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1/208. Severe hyperkalemia with minimal electrocardiographic manifestations: a report of seven cases.

    Severe hyperkalemia with minimal or nonspecific electrocardiographic (ECG) changes is unusual. We report data on seven patients with renal failure, metabolic acidosis, and severe hyperkalemia (K > or =8 mmol/L) without typical ECG changes. Initial ECGs revealed sinus rhythm and PR and QT intervals in the normal range. QRS intervals were slightly prolonged in two patients (110 ms), and incomplete right bundle branch block was evident in one. Thus, the absence of typical ECG changes does not preclude severe hyperkalemia. ( info)

2/208. Long-term follow-up of a true contractile left ventricular diverticulum.

    The natural history of contractile left ventricular diverticulum in the adult is not known. Serial left ventricular angiography in an adult revealed that a left ventricular diverticulum did not increase in size over a 13-year period, suggesting that the clinical course may be benign. ( info)

3/208. Decreased left ventricular filling pressure 8 months after corrective surgery in a 55-year-old man with tetralogy of fallot: adaptation for increased preload.

    A 55-year-old man with tetralogy of fallot underwent corrective surgery. Left ventricular filling pressure increased markedly with increased left ventricular volume one month after surgery, then decreased over the next 7 months, presumably due to increased left ventricular compliance. ( info)

4/208. The combination of risk factors for sudden death in a resuscitated elderly patient with an exceptional cause of left ventricular hypertrophy.

    The work-up of a previously asymptomatic 72-year-old man presenting with sudden cardiac death revealed a coarctation of the aorta as the cause of arterial hypertension, severe left ventricular hypertrophy, in combination with coronary artery disease with an apical myocardial infarction, severe autonomic dysfunction, and AV-nodal reentrant tachycardia. All these elements and their complex, probably synergistic interactions might have been involved in the development of sudden cardiac death. ( info)

5/208. Aortoventriculoplasty after a prior posterior root enlargement (Manougian): case report.

    A patient with congenital bicuspid aortic stenosis had an open commissurotomy followed 3 years later by a Manougian's operation along with an aortic valve replacement. Nine years later, due to residual aortic stenosis, a Konno's anterior root enlarging procedure with an aortic valve replacement was successfully done. Good relief of aortic and subaortic stenosis and the absence of significant gradient across the left ventricular outflow tract led us to believe that successful and effective relief could be obtained by adding a Konno-type of enlargement to a previously performed posterior enlargement procedure. ( info)

6/208. Coronary artery aneurysms, aortic dissection, and hypertension secondary to primary aldosteronism: a rare triad. A case report.

    Primary aldosteronism is a relatively uncommon etiology of hypertension. plasma renin activity is suppressed in the majority of the cases but not always. plasma renin activity has been associated with increased vascular injury. The occurrence of vascular complications has rarely been reported with low plasma renin activity. The authors report a case of long-standing secondary hypertension due to primary aldosteronism with coronary artery aneurysms and aortic dissection. Diagnosing is important, for therapeutic intervention can be curative. ( info)

7/208. torsades de pointes in a case of hypertrophic cardiomyopathy with special reference to the pathologic findings of the heart including the conduction system.

    A clinicopathologic study was performed in a 77-year-old female with hypertrophic cardiomyopathy who had experienced recurrent syncopal attacks due to Torsades de Pointes (TdP) following QT prolongation and atrioventricular block. She died suddenly two years later while eating dinner. Pathologic findings of the heart showed a dilated and hypertrophied left ventricle. The heart weighed 550 g. There were two foci of localized endocardial fibroelastosis (EFE) beneath the aortic valve, one with a size of 3.5 x 3.5 cm, and the other (2 x 1 cm) located on the upper ventricular septum. Histologic findings showed hypertrophy and disarray in the left ventricular myocardium. The conduction system using serial sectioning revealed remarkable bilateral bundle branch fibrosis and hypertrophied purkinje fibers in the left bundle branch adjacent to the EFE on the ventricular septum. These findings were thought to be related to the occurrence of TdP. ( info)

8/208. A probable relationship between an endogenous digitalis-like substance and concentric cardiac hypertrophy in primary aldosteronism.

    A 44-year-old woman was admitted to our hospital due to severe hypertension. An electrocardiogram (ECG) and an echocardiogram showed severe left ventricular hypertrophy. Her plasma aldosterone level was elevated. magnetic resonance imaging revealed a small mass in the right adrenal gland. Before removal of the tumor, plasma endogenous digitalis-like substance (EDLS) levels were elevated. After removal of the tumor, EDLS levels quickly returned to the normal level. A series of echocardiograms and ECGs over a 6- year period after removal of the tumor showed marked regression of cardiac hypertrophy. These findings suggest that EDLS may be closely related to the development of concentric cardiac hypertrophy in primary aldosteronism. ( info)

9/208. Double-orifice mitral valve with multiple papillary muscles--a report of two patients.

    Two patients with double-orifice mitral valve, in addition to ventricular septal defect in one patient and mitral insufficiency in the other, and multiplicity of left-ventricle papillary muscles are reported. ( info)

10/208. endocardial fibroelastosis as a cause of sudden unexpected death.

    We present a case of primary endocardial fibroelastosis (EFE) which had been diagnosed in a 16-year-old girl who died suddenly and unexpectedly. This exceptional cause of death in adolescence led to a short literature review comparing our findings with previous medicolegal reports. ( info)
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