Long-term usefulness of percutaneous intrapericardial fibrin-glue fixation therapy for oozing type of left ventricular free wall rupture: a case report.

This report describes a long-term survival case of left ventricular free wall rupture treated with percutaneous intrapericardial fibrin-glue fixation therapy. A 82-year-old woman was admitted to the emergency room because of vomiting and syncope diagnosed as acute posterolateral myocardial infarction complicated by cardiac tamponade. After her hemodynamic condition was stabilized by drawing off the bloody pericardial effusion, fibrin-glue was injected into pericardial space with the expectation that the glue would cover the oozing site of the left ventricular epicardium. After this therapy, the patient recovered and did not have any no recurrent cardiac events for 1 year. Serial echocardiographic studies revealed a preserved left ventricular function and no development of left ventricular restriction. This case suggests that percutaneous intrapericardial fibrin-glue fixation therapy is an effective treatment for the oozing type of left ventricular free wall rupture and that there is no risk of left ventricular restriction during long-term follow-up.     

闭合性心脏破裂伤1例

外伤性心脏破裂是一种严重危及生命的创伤,病情来势凶险,院前病死率高,救治难度大。我院近期收治一位闭合性心脏破裂患者,经积极抢救治疗后痊愈。1临床资料患者为男性,19岁,主因车祸外伤后4 h入院。患者于4 h前骑摩托车高速行驶时不慎摔倒,胸部受到     

Outcome of percutaneous intrapericardial fibrin-glue injection therapy for left ventricular free wall rupture secondary to acute myocardial infarction

Left ventricular free wall rupture (LVFWR) is a fetal complication of acute myocardial infarction. This study was conducted to test the feasibility of percutaneous intrapericardial fibrin-glue injection therapy (PIFIT) for LVFWR after acute myocardial infarction and to assess its clinical outcome. From January 2000 to December 2004, LVFWR was confirmed by echocardiography in 22 patients. Thirteen patients showing abrupt hemodynamic collapse failed to recover from resuscitation maneuvers and died <2 hours after LVFWR. The remaining 9 patients (5 women, mean age 73 +/- 10 years) underwent PIFIT. Pericardiocentesis was performed from the subxiphoid process, and a 6Fr pigtail catheter was introduced into the pericardial space. After bloody fluid was drained from the catheter, the fibrin glue was injected into the pericardial space. There were no complications relating to pericardiocentesis and PIFIT. One patient underwent surgical repair on the day of PIFIT because of uncontrollable bleeding from pericardial drainage. In-hospital death as a result of rerupture occurred in 2 patients on days 4 and 7 after PIFIT. Echocardiography during follow-up revealed no evidence of pseudoaneurysm or left ventricular restriction. On follow-up at a median of 4.0 years (interquartile range 3.1 to 4.8), 1 noncardiac death occurred at 3.3 months. The other 5 patients were free of cardiovascular events and in New York Heart Association functional class I. In conclusion, PIFIT is a simple, effective, and less invasive technique for the management of LVFWR and thus can be an alternative to surgical repair for LVFWR after acute myocardial infarction.     

Survival after oozing type cardiac rupture associated with subepicardial aneurysm evaluated by echocardiography: a case report

A 64-year-old woman was admitted to our hospital with acute myocardial infarction. She underwent emergent percutaneous transluminal coronary angioplasty. Transthoracic echocardiography revealed mild pericardial effusion on the third day. Pericarditis or cardiac rupture were suspected, so transthoracic echocardiography was repeated serially. On the sixth day, transthoracic echocardiography showed increasing pericardial effusion and abrupt interruption of the apical myocardium of the left ventricle and intact epicardial imaging with systolic expansion. The diagnosis was oozing type cardiac rupture of a subepicardial aneurysm. Surgical treatment was successful and the accuracy of the echocardiographic diagnosis was established.     

Diagnosis of pericardial disease using percutaneous biopsy: case report and literature review

We describe the case of a 75-year-old man who presented with a large pericardial effusion and an intrapericardial mass. Malignant thymoma with pericardial involvement was diagnosed by percutaneous pericardial tumor biopsy. The pleural effusion was not malignant. The patient underwent further oncologic evaluation followed by adjunctive chemotherapy and radical extirpation of the tumor. He remains asymptomatic and free of disease 24 months after the procedure. We also discuss the role of percutaneous biopsy in the diagnosis of pericardial diseases.     

