Makoto Motooka

Cardiac tamponade during transesophageal echocardiography in a patient with infective endocarditis.

An 81-year-old man with a history of diabetes mellitus and end-stage renal disease was admitted because of infective endocarditis. During transesophageal echocardiography (TEE), pericardial effusion rapidly increased and led to cardiac tamponade. Despite intensive therapy, the patient did not recover. Autopsy showed hemopericardium, ruptured sinus of Valsalva, and vegetation on the aortic valve. Our case suggests that cardiac tamponade due to the rupture of a sinus of Valsalva can occur in patients with aortic valve endocarditis complicated by perivalvular abscess. Therefore, we must be aware of this devastating complication and take preventive measures when performing TEE in such patients.

A case of significantly increased mitral regurgitation early after atrial septal defect closure

We report a rare case in which mitral regurgitation (MR) was exacerbated to a severe level early after atrial septal defect (ASD) closure, even though the female patient had preoperatively mild MR and mild changes in mitral valve (MV) and sinus rhythm. The mechanism of increased MR was considered as poor coaptation and tethering of the MV due to the restricted motion of the posterior leaflet in addition to geometric changes of the left ventricle (LV) after ASD closure.

A rare case of spontaneously dissolved calcification of the mitral annulus: Caseous calcification of the mitral annulus

Caseous calcification of the mitral annulus is a rare variant of mitral annular calcification (MAC). MAC is detected using conventional echocardiography and is prevalent in the elderly. However, limited information is currently available on the transformation of MAC. We herein report a case of a sudden liquified change in MAC, which was diagnosed using echocardiography and computed tomography. <Learning objective: The mechanisms underlying the pathogenesis of caseous calcification of the mitral annulus (CCMA) have not been elucidated in detail. This case report revealed the transition from mitral annular calcification to CCMA, indicating the marked transformation of calcification, which leads to spontaneous liquefaction.>.

Ablation of idiopathic ventricular fibrillation targeting short coupled ventricular premature contractions originating from a right ventricular papillary muscle

We describe a 38-year-old male who experienced several episodes of syncope after having ventricular fibrillation. The electrocardiographic monitoring after his hospitalization revealed repetitive polymorphic ventricular tachycardias. All polymorphic ventricular tachycardias were consistently initiated by a short-coupled monomorphic ventricular premature contraction (VPC). This VPC was suggested to originate from the inferoposterior region of the right ventricle (RV). Radiofrequency catheter ablation targeting the VPC was successfully performed, and the CARTO merge system (Biosense Webster Inc., Diamond Bar, CA, USA) revealed that the culprit region was the root of the posterior papillary muscle of the RV. A subsequent follow-up of 15 months has been uneventful. <Learning objective: This is a case report of idiopathic ventricular fibrillation (IVF) triggered by a ventricular premature contraction (VPC) from the posterior papillary muscle of the right ventricle. We can learn about the relationship between the anatomical structure and the possible mechanisms of the short-coupled variant of Torsade de Pointes.>.

Successful radiofrequency catheter ablation assisted by the CartoSound® system for outflow tract origin nonsustained ventricular tachycardia in a patient with a severely deformed thorax

We report the case of a 72‐year‐old man with a nonsustained ventricular tachycardia and a history of palpitations. He had a severely deformed thorax since childhood due to spinal caries. An integrated computed tomography image of the outflow tract region from the CartoSound® system revealed the detailed anatomical information around the origin of the tachycardia and that the left anterior descending coronary artery was very close (<10 mm) to the target site. We carefully ablated that site with a 3.5‐mm cooled‐tip catheter while confirming it in the sound view, and succeeded without any complications.

A growing accessory coronary artery aneurysm in the septal branch

Nine years ago, an asymptomatic 61-year-old woman was referred to our hospital because of diastolic murmur. Her medical history was unremarkable. An abnormal cavity in the interventricular septum with the jet flowing from the left anterior descending artery was detected by Doppler echocardiography. Coronary angiography showed a large aneurysm in the septal …

A case of intermittent claudication associated with the Angio-Seal™ vascular closure device after carotid artery stenting

We report a case of intermittent claudication caused by the use of Angio-Seal™ vascular closure device after carotid artery stenting. This device is widely used for hemostasis at the femoral arterial puncture site. It allows early ambulation of patients and reduces labor for manual compression. However, various vascular complications have been reported. Physicians need to know the unique structure of this device and possible complications arising after deployment.

The usefulness of contrast echocardiography for detecting right-to-left cardiac shunts during the diagnosis of hypoxemia: 2 case reports

We report two cases in which contrast echocardiography was useful for detecting right-to-left shunt. In case 1, a 53-year-old man was admitted to our hospital after being diagnosed with acute heart failure. Even after improvement of the heart failure, hypoxemia remained. Contrast echocardiography was performed. When contrast medium was injected into the left antecubital vein, it directly drained into the left atrium. When contrast medium was injected into the right antecubital vein, it drained into the right atrium not the left atrium. These findings proved the existence of a right-to-left shunt. In case 2, a 68-year-old man felt dyspnea on mild effort, especially when sitting in an anteflexing posture. In room air, his SpO2 was 95% when sitting in a resting posture and 79% when in an anteflexing sitting posture. Contrast echocardiography was performed. A patent foramen ovale (PFO) was proved using the Valsalva maneuver, and the contrast medium drained from right atrium into the left atrium via the PFO. He underwent patch closure of the PFO, and his symptoms disappeared. Contrast echocardiography should be performed for the diagnosis of chronic hypoxemia for which causes are not detected with routine clinical examinations, in order to confirm right-to-left shunt.