Left ventricular noncompaction (LVNC) is a relatively newly recognized cardiomyopathy. Its morphological traits are excessive trabeculations and deep recesses. Clinical features of this disorder vary widely from asymptomatic to severe ventricular dysfunction. There are several issues to be resolved on this disorder. In this review, we discuss the following issues:
1) Diagnostic criteria (how to diagnose LVNC)
2) Pathogenesis (Is it congenital or acquired?)
3) Differential diagnosis (Is there any overlap with other cardiomyopathies such as dilated cardiomyopathy or hypertrophic cardiomyopathy?)
4) Relevance of neuromuscular disorders
5) Natural history, predictors of prognosis
6) Ultrasonic evaluation of myocardial function

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Purpose: In this study, we aimed to determine the clinical value of the lung to thorax transverse area ratio (LTR) as a predictive parameter of short-term postnatal outcomes in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH). Subjects and Methods: Data from cases prenatally diagnosed with isolated left CDH between September 2005 and March 2012 were retrospectively collected from medical records. We divided the patients into two groups according to an LTR cutoff value of 0.08 immediately before birth. Differences in intact survival rate and duration of mechanical ventilation and supplemental oxygen were analyzed between the two groups using Fisher's exact test or the Mann-Whitney U test. The positive and negative predictive values of an LTR value < 0.08 in predicting a poor postnatal outcome were calculated. Poor outcome was defined as death or severe respiratory complications. The Spearman rank correlation was calculated to assess the correlation between LTR value and postnatal duration of ventilator support. Results and Discussion: Forty fetuses met the study criterion. The intact survival rate was significantly lower in patients with an LTR < 0.08 as compared with those with an LTR >= 0.08 (7/12 vs. 27/28). Additionally, the durations of mechanical ventilation and supplemental oxygen were significantly longer in the former group, and a negative correlation was noted between LTR values and duration of mechanical ventilatory support. When the LTR cutoff was < 0.08 for predicting a poor outcome, the positive predictive value and negative predictive value were 42% and 96%, respectively. Conclusion: The LTR was a useful predictive parameter of postnatal short-term outcomes in fetuses with isolated left CDH.

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A 67-year-old man was diagnosed with severe coronary artery stenosis in the left main trunk and two vessels in January 2009. Coronary artery bypass graft surgery was performed. After surgery, coronary angiograms revealed a severe stenosis of the left anterior descending artery at the distal portion of the anastomosis site. Percutaneous coronary intervention (PCI) to the culprit lesion was performed. During the operation, extravascular leakage of contrast agent was observed, and perforation of the coronary artery due to ballooning was suspected. The patient was referred to our hospital. A cystic mass (size 50×44×32 mm) was shown on the anterior interventricular sulcus by echocardiography. At follow-up echocardiography 20 days after the first detection, the mass had markedly increased in size to 57×47×70 mm. The risk of rupture was high, so an operation for closure of the coronary artery pseudoaneurysm was performed. Echocardiography was performed 1 year after surgery, at which time the mass had disappeared. We experienced a coronary artery pseudoaneurysm with penetration of the coronary artery due to PCI. Echocardiography was useful for evaluating the size of the pseudoaneurysm over time, allowing us to avoid the risk of rupture.

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A male in his 70s was admitted to our hospital with symptoms of ileus. Contrast-enhanced computed tomography confirmed the wall thickness of the sigmoid colon and a small mass in the area of the pancreatic head. Surgical treatment was performed with a preoperative diagnosis of cancer of the sigmoid colon. We examined the pancreatic lesion after the surgical operation. Transabdominal ultrasonography could not detect the pancreatic lesion. Endoscopic ultrasonography identified a solid, rounded, well-demarcated low echoic lesion, measuring 5 mm in diameter on the pancreatic head and third portion of the duodenum. Color Doppler EUS demonstrated no blood flow in the lesion. Therefore, contrast-enhanced color Doppler EUS, using a second-generation contrast agent, showed strong blood flow in the lesion with pulsatile branch vessel. 3D-angiography from computed tomography revealed a pancreaticoduodenal artery aneurysm. We performed preventive transcatheter arterial aneurysm coil embolization. Contrast-enhanced color Doppler EUS is useful for a small pancreaticoduodenal artery aneurysm.

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