Echocardiographic documentation of the instant of cardiac rupture: a case report

The instant of cardiac rupture was initially recorded using two-dimensional echocardiography in a patient with acute myocardial infarction. This 70-year-old woman was admitted to our hospital because of chest pain lasting for six hours. The admission electrocardiogram showed Q waves and S-T segment elevations in leads I, aVL, and V4-6. Two-dimensional echocardiography revealed hypokinesis in the middle and apical portions of the anterior septum and hyperkinesis in the basal portion of the anterior septum and the posterior wall. When the patient suddenly lost consciousness, echocardiography detected a rapidly developing pericardial effusion, which filled the pericardial sac within 13 sec. A myocardial tear was recognized at the apex of the left ventricle between portions of the hypokinesis and hyperkinesis. A simultaneously-recorded electrocardiogram showed sinus rhythm (84/min) which did not change at the moment of rupture and lasted further for 15 sec until a sudden alteration to sinus bradycardia (46/min) occurred. Cardio-pulmonary resuscitation was unsuccessful and the patient died. This is the first such case in the medical literature in which the instant of cardiac rupture was recorded. Detailed reviews of the video tapes revealed that rapid accumulation of pericardial fluid occurred, followed by transient sinus bradycardia, most likely due to vagal reflex to the stretched pericardium.     

Coronary arterial rupture during percutaneous transluminal coronary angioplasty: a case report

A case who developed rupture in a diagonal branch of the left anterior descending coronary artery (LAD) during percutaneous transluminal coronary angioplasty (PTCA) is reported here. The present case was 80-year-old man with severe focal stenosis of the LAD at its junction with a diagonal branch. PTCA for the LAD lesion was successfully performed, but occlusion of the diagonal branch developed later. A subsequent ECG showed elevation of an ST segment in a VL, and PTCA for the diagonal branch was attempted. A 018 Hi-torque floppy guide wire was introduced into the occluded diagonal branch, and its dilatation was attempted using a 2 mm Simpson-Robert catheter. During a maximal pressure of 120 psi, a deformity was found at the distal end of the balloon. Post-PTCA angiograms showed rupture of the diagonal arterial branch, and mild to moderate pericardial effusion was observed by echocardiography. The patient experienced transient hypotension (60 mmHg at systolic), but his condition gradually stabilized after the administration of only a pressor medication. Neither pericardiocentesis nor emergency surgery was performed. The next day, follow-up angiograms showed diagonal branch occlusion at the proximal portion of the rupture site. His clinical course was satisfactory with spontaneous resolution of pericardial effusion and mild elevation of his cardiac enzymes (CPK = 243IU). In this case, it was concluded that the cause of coronary arterial rupture was the difference in diameters of the coronary artery (1 mm) and the balloon catheter (2 mm). This was the first rupture case experienced among 750 PTCA sites (0.13%).(ABSTRACT TRUNCATED AT 250 WORDS)     

无水酒精注射术治疗血压正常的醛固酮瘤一例报告

血压正常的原发性醛固酮增多症罕见。报道本院收治的1例患者用无水酒精治疗情况,分析并讨论其临床和实验室资料。     

主动脉窦瘤破裂形成室间隔夹层一例

患者男性,46岁,因突发胸痛、胸闷60 min于2010年7月入院.患者无明显诱因突发心前区疼痛,伴胸闷、心悸、大汗及左上肢麻木,含服速效救心丸后症状稍缓解.患者有反复发作胸痛、气促病史1年余,多在情绪激动及劳累下发作,伴晕厥2次.2009年4月在当地医院查心电图示三度房室传导阻滞,查超声心动图示左心房增大,室壁增厚,主动脉瓣轻度反流.     

Uncomplicated spontaneous rupture of pancreatic pseudocyst into stomach: A case report

Pseudocysts of the pancreas are not rare, but spontaneous perforation and/or fistulization occurs in fewer than 3% of these pseudocysts. Perforation into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity and through the abdominal wall has been reported. Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection without bleeding. A 67-year-old women with a large pancreatic pseudocyst resulting from a complication of chronic pancreatitis was referred to our institution. During hospital stay, there was sudden decrease in the size of epigastric lump. Repeat computed tomography(CT) revealed that the size of the pseudocyst had decreased significantly; however, gas was observed in stomach and pseudocyst along with rent between lesser curvature of stomach and pseudocyst suggestive of spontaneous cystogastric fistula.The fistula tract occluded spontaneously and the patient recovered without any complication or need for surgical treatment. After 5 wk, follow up CT revealed complete resolution of pseudocyst. Esophagogastroduodenoscopy revealed that the orifice was completely occluded with ulcer at the site of previous fistulous opening.     

Benign pericardial schwannoma with massive pericardial effusion in a Chinese man: A case report

Primary cardiac neoplasms are rare, and the pericardial schwannoma has an even lower occurrence. We report a case of pericardial schwannoma in China, which is the eighth reported case adding to the existing literature on pericardial schwannoma, and this is the first case reported complicated with massive pericardial effusion. Pericardial schwannomas are usually benign, but they can sometimes have a malignant tendency and cause life‐threatening complications. Thus, it should be managed aggressively and completely resected.     

