a b s t r a c tVentricular fibrillation (VF) is an important cause of sudden cardiac death in patients with coronary vasospasm. Intensive medical treatment against coronary vasospasm is most important for prevention of VF recurrence, and the efficacy of implantable cardioverter-defibrillator (ICD) devices is controversial. We examined 19 consecutive patients with coronary spasm who had been successfully resuscitated from VF between 1993 and 2010, 13 of whom underwent ICD implantation. There were no apparent differences in the results of coronary angiography and acetylcholine provocation test or in medical therapy among them. Six patients underwent electrophysiological tests during the acetylcholine provocation test, and 3 of them showed ventricular arrhythmia. Three patients had recurrent VF under treatment with single calcium channel blocker (CCB), nitrates, and/or nicorandil. Two of them were without ICDs and were left in vegetative states, and the third was successfully resuscitated by an appropriate ICD discharge. The results of our study suggest that dual or multiple CCB treatment is preferable to prevent VF recurrence, and that combined treatment with ICD may be effective for some patients with coronary vasospasm who have been successfully resuscitated from VF. However, reasonable risk stratification for ICD implantation in these patients needs to be established in the future.
Folate is an essential vitamin for mammals that lack enzyme for de novo folate synthesis. The supply of folate is completely dependent on folate contained in dietary intake. Green leafy vegetables, mushrooms, legumes, and animal liver are good sources of folate supply for humans. Folate
Pericardial cysts are rare benign mediastinal lesions and most commonly located at the cardiophrenic angle. We present a case of an atypically located pericardial cyst in a patient who underwent myocardial revascularization. A 61-year-old man with acute myocardial infarction was scheduled for coronary artery bypass grafting (CABG). Preoperative chest computed tomography revealed a homogenous cystic lesion in the superior mediastinum. The mass was located between the ascending aorta, the superior vena cava, and the left innominate vein. It was growing to the anterior of the aorta and to the right anterior paratracheal area. The density of the mass was close to that of water; thus, the contrast medium failed to enhance its visualization. A concomitant resection of the mass and the CABG was scheduled. After a medial sternotomy and bypass graft harvest, a median pericardectomy was performed. The surgeon found the cystic mass along the roof of the pericardium and located between the ascending aorta and superior vena cava. There was no adhesion between the mass and cardiovascular components. The mass was resected en bloc; therefore, off-pump CABG was completed. Histopathological examination of the resected specimen confirmed diagnosis of a pericardial cyst.
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