I solated ventricular noncompaction (IVNC) is a rare genetic cardiomyopathy characterized by excessively prominent ventricular trabeculations and deep intertrabecular recesses. It is thought to arise in utero from arrested compaction of a loose myocardial meshwork. The major clinical presentations of left ventricular noncompaction (LVNC) are heart failure, arrhythmias, and thromboembolism. The diagnosis is established with use of 2-dimensional echocardiography or cardiac magnetic resonance (CMR).We report the case of a patient with dilated cardiomyopathy and LVNC, and we discuss the effects of standard heart failure therapy on his condition. Case ReportIn March 2011, a 35-year-old man presented at a cardiology outpatient clinic with a several-week history of palpitations. His medical history yielded nothing relevant, and routine laboratory test results were normal. His chest radiograph showed mild cardiomegaly and normal lung fields. Physical examination revealed normal heart sounds and a mild systolic murmur heard best at the apex. A 12-lead electrocardiogram (ECG) showed sinus rhythm with poor R-wave progression and T-wave inversion in the precordial leads. A transthoracic echocardiogram (TTE) revealed a dilated left ventricle (LV), a depressed LV ejection fraction (LVEF) of 0.25, and moderate mitral regurgitation. A coronary angiogram revealed normal results. A 24-hour ECG showed frequent premature ventricular complexes and runs of nonsustained ventricular tachycardia.Results of a CMR study included a markedly dilated LV with an LVEF of 0.19, an end-diastolic volume of 395 mL, and an end-systolic volume of 319 mL (Fig. 1). Prominent trabeculations were seen in the apical segments and lateral wall of the LV (Fig. 2). The ratio of noncompacted-to-compacted myocardium was 3.35:1. The indexed LV mass was 76 g/m 2 with no evidence of hypertrophy. Right ventricular (RV) size, function, and wall structure were normal. Delayed myocardial gadolinium enhancement produced subtle mid-wall stripes along the anterior and lateral LV wall and the inferior half of the interventricular septum. There was also marked myocardial wall-thinning, particularly of the apical segments. The left atrial diameter was 36 mm. The diagnosis was LVNC with heart failure. The patient was started on perindopril and carvedilol, with gradual upward titration.Because of the patient's ventricular tachycardia and low LVEF, we referred him for implantable cardioverter-defibrillator placement. However, according to the im- Case ReportsKyriacos Papadopoulos, MD Petros M. Petrou, MBChB, MRCP (UK) Demos Michaelides, FRCR, FRCP
Spontaneous coronary artery dissection in association with strenuous exercise and weightlifting is rather sparsely described in the medical literature. Diagnosis S pontaneous coronary artery dissection (SCAD), a rare cause of myocardial infarction (MI) and sudden cardiac death, can present with various acute coronary symptoms. It usually occurs in the peripartum period. In association with strenuous exercise and heavy lifting, SCAD is rather sparsely documented in the medical literature. We report the case of a patient in whom heavy lifting caused SCAD, and we review the literature on this topic. Case ReportIn January 2014, a 54-year-old woman had acute-onset retrosternal chest pain immediately after gardening and disposing of a heavy basket of cut grass. She had a normal body weight, no relevant medical history, and no known risk factors for coronary artery disease. She was 4 years postmenopausal. After an hour of worsening pain, she presented at the emergency department, having experienced cardiac arrest and resuscitation en route. After she was intubated, an electrocardiogram (ECG) showed ST-segment elevation in leads V 2 through V 5 , so she underwent thrombolysis. The patient's troponin T level was elevated at 0.4 ng/mL. The next day, her ECG results were consistent with anterior MI. Coronary angiograms revealed a spiral dissection of the left anterior descending coronary artery (LAD) (Fig. 1), which was successfully treated by means of angioplasty and the implantation of 3 drug-eluting stents. The rest of the coronary tree was smooth. The patient was discharged from the hospital after an uneventful 6-day stay, with instructions to take aspirin, prasugrel, a β-blocker, and a statin. Seven months later, results of an exercise ECG were normal, and the patient had returned to normal activity and full-time work. DiscussionCoronary artery dissection refers to the splitting of the arterial wall layers, the result of which is a false lumen. This dissection can occur spontaneously; after chest trauma, percutaneous coronary intervention, or cardiac surgery; or as part of aortic dissection. Accumulated blood in the false lumen can encroach on the true lumen, thereby impairing blood flow and causing myocardial ischemia, MI, or sudden cardiac death. [1][2][3][4][5] Since the first description of SCAD, 6 approximately 320 documented cases have been reported. This figure might be misleading, because many of the reports were Case Reports
Background-Aim:The vast majority of bile duct injuries occur in cases of open or laparoscopic cholecystectomy. Numerous reports have demonstrated that the incidence of iatrogenic bile duct injuries (IBDI) has risen from 0.3% to 0.6% since the introduction of laparoscopic cholecystectomy. There are many classifications of iatrogenic bile duct injuries, none of which is universally accepted as each has its own limitation. The aim of the present study is to present the results of our investigation of this clinical topic and to propose a therapeutic algorithm for IBDI, considering the time of treatment, diagnosis and multimodal therapy of these lesions.
SUMMARYCardiac haemangiomas are extremely rare and account for approximately 2% of all primary resected cardiac tumours. They can occur in any chamber and at any level, from pericardium to endocardium. Myocardial contrast echocardiography is an imaging tool for the assessment of myocardial microcirculation. It can also be used for the evaluation of the relative perfusion of a cardiac mass. We report a case of a 17-year-old male patient who was referred for cardiological evaluation because of a 2/6 systolic murmur. Transthoracic echocardiography revealed a mass in the left ventricle. Using myocardial perfusion contrast echocardiography, the mass was rapidly filled with contrast greater than the adjacent myocardium, suggesting intense vascularisation. The mass was successfully resected and the subsequent histopathological examination showed a cardiac haemangioma. Therefore, myocardial perfusion contrast echocardiography appears to be a valuable diagnostic tool in differentiating the different types of cardiac masses. BACKGROUND
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