1/13. Swinging motion of intimal flap through the aortic valve in acute aortic dissection.The purpose of this article is to present a very rare case of Stanford type A acute aortic dissection featuring a swinging motion of the cylinder-shaped intimal flap through the aortic valve. The patient was a 62-year-old male suffering from severe cardiogenic shock. A transthoracic echocardiogram revealed aortic dissection and severe aortic regurgitation. A transesophageal echocardiogram demonstrated that the aortic dissection in the ascending aorta was circumferential and the proximal portion of the intimal flap was swinging through the aortic valve, ie., falling into the left ventricle during the diastolic phase and being ejected back into the ascending aorta during the systolic phase. An emergency graft replacement of the ascending aorta was performed. During ventricular fibrillation under total cardiopulmonary bypass, we performed cardiac massage to prevent myocardial ischemia, because blood flow from a heart lung machine inverted the intimal flap, which might have disturbed the coronary circulation. The patient's postoperative course was uneventful, and his postoperative echocardiogram revealed only a trace of regurgitant flow through the aortic valve. back-and-forth movement of the cylinder-shaped intima requires coexistence of the following three conditions: severe aortic regurgitation, circumferential dissection, and complete transection of the intimal flap. We conclude that this movement of the intimal flap should be regarded as one of the most serious complications leading rapidly to cardiogenic shock. From a surgical point of view, it is most important to prevent myocardial ischemia during cardiopulmonary bypass especially in cases in which ventricular fibrillation has occurred. We describe the ways to prevent myocardial ischemia in this rare situation.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/13. Echocardiographic patterns in scleroderma.The echocardiograms of two patients with sclerodermatous cardiac disease are described. In one patient the pattern was that of a congestive cardiomyopathy with ventricular dilatation and reduced wall motion. In the second patient the pattern was that of an infiltrative cardiomyopathy with thickened walls and reduced wall motion in the absence of ventricular dilatation. Echocardiographic studies are useful in the early detection of pericardial involvement and primary or secondary myocardial involvement by scleroderma and in following the progression of the disease process.- - - - - - - - - - ranking = 0.4keywords = motion (Clic here for more details about this article) |
3/13. Transesophageal and transpharyngeal ultrasound demonstration of reversed diastolic flow in aortic arch branches and neck vessels in severe aortic regurgitation.In the current study, we describe an adult patient with torrential aortic regurgitation due to an aortic dissection flap interfering with aortic cusp motion, in whom a transesophageal echocardiogram with the probe positioned in the upper esophagus and transpharyngeal ultrasound examination demonstrated prominent reversed flow throughout diastole in the left subclavian, left vertebral, left common carotid, and left internal carotid arteries. Another unique finding was the demonstration of aortic valve leaflets held in the fully opened position in diastole by the dissection flap as it prolapsed into the left ventricular outflow tract, dramatically documenting the mechanism of torrential aortic regurgitation in this patient.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
4/13. Aortic dissection with pseudo-aortic regurgitation and transient myocardial ischemia--a case report.Aortic dissection causes acute aortic regurgitation in one half to two thirds of cases, which is due, mainly, to dilatation of the aortic root. The unsupported intimal flap prolapse, which crosses the aortic valve, rarely produces aortic regurgitation. Moreover, transient myocardial ischemia rarely occurs by malperfusion, which might be due to compression of the ostium of the coronary artery by the false lumen or by the intimal flap. The authors had a rare case of aortic dissection with "pseudo-''aortic regurgitation; ie, regurgitation flow existed just in the area surrounding the intimal flap during diastole and produced transient myocardial ischemia. In this case, the swinging motion of the intimal flap through the aortic valve caused pseudoaortic regurgitation and transient myocardial ischemia, which should be repaired by emergency surgical procedure. Surgery was successful and saved the patient's life.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
