1/30. An aneurysm involving the axillary artery and its branch vessels in a major league baseball pitcher. A case report and review of the literature.baseball pitchers appear to be prone to aneurysms of the axillary artery and its branches. The cause is probably related to repetitive compression of or tension on the vessels at the level of the pectoralis minor muscle and the humeral head, which is exacerbated by the pitching motion. The incidence of aneurysms of the axillary artery and its branches among pitchers and other athletes is not known, nor is it clear whether pitchers who are at high risk of vascular injury can be identified before irreversible damage to the vessels has occurred. Perhaps patients who have documented compression or occlusion of the vessel with the arm in the abducted, externally rotated position are at higher risk. Screening pitchers to identify those with axillary artery compression, aneurysm, or thrombosis has also not been shown to be effective. Certainly, many pitchers will have some level of compression of the axillary artery with their arm in the pitching position but will never develop any clinical abnormality requiring treatment. Screening would therefore probably lead to a high false-positive rate. It is clear, however, that pitchers who complain of ischemia-type symptoms such as early fatigue or who have evidence of emboli require a complete evaluation to rule out any abnormality of the axillary artery or one of its branches. Orthopaedic surgeons who see pitchers and other athletes involved in repetitive overhead motions need to be aware of this disorder so that they order the appropriate tests and obtain a vascular consultation--and make a prompt diagnosis. Treatment will vary depending on the type of lesion and on which vessel or vessels are involved, and should be decided on by the team of surgeons treating the patient.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/30. A rare cause of right atrial mass: thrombus formation and infection complicating a ventriculoatrial shunt for hydrocephalus.BACKGROUND: Thrombus formation around the intracardiac end of the catheter, thromboembolism, and infection are the most important and life-threatening complications of ventriculoatrial shunts. In this article we report a patient with a large right atrial mass that was diagnosed by 2-D echocardiogram and removed via standard median sternotomy and cardiopulmonary bypass. CASE DESCRIPTION: A 63-year-old man who had a right ventriculoatrial shunt was admitted to our department in a septic clinical condition. His hemoglobin was 10.7 grams, white blood cell count was 22,900/mm3, and sedimentation rate was 50 mm/hr. Blood cultures grew coagulase negative staphylococcus. The echocardiogram showed a right atrial mass at the tip of the shunt catheter. The mass had a cystic and "glove-like" appearance and had a pendulous motion in the right atrium. After combined antibiotic therapy for 10 days, symptoms were relieved but echocardiographic findings did not change. A surgical approach was chosen because of the unchanged size of the mass and the risk of pulmonary embolism. First, the distal part of the ventriculoatrial shunt was separated from its pump and a new ventriculoperitoneal shunt was placed. After this, a standard median sternotomy, cardiopulmonary bypass and right atriotomy was performed. The tip of the shunt catheter with the attached pedunculated mass was removed. CONCLUSION: There are few cases of a large right atrial thrombus secondary to a ventriculoatrial shunt in the literature. Because of these serious complications of ventriculoatrial shunting, careful 2-D transthoracic echocardiographic examination should be mandatory for patients with ventriculoatrial shunts.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/30. Malfunction of a Bjork-Shiley prosthetic heart valve in the mitral position producing an abnormal echocardiographic pattern.This report presents an echocardiographic study of a patient with fibrous ingrowth about the sewing ring and hinges of a Bjork-Shiley valve in the mitral position. The valve was obstructed and produced a distinct motion pattern. In addition to having a rounded diastolic motion, the disk excursion was decreased.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/30. Multislice cardiac spiral CT evaluation of atypical hypertrophic cardiomyopathy with a calcified left ventricular thrombus.We report a case of a 43-year-old male patient with an atypical nonobstructive hypertrophic cardiomyopathy and a calcified left ventricular thrombus, and present results of multislice computed tomography (MSCT) using retrospective electrocardiograph gating, which is a new modality in cardiac imaging. Obtaining virtually motion-free images with a temporal resolution of 250 ms in an optimized heart scan MSCT allows functional imaging with evaluation of impaired systolic and diastolic left ventricular wall motion.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/30. The role of thrombolysis in the management of left-sided prosthetic valve thrombosis: a study of 85 cases diagnosed by transesophageal echocardiography.BACKGROUND AND AIM OF THE STUDY: Treatment strategies of prosthetic valve thrombosis (PVT) are controversial. The aim of this study was to compare the efficacy and safety of thrombolysis, surgery and heparin therapy in patients with either obstructive or non-obstructive PVT. methods: Between 1993 and 2000, 85 episodes of PVT were found (82 in the mitral position, three in the aortic) in 59 patients (22 males, 37 females; mean age 53 years; range: 28-80 years) by multiplane transesophageal echocardiography (TEE). Obstructive PVT was defined as restricted leaflet (occluder) motion with increased gradient, even if thrombus was not seen by TEE; non-obstructive PVT was considered as normal leaflet motion, irrespective of the gradients. Thrombolysis was given in 43 episodes (streptokinase, n = 37) by standard dosage protocols, surgery was performed in 20, and i.v. heparin was used in 22. recurrence rate was calculated in 26 survivors of successful thrombolysis based on six months to six years follow up. Treatment with thrombolysis and heparin was monitored using TEE. RESULTS: There were 54 cases of obstructive PVT and 31 cases of non-obstructive PVT. Anticoagulation was inadequate in 82% of cases. Thrombolysis was completely successful in 37 cases (86% success rate); in 27 of 32 patients with