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1.  Carcinoid heart disease and the utility of 3D trans-thoracic and trans-esophageal echocardiography: Two clinical cases 
Carcinoid tumors are rare neuroendocrine malignancies. We present two cases of metastatic carcinoid tumors, complicated by carcinoid syndrome and by cardiac valve involvement. Carcinoid syndrome is characterized by secretory diarrhea, episodic flushing, and bronchospasm. Cardiac involvement occurs in up to 50% of patients with metastatic carcinoid tumors which commonly causes abnormalities of the right sided valves. Echocardiography is the best available and non invasive technique for diagnosis. Characteristic features of carcinoid heart disease are thickened, shortened, retracted, and fixed or partially fixed valve leaflets. Three-dimensional (3D) echocardiography provided an en face view of pulmonary and tricuspid valve, not obtainable by two-dimensional echocardiography, and improved delineation of the relationship between these structures and cardiac chambers.
PMCID: PMC3936238  PMID: 24578601
Carcinoid heart disease; Echocardiography; Pulmonary; Three-dimensional; Tricuspid; Valve
2.  Serum antibody titers against heat shock protein 27 are associated with the severity of coronary artery disease 
Cell Stress & Chaperones  2010;16(3):309-316.
Antibody titers to several heat shock proteins (anti-Hsps) have been reported to be associated with the severity and progression of cardiovascular disease. However, there are little data regarding anti-Hsp27 titers in patients with coronary artery disease (CAD). A total of 400 patients with suspected CAD were recruited. Based on the results of coronary angiography, these patients were classified into CAD+ (n = 300) and CAD− (n = 100) groups defined as patients with ≥50% and <50% stenosis of any major coronary artery, respectively. Eighty-three healthy subjects were also recruited as the control group. Serum anti-Hsp27 IgG titers were measured using an in-house enzyme-linked immunosorbent assay. CAD+ patients had significantly higher anti-Hsp27 titers compared with both CAD− and control groups. Anti-Hsp27 titers were also higher in the CAD− group compared with the control group. With regard to the number of affected vessels in the CAD+ group, patients with three-vessel disease had higher anti-Hsp27 titers compared with both two-vessel disease (2VD) and one-vessel disease (1VD) subgroups. However, there was no significant difference between 1VD and 2VD subgroups. In multiple linear regression analysis, the number of narrowed vessels and smoking were significant independent determinants of serum anti-Hsp27 titers. The present findings indicate that serum anti-Hsp27 titers may be associated with the presence and severity of coronary artery disease.
PMCID: PMC3077226  PMID: 21107776
Coronary artery disease; Heat shock protein 27; ELISA; Angiography
3.  Incidental Finding of Cor Triatriatum Sinistrum in a Middle-Aged Man Candidated for Coronary Bypass Grafting (with three-D imaging) 
Cor triatriatum sinistrum is a rare congenital cardiac malformation, accounting for about 0.1–0.4% of all congenital heart diseases and characterized by the presence of a fibromuscular membrane that subdivides the left atrium into two chambers in the classical form. While classic cor triatriatum in most patients can be observed during the neonatal period or early infancy, it is very rare in adults.
We herein present an incidental finding of cor triatriatum sinistrum in a middle-aged man with coronary artery disease scheduled for coronary artery bypass graft surgery. The patient was admitted for exertional dyspnea and chest pain of a three-month duration. He had a past medical history of mild hyperlipidemia and mild hypertension. Transthoracic two-D echocardiography (TTE) demonstrated a visible presence of a membranous band in the mid portion of the left atrium with obvious obstruction by color and Doppler flow measurements, confirmed by three-D echocardiography. Selective coronary angiography also revealed a severe ostioproximal stenosis of the left anterior descending artery of up to 99%.
On-pump coronary artery bypass grafting was performed without complications, during which the anastomosis of the left internal mammary artery to the left anterior descending artery and the removal of the membrane were done.
PMCID: PMC3466872  PMID: 23074611
Cor triatriatum; Coronary artery disease; Coronary artery bypass; Heart defects; congenital
4.  Pulmonic Valve Endocarditis with Pulmonary Artery Endarteritis in a Young Man with Congenital Ventral Septal Defect 
ARYA Atherosclerosis  2010;6(1):42-44.
Isolated pulmonic valve endocarditis is a rare condition. The clinical and laboratory finding are not specific and experiences about that are limited. Most cases of that occur in children with congenital heart disease or in intravenous drug abusers and the main predisposing factor in adults is intravenous drug abuse. The most common pathogens are staphylococcus aurous and coagulase negative staphylococcus.
In this case report we present a 27 years old man with chronic fever (4 months) and a history of congenital ventral septal defect (VSD). Echocardiography revealed the pulmonic valve and pulmonary artery vegetations. He referred for surgery after 3 weeks of intravenous antibiotic therapy.
Careful evaluation of pulmonic valve in echocardiography should be done, when ever vegetation is not detected in other valves, and clinical suspicion for infective endocarditis is high.
PMCID: PMC3347810  PMID: 22577412
Infective endocarditis; Pulmonic valve; Vegetation; Endartritis

Results 1-4 (4)