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￭ S-187 ￭
Combined subpectoral ICD implantation and augmentation mammoplasty in a young female patient
Departments of Internal medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
*Dong-Jun Kim
Implantable cardioverter-defibrillator(ICD) is a treatment of choice for sudden cardiac arrest, life-threatening ventricular arrhythmia, and high risk heart failure. Cases of primary prevention with ICD have been increasing due to early detection of heart disease. Recently many patients, especially the low- er-weight and younger ones, are now asking for their physicians’attention to esthetic concerns following ICD implantation. We report a case of com- bined subpectoral ICD implantation and augmentation mammoplasty in a young female patient, which has never been reported in Korea. A 20-year-old female diagnosed with idiopathic dilated cardiomyopathy 9-month ago, was referred to an electrophysiology specialist. After nine months of optimal medical therapy, her left ventricular systolic function still had remained under 35%. She was indicated for primary prevention of ICD. She had small breasts and concerned about her body image after implantation. After discussion with department of plastic surgery, co-operation of subpectoral ICD implantation and augmentation mammoplasty was decided. Under general anesthesia, skin incisions were done on both axillary creases. Subpectoral plane was dissected and mammary implants were inserted. After breast augmentation, ICD pocketwas made via the left axillary incision. A defibrillat- ing V-lead was inserted stably anchored at right ventricular septum. And an A lead was fixed into the right atrial appendage. V and A lead were con- nected to ICD generator. Co-operation was done successfully. Scars were not exposed due to skin incisions were done on both axillary creases. An im- planted ICD was less protruding than others due to breast augmentation. The patient was satisfied and less concerned about her body image. In con- clusion, combined subpectoral ICD implantation and augmentation mammoplasty were a good option for female patients who have small breasts.
￭ S-188 ￭
A Case of Multivessel Spontaneous Coronary Artery Dissection
Division of Cardiology, Department of Internal medicine, Kwangju Christian Hospital, Gwangju, Korea
*Seung Ki Moon, SeungUk Lee, Dong Hoon, Yang, Cheol Min, Park, Shin Hyoung Cho, Soo Kim, Dong Goo Kang, Sang Ki Cho
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI) which may be related with sudden cardiac death.
The incidence, causes, pathogenesis, and treatment have not been defined clearly. Among them, multivessel SCAD is extremely rare and only a few cases have been reported. we experienced a rare case of an elderly man with multivessel SCAD presenting as AMI, which was treated with percuta- neous coronary intervention. A 63-year-old man was transferred with squeezing chest pain that had increased over the past four days. He had no risk factors for coronary artery disease and no history of trauma, infection, or systemic vasculitis. Electrocardiogram showed premature ventricular beats but cardiac enzymes were elevated. Echocardiography demonstrated akinesia in the inferior wall and septal wall with a decreased ejection fraction (EF＝
40%). He underwent emergent coronary angiography, which revealed diffuse long lesion from the proximal to midright coronary artery (RCA) and proximal to mid left anterior descending artery(LAD) with suspicious radiolucent intimal flap. Intravascular ultrasound (IVUS) showed the dissection flap with intramural hematoma compressing the true lumen. We treated with everolimus-eluting stents in the p-m RCA and p-m LAD. Subsequent IVUS demonstrated a fully covered dissection lesion and showed good distal flow without residual stenosis. He was discharged with dual antiplatelet therapy and has been followed up at the outpatient clinic. At 12-month follow-up, the patient was well and aymptomatic.
