Successful treatment of a ruptured left internal mammary artery aneurysm with a delayed diagnosis of type I neurofibromatosis.

Neurofibromatosis type I (NF-1) induced vasculopathy is rare but catastrophic complication after aneurysmal rupture. We present the case of a 55-year-old female who developed hypovolemic shock because of left internal mammary artery (IMA) pseudoaneurysm rupture associated with NF-1. Even she was not detected NF-1 at the time of arrival in emergency room. We decided to perform percutaneous embolization instead of surgical approach. In this case, after intervention, the ruptured left IMA aneurysm was well treated. After 10 days, the patient discharged without any complications.

Surgical resection of cardiac myxoma-a 30-year single institutional experience.

BACKGROUND: Primary cardiac tumors are rare and myxoma constitutes the majority. The present study summarizes our 30-year clinical outcomes of surgical myxoma resection. METHODS: Between January 1986 and December 2015, 93 patients (30 men, 63 women; mean age, 54.7 ± 16.6 years) underwent surgical myxoma resection. The most common origin site was the left atrium. Surgery was performed via a biatrial approach in 74.2%, atrial septotomy through right atriotomy in 17.2%, and left atriotomy only in 8.6%. Mean myxoma size based on longest length was 4.73 ± 1.92 cm (range, 1.2-11.0 cm). RESULTS: The mean follow-up duration was 9.9 ± 7.8 years (range, 0-29 years). In-hospital mortality was 3.2%. The most common postoperative complication was atrial fibrillation (4.3%). The 5-, 10-, and 30-year survival rates were 92.9%, 87.2%, and 75.5%, respectively. Recurrence occurred in two patients (2.1%), which were detected at 20 and 79 months after the first surgery, respectively. CONCLUSIONS: Long-term survival after myxoma resection was excellent and recurrence was rare. Based on our experience, surgical method did not affect the outcome.

Supraclavicular transposition of aberrant left vertebral artery for hybrid treatment of aortic arch aneurysm: a case report.

BACKGROUND: Vertebral artery variations are common in thoracic aortic patients. If patients have the aberrant left vertebral artery, the more difficult to determine the treatment modality. CASE PRESENTATION: We report the case of a 63-year-old man with an aberrant left vertebral artery originating from an aneurysmal aortic arch. The patient underwent a successful hybrid thoracic endovascular aortic repair after aortic arch debranching and transposition of the aberrant left vertebral artery to the left common carotid artery through a supraclavicular incision without sternotomy. CONCLUSIONS: The aberrant left vertebral artery originating from the aortic arch can be safely transposed to the left common carotid artery through a supraclavicular approach.

Coronary Sinus Ostial Atresia Presenting as Infective Endocarditis in a Previously Healthy Young Woman.

Coronary sinus ostial atresia is a rare disease. Most patients are usually asymptomatic and diagnosed incidentally during surgery or at autopsy. We report a case of coronary sinus ostial atresia with unroofed coronary sinus syndrome in a previously healthy woman who presented with infective endocarditis.

Subsequently occurring bilateral iliopsoas hematoma: a case report.

BACKGROUND: Spontaneous bilateral iliopsoas hematomas is a rare complication after anticoagulant therapy. Furthermore, the onset of bilateral iliopsoas hematoma is unknown because the causes are unclear. CASE PRESENTATION: A 65-year-old man on anticoagulant therapy after mechanical aortic valve replacement was admitted after presenting with severe pain in the left flank and abdomen. Abdominal CT revealed a large left-sided iliopsoas hematoma with extravasation. Fresh frozen plasma was transfused due to prolonged prothrombin time. Transarterial embolization was successfully performed. During the hospital stay, follow-up abdominal CT was performed and a small right-sided iliopsoas hematoma was detected. This was closely observed and an intervention was not performed, as the patient was asymptomatic. The final CT prior to discharge revealed a reduction in size of each hematoma. CONCLUSIONS: Spontaneous bilateral iliopsoas hematoma can be developed subsequently. Patients with unilateral iliopsoas hematoma should be closely monitored for development of bilateral iliopsoas hematoma.

Unusual cause of heart failure: Mitral stenosis and pulmonary venous obstructions caused by the direct invasion of primary cardiac sarcoma.

Cardiac tumor can produce a variety of symptoms and clinical findings depending on the location, size, and histologic type. It may cause heart failure usually by interfering with intracardiac blood flows associated with the mass effects. Here, we report an extremely rare case of heart failure caused by primary cardiac sarcoma with a review of the literature. The cause of heart failure was moderate to severe mitral steno-insufficiency due to the direct tumoral invasion of mitral valve apparatus combined with obstruction of the pulmonary veins.

Altered patterns of gene expression in response to chronic atrial fibrillation.

To obtain greater insight into atrial remodeling at the molecular level we analyzed the changes in gene expression in human atrial tissue between patients with chronic atrial fibrillation (AF) and those with normal sinus rhythm (NSR). cDNA microarray analysis was used to identify genes differentially expressed during sustained AF of more than 6 months (n = 9, mean age, 45 +/- 12, 6 males and 3 females) as compared to those with NSR (n = 9, mean age, 47 +/- 13, 6 males and 3 females). Western blot analysis was performed to confirm the altered gene expression and to establish the changes in protein expression. DNA gel electrophoresis to establish DNA ladder formation, which was associated with apoptosis in response to chronic AF, was performed. Microscopic findings were observed via electron microscopy. In the microarray analysis, out of 8,167 candidate genes, 66 genes showed a significant change in the expression level in the patients with chronic AF, which was in contrast to those with NSR. Among those, 31 genes were consistently down-regulated and 35 up-regulated more than 2-fold. The relative amounts of the Bcl-2 and p27 in the atrial tissue were decreased and angiotensin II type 2 (AT2) receptor and p21 were increased in the patients with chronic AF as compared to those with NSR. The atrial cardiomyocytes in chronic AF showed a prominent DNA ladder, which is a biochemical hallmark of apoptosis. The expression of Bcl-2, AT2 receptor, p21, and p27 were consistent with a significant role in the apoptosis of cardiac myocytes in the patients with chronic AF.