Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Oct 1998
Case ReportsTransesophageal echocardiographic identification of left upper pulmonary venous obstruction caused by compression by spontaneous pseudoaneurysm of the descending thoracic aorta.
Pseudoaneurysm of the aorta usually occurs as a complication of nonpenetrating trauma or deceleration injuries. Spontaneous pseudoaneurysm of the aorta is, however, extremely rare. ⋯ However, it is often overlooked during clinical examination, during routine echocardiography, and even at invasive angiography. This report describes the importance of transesophageal echocardiography in the detection of pulmonary vein compression, which is not suspected during other noninvasive and invasive diagnostic tests, in a patient with spontaneous pseudoaneurysm of the descending thoracic aorta.
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J Am Soc Echocardiogr · Jul 1998
Clinical, echocardiographic, and pathologic features of aortic wall dehiscence of porcine bioprosthetic valves: a cause of rapidly progressive mitral regurgitation and heart failure after bioprosthetic mitral valve replacement.
The aim of this study was to define the clinical, echocardiographic, and pathologic correlates of commissural dehiscence of aortic wall from the stent post of the porcine bioprostheses in the mitral position. This form of valve degeneration was found in 5 of 23 explanted mitral bioprostheses. A thickened, separated aortic wall at multiple commissural sites along with other evidence of valve degeneration was identified in the three patients who had chronic congestive heart failure. ⋯ Two dimensional/Doppler echocardiography showed a prolapsing or a flail anteriorly positioned leaflet and an eccentric posteriorly directed mitral regurgitation jet in all patients. These echocardiographic findings in patients with a porcine bioprosthetic mitral valve should suggest commissural dehiscence from the aortic wall as a possible mechanism of valve failure. Exclusive involvement of the porcine aortic bioprosthesis placed in the mitral position along with involvement of strut of the bioprosthesis facing the aortic root in all cases suggests excessive hemodynamic stress on the valve in the mitral position and in particular on the anteriorly placed strut as the potential cause of this form of valve degeneration.
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J Am Soc Echocardiogr · May 1998
Case ReportsAcquired ventricular septal defect and mitral insufficiency without pericardial effusion after stab wound to the chest.
Echocardiography has a role in the management of acute complications of penetrating cardiac trauma. We report the case of a 30-year-old man who sustained a stab wound to the chest. ⋯ The diagnosis was made by transthoracic echocardiography. The ability of transesophageal echocardiography to delineate the intracardiac injuries more precisely helped to guide the surgical procedure.
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J Am Soc Echocardiogr · May 1998
Case ReportsTransesophageal echocardiography in a case of cardiac compression: was it therapeutic?
Cardiac compression is a potentially life-threatening complication of heart surgery. This syndrome often has atypical manifestations, challenging our ability to make a rapid diagnosis and to institute emergent, life-saving treatment. We recently evaluated one such patient who showed cardiac compression caused by an unusual paracardiac mass. The addition of transesophageal echocardiography to the usual transthoracic study may have played more than just a diagnostic role in this case.
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J Am Soc Echocardiogr · Mar 1998
Comparative StudyThree-dimensional imaging in aortic disease by lighthouse transesophageal echocardiography using intravascular ultrasound catheters. Comparison to three-dimensional transesophageal echocardiography and three-dimensional intra-aortic ultrasound imaging.
Two-dimensional (2D) transesophageal echocardiography (TEE) and 2D intravascular ultrasound (IVUS) imaging face their greatest limitation in visualizing aortic disease in patients. With the aid of three-dimensional (3D) image reconstruction, TEE and IVUS can potentially overcome this limitation but still provide only limited spatial appreciation in aortic disease because 3D imaging of the thoracic aorta requires a broader spatial visualization of the mediastinum than provided by both techniques. Moreover, for timely decision making about aortic disease TEE is limited by a large probe, which requires sedation. ⋯ Spatial visualization of the aortic arch by 3D TEE was incomplete because of the relatively narrow 90-degree image sector. However, in other segments 3D image quality by 3D TEE was superior to 3D LTEE and 3D IVUS. Because of the thin catheter, patient discomfort (p < 0.0001) and examination time (p = 0.015) were significantly less for 3D LTEE compared with 3D TEE. 3D LTEE is a promising new technique for 3D imaging of the thoracic aorta and detection of aortic disease with improved spatial visualization and reduced patient discomfort compared with 3D TEE and 3D IVUS.