Background Percutaneous transluminal coronary angioplasty (PTCA) has rarely been performed on patients with coronary lesions that result from Kawasaki disease. In this study, we retrospectively evaluated the effectiveness of PTCA in five patients with coronary arterial stenosis that resulted from Kawasaki disease and reviewed previous reports for possible indicators of PTCA effectiveness. Methods and Results Five patients, ranging in age from 2 to 16 years (median, 8 years), underwent conventional PTCA for localized stenosis. The lesion targeted for PTCA was located in the middle right coronary artery of three patients and in the left anterior descending artery in two patients. In four of the five patients, PTCA was angiographically effective, with stenosis rates improving from 84±10% to 33±11% (P<.05). When the previously reported cases of six similar patients were taken into consideration, the only predictor of successful PTCA seemed to be the time elapsed between the onset of Kawasaki disease and perfo...

Application of Percutaneous Transluminal Coronary Angioplasty to Coronary Arterial Stenosis in Kawasaki Disease

Cardiac myxomas (CM) are the most common type of primary cardiac tumours in adults, which have an approximate incidence of up to 0.2% in some autopsy series. The purpose of this review is to summarise the literature on CM, including clinical presentation, differential diagnosis, work-up including imaging modalities and histopathology, management, and prognosis. CM are benign neoplasms developed from multipotent mesenchyme and usually present as an undifferentiated atrial mass. They are typically pedunculated and attached at the fossa ovalis, on the left side of the atrial septum. Potentially life-threatening, the presence of CM calls for prompt diagnosis and surgical resection. Infrequently asymptomatic, patients with CM exhibit various manifestations, ranging from influenza-like symptoms, heart failure and stroke, to sudden death. Although non-specific, a classic triad for CM involves constitutional, embolic, and obstructive or cardiac symptoms. CM may be purposefully characterised or incidentally diagnosed on an echocardiogram, CT scan or cardiac MRI, all of which can help to differentiate CM from other differentials. Echocardiogram is the first-line imaging technique; however, it is fallible, potentially resulting in uncommonly situated CM being overlooked. The diagnosis of CM can often be established based on clinical, imaging and histopathology features. Definitive diagnosis requires macroscopic and histopathological assessment, including positivity for endothelial cell markers such as CD31 and CD34. Their prognosis is excellent when treated with prompt surgical resection, with postsurgical survival rates analogous to overall survival in the age-matched general population.

https://heart.bmj.com/content/heartjnl/early/2021/09/06/heartjnl-2021-319479.full.pdf

Cardiac myxomas: clinical presentation, diagnosis and management.

ブドウ球菌感染症toxic shock syndrome発症機序の解析 ： toxic shock syndrome toxin-1 標的細胞の同定

Objective—To determine whether oral administration of metoclopramide or a commercially available powdered whole grapefruit (PWG) nutraceutical in combination with cyclosporine enhances systemic availability of cyclosporine in dogs. Sample—8 healthy mixed-breed dogs in part 1 and 6 of these 8 dogs in part 2. Procedures—Cyclosporine pharmacokinetics were determined over the course of 24 hours after oral administration of cyclosporine (5 mg/kg) alone, cyclosporine with metoclopramide (0.3 to 0.5 mg/kg), cyclosporine with 2 g of PWG, or cyclosporine combined with both metoclopramide and 2 g of PWG by use of a Latin square crossover study with a 14-day washout period between treatments. Sixty days later, 6 of the 8 dogs were given 10 g of PWG followed by cyclosporine, and pharmacokinetic parameters were compared with those previously obtained after administration of cyclosporine alone. Results—Although metoclopramide or coadministration of metoclopramide and 2 g of PWG had no effect on the pharmacokinetic para...

Effects of powdered whole grapefruit and metoclopramide on the pharmacokinetics of cyclosporine in dogs.

Clinical manifestation and surgical treatment analysis of five cases with biatrial myxoma.

