Mitral Regurgitation due to Entrapment of Cut Mitral Chordal Apparatus in a Bileaflet Disk Prosthesis.

• TEE is essential for the assessment of MVR dysfunction. • TEE can comprehensively assess paravalvular or central MR. • Understanding the pathophysiology of MR after MVR is essential.

Extrinsic Circumflex Coronary Artery Compression and Occlusion by Mycotic Aneurysm of Left Aortic Sinus.

• Mycotic aneurysm of the aortic sinus is a rare complication of aortic valve endocarditis. • Mycotic aneurysm of left sinus causing LM compression and circumflex occlusion is shown. • We present TTE and TEE approaches to making the diagnosis of this complex lesion.

Case Illustrations of the Utility of Echocardiography in Gunshot Wound Trauma.

• TEE is a necessary modality for diagnosing cardiac/thoracic bullet embolization. • In gunshot cardiac injury, lack of exit wound should raise suspicion for bullet embolization. • The bullet will appear as a hyperechoic structure on ultrasound imaging.

Unroofed Coronary Sinus Discovered Incidentally during Cardiac Surgery: Systematic Approach to Diagnosis by Transesophageal Echocardiography.

• We report repaired URCS defect concomitant with coronary bypass surgery. • Systematic TEE was used to determine the etiology of isolated dilatation of right heart. • A diagram including the complete spectrum of URCS is provided.

Aortocoronary Saphenous Vein Graft Aneurysm: Diagnosis Using Color Doppler and Contrast Transesophageal Echocardiography.

• SVG aneurysm may be diagnosed using TEE, color Doppler, and UEA. • An extracardiac mass after CABG raises suspicion of an SVG aneurysm. • Demonstration of flow by color Doppler or UEA aids in diagnosing SVG aneurysm.

Single coronary artery Left (SCA L)-Right coronary artery arising from mid-left anterior descending coronary artery: New variant of Lipton classification (SCA L-II) diagnosed by computed tomographic angiography.

Isolated single coronary artery (SCA) is a rare anomaly. Current classification of left and right is further classified based on the course of the anomalous vessel. We report two SCA L cases where right coronary artery (RCA) arose from mid-left anterior descending coronary artery (LAD).

Real time three-dimensional transesophageal echocardiographic evaluation of aortic valve perforation.

Objectives: This study evaluated the feasibility of real time three-dimensional transesophageal echocardiography (RT3DTEE) in the diagnosis and localization of aortic valve perforation.

Methods: Aortic valve perforation was diagnosed in 12 patients by multiplane two-dimensional transesophageal echocardiography (2DTEE). We studied the feasibility of RT3DTEE using en face view in detection and precise localization of the aortic valve perforation.

Mitral annular geometry in normal and myxomatous mitral valves: three-dimensional transesophageal echocardiographic quantification.

Background And Aim Of The Study: The mitral annulus (MA) has a complex dynamic geometry that is difficult to visualize in two dimensions; hence, novel real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) provides insights into its dynamic nature. The study aim was to investigate changes in MA geometry in normal subjects and to explore differences in patients with myxomatous mitral valve disease (MMVD), using 3D quantitation with RT-3D-TEE.

Methods: Thirty-five participants (18 with MMVD, 17 normal subjects as controls) were enrolled into the study.

Measuring cardiac index with a focused cardiac ultrasound examination in the ED.

Objectives: Noninvasive technology may assist the emergency department (ED) physician in determining the hemodynamic status in critically ill patients. The objective of our study was to show that ED physicians can accurately measure cardiac index (CI) by performing a bedside focused cardiac ultrasound examination.

Methods: A convenience sample of adult subjects were prospectively enrolled.

Late outcome after repair of mitral valve rupture during balloon atrial septostomy in a neonate.

Balloon atrial septostomy is ordinarily a safe palliative procedure for cyanotic congenital heart disease; however, if echocardiographic guidance is unavailable and fluoroscopy is used, distortions in the cardiac anatomy can invalidate the usual landmarks. Herein, we report iatrogenic mitral papillary muscle rupture during balloon atrial septostomy in a 4-day-old male neonate with total anomalous connection of the pulmonary veins. The anomalous connection and severe mitral regurgitation were emergently corrected, and the patient grew and developed normally.

Ostial left main stenosis due to takayasu arteritis: multimodality imaging and surgical ostioplasty.

Takayasu's arteritis is an inflammatory process, involving larger blood vessels-namely the aorta and its branches. The majority of these patients present with symptoms of vascular obstruction. We report a case of a 38-year-old Chinese female who presented with one month history of angina pectoris as the initial manifestation.

Left ventricular pseudoaneurysm due to embolic myocardial infarction in infective endocarditis: real time three-dimensional transesophageal echocardiographic evaluation.

