1/11. Iatrogenic left ventricular-right atrial fistula following mitral valve replacement and tricuspid annuloplasty: diagnosis by transthoracic and transesophageal echocardiography.Acquired left ventricle-to-right atrium communications are a known complication of valvular heart surgery. Previous reports have described the clinical features and diagnosis using cardiac catheterization. We report two cases of acquired left ventricle-to-right atrium fistula following mitral valve replacement. Particular emphasis is placed on the diagnosis using transthoracic and transesophageal echocardiography, obviating the need for cardiac catheterization before repair.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/11. Constrictive pericarditis associated with Marlex mesh. Two case reports.Two patients were referred to our hospital with constrictive pericarditis approximately 1 year after undergoing mitral valve repair at another institution. Both repairs had included the use of a pericardial substitute, Marlex mesh, to prevent adhesion and to facilitate possible reoperations. Computed tomography and cardiac catheterization were used to establish the diagnosis of constrictive pericarditis. During surgery, dense, thickened fibrous tissue, the result of a Marlex mesh-related reaction, was found tightly adhered to the epicardium in each of the patients. It appeared that the Marlex mesh, which had been inserted to facilitate reoperation, had contributed to the development of constrictive pericarditis.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
3/11. Successful surgical ablation of sustained ventricular tachycardia associated with mitral valve prolapse guided by a multielectrode basket catheter.Ventricular tachycardia occurs frequently in patients with mitral valve prolapse. If antiarrhythmic drug therapy fails or mitral valve surgery is indicated, concomitant arrhythmia surgery may be considered. This report describes the first clinical use of an atrial transseptally inserted multielectrode basket catheter, placed across the mitral valve, to guide intraoperative mapping and ablation of monomorphic sustained ventricular tachycardia in association with mitral valve prolapse. Endocardial covering and signal quality of this percutaneous mapping catheter were of good quality, allowing an accurate localization of the site of origin of the tachycardia.- - - - - - - - - - ranking = 3keywords = catheter (Clic here for more details about this article) |
4/11. Fragmentation hemolysis in a patient with hypertrophic obstructive cardiomyopathy and mitral valve prolapse.We encountered a 65-year-old female with hypertrophic obstructive cardiomyopathy and mitral valve prolapse who had infective endocarditis and hemolytic anemia. The infecting organism of endocarditis was group A streptococci. With regard to the etiology of the hemolytic anemia, fragmentation hemolysis was considered because fragmented red cells and elevated lactic dehydrogenase were observed. Haptoglobin was markedly decreased. Coombs' test, Ham's test and abnormal hemoglobin were negative. She had not had a hemolytic attack in the past. Ultrasonic cardiography showed asymmetrical septal hypertrophy, mitral valve prolapse and 285 mmHg of calculated pressure gradient in the left ventricle. cardiac catheterization showed 115 mmHg of left intraventricular pressure gradient and mitral regurgitation (grade 2). hemolysis was slightly improved after treatment with propranolol. Thus, fragmentation of the normal red cells seemed to be due to shear stress.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
5/11. Systolic click from a Swan-Ganz catheter: phonoechocardiographic depiction of the underlying mechanism.Although echocardiographic manifestations of Swan-Ganz catheters have received increasing attention, auscultatory sequelae have not previously been described. In the patient described in this report, insertion of a Swan-Ganz catheter resulted in a loud mid systolic click; removal of the catheter eliminated the click. Simultaneous phonoechocardiograms suggest that the click resulted from crisp contact of the catheter against the ventricular septum. Catheter momentum was enhanced by wide excursion and systemic pressures in the right ventricle; paradoxical motion of the septum during systole may have accentuated the force of its contact with the catheter.- - - - - - - - - - ranking = 4.5keywords = catheter (Clic here for more details about this article) |
6/11. Echocardiographic findings in patients with left superior vena cava and dilated coronary sinus.Three patients with a left superior vena cava draining into a dilated coronary sinus were studied with cardiac catheterization and echocardiography. The diagnosis was confirmed at operation in two patients. A posterior echo-free space was filled with echoes during injection of contrast medium into the left but not the right arm. This echo-free space was localized to the left atrioventricular groove. This technique established the presence of a left superior vena cava communicating with the coronary sinus and excluded pericardial effusion as the source of the posterior echo-free space.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
7/11. Recurrent coronary artery spasm in the billowing mitral leaflet syndrome (primary mitral valve prolapse). A case report and review of the literature.A 46-year-old White man had a 2-year history of frequent atypical chest pain associated with palpitations and presyncope. Clinical examination revealed an intermittent mid-systolic non-ejection click followed by a blowing mid-to-late systolic murmur indicative of the billowing mitral leaflet syndrome (BMLS) (primary mitral valve prolapse (MVP); Barlow's syndrome). This diagnosis was confirmed on cardiac catheterization, left ventricular cine angiography showing mild mitral insufficiency. M-mode and cross-sectional echocardiography documented the intermittent non-ejection click and mid-systolic apical murmur. Ambulatory Holter monitoring showed symptomatic inferolateral myocardial ischaemia, and maximal stress-testing elicited asymptomatic ischaemia in the same zone. Selective coronary angiography delineated a normal left coronary artery and an insignificant fixed obstructive lesion in the second part of the dominant right coronary artery (RCA). Provocation with ergometrine (ergonovine) maleate gave rise to severe coronary vasospasm superimposed on the insignificant lesion in the RCA. This spasm provoked myocardial ischaemia resulting in symptomatic ventricular fibrillation which was successfully reversed. The patient's symptoms have been fairly well controlled by nitrates and nifedipine. As far as I am aware this is the first documentation of coronary vasospasm in the BMLS. In this syndrome coronary artery spasm has often been postulated to be responsible for acute myocardial infarction with a normal appearance of the coronary arteries on angiography. This mechanism has also been incriminated in the genesis of ventricular arrhythmias in cases of primary MVP. These various contentious and important issues are reviewed.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
8/11. mitral valve prolapse causing severe mitral regurgitation in a patient with absent right pulmonary artery.A 33-year-old man was investigated for dyspnea on exertion and the presence of a pansystolic murmur. physical examination revealed dextrocardia confirmed by chest radiograph, which also showed oligemic right lung field. Subsequent cardiac catheterization revealed secundum atrial septal defect, persistent left sided superior vena cava, and severe mitral valve prolapse causing severe mitral regurgitation with pulmonary hypertension. The right pulmonary artery was absent. It is the first report of the association between severe mitral valve prolapse and absent right pulmonary artery.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
9/11. Right coronary artery subselective angiography with a 5-French catheter mimicking a coronary arteriovenous fistula.We report the case of a 58-year-old woman who underwent outpatient coronary angiography with 5F catheters for atypical chest pain. Superselective angiography of a right superior septal artery mimicked a coronary arteriovenous fistula. Appropriate placement of the catheter in the ostium of the right coronary artery excluded the suspected anomaly.- - - - - - - - - - ranking = 3keywords = catheter (Clic here for more details about this article) |
10/11. Unsuspected infrahepatic interruption of inferior vena cava associated with floppy mitral valve, mitral valve prolapse, and severe mitral regurgitation.We describe a case of unsuspected infrahepatic interruption of the inferior vena cava with hemiazygos continuation in a 67-year-old man presenting with chest pain and evidence of mitral regurgitation. He had no persistent superior vena cava, with the hemiazygos draining directly into the right superior vena cava. Polysplenia and severe mitral prolapse were also present: the latter may represent more than an incidental finding in this condition. This malformation may deserve consideration in adults undergoing femoral right heart catheterization. Chest radiographic studies are the basic clue to the diagnosis.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
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