Yu-San Chou

Late Development of Renal Arteriovenous Fistula Following Gunshot Trauma A Case Report

A 43-year-old man presenting with symptoms of congestive heart failure, cardiomegaly, and impaired left ventricular (LV) function was diagnosed as having a huge left renal arteriovenous (AV) fistula. The AV fistula might be attributed to a gunshot wound suffered during his military service twenty years ago. Percutaneous transcatheter arterial embolization utilizing multiple spring coils in conjunction with cyanoacrylic glue success fully occluded the fistula, with subsequent improvement of LV function and reduction of LV size on his serial echocardiographic follow-up.

Transesophageal echocardiographic image of double-chambered right ventricle

Double-chambered right ventricle is a rare congenital heart disease. Anomalous muscle bundles in the right ventricle divide the right ventricle into two portions and cause intracavitary obstruction of the right ventricle. Transesophageal echocardiography of the double-chambered right ventricle has never been reported. We present a 32-year-old man with double-chambered right ventricle associated with perimembranous-type ventricular septal defect and left superior vena cava. Multiplane transesophageal echocardiography provides excellent views of an anomalous muscle bundle in the right ventricle, which differed from a moderator band by its insertion site on the right ventricle.

Bacillus popilliae Endocarditis with Prolonged Complete Heart Block

Bacillus popilliae, a fastidious, aerobic, gram-positive, spore-forming bacillus, has never been reported as a pathogen in human infectious diseases. We report the first case of a human infected by the pathogen B. popilliae, which presented as endocarditis involving the bicuspid aortic valve and complicated with prolonged (> 30 days; to our knowledge, the longest in the literature) complete heart block. Although surgery may be warranted by previous reports, the patient was successfully managed by medical treatment instead, because of the absence of evidence from various approaches that support the existence of perivalvular extension of infection.

Idiopathic Dilatation of the Pulmonary Artery A Case Presentation

Idiopathic dilatation of the pulmonary artery is an uncommon, but not rare, congenital anomaly that is diagnosed by exclusion and generally has a benign clinical course. A left hilar mass on the chest x-ray film is the major presentation. The authors present a case of idiopathic dilatation of the pulmonary artery with posttraumatic chest pain clinically. After serial examinations, idiopathic dilatation of the pulmonary artery was diagnosed. They discuss the phenomenon of transpulmonary valvular pressure gradient and noninvasive tools for long-term follow-up, including transesophageal echocardiography and magnetic resonance imaging.

Adult Isolated Hypoplasia of Left Pulmonary Artery with Exertional Angina and Abnormal Exercise Stress Test: A Case Report and Treatment Implication

Pulmonary artery hypoplasia, either congenital or acquired, is a rare abnormality seen in adults. We reported the first case of adult, isolated, left pulmonary artery hypoplasia, with exertional angina and prominent ST depression in exercise stress test, that seemed to be caused by exertional hypoxemia. Several vasodilators, including nitroglycerin, prostaglandin E1, and nifedipine, were administered individually, each with subsequent hemodynamic monitoring, pulse oximetric monitoring, and exercise test. Vasodilator administrations reduced pulmonary vascular resistance (baseline, 599; vasodilators, 306, 211, and 284 dyne x sec x m2/cm5, respectively) and attenuated ST depression (by 52, 72, and 27%, respectively) but without an immediate benefit on exercise tolerance. All vasodilators except nifedipine ameliorated exertional hypoxemia (expressed by arterial oxygen saturation during peak exercise, baseline, 69%; vasodilators, 85, 78, and 65%, respectively). Additional oxygen supply after nitroglycerin administration further benefited exertional hypoxemia (arterial oxygen saturation, 96%) and exercise ST depression (attenuated by 82%).

Thrombolysis in Myocardial Infarction Frame Count in Single-Vessel Disease After Angioplasty

SUMMARY Background: We compared the thrombolysis in myocardial infarction (TIMI) frame count and examined the impact of angioplasty on the count between patients with normal coronary angiograms and those with singlevessel disease (SVD). Methods: In 780 consecutive patients referred for coronary angiography, TIMI frame count was measured for 149 patients who had SVD and 32 patients with normal angiograms who underwent the procedure for electrophysiologic study or valvular heart disease survey. Results: Comparison of each of the three vessels in the normal vessel group with the corresponding nonstenotic vessels in the SVD group showed similar counts in each of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). For the stenotic vessels, after successful angioplasty, the counts were all reduced (LAD, 54.5 ± 28.8 vs. 34.0 ± 19.3; LCX, 67.3 ± 31.1 vs. 34.1 ± 19.0; RCA, 33.2 ± 28.1 vs. 19.3 ± 7.9; all p < 0.05). In addition, the count in the RCA after angioplasty was lower, compared with the RCA of the normal group (19.3 ± 7.9 vs. 29.1 ± 14.6, p = 0.001). Multivariate analysis showed that the use of oral calcium channel blockers was the only independent predictor for the reduction in RCA after angioplasty. Conclusion: In patients with SVD, the data of TIMI frame count in the nonstenotic vessels were similar to those without the disease, suggesting that the count in the normal artery is not affected by the adjacent stenotic artery. For the stenotic vessels, angioplasty had differential effects on each of the three arteries, indicating the existence of distinct properties, which is affected by calcium channel blockers, for individual coronary arteries in response to atherosclerosis and/or angioplasty. [International Journal of Gerontology 2007; 1(3): 125–130]

Multiple Left Ventricular Aneurysms in Silent Coronary Artery Disease A Case Report

Myocardial infarction leading to left ventricular aneurysm was found in less than 5% of patients. Usually, aneurysm is located at anterior wall, and is rare in other segment. Heart failure could be the major clinical manifestation in a patient with aneurysm, and surgical approach may provide clinical benefit. Here, we report a case with coexistent multiple left ventricular aneurysms without previous chest pain presenting with progressive dyspnea at rest. Reduction myoplasty was successfully performed with bypass graft of coronary arteries leading to subsequent functional improvement

Intracoronary Stenting for Acute Myocardial Infarction Caused by Myocardial Bridging: A Case Report

Myocardial bridging is a benign condition with a favorable long-term outcome. However, some serious complications can be caused by myocardial bridges, such as myocardial infarction, sudden death, or serious arrhythmia, but such reports are rare. We report on a 61-year-old woman who experienced sudden onset of retrosternal chest tightness with radiation to the back lasting over 60 minutes and who came to our hosp ital for help. She had difficulty breathing and chest tightness, and an interoapical infarction on the EKG and elevated cardiac enzymes were found. Cardiac catheterization was performed and revealed myocardial bridging in the left anterior descending coronary artery, resulting in an estimated dynamic stenosis of 90% during systole and complete recovery during diastole. We successfully deployed an intracoronary stent to treat this patient, and she was asymptomatic without complications after 6 months of follow-up. We review the literature and discuss the clinical practice and methods in treating myocardial bridging. We feel we must remind physicians that even benign disease may need invasive intervention when serious complications occur. Intracoronary stenting causes little suffering, has few complications, and is an easy procedure as a first choice before an operation.