We report a case of a 63-year-old woman who presented with infective endocarditis and developed a pseudoaneurysm (PA) of the left ventricle presumably as a result of an embolic infarct. The diagnosis was made by typical features of PA on tranesophageal echocardiography and color Doppler studies. In addition, three-dimensional transesophageal echocardiography showed the narrow neck of the PA.

Real time three-dimensional transesophageal echocardiographic evaluation of a sinus venosus atrial septal defect.

We present a case of a 65-year-old man who presented with atrial flutter and dilation of right heart was noted on transthoracic echocardiography. Transesophageal echocardiography revealed a large sinus venosus atrial septal defect close to superior vena cava and anomalous connection of right superior pulmonary vein. Additionally, real time three-dimensional transesophageal echocardiography provided superior spatial details and demonstrated the size, location of the defect and its spatial relationship to the surrounding structures.

Practical guide for three-dimensional transthoracic echocardiography using a fully sampled matrix array transducer.

Real-time three-dimensional (3D) echocardiography is a major innovation in the history of cardiovascular ultrasound. Advances in computer and transducer technologies, especially the fully-sampled matrix array transducer, have permitted real-time 3D image acquisition and display. Several vendors provide 3D imaging but use different terminology for similar functions, creating confusion for consumers.

Aortic valve replacement improves survival in severe aortic stenosis associated with severe pulmonary hypertension.

Background: Severe pulmonary arterial hypertension in patients with severe aortic stenosis (AS) carries a poor prognosis. There are limited data on the effect of aortic valve replacement (AVR) in these patients.

Methods: Our echocardiographic database between 1993 and 2003 was searched for patients with severe AS defined as a Doppler estimated aortic valve area of 0.

Malignant natural history of asymptomatic severe aortic stenosis: benefit of aortic valve replacement.

Background: Patients with asymptomatic severe aortic stenosis (AS) are reported to have a benign prognosis and hence the American College of Cardiology/American Heart Association guidelines do not recommend aortic valve replacement (AVR) for patients with isolated asymptomatic severe AS. However, symptoms are subjective and would depend upon patient's life style. We examined the natural and unnatural history of initially asymptomatic patients with severe AS.

Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis.

Background: Severe aortic stenosis (AS) is a surgically correctable condition. However, aortic valve replacement (AVR) is not offered to many patients with severe AS for various reasons. We investigated the profile and survival patterns of patients with severe AS who did not have AVR.

Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement: Results from a cohort of 277 patients aged > or =80 years.

Background: Calcific aortic stenosis (AS) is a disease of the elderly. However, there is reluctance to offer aortic valve replacement (AVR) for elderly patients with severe AS. We investigated if AVR confers a survival benefit in elderly patients with severe AS.

Mitral regurgitation progression following isolated coronary artery bypass surgery: frequency, risk factors, and potential prevention strategies.

Background: Though de novo mitral regurgitation (MR) is frequently seen in patients who have undergone coronary artery bypass surgery (CABG), its incidence, predictors, and mechanisms are not known.

Methods: Our surgical registry was screened for patients undergoing isolated CABG who had preoperative and postoperative resting echocardiograms performed at our institution with View Article and Find Full Text PDF

Factors affecting regression of mitral regurgitation following isolated coronary artery bypass surgery.

Objective: Fate of MR following CABG is variable. Predictors of MR regression following CABG alone are not known.

Methods: From our surgical registry, CABG patients with both pre-operative and post-operative resting echocardiograms at our institution were screened.

Factors affecting regression of mitral regurgitation following isolated coronary artery bypass surgery.

Objective: Fate of MR following CABG is variable. Predictors of MR regression following CABG alone are not known.

Methods: From our surgical registry, CABG patients with both pre-operative and post-operative resting echocardiograms at our institution were screened.

Echocardiographic features of an unruptured mycotic aneurysm of the right aortic sinus of Valsalva.

This report describes a 25-year-old man with a pierced tongue in whom Streptococcus constellatus endocarditis of the aortic valve developed. Bacterial endocarditis in this patient was complicated by the development of a mycotic aneurysm of the right aortic sinus of Valsalva. Transthoracic and transesophageal echocardiographic studies were useful for the diagnosis of this rare lesion.

Echocardiographic diagnosis of an asymptomatic aneurysm of a saphenous vein graft.

A case of a 73-year-old asymptomatic man with a large saphenous vein graft aneurysm first diagnosed 16 years after bypass operation is presented. The lesion was first suspected on routine transthoracic echocardiography and further clarified by transesophageal echocardiography. Selective graft angiography confirmed the diagnosis and surgical therapy included resection of the graft aneurysm and coronary artery bypass grafting.