1/14. Pulmonary vein atresia with Shone's anomaly in an infant: a case report.We report a case of individual pulmonary vein atresia associated with multiple levels of left heart obstruction, including aortic coarctation, valvular aortic stenosis, and parachute mitral valves with stenosis. The diagnosis of pulmonary vein obstruction is likely to be missed in patients who also have other left heart obstructive diseases, since the latter usually dominates the clinical presentation. We diagnosed the existence of individual pulmonary vein atresia preoperatively via cardiac catheterization. The pulmonary artery angiograms revealed back and forth motion of the dye with no visualization of either a capillary or venous phase on the lesion side. The pulmonary capillary wedge pressure was unevenly elevated and highest on the lesion side. The results were later confirmed by operation and autopsy. Thus, selective pulmonary artery catheterization and angiography remains a good diagnostic tool to rule out the existence of pulmonary vein obstruction in cases which have multiple levels of left heart obstruction.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/14. Intra-aortic balloon pump associated with dynamic left ventricular outflow tract obstruction after valve replacement for aortic stenosis.An unstable patient with critical aortic stenosis had an intra-aortic balloon pump placed preoperatively for hemodynamic support and alleviation of symptoms. After separation from cardiopulmonary bypass following aortic valve replacement, the patient was hypotensive with increased pulmonary artery pressures. Transesophageal echocardiography revealed left ventricular outflow tract obstruction associated with systolic anterior motion of the mitral valve and severe mitral regurgitation. This pathophysiology was present when ventricular systole was preceded by balloon counterpulsation, but was absent during unassisted systole. This case report demonstrates a potentially significant untoward effect of intra-aortic balloon pump augmentation after aortic valve replacement for aortic stenosis. The timely diagnosis of this iatrogenic condition in the operating room permitted the prompt implementation of appropriate management strategies and avoided unnecessary surgical intervention.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/14. Combined hyertrophic subaortic stenosis and calcific aortic valvular stenosis.A well documented case of combined hypertrophic subaortic stenosis and calcific aortic stenosis is reported. Detection of multilevel involvement in cases of left ventricular outflow obstruction requires a high index of suspicion and precise hemodynamic and angiographic documentation. Careful analysis of the total data base is necessary for proper management of the patient. The pathogenesis of this combined lesion is unclear: Asymmetrical septal hypertrophy may occur as a consequence of the valvular stenosis, or it may be that abnormal leaflet motion in patients with hypertrophic obstruction produces leaflet thickening, calcification, deformity and stenosis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/14. Membranous subaortic stenosis complicated by aneurysm of the membranous septum and mitral valve prolapse.The clinical, echocardiographic, and catheterization findings in a patient with discrete subaortic stenosis, aneurysm of the membranous interventricular septum, and mitral valve prolapse are presented. Echocardiography showed a subaortic membrane, abnormal aortic valve motion, accentuated systolic anterior motion of the membranous interventricular septum, and prolapsing mitral leaflets. cardiac catheterization confirmed the diagnoses. The possible functional interrelationship of these lesions is discussed.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
5/14. Left ventricular free-floating ball thrombus complicating aortic valve stenosis.A 67-year-old man was referred for evaluation of near-syncopal attacks and left hemiparesis. Echocardiography revealed moderate to severe calcific aortic valve stenosis and a free-floating thrombus. Left ventricular (LV) systolic function was normal. No regional wall motion abnormality was detected in the left ventricle. On serial echocardiography, the thrombus began to fragment. Urgent surgery was commenced, during which the mass was seen to be a free-floating ball thrombus in the LV cavity, in addition to apical fibrin bands mimicking abnormal trabeculation. The thrombus was removed and aortic prosthetic valve replacement performed. No coagulation abnormalities were detected. The patient made a full recovery after surgery. Floating thrombus can embolize at any moment and require emergency treatment, notably because of a high mortality rate of systemic embolic events or acute hemodynamic decompensation caused by LV outflow tract obstruction. To the authors' knowledge, this is the first report of LV free-floating thrombus concomitant with isolated calcific aortic valve stenosis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/14. Nongenetically transmitted disproportionate ventricular septal thickening associated with left ventricular outflow obstruction.Clinical, haemodynamic, and morphological features are described in 2 patients with disproportionate ventricular septal thickening, left ventricular outflow obstruction with systolic anterior motion of the anterior mitral leaflet, and either acquired or congenital heart disease. The disproportionate septal thickening in these patients appeared to be secondary to their underlying cardiac disease rather than a manifestation of genetically transmitted hypertrophic cardiomyopathy. One patient with combined aortic and mitral stenosis had severe systolic anterior motion of the anterior mitral leaflet and a residual large systolic pressure gradient between left ventricle and systemic artery after aortic valve replacement. In this patient the systolic anterior motion was evident in the presence of mitral valve stenosis. The other patient with mild aortic stenosis and a previously repaired coarctation of the aorta also had mild systolic anterior motion and a small subaortic systolic pressure gradient. Hence, these 2 patients demonstrate that disproportionate septal thickening secondary to acquired or congenital heart disease may be associated with left ventricular outflow obstruction and systolic anterior motion of the anterior mitral leaflet.- - - - - - - - - - ranking = 5keywords = motion (Clic here for more details about this article) |
7/14. 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 = 1keywords = motion (Clic here for more details about this article) |
8/14. Dynamic left ventricular outflow obstruction after aortic valve replacement: a Doppler echocardiographic study.An 81-year-old woman with severe symptomatic aortic stenosis underwent aortic valve replacement. The postoperative course was complicated by new subvalvular left ventricular outflow tract obstruction created by systolic anterior motion of the anterior mitral leaflet. The condition was recognized by echocardiography and was successfully treated medically.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/14. Implantation of a xenogeneic stentless aortic bioprosthesis. First experience.To overcome the specific disadvantages of mechanical valves and stented bioprostheses, we implanted a stentless xenogeneic aortic valve in a patient with calcified aortic stenosis. The postoperative study revealed a pressure gradient of 25 mmHg, a minor insufficiency of 10% of total stroke volume and a slightly restricted motion of the leaflets. Although the implantation of a stentless xenogeneic aortic valve is feasible, one should be aware of the specific technical difficulties due to the increased rigidity of the fixed tissue, which is not known in homografts. To our knowledge this is the first report on the implantation of a stentless xenogeneic aortic valve.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/14. Mechanism of reduction of aortic valvular stenosis by percutaneous transluminal balloon valvuloplasty: report of five cases and review of literature.Among five patients (69 to 93 years of age) in whom percutaneous transluminal balloon valvuloplasty was performed for severe aortic stenosis, fractures of cuspid calcium were observed in three, fractures and a cuspid tear in one, and no gross alterations in one. Aortic stenosis resulted from degenerative (senile) calcification of tricuspid aortic valves in two patients, calcification of congenitally bicuspid aortic valves in two, and postinflammatory (presumably rheumatic) fibrocalcific disease in one. Fractures of calcific lesions, by allowing hingelike motion along their sites, seemed to facilitate cuspid mobility and thereby provided the apparent morphologic substrate for reduction in functional stenosis. Among three cases with fused commissures (two bicuspid and one postinflammatory), however, mobility of the conjoined cusps was not achieved after valvuloplasty, despite fracture of calcific nodules in the adjacent valve pocket of one case, because the fused and calcified commissures were not split or fractured and therefore continued to act as rigid struts that impeded cuspid motion. In the current autopsy evaluation of the effects of aortic balloon valvuloplasty, greater cuspid mobility seemed to be achieved in subjects with degenerative calcific stenosis than in those with calcified bicuspid valves or distortion by postinflammatory disease.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
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