1/25. Spontaneous native aortic valve thrombosis.Spontaneous thrombosis of a native aortic valve is an uncommon event that usually follows local trauma, such as cardiac surgery or left heart catheterization, or occurs as a complication of bacterial endocarditis. We report the case of a 65-year-old woman with a history of retinal artery occlusion and severe aortic valve stenosis, in whom transesophageal echocardiography revealed a mobile mass attached to the ventricular surface of the aortic valve. There was no evidence of any hypercoagulable state or infection process. Surgery was performed and a severely stenotic valve resected; a partially organized and firmly adherent free-floating thrombotic mass was observed on the ventricular surface of the aortic valve. Histologic examination demonstrated an organized thrombus. Eleven months after surgery the patient is doing well.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
2/25. Quadruple valve commissurotomy.A 12-year-old girl in congestive heart failure was diagnosed to be suffering from severe polyvalvular disease due to a combination of congenital and rheumatic lesions. cardiac catheterization demonstrated stenotic lesions of all the heart valves. The child underwent quadruple valve commissurotomy and is symptom free and thriving 2 years later.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
3/25. Echocardiographic evidence of outflow tract obstruction in Pompe's disease (glycogen storage disease of the heart).A 7 month old black female infant with the clinical findings of Pompe's disease is presented. The diagnosis of an infiltrative myocardiopathy with left ventricular outflow tract obstruction presenting with a pronounced systolic anterior motion of the anterior mitral valve leaflet was made by echocardiography. This diagnosis was confirmed by cardiac catheterization and angiocardiography. Pathologic findings were consistent with Pompe's disease (type II glycogen storage disease). The presence of systolic anterior motion of the mitral valve in this patient suggests that this finding is not pathognomonic of idiopathic hypertrophic subaortic stenosis.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
4/25. Transcatheter umbrella closure of valvular and paravalvular leaks.OBJECTIVES. Our aim was to adapt the technique of transcatheter umbrella closure of intracardiac defects for closure of valvular and paravalvular defects. BACKGROUND. The double-umbrella device developed by Rashkind and Cuaso has been safely and effectively delivered across a host of intracardiac defects, but transcatheter closure of valvular and paravalvular leaks has not been reported. methods. Between February 1987 and September 1990, eight patients who were believed to be poor operative candidates were taken to the catheterization laboratory for transcatheter double-umbrella closure of a valvular or a paravalvular leak. Four patients had a paravalvular leak around a prosthetic aortic valve. The other four patients had a valvular leak: one patient with a regurgitant native aortic valve after a Stansel procedure and three patients with a regurgitant porcine valve in a left ventricular apex to descending aorta conduit. RESULTS. Placement of a double-umbrella device was attempted in seven of the eight patients and was successful in all seven. Device placement was not attempted in one patient because of the crescentic shape of his defect. Two patients required two devices for each closure; the other five required only one device each. angiography, performed on six patients after device closure, demonstrated that three patients had a completely occluded defect, two had trivial residual flow and one patient had mild residual flow through the device. All significant complications occurred in one patient who had hemolysis and oliguria that resolved when the initial umbrella was replaced by a larger device. In addition, two devices migrated to the patient's pulmonary arteries but were retrieved in the catheterization laboratory without difficulty. No other early or late complications occurred in 21 to 50 months of follow-up. Of the four patients with a paravalvular leak, the one who did not receive a device died at operation, one patient died at operation for an associated defect (in the operating room the umbrella was found securely in place across the paraaortic defect) and two patients are clinically well at home after 21 and 32 months, respectively. Of the four patients with closure of a valvular leak, one patient remains well at home 50 months later, one patient died at operation for associated defects and two patients had additional successful surgical treatment and remain well 29 months after device placement. CONCLUSIONS. Transcatheter umbrella closure appears to be a reasonable alternative for closure of a valvular or paravalvular leak in patients who are poor operative candidates.- - - - - - - - - - ranking = 2keywords = catheterization (Clic here for more details about this article) |
