1/135. Localized pericarditis with calcifications mimicking a pericardial tumor.A 62-year-old man was admitted with increasing palpitations. radiography of the chest demonstrated a calcified mass. magnetic resonance imaging revealed compression of the right ventricle by a tumor. At the time of cardiac catheterization, the coronary arteries were found not to supply blood flow of the mass, and no dip-and-plateau pattern was seen in the right ventricular pressure measurements. At the time of surgery, the mass was found to be a focal calcified thickening of the pericardium containing only pus. The thickening resembled an oval pericardial tumor. Microbiologic examination of the pus revealed propionibacterium acnes.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/135. Symptomatic calcified subdural hematomas.Two unique cases of chronic calcified subdural hematomas are reported in children as a long-term complication of a ventriculoperitoneal shunt. Both the patients had undergone shunt procedures in infancy for congenital hydrocephalus. In one patient, the cause of the hydrocephalus was aqueduct stenosis, while in the second patient, a lumbar meningomyelocele was associated with hydrocephalus. In both these patients, a ventriculoperitoneal shunt was done in infancy. In one of them, following the shunt surgery, a bilateral subdural collection was noticed which required burr hole evacuation. Both the patients remained asymptomatic for 9 years, when they presented to our center with acute raised intracranial pressure and contralateral hemiparesis. Both the patients had a relatively short history and had altered sensorium at admission. Surprisingly, in both the patients, the CT scan showed significant mass effect producing calcified subdural hematomas. The shunt systems were found to be working well at surgery. craniotomy and excision of the calcified subdural hematomas was undertaken. Postoperatively, the patients showed satisfactory recovery, and at discharge the patients were doing well. At the follow-up at the outpatient clinic, the patients were asymptomatic.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/135. Coronary artery erosion and dissection: an unusual complication of mitral annular calcification.This article describes a 42-year-old male patient with a longstanding history of insulin-dependent diabetes mellitus, systemic arterial hypertension, and chronic renal failure. The patient had severe mitral annular calcification (MAC) identified at autopsy. This MAC was of an amorphous, caseous-appearing type; it displaced the posterior mitral valve leaflet and extruded into the myocardium of the lateral and posterolateral left ventricle to involve the epicardial surface. The MAC produced extramural erosion of the wall, and dissection into the media, of the first left/obtuse marginal coronary artery. This coronary artery involvement by, and other complications of, MAC are discussed.- - - - - - - - - - ranking = 4.7121434836127keywords = hypertension (Clic here for more details about this article) |
4/135. Closure of calcified patent ductus arteriosus.Patent ductus arteriosus (PDA) in adults is occasionally associated with calcification and pulmonary hypertension, for which an anterior approach through a median sternotomy with cardiopulmonary bypass is often used. sutures are placed without circulatory arrest by using a transpulmonary balloon catheter as an occluder. To secure the suture tie, we used Nelaton's catheters as tourniquets.- - - - - - - - - - ranking = 4.7121434836127keywords = hypertension (Clic here for more details about this article) |
5/135. Symptomatic calcific stenosis of a Toronto stentless porcine valve.We describe the calcific structural failure of a Toronto stentless porcine valve (TSPV) which had been used to replace a calcified bicuspid aortic valve in a 46-year-old man. Against expectations, left ventricular hypertrophy persisted and the transvalvular pressure gradient rose to 125 mmHg by 6 years with the patient becoming symptomatic and requiring redo surgery. On removal the TSPV showed atypical calcification of the leaflet hinges and wall. To our knowledge this is the first case reported and it may have implications for long term durability and future surgery using this prosthesis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/135. Ultrasonic aortic valve decalcification.We report a case of calcific aortic stenosis in a 79-year-old man who had undergone aortocoronary bypass. Since ordinary valve replacement was problematic because of severe annular calcification, a small annular diameter, and three patent vein grafts, we performed ultrasonic aortic valve decalcification. As a result, the pressure gradient across the aortic valve decreased from 100 mmHg to 25 mmHg, and the patient is doing well to date at two years after the operation. Although long-term results of ultrasonic aortic valve decalcification are still undetermined, it appears worth considering in cases in which ordinary valve replacement could be extremely difficult.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/135. Spectrum of complications related to secondary hyperparathyroidism in a peritoneal dialysis patient.The index patient is a 23-year-old female with end-stage renal disease (ESRD) secondary to chemotherapeutic agents. Continuous cycling peritoneal dialysis (CCPD) has been the renal replacement therapy for the past 5 years since a failed cadaveric renal transplant. Past medical history was significant for diabetes mellitus, hypertension, anemia, bilateral subclavian vein thrombosis with superior vena cava syndrome, secondary hyperparathyroidism, leukemia (at age 8), and hyperlipidemia. On presentation, soft tissue nodules were noted in the anterolateral surfaces of the legs. After 3 months of continued low-calcium-dialysate CCPD, calcitriol, and oral phosphate binders, a 2 x 3 cm nodule was noted on the posterior aspect of the thorax at the scapula. The only complaint at this time was shoulder pain at the acromioclavicular joint. Radiological examination revealed a 3 x 4 cm soft