Seung Pyo Hong

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Initially Visualized by Echocardiography and Multidetector Computed Tomography Coronary Angiography

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly associated with very high mortality during infancy. We report a 35-year-old female patient with ALCAPA initially visualized by echocardiography. She visited outpatient department presenting with intermittent chest discomfort for 3 weeks. Transthoracic echocardiography showed left coronary artery arising from main pulmonary artery and abundant septal color flow Doppler signals. Transesophageal echocardiography clearly revealed markedly dilated and tortuous right coronary artery showing windsock appearance. Multidetector computed tomography and coronary angiography enabled visualization of anomalous left coronary artery originating from left side of main pulmonary trunk. After treadmill exercise test which showed ST-segment depression presenting inducible myocardial ischemia, patient underwent direct re-implantation of the anomalous coronary artery into the aorta without any complication.

Reversible Pulmonary Hypertension in Adolescent with Left Atrial Myxoma

We report a patient of left atrial huge myxoma presenting with severe pulmonary hypertension in adolescents. A patient was a 14-year-old boy presented with sudden onset dyspnea. Transthoracic echocardiographic study revealed the presence of a nodular, 4.34 × 8.11 cm sized, mobile, hyperechoic mass in the left atrium and severe pulmonary hypertension with tricuspid insufficiency. After surgical therapy, tricuspid regurgitation and pulmonary hypertension was decreased and the patient was stabilized and had an uneventful clinical course.

Usefulness of the Doppler Flow of the Ophthalmic Artery in the Evaluation of Carotid and Coronary Atherosclerosis

Background and Objectives There is little information about the relationship between the Doppler flow of the ophthalmic artery (OA) and carotid and coronary atherosclerosis. The aim of the investigation was to assess the clinical usefulness of the Doppler flow of the OA to estimate the severity of carotid and coronary atherosclerosis. Subjects and Methods The study was a retrospective analysis of the findings in 140 patients (mean age: 60 years, male: 64%) who underwent coronary angiography (CA) for the evaluation of typical angina between July 2010 and October 2011 in our single center. The severity of coronary artery stenosis was based on the Gensini score (GS). Significant coronary artery disease (CAD) was defined as the obstruction of over 75% of the major coronary arteries confirmed with CA. The pulsed Doppler flow of the OA and carotid ultrasound were performed before CA. Results The mean systolic velocity/mean diastolic velocity (MSV/MDV), pulsatile index and resistance index in the Doppler flow of the OA were identified as significant and independent correlations with carotid intima-media thickness, and MSV/MDV was identified to have a significant and independent correlation with the GS. MSV/MDV >2.1 was the independent predictor for significant CAD {odds ratio (OR) 3.8, 95% confidence interval (CI) 1.5-9.7, p=0.005} and carotid plaque (OR 2.8, 95% CI 1.1-7.0, p=0.028), after adjustment for CAD-associated factors. Conclusion The Doppler flow of the OA might be a useful predictor of the severity of carotid and coronary atherosclerosis.

Recurrent deep vein thrombosis and pulmonary embolism in a patient with Klinefelter's syndrome.

Klinefelter’s syndrome, which is characterized by small testes, gynecomastia, hypogonadism, and infertility, is the most common cause of primary testicular failure, and commonly has an XXY karyotype. Deep vein thrombosis and thomboembolic events are a rare occurrence in these patients. Although the exact mechanism is not completely understood, it is thought that increased thromboembolic risk in hypogonadic men can be explained by hypofibrinolysis resulting from androgen deficiency. We present the case of a 48-year-old man with Klinefelter’s syndrome who experienced recurrent episodes of deep venous thrombosis and pulmonary embolism while undergoing therapeutic anticoagulation. Our report discusses this association and management of the prothrombotic state in patients with Klinefelter’s syndrome.ZusammenfassungCharakteristisch für das Klinefelter-Syndrom sind kleine Hoden, Gynäkomastie, Hypogonadismus und Infertilität. Das Syndrom ist die häufigste Ursache einer primären Funktionsstörung der Hoden. Meist liegt ein XXY-Karyotyp vor. Tiefe Venenthrombosen und Thromboembolien ereignen sich bei Klinefelter-Patienten selten. Ein erhöhtes thromboembolisches Risiko bei Männern mit Hypogonadismus lässt sich vermutlich durch eine Hypofibrinolyse erklären, die auf einen Androgenmangel zurückgeht. Der genaue Mechanismus ist allerdings nicht vollständig verstanden. Wir berichten über einen 48-jährigen Mann mit Klinefelter-Syndrom und rezidivierenden tiefen Venenthrombosen sowie Lungenembolien unter therapeutischer Antikoagulation. In unserem Fallbericht erörtern wir diese Assoziation und die Behandlung der Thromboseneigung bei Patienten mit Klinefelter-Syndrom.