5/13. Gaucher's disease with mitral and aortic involvement: echocardiographic findings.Cardiac involvement in Gaucher's disease has been reported in only a few patients, mostly adults with pericardial changes. We describe findings in two siblings with Gaucher's disease, aged 15 and 9 years respectively, in whom mitral and aortic valve lesions were evaluated by auscultation and echocardiography. In both cases the mitral and aortic valves were thick and restricted in motion. Continuous Doppler echocardiography revealed significant mitral regurgitation and mitral stenosis. At the aortic valve level there was a systolic pressure gradient. Echocardiographic investigation of patients with suspected cardiac involvement with Gaucher's disease is recommended.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
6/13. Management of valvular heart disease: an illustrative cases approach.As indicated by the 22 illustrative cases included in this monograph, a stepwise approach to the assessment of valvular heart disease provides the information necessary to make good clinical decisions. The ECG and chest x-ray add useful information to the history and physical examination. echocardiography, doppler, and color flow Doppler techniques have an important role in defining the presence and severity of valvular stenosis and regurgitation. Nuclear techniques provide useful information about global biventricular systolic function, regional wall motion, and myocardial perfusion. Exercise testing is most valuable in confirming objectively the patient's functional status and exercise tolerance. Newer imaging techniques, such as cine CT and MRI, are capable of displaying and measuring cardiac chamber size and myocardial thickness; however, visualization of the cardiac valves and demonstration of flow abnormalities are difficult, limiting the current usefulness of these techniques in patients with valvular heart disease.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
7/13. Major dehiscence of a prosthetic aortic valve: detection by echocardiography.A 21-year-old man had acute aortic insufficiency three months after insertion of an aortic valve prosthesis. Chest roentgenography demonstrated abnormal orientation of the prosthesis. M-mode echocardiography showed dense, linear echoes from the prosthetic valve between the interventricular septum and the mitral valve, along with loss of normal poppet motion within the aortic root. At surgery, the prosthesis was found to be extensively disrupted, resulting in prolapse into the left ventricular outflow tract. Another valve replacement was performed with patient survival. Echocardiography appears to be a useful adjunct to established roentgenographic procedures in the diagnosis of major dehiscence of prosthetic aortic valves.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
8/13. Echocardiographic features of combined membranous subaortic stenosis and acquired calcific aortic valvulopathy.The M-mode echocardiographic features of aortic valve structure and motion in a 45-year-old male with combined congenital subaortic diaphragm and acquired deformity of the aortic valve are described. Clinical, hemodynamic, and angiographic studies suggested calcific aortic valve disease with stenosis and insufficiency, but the additional presence of a subaortic diaphragm was not appreciated. Cardiac ultrasonography demonstrated multiple, central diastolic aortic valve cusp echoes consistent with a thickened, calcified, tricuspid aortic valve. Despite calcification of the cusps, however, enough systolic cusp excursion remained to demonstrate an early systolic, rapid movement toward closure of the right coronary cusp-a finding suggestive of fixed subvalvular obstruction. Surgery confirmed a discrete subaortic diaphragm and a tricuspid, thichened, mildly calcified aortic valve with fusion of the cusp commissures at their origins and rolling back of the cusp edges. The value of echocardiography in the evaluation of the left ventricular outflow tract and aortic valve is emphasized.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
9/13. Two-dimensional echocardiographic recognition of an aortic intimal flap prolapsing into the left ventricular outflow tract.A 59 year old man presented with dyspnea and a new murmur of aortic regurgitation. Two-dimensional echocardiography demonstrated a to and fro motion of the intimal flap as it prolapsed into the left ventricle and was thrust into the aorta during diastole and systole, respectively. At surgery, the echocardiographic and angiographic findings were confirmed and a proximal aortic dissection was identified. prolapse of an intimal flap from the aorta into the left ventricular outflow tract represents a new two-dimensional echocardiographic sign of aortic dissection.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
10/13. Atypical echocardiographic pattern of the posterior leaflet motion in mitral stenosis.In 10% of cases of mitral stenosis the echocardiogram shows a normal backward movement of the posterior mitral leaflet. On the basis of a personal observation the authors suggest that this atypical pattern is related to the type (commissural) and degree (slight) of the valvular involvement.- - - - - - - - - - ranking = 0.8keywords = motion (Clic here for more details about this article) |
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