tissue opacity in the superior segment of the left lower lobe laterally. Despite a prior subtotal parathyroidectomy, phosphate binders, and calcitriol, the parathyroid hormone levels continued to increase, with development of tumoral calcinosis, worsening renal osteodystrophy, and calciphylaxis. Computed tomography examination revealed extensive soft tissue calcification consistent with tumoral calcinosis. An ulcerative lesion (1 cm) developed on the lateral aspect of the upper thigh owing to warfarin necrosis versus calciphylaxis. At this time, the phosphate binder was changed from calcium acetate to sevelamer hydrochloride. Aggressive wound treatment and aggressive calcium and phosphate control added to the treatment regimen has resulted in healing of the single ulcer and a decrease in the size of the tumoral lesions. In conclusion, early recognition and aggressive treatment of calciphylaxis can result in reduced morbidity and mortality from calciphylaxis in ESRD patients.- - - - - - - - - - ranking = 4.7121434836127keywords = hypertension (Clic here for more details about this article) |
8/135. Portal venous calcifications 20 years after portosystemic shunting: demonstration by spiral CT with CT angiography and 3D reconstructions.BACKGROUND: Evaluation of the value of spiral computed tomography (SCT), and postprocessing procedures in patients with extensive portal venous calcifications 20 years after portosystemic shunting was performed. methods: In two patients spiral CT (SCT) examinations of the abdomen (slice thickness 3 mm, table feed 6 mm/s) were performed prior and after application of 150 ml of contrast material administered at a flow rate of 4 ml/s. Axial images were reconstructed at 2 mm increments for postprocessing procedures and 6 mm increments for axial source images. Postprocessing was performed with a maximum intensity projection (MIP) and shaded surface display (SSD) imaging program. RESULTS: In both cases preoperative plain film radiography of the chest and abdomen showed large curvilinear calcifications located at the upper quadrant of the abdomen. The calcifications were directed along the expected axis and position of the portal vein and the portosystemic venous anastomosis. Axial CT slices and CTA showed that the calcifications were located in the vessel wall and that the portal vein lumen as well as the portosystemic venous anastomosis were patent. CONCLUSION: Long-standing portal hypertension is capable of causing portal venous calcifications due to mechanical stress to the vessel wall even years after performing portosystemic shunting. Typically, the calcifications are directed along the expected axis and position of the portal vein. SCT of the portal venous system is a reliable method to differentiate between calcifications in a thrombus or in the vessel wall, which may have therapeutic significance.- - - - - - - - - - ranking = 4.7121434836127keywords = hypertension (Clic here for more details about this article) |
9/135. Variant angina pectoris.A patient with variant angina pectoris due to a pedunculated calcific mass extending from the aortic valve and resulting in intermittent obstruction of the left coronary ostia is reported. No atherosclerotic disease was demonstrated by coronary angiography. During attacks, marked ST segment elevation and episodes of tachycardia were associated with a moderate rise in pulmonary artery pressure. Replacement of the calcified aortic valve resulted in total relief of symptomatology.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/135. Dramatic worsening of vascular calcifications after kidney transplantation in spite of early parathyroidectomy.vascular calcification is a common feature in chronic dialysis patients, but their clinical significance is debated and the role of kidney transplantation (TP) in the natural history of their development has received scanty attention. We will describe a case of dramatic worsening of vascular calcifications during TP in a young patient in spite of early and successful parathyroidectomy (PTX), and will discuss other causes which might be putatively linked to vascular damage during the time of TP. A 37-year-old man on regular dialytic treatment (RDT) for 11 years, received his first cadaveric transplantation in January 1993. He underwent PTX 6 months after TP because of the lack of decreasing in parathyroid hormone values despite normal graft function. Although PTX was effective, a dramatic worsening was evident in large as well as in medium and small-sized arteries during the following three years of TP. In February 1997, few months after starting dialysis again because of the recurrence of his primary membranoproliferative glomerulonephritis (MPGN), the patient experienced myocardial infarction followed by aorto-coronary bypass (right coronary artery and anterior descending coronary artery) and leg "claudicatio". Though a role for parathyroid hormone in vascular disease has been commonly accepted, the case here reported clearly shows that blunting parathyroid gland activity may be unable to avoid the worsening of a process of vascular disease during the time of TP. Many other factors--linked to the time of TP--may be involved in vascular diseases, such as nephrotic syndrome, dyslipidemia, hypertension and drugs. In the case of our patient, a clear cut risk factor for his progressive atherosclerosis can be designated hyperlipidema and other disturbancies secondary to a nephrotic syndrome due to relapse of MPGN, together with persistent hypertension. This is the first case report in the English literature which clearly demonstrates that TP may add fuel to the fire of vascular disease also in young people and even in the absence of parathyroid hyperactivity, perhaps on the basis of a favorable genetic background. Furthermore, the history of our patient demonstrates that vascular calcifcation heralds major cardiovascular diseases.- - - - - - - - - - ranking = 9.4242869672253keywords = hypertension (Clic here for more details about this article) |
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