Biomedical subjects

Sheng-Hsiung Sheu

Publications and source records attributed to Sheng-Hsiung Sheu.

At least 37 records · Page 2Linked to original sources

PubMed2006

Ruptured sinus of valsalva and complete atrioventricular block complicating fulminant course of infective endocarditis: a case report and literature review.

Patients with infective endocarditis usually developed persistent fever and heart failure, especially when the valve structures are invaded and destroyed. Persistent bacteremia often leads to severe sepsis or overwhelming septic shock. Septic emboli from the vegetation will possibly result in systemic thromboembolism with multiple organ infarction. Patients with infective endocarditis have been reported to present with either ruptured sinus of Valsalva or complete atrioventricular block. However, both of these serious complications occurring in a single patient is rare. In this case report, we present a 54-year-old man with a previous history of alcoholic cirrhosis and chronic renal failure who suffered from a fulminant course of infective endocarditis. Simultaneously, ruptured sinus of Valsalva and complete atrioventricular block further complicated the preexisting septic shock and multiple organ failure.

Aortic Rupture↗

PubMed2006

Acute pulmonary embolism following laparoscopic ovariectomy: a case report.

Laparoscopic surgery is usually considered to be less invasive when compared to traditional laparotomy, and is regarded as a relatively low-risk procedure for postoperative complications because of the reduced surgical stress and earlier mobilization. However, we describe a 47-year-old woman who presented with acute respiratory distress, drowsy consciousness, and circulatory collapse shortly after gynecologic laparoscopic ovariectomy for removing an ovarian teratoma at a local hospital. After resuscitation, the patient was transferred to our emergency department. Immediate bedside electrocardiographic and echocardiographic examination results led to acute pulmonary embolism being quickly diagnosed. The patient received subsequent intensive care with smooth course. Although pulmonary embolism is rare after laparoscopic surgery, early detection and quick treatment are important in the management of this life-threatening complication and offer good prognosis. The risk of pulmonary embolism after gynecologic laparoscopic surgery remains unclear. Therefore, the decision to provide prophylaxis is up to the individual physician, and should take into consideration the patient's individual risk factors and comorbidities.

Acute Disease↗

PubMed2006

Traumatic tricuspid insufficiency with chordae tendinae rupture: a case report and literature review.

With the increase in the number of automobile accidents, traumatic tricuspid insufficiency, a rare complication of non-penetrating blunt chest injury, has become an important problem. This kind of injury has been found more frequently during the last decade, partly because of better diagnostic procedures and a better understanding of the pathology. Here, we report a 22-year-old male patient who suffered chest trauma from an automobile accident. Echocardiography demonstrated tricuspid chordae tendinae rupture with remarkable tricuspid regurgitation. We discuss this case in comparison with the previous literature. This case reminds us that physicians in the emergency department should be aware of this potential complication following non-penetrating chest trauma.

Adult↗

PubMed2006

Differentiation of left ventricular diastolic dysfunction, identification of pseudonormal/restrictive mitral inflow pattern and determination of left ventricular filling pressure by Tei index obtained from tissue Doppler echocardiography.

BACKGROUND: Tei index obtained from tissue Doppler echocardiography (TDE-Tei index) has an inherent advantage of recording its systolic and diastolic components simultaneously on the same cardiac cycle. The aims of this study are to evaluate whether TDE-Tei index also exerts a correlation with left ventricular (LV) systolic and diastolic function and filling pressure and to see whether it can effectively identify the pseudonormal/restrictive mitral filling pattern. METHODS: Echocardiographic examination was performed in 243 consecutive patients. These patients were classified into three groups as normal, abnormal relaxation, and pseudonormal/restrictive groups according to the transmitral E/A-wave velocity (E/A), early diastolic velocity of lateral mitral annulus (Ea) and E/Ea. RESULTS: Standard Doppler indices of LV filling such as E, A, E/A, and E-wave deceleration time had a bimodal distribution, but Ea decreased and E/Ea and TDE-Tei index increased progressively with worsening of LV diastolic function. The sensitivity and specificity of TDE-Tei index>0.51 in the discrimination of pseudonormal/restrictive filling pattern were 85% and 96%, respectively. After stepwise multiple linear regression analysis, TDE-Tei index had a significant negative correlation with Ea (beta=-0.296, P<0.001) and ejection fraction (beta=-0.293, P<0.001) and positive correlation with E/Ea (beta=0.235, P=0.001). CONCLUSIONS: TDE-Tei index increased with worsening of LV diastolic function and can effectively identify the pseudonormal/restrictive mitral inflow pattern. It also correlated with the echocardiographic parameters of LV systolic and diastolic function and filling pressure. It suggests that TDE-Tei index is a simple and feasible marker in assessing global LV function.

