Contemporary midterm echocardiographic outcomes of Bentall procedure and aortic valve sparing root replacement.

Background: Valve sparing root replacement (VSRR) and aortic valve repair (AVr) is an attractive treatment option compared with composite valve and root replacement (Bentall procedure) for patients with aortic root dilatation with or without aortic valve disease. While aortic valve preservation reduces the risk of valve-related complications, little is known about echocardiographic differences at follow-up between these 2 strategies.

Methods: Consecutive nonemergent patients undergoing VSRR and AVr (n=68) were compared with contemporary historical controls undergoing the Bentall procedure for aortic root pathology with or without mixed aortic valve disease (insufficiency or stenosis) (n=96).

An unusual case of cardiogenic shock: common cause from uncommon etiology.

Mechanical complications of an acute coronary syndrome can lead to hemodynamic instability out of proportion to the degree of left ventricular dysfunction. We present the case of a patient with cardiogenic shock secondary to severe mitral regurgitation in the setting of an acutely occluded obtuse marginal artery. Echocardiography and pathologic findings revealed an uncommon cause of anterolateral papillary muscle rupture.

Unusual cause of an ejection murmur: myxoma in the left ventricular outflow tract.

We present the case of a healthy, asymptomatic 50-year-old woman with a systolic ejection murmur who was found to have an obstructive left ventricular outflow tract mass. Transthoracic echocardiography revealed a large mobile mass attached to the basal anterior septum of the left ventricle. Surgical resection was performed and a benign left ventricular outflow tract myxoma was diagnosed.

Acute mitral regurgitation in suspected acute coronary syndrome: what is the cause?

Patients presenting with acute chest pain and suspected acute coronary syndrome (ACS) who have nonobstructive coronary disease on angiography, but new regional wall motion abnormalities are often diagnosed with takotsubo cardiomyopathy (TTC). The cause of TTC is often physical or emotional stress, and this clinical syndrome occurs more often in women than men. When hemodynamically significant mitral regurgitation (MR) accompanies TTC, the mechanism must be carefully elucidated, as systolic anterior motion (SAM) of the mitral valve can cause significant MR and left ventricular outflow tract (LVOT) obstruction.

The challenge of timing surgery in a complex case of endocarditis.

While the results of clinical trials are useful in guiding management of the "average" patient, physicians are often left to their own devices when confronted with cases that neither fulfil the entrance criteria for clinical trials nor conveniently match evidence-based guidelines. We present a teaching exercise, built around a complex case of endocarditis, in a branched self-assessment format that challenges the reader's clinical judgement. The case involves a woman aged 45 years with decompensated liver cirrhosis who presents with endocarditis complicated by heart failure and multiple systemic emboli.

Temporal trends and patterns of early clopidogrel use across the spectrum of acute coronary syndromes.

Background: Randomized trials have established efficacy of clopidogrel in various types of acute coronary syndromes (ACS). The objective of this study was to examine the temporal trends and patterns of early clopidogrel use (within the first 24 hours of hospitalization) across the spectrum of patients with ACS in Canada.

Methods: Using the multinational, prospective GRACE (Global Registry of Acute Coronary Events) and GRACE(2), we identified 11,177 patients who were admitted for ACS from January 2003 to December 2007 in Canada.