Spontaneous nasal septal perforation in patients with rheumatoid arthritis

Nasal septal perforation is known to be associated with various traumatic and disease states, yet spontaneous nasal septal perforation (SNSP) is relatively rare. SNSP has been reported in three patients with seropositive rheumatoid arthritis (RA) and we report an additional seven patients with SNSP and RA, four of whom were seronegative and none of whom had Raynaud's, in contrast to those reported previously. Manifestations of overt infectious, neoplastic or granulomatous disease have not been found in our seven patients over several years of close follow-up. We have identified no obvious pathogenesis or specific etiology for SNSP. We suggest that SNSP may represent an unusual manifestation of RA previously not well recognized.     

Nasal septal perforation and systemic disease

INTRODUCTION: Nasal septal perforations are mainly due to trauma. Our review highlights systemic diseases leading to this disorder. CURRENT KNOWLEDGE AND KEY POINTS: Various systemic diseases may be responsible of nasal septal perforation: Wegener's granulomatosis, systemic lupus erythematosus, antiphospholipid syndrome, sarcoidosis, cryoglobulinaemia. But, very few data are available about the frequency of septum nasal perforation in each disease. Clinical manifestations are numerous and not specific: obstruction, epistaxis, postnasal discharge, whistling, crusting. Asymptomatic forms are frequent. Biopsy of nasal septum is poorly useful for the diagnosis except when granuloma or vasculitis is found. Pathophysiologic mechanisms of nasal septal perforation are ischemic, infectious or inflammatory. FUTURE PROSPECTS AND PROJECTS: Systemic disease may be suspected in unclear nasal septal perforation. More, in systemic disease, even when symptoms are absent, intranasal examination is required.     

Tako-tsubo cardiomyopathy complicated by ventricular septal perforation and septal dissection

Tako-tsubo cardiomyopathy is a form of reversible left ventricular dysfunction, with a clinical and electrocardiographic picture of acute myocardial infarction in the absence of significant coronary disease. The precise clinical features and etiologic basis of this syndrome remain unclear, although an association with emotional or stressful triggers has been recognized. We describe the first case of this syndrome complicated with a ventricular septal perforation and dissection.     

Ventricular septal perforation following left ventricular angiography

A rare case of ventricular septal perforation at the time of left ventricular angiography is reported. The complication, which may lead to an erroneous diagnosis of ventricular septal defect, is suggested by detection of extravasation of contrast agent within the septum itself.     

Cardiac perforation after device closure of atrial septal defects with the Amplatzer septal occluder

OBJECTIVES: Amplatzer septal occluder (ASO)-associated cardiac perforation (CP) at our institution prompted this retrospective review. BACKGROUND: Cardiac perforation is a rare complication after transcatheter atrial septal defect (ASD) closure. METHODS: To identify CP after transcatheter ASD closure with ASO, cardiac events (CE) describing definite CP, hemopericardium, pericardial effusion, cardiovascular collapse, or sudden death were analyzed. Cardiac events were identified from published literature (MEDLINE), medical device regulating agencies in North America and the European Commission, and AGA Medical Corporation (Golden Valley, Minnesota). Institutional cases were reviewed. Cardiac events were defined as early (pre-discharge) or late (post-discharge). RESULTS: Twenty-nine CEs were identified. Five were excluded because findings were inconclusive for device-related CP. Ten patients were <18 years of age. Late CEs occurred in 66.6%; 25% presented weeks later (longest, three years). Three deaths were reported. Cardiac perforation occurred predominantly in the anterosuperior atrial walls and/or adjacent aorta. CONCLUSIONS: Amplatzer septal occluder-associated CP uniquely involves the anterosuperior atrial walls and adjacent aorta. Pathophysiology remains poorly understood.     

