11/129. Diverticulosis of the left ventricle.Nine patients, 4--60 years old, had single or multiple left ventricular outpouchings, best seen during diastole, and believed to represent congenital diverticula. The 14 diverticula, 5--28 mm long, were either along the diaphragmatic or anterior ventricular wall. Only one patient had his diverticulum surgically removed; the wall was lined by thick endocardium surrounded by normal myocardium. The lesions did not produce local or systemic complications. All patients had normal chest radiographs. The material suggests that left ventricular diverticula not associated with midline anomalies are perhaps not very rare and should be distinguished from cardiac aneurysm.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
12/129. Left ventricular false aneurysm.False aneurysms of the left ventricle develop after rupture of the ventricular wall in an area of pericardial adhesions. This complication of myocardial infarction is uncommon. Images of a post-infarction false aneurysm are presented.- - - - - - - - - - ranking = 0.004871982114892keywords = area (Clic here for more details about this article) |
13/129. Totally endoscopic atrial septal defect closure using robotic techniques: report of two cases.BACKGROUND: The development of minimally invasive cardiac surgery has shown good clinical results with shorter recovery time and better cosmetic results. We report 2 cases of totally endoscopic atrial septal defect (ASD) closure using a robotic system. Open-heart closure of an ASD without opening the chest has never been previously reported. methods: Following percutaneous cannulation for cardiopulmonary bypass, aortic occlusion and delivery of cardioplegia, 2 patients with an ASD were successfully operated on using a robotic surgical device. After exclusion of the right lung, two robotic arms and an endoscopic camera were inserted through ports in the right hemithorax. A fourth port was inserted for an accessory endoscopic instrument. The ASD closure was carried out with interrupted stitches in one case and with a continuous suture in the other. RESULTS: cardiopulmonary bypass and cardioplegic arrest times were respectively 130 and 75 min in the first and 87 and 60 min in the second case. Extubation was carried out 3 and 5 hours postoperatively. Both patients resumed a totally normal lifestyle 1 week after the operation. CONCLUSIONS: Totally endoscopic open-heart ASD closure can be carried out safely using robotic techniques with rapid postoperative recovery and excellent cosmetic results. This modality of treatment can be considered an alternative to the transcatheter closure of ASD.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
14/129. Congenital giant aneurysm of the left atrial appendage mimicking pericardial absence case report.A 25-year-old man was found to have an abnormal cardiac contour on a chest radiograph, and was referred. Transesophageal echocardiography suggested herniation of the left atrial appendage (LAA) through a gap in the pericardium, and magnetic resonance imaging indicated congenital partial absence of the pericardium. Cardiac dysfunction was caused by compression from the enlarged left atrium and thrombi were thought to be present in the appendage, so surgery was performed. The intraoperative diagnosis was congenital LAA aneurysm. Although distinguishing between congenital LAA aneurysm and congenital absence of the pericardium is reported to be possible with magnetic resonance imaging, we were unable to so in this case.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
15/129. aneurysm of the body of the left atrium presenting with chest pain.A patient with aneurysm of the body of the left atrium presenting with angina pectoris and mild congestive heart failure, but completely normal coronary arteriograms, is reported. A deverticulum seen in the left ventricular angiogram, read as a ventricular diverticulum, was found at surgery to be an aneurysm of the body of the left atrium. The possible etiologics and complications of the left atrial aneurysm are briefly discussed.- - - - - - - - - - ranking = 23.309131720122keywords = chest pain, chest, pain (Clic here for more details about this article) |
16/129. Left ventricular septal aneurysm in association with bicuspid aortic valve--a case report.Diverticula of the left ventricle are rare cardiac anomalies. Most cases arise from the apex of the left ventricle and are usually found in children. Only a few cases have been documented in adults. The authors report a case of a 38-year-old woman who presented with dyspnea and chest pain. She was found to have a septal left ventricular diverticulum associated with bicuspid aortic valve, aortic stenosis, and aortic regurgitation. The aortic valve was replaced with the resection of the diverticulum. Pathologic examination confirmed the diagnosis of fibrous diverticulum.- - - - - - - - - - ranking = 5.8272829300306keywords = chest pain, chest, pain (Clic here for more details about this article) |