Adult↗

PubMed2006

Preload independence of isovolumic relaxation flow propagation velocity.

To evaluate whether isovolumic relaxation flow propagation velocity (IRFPV) is independent of preload alterations, 41 healthy subjects (35 +/- 7 years) were included for Doppler examinations at three different positions, i.e., supine, Trendelenburg, and reverse Trendelenburg. A positional difference was detected in the peak velocity of the transmitral early diastolic flow wave (P = 0.012) and the peak velocities of both early (P = 0.004) and late (P = 0.007) diastolic mitral annular velocity waves. In contrast, there was no positional difference in the early diastolic inflow propagation velocity or IRFPV. In conclusion, IRFPV is a preload-independent Doppler parameter.

Adult↗

PubMed2006

Effects of atorvastatin and atorvastatin withdrawal on soluble CD40L and adipocytokines in patients with hypercholesterolaemia.

OBJECTIVE: Beyond lipid lowering, statins have pleiotropic effects with favourable benefits against atherogenesis. Withdrawal of statin therapy has been demonstrated to abrogate vascular protective activity and even increase the incidence of thrombotic vascular events. The purpose of this study is to investigate the serial changes of soluble CD40 ligand (sCD40L) and two adipocytokines, adiponectin and resistin, after short-term atorvastatin therapy and withdrawal in patients with hypercholesterolaemia. METHODS AND RESULTS: Thirty-two patients with hypercholesterolaemia received atorvastatin 10 mg/day for 3 months. Serum lipid profiles, and levels of sCD40L, adiponectin and resistin, were assessed before and immediately after 3 months' statin therapy. Serum levels of sCD40L and adiponectin were also measured on the 3 consecutive days after statin withdrawal. After 3 months' statin therapy, levels of sCD40L (1.93 +/- 1.13 vs. 1.30 +/- 0.97 ng/mL), total cholesterol and low-density lipoprotein cholesterol (LDL-C) were all reduced significantly (p < 0.05). However, sCD40L level tended to increase towards baseline on the first and second days after statin withdrawal, but was not significantly elevated until the third day after withdrawal (1.89 +/- 1.28 vs. 1.30 +/- 0.97 ng/mL, p < 0.05). Total cholesterol and LDL-C levels did not increase during the 3 days of statin withdrawal. No significant changes of adiponectin and resistin levels were shown after statin therapy. CONCLUSIONS: These results indicate that the effect of statin on sCD40L level was abrogated after therapy withdrawal, and was independent of serum cholesterol level. Statin therapy did not significantly alter levels of adiponectin and resistin.

Adiponectin↗

PubMed2005

Influence of withdrawal of statin treatment on proinflammatory response and fibrinolytic activity in humans: an effect independent on cholesterol elevation.

BACKGROUND: In addition to lowering lipid profile, statins have pleiotropic effects on improving vascular function. Changes of these pleiotropic effects and their relationship to lipid profile after withdrawal of statin treatment remained unclear. METHODS: We investigated the changes of lipid profile and plasma concentrations of human soluble vascular cell adhesion molecule-1 (sVCAM-1) and human tissue type plasminogen activator (tPA) after withdrawal of statin treatment. Twenty-two patients (14 F, 8 M, aged 63+/-13 years) with hypercholesterolemia were treated with atorvastatin (ATOR; 10 mg/day) for 12 weeks. Blood samplings for serum lipid and markers were collected before, after and withdrawal of statin treatment. RESULTS: The total cholesterol, LDL-cholesterol and sVCAM-1 (from 394.4+/-251.7 to 321.0+/-198.9 ng/ml, p<0.05) all decreased significantly and the tPA (from 9.47+/-3.57 to 11.62+/-3.99 ng/ml, p<0.05) increased significantly after atorvastatin treatment. During the following 3 days after withdrawal of atorvastatin, the total cholesterol and LDL-cholesterol did not show any significant change. However, the plasma sVCAM-1 significantly elevated on day 2 (from 321.0+/-198.9 to 371.2+/-220.4 ng/ml, p<0.05) and the plasma tPA significantly decreased on day 1 (from 11.62+/-3.99 to 10.52+/-3.55 ng/ml, p<0.05) and day 3 (from 11.62+/-3.99 to 10.27+/-3.69 ng/ml, p<0.05). Both the significant elevation of sVCAM-1 and decrease of tPA after withdrawal of atorvastatin treatment occurred within 3 days, while the serum cholesterol and LDL-chol levels did not have any significant change and were still within the therapeutic range. CONCLUSIONS: After 12 weeks of atorvastatin treatment, the beneficial pleiotropic effects can be demonstrated simultaneously with lowering the lipid profile. However, after withdrawal of atorvastatin, the beneficial pleiotropic effects are abrogated rapidly within days and are independent on elevation of serum cholesterol.

