Robbinscovington3260

Patients with aortic stenosis (AS) are likely to have sleep-disordered breathing (SDB) and improvements in AS by transcatheter or surgical aortic valve replacement alter the type and severity of SDB. However, limited data are available whether polysomnographic findings changed following transcatheter aortic valve implantation (TAVI). In this report, we describe the case of a patient with severe AS and SDB whose polysomnographic findings showed that after TAVI, sleep disturbances occurred in association with worsened periodic leg movements despite improvement in the SDB. . © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.In all young and middle-aged patients presenting with symptoms of acute heart failure and new heart murmurs, sinus of Valsalva aneurysm (SVA) rupture should be considered in the differential diagnosis. Most of SVAs rupture into the right side of the heart. Percutaneous closure is a less invasive alternative to surgery. A 25-year-old man presented with shortness of breath New York Heart Association class III of nine months' duration with a progressive course. He had a continuous murmur with maximum intensity over the left sternal border and propagated all over the pericardium. Chest radiographs revealed moderate congestion. Transthoracic and transesophageal echocardiograms with 3D imaging revealed a shunt between the ruptured noncoronary SVA and the right atrium. Percutaneous closure decided; the wire passed from superior vena caca through the ruptured sinus to the aorta. The distal disc of the device deployed in the aorta and the proximal disc in the right atrium. The ruptured aneurysm closed with no more flow to the right atrium. The patient was discharged from the hospital after two days. In conclusion, device closure of ruptured coronary sinus to the right atrium is feasible and safe. Surgery should be reserved for patients with failed device closure. . © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Eosinophilic coronary periarteritis (ECPA) is a poorly studied type of coronary arteritis. It causes myocardial ischemia and most cases are diagnosed at autopsy. We report the case of a 35-year-old woman who presented with sudden unexpected cardiac arrest and was brought to the emergency ward. Cardiopulmonary resuscitation was started by ambulance paramedic. On arrival, the patient was transferred to the catheterization laboratory due to sudden aborted cardiac death. The angiography was performed and dissection of the left main coronary artery, extended to the left anterior descending artery was detected. Pathological study confirmed ECPA. It appears that young and healthy patients with a history of intermittent vasospastic angina should be evaluated for ECPA. . © 2019 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.A 65-year-old Japanese woman with an intrapericardial tumor and neck tumor was admitted to our hospital. Intrapericardial tumor had not been resected because of massive bleeding from the hypervascular tumor and its invasion into the pericardium, ascending aorta, and pulmonary artery. The neck tumor had been successfully resected, and paraganglioma was pathologically diagnosed. Abnormal accumulation in the intrapericardial tumor was seen with 123I-metaiodobenzylguanidine scintigraphy. Moreover, gene mutation of succinate dehydrogenase type D was found. Finally, paraganglioma of the carotid body and intrapericardium was diagnosed. . © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.A 17-year-old male with hypertrophic cardiomyopathy underwent placement of a dual-chamber implantable cardioverter defibrillator (ICD) in 2010. In October 2016, he suffered a cardiac arrest. His ICD was interrogated after visiting our hospital. The shock failed, and ventricular fibrillation (VF) terminated spontaneously to sinus rhythm. The Durata lead (SJM, Sylmar, CA, USA) was removed for investigation. The lead had an internal abrasion of a right ventricular conductor cable at the superior vena cava coil. These findings suggest that the ICD shocks that failed to terminate the VF were delivered with low energy due to an internal short circuit of the Durata lead. The very short charge time indicates insufficient energy delivery, which may cause failure of cardioversion and defibrillation. . © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.We encountered an unfamiliar finding during electron microscopic examination of an endomyocardial biopsy obtained from a 55-year-old woman suffering from heart failure due to dilated phase hypertrophic cardiomyopathy. Many cardiomyocytes contained large vacuoles that were mainly empty except for small amounts of amorphous substrate. These were not autophagic vacuoles, as they lacked limiting membranes. Six years later, we encountered similar histological findings in three successive biopsies sourced from another hospital. They were obtained from a 77-year-old man with hypertrophic cardiomyopathy, a 28-year-old woman with endocardial fibrosis, and a 33-year-old man with dilated cardiomyopathy. This biopsy was the second for the endocardial fibrosis patient, and her first biopsy showed no vacuoles within cardiomyocytes. Close inspection of the procedures revealed that in all of these cases the fixed biopsy specimens were carried to the hospital from other institutes using a refrigerated courier service. We then fixed rat heart tissues, froze them once, and processed them for electron microscopy. In that experiment, we were able to reproduce the vacuolar cardiomyocytes, thereby demonstrating it to be a laboratory artifact. We therefore want to emphasize to physicians not to freeze biopsy specimens and not to use a refrigerated courier service for their transport. . © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.99mTechnetium pyrophosphate (99mTc-PYP) scintigraphy has shown utility for diagnosis of transthyretin (ATTR) cardiac amyloidosis with a high sensitivity and specificity. However, in clinical practice, a protocol and a method of analysis of this modality are not yet unified. We present a case of ATTR cardiac amyloidosis showing a positive cardiac uptake in planar imaging but no myocardial uptake in single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging on 99mTc-PYP scintigraphy. BTK signaling inhibitor We considered this tracer accumulation in the cardiac blood pool to be an inconclusive study. In this report, we focus on an inconclusive study case as a potential pitfall of 99mTc-PYP scintigraphy and discuss the interpretation of 99mTc-PYP scintigraphy findings with using both planar and SPECT/CT imaging for improvement of diagnostic accuracy for ATTR cardiac amyloidosis. . © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.