Chordal Preservation Mitral Valve Replacement for Delayed MitraClip Failure.

Mitral valve replacement may be indicated in delayed MitraClip (Abbott) failure. Although it would be best to preserve the chordal apparatus during surgical mitral valve replacement, this has not been reported for delayed MitraClip failure, probably because there is almost always impressive inflammation around the MitraClip, which has likely precluded previous attempts at chordal preservation. A successful surgical chordal preservation mitral valve replacement in delayed MitraClip failure is reported here.

Prevalence and Clinical Correlates of Aortic Dilation in Hypertrophic Cardiomyopathy.

Background: Aortic dilation has been associated with various cardiac conditions, although its prevalence and clinical correlates in hypertrophic cardiomyopathy (HCM) remain unclear.

Objectives: The purposes of this study were to define the prevalence of ascending aortic dilation in a large referral population of patients with HCM and to determine clinical and echocardiographic correlates of aortic dilation.

Methods: A total of 1,698 patients with HCM underwent echocardiographic measurement of the tubular ascending aorta (proximal and midlevel) during index evaluation at a tertiary HCM referral center.

Imaging in blunt thoracic trauma: The importance of clinical correlation.

We present the case of a 26-year-old female restrained front-seat passenger who presents following a motor vehicle accident, with CT angiogram features suggestive of possible acute aortic injury. However, clinical features including relative hemodynamic stability and absence of typical symptoms were discordant with these imaging findings. This case illustrates that even with ECG-gating, CT angiogram artifact mimicking acute aortic injury may still occur.

Reference Values for Mid-Ascending Aorta Diameters by Transthoracic Echocardiography in Adults.

We sought to characterize mid-ascending aorta diameter reference values by age, sex, and body surface area (BSA) in a large echocardiography laboratory practice-based cohort. All subjects with transthoracic echocardiograms with mid-ascending aorta diameter measure from January 2004 to December 2009 were identified, and medical records were reviewed for medical history and anthropometric data. Those with aortic valve disease or replacement, congenital heart disease, any connective tissue or inflammatory disease that may affect the aorta, or known aortic aneurysm (>55 mm) were excluded.

Pulmonary Venous Obstruction From a Large Left Atrial Sarcoma: Resection Combined With Mitral Valve Bypass.

Cardiac sarcomas represent the majority of primary malignant cardiac tumors. They are usually located in the right atrium and are frequently angiosarcomas. We present a case of primary cardiac sarcoma originating from the left atrium in a 40-year-old woman that was treated with resection combined with mitral valve bypass.

Vasospasm Is a Consistent Finding in Pernio (Chilblains) and a Possible Clue to Pathogenesis.

Background/aims: Pernio (chilblains) is an inflammatory condition classically characterized by localized erythema and swelling of acral sites upon exposure to cool and damp conditions. We sought to determine whether cold-induced vasospasm has a role in the development of pernio.

Methods: We retrospectively reviewed 5 patients with pernio who were seen at our institution between January 1, 2000 and December 31, 2011, and had undergone a noninvasive arterial vascular study of the upper extremities that corresponded to a site of clinical involvement of pernio and who had also undergone vasospastic testing and ice water immersion as part of the noninvasive arterial vascular study protocol.

The effect of chair massage on muscular discomfort in cardiac sonographers: a pilot study.

Background: Cardiac sonographers frequently have work-related muscular discomfort. We aimed to assess the feasibility of having sonographers receive massages during working hours in an area adjacent to an echocardiography laboratory and to assess relief of discomfort with use of the massages with or without stretching exercises.

Methods: A group of 45 full-time sonographers was randomly assigned to receive weekly 30-minute massage sessions, massages plus stretching exercises to be performed twice a day, or no intervention.

Geometric reconstruction of the sinus of Valsalva: utilization of the porcine aortic root.

Surgical repair of ruptured sinus of Valsalva aneurysm can be challenging, although it has been reported that mortality and morbidity is low. Distortion of sinus of Valsalva geometry can cause aortic valve regurgitation immediately or progressively after surgery. Maintenance of the appropriate geometry of sinus of Valsalva after resection of the aneurysm is critical in preserving the native aortic valve and its competency.

Biphasic Doppler pattern of the descending thoracic aorta: a new echocardiographic finding in patients with aortic valve stenosis.

