WCIM 2014 SEOUL KOREA 71
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0099 Cardiology
Morphological Variation of the Carotid Sinus Location
Satoshi FURUKAWA1, Satomu MORITA1, Katsuji NISHI1, Masahito HITOSUGI1 Shiga University of Medical Science, Japan1
Background: Carotid sinus massage is widely used to detect carotid sinus hypersen- sitivity in patients presenting with syncope. Recent guidelines recommend 5 to 10 seconds of carotid sinus massage in supine and upright positions with beat-to-beat monitoring, but somebody did not respond to the procedure.
Objectives: The aim of this study was to describe the common Carotid Artery Bifurca- tion (CB).
Method and result: Measurements were performed on 100 cadavers by the direct inspection method. The vertebra level of CB was differently distributed in distance of the whole neck measured along the vertebral column between upper borders of C1- C2 to lower border of C5. 54% of the level of CB was asymmetrical between the right and left side.
Conclusion: We showed the anatomical variation of carotid sinus location. Anatomical locations of the carotid sinus bifurcation indicated wide variability. This variation was found to have an impact on the pressure transmission at the carotid sinus region in those individuals that displayed the superior/inferior range of carotid sinus loci.
PS 0100 Cardiology
Features of Microcirculatory Parameters in Patients with Arterial Hypertension and Metabolic Syndrome and Subclinical Hypothyroidism
Ekaterina BYCHINA1, Ludmila PANCHENKOVA1, Ekaterina TROSHINA2
Moscow State University of Medicine and Dentistry, Russia1, Endocrinology Research Center, Russia2 Background: Data on microcirculatory changes in arterial hypertension (AH) is ade- quately represented in modern publications, but the issue of disorders of microcircu- lation in comorbid pathology, including the combination of AH within the metabolic syndrome (MS) and subclinical hypothyroidism (SH) remains poorly understood.
Methods: The study included 87 patients divided into 3 groups: 25 (28,7%) patients with AH, 37 (42,6%) patients with AH in the MS, 25 (28,7%) patients with AH as- sociated with MS and SH. Control group (CG) were 22 practically healthy people. All the patients underwent examination of the state of microcirculation by laser doppler fl owmetry.
Results: There was a statistically significant reduction of the standard deviation of microcirculation (SD M) in all major groups compared with the CG. In the group AH+MS+SH noted a signifi cant increase in heart rate indices fl uctuations (AmaxCF/3SD M) (values more 30%), respiratory rate fl uctuations (AmaxHF/3SD M) (values more 30%) and intravascular resistance (AmaxCF/M) (values more 10 perfusion units (PU)) in the analysis of the distribution of these parameters within the groups as compared to healthy individuals, patients with AH and patients with AH associated with MS. In the group AH+MS+SH revealed a statistically signifi cant decrease in the index of the effectiveness of the microcirculation (IEM) as compared in healthy and patients of the group AH+MS (1,23 [0,99; 1,65] vs 1,75 [1,23; 2,24] и 1,67 [1,31; 2,00] PU respective- ly (p<0,05)).Normotsirkulyatorny type of microcirculation signifi cantly less common in all hypertensive patients compared with controls, and the predominant type of hemo- dynamic microcirculation was spastic.
Conclusions: Microcirculation in hypertensive patients with MS and SH is particularly characterized by the redistribution mechanisms of regulation of the microcirculatory level (prevalence of passive, active suppression mechanisms), severe congestive on venular and capillary levels, worsening of the microvessels.
PS 0101 Cardiology
Intracardiac Bronchogenic Cyst: Report of a Growing Lesion
Jonghanne PARK1, Goo-Yeong CHO2, Kay-Hyun PARK3, Il-Young OH2
Seoul National University Hospital, Korea1, Seoul National University Bundang Hospital, Korea2, Seoul National University Bundang Hospital, Korea3
Introduction: Intracardiac bronchogenic cyst is a rare congenital malformation which is a remnant from abnormal budding of the embryonic foregut. As most of the intra- cardiac cysts are surgically removed promptly after detection, the natural course of intracardiac bronchogenic cyst is unknown.
Case Presentation: 35-year-old man on adjuvant chemotherapy for gastric cancer presented with rapidly growing intracardiac mass incidentally detected at follow-up CT scan. Retrospective review of his pre-op stomach CT scan and follow-up abdomen CT scan revealed that the cyst had increased up to 6-fold in volume over a period of 13 months. Transthoracic echocardiography and magnetic resonance imaging revealed a homogenous cystic mass located at the interatrial septum. The patient underwent surgical excision of the mass. Histopathology identified columnar epithelial cells with focal cilia, consistent with the diagnosis of bronchogenic cyst. At immediate post-operation, 12-lead ECG showed CAVB, which persisted 6 days after surgery. A dual-chamber pacemaker was then implanted before discharge. At two months follow up, the patient was symptom free without any evidence of cardiac tumor or gastric cancer recurrence.
Discussion: Here, we report a case of incidentally detected intracardiac bronchogenic cyst which was rapidly growing. To our knowledge, this is the fi rst report documenting growth of an intracardiac bronchogenic cyst in adult. Generally, growth of broncho- genic cyst is thought to be result of mucus accumulation, bleeding, infection or malig- nant transformation. We speculate that chronic infl ammation precipitated by adjuvant chemotherapy could be the cause of cyst growth.
