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1.
Korean Journal of Medicine ; : 287-292, 2020.
Article | WPRIM | ID: wpr-836643

RÉSUMÉ

Kommerell diverticulum is a rare congenital anomaly of the aortic arch characterized by dilation at the proximal descending aorta, which gives rise to an aberrant subclavian artery. Kommerell diverticulum is usually asymptomatic, but can also be associated with symptoms due to compression of the esophagus or trachea, and can rarely be fatal due to dissection or rupture of the diverticulum. Here, we report a rare case of dysphagia caused by compression of the esophagus by Kommerell diverticulum originating from the right-sided aortic arch.

2.
Article de Anglais | WPRIM | ID: wpr-151266

RÉSUMÉ

BACKGROUND/AIMS: Coronary vasospasms are one of the important causes of sudden cardiac death (SCD). Provocation of coronary vasospasms can be useful, though some results may lead to false positives, with patients potentially experiencing recurrent SCD despite appropriate medical treatments. We hypothesized that it is not coronary vasospasms but inherited primary arrhythmia syndromes (IPAS) that underlie the development of SCD. METHODS: We analyzed 74 consecutive patients (3.8%) who survived out-of-hospital cardiac arrest among 1,986 patients who had angiographically proven coronary vasospasms. Electrical abnormalities were evaluated in serial follow-up electrocardiograms (ECGs) during and after the index event for a 3.9 years median follow-up. Major clinical events were defined as the composite of death and recurrent SCD events. RESULTS: Forty five patients (60.8%) displayed electrocardiographic abnormalities suggesting IPAS: Brugada type patterns in six (8.2%), arrhythmogenic right ventricular dysplasia patterns in three (4.1%), long QT syndrome pattern in one (2.2%), and early repolarization in 38 (51.4%). Patients having major clinical events showed more frequent Brugada type patterns, early repolarization, and more diffuse multivessel coronary vasospasms. Brugada type pattern ECGs (adjusted hazard ratio [HR], 4.22; 95% confidence interval [CI], 1.16 to 15.99; p = 0.034), and early repolarization (HR, 2.97; 95% CI, 1.09 to 8.10; p = 0.034) were ultimately associated with an increased risk of mortality. CONCLUSIONS: Even though a number of aborted SCD survivors have coronary vasospasms, some also have IPAS, which has the potential to cause SCD. Therefore, meticulous evaluations and follow-ups for IPAS are required in those patients.


Sujet(s)
Humains , Troubles du rythme cardiaque , Dysplasie ventriculaire droite arythmogène , Spasme coronaire , Mort subite cardiaque , Électrocardiographie , Études de suivi , Arrêt cardiaque , Syndrome du QT long , Masques , Mortalité , Arrêt cardiaque hors hôpital , Survivants
3.
Article de Anglais | WPRIM | ID: wpr-165842

RÉSUMÉ

Acute pancreatitis is an uncommon side effect of pegylated interferon (PEG-IFN) alpha-2b and ribavirin (RBV) combination therapy. In South Korea, There is a no report of acute pancreatitis associated PEG-IFN alpha-2b plus RBV combination therapy. Here, acute pancreatitis associated with PEG-IFN alpha-2b plus RBV treatment is described in two patients with chronic hepatitis C. We started on weekly subcutaneous injection of PEG-IFN alpha-2b plus daily RBV. During this therapy, acute pancreatitis occurred in these patients without other causes of acute pancreatitis. We thought that the cause of acute pancreatitis in these patients was PEG-IFN alpha-2b and RBV. We stopped the treatment of PEG-IFN alpha-2b and RBV, and patients were improved.


Sujet(s)
Humains , Hépatite C chronique , Injections sous-cutanées , Interférons , Corée , Pancréatite , Ribavirine
4.
Article de Anglais | WPRIM | ID: wpr-165845

RÉSUMÉ

Pacemaker implantation for patients with mechanical tricuspid valve is quite challengeable because lead insertion through prosthetic tricuspid valve may cause valve dysfunction or lead impingement. Also complications due to interrupt of anticoagulation should be considered. A 65 years old woman received AAI (atrium paced, atrium sensed, inhibited) pacemaker for sick sinus syndrome and mechanical mitral valve replacement for severe mitral steno-insufficiency at the same time 16 years before. She needed to undergo mechanical tricuspid valve replacement (TVR) because of severe tricuspid regurgitation despite of medical therapy. Complete atrioventricular block developed during the TVR operation and it was not recovered even after several days of temporary pacing. We decided left ventricular pacing through coronary sinus because ventricular lead could not pass mechanical tricuspid or mitral valve and also planned to continue oral anticoagulation therapy. We could find a place where high pacing output did not pace phrenic nerve with acceptable sensing, pacing threshold. The patient recovered well without any periprocedural complications. Left ventriclcular pacing lead implantation through coronary sinus without interruption of anticoagulation can be an alternative to epicardial pacing for patients with mechanical tricuspid valve.


Sujet(s)
Femelle , Humains , Bloc atrioventriculaire , Sinus coronaire , Valve atrioventriculaire gauche , Nerf phrénique , Maladie du sinus , Insuffisance tricuspide , Valve atrioventriculaire droite
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