Successful palliation for an aged patient with primary pericardial mesothelioma.

An 85-year-old Japanese man with a complaint of exertional dyspnea was admitted to our hospital. Sixty-three years prior to admission at our hospital, he handled asbestos for 2 years in a factory. His chest computed tomography showed a massive pericardial effusion leading to cardiac tamponade and right pleural plaque. After a pericardiocentesis was performed, he recovered from cardiac failure caused by the cardiac tamponade. Pathological examination of the pericardial effusion revealed malignant mesothelial cells. Therefore, he was diagnosed with primary pericardial mesothelioma (PPM) related to asbestos exposure. Although his disease slowly progressed over 18 months, he remained active without any adjuvant treatments such as chemotherapy. Long-term palliation in an aged patient with PPM is rarely obtained using supportive care alone because the prognosis of PPM has been consistently reported to be very poor and almost fatal within a year. Clinical oncologists and thoracic surgeons should be aware of this disease because the accumulation of knowledge on PPM may lead to successful treatment even in aged patients.

Impact of target lesion coronary calcification on stent expansion.

BACKGROUND: Stent underexpansion remains a concern as a cause of drug-eluting stent (DES) failure. Although coronary calcification is considered to be a contributing factor in stent underexpansion, previous intravascular ultrasound studies have failed to demonstrate this relationship. We investigated whether stent expansion could be predicted by coronary calcification as assessed by optical coherence tomography (OCT). METHODS AND RESULTS: We enrolled 51 de novo native coronary artery lesions treated by a single 2nd-generation DES (3 types). Prior to stent deployment, the arc and area of calcium at the target lesion were measured using OCT. After successful stent implantation, OCT imaging was repeated to assess minimal stent diameter and area (MSD and MSA). Stent expansion was defined as MSD (or MSA) divided by the values predicted by the manufacturers' compliance charts. Patients were divided into 4 groups according to the median values of the arc and area of calcium. Mean stent expansion was 73.3±8.7% for MSD and 65.2±12.0% for MSA. Stent expansion defined by MSD was significantly different among the 4 groups (P=0.02). A similar trend was observed for stent expansion defined by MSA (P=0.16). CONCLUSIONS: The extent of target lesion calcification as assessed by OCT may be an important determinant of the expansion of 2nd-generation DES.

Successful stent implantation guided by intravascular ultrasound and a Doppler guidewire without contrast injection in a patient with allergy to iodinated contrast media.

Presence of allergy to iodinated contrast may prevent percutaneous coronary intervention (PCI) to be performed. We present a 76-year-old male with a history of allergic reaction to iodinated contrast who successfully underwent intravascular ultrasound (IVUS) and a Doppler guidewire-guided PCI. Stent size was determined based on IVUS. After PCI, stent expansion and a lack of edge dissection or incomplete apposition were confirmed by IVUS and a good antegrade coronary flow was confirmed by a Doppler guidewire. Thus, PCI without contrast injection under IVUS and a Doppler guidewire-guidance may be feasible in selected patients with allergy to iodinated contrast.

Local release of catecholamines from the hearts of patients with tako-tsubo-like left ventricular dysfunction.

BACKGROUND: The precise mechanism of tako-tsubo-like left ventricular (LV) dysfunction remains unclear, although recent studies have shown that activation of sympathetic tone might be involved. However, local release of catecholamines from cardiac sympathetic efferent neurons in patients with tako-tsubo-like LV dysfunction remains poorly understood. The purpose of this study was to investigate evidence of local release of catecholamines from the hearts of patients with tako-tsubo-like LV dysfunction. METHODS AND RESULTS: Five consecutive patients with tako-tsubo-like LV dysfunction were studied. After confirming LV apical ballooning and a normal coronary angiogram, sampling of blood for the measurement of plasma catecholamine levels was performed at the aortic root (Ao) and coronary sinus (CS). In all 5 cases, increased local release of norepinephrine from the heart was documented (597, 4,238, 2,121, 486, 371 pg/ml at the Ao; 836, 5,719, 3,386, 658, 472 pg/ml at the CS, respectively). CONCLUSIONS: Increased cardiac catecholamines might cause the transient LV apical ballooning in patients with tako-tsubo-like LV dysfunction.