Double chambered right ventricle with severe calcification of the tricuspid valve in an elderly woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Double chambered right ventricle is a rare congenital cardiac anomaly in which the right ventricle is divided into two chambers by an anomalous muscle bundle. The diagnosis of this disorder is difficult in adults. Calcification of the tricuspid valve is extremely rare, and very few cases have been reported. Most cases of tricuspid valve calcification had a congenital disorder with high pressure in the right ventricle.</p> <p>Case presentation</p> <p>We report a rare case of a 71-year-old Japanese woman who presented with chest discomfort, and was found to have a double chambered right ventricle with severe calcification of the tricuspid valve. This abnormality was found by echocardiography, and the diagnosis was confirmed by multislice cardiac computerized tomography, cardiac magnetic resonance imaging, and cardiac catheterization. Our patient rejected surgical repair, and medical therapy with carvedilol was effective to reduce her symptoms.</p> <p>Conclusion</p> <p>Calcification of the tricuspid valve is extremely rare, and considered to be due to high pressure in the right ventricle. To the best of our knowledge, there are no other reported cases of this combination of double chambered right ventricle and calcification of the tricuspid valve.</p

Late in-stent restenosis after sirolimus-eluting stent implantation is related to thrombus formation—Insight from a case with IVUS, OCT, and histological findings

SummaryWe experienced a case of very late in-stent restenosis of a sirolimus-eluting stent (SES) (3.0mm×18mm) in the left anterior descending coronary artery in a 62-year-old man with type 2 diabetes mellitus, dyslipidemia, and hypertension. Angina pectoris recurred 39 months after the index percutaneous coronary intervention (PCI). We performed PCI with optical coherence tomography (OCT) and intravascular ultrasound (IVUS) guidance. OCT showed very eccentric low signal plaque with a high signal thin cap on the delayed healing stent struts without intimal coverage. IVUS showed that the plaque was eccentric and hypoechogenic with a “black hole appearance.” We used a filter wire (Filtrap™, Nipro, Osaka, Japan) to prevent distal embolism. Filter no-reflow occurred after predilatation. We deployed a paclitaxel-eluting stent followed by postdilatation. After aspiration and Filtrap™ withdrawal, thrombolysis in myocardial infarction 3 flow was obtained. Histopathological analysis revealed that the main tissue was composed of fibrin deposits with scarce inflammatory cells and proteoglycans. This case revealed that fibrin formation is related to very late in-stent restenosis and OCT and IVUS characteristics of this case are shown

Current status and future perspectives of endoscopic diagnosis and treatment of diminutive colorectal polyps

During colonoscopy, small and diminutive colorectal polyps are commonly encountered. It is estimated that at least one adenomatous polyp is detected in almost half of all patients undergoing screening colonoscopy. In contrast, the ‘predict, resect, and discard’ strategy for diminutive and small colorectal polyps is a current topic especially in Western countries. ‘Is this an acceptable policy in Japan?’ Herein, we report the results of a questionnaire survey with regard to the management of diminutive colorectal polyps, including the thoughts of Japanese endoscopists regarding the ‘predict, resect, and discard’ strategy. At the moment, we propose that this strategy should be used by skilled endoscopists only