17/129. Giant left atrial intrapericardial aneurysm: noninvasive preoperative imaging.Congenital giant intrapericardial aneurysms of the left atrium are rare. A 17-year-old boy presented with paroxysmal episodes of palpitations, chest pain, and dyspnea. A chest roentgenogram showed an enlarged left cardiac silhouette. Transthoracic echocardiography imaging showed an intrapericardial aneurysm of the left atrium. Cardiac magnetic resonance imaging confirmed the diagnosis and delineated adjacent structures to plan the surgical resection. We have found no previous reports of cases of diagnosis and preoperative assessment based solely on noninvasive imaging.- - - - - - - - - - ranking = 6.8272829300306keywords = chest pain, chest, pain (Clic here for more details about this article) |
18/129. Electrocardiographic ST-segment elevation: correct identification of acute myocardial infarction (AMI) and non-AMI syndromes by emergency physicians.OBJECTIVE: To determine the emergency physician's (EP's) ability to identify the cause of ST-segment elevation (STE) in a hypothetical chest pain patient. methods: Eleven electrocardiograms (ECGs) with STE were given to EPs; the patient in each instance was a 45-year-old male with a medical history of hypertension and diabetes mellitus with the chief complaint of chest pain. The EP was asked to determine the cause of the STE and, if due to acute myocardial infarction (AMI), to decide whether thrombolytic therapy (TT) would be administered (the patient had no contraindication to such treatment). Rates of TT administration were determined; appropriate TT administration was defined as that occurring in an AMI patient, while inappropriate TT administration was defined as that in the non-AMI patient. RESULTS: Four hundred fifty-eight EPs completed the questionnaire; levels of medical experience included the following: postgraduate year 2-3, 193 (42%); and attending, 265 (58%). The overall rate of correct interpretation of the study ECGs was 94.9% (4,782 correct interpretations out of 5,038 instances). Acute myocardial infarction with typical STE, ventricular paced rhythm, and right bundle branch block were never misinterpreted. The remaining conditions were misinterpreted with rates ranging between 9% (left bundle branch block, LBBB) and 72% (left ventricular aneurysm, LVA). The overall rate of appropriate thrombolytic agent administration was 83% (1,525 correct administrations out of 1,832 indicated administrations). The leading diagnosis for which thrombolytic agent was given inappropriately was LVA (28%), followed by benign early repolarization (23%), pericarditis (21%), and LBBB without electrocardiographic AMI (5%). Thrombolytic agent was appropriately given in all cases of AMI except when associated with atypical STE, where it was inappropriately withheld 67% of the time. CONCLUSIONS: In this survey, EPs were asked whether they would give TT based on limited information (ECG). Certain syndromes with STE were frequently misdiagnosed. Emergency physician electrocardiographic education must focus on the proper identification of these syndromes so that TT may be appropriately utilized.- - - - - - - - - - ranking = 11.654565860061keywords = chest pain, chest, pain (Clic here for more details about this article) |
19/129. Ruptured left ventricular pseudoaneurysm penetrating into the left pleural cavity.We experienced a rare case of ruptured left ventricular pseudoaneurysm penetrating into the left pleural cavity. A 77-year-old woman was first diagnosed with unstable angina due to sudden chest pain onset and abnormal electrocardiographic findings. In 2 days, massive left pleural effusion was recognized by chest X-ray, though subsequent computed tomographic scans did not show any aortic pathology. We observed her with left thoracentesis alone. Two days later, cardiac arrest suddenly occurred and emergency surgery was undertaken after resuscitation by percutaneous cardiopulmonary support. In surgery, a moderate amount of intrapericardial hematoma caused by rupture of a left ventricular pseudoaneurysm penetrating into the left pleural cavity was found and successfully repaired. This rare rupture of a left ventricular pseudoaneurysm penetrating into the left pleural cavity generated massive hemo-hydrothorax.- - - - - - - - - - ranking = 6.8272829300306keywords = chest pain, chest, pain (Clic here for more details about this article) |
20/129. Calcified left ventricular aneurysm and non-atherosclerotic myocardial infarction in a child.A 14-year-old boy, admitted with intractable chest pain, was found to have an enlarged heart and calcification in the apical region, with electrocardiographic features of massive inferolateral myocardial infarction. Left ventricular angiography revealed a large left ventricular aneurysm. He died following resection of the aneurysm and post mortem examination showed changes of a non-specific chronic myocarditis. A vasculitis involving small coronary arterioles was also found in the vicinity of the aneurysm, and the possibility of a rheumatic vasculitis was suggested by a transient episode of an erythema marginatum-like eruption. It is concluded that the association of infarction pattern on the electrocardiogram together with calcification of the heart in children is highly suggestive of a ventricular aneurysm secondary to a myocarditis or a vasculitis involving small, intramyocardial branches of the coronary arteries.- - - - - - - - - - ranking = 5.8272829300306keywords = chest pain, chest, pain (Clic here for more details about this article) |
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