21例心肌梗死后室间隔穿孔的外科治疗

目的:探讨心肌梗死(MI)后室间隔穿孔患者的外科治疗方法。方法:2003年11月至2011年10月,21例AMI后室间隔穿孔行外科手术治疗,本研究回顾性分析全组围术期及中长期生存状况,比较手术前后心功能评级、左心室射血分数(LVEF)和舒张期末内径(LVEDD)。结果:全组围术期死亡2例(2/21)。随访(36±13)个月,死亡3例,全组5年生存率为(76.8±13.5)%。全组患者手术前射血分数为(45.1±9.1)%,术后6个月随访期,射血分数为(51.3±4.3)%,P<0.05。结论:心肌梗死(MI)合并室间隔穿孔手术治疗,可以取得较满意的围术期和中长期效果,并显著提高左心室射血分数。     

Electrophysiological characteristics of septal perforation during left bundle branch pacing

1. Download : Download high-res image (192KB)
2. Download : Download full-size image

     

A case of takotsubo cardiomyopathy complicated by ventricular septal perforation

The patient was a 73-year-old female who developed chest pain and dyspnea 16 days after her husband passed away. ST segment elevation was detected on V(2-5) by electrocardiography and emergency coronary arteriography was done for suspected acute myocardial infarction. No coronary arterial stenosis was present and ventricular septal perforation and takotsubo cardiomyopathy were diagnosed by left ventriculography. The perforation was closed and the patient was discharged 23 days after surgery. This patient had a very rare case of takotsubo cardiomyopathy, which was complicated by ventricular septal perforation and was saved by surgical treatment. (Circ J 2008; 72: 1540 - 1543).     

Ventricular septal perforation in a patient with takotsubo cardiomyopathy.

An 84-year-old woman was admitted with anorexia and because the serum cardiac markers, electrocardiogram and echocardiography suggested acute myocardial infarction she underwent emergency cardiac catheterization. Coronary angiography revealed no significant coronary artery stenosis, but left ventriculography revealed akinesis of the left ventricular apex with shunt flow to the right ventricle. The diagnosis was a rare case of takotsubo cardiomyopathy complicated by ventricular septal perforation. The patient died of cardiogenic shock on the day of admission day.     

急性心肌梗死合并室间隔穿孔5例分析

目的探讨急性心肌梗死 ( AMI)并发室间隔穿孔 ( VSP)防治措施。方法　对 5例 AMI合并 VSP患者临床资料进行回顾性分析。结果　应用硝普钠、多巴胺等药物和主动脉内球囊反搏术 ( IABP)可使 AMI合并 VSP患者围手术期获得暂时血流动力学稳定。结论　对 6 0岁以上、首次发生、特别是前壁 AMI患者 1周内应采取积极的预防措施 ,防止 VSP的发生 ,一旦发生应立即应用内科药物和 IABP,适时进行手术矫正机械并发症和血运重建     

室缺修补术后，主动脉瓣穿孔一例

室间隔缺损修补术后，主动脉瓣穿孔一例的个案报道     

Transcatheter creation of an atrial septal defect using radiofrequency perforation.

Transseptal perforation using radiofrequency energy was performed successfully in a patient with congenital heart disease and a thickened interatrial septum. This was followed by balloon dilatation of the atrial septal defect. Radiofrequency is presented as a alternative to standard transseptal needle puncture. Cathet Cardiovasc Intervent 2001;54:83-87.     

Determinants of in-hospital death in patients with postinfarction ventricular septal perforation

Ventricular septal perforation (VSP) is a serious complication associated with acute myocardial infarction (MI). The purpose of this study was to investigate the determinants of in-hospital death in patients with postinfarction VSP. Between January 1990 and April 2010, we identified 37 patients from our hospital records. Univariate analysis and multivariate logistic regression analysis were performed to find the determinants of in-hospital death. In-hospital mortality was 35% (13/37 patients). History of hypertension (P = 0.03), percutaneous coronary intervention (P = 0.04), and preoperative percutaneous cardiopulmonary support (P = 0.04) were associated with in-hospital death, whereas history of hyperlipidemia was associated with in-hospital survival. The interval from MI to VSP in survivors was significantly longer than that in nonsurvivors (P < 0.01). In multivariate logistic regression analysis, a shorter interval from MI to VSP (odds ratio 0.57, 95% confidence interval 0.34-0.95, P = 0.03) was found to be an independent predictor of in-hospital death. In conclusion, in-hospital mortality was high in patients with postinfarction VSP. A shorter interval from MI to VSP was a significant independent predictor of in-hospital death.