We report a 50 year-old hypertensive and asymptomatic woman in whom a left ventricular tumor was found on a routine two-dimensional transthoracic echocardiogram. Complementary 3D echocardiography, cardiac magnetic resonance and cardiac computed tomography allowed the diagnosis of a calcified left ventricular myxoma. Surgical treatment was performed through a transaortic transvalvular approach with tumor resection and implantation of a pericardial bovine patch. This case confirms the importance of transthoracic echocardiography in the diagnosis of cardiac tumors and the complementary role of 3D echocardiography, cardiac magnetic resonance imaging and computed tomography for the differential diagnosis before surgery.

/pdf/mixoma-ventricular-izquierdo-asintomatico-diagnosticado-5g49q0bcgf.pdf

Mixoma ventricular izquierdo asintomático diagnósticado circunstancialmente por ecocardiografía

We report a 16 year old male with a history of angina on exertion.A treadmill exercise test was positive for ischemia in concordance with a Thallium-201scintigraphy showing a septal and infero-posterior reversible myocardial perfusion defect.Coronary angiography disclosed severe aneurysmal coronary artery disease. Bilateral internalmammary coronary artery bypass grafting was successfully performed. Kawasaki disease is themost likely etiology, although not confirmed (Rev Med Chile 2007; 135: 1182-85).(

/pdf/enfermedad-coronaria-aneurismatica-severa-en-un-adolescente-4f7iyp1g4x.pdf

Enfermedad coronaria aneurismática severa en un adolescente con angina de esfuerzo secundaria a enfermedad de Kawasaki no diagnosticada previamente

Shock cardiogénico refractario: rescate con ECMO, asistencia ventricular y trasplante

Background The incidence rates of cardiac tumors are low. Aim To report the clinical presentation of cardiac myxomas and long-term evolution after resection. Material and methods Review of a database of surgical patients undergoing surgical resection of a cardiac myxoma in a public hospital between 1990 and 2018. Results Seventy-eight patients aged 53 ± 15 years (65% females) were included. The most frequent comorbidities were arterial hypertension (40.5%), hypothyroidism (15%) and diabetes mellitus (12%). The main presenting symptoms were dyspnea (33%), neurological deficit secondary to embolism (30%) and acute pulmonary edema (5%). The most common location was the left atrium, in 87%. During surgery, cardiopulmonary bypass and aortic cross-clamp times were 50.2 ± 19.6 and 33.4 ± 15.2 min, respectively. One patient died due to severe neurological involvement. Follow-up was completed in seventy-seven patients, with a mean echocardiographic follow-up time of 10.4 ± 7.7 years. Thirty-four patients were followed for more than 10 years. Six patients (7.7%) died during the follow-up and in six patients (7%) a recurrence was identified. Conclusions Cardiac myxoma usually has nonspecific symptoms. Surgical excision offers excellent short and long-term results. Complications and recurrence rates are low in non-hereditary myxomas but obligates to perform echocardiographic follow-up for early diagnosis of recurrence.

https://www.scielo.cl/pdf/rmc/v148n1/0717-6163-rmc-148-01-0078.pdf

Mixoma cardíaco: experiencia de 28 años en resección quirúrgica

Use of cyclosporin A has improved survival in patients submitted to cardiac transplantation. However, high cost of cyclosporin poses a problem for many patients in Chile. Ketoconazole is able to reduce hepatic metabolism of cyclosporin and thus prolong therapeutic levels. A 74 to 82% reduction in cyclosporin requirements was obtained in a cardiac transplant patient by adding ketoconazole. No renal damage was detected. Therefore, this drug association may help extend cardiac transplantation programs in Chile.

Ernesto Aranguiz

Papers

Mixoma ventricular izquierdo asintomático diagnósticado circunstancialmente por ecocardiografía

Enfermedad coronaria aneurismática severa en un adolescente con angina de esfuerzo secundaria a enfermedad de Kawasaki no diagnosticada previamente

Shock cardiogénico refractario: rescate con ECMO, asistencia ventricular y trasplante

Mixoma cardíaco: experiencia de 28 años en resección quirúrgica

[Cardiac transplantation: economizing cyclosporin A by including ketoconazole in the immunosuppressive schedule].