1/8. Trapped renal arteries: functional renal artery stenosis due to occlusion of the aorta in the arch and below the kidneys.Acute renal failure is a well recognized complication from the use of angiotensin-converting enzyme inhibitors in patients with severe bilateral renovascular disease. A 54-year-old woman presented with acute pulmonary edema with intractable hypertension and a history of lower limb claudication. The addition of lisinopril to her antihypertensive regimen resulted, within 48 h, in the development of acute renal failure that remitted with cessation of the drug. She was found to have a heavily calcified occlusion of her aortic arch and another occlusion of the aorta below the renal arteries. Angiography and Doppler ultrasonography showed normal renal arteries. This is the first reported case of angiotensin-converting enzyme inhibitor-induced renal failure occurring in a patient with atherosclerotic occlusion of the aorta. The literature on suprarenal aortic occlusion is reviewed to determine the manner of presentation, prevalent risk factors and physical findings that typify this unique clinical entity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Left ventricular outflow tract obstruction produced by redundant mitral valve tissue in a neonate. Clinical, angiographic, and operative findings.An unusual case of left ventricular outflow tract obstruction associated with severe left ventricular failure in a neonate is reported. The physical and laboratory data were consistent with the diagnosis of infantile valvular aortic stenosis. At operation, however, redundant gelatinous pedunculated tissue attached to the mitral valve annulus appeared to move through and obstruct the aortic valve during systole. The aortic valve showed only minimal thickening of the right and left coronary cusps. A distinct angiographic pattern was demonstrated during left ventricular cineangiography. In the frontal projection a large ovoid filling defect appeared to protrude through the aortic valve during systole and return to a subvalvular location during diastole. Recognition of this angiographic pattern should facilitate diagnosis and subsequent repair. Complete correction is possible by operative excision of the obstructing tissue without damaging the mitral valve. In contrast to isolated congenital infantile valvular aortic stenosis, a condition in which the valve leaflets are often primitive and deformed, aortic valvotomy and/or subsequent valve replacement are not necessary, resulting in a better long-term prognosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. Aortic stenosis and autonomic dysfunction: co-conspirators in syncope.Autonomic dysfunction and aortic stenosis share several clinical characteristics, including, in severe cases, syncope. Both illnesses tend to manifest later in life, and most cases are idiopathic in origin. In a short period of 4 weeks, the authors noted that three patients out of 36 referrals for autonomic dysfunction also had histories of aortic valve replacement due to stenosis. In each case, similar presenting symptoms of fatigue, light-headedness, and syncope were attributed to aortic stenosis without mention of autonomic failure as a possible contributor. The authors propose that patients for whom symptoms of aortic valve stenosis are not relieved by surgical intervention may have concomitant autonomic dysfunction contributing significantly to their symptoms. Furthermore, the two conditions may comprise a dangerous combination, aortic stenosis causing physical obstruction of ventricular outflow, and autonomic dysfunction causing decreased venous return and insufficient cardiac filling. It may be beneficial for patients with aortic stenosis who present with syncope to be considered for possible autonomic dysfunction to address both potential pathophysiologies contributing to the syncope.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. aortic valve replacement with a stentless pericardial valve through minimal access surgery.We are presenting here a case of a 45-year-old physically active man who underwent aortic valve replacement with a stentless biological valve by means of minimally invasive Heartport technique. Access was gained via a midline incision of 4 cm at the upper part of the sternum and a midline manubriotomy with one-sided extension into the third intercostal space. cardiopulmonary bypass was established with a Heartport straightshot arterial cannula and two venous cannulae inserted into superior vena cava (SVC) and via femoral vein into inferior vena cava (IVC). The long instruments supplied for minimal access surgery were used for the standard stentless valve implantation technique. The patient had a speedy and uneventful recovery, discharged from hospital on the third postoperative day and resumed full activities within 2 weeks. Minimally invasive stentless tissue valve replacement is presented as a safe and feasible treatment option for the young/middle-aged group of patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. Continuous wave Doppler signal: a mystery.Doppler echocardiography is an established noninvasive cardiovascular investigational tool. However, the physical nature of the ultrasound beam may lead to unexpected findings in routine echocardiographic examination, which may lead to misdiagnosis and subsequent wrong clinical decisions.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. Management of valvular heart disease: an illustrative cases approach.As indicated by the 22 illustrative cases included in this monograph, a stepwise approach to the assessment of valvular heart disease provides the information necessary to make good clinical decisions. The ECG and chest x-ray add useful information to the history and physical examination. echocardiography, doppler, and color flow Doppler techniques have an important role in defining the presence and severity of valvular stenosis and regurgitation. Nuclear techniques provide useful information about global biventricular systolic function, regional wall motion, and myocardial perfusion. Exercise testing is most valuable in confirming objectively the patient's functional status and exercise tolerance. Newer imaging techniques, such as cine CT and MRI, are capable of displaying and measuring cardiac chamber size and myocardial thickness; however, visualization of the cardiac valves and demonstration of flow abnormalities are difficult, limiting the current usefulness of these techniques in patients with valvular heart disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Case report: trivalvular rheumatic stenosis: documentation of disease progression by serial cardiac catheterization.A 56-year-old female with known rheumatic tricuspid stenosis was admitted for treatment of palpitations, abdominal discomfort and supraventricular tachyarrhythmias. Twenty years after an initial study, cardiac catheterization disclosed additional mitral and aortic stenoses. Trivalve prosthetic replacement was recommended, but cardiac arrest occurred, allowing pathologic confirmation of the hemodynamic findings. documentation of disease progression in nonoperated multivalvular rheumatic heart disease by cardiac catheterizations over such extended intervals of time has not previously been described. Also, the clinician is warned that historical and physical signs in such cases can underplay the actual severity and extent of disease, and he should not, therefore, be misled by unimpressive findings that the valvular deformity is insignificant.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. thrombosis on Bjork-Shiley aortic valve prosthesis. A case report and review of the literature.A patient who developed thrombosis on a Bjork-Shiley aortic valve prosthesis is reported. The patient presented with severe angina pectoris and the main physical findings were absence of the closing click of the prosthetic valve and the presence of systolic and diastolic aortic murmurs. Echocardiography showed early closure of the mitral valve and depressed left ventricular function. An emergency operation was performed and the clot was removed. The patient's recovery was uneventful and he is well one year after surgery. awareness of the possibility of valve thrombosis is necessary in view of the need for emergency surgical treatment. The literature on the subject is reviewed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |