A 95-year-old woman with no prior cardiac history presented with symptomatic complete atrioventricular block. She underwent temporary cardiac pacing via the cervical vein, but a pacing lead could not be introduced via the usual route because of a mediastinal tumor. A leadless pacemaker (MicraTM; Medtronic, Minneapolis, MN) was implanted on the right ventricular septum via the right femoral vein. The procedure time was 40 minutes without any complication. The implantation of a leadless pacemaker was useful to improve the symptoms of a super-elderly woman with mediastinal tumor.
We studied the efficacy of sublingual midazolam compared with oral midazolam for predmedication in children.Forty-two children (9 months-11 years of age) for minor elective surgery were divided into 2 groups; one group treated with sublingual midazolam at 30 minutes before the entrance into operating room, and the other group receiving oral midazolam at 30 minutes before entering operating room. The group treated with sublingual midazolam at 30 minutes received sublingual midazolam 0.2 mg x kg(-1), while the other group received oral midazolam 0.5 mg x kg(-1) with syrup. We evaluated the taste acceptability, the effect of sedation, the anxiolysis and the cooperation for mask acceptance by using scales.Twenty children accepted sublingual midazolam, and twenty-one accepted oral midazolam. It was effective and satisfactory in taste acceptability, sedation, anxiolysis and cooperation in both groups. There was no difference between the two groups. Any respiratory depression and delayed recovery were not observed.Sublingual midazolam 0.2 mg x kg(-1) is useful for premedication in pediatric anesthesia, and it equals with oral midazolam 0.5 mg x kg(-1) in efficacy.
The diagnosis of cardiac sarcoidosis (CS) has become easier due to advances in imaging modalities, but we sometimes encounter difficult-to-diagnose patients. We herein report the case of a 60-year-old Japanese woman who was diagnosed with isolated CS, although she also met the diagnostic criteria of arrhythmogenic right ventricular cardiomyopathy (ARVC). A histological examination by an endomyocardial biopsy of the right ventricle revealed the typical findings of granulomatous change for CS. Although she did not show any characteristics of systemic sarcoidosis, oral prednisolone treatment was introduced, and she achieved a good response. This case shows that the characteristics of CS can overlap with the diagnostic criteria of ARVC, and that a histological examination is essential for the correct diagnosis of CS.
Introduction: Whether age-related differences exist in the association between leanness and cardiovascular events remains unclear. Hypothesis: We hypothesized that the association between leanness ...
A longer stent length is known to be a predictor of adverse events after a percutaneous coronary intervention (PCI). However, the evaluation of the stent length on the outcome of ST-segment elevation myocardial infarction (STEMI) patients is not enough.A total of 686 STEMI patients who underwent primary PCI were divided into four groups according to the total stent length as follows: short (<18 mm, n=183), lower-medium (18-23 mm, n=256), upper-medium (24-31 mm, n=155), and long (≥32 mm, n=92). We compared the all-cause mortality, major adverse cardiovascular events (MACEs; composite of cardiovascular death, myocardial infarction, and stroke after discharge), target lesion revascularization, and target vessel revascularization with a median follow-up of 1213 days among these four groups.There were no significant differences in MACEs (10.4% in the short, 7.0% in the lower-medium, 6.5% in the upper-medium, 7.6% in the long, P=0.633) among the different stent length groups. The all-cause mortality, target lesion revascularization, and target vessel revascularization also did not differ among the four groups. In the drug-eluting stent (n=237) and bare-metal stent subgroups (n=449), all outcomes were comparable among the groups. However, in the diabetes subgroup (n=265), the rate of MACEs was higher in the long group than in the other groups, although the difference was not significant (6.6% in the short, 9.6% in the lower-medium, 3.4% in upper-medium, 16.7% in long group, P=0.095).A long stent length was not associated with adverse clinical outcomes in STEMI patients who underwent primary PCI.
Abstract Background The optimum timing of revascularization strategy for stenoses in nonculprit vessels in patients with ST‐segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) remains unclear. At present, there is no evidence investigating the outcome of staged percutaneous coronary intervention (PCI) within two weeks from admission among STEMI patients with MVD. Methods A total of 210 STEMI patients with MVD who underwent primary PCI were analyzed. We compared the all‐cause mortality and major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, heart failure, unstable angina, and stroke) with median follow‐up of 1200 days among the patients who underwent staged PCI within two weeks from admission (staged PCI ≤2 W) ( n = 75), staged PCI after two weeks from admission (staged PCI >2 W) ( n = 37) and culprit‐only PCI ( n = 98) in patients with STEMI and MVD. Results The staged PCI ≤2 W showed lower all‐cause mortality than culprit‐only PCI (4.0 vs 29.6%, log‐rank P = 0.001), and lower incidence of MACE than the staged PCI >2 W group (1.3 vs 18.9%, log‐rank P = 0.001) and culprit‐only PCI group (1.3 vs 22.5%, log‐rank P = 0.001). In the multivariable Cox regression analysis, the staged PCI ≤2 W was a predictor of lower all‐cause mortality (hazard ratio [HR], 0.176; 95% confidence interval [CI], 0.049‐0.630; P = 0.008) and lower incidence of MACE (HR, 0.068; 95% CI, 0.009‐0.533; P = 0.011), but staged PCI >2 W was not. Conclusion In conclusion, staged PCI within two weeks after admission showed more favorable outcomes compared with staged PCI after two weeks from admission or culprit‐only PCI in STEMI patients with MVD.
A 95-year-old woman with no cardiac history presented with symptomatic complete atrioventricular block. She underwent temporary cardiac pacing via the cervical vein, but a pacing lead could not be introduced via the usual route because of a mediastinal tumor. A leadless pacemaker (Micra™; Medtronic, Minneapolis, USA) was implanted at the right ventricular septum via the right femoral vein. The procedure time was 40 minutes, with no complications noted. Over the two-year follow-up period, the threshold and impedance remained stable. The implantation of a leadless pacemaker was useful for improving the symptoms of a super-elderly woman with a mediastinal tumor.
