Prosthetic aortic valve endocarditis due to Ochrobactrum anthropi.

Ochrobactrum anthropi is an emerging pathogen increasingly affecting the immunocompromised host. Only four cases of infective endocarditis have been documented in literature. Therapeutic approach is a rising challenge as it is resistant to most of the currently available beta lactam antibiotics with the exception of carbapenems.

Changing outcomes and treatment strategies for wire induced coronary perforations in the era of bivalirudin use.

Objectives: The objective of this study is to analyze the clinical outcomes and treatment strategies of coronary wire perforations (WPs) in the era of heparin use compared to the era of bivalirudin use.

Background: Percutaneous coronary intervention (PCI) advances have led to progressive decrease in complications. Therefore, complex coronary lesions such as chronic total occlusions and calcified lesions are being attempted with stiff/hydrophilic wires with resultant higher incidence of coronary WP.

Outcome of intracoronary stenting after failed maximal medical therapy in patients with symptomatic myocardial bridge.

Objectives: The aim of the present study was to study the outcome of coronary stenting in patients with symptomatic myocardial bridging refractory to standard medical therapy.

Background: Medical therapy constitutes the first line treatment for patients with symptomatic myocardial bridge, surgical correction may be offered to select patients with refractory symptoms. Limited data exists on the outcome of coronary stenting in this patient cohort.

Clinical application of prophylactic percutaneous left ventricular assist device (TandemHeart) in high-risk percutaneous coronary intervention using an arterial preclosure technique: single-center experience.

Objectives: The objectives of the present study were to evaluate the feasibility and safety of implanting a prophylactic left ventricular (LV) assist device prior to high-risk percutaneous coronary intervention (PCI) and to assess the impact of suturemediated preclosure of the arteriotomy site on minimizing vascular complications.

Background: Patients with multivessel disease, left main coronary artery disease (LMCA) or left main equivalent and/or moderate-to-severe LV dysfunction with elevated LV end-diastolic pressure are at increased risk of complications during PCI. The TandemHeart (TH) is a nonpulsatile percutaneous transseptal ventricular assist device (PTVA) that offers vital temporary hemodynamic support during high-risk PCI.

Real time/three-dimensional transthoracic echocardiographic visualization of the valve of foramen ovale.

We describe an adult patient in whom the valve of foramen ovale and its opening and closing movements were well visualized by live/real time three-dimensional transthoracic echocardiography.

Clinical utility of TandemHeart for high-risk tandem procedures: percutaneous balloon aortic valvuloplasty followed by complex PCI.

Periprocedural hemodynamic stability is the cornerstone of success for complex percutaneous interventions. Percutaneous left ventricular assist devices (VSD) are increasingly being used to perform complex percutaneous coronary and non-coronary interventions. We report our experience in utilizing the TandemHeart, a percutaneous VSD, to successfully perform complex tandem procedures; balloon aortic valvuloplasty and angioplasty.

Use of Tandem Heart as a temporary hemodynamic support option for severe pulmonary artery hypertension complicated by cardiogenic shock.

The TandemHeart is a recently-introduced percutaneous ventricular assist device that may be used for short-term hemodynamic support. Its utility has been shown for assisting the left ventricle in a variety of high-risk percutaneous interventions, in helping the left ventricle recover from myocarditis, in cardiomyopathies and in cardiogenic shock following acute coronary syndromes. Limited data exist on its applications in patients with right ventricular failure.

Comparison of two- and three-dimensional transthoracic echocardiography in the assessment of trabeculations and trabecular mass in left ventricular noncompaction.

Twenty-one patients (mean age 47.5 years, 9 females) with left ventricular noncompaction (LVNC) diagnosed by both two-dimensional transthoracic echocardiography (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE) were included in the study. Left ventricular (LV) mass was calculated with epicardial and endocardial border tracings first including the LV trabeculations and then excluding them.

First human case description of TandemHeart-assisted high-risk percutaneous balloon aortic valvuloplasty using bivalirudin anticoagulation.

TandemHeart is a recently-introduced percutaneous left ventricular assist device that can be used for hemodynamic support during high-risk interventional procedures in severely compromised patients. Angioplasty and stent placement in patients with coronary artery disease and high-risk coronary anatomy including the left main coronary artery have been described using this device. We report the first human case description of a high-risk percutaneous balloon aortic valvuloplasty for critical bicuspid aortic stenosis using the TandemHeart for periprocedural hemodynamic support.

Papillary fibroelastoma of the pulmonary valve: assessment by live/real time three-dimensional transthoracic echocardiography.

The differential diagnosis of a cardiac valve mass includes fibroelastoma, myxoma, lipoma, Lambl's excrescences, thrombus, and vegetation. Fibroelastomas are extremely rare primary cardiac tumors. Their incidence is 0.

