1/9. Left ventricular free wall rupture in acute fulminant myocarditis during long-term cardiopulmonary support.A 77-year-old woman with acute myocarditis developed cardiogenic shock soon after admission and was given mechanical cardiopulmonary support. echocardiography revealed severe global left ventricular hypokinesia. After 5 days of mechanical support, left ventricular wall motion gradually began to improve, but the patient died of cardiac tamponade on day 13. At necropsy, a free wall rupture was found where the apical akinetic area bordered the basal portion, an area which had shown better wall motion. Left ventricular free wall rupture in acute myocarditis has not been reported, but this case indicates that it may occur in fulminant myocarditis when a cardiopulmonary support system is used.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/9. Mitral regurgitation due to ruptured chordae tendineae in patients with hypertrophic obstructive cardiomyopathy.mitral valve regurgitation in association with hypertrophic obstructive cardiomyopathy is usually caused by the systolic anterior motion of the anterior mitral leaflet. Recently, five patients were encountered with hypertrophic obstructive cardiomyopathy who had mitral regurgitation due to ruptured chordae tendineae. The diagnosis was confirmed in all patients during operation for left ventricular septal myectomy-myotomy (Morrow procedure). Preoperative identification of ruptured chordae tendineae as the cause of mitral regurgitation was established by transesophageal echocardiography in the three most recent cases. All patients had successful septal myectomy-myotomy for relief of left ventricular outflow obstruction, and mitral valve competence was restored by valve repair rather than by prosthetic valve replacement. The clinical course of these patients illustrates important management considerations as well as the utility of transesophageal echocardiography for diagnosis. Chordal rupture should be considered in the differential diagnosis of mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy, especially in those with acute hemodynamic deterioration.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/9. Acute mitral regurgitation due to ruptured chordae tendineae in a patient with hypertrophic obstructive cardiomyopathy: a case report.A 63-year-old woman had been followed up for hypertrophic obstructive cardiomyopathy with 85 mmHg of left ventricular outflow tract pressure gradient over 7 years. She was hospitalized because of acute dyspnea and syncope. On admission, echocardiography revealed severe mitral regurgitation with ruptured chordae tendineae at the medial scallop of the posterior mitral leaflet. mitral valve replacement was successfully performed and her symptoms improved to 28 mmHg of left ventricular outflow tract pressure gradient. In patients with hypertrophic obstructive cardiomyopathy, elevated left ventricular systolic pressure and systolic anterior motion of the mitral leaflets may lead to mucoid degeneration in the chordae tendineae. Rupture of the mitral chordae tendineae should be considered in the differential diagnosis of acutely deteriorated mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy, because this is a rare but critical complication.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
4/9. Echocardiographic findings in ventricular septal rupture and anterior wall aneurysm complicating myocardial infarction.Echocardiographic findings in a patient with ventricular septal rupture and anterolateral wall aneurysm complicating myocardial infarction are presented. The findings were confirmed by cardiac catheterization and surgery. Using M-mode ultrasonocardiography one was able to demonstrate and localize the aneurysm as well as the ventricular septal defect which presented as an oblique interventricular communication appearing only during systole. Thus echocardiography supplemented the invasive examinations in exactly revealing the site of ventricular septal rupture. Other echocardiographic features of ventricular septal rupture were right ventricular dilatation, pathological septal motion and abnormal tricuspid valve motion as recently reported by other authors.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/9. Chaotic echo motion in the left ventricular cavity. Visualization of ruptured chordae tendineae of the mitral valve by real-time two-dimensional echocardiography.The aim of the present study is to perform a detailed analysis of the spot echoes which show chaotic motion of the left ventricular cavity of patients with ruptured chordae tendineae. The subjects were 12 patients with surgically documented ruptured chordae tendineae. They were carefully examined preoperatively by real-time two-dimensional echocardiography with a commercially available wide-angle phased array system (Toshiba SSH-11A). An abnormal moving spot echo was often seen instantaneously in the left ventricle. Its motion was chaotic, and it moved both longitudinally and laterally. Lateral movements were seen in 10 of the 12 subjects and were not found in any of 10 controls. The site of this echo in the left ventricle was identical with the site of the rupture of the mitral chordae confirmed during surgery. Therefore, it was concluded that the spot echo with chaotic motion represents a direct visualization of ruptured chordae. This chaotic motion is considered to be a useful clue in diagnosis. The lateral component (left to right) of the movement is especially important. However, one must carefully examine the left ventricular cavity with moving pictures over a period of many heart beats in order to detect these chaotic movements of spot echoes.- - - - - - - - - - ranking = 4keywords = motion (Clic here for more details about this article) |
