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Isolated Rheumatic Pulmonary Valve Disease—Case Reports

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Case Reports in Clinical Medicine 2016年第6期5卷 207-215页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in children and young adults worldwide and particularly developing countries continuing to experience a high incidence of this disease. The unexpected increase in the incidence of the disease in certain areas may explain the clinical and epidemiological characteristics of this disease. The key manifestation of RHD is the cardiac valvular abnormalities characterized principally by deforming the layered and avascular leaflet architecture due to inflammation and subsequent diffuse fibrosis. Mitral valve is mostly involved and pulmonary valve is rarely affected. Background of these case reports highlighted the increased incidence of rheumatic pulmonary valve disease in Thoothukudi region of India in Tamil Nadu state.

关键词： Rheumatic Fever Pulmonary Valve Echocardiography ASO Screening Test

Right Atrial Myxoma—A Case Report

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Case Reports in Clinical Medicine 2016年第3期5卷 71-76页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Myxomas comprise 6% to 10% of primary cardiac tumors in childhood. Less than 10% of patients with cardiac myxomas are under 15 years of age. A large myxoma occupying in the right atrium and prolapsing into the right ventricle, pulmonary artery and producing tricuspid and pulmonary valve obstructions was diagnosed by Transthoracic 2D echocardiographic imaging in a 12-year-old male child.

关键词： Myxoma Right Atrium Tricuspid and Pulmonary Valve Obstructions

“Burnt-Out” Endomyocardial Fibrosis—An Overview

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Case Reports in Clinical Medicine 2016年第11期5卷 437-493页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Tropical endomyocardial fibrosis (EMF) is a public health problem affecting the children, young adults and elderly individuals in an epidemic fashion in the coastal districts of south India. Due to lack of resources for research in these endemic areas, its etiology remains elusive and hypotheses ranging from infections and allergic causes to malnutrition and toxins have not been tested rigorously. The disease is characterized by endocardial fibrosis and the right ventricle is the cardiac chamber most frequently affected. Patients may present clinically with heart failure and an associated AV (atrioventricular) valve regurgitation is common. Several features of the advanced disease called as “burnt-out” stage of endomyocardial fibrosis (EMF) are not fully understood. Background of these case studies described the clinical presentation, echocardiographic features and management of this late stage of the disease.

关键词： Endomyocardial Fibrosis Burnt-Out Stage Pericardial Effusion Endocardial Calcification “Cobra-Head” Fibrosis

Costello Syndrome with Congenital Pulmonary Valve Stenosis and Ventriculomegaly—A Case Report

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Case Reports in Clinical Medicine 2016年第8期5卷 250-267页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Costello syndrome is an extremely rare genetic disorder with growth delay after birth and typically results in short stature during childhood. It is one of the RASopathy of Ras/MAPK pathway syndromes. It affects the transforming protein p21, an enzyme that in humans is encoded by the HRAS gene. H-Ras is a small G protein and once bound to Guanosine triphosphate, it will activate a Raf kinase like C-Raf, the next step in the MAPK/ERK pathway (mitogen-actvated protein kinase/extracellular signal-regulated kinase) i.e., MEK (mitogen-actvated ERK kinase), a protein that phosphorylate ERK which can directly and indirectly activate many transcription factors. This pathway is also known as Ras-Raf, MEK-ERK pathway, which is a chain of proteins on the cell that communicate a signal from a receptor on the surface of the cell to the DNA in the nucleus of the cell. Activation of ERK 1/2 is involved in signal transduction pathways associated with cardiac hypertrophy. The developmental syndromes caused by germline mutations in genes that alter the RAS components of the MAP/ERK signal transduction pathway are called “RASopathies”. Cardiovascular abnormalities are important features of Costello syndrome and other RASopathies such as Noonan syndrome. Background of this case report described the congenital valvular pulmonic stenosis and ventriculomegaly associated with Costello syndrome by transthoracic echocardiographic imaging in a 9-year-old male boy.

关键词： Costello Syndrome Rasopathy Short Stature Congenital Valvular Pulmonic Stenosis Ventriculomegaly

Left Ventricular Myxoma—A Case Report

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Case Reports in Clinical Medicine 2016年第3期5卷 88-94页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Left ventricular myxomas are extremely rare and account for 2.5% of all cardiac myxoma cases. A left ventricular myxoma originating from the apical interventricular septum and projecting into the left ventricular cavity was diagnosed by Transthoracic two-dimensional echocardiographic imaging in a 29-year-old male. The presentation of myxoma with symptoms masquerading as infectious hepatitis and dilated cardiomyopathy with a measured ejection fraction of 20% has been described.

