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A Case of Sudden Cardiac Death due to Pilsicainide-Induced Torsades de Pointes
Shimpei Nakatani,Masayuki Taniike,Nobuhiko Makino, MD,Yasuyuki Egami,Ryu Shutta,Jun Tanouchi,Masami Nishino 대한심장학회 2014 Korean Circulation Journal Vol.44 No.2
An 84-year-old male received oral pilsicainide, a pure sodium channel blocker with slow recovery kinetics, to convert his paroxysmal atrialfibrillation to a sinus rhythm; the patient developed sudden cardiac death two days later. The Holter electrocardiogram, which was wornby chance, revealed torsade de pointes with gradually prolonged QT intervals. This drug is rapidly absorbed from the gastrointestinal tract,and most of it is excreted from the kidney. Although the patient’s renal function was not highly impaired and the dose of pilsicainide waslow, the plasma concentration of pilsicainide may have been high, which can produce torsades de pointes in the octogenarian. Althoughthe oral administration of class IC drugs, including pilsicainide, is effective to terminate atrial fibrillation, careful consideration must betaken before giving these drugs to octogenarians.
Valsalva Aneurysm Filled with Thrombi Mimicking a Cardiac Tumor
Yasuharu Lee,Naoki Mori,Daisuke Nakamura,Takahiro Yoshimura,Masayuki Taniike,Nobuhiko Makino,Hiroyasu Kato,Yasuyuki Egami,Ryu Shutta,Jun Tanouchi,Yoshio Yamada,Masami Nishino 대한심장학회 2012 Korean Circulation Journal Vol.42 No.12
A Valsalva aneurysm filled with thrombi can be difficult to diagnose, because it mimics a cardiac tumor. Both cardiac magnetic resonance imaging (MRI) and transesophageal echocardiogram (TEE) were performed on a patient who showed a low-echoic mass located between the atrial septum and the non-coronary sinus. Based on MRI findings allowing tissue characterization and the accurate location of the mass and the TEE findings of an irregular surface of the mass and a partial defect in the edge of the non-coronary sinus, we diagnosed the mass as a thrombosed Valsalva aneurysm that had perforated the inter-atrial septum. The operative findings coincided with the preoperative di-agnosis. Both MRI and TEE are useful for diagnosing this condition.