Aged↗

PubMed2005

Left ventricular inflow propagation velocity at pulsed wave Doppler analysis: an index of relaxation.

To test whether left ventricular inflow propagation velocity at the pulsed wave Doppler analysis (IPVpw) is a useful noninvasive index of relaxation, 21 patients under coronary angiography for chest pain were included for simultaneous catheter-based and Doppler studies. IPVpw was derived through the application of range ambiguity, and the time constant of isovolumic left ventricular pressure decline (tau) was acquired by a previously described method. At baseline status, IPVpw correlated significantly with the peak negative dP/dt and tau ( r = -0.609, P = .003), but not with the peak velocity of transmitral early flow (E) wave. Sublingual application of nitroglycerin increased heart rate, decreased the transmitral E velocity and transmitral E-to-A velocity ratio, and prolonged the deceleration time of the transmitral E wave. However, there was no significant impact on IPVpw, peak negative dP/dt, or tau. IPVpw correlated with tau ( r = -0.533, P < .001) at the combined analysis of the data before and after nitroglycerin application. In conclusion, IPVpw is a preload-independent, noninvasive index of left ventricular relaxation.

Blood Flow Velocity↗

PubMed2005

Isovolumic relaxation flow propagation velocity in patients with diseases impairing ventricular relaxation.

To evaluate the propagation velocity of isovolumic relaxation flow within the left ventricle (IRFPV) associated with impaired ventricular relaxation, 49 patients with diseases known to impair ventricular relaxation (disease group) and 38 age-matched control subjects (control group) were studied. IRFPV was measured as the slope of the first aliasing velocity line segment of the isovolumic relaxation flow wave front in the color M-mode Doppler echocardiogram. Compared with the control group, the disease group had thicker interventricular septum and left ventricular posterior wall, more left ventricular mass, and lower early diastolic mitral annular velocity (8 +/- 3 vs 11 +/- 4 cm/s, P < .001), early (E) wave propagation velocity (47 +/- 16 vs 70 +/- 41 cm/s, P = .002), and IRFPV (193 +/- 149 vs 395 +/- 220 cm/s, P < .001). No matter in subgroup or whole population analysis, either the early diastolic mitral annular velocity or the E wave propagation velocity was selected as one of the determinants of IRFPV. In conclusion, diseases impairing ventricular relaxation may retard IRFPV.

Aortic Valve Stenosis↗

PubMed2005

Determination of pulmonary capillary wedge pressure using pulsed wave Doppler echocardiography: clinical application of range ambiguity phenomenon.

To predict pulmonary capillary wedge pressure (PCWP) noninvasively, several Doppler combination indices have been developed. Recently, a fair correlation has been found between the time constant of isovolumic left ventricular (LV) relaxation (tau) and pulsed wave Doppler LV inflow propagation velocity (LVIPVpw) derived through the application of range ambiguity phenomenon. In the measurement of LVIPVpw, we can simultaneously measure the peak phantom E-wave velocity (Ep) from the same heartbeat. Hence, it is hypothesized that Ep/LVIPVpw is a useful index in predicting PCWP. In all, 29 patients who underwent elective cardiac catheterization for suggested coronary artery disease were included. Mean PCWP (mPCWP) obtained from right heart catheterization was compared with echocardiographic data before and 5 minutes after sublingual application of nitroglycerin (0.6 mg). Nitroglycerin caused a significant decrease in Ep and mPCWP, but not in LVIPVpw (P < .001, P < .001, and P = .687, respectively). By stepwise multiple linear regression analysis, only the Ep/LVIPVpw (beta = 0.832, P < .001) was the independent predictor of mPCWP. After nitroglycerin intake, the change in mPCWP was significantly correlated with the change in Ep/LVIPVpw (r = 0.455, P = .015). The sensitivity and specificity of Ep/LVIPVpw > 0.74 in predicting mPCWP > 15 mm Hg were 78% and 90%, respectively (area under curve 0.86). In conclusion, Ep/LVIPVpw derived from the same heartbeat provides a good estimate of mPCWP and can be used to rapidly track the change in mPCWP.

