The enigma of fine mobile structures on the aortic surface in a patient undergoing transcatheter aortic valve replacement: a case report.

Background: The surface of the aorta generally does not show motion unless mobile atheroma, thrombi, vegetations, or intimal flaps are present. We previously described unusual mobile filamentous structures in the carotid artery. Here, we describe similar findings in the aorta and their possible cause.

Percutaneous thrombectomy and right ventricular mechanical circulatory support for pulmonary embolism in a coronavirus disease 2019 patient: case report, 1-year update, and echocardiographic findings.

Background: We previously described percutaneous thrombectomy and right ventricular (RV) mechanical support of a coronavirus disease 2019 (COVID-19) patient with a massive pulmonary embolism. Here, we present a detailed echocardiographic and clinical timeline with 1-year follow-up.

Case Summary: A 57-year-old female with COVID-19 went into shock from a massive pulmonary embolism.

Carotid Strands: Possible Mechanisms and Implications of a Novel Finding.

• Carotid strands are a novel ultrasound finding of unknown prevalence. • Three cases of carotid strands are reported in subjects with or at risk for carotid atheroma. • In one subject, new material deposited in the bulb that disappeared with statin use.

The TAVR that Got Away: A Case Report.

• Prosthetic valve migration and coronary occlusion are relatively rare complications. • Precise preoperative imaging can help reduce the risk for complications. • Alternative-modality imaging is crucial when CT provides inconclusive data.

A practical guide to graphic communication for quality assurance, education, and patient care in echocardiography.

Graphic communication (GC) is useful for continuous quality improvement (CQI), education, and patient care when in-person discussion is not possible because of geographic and schedule constraints. In echocardiography, these constraints can be mitigated by (a) capturing screenshots and device photos or videos and sharing them by email or text message, (b) simultaneous viewing of images on digital displays, and (c) broadcasting the study real time during acquisition to other mobile or stationary devices. Screenshots are useful for CQI and education and can be acquired, annotated, and shared with minimal impact on the flow of clinical echo interpretation.

Pathologic Intracardiac Bubbles in Patients With Cirrhosis: The Case for an Intestinal Origin.

• LV, RV, RA, and LA bubbles were noted in two patients without active infusion. • Bubbles were detected in the portal and hepatic veins and the IVC in one patient. • Patients were at risk for portal vein gas and portosystemic and pulmonary shunting.

Reduction in Radiation Exposure through a Stress Test Algorithm in an Emergency Department Observation Unit.

Introduction: Clinicians are urged to decrease radiation exposure from unnecessary medical procedures. Many emergency department (ED) patients placed in an observation unit (EDOU) do not require chest pain evaluation with a nuclear stress test (NucST). We sought to implement a simple ST algorithm that favors non-nuclear stress test (Non-NucST) options to evaluate the effect of the algorithm on the proportion of patients exposed to radiation by comparing use of NucST versus Non-NucST pre- and post-algorithm.

Relationship between carotid disease on ultrasound and coronary disease on CT angiography.

Objectives: The purpose of this study was to assess the relationship between carotid artery disease by ultrasound and coronary artery disease by coronary computed tomography angiography (CTA) and to identify carotid ultrasound parameters predictive of coronary artery disease.

Background: Carotid ultrasound and CTA are noninvasive modalities used to image atherosclerosis. Studies examining the relationship between the 2 tests, however, are lacking.

Usefulness of carotid ultrasound to improve the ability of stress testing to predict coronary artery disease.

Carotid ultrasound is a useful tool to detect plaque and measure carotid intimal-medial thickness (CIMT), which help identify asymptomatic patients at risk of cardiovascular events. However, the role of carotid ultrasound in stratifying risk in symptomatic patients has not been studied. We prospectively examined the hypothesis that in symptomatic patients undergoing exercise (or pharmacologic) stress testing (EST), CIMT and carotid plaque will improve the ability to identify patients with > or =50% coronary diameter stenosis.

Myocardial oxidative metabolic supply-demand relationships in patients with nonischemic dilated cardiomyopathy.

Background: Nonischemic dilated cardiomyopathy (NIDCM) is associated with left ventricular remodeling, hypertrophy, and mitochondrial metabolic abnormalities in vitro. We evaluated the hypothesis that energy supply, as judged by the rate of myocardial oxidative metabolism, is inadequate to meet oxygen demand in patients with NIDCM compared with normal subjects.

Methods And Results: We used positron emission tomography to determine the myocardial carbon 11 acetate decay rate (kmono) as an index of energy supply, and we compared kmono with the rate-pressure product (RPP) as an index of metabolic demand in 7 patients with NIDCM and 7 normal subjects.

Technical aspects of diastology: why mitral inflow and tissue Doppler imaging are the preferred parameters?

Doppler methods for assessing left ventricular (LV) diastolic function have increased in number and complexity. However, time constraints may prevent measurement of all parameters during routine transthoracic echocardiography. Therefore, we designed a study to determine which Doppler parameters could be most successfully and quickly obtained.

Can transthoracic echocardiography with subcostal view predict abdominal aortic atherosclerosis?

Background: Prompt detection of atherosclerosis (ATH) may profoundly impact therapy and patient outcome. During transthoracic echocardiography (TTE), subcostal views may suggest abdominal (ABD) aortic (AO) ATH, but this diagnosis may be inaccurate due to suboptimal images, which may in part relate to use of nonlinear probes. Therefore, we investigated the accuracy of TTE assessment of ABD AO ATH relative to transesophageal (TEE) AO images.

Which echocardiographic Doppler left ventricular diastolic function measurements are most feasible in the clinical echocardiographic laboratory?

Numerous measures of left ventricular diastolic function are currently in clinical use. To determine which echo-Doppler left ventricular diastolic function measurements are most feasible in the clinical echocardiographic laboratory, the success rate, recording time taken by the sonographer, and inter-reader variability were calculated for transmitral valve inflow, pulmonary vein flow, tissue Doppler imaging, and color M-mode flow propagation velocity in 80 inpatients.

Both diastolic and systolic function alternate in pulsus alternans: a case report and review.

Pulsus alternans is occasionally seen in the setting of heart failure. This case describes a patient with both these findings, and alternating diastolic and systolic left ventricular function on color Doppler and Doppler tissue imaging.