A total of 59 patients (> or = 65 years of age) with normal left ventricular function (ejection fraction > 50%) and varying degrees of aortic valve structure and hemodynamics (normal to severely stenotic) were screened; 50 were subsequently enrolled. Continuous wave Doppler echocardiography in the descending thoracic aorta showed two general patterns: (1) in aortic stenosis, the pattern consisted of two peak systolic velocity components (S1 and S2); and (2) in normal aortic valve function, the pattern was a uniphasic signal with a single peak systolic velocity component. The new Doppler pattern yielded 95% sensitivity and 90% specificity in the detection of clinically significant aortic valve stenosis, and 92% sensitivity and 70% specificity in the detection of severe aortic valve stenosis.

Residents can be trained to detect abdominal aortic aneurysms using personal ultrasound imagers: a pilot study.

Our objective was to test the hypothesis that internal medicine residents can be trained to screen for abdominal aortic aneurysm (AAA) using personal ultrasound imagers. We trained 5 randomly chosen internal medicine residents to image the abdominal aorta for patients with risk factors for AAAs using personal ultrasound imagers. Residents were trained in 3 or 4 one-on-one sessions with an instructor.

Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture.

Objectives: To ascertain whether acute aortic dissection (AAD) remains the most common aortic catastrophe, as generally believed, and to detect any improvement in outcomes compared with previously reported population-based data.

Patients And Methods: We determined the incidence, operative intervention rate, and long-term survival rate of Olmsted County, Minnesota, residents with a clinical diagnosis of AAD initially made between 1980 and 1994. The incidence of degenerative thoracic aortic aneurysm (TAA) rupture was also delineated.

Obstructive external iliac arteriopathy in avid bicyclists: new and variable histopathologic features in four women.

Objective: Avid competition bicycling may be associated with the development of external iliac artery stenosis. European studies have documented endofibrosis that primarily has affected young men. Our objective was to review the histopathologic features of obstructed external iliac arteries resected from avid competition bicyclists at a single institution.

Intermittent claudication: an objective office-based assessment.

Objectives: We sought to compare standard lower extremity vascular laboratory treadmill exercise with the office-based active pedal plantarflexion technique.

Background: Intermittent claudication is relatively common in elderly patients and is an important predictor of cardiovascular morbidity and mortality. Noninvasive testing using resting and posttreadmill exercise ankle:brachial systolic blood pressure indices is often required to confirm the diagnosis and objectively assess the severity of lower extremity arterial occlusive disease.

Association of atrial fibrillation and aortic atherosclerosis: a population-based study.

Objective: To examine the association between atrial fibrillation (AF) and aortic atherosclerosis in the general population.

Subjects And Methods: Transesophageal echocardiography was performed in 581 subjects, a random sample of the adult Olmsted County, Minnesota, population (45 years of age or older) participating in the Stroke Prevention: Assessment of Risk in a Community (SPARC) study. The frequency of aortic atherosclerosis was determined in 42 subjects with AF and compared with that in 539 subjects without AF (non-AF group).

Severe digital arterial occlusive disease and acute parvovirus B19 infection.

We report a case of arterial occlusive disease and digital ischaemia associated with acute parvovirus B19 infection. Treatment with intravenous epoprostanol improved her symptoms.

Personal ultrasound imager: abdominal aortic aneurysm screening.

Background: Miniaturized ultrasonographic machines (2.5-MHz curved-array transducer connected to a compact 2.6-kg console), termed personal ultrasound imagers (PUIs), may enable detection of occult abdominal aortic aneurysms (AAAs).

Mobile thrombi in the abdominal aorta in cases of lower extremity embolic arterial occlusion: value of extended transthoracic echocardiography.

Background: Lower extremity embolic arterial occlusion is often associated with proximal atherosclerotic and/or aneurysmal disease. Fixed atherosclerotic disease of the abdominal aorta has been demonstrated by ultrasonography, tomographic studies, and aortography, but mobile debris has not previously been described. We report detection of mobile thrombi in the abdominal aorta during transthoracic echocardiography screening in 6 patients with lower extremity embolic arterial occlusion.

Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonography: the SPARC study. Stroke Prevention: Assessment of Risk in a Community.

Objective: The SPARC (Stroke Prevention: Assessment of Risk in a Community) study was designed to identify risk factors for stroke and cardiovascular disease using transesophageal echocardiography and carotid ultrasonography. This protocol was undertaken to establish a cohort in which putative risk factors for stroke were identified so that subsequent follow-up could discern the roles these risk factors play in stroke incidence.

Subjects And Methods: This was a prospective, population-based study.