Owing to dramatic advances in diagnosis, medical treatment, and surgical repair, the number of adults with congenital heart disease (CHD) now exceeds that of children with CHD. Most surgical interventions are not curable or radical in patients with CHD. Thus, not a few patients with moderate to severe CHD will require one or more surgical interventions. Therefore, regular life-long follow-up should be necessary in most adults with CHD. Echocardiography is one of the most essential diagnostic methods for adult CHD. In this review, the focus is on the preoperative diagnosis using echocardiography in six common CHDs, i.e., atrial septal defect, ventricular septal defect, atrioventricular septal defect, congenitally corrected transposition of the great arteries, tetralogy of Fallot, and Ebstein’s anomaly.

View full abstract

Purpose: The traditional treatment of iatrogenic pseudoaneurysms required repair with surgery, US-guided compression repair (UGCR). US-guided thrombin injection (UGTI) has emerged as an alternative to sonographically guided compression repair. Studies have reported success rates since the late 1980s. This paper reviews 4 clinical cases in which we used UGTI to treat iatrogenic femoral pseudoaneurysms. Materials and Methods: From June 2005 through December 2008, we treated 4 patients with femoral artery pseudoaneurysms after angiography. A 23-gauge needle was placed into the lumen of the pseudoaneurysm under sonographic guidance, and an average dose of 100 U (range, 300-1,000 U) of thrombin was injected under continuous color-flow Doppler sonography. Injections were continued until the pseudoaneurysm thrombosed. Results: The average dose of thrombin was 575 U, a much smaller dose than previously reported. All 4 pseudoaneurysms were successfully thrombosed, and there were no complications. Conclusion: We reported 4 clinical cases. For the treatment of iatrogenic femoral pseudoaneurysms, US-guided thrombin injection is an effective treatment associated with a low rate of recurrence and few complications, even at lower doses of thrombin than previously reported.

View full abstract

Pancreatic mucinous cystic neoplasms have a potential for malignancy, and surgical resection is usually recommended. Therefore, long-term follow-up of this disease is rarely reported. We experienced a case of mucinous cystic neoplasm in which the appearance and size of the cyst changed markedly during five years of follow-up. A simple cyst of 24 mm in diameter was detected occupying the body to the tail of the pancreas of a woman in her 50s who complained of left upper abdominal pain. The communication between the cyst and the main pancreatic duct was revealed with endoscopic retrograde pancreatography, and the main pancreatic duct dilatation at the upper stream of the cyst was detected by magnetic resonance pancreatography. The cyst was initially suspected to be an intra-ductal papillary mucinous neoplasm. Pancreatic juice cytology was negative, so the cyst was followed-up with ultrasonography every three month. During the follow-up period, the size of the cyst remained around 15 to 20 mm, but transient enlargement was observed accompanied with symptoms of acute pancreatitis. So that it was also suspected to be a pseudo cyst caused by pancreatitis. Five years later, a septum was first detected in the cyst, and after that pleural septa appeared. On contrast-enhanced ultrasonography, the septa within the cyst were strongly enhanced, and the so-called cyst-in-cyst appearance, a characteristic finding of a mucinous cystic neoplasm, was clearly visualized. Moreover, virtual sonographic cystoscopy reconstructed from the volume data depicted the cyst as having a smooth internal surface without any nodules. Both of these techniques were very useful for diagnosis of this case as a benign mucinous cystic neoplasm. After surgical resection, the lesion was pathologically confirmed to be a mucinous cystic neoplasm with moderate dysplasia.

View full abstract