Recurrent pericardial effusion due to retained cardiac pellets: a case report and review of the literature

 A 52-year-old man presented with severe dyspnea 6 months after a thoracic firearm injury. Many pellets distributed in the thoracic wall and an enlarged cardiac silhouette were detected on chest X-ray. There was low voltage in all 12 leads and electrical alternans on electrocardiography. Echocardiography showed a massive pericardial effusion causing cardiac tamponade. Pericardial drainage was performed and 2 400 cc of hemorrhagic fluid was drained using a sheath and pigtail catheter. Coronary arteries were evaluated as normal by angiography, but four pellets which were moving simultaneously within the heart were detected on cardiac fluoroscopy. We thought that the recurrent pericardial effusion in our patient was secondary to pericardial damage due to the gunshot wound, as is seen in postpericardiotomy syndrome. An excellent result was achieved by drainage of the pericardial fluid and oral administration of indomethacin plus prednisolone treatment. Received: August 26, 2002 / Accepted: September 6, 2002 Correspondence to R. Akdemir     

Efficacy of percutaneous balloon pericardiotomy and intrapericardial instillation for the management of refractory pericardial effusion: a case report

Percutaneous balloon pericardiotomy and intrapericardial instillation seemed to be less invasive and effective treatments for refractory pericardial effusion. A 65-year-old man who suffered from refractory pericardial effusion associated with gastric cancer and had been hospitalized three times for pericardiocentesis, complained of dyspnea at rest and visited our emergency room. Echocardiography showed a large amount of pericardial effusion all around the heart and signs of cardiac tamponade. Percutaneous balloon pericardiotomy was performed and pericardial effusion turned to pleural effusion. We performed left thoracocentesis. One week later, massive pericardial effusion localized only around the right heart appeared, and pericardiocentesis was performed again. After another month, pericardial effusion around right heart appeared again and intrapericardial instillation with OK-432 (Picibanil) was tried. After the procedure, the pericardial effusion did not increase, and he has had few symptoms for 2 months as an outpatient.     

Diagnosis of cardiac tumor by percutaneous thromboaspiration. A case report

Percutaneous endovascular thromboaspiration is a valuable tool as illustrated by the case of a patient suffering from a large intracardiac tumour. Histological and immuno-histochemical analysis of the tumour fragments provided the diagnosis of a cardiac angiosarcoma. The patient was a 44 year old man admitted for a large sero-sanguinous pericardial effusion which recurred after drainage. The case was complicated by a haemorrhagic cerebrovascular accident unrelated to a secondary deposit. Initially suspected after transthoracic echocardiography, the diagnosis of a tumour invading the right atrium was confirmed by transoesophageal echocardiography and cardiac CT scan. Surgery was declined and as the diagnosis of lymphoma could not be excluded, the patient underwent biopsy by an original method of percutaneous thromboaspiration. This minimally invasive, low cost technique would appear to be a valuable alternative to other endovascular biopsy techniques (saber, biotome) and to surgical biopsy, and could be proposed as the technique of first intent in an a priori non-operable intra-cardiac tumour or when lymphoma is suspected.     

A rupture of a huge thymic cyst into the pleural cavity: A case report

Thymic cysts (TCs) represent 1-2% of all mediastinal masses. To the best of our knowledge transudative effusion due to rupture of a TC into the pleural cavity, as it happened with our patient, has never been described before. The patient was admitted in 5th Department of Respiratory Medicine of "SOTIRIA" Hospital complaining of pleuritic chest pain in the right hemithorax and dyspnea on exertion. Clinical and laboratory examinations indicated a right pleural effusion. Then, the patient was transferred to the 2nd Department of Propedeutic Surgery of 'LAIKO' Hospital where he underwent surgery. Video-assisted thoracic surgery (VATS) revealed an enormous 25-cm cyst ruptured into the right pleural cavity. The cyst was removed by open thoracotomy due to adhesion to contiguous tissues. Pathological examination indicated thymic origins.     

A case of Sengstaken-Blakemore tube-induced esophageal rupture repaired by endoscopic clipping

A 57-year-old man was admitted to another hospital for hematemesis due to heavy drinking. A Sengstaken-Blakemore tube was inserted and the patient was transferred to our hospital. The patient's ensuing movements inadvertently caused an esophageal rupture 2.5 cm in size. Since the patient's condition was stable, treatment via endoscopic repair using metallic clips was chosen over emergency surgery. Two hemoclips were fixed at the ends of the ruptured area; by employing an endoscopic detachable snare, the ruptured area was carefully repaired with 10 metallic clips. As a result, the esophageal rupture could be successfully repaired by endoscopic procedure rather than performing surgery.