Tissue Doppler assessment of longitudinal right and left ventricular strain and strain rate in pulmonary artery hypertension.

Tissue Doppler imaging (TDI) in 38 adult patients with pulmonary artery hypertension of varied etiology and normal left ventricular systolic function by two-dimensional transthoracic echocardiography showed significantly reduced peak systolic strain (SS) in all three segments of left ventricular free wall and ventricular septum and two of three segments of right ventricular free wall when compared to 29 adults with no clinical or echocardiographic evidence of heart disease and normal left and right ventricular systolic function. A similar reduction in peak diastolic strain (DS) was also noted in all three segments of left ventricular free wall and ventricular septum and one of three segments of right ventricular free wall. This reduction in strain indices in patients with pulmonary hypertension was noted irrespective of whether right ventricular systolic function was normal or reduced as assessed by two-dimensional transthoracic echocardiography.

Cor triatriatum sinister: assessment by live/real time three-dimensional transthoracic echocardiography.

We report a 49-year-old morbidly obese female with a poor acoustic window in whom live/real time three-dimensional transthoracic echocardiography was able to make a confident diagnosis of cor triatriatum sinister. En face views of the membrane facilitated accurate assessment of the size and shape of the large nonobstructing opening in the membrane. Maximum dimensions of the opening were 3.

Quantification of tricuspid regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area.

We evaluated tricuspid regurgitation (TR) by multiple echocardiographic techniques in 93 consecutive patients who underwent standard two-dimensional (2D) and live three-dimensional (3D) transthoracic echocardiography (TTE). TR vena contracta (VC) area was obtained by 3D TTE by systematic and sequential cropping of the acquired 3D TTE dataset. Assessment of VC area by 3D TTE was compared to 2D TTE measurements of the ratio of TR regurgitant jet area to right atrial area (RJA/RAA), RJA alone, VC width, and calculated VC area.

Live/real time three-dimensional echocardiographic demonstration of left ventricular noncompaction and thrombi.

We describe two adult patients with left ventricular noncompaction in whom live/real time three-dimensional transthoracic echocardiography (3DTTE) supplemented two-dimensional transthoracic echocardiography in making a definitive diagnosis of clots coexisting with trabeculations in the left ventricle. Mobility of clots and the presence of central echolucencies consistent with clot lysis were best demonstrated by 3DTTE and served to confidently differentiate clots from adjacent trabeculations.

Usefulness of live/real time three-dimensional transthoracic echocardiography in the assessment of atrioventricular septal defects.

We studied nine patients (five newborns and infants, two children, and two adults) with atrioventricular septal defects (four complete, one intermediate, and four partial) utilizing live/real time three-dimensional transthoracic echocardiography (3DTTE) and a 4-MHz matrix array transducer. In all patients, 3DTTE provided additional morphological and/or functional information as compared to standard two-dimensional transthoracic echocardiography (2DTTE). 3DTTE may be a useful supplement to 2DTTE in the assessment of atrioventricular septal defects.

Usefulness of live/real time three-dimensional transthoracic echocardiography in the identification of individual segment/scallop prolapse of the mitral valve.

In this report, we present 34 patients in whom surgical intervention was undertaken for severe mitral insufficiency due to mitral valve prolapse (MVP). Location and severity of MVP and regurgitation were assessed preoperatively by live/real time three-dimensional transthoracic echocardiography and closely agreed with the surgical findings.

Usefulness of live/real time three-dimensional transthoracic echocardiography in the characterization of ventricular septal defects in adults.

In this report, we present 12 patients (range 14-76 years, mean 40 +/- 22.7 years) who underwent surgical repair of a ventricular septal defect (VSD). Location, size, and surrounding anatomy of the VSD were assessed prior to intervention in all patients with live/real time three-dimensional transthoracic echocardiography (3DTTE).

Live/real time three-dimensional transthoracic echocardiographic assessment of mycotic pseudoaneurysm involving the descending thoracic aorta.

We describe a patient in whom a mycotic aneurysm involving the distal descending thoracic aorta could be definitively diagnosed by live/real time three-dimensional transthoracic echocardiography.

Live/real time three-dimensional transthoracic echocardiographic assessment of Ebstein's anomaly.

We describe our experience in using live/real time three-dimensional transthoracic echocardiography (3D TTE) in the assessment of five adult patients with Ebstein's anomaly. The technique was found useful in assessing the distribution and extent of tethering of each of the three leaflets of the tricuspid valve (TV) to the underlying right ventricular walls and the ventricular septum. The characteristic bubble-like appearance resulting from bulging of the non-tethered areas of the TV leaflets was also well visualized in three dimensions and their size measured.