关键词： Myxoma Interventricular Septum Left Ventricle Cardiomyopathy

Apical Left Ventricular Hypertrophic Cardiomyopathy: A Case Report

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Case Reports in Clinical Medicine 2016年第9期5卷 308-329页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Apical hypertrophic cardiomyopathy (apical HCM) is a rare variant of hypertrophic cardiomyopathy with a prevalence of 1% - 2% in Asian population and carries a benign prognosis. It is usually silent in early stages and manifests in adults with a suspicion of typical ECG changes of giant T wave inversion in left precordial leads. Transthoracic echocardiography is the mainstay of non-invasive diagnosis and provides a heterogeneous appearance of its morphological features with a spade-shaped LV (left ventricular) cavity. Background of this case study describes the apical HCM in an asymptomatic male at the age of 54 years old and also predicts the mixed and mid-ventricular forms of left ventricular HCM at this region of Thoothukudi in India.

关键词： Apical Hypertrophy Left Ventricle Spade-Shaped LV Cavity Echocardiography Yamaguchi Syndrome Apical Ballooning Syndrome

Isolated Acute Rheumatic Pancreatitis—A Case Report

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Case Reports in Clinical Medicine 2021年第2期10卷 52-77页

作者： ramachandran muthiah Morning Star Hospital Marthandam Kanyakumari District India

Aim: To emphasize the role of antibiotics in acute pancreatitis as prophylactic and therapeutic benefits. Case Report: A 32-year-old obese male was admitted with acute abdomen in the emergency room. He was supported with intravenous fluids and the blood chemistry revealed elevated amylase and lipase levels, raised ESR and a positive ASO titer test. CT abdomen suggested interstitial edematous pancreatitis (IEP) and no fluid collection. Patient was treated with IV cefotaxime and IV metronidazole, his condition remarkably improved with therapy, blood parameters returned normal at the end of 4 weeks, and follow-up CT revealed no abnormal findings and symptom free thereafter. Conclusion: Acute pancreatitis is usually a sterile inflammatory process caused by chemical autodigestion of pancreas. The edematous form of acute pancreatitis needs to correct its etiological factor to avoid recurrence. It is observed as an initial manifestation of group A beta hemolytic streptococcal infection in this patient and antibiotics play a role as curative and prophylactic in selected cases.

关键词： Acute Abdomen Pancreatitis ASO Titer Elevated Pancreatic Enzymes Antibiotics

Left Ventricular “Horseshoe-Thrombus”—A Case Report

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Case Reports in Clinical Medicine 2016年第4期5卷 140-146页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Thrombi represent the most frequently found intracardiac masses. Left ventricular thrombus (LVT) is an important complication in patients with ischemic heart diseases and in those with dilated cardiomyopathy and systolic heart failure. The diagnosis of left ventricular thrombus remains important since anticoagulation will reduce the risk of systemic embolization and stroke. Despite advances in other imaging modalities, echocardiography remains the most important tool for diagnosis and risk stratification in patients predisposed to develop left ventricular thrombi. Mural thrombi formed on the left ventricular endocardium and horseshoe-shaped in chronic dilated cardiomyopathy, masquerading as left ventricular endomyocardial fibrosis was diagnosed by transthoracic 2D echocardiographic imaging in a 38 years old middle aged man. Background of this case highlighted the pathophysiology, high risk echocardiographic features and the role of anticoagulant therapy in LV thrombus with dilated cardiomyopathy.

关键词： Thrombus Left Ventricle Dilated Cardiomyopathy Echocardiography Anticoagulant Therapy

Rheumatic Aortic Valve Disease with Mitral Stenosis—A Case Report

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Case Reports in Clinical Medicine 2016年第8期5卷 268-295页

作者： ramachandran muthiah Thoothukudi Medical College Hospital Thoothukudi India

Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.

关键词： Rheumatic Bicuspid Aortic Valve Aortic Regurgitation Mitral Stenosis Eccentricity Index Smoke Water Fall Sign Bow and Arrow Sign