Optimal Imaging Guidance During Transcatheter Mitral Valve-in-Valve Replacement in Bioprostheses With Radiolucent Sewing Rings.

Transcatheter mitral valve-in-valve replacement (TMVR) offers a less invasive strategy for managing bioprosthetic mitral valve dysfunction. TMVR positioning is challenging in the setting of a radiolucent bioprosthetic sewing ring. We present 2 cases demonstrating the roles of fluoroscopy and echocardiography in guiding TMVR placement within bioprostheses with radiolucent sewing rings.

Avian demographic responses to drought and fire: a community-level perspective.

Drought stress is an important consideration for wildlife in arid and semiarid regions under climate change. Drought can impact plant and animal populations directly, through effects on their physiology, as well as indirectly through effects on vegetation productivity and resource availability, and by creating conditions conducive to secondary disturbance, such as wildfire. We implemented a novel approach to understanding community-level demographic responses of birds and their habitats to these stressors in the context of climate change at 14 study sites in the Four Corners region of the southwestern United States.

Global versus local conservation focus of U.S. state agency endangered bird species lists.

The development of species priorities for conservation at local or regional scales (for example, within a state or province) poses an interesting paradox. One the one hand, locally or regionally-derived species priorities may lead to greater interest in and resources directed to biodiversity conservation by local or regional institutions. On the other hand, locally or regionally-derived species priorities could overlook national or global priorities.

Accelerating restrictive cardiomyopathy after liver transplantation in a patient with familial amyloidotic polyneuropathy: a case report.

Introduction: Hereditary amyloidodis is a rare disease process with a propensity to cause polyneuropathies, autonomic dysfunction, and restrictive cardiomyopathy. It is transmitted in an autosomal dominant manner, with disease onset usually in the 20s-40s. The most common hereditary amyloidogenic protein, transthyretin, is synthesized in the liver and lies on Chromosome 18.

Preservation of ventricular function in amateur athletes after completion of a marathon.

Background: Previous studies have demonstrated the development of impaired systolic function and new segmental wall motion abnormalities following completion of ultraendurance events. Limited information is available on the effect of an endurance event such as a marathon on the left ventricular indices and hemodynamics.

Methods: We examined 45 patients (26 men, 19 women with the average age of 35+/- 8 years) who successfully trained and completed the 2001 Chicago Marathon (26.

Structural evaluation of porcine heart valve prostheses with radiofrequency ultrasound.

Background: Bioprosthetic heart valve use is limited by progressive degeneration. Early degenerative changes are often occult, making assessment of tissue integrity difficult. Ultrasound tissue characterization may detect alterations in tissue structure and allow early detection of leaflet degeneration.

Echocardiographic prevalence of mitral and/or aortic regurgitation in patients exposed to either fenfluramine-phentermine combination or to dexfenfluramine.

We evaluated the prevalence of valvular regurgitation in patients who have taken anorectic medications. Two-dimensional echocardiograms with color flow Doppler were recorded in 200 consecutive patients referred to a major metropolitan hospital for evaluation of cardiac function because of a history of anorectic medication use. Each patient filled out a questionnaire at the time of the visit or through telephone contact.

Atherosclerotic plaque evolution in the descending thoracic aorta in familial hypercholesterolemic patients. A transesophageal echo study.

We explored the concept that transesophageal echocardiography can be used as a tool to detect, characterize, and study plaque morphology in the descending thoracic aorta. The pattern of atherosclerotic plaques in the descending thoracic aorta in familial hypercholesterolemic (FH) patients was evaluated. Additionally, evolution of plaque characteristics as a result of therapy was analyzed.

Improvement in the diagnosis of bioprosthetic valve dysfunction by transesophageal echocardiography.

Transthoracic two-dimensional echocardiography has been considered the method of choice for the non-invasive assessment of bioprosthetic valves. Recently, transesophageal echocardiography has provided a better imaging window for detecting valve abnormalities not identified otherwise, but pathologic confirmation is essential to establish the role of new diagnostic techniques in clinical practice. Therefore, the purpose of this study was to evaluate the usefulness of transesophageal echocardiography in determining the etiology of bioprosthetic valve dysfunction.

Pathologic and angiographic correlations of transesophageal echocardiography in prosthetic heart valve dysfunction.

To determine the diagnostic accuracy of transesophageal echocardiography (TEE) in prosthetic valve dysfunction, the pathologic and/or angiographic data from 37 valves were compared with that obtained by transesophageal and transthoracic echocardiography. Of the 21 prostheses with severe regurgitation, TEE identified all 14 mitral, the five aortic, and one of the two tricuspid valves; on the other hand transthoracic echocardiography identified 2 of the 14 mitral, the five aortic, and one of the two tricuspid valves. Of the 10 prostheses with flail cusp(s), nine (90%) were correctly identified by TEE and four (40%) were correctly identified by transthoracic echocardiography.

Plaque and structural characteristics of the descending thoracic aorta using transesophageal echocardiography.

The in vivo acoustic and structural characteristics of atherosclerosis in the descending thoracic aorta have not been well delineated. We prospectively evaluated the descending thoracic aorta of 147 patients (35 women and 112 men; age, 61 +/- 14 years) who underwent clinically indicated transesophageal echocardiography. Patients with suspected disease of the aorta were excluded.

Functional chiral asymmetry in descending thoracic aorta.

To determine whether rotational blood flow or chiral asymmetry exists in the human descending thoracic aorta, we established the ability of color Doppler ultrasound to detect rotational flow in a tornado tube model of a vortex descending fluid column. In a model of the human aortic arch with a pulse duplicator, color Doppler was then used to demonstrate that rotational flow occurs first in the transverse arch and then in the proximal descending thoracic aorta. With the use of color Doppler esophageal echocardiography, 53 patients (age range, 25-78 years; mean age, 56.

Transesophageal echocardiography in the awake elderly patient: its role in the clinical decision-making process.

To assess the impact on the management and safety of transesophageal echocardiography (TEE) in the elderly population, the results and limitations of this technique were retrospectively analyzed in 88 patients. TEE was indicated whenever the transthoracic approach was not diagnostic or was inconsistent with the clinical setting. The most frequent clinical indications were to investigate the source of emboli, assess valvular regurgitation, and identify valvular vegetations.

Metastatic squamous cell carcinoma to the heart. Unusual cause of angina decubitus and cardiac murmur.

A 61-year-old woman was admitted to the hospital with the new onset of angina at rest and an ECG consistent with anterior wall ischemia. She was also noted to have a new cardiac murmur. Eighteen months earlier, she had been treated for squamous cell carcinoma of the base of the tongue.