1/92. Massive left atrial thrombus: a case report.This case report describes a patient with aortic and mitral valvular disease who had a massive left atrial thrombus. The left atrial thrombus produced a disappearance of signs of mitral stenosis and a reversed pan diastolic mitral valve gradient. This gradient occurred in the absence of any diastolic mitral insufficiency and may have been due to artifactual lowering of the left atrial pressure by an organized left atrial clot.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/92. Posterior myocardial infarction complicated by rupture of the posteromedial papillary muscle.A 61-year-old man was admitted with acute posterior myocardial infarction and, on physical examination, was shown to have a mitral regurgitation (MR) murmur. Transthoracic echocardiography (TTE) showed severe hypokinesis of the posterior wall and severe MR by color flow. Right heart catheterization with a balloon-tipped catheter revealed a pulmonary artery wedge pressure of 30 mmHg. No 'step-up' was seen in blood samples from the right atrium and right ventricle. On angiography, a subtotal occlusion of the mid circumflex artery was found which was angioplastied and stented. As the patient's clinical condition did not improve, he underwent transesophageal echocardiography (TEE) for further evaluation. This showed complete rupture of the posteromedial papillary muscle. The patient underwent urgent surgery with successful mitral valve replacement. The postoperative course was uncomplicated, and clinical improvement seen. This case report underscores the value of TEE in accurate preoperative diagnosis of papillary muscle rupture by providing preoperative anatomic details of the mitral valve apparatus and surrounding structures.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/92. Treatment of left atrial dissection after mitral repair: internal drainage.Two patients with intraoperative dissection of the entire left atrium after mitral valve repair are presented. Intraoperative transesophageal echocardiography detected left atrial dissection with formation of a large cavity compressing the left atrium. The false lumen was opened and widely connected to the right atrium to perform the decompression. This technique permits the runoff into the low pressure system in case of persisting hemorrhage from the unknown entry, and eliminates the risk of systemic embolization from the cavity.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/92. A case of constrictive pericarditis with local thickening of the pericardium without manifest ventricular interdependence.This is the first case report of postsurgical constrictive pericarditis confined to the left ventricle in which the majority of diagnosis tests were not indicative of the disease. A 50-year-old woman with a past history of mitral valve replacement was admitted for right heart failure. cardiac catheterization showed impaired diastolic filling but lacked the characteristic ventricular interdependence recently reported to be specific for the disease, without manifest radiological appearance of pericardial thickening. However, a new technique using magnetic resonance tagging cine revealed pericardial adhesion, limited to the left ventricle, which was confirmed during pericardiectomy. After the surgery, right heart failure and diastolic filling abnormality disappeared with restoration of normal heart pressures.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/92. Worsening of mitral regurgitation secondary to ventricular pacing.A 68-year-old woman was admitted to hospital for possible mitral valve surgery for severe mitral regurgitation (MR). Six months before admission, a DDD pacemaker was implanted for symptomatic bradycardia. She developed atrial fibrillation and the pacer was changed to a VVI mode. At cardiac catheterization, the pulmonary artery and wedge pressures were elevated; coronary angiography showed non-obstructive coronary artery disease. 2-D echocardiography confirmed preserved left ventricular function, severe MR and moderate tricuspid regurgitation. The change in pacing had a dramatic effect on MR severity; ventricular pacing was associated with a MR jet that occupied a larger area of the left atrium than with the unpaced rhythm, the continuous-wave mitral regurgitant Doppler profile was 'dagger'-shaped, and the signal intensity stronger compared with the unpaced rhythm. These findings are consistent with severe MR. The pacer was reprogrammed to reduce the pacing rate from 70 to 45 beats/min, allowing an unpaced rhythm for the most part. The patient improved and was discharged two days later. Six months later she was asymptomatic; repeat echocardiography confirmed mild to moderate MR.