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Background/aims Pheochromocytoma and paraganglioma (PPGL) are catecholamine-producing tumors that can cause blood pressure (BP) elevation and cardiovascular complications. Clinical presentation of these tumors may be changed through widespread use of imaging studies, which enables detection of PPGLs before onset of symptoms. We investigated clinical profiles of patients with surgically resected PPGLs. Methods From 2005 to 2017, 111 consecutive patients with surgically resected PPGLs in two tertiary hospitals in Korea were studied. Results Mean age was 52 ± 16 years, 57 patients (51.4%) were male and 54 (48.6%) were hypertensive. Twenty-nine PPGLs (26.1%) were extra-adrenal paragangliomas. Sixteen (14.4%) and seven patients (6.3%) (Group 1, n = 23) were diagnosed during work-up of hypertension and transient cardiomyopathy respectively, and the remainder (Group 2, n = 88) were incidentalomas detected during routine abdominal imaging. Patients in the Group 1 were younger and more frequently symptomatic, and had higher BPs, heart rates and levels of urinary catecholamines than those in the Group 2. Paragangliomas were less frequent and secretion of epinephrine and metanephrine was more predominant in the Group 1 than in Group 2. After the surgical resections, 18.2% of patients still needed antihypertensive medications. Conclusion Out of 111 patients with surgically resected PPGLs, 88 (79.3%) were diagnosed as incidentalomas. Seven patients presented with transient cardiomyopathy and 16 with hypertension. Tumor location and secretion of catecholamine may vary depending on the presence of symptoms.

Background: Atrial mechanical dysfunction and its recovery time course after successful radiofrequency ablation of chronic atrial flutter (AFL) has been largely unknown. We serially evaluated left atrial function by echocardiography after successful ablation of chronic atrial flutter. Methods: In 13 patients with chronic AFL, mitral E wave A wave, and the ratio of A/E velocity were measured at 1 day, 1 month, 3 months and 6–12 months after successful radiofrequency (RF) ablation. Doppler tissue imaging (DTI) technique was also used to avoid load-dependent variation in the flow velocity pattern. Results: Left atrial mechanical function, assessed by A wave velocity and the annular motion, was depressed at 1 day, but improved significantly at 1 month and maintained through 6–12 months after the ablation. Left atrial size did not change significantly. Conclusion: Left atrial mechanical function was depressed immediately after successful RF ablation of chronic AFL, but it improved significantly after 1 month and was maintained over one year.

A 62-year-old man suffered from exertional dyspnea and repetitive momentary dizziness that began occurring just after forceful chest beating to end an episode of acute shortness of breath 3 days prior. His blood pressure was 102/66 mmHg. His D-dimer level (435 µg/L) and N-terminal pro-brain natriuretic peptide level (2,863 pg/mL) were elevated. Electrocardiography exhibited atrial fibrillation with a regular junctional rhythm and a rate of 56 bpm. An intracardiac mass and acute thromboembolism in both pulmonary arteries (APTE) were diagnosed by computed tomography (Fig. 1A and 1B). Echocardiography revealed a very large 60 × 50 mm deformable mass f loating freely in the markedly enlarged right atrium (RA), plugging the right ventricle through the tricuspid valve and periodically occupying the entire cavity (Fig. 1C). Emergent surgery was performed to remove the mass and the APTE. The RA mass was a Chinese moon cake-like thrombus (65 × 55 × 20 mm) (Fig. 2). Two remnant stalks were found on the RA wall. Pathology confirmed that the mass was an organized thrombus and that the stalks were degenerative muscular tissue. Figure 1 (A, B) Computerized tomographic images showing a mass floating in the right heart (A, black arrows) and embolism in both pulmonary arteries (B, white arrows). (C) A series of echocardiographic images of the right heart. A huge deformable echogenic mass ... Figure 2 An easily deformable huge thrombus (65 × 55 × 20 mm) removed from the right atrium.

Ventricular premature complexes (VPCs) are known to be one of the most benign cardiac arrhythmias when they occur in structurally normal hearts. We experienced a 32-year old man who presented with dyspnea, palpitations and very frequent VPCs (31% of the total heart beats). Echocardiography revealed a dilated left ventricle (LV 66 mm at end-diastole and 57 mm at end-systole) and a decreased ejection fraction (34%). Very frequent VPCs had been detected 10 years previously and he underwent a failed radiofrequency catheter ablation (RFCA) procedure at that time. The patient had been treated with heart failure medications including betablockers, ACE inhibitors and spironolactone for the two most recent years. Six months after we eliminated these VPCs with a second RFCA procedure, the heart returned to normal function and size. Long standing and very frequent VPCs could be the cause of left ventricular dysfunction in a subset of patients who suffer with dilated cardiomyopathy, and RFCA should be the choice of therapy for these patients.