 weeks gestation. The respiratory rate was 44 breaths x min(-1), blood pressure 110/70 mmHg, pulse 120 beats x min(-1) and rales were heard in both lung fields. The diagnosis of peripartum cardiomyopathy was made based on sinus tachycardia with no evidence of ischemia on the electrocardiogram, and global left ventricular hypokinesis with an ejection fraction of 40-45% noted on transthoracic echocardiography. Cesarean delivery was planned to improve maternal respiratory status and hemodynamics. General anesthesia with invasive monitoring was planned, and surgery and anesthesia proceeded uneventfully. Less than 24 hr postoperatively, she sustained a thrombotic cerebral infarct leaving her hemiparetic and dysarthric. Subsequent investigations revealed a thrombophilic state due to elevated anticardiolipin antibody. CONCLUSION: General anesthesia is an acceptable option in parturients with heart failure secondary to cardiomyopathy. Thromboembolic complications are common, and early consideration should be given to prophylactic anticoagulation.- - - - - - - - - - ranking = 0.027379535220744keywords = area (Clic here for more details about this article) |
20/169. Chronic left ventricular pseudoaneurism.We present the case of a 70-year-old white male presenting with an abnormal cardiac silhouette on the chest X-ray and complaining of fatigue in the week before hospital admission. Four months before admission he had a single prolonged ischemic chest pain episode. The ECG revealed an old true posterior myocardial infarction. The transthoracic echocardiogram showed a large left ventricular pseudoaneurysm and surgical resection was performed successfully. The etiology, diagnosis and treatment of left ventricular pseudoaneurysm are reviewed.- - - - - - - - - - ranking = 28.526077569824keywords = chest pain, chest, pain (Clic here for more details about this article) |
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