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/92. mitral valve repair and septal myectomy for hypertrophic obstructive cardiomyopathy.Combined mitral valve repair using the sliding leaflet technique and septal myectomy were employed to successfully treat left ventricular outflow tract (LVOT) obstruction and mitral regurgitation due to hypertrophic obstructive cardiomyopathy (HOCM). A 46-year-old man was diagnosed with HOCM along with congestive heart failure and was treated medically. These symptoms, however, were resistant to medical treatments with a beta-blocker, a Ca-antagonist, and disopyramide, and he was referred to our hospital for surgery. Doppler echocardiography demonstrated an LVOT obstruction at rest with a peak pressure gradient of 138 mmHg. The interventricular septum thickness was 14 mm. Mitral regurgitation of 3 with severe SAM was also observed. Temporary dual chamber pacing was tried without significant improvement. Following these examinations, the patient underwent surgery. A transaortic septal myotomy-myectomy was performed first, and the mitral valve was then approached through the left atrium. mitral valve repair was performed with the sliding leaflet technique to reduce the height of the posterior leaflet from 2 cm to 1 cm. Postpump transesophageal echocardiography revealed no MR and a peak LVOT gradient of 15 mmHg. The patient recovered well except for a residual mild SAM, and MR2 . We therefore concluded that this surgical approach might provide results which are superior to those of myectomy alone.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/92. cardiac tamponade complicating closure of a median sternotomy.A case of intraoperative cardiac tamponade manifested during closure of a median sternotomy is presented. We postulate that cardiac tamponade was caused by acute dilatation of the cardiac chambers as a result of intraoartic balloon pumping in a patient with aortic and mitral regurgitation. It has been shown experimentally that acute rises in ventricular end-diastolic pressure result in increased intrapericardial pressure and that if a certain point on the pericardial pressure-volume curve is reached, cardiac tamponade will occur. sternotomy closure was accomplished easily as soon as the need for intra-aortic balloon pumping diminished.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
8/92. Conversion of atrial fibrillation into a sinus rhythm by coronary angioplasty in a patient with acute myocardial infarction.Atrial tachyarrhythmias are important complications occurring in more than 8% of acute myocardial infarctions (AMI). atrial fibrillation (AFi) during the early phase of AMI is caused by atrial ischaemia, atrial distension due to the left ventricular failure or significant diastolic left ventricular dysfunction. AFi in patients with inferior and posterior AMI indicates at least two vessel coronary diseases, a circumflex coronary artery (CX) occlusion before taking off of the left atrial branches as well as significant stenosis or occlusion of the right coronary artery (RCA). In this article the case of a 67-year-old woman with an acute infero-posterior AMI is described. AMI was complicated with a left heart failure, acute AFi with tachyarrhythmia, transient arterial hypotension and ischaemic mitral regurgitation. Emergency coronary angiography disclosed occlusion of the CX, myocardial infarct related artery, and significant stenoses of the RCA. After opening the occluded CX during the PTCA, AFi with a tachyarrhythmia of 160 beats per minute (bpm) immediately converted into a sinus rhythm with 80 bpm, followed by a normalization of blood pressure and cardiac recompensation. Our case report supports the opinion that AFi in patients with inferior and posterior AMI indicates at least a two-vessel coronary disease. Reopening of the occluded atrial coronary branches during urgent medical treatment was casual and effective treatment of both ischaemic heart disease and consequent AFi.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/92. Unusual hemodynamic response during exercise-induced angina pectoris.A patient with coronary artery disease exhibited reduction in systemic arterial pressure and striking changes in pulmonary artery wedge pressure and pulse contour during an episode of exercise-associated angina pectoris. There is suggestive evidence that these phenomena were secondary to marked but reversible exacerbation of mitral regurgitation.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
10/92. Improved left ventricular contraction and energetics in a patient with Chagas' disease undergoing partial left ventriculectomy.A 43-year-old patient with heart failure, precluded from heart transplantation or dynamic cardiomyoplasty because of Chagas' disease cardiomyopathy, mitral regurgitation, and ventricular mural thrombi, underwent mitral valvuloplasty and partial left ventriculectomy (PLV) between the papillary muscles. Intraoperative pressure-volume relationship analyses suggested improvement in left ventricular contraction, energetics, isovolumic relaxation, and mitral valve competency. These improvements allowed prompt, short-term recovery despite unchanged myocardial pathology, which suggests that a surgical approach can alter anatomic-geometric factors and achieve clinical improvement in a dilated failing ventricle.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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