1/9. Severe intracranial bleeding mimicking acute inferior myocardial infarction with right ventricular involvement.Electrocardiographic (ECG) changes and wall motion abnormalities of the left ventricle have been observed in patients with severe intracranial hemorrhage. However, ECG evidence of an acute myocardial infarction in this setting is extremely rare but may have important therapeutic consequences. We report the case of a 45-year-old female who became unconscious with respiratory insufficiency after an endoscopic retrograde cholangiopancreaticoscopy with ECG changes consistent of an inferior myocardial infarction with right ventricular involvement. Immediate coronary angiography revealed normal coronaries; however, left ventricular angiography showed extensive wall motion abnormalities predominantly in the anteroseptal region. Immediate cranial computer tomography demonstrated massive intracranial bleeding. Intracranial hemorrhage can be associated in the initial phase with ECG evidence of an acute myocardial infarction. This has to be taken into consideration in the setting of unexplained loss of consciousness or nonresponsiveness of a patient. A rapid diagnostic evaluation has to be initiated to rule out a myocardial infarction and to diagnose intracranial hemorrhage before the use of thrombolytic or anticoagulant therapy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/9. Primary angioplasty for isolated right ventricular infarction.We describe a case of isolated right ventricular infarction that has rarely been diagnosed antemortem. Electrocardiogram showed ST segment elevation in left precordial chest, right precordial chest, and inferior leads, which mimicked those of anterior and inferior left ventricular infarction. coronary angiography revealed that culprit lesion was totally occluded right coronary artery. Infarcted artery was nondominant right coronary artery with branches supplying only right ventricular wall. Restoration of coronary blood flow was obtained by primary stenting and resulted in prompt ST segment normalization in all leads. Despite extensive right ventricular wall motion abnormality, subsequent right ventricular dysfunction was not observed.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/9. De Vega's tricuspid annuloplasty for Ebstein's anomaly.A case of Ebstein's anomaly as demonstrated by echocardiography and electrophysiological studies is discussed. In view of deterioration in tricuspid regurgitation and right ventricular dysfunction, successful surgical repair employing De Vega's tricuspid annuloplasty along with plication of the atrialised portion of the right ventricle is described. Intraoperative transesophageal echocardiography following the procedure revealed satisfactory repair and a significant decrease in tricuspid regurgitation. This simple technique appears to be effective in patients having anterior leaflet sufficiently large area and motion. Adequate long-term follow-up in a large series of patients is essential to confirm that it is also beneficial and durable.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
4/9. Prolonged right ventricular failure after relief of cardiac tamponade.PURPOSE: To report a case of severe and fatal cardiac complication following pericardiotomy to relieve a malignant tamponade. Right ventricular (RV) failure was responsible for major hypoxemia and for a persistent shunt through a patent foramen ovale. In the absence of pulmonary embolism and coronary occlusion, possible pathophysiologic mechanisms are discussed. CLINICAL FEATURES: This 53-yr-old patient presented with oropharyngeal carcinoma previously treated by chemotherapy. One month later, he showed clinical and echocardiographic signs of cardiac tamponade. He had a circumferential pericardial effusion with complete end-diastolic collapse of the right cavities. After an emergent pericardiotomy, he rapidly presented severe hypoxemia. Transesophageal echocardiography showed an akinetic and dilated right ventricle, paradoxical septal wall motion and a normal left ventricular function. A contrast study revealed a right-to-left shunt. No residual pericardial effusion was detectable. Pulmonary angiography excluded a pulmonary embolism and the coronary angiogram was normal. troponin Ic was elevated postoperatively and peaked on day two (3.78 micro g x L(-1)). The patient died of refractory shock with persistent intracardiac shunt and RV akinesia on day nine. CONCLUSION: Although pulmonary embolism or thrombus of a coronary vessel are the most common causes of prolonged RV failure after pericardiotomy, other mechanisms may be invoked. The possibility is raised that a rapid increase in RV tension may induce the development of muscular injury and impair coronary blood flow, despite a normal coronary angiogram. These could result in a stunned myocardium and opening of a patent foramen ovale. We hypothesize that gradual decompression of a chronic pericardial effusion might be beneficial in patients at risk.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
