Circulation journal : official journal of the Japanese Circulation Society
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A 57-year-old man was admitted with dyspnea. Clinical evaluation revealed atrial fibrillation and congestive heart failure (CHF). Standard medical therapy of CHF failed to completely improve the dyspnea and polysomnography revealed Cheyne-Stokes respiration with central sleep apnea (CSR-CSA). ⋯ This regimen resulted in marked improvement of cardiac function, evaluated by echocardiography, and reduction of plasma concentration of brain natriuretic peptide. After the patient recovered from CHF and was discharged from hospital, he continued to use NPPV with BiPAP at home. In patients with CHF, it is important to be aware of sleep-related breathing disorders because treatment will not only improve the hypoxemia, but also the cardiac dysfunction.
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A 64-year-old female, admitted because of severe dyspnea on exertion and facial edema, showed echocardiographic findings of a large tumor in the right ventricle (RV). Echocardiography revealed a cardiac mass extending from the RV across the tricuspid valve into the right atrium, synchronized with the cardiac cycle, and severe tricuspid regurgitation was apparent. The mass was removed under cardiopulmonary bypass. ⋯ During the same procedure, after the successful excision of the tumor, small atrial and ventricular septal defects were found that had been caused by the tumor and these were closed directly. The tricuspid valve was repaired with valvuloplasty, chordoplasty and annuloplasty. The microscopic findings were of typical myxoma; however, a right ventricular myxoma protruding into the right atrium is exceedingly rare.
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The factors that influence survival of out-of-hospital cardiac arrest in Japan have not been fully investigated. ⋯ Quick arrival of a paramedic team would improve the survival after out-of-hospital cardiac arrest. General education of lifesaving techniques would be another key factor.
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Although the circulating concentration of B-type natriuretic peptide (BNP) has both a prognostic and diagnostic value in heart disease, no data are available regarding its resuscitative value for out-of-hospital cardiac arrest. ⋯ The measurement of BNP was found to provide valuable predictive information for survival to hospital discharge in patients with out-of-hospital cardiac arrest of cardiac etiology.
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Case Reports
Replacement of an aortic Starr-Edwards ball valve prosthesis 28 years after implantation.
A 53-year-old woman who had undergone aortic valve replacement with a Starr-Edwards (S-E) valve (Model 1260) and open mitral commissurotomy 28 years previously was hospitalized with cardiac failure. Echocardiography showed mitral stenosis, mitral regurgitation, and a normally functioning S-E prosthesis. At reoperation, the mitral and aortic valves were replaced with St Jude bileaflet mechanical prostheses. Examination of the explanted S-E prosthesis revealed no structural abnormality other than lipid infiltration of the silastic ball.