A 73-year-old male patient presented to our hospital with chronic cough. Chest computed tomography (CT) showed pericardial lymphadenopathy, and surgical removal was planned. During preoperative echocardiography, an anechoic cyst-like lesion was identified at the right ventricular (RV) apex that did not correspond to the CT finding. Further echocardiographic evaluation suggested communication between the RV and the lesion, and contrast echocardiography confirmed a congenital RV aneurysm. The patient had a history of stable angina. Review of previous records showed an anomalous origin of the left coronary artery from the right coronary sinus and prior coronary stent implantation in the right coronary artery for diffuse atherosclerosis. An RV apical aneurysm was also visible on CT obtained 9 years earlier, with little interval change in size; therefore, conservative monitoring was continued. Congenital RV aneurysm is rare. In this case, multimodal imaging enabled accurate diagnosis of a congenital RV aneurysm that had remained stable over 9 years.
Background The significance of risk modification in patients with acute coronary syndrome (ACS) is well recognized; however, the optimal timing for adminstering PCSK9 inhibitors remains unclear. Additionally, the lipid-lowering efficacy of evolocumab and alirocumab has not been fully established. This study evaluated the lipid-lowering effects of these two PCSK9 inhibitors.
Methods Patients diagnosed with ACS, including unstable angina, ST-segment elevation myocardial infarction, and non-ST-segment elevation myocardial infarction, who were treated with a PCSK9 inhibitor (evolocumab or alirocumab) during hospitalization for ACS between 2021 and 2023 were retrospectively analyzed. Baseline low-density lipoprotein cholesterol (LDL-C) levels were assessed, and changes in LDL-C levels during the acute and subacute phases after PCSK9 inhibitor administration were compared between the evolocumab and alirocumab groups.
Results Among 80 patients diagnosed with ACS, 36 received evolocumab, while 44 were treated with alirocumab. The mean baseline LDL-C level was 123 mg/dL in the evolocumab group and 128 mg/dL in the alirocumab group (p=0.456). In the subacute phase, the mean follow-up LDL-C levels were 47.05 mg/dL in the evolocumab group and 49.5 mg/dL in the alirocumab group (p=0.585). The mean percentage reduction in LDL-C levels during the subacute phase was 60.41% in the evolocumab group and 58.51% in the alirocumab group (p=0.431). These differences were not statistically significant.
Conclusions No significant differences were observed between evolocumab and alirocumab. LDL-C levels exhibited a similar trend, characterized by a rapid decline in the acute phase, followed by a slight rebound in the subacute phase.
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We experienced a case of disseminated Staphylococcus aureus infection with bacterial pericarditis that progressed to septic shock and multiorgan failure despite pericardiocentesis and surgical removal of the original abscess with intensive antibiotic therapy. We report this case because of the patient’s very rare and remarkable echocardiographic findings and highly turbid pericardial effusion.
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