Pectus excavatum compresses the underlying right side of the heart, which might lead to right ventricular dysfunction as illustrated in this case report.

Aorto-right ventricular fistula is a very rare complication of aortic dissection. We report a case of acute aortic dissection extending into the right ventricle as documented by echocardiography. The patient survived after successful surgical repair.

A 29-year-old man suffering from dyspnea and eosinophilic pleural effusion after being on warfarin for pulmonary thromboembolism for a period of one month, was readmitted to our hospital. Etiology of pleural effusion other than warfarin was excluded. To the best of our knowledge, this is the first case of warfarin-induced pleural effusion reported in Korea.

Background and ObjectivesAlthough the Tei index is a useful predictor of global ventricular function, it has not been investigated at the level of regional myocardial function. We therefore investigated the segmental tissue Doppler image derived-Tei index (TDI-Tei index) in patients with regional wall motion abnormalities.Subjects and MethodsWe prospectively studied 17 patients (mean age 62±9 years, 5 women) with left ventricular (LV) regional wall motion abnormalities. The Tei index, defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET), was measured in the basal and mid segments of the LV walls from standard apical views (4-, 2-, and 5-chamber views). We also obtained TDI velocity data in each segment. LV wall motion was classified as normal, hypokinetic, or akinetic, based on visual analysis. The TDI-Tei index, peak systolic myocardial velocity (Sm), early diastolic myocardial velocity (Em), and late diastolic myocardial velocity (Am) were analyzed in a total of 203 segments.ResultsMean LV ejection fraction was 41.8±8.5%. TDI-Tei indices of dysfunctional segments (akinesis or hypokinesis, n=63) were significantly higher than those of normal segments (n=140) (0.714±0.169 vs. 0.669±0.135, p=0.041, respectively). Average values of TDI-Tei index, Sm, Em, and Am were 0.742±0.201, 4.206±1.336, 5.258±1.867, and 5.578±2.354 in akinetic segments; 0.677±0.101, 4.908±1.615, 5.369±2.121, and 5.542±2.492 in hypokinetic segments; and 0.669±0.135, 5.409±1.519, 6.108±2.356, and 6.719±2.466 in normal segments, respectively. A significant negative correlation was apparent between the TDI-Tei index and Sm (r=-0.302, p<0.001).ConclusionThese data suggest that the value of the segmental TDI-Tei index differs significantly according to regional function grade.

Objective: To assess the 10-year cumulative survival outcome of polymyositis (PM) and dermatomyositis (DM) as well as the factors associated with the the outcome.Methods: Eighty five patients with PM and twenty one patients with DM were diagnosed at our university medical center between 1997 and 2007. Thirty six patients with PM and 13 patients with DM were followed up until death or until the end of January, 2008. Gender, age, AST, ALT, CPK, LDH, ESR, CRP, aldolase, drugs of therapy, combined ILD, and cancer, and duration of remission after therapy were assessed as prognostic factors of death by the Kaplan-Meier curve and Cox regression model. Results:The respective 10-year survival rate for PM and DM was 80.8% (95% confidence interval (CI): 73.3∼87.2) and 55.9% (95% CI: 40.7∼71.1), respectively. The median survival for PM and DM was 11.3 years (95% CI: 9.8∼12.9) and 7.0 years (95% CI: 3.6∼10.5), respectively. Compared to DM patients, the subjects with PM had a 167.26 fold (95% CI: 7.59∼ 3683.19) combined ILD adjusted risk of mortality (p＜0.05) and no other individual factor reached significance as a predictor of death. However, cancer had a hazard ratio (HR) of 17.00 (95% CI: 1.06∼281.79) and 2.45 (95% CI: 0.78∼12.45) for death in the PM and DM group, respectively. Conclusion: According to an analysis of the survival and its prognostic factors in patients with