No abstract

A 26-year-old man was admitted to the hospital with acute onset of palpitation. His electrocardiogram revealed atrial fibrillation. Transthoracic echocardiography showed a huge coronary sinus and apical displacement of the tricuspid septal leaflets ( Figure 1A-B and Movie 1). We suspected the Ebstein anomaly and tried to find atrial septal defect (ASD), which is often accompanied by such anomalies. But we could not find this defect because he had a very poor acoustic window, and the heart structure was hidden by a huge coronary sinus. To identify persistent left superior vena cava (PLSVC) that may be causing huge coronary sinus, we performed contrast echocardiogram with agitated saline. After infusing saline via the left antecubital vein, the coronary sinus is filled with agitated saline before right atrial enhancement (Figure 1C and Movie 2). This process suggested the existence of PLSVC. For detailed confirmation, the patient underwent cardiac magnetic resonance (CMR) imaging. Cine images showed apical displacement of the septal leaflet from the insertion of the anterior leaflet of the mitral valve by 1.35 mm/m 2 body surface area, consistent with Ebstein anomaly. In addition, 12-mm-sized secundum type ASD and presence of PLSVC were revealed (Figure 2 and Movie 3).

A 52-year-old woman presented with atypical chest pain. Coronary angiography demonstrated multiple microfistulae between left coronary artery and left ventricle (LV) cavity, extensive enough to produce an LV angiogram. This LV angiogram revealed apical hypertrophic cardiomyopathy (HCM) which was confirmed by echocardiography. Coronary steal phenomenon by coronary artery microfistulae and HCM might have a role for developing of angina in patient with apical HCM.

The radiodensity and volume of epicardial adipose tissue (EAT) on computed tomography angiography (CTA) may provide information regarding cardiovascular risk and long-term outcomes. EAT volume is associated with mortality in patients undergoing incident hemodialysis. However, the relationship between EAT radiodensity/volume and all-cause mortality in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis remains elusive. In this retrospective study, EAT radiodensity (in Hounsfield units) and volume (in cm3) on coronary CTA were quantified for patients with ESRD using automatic, quantitative measurement software between January 2012 and December 2018. All-cause mortality data (up to December 2019) were obtained from the Korean National Statistical Office. The prognostic values of EAT radiodensity and volume for predicting long-term mortality were assessed using multivariable Cox regression models, which were adjusted for potential confounders. A total of 221 patients (mean age: 64.88 ± 11.09 years; 114 women and 107 men) with ESRD were included. The median follow-up duration (interquartile range) after coronary CTA was 29.63 (range 16.67–44.7) months. During follow-up, 82 (37.1%) deaths occurred. In the multivariable analysis, EAT radiodensity (hazard ratio [HR] 1.055; 95% confidence interval [CI] 1.015–1.095; p = 0.006) was an independent predictor of all-cause mortality in patients with ESRD. However, EAT volume was not associated with mortality. Higher EAT radiodensity on CTA is associated with higher long-term all-cause mortality in patients undergoing prevalent hemodialysis, highlighting its potential as a prognostic imaging biomarker in patients undergoing hemodialysis.

We report a case of a 41-year-old man undergoing hemodialysis who presented with a sudden fever and dyspnea. He developed a severe pericardial effusion due to methicillin-resistant Staphylococcus aureus, which was identified in both blood and pericardial fluid cultures. He was successfully treated with intravenous vancomycin for 6 weeks. Although such cases are very rare in Korea, the current case describes a primary purulent pericarditis without any other potential infectious foci.