5/9. A novel regional right ventricular wall-motion abnormality observed in a case of acute pulmonary embolism (reverse McConnell sign).Among various echocardiographic parameters for diagnosis of pulmonary embolism, an abnormal regional contraction pattern of the right ventricular free wall consisting of normokinesia of the apical segment and akinesia of the midfree wall with persistence of abnormal wall motion at the base has proved to be fairly specific for pulmonary embolism. This echocardiographic abnormality has been termed "McConnell sign." We describe the case of a patient with acute pulmonary embolism who developed reversible akinesia of the apex and right ventricular midfree wall, a finding we would like to term "reverse McConnell sign."- - - - - - - - - - ranking = 2.5keywords = motion (Clic here for more details about this article) |
6/9. myocardial bridging confined to the right ventricular branch of the right coronary artery in a patient with severe pulmonary hypertension.Although myocardial bridges are mostly confined to the left anterior descending coronary artery, several cases of right coronary artery myocardial bridging have been reported in the literature. In the current case report, we present a 65-year-old female with a well-functioning mechanical mitral valve prosthesis, severe pulmonary hypertension and right ventricle wall motion abnormality in whom diagnostic angiography revealed myocardial bridging confined to the right ventricular branch of the right coronary artery.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
7/9. Right ventricular regional wall motion abnormality in congenital heart disease.Four cases of congenital heart disease with right ventricular overload and echocardiographic evidence of persistent right ventricular regional wall motion abnormalities are presented. Right ventricular infarction could be a possibility. Such regional wall motion abnormalities could add to overall right ventricular dysfunction in these cases. echocardiography is useful in diagnosis. Right ventricular wall motion abnormalities should be studied in detail in all cases of congenital heart disease with right ventricular overload.- - - - - - - - - - ranking = 3.5keywords = motion (Clic here for more details about this article) |
8/9. Echocardiographic detection of reversible right ventricular strain in patients with acute pulmonary embolism: report of 2 cases.This report presents serial echocardiographic changes recorded before and after anticoagulant therapy was administered to 2 patients with acute pulmonary embolism. dilatation of the right ventricle, abnormal motion of the interventricular septum and mild tricuspid regurgitation were noted in both patients. The results of the echocardiogram suggested that the patients had right ventricular pressure overload resulting from pulmonary hypertension caused by an acute pulmonary embolism. Echocardiograms performed after the patients had received anticoagulant therapy revealed a normalization of the echocardiographic parameters in both patients. The reversal of the right ventricular strain pattern revealed by an echocardiogram occurred as the result of the regression of pulmonary hypertension after anticoagulant therapy. In conclusion, echocardiographic detection of right ventricular strain in patients who present acute cardiopulmonary manifestations with no previous history of severe pulmonary disease may indicate the possibility of a pulmonary embolism.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
9/9. Sustained right ventricular dyskinesis complicated by right ventricular infarction.We encountered a 66-yr-old man with acute left inferior and right ventricular infarction. Tomographic radionuclide ventriculography and fourier analysis clearly demonstrated reduced wall motion in the inferior walls of both ventricles and markedly delayed phase angles in the inferior right ventricular segment, indicating dyskinesis, which was confirmed by two-dimensional echocardiography and contrast right ventriculography. Four years later, right ventricular dyskinesis was still present and corresponded to a right ventricular perfusion defect on 99mTc-labeled tetrofosmin tomogram. Right ventricular imaging with tomographic radionuclide ventriculography with fourier analysis and 99mTc-labeled myocardial tomography demonstrates that, even after improved global function and hemodynamics, right ventricular dyskinesis related to right ventricular perfusion defect can be sustained for several years. Thus, these imaging techniques may contribute to diagnosing right ventricular infarction and investigating the pathophysiology.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |