Bioprosthetic mitral valve thrombosis: the role of cardiac CT in diagnosis and guiding the management.

A patient in his 60s with a bioprosthetic aortic and mitral valve replacement presented with dyspnoea, tiredness and dizziness 2 years postoperatively. Transthoracic echocardiography showed mitral valve stenosis and increased pulmonary artery pressure suggesting bioprosthetic valve failure. Cardiac CT confirmed the diagnosis of bioprosthetic mitral valve thrombosis.

Cardiac Cephalgia.

Although most of the patients presenting with ischemic heart disease have chest pains, there are other rare presenting symptoms like cardiac cephalgia. In this report, we present a case of acute coronary syndrome with an only presentation of exertional headache. It was postulated as acute presentation of coronary artery disease, due to previous history of similar presentation associated with some chest pains with previous left coronary artery stenting.

A previously undescribed type of quadricuspid aortic valve: type H.

The discovery is reported of a previously undescribed type of quadricuspid aortic valve, which was comprised of two equal-sized smaller cusps and two unequal-sized larger cusps. This was proposed as the eighth type of quadricuspid valve, type H. This anatomic variation is the only type of quadricuspid valve that could exist in theory, but has not been previously described.

Culture-negative endocarditis: "whatever remains, however improbable, must be the truth"; the importance of asking the right questions!

The complicated case of a patient with recurrent culture-negative endocarditis with a history of repeated mitral valve replacement is described. Investigations disqualified common pathology but serology revealed a diagnosis of Q fever endocarditis. The ongoing problematic management of this patient is described, followed by a brief review of the clinical features, investigations and treatment of Q fever.