1/13. Successful use of thoracoscopic pericardiectomy in elderly patients with massive pericardial effusion caused by uremic pericarditis.We report the use of thoracoscopic pericardiectomy to treat two elderly patients with massive pericardial effusion caused by uremic pericarditis. A 79-year-old man, admitted to our hospital complaining of dyspnea, was diagnosed with end-stage renal failure and began maintenance hemodialysis. Although intensive hemodialysis was performed, the patient could not remain on hemodialysis because of severe hypotension during the procedure. echocardiography revealed massive pericardial effusion and severe hypokinesis of the left ventricular wall. pericardiocentesis was performed first, without success, followed by thoracoscopic pericardiectomy under general anesthesia. One month after the pericardiectomy, episodes of hypotension during hemodialysis improved, and dyspnea diminished. echocardiography showed no pericardial effusion and improvement of left ventricular wall motion. pericarditis is a fatal complication in patients with end-stage renal failure and patients on maintenance hemodialysis. The second patient received the same procedure with a similar improvement of clinical symptoms. These cases suggest that thoracoscopic pericardiectomy is a safe and effective treatment of pericardial effusion caused by uremic pericarditis in elderly patients on hemodialysis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/13. diagnosis of cardiac tamponade by echocardiography: changes in mitral valve motion and ventricular dimensions, with special reference to paradoxical pulse.The echocardiographic findings in three patients who presented with pericardial effusion and cardiac tamponade are described. Cyclic respiratory changes affected the diastolic movement of the anterior mitral leaflet, viz., during inspiration its anterior excursion decreased in amplitude and the E-F slope diminished. This inspiratory alteration in mitral valve motion was accompanied by an increase in right ventricular dimensions and a reciprocal decrease in left ventricular dimensions. Pericardial paracentesis confirmed the presence of effusion and relieved cardiac tamponade in all the patients. Repeat echocardiography, performed in two of the patients immediately after the pericardial tap, showed that the E-F slope had become steeper and that phasic respiratory variations in the diastolic motion of the anterior mitral leaflet were no longer present. The compatibility of our observations with the theories which endeavor to explain the mechanism of the paradoxical pulse in pericardial effusion with cardiac tamponade is discussed. We suggest that the abnormalities in anterior mitral leaflet motion defined by echocardiography constitute a useful addition to the study of patients with suspected cardiac tamponade resulting from pericardial effusion.- - - - - - - - - - ranking = 7keywords = motion (Clic here for more details about this article) |
3/13. Delayed hemopericardium following penetrating foreign body into the aorta.A four and a half year old girl with delayed appearance of traumatic hemopericardium, detected radiologically despite misleading clinical manifestations, is presented. The presence of cardiomegaly and a needle in the right upper mediastinum on the chest roentgenogram and its partial motion together with diminished cardiac pulsations at fluoroscopy led to angiocardiography. The radiological demonstration of hemopericardium due to the needle penetrating the aortic root, enabled successful surgical intervention.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/13. Further echocardiographic observations in pericardial effusion.Although the presence of fluid behind the left atrium, on echocardiography, has been used to differentiate pleural from pericardial effusions, five cases are reported showing that pericardial fluid can and does accumulate behind the left atrium. Abnormal valvular motion, as a result of free swinging of the heart in the pericardial sac, was also demonstrated in these patients.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/13. Echocardiographic pseudoidiopathic hypertrophic subaortic stenosis in a patient with pericardial effusion.A 26 year old white male with chronic renal failure presented to our institution with a large pericardial effusion. In addition to the effusion, an echocardiogram demonstrated systolic anterior movement of the anterior leaflet of the mitral valve (SAM), suggesting idiopathic hypertrophic subaortic stenosis (IH-S). pericardiectomy was performed to treat the effusion. After surgery and relief of the effusion, the mitral valve motion returned to normal. It is concluded that SAM can be seen with pericardial effusion in the absence of IHSS.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/13. Echocardiographic swinging heart motion in loculated anterior pericardial effusion.A patient in chronic renal failure presented with cardiomegaly. echocardiography and cardiac scan demonstrated loculated anterior pericardial effusion. Another unusual echocardiographic feature was the presence of swinging heart motion, usually seen only with large nonlocalized pericardial effusion. When dialysis led to substantial regression of cardiac size, the echocardiographic abnormalities disappeared.- - - - - - - - - - ranking = 5keywords = motion (Clic here for more details about this article) |
7/13. pericardial effusion and electrical alternans: echocardiographic assessment.Clinical diagnosis of pericardial effusion is often difficult, and assessment of the effects of effusion on cardiac hemodynamics is often imprecise. Electrical alternans is a reasonably specific ECG indicator of the presence of a large effusion and imminent or actual cardiac tamponade. If echocardiography verifies the presennce of pericardial fluid and shows abnormal cardiac motion, a diagnosis of cardiac tamponade can be made without further, more invasive, studies.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/13. Mechanism of electrical alternans in patients with pericardial effusion.Electrical alternans concomitant with pericardial effusion has been considered a pathognomonic sign suggestive of a large effusion with cardiac tamponade, particularly if there is P wave alternans as well as QRS alternans. However, the mechanism of this phenomonon remains controversial. A patient with pericardial effusion secondary to adenocarcinoma of the lung with metastases, pericardial effusion, electrical alternans, and cardiac tamponade was studied by echocardiography, right and left heart catheterization, and pericardiocentesis. Hemodynamic data were consistent with cadiac tamponade. The echocardiogram demonstrated a large anterior and posterior pericardial effusion. Noncongruous motion of the septum and posterior wall was pericardial effusion. Noncongruous motion of the septum and posterior wall was recorded at a rate equal to the heart rate. In addition, congruous motion of the septum and posterior wall was recorded at a rate that was half the heart rate and corresponded to the electrical alternans. The congruous movement disappeared after pericardiocentesis, as did the electrical alternans. The electrical alternans is synchronous with and due to the pendulous movement of the heart within the pericardial sac, as demonstrated by echocardiogram and cineangiograms.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
9/13. Radionuclide ventriculographic findings in pericardial effusion.We present a patient with a large pericardial effusion, in whom the first-pass radionuclide ventriculogram demonstrated rocking motion of the left ventricle and apparent asynergy of the inferior wall. These abnormalities disappeared after removal of the fluid. Inspection of the cinematic display of the images was useful in explaining the apparent asynergy of the inferior wall.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/13. Traumatic pericardiocentesis: two-dimensional echocardiographic visualization of an unfortunate event.Two-dimensional echocardiography was performed simultaneously with pericardiocentesis in an attempt to visualize the pericardiocentesis needle. Rapid penetration of the right ventricular myocardium by the pericardiocentesis needle occurred and was only appreciated in a slow-motion analysis of the two-dimensional echocardiogram videotape. Development of an intrapericardial thrombus was clearly detected by the two-dimensional echocardiogram videotape. Development of an intrapericardial thrombus was clearly detected by the two-dimensional echocardiogram within 24 hours following this traumatic pericardiocentesis. While two-dimensional echocardiography may offer the possibility for seeing the pericardiocentesis needle, technical considerations may limit the easy visualization of the pericardiocentesis needle and accurate localization of its tip. However, two-dimensional echocardiography may be useful in identifying consequences of suspected or proved traumatic pericardiocentesis procedures.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
| | Next -> |