Blood Pressure Determination↗

PubMed2005

Tuberculous pericardial abscess: a case report.

We present the case of a 71-year-old diabetic man who came to us complaining of dyspnea for 1 month. Chest X-ray showed cardiomegaly and bilateral pleural effusion. Echocardiography showed a pericardial cystic mass with external compression of the right ventricle. Because of clinically impending cardiac tamponade, we performed urgent sternotomy and removed the pericardial mass without event. Pathologic examination of the excised pericardial specimen showed caseous necrosis compatible with tuberculosis infection. The patient was put on a 1-year treatment regimen of anti-tuberculosis medication. This case is an important reminder that tuberculosis can occur as a pericardial abscess.

Abscess↗

PubMed2005

Flutrer-like P waves in a case of atrioventricular reciprocating tachycardia.

Typical atrial flutter is characterized by its sawtooth flutter wave in leads II, III, aVF, and V1. Atrioventricular reciprocating tachycardia is characterized by its small retrograde P wave after completion of QRS complex, where sawtooth flutter-like P waves are rarely seen in the electrocardiogram during atrioventricular reciprocating tachycardia. We report on a 62-year-old patient who presented the characteristic sawtooth flutter-like P waves in the electrocardiogram during attack of supraventricular tachycardia. By electrophysiologic study, the mechanism of his supraventricular tachycardia was atrioventricular reciprocating tachycardia using the left posterior lateral concealed accessory pathway for retrograde conduction. The accessory pathway was successfully ablated by radiofrequency ablation therapy.

Atrial Flutter↗

PubMed2005

Effects of total coronary artery occlusion on vascular endothieial growth factor and transforming growth factor beta.

Vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-beta1) play an important role in angiogenesis. We wanted to determine if concentrations of growth factors in the coronary sinus (CS) and right atrium (RA) are higher in coronary artery disease patients with total occlusions than in those with partial occlusions. Fifty-one patients scheduled for coronary artery angiography were evaluated for possible recruitment. A 6F Goodale-Lubin catheter was used to collect blood from the CS and RA. Data for all but four patients were gathered successfully, leaving 47 study patients. The reviewer was blinded to growth factor data when interpreting coronary angiographic findings. Of the 47 enrolled patients, 32 had at least one diseased vessel, seven of whom had at least one major total epicardial coronary occlusion. In all 32 patients, the concentrations of VEGF in the CS were higher than those in the RA (31.5 +/- 2.7 vs 27.1 +/- 1.8 pg/mL; p = 0.005). Patients with total occlusions had higher VEGF concentrations in the CS than those with non-total occlusions (38.9 +/- 8.0 vs 29.5 +/- 2.6 pg/mL; p = 0.037). The differences in TGF-beta1 in the two groups were not statistically significant. The higher CS VEGF concentrations in patients with total occlusion indicate that VEGF may play a part in the development of angiogenesis.

Aged↗

PubMed2005

Tolerability of ramipril 10 mg daily in high-risk cardiovascular patients in Taiwan: experience from Kaohsiung Medical University Chung-Ho Memorial Hospital.

The Heart Outcomes Prevention Evaluation (HOPE) study demonstrated that the angiotensin-converting enzyme inhibitor, ramipril, significantly reduces mortality, myocardial infarction and stroke in high-risk cardiovascular patients, beyond the benefits from blood pressure lowering. The tolerability of ramipril 10 mg/day has been an important concern when applying these results. Following the same criteria as the HOPE study, we investigated the adverse effects profile and tolerability of 10 mg ramipril in high-risk patients at our institution. In total, 92 patients with high cardiovascular risk were eligible for this study. Initially, ramipril was prescribed 2.5 mg orally once daily, and then titrated up to 5.0, 7.5, and 10.0 mg/day at 1-month intervals. The target maintenance dose was 10 mg/day. All adverse events were recorded during at least 3 months of follow-up. After 4-6 months of the titration protocol, only 18 patients (25.3%) reached and remained on ramipril 10 mg/day; 11 (15.5%), 22 (30.9%), and 20 patients (28.2%) remained on 2.5, 5.0, and 7.5 mg/day, respectively. Twenty-one patients (22.6%) had at least one adverse event. Twelve patients (13.0%) stopped treatment because of adverse effects. A total of 23 episodes of adverse events were reported, including cough (15.1%), dizziness (6.0%), and hypotension (2.4%). Ramipril was relatively well tolerated in our study population. However, only one-quarter of our patients reached the target maintenance dose of 10 mg/day. Dry cough, dizziness, and hypotension were the major side effects. About 15% of our patients discontinued ramipril treatment, which is comparable with previous reports.