Heterotopic Ossification of the Xiphoid Process after Abdominal Surgery for Traumatic Hemoperitoneum

Heterotopic ossification of the xiphoid process is extremely rare, with only three cases previously reported. However, the surgical pathology for postoperative elongation of the xiphoid process after abdominal surgery has not yet been reported. We report a case of the postoperative elongation of the xiphoid process, 8 years after abdominal surgery for traumatic hemoperitoneum in a 53-year-old man. The patient underwent surgical excision of the elongated mass of the xiphoid process. Histopathology revealed multiple exostoses. Heterotopic ossification can occur after surgical trauma to soft or bone tissue. Surgical excision with primary closure is the treatment of choice for symptomatic heterotopic ossification.

Free Floating Left Atrial Thrombus Disappearing during Echocardiography

An 82-year-old woman with a history of previous cerebral infarction and atrial fibrillation was hospitalized with aphagia. Brain magnetic resonance imaging showed a dot-like high signal intensity in the left occipital subcortex. With a working diagnosis of acute cerebral infarction due to cardiac emboli, trans-thoracic echocardiography (TTE) was performed. The TTE showed an oval shaped, mobile thrombus, approximately 1.9 × 1.5 cm in size within the left atrial appendage. For further evaluation of mobile thrombus in the left atrial appendage, a trans-esophageal echocardiography (TEE) was done. The TEE showed an oval shaped, mobile thrombus in the left atrial appendage (Fig. 1A). Subsequently, during follow-up TTE, the thrombus was found to be freely floating in the left atrial cavity during each cardiac cycle (Fig. 1B-F and Supplementary movie 1). After a number of cardiac cycles, the thrombus suddenly disappeared in TTE. The patients overall clinical condition and neurologic examination continued to appear stable for the entirety of echocardiographic examination. n n n nFig. 1 n nTrans-esophageal echocardiography showed a free floating thrombus in the left atrial appendage (A). Trans-thoracic echocardiography (TTE) showed free floating thrombus in the left atrial appendage (B). TTE showed the thrombus moving from left atrial appendage ... n n n nAfter one day, the patient complained claudication in the lower right limb. In physical examination, the patients femoral pulses were not present to prompt a pulse exam. We performed a 3-dimensional (3D) femoral computer tomography (CT) to evaluate for occlusion. The 3D femoral CT showed a new filling defect in the right femoral artery in comparison with an abdominal enhanced CT performed for evaluation of fever 2 days ago (Fig. 2). Following the examination, the patient was placed on warfarin for anticoagulation therapy. The patient was discharged from the hospital with an uneventful recovery and has been doing well without additional embolic events after discharge and maintenance anticoagulation therapy. n n n nFig. 2 n nAbdominal enhanced computer tomography (CT) for evaluation of fever did not show a filling defect in the right femoral artery in axial plane 2 days ago (A and C). 3-dimensional (3D) femoral CT showed a filling defect (arrow) in the right femoral artery ... n n n nLeft atrial free floating thrombus is infrequent but predominantly associated with mitral valve disease, atrial fibrillation, as in our case, and hypertrophic cardiomyopathy.1-4) The presence of left atrial free floating thrombus is linked to higher embolic rates and the most common presentation of left atrial thrombus is, as in our case, peripheral embolization.5) This case is an interesting case of free-floating left atrial thrombus disappearing during echocardiography.