1/29. Treatment of a large congenital coronary fistula with coil embolization.A 77-year-old woman suffering from progressive dyspnea and chest pain for 2 1/2 years was admitted to hospital. There were no ECG changes at exercise test and a dobutamine stress echocardiography was normal. At catheterization, right-sided pressures were within normal limits. coronary angiography revealed a congenital coronary fistula, 3-4 mm in diameter, from the left anterior descending artery to the proximal pulmonary artery. There was no significant rise in blood oxygen saturation in the pulmonary artery. Transcatheter coil embolization was performed in the distal part of the tortuous fistula. Flow ceased within minutes, demonstrating the feasibility and efficacy of this technique for treating large fistulas.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
2/29. Chronic constrictive pericarditis induced by long-term bromocriptine therapy: report of two cases.OBJECTIVE: To report two cases of chronic constrictive pericarditis that appear to be related to the intake of bromocriptine for Parkinson's disease. CASE SUMMARY: Two white men (aged 63 and 69 y) were treated with bromocriptine for four (40 mg/d) and two years (30 mg/d), respectively, with a cumulative dose intake of 58.4 and 21.9 g, respectively. The patients experienced dyspnea with bilateral lower-limb edema and pleural effusion, suggesting right cardiac dysfunction. echocardiography, computed tomography, and cardiac catheterization results were compatible with a diagnosis of constrictive pericarditis, so pericardectomy was performed on both patients. The anatomic pathology examination showed a fibrous pericardium; cultures were sterile. In the first case, pleural effusion recurred seven months after the pericarditis; bromocriptine was suspected and treatment was discontinued. In the second case, just prior to the pericardectomy, an episode of mental confusion occurred and prompted the cessation of bromocriptine therapy. DISCUSSION: To the best of our knowledge, only one case of constrictive pericarditis induced by bromocriptine therapy has previously been described in the literature. CONCLUSIONS: Our cases call attention to a possible association between bromocriptine use in patients who have Parkinson's disease and constrictive pericarditis.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
3/29. amniotic fluid embolism.amniotic fluid embolism is a rare occurrence, with no single pathognomonic clinical or laboratory finding. diagnosis is based on clinical presentation and supportive laboratory values. We describe the case of a 17-year-old nulliparous woman at 27 weeks' gestation who had uterine bleeding, hematuria, hemoptysis, hypotension, dyspnea, and hypoxemia within 30 minutes of vaginal delivery. Laboratory values revealed diffuse intravascular coagulation. Chest films were consistent with adult respiratory distress syndrome. pulmonary artery catheterization revealed moderately increased pulmonary capillary wedge pressure. Supportive measures, including oxygenation, fluid resuscitation, and plasma, were administered. Central hemodynamic monitoring and inotropic support were necessary. Our patient recovered uneventfully and 6 weeks later was living an unrestricted life-style.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
4/29. A case of pulmonary arteritis with stenosis of the main pulmonary arteries with positive myeloperoxidase-antineutrophil cytoplasmic autoantibodies.A 53-year-old woman was referred to our hospital with the main symptoms of productive cough, fever and exertional dyspnoea. Chest X-ray revealed enlargement of the left hilar shadow and cavitary infiltration in the right upper lobe. 99mTechnetium-macroaggregated albumin (99mTc-MAA) perfusion scintigram showed complete hypoperfusion through the entire right lung. A pulmonary angiogram revealed stenotic lesions in the right and left main pulmonary arteries. Right cardiac catheterization showed an elevated right ventricular systolic pressure. There was no evidence of systemic arterial lesions nor vasculitis. The patient was positive for myeloperoxidase (MPO)-antineutrophil cytoplasmic autoantibodies (ANCA) (168 EU). The mycobacterium avium complex sputum culture was positive. The pulmonary stenotic lesions were surgically resected. The resected pulmonary arterial lesions were pathologically diagnosed as non-specific vasculitis. The cavitary lesion disappeared 6 months after the surgery. Two years after the surgery, although the MPO-ANCA level had decreased to 12 EU, stenosis of the pulmonary arteries reappeared. It is suggested that the patient became positive for MPO-ANCA in association with the mycobacterium avium complex infection, and that the presence of MPO-ANCA may not be related to the development of pulmonary stenosis of the main pulmonary arteries.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