Aged↗

PubMed2005

Ruptured aneurysm of the sinus of valsalva into the right atrium without ventricular septal defect: a case report and literature review.

Aneurysm of the sinus of Valsalva (ASV), frequently associated with ventricular septal defect (VSD), is a rare cardiac disease that may be acquired or congenital. Rupture of an ASV, rare in the noncoronary cusp, usually produces serious hemodynamic change and carries poor prognosis if not treated surgically. We present the case of a 55-year-old female who came to us complaining of exertional dyspnea. Transthoracic echocardiography and aortography showed a noncoronary cusp ASV with rupture into the right atrium but without VSD. Because of high left to right shunt flow, she underwent successful surgical intervention with aneurysm repair approached from both the aorta and right atrium with a knitted Dacron patch. This was a rare case of noncoronary cusp involvement in ASV that ruptured into the right atrium without VSD.

Aneurysm, Ruptured↗

PubMed2005

Successful retrieval of dislodged paclitaxel-eluting stent with a nitinol loop snare: a case report.

Coronary stent dislodgment or embolization before deployment is a rare but challenging complication in interventional cardiology. Intracoronary embolization of the dislodged stent is associated with a high risk of coronary occlusion, due to thrombus formation and subsequent myocardial infarction. Furthermore, systemic embolization may cause severe cerebrovascular events. Nonsurgical retrieval strategies for this complication have been suggested, but bailout cardiac surgery may be indicated if percutaneous retrieval attempts fail. To our knowledge, this is the first case report of intracoronary drug-eluting stent dislodgment, and successful retrieval was accomplished by a loop snare technique. With the increasing trend of using drug-eluting stents in percutaneous coronary intervention, the likelihood of stent dislodgment or embolization may increase. It should be kept in mind, especially by coronary interventionists, how to manage this complication.

Angioplasty, Balloon, Coronary↗

PubMed2005

Unstable angina with normal coronary angiography in hyperthyroidism: a case report.

Hyperthyroidism is associated with an increase in myocardial oxygen consumption that, due to an imbalance of oxygen demand and supply, can cause angina. However, subclinical hyperthyroidism rarely presents as chest pain in the resting state. Herein, we present a case of subclinical hyperthyroidism involving a 58-year-old male who complained of frequent chest tightness and typical electrocardiographic changes while in a resting state. Coronary angiography showed no significant lesion. Laboratory data showed that the patient suffered from hyperthyroidism, for which he was successfully treated with anti-thyroid agents. We are reminded that typical chest pain might be the first symptom of hyperthyroidism.

Angina, Unstable↗

PubMed2005

Acute respiratory distress syndrome after early successful primary percutaneous coronary intervention therapy in acute myocardial infarction: a case report.

Acute respiratory distress syndrome (ARDS) is characterized by acute-onset dyspnea, diffuse bilateral pulmonary infiltration, low pulmonary capillary wedge pressure (PCWP), and an arterial oxygen tension/inspired oxygen fraction (PaO2/FiO2) ratio of less than 200 mmHg. Acute myocardial infarction (AMI), whether complicated by circulatory arrest, cardiogenic shock, and hypotension or not, was reported as an etiologic factor in the development of ARDS in the prethrombolytic era. In the thrombolytic era, two cases of AMI complicated with ARDS have been reported. ARDS in these two patients resulted from anaphylactic reaction to the thrombolytic agent and not from the hemodynamic consequences of AMI. Development of ARDS during the AMI period has not been reported after early successful primary percutaneous coronary intervention (PCI). Herein, we report a 61-year-old male patient with persistent chest pain who was diagnosed with Killip II anterior ST-segment elevation AMI. He was treated successfully with primary PCI 2.5 hours after the onset of chest pain. Unfortunately, on the third hospital day, acute-onset dyspnea (respiratory rate, 33 beats/min), fever (38.5 degrees C), leukocytosis (white blood cell count, 18,360/microL), and diffuse bilateral pulmonary infiltration were noted. ARDS was diagnosed from the low PCWP (8 mmHg) and a PaO2/FiO2 of less than 200 mmHg (160 mmHg). No usual causes of ARDS such as infection, aspiration, trauma, shock, or drug reactions were noted. We assumed that, in this particular patient, the systemic inflammatory response syndrome frequently induced by AMI might have caused this episode of ARDS. This may imply that AMI itself is a possible etiology of ARDS.

Angioplasty, Balloon, Coronary↗