72 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0102 Cardiology
Isolated Partial Anomalous Pulmonary Venous Connection
Garol Franz Albert GO1, James HO1 Philippine Heart Center, Philippines1
Background: Isolated partial anomalous venous connection (PAPVC) is a very rare variant of PAPVC and mostly involves the anomalous drainage of the right upper pulmonary vein into the superior vena cava (SVC) with no associated interatrial septal defect. It presents with right sided heart failure, arrhythmias, pulmonary vascular dis- ease and may mimic other more common congenital anomalies, such as atrial septal defect.
Case: We present a case of isolated PAPVC occurring in 26 year old female patient who presented with palpitations, exertional dyspnea and easy fatigability. Physical examination revealed dynamic precordium, RV heave, and tricuspid regurgitation murmur. Transthoracic echocardiogram showed right atrial, ventricular, and main pul- monary artery dilatation with moderate pulmonary hypertension. Hemodynamic study was performed revealing isolated partial anomalous venous connection with severe pulmonary hypertension. She underwent Warden’s procedure (superior vena cava translocation with atriocaval anastomosis) which remarkably improved her symptoms.
Conclusions: This case report shows a very rare case of isolated PAPVC presenting with heart failure symptoms and right sided chamber enlargement. The clinical pres- entation may not be specifi c for particular cardiac disease entity and may simulate more common diseases like acyanotic ASD and primary pulmonary hypertension. It is important to report such a case, because this can highlight the importance of high index of suspicion in considering isolated PAPVC in patients with right sided cardiac chamber dilatation.
PS 0103 Cardiology
Anomalous Origin of the Right Coronary Artery from the Posterior Sinus of Valsalva
Garol Franz Albert GO1, Richard TORRES1, Romeo SAAVEDRA1 Philippine Heart Center, Philippines1
Background: Coronary artery anomalies are considered variants of the normal coro- nary artery. These anomalies are rare with an incidence of 0.6% to 5.6% of patients undergoing diagnostic coronary angiography, and approximately 1% of routine autop- sy examinations. Anomalous origin of the right coronary artery from posterior sinus of Valsalva is one particular variant with an incidence of 0.003% of the above reported coronary anomalies. This particular disease entity is mostly asymptomatic, however in 25% of reported cases had sudden cardiac death.
Case: We present a case of an anomalous origin of the right coronary artery from the posterior sinus of Valsalva occurring in 34 year old female patient who present- ed with recurrent easy fatigability, exertional dyspnea, and bipedal edema. Physical examination revealed normal cardiovascular fi ndings but with bipedal edema. Electro- cardiogram and Chest X-ray were normal. Treadmill stress test was inadequate at 4.6 Mets due to early termination at stage 3 secondary to dizziness; isolated premature ventricular contractions and inadequate heart rate response during exercise were ob- served. Echocardiogram showed concentric left ventricular remodeling with adequate contractility and systolic function with no evidence of diastolic dysfunction. Coronary angiogram was done revealing angiographically normal coronaries with anomalous origin of the right coronary artery from the non-coronary sinus (posterior sinus of Val- salva). Medical management was done with noted improvement in symptoms.
Conclusions: This case report exhibits a very rare case of anomalous origin of the right coronary artery from the posterior sinus of Valsalva. It clinically presents with intermittent or episodic right sided heart failure syndrome. It is important to report such a case, because this can emphasize the importance of considering such coronary artery anomaly in the background of right sided heart failure.
PS 0104 Cardiology
Coarctation of the Aorta, Patent Ductus Arteriosus, Bicuspid Aortic Valve, Double Chambered Left Ven- tricle, and a Parachute Mitral Valve in an Adult Pre- senting with Differential Cyanosis Between the Upper Extremities: A Case Report
Jaime AHERRERA1, Ma Teresa ABOLA1, Jose Donato MAGNO1, Ma Helga STA MARIA1, Lauro ABRAHAN1, Richard TIONGCO1, John ANONUEVO1
Philippine General Hospital, Philippines1
Synopsis: We present a unique case of differential cyanosis of the left upper ex- tremity and both lower extremities. Work-up revealed multiple congenital defects.
Survival into adulthood is presumed to be due to a PDA, at the expense of a right to left shunt.
Clinical Presentation: A 22 year old male sought consult for cyanosis. Blood pressure was lower on both lower extremities. He had an ejection murmur on the aortic area, clubbing, and cyanosis & hypoxemia on his left hand and both feet. Imaging (echo- cardiogram and cardiac MRI) revealed a parachute mitral valve, bicuspid aortic valve, double chambered left ventricle, severe coarctation of the aorta, and a PDA at the level of the coarctation. Flow images showed two jets with right to left shunting: 1) an antegrade fl ow from the pulmonary artery through the duct towards the aorta; and a 2) retrograde fl ow towards the left subclavian artery (explaining the cyanosis of the left upper with sparing of the right upper extremity). Our patient opted palliative therapy.
Conclusion: We presented a young male with an atypical presentation of differential cyanosis between the upper extremities diagnosed to have an enigma of heart defects causing multiple obstructions in the left side of the heart. This case demonstrates a unique adaptation of the body in response to severe congenital left sided obstruc- tions. Because of preferential fl ow from the pulmonary artery to the descending aor- ta thru a PDA, severe heart failure was attenuated during childhood allowing him to survive into adulthood. To our knowledge, this is the fi rst reported case that includes this combination of anomalies who survived into adulthood.