5/25. radiotherapy-induced aortic valve disease associated with porcelain aorta.Mediastinal irradiation has been reported to induce cardiac disease such as pericarditis, valvular dysfunction, conduction abnormalities, accelerated arteriosclerosis of the coronary arteries, and also calcifications of the ascending aorta. We herein describe a case of radiotherapy-induced porcelain aorta and aortic valve disease and their surgical treatment. The patient was diagnosed with myasthenia gravis (MG) in 1965 (Osserman's type II), and mediastinal irradiation was performed in 1970 for treatment of thymic tumor associated with MG. Thirty years after radiation therapy, complete atrioventricular block and aortic valve disease with severe calcification of the ascending aorta and aortic arch (porcelain aorta) were detected on echo cardiogram and cardiac catheterization. A permanent pacemaker was implanted via the left subclavian vein and aortic valve replacement was performed under extracorporeal circulation established by selective cerebral perfusion and balloon occlusion instead of aortic cross-clamping. As no risk factors of arteriosclerosis such as hypercholesterolemia, hyperglycemia and hypertension were apparent, we concluded that the aortic valve disease and porcelain aorta were primarily induced by radiotherapy.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
6/25. Intracardiac echocardiographic guidance for hemodynamic assessment in a patient with congenital abnormalities and a prosthetic aortic valve.In this case report, we present the use of intracardiac echocardiography (ice) for guiding the cardiac catheterization and subsequent hemodynamic investigation in an unusual patient case with multiple congenital abnormalities (bicuspid aortic valve, left cervical aortic arch, two aortic coarctations) and two aortic valve replacement operations in the past. The ice catheter (AcuNav) permitted us to accurately and safely puncture the interatrial septum and place the Swan-Ganz catheter in the left ventricle; additionally, visualization of the aortic coarctation in the ascending aorta was also achieved.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
7/25. Sudden development of intraoperative left ventricular outflow obstruction: differential and mechanism. An intraoperative two-dimensional echocardiographic study.Systolic anterior motion (SAM) of the mitral valve, once considered to be pathognomonic of hypertrophic cardiomyopathy, has been reported in the absence of asymmetric septal hypertrophy. Of the 1,000 open heart operations performed with intraoperative two-dimensional epicardial echocardiography monitoring, four patients developed intraoperative dynamic left ventricular outflow obstruction associated with systolic anterior motion of the mitral valve that was not present preoperatively: three cases of mitral valve annuloplasty with Carpentier ring insertion and one of coronary artery bypass grafting. Though no patient had asymmetric septal hypertrophy or echocardiographic evidence of outflow obstruction by either preoperative cardiac catheterization or echocardiography, intraoperative two-dimensional epicardial echocardiography revealed SAM, and hyperdynamic left ventricles with three of these patients having documented left ventricular outflow tract gradients causing hemodynamic compromise. (Case 4 was hemodynamically stable following mitral valve repair, but had SAM and significant residual mitral regurgitation [MR] requiring reinstitution of cardiopulmonary bypass and re-repair). Measurement of mitral annular dimension demonstrated a normal decrease in size from diastole to systole in control operative subjects but not in the patients who developed outflow obstruction. The pathophysiology, treatment, and role of intraoperative echocardiography of dynamic left ventricular outflow tract obstruction are discussed.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
8/25. Two-dimensional and pulsed Doppler echocardiographic diagnosis of an acquired aortic right ventricular fistula.A patient with an asymptomatic aortic right ventricular fistula acquired after aortic valve and mitral valve replacement is presented. This was diagnosed by two-dimensional and pulsed Doppler echocardiography, and confirmed at cardiac catheterization.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
9/25. Subvalvular aneurysm. Two-dimensional echocardiographic features.A rare case of subvalvular aneurysm diagnosed by two-dimensional echocardiography and confirmed at cardiac catheterization is presented.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
10/25. aspergillus clavatus endocarditis involving a normal aortic valve following coronary artery surgery.aspergillus species causing endocarditis on a native heart valve is a rare occurrence with an exceedingly high mortality. This report describes a 60-year-old man who developed aspergillus clavatus endocarditis of the aortic valve 18 months after coronary artery bypass surgery. The aortic valve was angiographically normal on cardiac catheterization performed before coronary artery surgery. Despite aortic valve replacement and amphotericin b therapy, the patient died as a result of aspergillus species aortitis with occlusion of the coronary ostia and bypass grafts. Coronary artery surgery may be complicated by this highly lethal infection, which is difficult to diagnose and treat.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
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