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View Article and Find Full Text PDFThe availability of drug-eluting stents has resulted in a paradigm shift in the management of patients with coronary artery disease with a substantial increase in the percentage of patients being revascularized percutaneously rather than surgically. Since its introduction, there has been a tremendous increase in the use of drug-eluting stents with nearly 90% of patients in the US who undergo percutaneous interventions receiving drug-eluting stents. The promising results of several randomized trials that demonstrated a profound reduction in restenosis rates compared with bare-metal stents, underscores the unprecedented enthusiasm among the cardiology community to adopt this new technology swiftly.
View Article and Find Full Text PDFObjective: To determine echocardiographic characteristics that may identify patients likely to have residual right-to-left shunt after percutaneous closure of a patent foramen ovale (PFO).
Background: Characteristics of the atrial septum and PFO may identify patients who are likely to have residual shunt following percutaneous closure.
Methods: We reviewed 76 consecutive patients (42 women; 34 men) who underwent percutaneous PFO closure (AGA Amplatzer PFO occluder) for hypoxemia or paradoxical embolization who failed or were unable to receive systemic anticoagulation.
Automobile airbags have been universally installed to save lives in motor vehicle accidents, but have also been linked with facial and thoracic burns and chest trauma during rapid deployment. Blunt trauma to the chest may result in electrical and mechanical injuries to the heart and great vessels. We report a case of a 19-year-old man who presented with acute myocardial infarction following a blunt chest trauma from an automobile airbag deployment.
View Article and Find Full Text PDFAgitated saline contrast studies (bubble studies) can be performed with either transthoracic or transesophageal echocardiography for the detection of right-to-left atrial shunts. The echocardiograms of 94 consecutive patients who underwent saline contrast studies with transthoracic and transesophageal approaches were reviewed to compare the ability of these modalities to detect right-to-left atrial shunts.
View Article and Find Full Text PDFAims: To illustrate the association between a patent foramen ovale (PFO) and paradoxical embolization.
Methods And Results: We report a unique case of a paradoxical embolization across a PFO noted during a transesophageal echocardiographic study. Serial images demonstrate the thrombus migrating from the superior vena cava to the left atrium across the PFO.
Accessory mitral valve is a rare congenital abnormality and is an unusual cause for subvalvular left ventricular outflow tract (LVOT) obstruction. It is detected first in children and is very rarely noticed in adults. The most common clinical presentation is symptomatic LVOT obstruction.
View Article and Find Full Text PDFThere are reports in the literature describing the utility of transesophageal echocardiography (TEE) in the evaluation of the coronary arteries. Studies have also shown the value of TEE in patients undergoing coronary intervention such as assessing coronary anatomy and flow following angioplasty. We report an interesting case where TEE helped to establish the location of a fractured cutting balloon device lodged in the left main coronary artery and obviated the need for cardiac surgery to remove the fractured balloon catheter.
View Article and Find Full Text PDFA unique case of spontaneous multivessel coronary artery dissection in a young woman without identifiable risk factors, who remained asymptomatic despite extensive coronary dissection is presented. The management of this condition and a review of the current literature on this subject are presented.
View Article and Find Full Text PDFTo determine the prevalence of left ventricular diastolic dysfunction in asymptomatic, normotensive patients with type 2 diabetes mellitus, we studied 61 consecutive normotensive patients with type 2 diabetes using conventional Doppler echocardiography at rest (deceleration time, isovolumic relaxation time, early diastolic velocity [E]/peak atrial systolic velocity [A] ratio), and during the Valsalva maneuver. In addition, mitral annular velocity and velocity of flow propagation were assessed in all patients using tissue Doppler imaging (TDI) and color M-mode echocardiography. A standard resting echocardiogram excluded significant valvular disease and stress echocardiography excluded significant coronary artery disease in those with diastolic dysfunction.
View Article and Find Full Text PDFAm J Physiol Heart Circ Physiol
August 2002
The objectives of this study were to investigate the temporal response of left ventricular (LV) matrix metalloproteinase (MMP) activity and collagen volume fraction (CVF) induced by an aortocaval fistula and the role of cardiac mast cells in regulating MMP activity. LV tissue was analyzed for MMP activity, CVF, and mast cell number in rats euthanized at 0.5, 1, 2, 3, 5, 14, 21, 35, and 56 days.
View Article and Find Full Text PDFContrast echocardiography improves left ventricular (LV) endocardial border delineation by enhancement of the blood-tissue interface. In particular, the contrast appearing within the LV chamber exhibits characteristic flow patterns over the cardiac cycle, which may be related to the surrounding myocardial wall motion. To determine the relation between the LV intracavitary contrast flow pattern and surrounding wall motion, we reviewed the contrast-enhanced images of 348 consecutive patients studied at rest.
View Article and Find Full Text PDFJ Am Soc Echocardiogr
September 2000
We describe 3 patients with suspected subacute cardiac rupture in whom contrast-enhanced echocardiography played a key role in the diagnosis. In 2 patients, extravasation of the contrast material into the extracardiac space provided direct evidence of subacute cardiac rupture. Absence of this feature helped to exclude cardiac rupture with active hemorrhage into the pericardial space in the third patient.
View Article and Find Full Text PDFThe use of a peripherally inserted central catheter (PICC) is occasionally complicated by intravascular fracture and central embolization of the catheter fragment. We present a patient in whom a PICC fragment was retrieved from the pulmonary artery 11 years after embolization following its incidental detection. Despite a history of IV drug abuse and mitral regurgitation, this patient remained asymptomatic and without complications.
View Article and Find Full Text PDFPremature ventricular beats or paced beats can unmask new or old myocardial infarction when sinus beats fail to exhibit the typical infarct pattern. Knowledge of their morphology is vital, since they may be the earliest or even the only evidence of a myocardial infarction in certain cases. Morphology of premature ventricular beats or paced beats in anterior, anteroseptal, and inferior infarct has been described but not in the setting of a posterior infarct.
View Article and Find Full Text PDFJ Am Soc Echocardiogr
February 2000
Echocardiographic image enhancement with an intravenous second-generation contrast agent established the diagnosis of apical hypertrophic cardiomyopathy in 2 patients initially thought to have left ventricular apical thrombus. Image enhancement with contrast agent obviated the need for invasive diagnostic tests, underscoring its applicability in patients with suspected left ventricular masses.
View Article and Find Full Text PDFTransthoracic echocardiography is the most widely used diagnostic test for left ventricular (LV) thrombus, which must be distinguished from other intraventricular structures and image artifacts. To determine whether second-generation intravenous echocardiographic contrast agents provide better delineation of LV thrombus, we reviewed the results of 2-dimensional echocardiographic studies that were performed in 409 patients over a 1-year period to detect LV thrombus. Studies of 190 (46%) patients were interpreted as nondiagnostic for this purpose, of which 48 patients underwent an additional study after intravenous injection of 0.
View Article and Find Full Text PDFThe 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD) enzymes convert corticosterone and cortisol to 11-dehydrocorticosterone and cortisone, and are thought to convey extrinsic specificity to the mineralocorticoid receptor by limiting access of the relatively more abundant glucocorticoids to it. Two different 11 beta-hydroxysteroid dehydrogenases (11 beta-HSD) have been described and cloned. The liver-type, NADP(+)-dependent 11 beta-HSD-1, has an affinity in the micromolar range and bidirectional activity.
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