obstructive PVT (in both cases of aortic location), and in 10 of 11 non-obstructive PVT. heparin was successful in only nine of 18 non-obstructive PVT, and in none of four obstructive cases. Nine patients died, all with obstructive PVT, and all but one were in NYHA class IV; two were treated by thrombolysis (5% mortality), six by surgery (30% mortality) and one with heparin (5% mortality). Complications of thrombolysis included two strokes and two transient ischemic attack episodes (9%), and bleeding in one case (2%). There were six complications due to heparin treatment: newly developed obstruction in five patients and stroke in one patient. recurrence was diagnosed in eight episodes in six patients with obstructive PVT after successful thrombolysis (22%); rethrombolysis was successful in four of five cases. CONCLUSION: Thrombolysis was shown to be superior to surgery in obstructive PVT, especially in NYHA class IV patients. Severe complications of thrombolysis were noted only in the critically ill. As heparin treatment appeared ineffective and unsafe for the treatment of PVT, thrombolysis appeared to be the optimal therapeutic choice in this condition.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/30. Echocardiographic findings of ventricular septal rupture in acute myocardial infarction.Echocardiograms were recorded both before and after the clinical appearance of an autopsy-confirmed interventricular septal rupture in a patient with an acute myocardial infarction. The major findings were related to the upper portion of the interventricular septum. Before rupture, this portion of the septum was relatively akinetic with a slight anterior motion during systole, whereas after rupture there was a marked increase in the amplitude of septal motion with abrupt posterior motion occurring with the onset of ventricular diastole.- - - - - - - - - - ranking = 1.5keywords = motion (Clic here for more details about this article) |
7/30. Successful thrombolysis of st. Jude medical aortic prosthesis with tissue-type plasminogen activator in a pregnant woman: a case report.Mechanical valve thrombosis is a life-threatening event. pregnancy is associated with a hypercoagulable state that further emphasizes the importance of adequate anticoagulation. This is associated with a therapeutic dilemma. Continued anticoagulation with warfarin throughout the first trimester can result in fetopathic effects, while replacement of warfarin by heparin between 6 and 12 weeks of gestation does not completely prevent the risk of valve thrombosis. There are a small number of reported cases of pregnant women with prosthetic heart valve thrombosis under low molecular weight heparin and consecutive lytic therapy. The authors report a 33-year-old pregnant woman with a St. Jude Medical aortic prosthesis, anticoagulated with a therapeutic dosage of low molecular weight heparin from 6 weeks of gestation, who developed prosthetic heart valve thrombosis at 17 weeks of gestation. A thrombolysis with recombinant tissue-type plasminogen activator (50 mg for 2 hours) was performed. Under thrombolysis, ST-segment elevation in leads II, III, aVF, V5, and V6 developed electrocardiographically with a maximal creatine kinase (CK) of 349 U/L (CK-MB isoenzyme of 48 U/L). echocardiography revealed normal function of the St. Jude Medical aortic prosthesis 2 hours after thrombolysis and normal wall motions. Short-course thrombolytic therapy appears to be an effective alternative to surgical intervention for the treatment of thrombotic dysfunction of valve prostheses in pregnancy.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
8/30. Valve adaptation as a cause of disc opening reduction in mechanical heart valves: the case of the Lillehei-Kaster valve.At fluoroscopy a decreased disc motion in mechanical heart prostheses is often a sign of valve thrombosis. On occasion, however, despite an exhaustive diagnostic work-up, common causes of prosthetic valve thrombosis are not found. In these cases the valve disc abnormalities are thought to be due to functional changes. We here report our experience with 5 consecutive patients carrying the Lillehei-Kaster prosthesis who had this fluoroscopic finding that was lately attributed to "valve physiologic adaptation". The time of onset, differential diagnosis and clinical/hemodynamic impact of valve adaptation are discussed.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
9/30. Serial echocardiographic abnormalities in nonbacterial thrombotic endocarditis of the mitral valve.This report describes the clinical course and serial echocardiographic abnormalities in a patient with nonbacterial thrombotic endocarditis and repeated embolic episodes. Serial echocardiograms revealed a mass of abnormal echoes on the anterior mitral leaflet and progressive restriction of mitral valvular motion. Cineangiographic studies demonstrated a large filling defect in the area of the mitral valve. Surgical intervention confirmed the presence of a large vegetation on the mitral valve. The surgical specimen consisted of a sterile, partially organized fibrin thrombus. The echocardiographic abnormalities are described and discussed in relation to the clinical and pathologic findings.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
10/30. Left ventricular apical thrombus formation in a patient with suspected tako-tsubo-like left ventricular dysfunction.A 74-year-old woman with hypertension and bronchial asthma had chest discomfort at rest and 4 days later was admitted to her nearby hospital because of the sudden onset of right hemiparesis. The hemiparesis had almost disappeared within 24 h of onset, but because an electrocardiogram showed sinus tachycardia and diffuse symmetrical T-wave inversion, she was referred for cardiac examination. coronary angiography did not reveal any significant coronary artery stenosis, but left ventriculography revealed severe hypokinesis of the left ventricular apical region, which contained a 4 x 4-mm solid thrombus moving freely with a wavy motion. Moreover, the activity of both protein c and protein s had decreased. The thrombus disappeared after 2 weeks of anticoagulant treatment with warfarin. Her clinical course suggested that the transient cerebral ischemic attack was caused by embolism of the left ventricular thrombus associated with 'tako-tsubo-like left ventricular dysfunction'.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
| | Next -> |