6/9. Echocardiographic features of a mycotic aneurysm of the left ventricular outflow tract caused by perforation of mitral-aortic intervalvular fibrosa.We present the apparently unique M-mode and two-dimensional echocardiographic features of a surgically confirmed pseudoaneurysm of the left ventricular outflow tract, which probably developed as a result of perforation of the mitral-aortic intervalvular fibrosa. Echocardiographic studies revealed an aneurysmal sac situated between the aortic root and the left atrium. The aneurysm expanded in systole and collapsed or emptied in diastole, suggesting direct communication with the left ventricle. Such an aneurysm must be differentiated from various pathologic findings of the aortic root. The location and characteristic motion during the cardiac cycle should alert the clinician to the correct diagnosis of such an aneurysm.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
7/9. natural history and prognosis of ischemic heart disease.Forty-four cases with myocardial rupture (33 with free wall rupture, 9 with interventricular septal perforation and 2 with papillary muscle rupture), all of which were ascertained by autopsy and/or at surgery, were analyzed. When the following 7 risk factors were actively managed in the acute stage of myocardial infarction, the incidence of myocardial rupture was significantly reduced: a) high blood pressure on admission, b) physical and emotional instability, c) recurrent chest pain, d) aged females, e) no history of angina or myocardial infarction, f) large myocardial infarction on ECG and g) the first 10 days after the attack of myocardial infarction. If cardiogenic shock occurs, surgery should be performed as soon as possible; if not, it should be delayed 3 weeks. The natural history of ischemic heart disease was analyzed in 400 medically-treated patients with significant coronary artery disease. They had been followed up continuously and periodically for more than one year. The prognosis of the patients with 3-vessel disease or left main trunk disease, those with poor left ventricular function (EF less than 30%) and of old age (greater than or equal to 60) and those who had a history of ischemic heart disease was poor. Follow-up study was done in 30 patients with variant angina. They often had life-threatening arrhythmias during attacks (8 ventricular tachycardia or ventricular fibrillation, 8 serious bradyarrhythmia). All patients with variant angina should be treated medically at first, and only patients with organic coronary artery disease and chest pain on effort in spite of the medical treatment should be considered as candidates for AC bypass surgery.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
8/9. ventricular septal rupture detected by cross-sectional echocardiography.Cross-sectional echocardiography was used to directly visualize abnormal wall motion and detect the site of ventricular septal rupture in a patient with acute inferior myocardial infarction. The presence of the defect was confirmed by injecting indocyanine green into the left ventricle at the time of cardiac catheterization. Cross-sectional echocardiography provides a rapid, atraumatic means for evaluating patients with complicated acute myocardial infarction.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
9/9. Aortic regurgitation due to non-traumatic rupture of the aortic valve commissures: report of two cases.Two cases of severe aortic regurgitation due to non-traumatic rupture of the aortic valve commissures are reported. The cause of rupture was hypertension in one patient, but it could not be identified in the other, where microscopic examinations of the aortic wall and the aortic cusps showed no particular pathologic changes. M-mode echocardiography revealed enlargement of the left ventricle, diastolic flutter of the anterior mitral leaflet and diastolic separation of the closure line of the aortic cusps in both patients. Two-dimensional echocardiography showed a downward displacement of the prolapsing motion of the aortic valve cusp during diastole toward the left ventricular outflow tract in one patient, and eccentricity of the coaptation point of the aortic valve without thickening of the cusps in the other. In addition to clinical features of progressive heart failure and characteristic cardiac murmur, echocardiographic studies provided correct diagnosis of aortic valve prolapse resulting from rupture of the aortic valve commissures. Both patients underwent aortic valve replacement successfully.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |