心血管疾患と診断

Cardiovascular symptoms are often predominant features in patients with hyperthyroidism. But cardiovascular findings in hypothyroidism are more subtle. Hypothyroidism mainly presents as lethargy, cold intolerance, constipation, proximal muscle weakness, weight gain, decreased appetite, coarse dry skin, hair loss and nonpitting edema. Cardiovascular findings in hypothyroidism are mild degree of bradycardia, diastolic hypertension and narrow pulse pressure. Mild degree of pericardial effusion is seen in up to 30% of overtly hypothyroid patients. There are several case reports on myxedema ascites, but only few case reports of hypothyroidism presenting as massive pericardial effusion. We report a case of 54-year-old female presenting with breathlessness and found to have massive pericardial effusion without tamponade. After extensive workup, she was found to have primary hypothyroidism. In contrast, she had no other symptoms and clinical signs suggestive of hypothyroidism. She was improved after treatment with levothyroxine.

Multiple Pulmonary Arteriovenous Fistulas (PAVFs) are rare vascular abnormalities in the general population, with a report on 15000 autopsies revealing only 3 cases of multiple PAVFs. However, these abnormal communications between pulmonary arteries and veins are commonly seen in patients with Hereditary Hemorrhagic Telangiectasia (HHT). Several conditions such as cirrhosis, chest trauma, metastatic carcinoma, schistosomiasis, and systemic amyloidosis are accountable for acquired form PAVF. We describe 2 patients (mother and son) with multiple PAVFs and no apparent signs or symptoms suggestive of HHT. A pulmonary artery injection wes performed for Case 1 (mother) and showed bilateral PAVFs with aneurysmal dilation. Given the diagnosis of PAVFs in the mother, we considered the same pathology for the child’s symptoms. Therefore, the boy also underwent pulmonary angiography, which revealed multiple bilateral PAVFs. Both patients underwent interventional angiography and the PAVFs were occulted with stainless coil. In conclusion, the presence of multiple PAVFs should be considered in the differential diagnosis of patients with unexplained exertional dyspnea and cyanosis, even in the absence of diagnostic features suggestive of HHT.

This report describes a rare and life threatening occurrence of right atrial tamponade secondary to massive intrapericardial clot compressing the right atrium, in a three year old child post atrial septal defect surgery.

Systemic sclerosis (SSc) is a rare, auto immunological, connective tissue disease characterized by vasomotor disturbances, fibrosis and further atrophy of the skin and internal organs. There are many factors leading to immunological and vascular changes. One of the most prominent vascular symptoms is Raynaud’s phenomenon, which may be caused by different factors such as cold or excessive stress. This case report presents a 37- year old Caucasian woman with SSc, with severely impaired microcirculation of the hands and necrosis of the distal phalanges due to several hours of exposure to the cold. The patient required intensification of intravenous rheological treatment with alprostadil and oral usage of sildenafil, which had a positive effect on the improvement of the impaired microcirculation. Like many others, this case demonstrates that IV. rheological treatment may be effective in restoring microcirculation in such cases among SSc patients.

Purpose: Tricuspid annuloplasty rings are commonly used to cinch an enlarged tricuspid annulus back to its original shape and size in patients with severe functional tricuspid regurgitation. However, the invasive operation is contraindicated for patients at risk for reoperation. Fortunately, transcatheter repair procedures, currently in the development process, are minimally invasive alternatives to current repair techniques. This study aims to determine the species-dependence of cinching force with the potential of informing transcatheter repair design by quantifying the minimum required cinching force necessary to reduce tricuspid regurgitation.

Methods: The cinching force necessary to reduce the septal-lateral diameter of a dilated annuls was quantified and compared in ten ovine hearts and nine porcine hearts. Additionally, a deparaffinization protocol and Verhoeff- Van Gieson stain were used to compare the microscopic structure of tissue samples at different stages of the experimental procedure in the two species.

Results: The maximum annulus dilation observed for the porcine was 11.2%, and the maximum cinching force was 0.40 ± 0.12 N. As previously demonstrated, ovine hearts yielded a maximum annulus dilation and cinching force of 8.82% and 0.38 ± 0.09 N respectively. Histological stains revealed no gross tissue differences between ovine and porcine septal or free wall tissues.

Conclusion: The cinching force was not species dependent between ovine and porcine models. This study is an essential first step for determining which animal model should be utilized for the development of transcatheter devices.

Aim: In the present study, we aimed to present the retrospective outcomes of the patients who underwent carotid endarterectomy under local anesthesia followed by cardiopulmonary bypass under general anesthesia during the same session.

Material and methods: 52 patients (36 male, 16 female patients; mean age was 69.0 ± 8.5 years: range 42 to 75 years) with carotid lesions underwent carotid endarterectomy under local anesthesia and simultaneous cardiopulmonary bypass between 1st March 2015 and 1st March 2016 in our center. This study involved patients with myocardial revascularization and 80% or more carotid stenosis (with or without contralateral disease). Preoperative, preoperative and postoperative characteristics of the patients were retrospectively analyzed.

Results: Operative mortality rate was 1.9% with one patient. Early postoperative revision was performed in 3 patients (5.7%) bleeding. Postoperative atrial fibrillation developed in 6 patients (11.5%). There was no cerebrovasculary accident postoperatively.

Conclusion: The incidence of coronary and carotid artery disease coexistence is not too low. The combined approach increases the stroke and mortality rate by using general anesthesia in the procedure, although the odds of complications appearing to reduce the duration of hospitalization with the performance of a single seansta procedure. In this study, we reported that local carotid artery intervention and simultaneous coronary artery bypass surgery reduced the stroke risk and mortality rates.