5/29. Aberrant right subclavian artery (arteria lusoria) as a rare cause of dysphagia and dyspnea in a 79-year old women with right mediastinal and retrotracheal mass, and co-existing coronary artery disease.A rare case of a 79-year old women with dysphagia and dyspnea secondary to compression of the esophagus by an aberrant right subclavian artery (ARSA, A. lusoria) is presented. This abnormality is generally silent and often an incidental x-ray finding. Computed tomography and intraarterial angiography, including direct catheterization of the ARSA, established the diagnosis. The interdependence with a co-existing coronary artery disease is discussed. Thus, ARSA has to be taken into account in patients with abnormal x-ray findings presenting with dysphagia and dyspnea.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
6/29. Right-to-left atrial shunt without pulmonary artery hypertension.A 70-year-old woman without any history of pulmonary or cardiac disease developed breathlessness with severe arterial hypoxemia. Cardiac ultrasound examination and spirometry were normal. cardiac catheterization and intravenous microbubble injection demonstrated an interatrial right-to-left shunt. The defect was closed surgically, and the patient recovered immediately. On surgery, the aorta was elongated, inducing an angulation of the interatrial septum and leading to the atrial septal defect just above the inferior vena cava.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
7/29. Platypnea - orthodeoxia syndrome with atrial septal defect.A 75-year old man was referred to hospital for symptomatic hypoxemia. He did not complain of dyspnea while supine, but while sitting or standing, he experienced dyspnea with severe hypoxemia. He did not have any pulmonary diseases that could cause dyspnea. Transesophageal echocardiography revealed an atrial septal aneurysm with a small atrial septal defect (ASD) and a mild left-to-right shunt through the ASD when the patient was supine. However, when he became upright, a severe right-to-left shunt occurred and the arterial oxygen saturation decreased from 96% to 80% with dyspnea. cardiac catheterization revealed normal pulmonary artery pressure. He was therefore diagnosed as having platypnea - orthodeoxia syndrome. magnetic resonance imaging of the chest showed a deformity of the atrium associated with elongation of the ascending aorta. The ASD was closed surgically and the dyspnea and hypoxemia that occurred while he was upright completely resolved.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
8/29. Chronic mitral regurgitation secondary to a perivalvular leak from remote trauma.We report a rare case of mitral regurgitation as a result of perivalvular leak in a 49-year-old man with a history of blunt trauma. He presented with a 2-month history of progressive exertional dyspnea, angina, and heart failure. Preoperative transesophageal echocardiography demonstrated severe mitral regurgitation as a result of a perivalvular leak of the mitral valve that was not evident on transthoracic echocardiography and cardiac catheterization.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
9/29. Severe pulmonary hypertension in chronic idiopathic myelofibrosis.BACKGROUND: Chronic myeloproliferative disorders (CMPD) seem to be associated with an increased risk for pulmonary hypertension (PH). CASE REPORT: A patient with history of chronic idiopathic myelofibrosis (CIMF) presented with progressive dyspnea (new york Heart association class III). Until this time he had not received specific treatment for CIMF. echocardiography and rightheart catheterization confirmed PH. Further diagnostic procedures excluded a specific cause of PH. Therefore, primary PH was assumed. 2 years later he presented again with progressive dyspnea due to a progress of PH. A few days later the patient died from acute posterior myocardial infarction. Pathologic examination of the lung showed an obstruction of the small vessels by conglomerates of megakaryocytes. DISCUSSION: We conclude that PH developed secondarily due to CMPD. PH should be suspected in patients with CMPD and should influence the decision for treatment of CMPD.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
10/29. Shortness of breath, syncope, and cardiac arrest caused by systemic mastocytosis.During a 3-month period, a 33-year-old man presented to the emergency department on 4 occasions with dyspnea, palpitations, and syncope. His initial presentation was accompanied by acute myocardial injury and ventricular fibrillation. An extensive evaluation spanned the 3 months and included echocardiography, cardiac catheterization, electrophysiology study, tilt-table evaluation, pulmonary angiography, electroencephalography, and serum and urine analysis. diagnosis eluded clinicians until a rash was recognized to be urticaria pigmentosa, and biopsy of the rash then implicated mastocytosis. Since the initiation of pharmacotherapy nearly 5 years ago, the patient has remained asymptomatic. This case demonstrates that systemic mastocytosis can present as recurrent syncope and even as cardiac arrest. diagnosis of this rare but potentially fatal disease is made particularly challenging by its protean manifestations.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
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