Kenjiro Hori

Deep negative T waves associated with reversible left ventricular dysfunction in acute adrenal crisis

We report two cases of reversible left ventricular dysfunction associated with deep negative T waves during acute adrenal crisis due to isolated deficiency of adrenocorticotrophic hormone. There were no symptoms suggestive of heart disease in either case and left ventricular wall motion abnormalities, present mainly around the left ventricular apex, returned to normal in 1–2 weeks. Deep negative T waves normalized 4 weeks after corticosteroid administration. Acute adrenal crisis should be considered when deep negative T waves are associated with left ventricular dysfunction without cardiac symptoms.

Abnormal venous connection between the left upper pulmonary vein and the left brachiocephalic vein, associated with rheumatic combined valvular heart disease

SummaryA case of partial anomalous pulmonary venous return (PAPVR) associated with mitral stenosis and aortic regurgitation is described. The diagnostic clue was radiocardiography using radioiodide serum albumin (RISA), our routine procedure before cardiac catheterization. The abnormal vessel connected with both the left upper pulmonary vein (PV) and the left brachiocephalic vein, without a stenotic lesion. Aortic valve replacement, open mitral commissurotomy, and simple ligation of the anomalous vein were successfully performed.

Unroofed coronary sinus syndrome: Diagnostic consideration by contrast echocardiography and usefulness of transesophageal echocardiography and magnetic resonance imaging

We present two cases of unroofed coronary sinus syndrome without a left superior vena cava [1]; one is associated with mitral stenosis and the other is an isolated form. The diagnostic clue was a markedly enlarged coronary sinus with color flow within it detected by transthoracic echocardiography. Contrast echocardiography with injection of contrast medium through the left antecubital vein [2] showed a negative jet from the coronary sinus in the right atrium, indicating the presence of a left-to-right shunt through the enlarged coronary sinus. This enlarged coronary sinus was clearly seen lying behind the left atrium by transesophageal echocardiography (TEE) and a communication between the left atrium and the coronary sinus was documented. Echo Doppler gave us additional information about the presence of the flow across the fenestrations. Spin echo magnetic resonance imaging (MRI) demonstrated the fenestration present between the coronary sinus and the left atrium, and cine mode confirmed the flow across these fenestrations. When the coronary sinus is enlarged on transthoracic echocardiography and cannot be filled by contrast echocardiography via the left antecubital vein, further examination for the presence of an unroofed coronary sinus is necessary. T E E and MRI give us useful information in this situation.