1/15. The diagnosis of cor triatriatum sinistrum in children: a continuing dilemma.cor triatriatum (CT) is a rare congenital cardiac anomaly. The salient clinical, roentgenographic, electrocardiographic, echocardiographic, and hemodynamic findings are presented in two asymptomatic children and one with nonspecific dyspnea on exertion. Two male children had a classical form of cor triatriatum with normal physical and inconsequential roentgenographic and electrocardiographic findings. One of the male patients had surgery for a large atrial septal defect ostium secundum (ASD 2 degrees) and pulmonary hypertension in infancy. The female patient had CT with a communicating accessory chamber to right atrium and a rare patent foramen ovale. Her clinical findings confirmed an atrial level shunt. All patients had excision of the fibromuscular membrane from the right and left atrial transseptal approach with excellent results and with no recurrence during 2 to 4 year follow-up. We report the dilemma encountered in the clinical diagnosis of CT in children and the pivotal role played by echocardiography in the diagnosis of this anomaly.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/15. Case report of a patient with an intimal sarcoma of the pulmonary trunk presenting as a pulmonary embolism.A fatal case of an 89-year-old woman with an intimal sarcoma obstructing the pulmonary trunk and an open foramen ovale is presented. Clinical symptoms, physical examination and further evaluation originally raised suspicion of a pulmonary embolism. Recent classification systems, specific radiological and pathological characteristics of sarcomas of the pulmonary trunk are discussed.- - - - - - - - - - ranking = 11.302029136316keywords = physical examination, physical (Clic here for more details about this article) |
3/15. family cluster of atrial septal defect.Atrial septal defect is one of the most common congenital cardiac defects, occurring in 9% to 15% of live births. This defect has been reported to have a genetic etiology in some cases, although the full extent of genetic involvement in atrial septal defect is not known. Because symptoms are often lacking in childhood and manifest primarily in adulthood and because physical findings may be lacking, it is important to take a family history in patients in whom the defect is suspected. When evaluating children, a family history of atrial septal defect should raise suspicion of increased risk so that early diagnosis and treatment can be made. The author reports a cluster of 11 diagnosed atrial septal defects within one 32-member family group, 6 of whom required surgery to repair the defects. It is significant that most of the individuals were lacking in objective findings on physical examination, notably a murmur, as well as in subjective complaints. Diagnoses were made by use of two-dimensional echocardiography with color-enhanced Doppler ultrasonography in all but two cases--one diagnosed with transesophageal echocardiography and one, serendipitously, during cardiac catheterization. echocardiography also revealed mitral valve prolapse, thin atrial septal wall, with aneurysm in some cases, and regurgitation of mitral or tricuspid valves in several individuals. Cardiac enlargement, usually of the right atrium, was seen in most of the individuals.- - - - - - - - - - ranking = 12.302029136316keywords = physical examination, physical (Clic here for more details about this article) |
4/15. Transcutaneous-PO2 monitoring for detection of exercise-induced right-to-left shunts in children with congenital heart defects: a case report.A 2-y-old boy with scimitar syndrome underwent surgery involving the redirection of partial anomalous pulmonary venous return to the left atrium. Heart catheterization after the operation did not reveal any significant intra-cardiac shunts. An exercise test performed at the age of 10 y revealed a reduction in working capacity. At the age of 12 y, the patient became unconscious and experienced seizures during heavy physical exercise. EEG and Holter ECG examinations were normal. In a second exercise test, a fall in transcutaneous PO2 was demonstrated at the start of the test. A new heart catheterization revealed communication between the inferior vena cava and the left atrium owing to a misplaced patch. No right-to-left shunt was found at rest, probably as a result of drainage of the inferior vena cava to the superior vena cava by the azygous vein. An exercise test after re-operation revealed normal conditions. CONCLUSION: Haemodynamic studies during heart catheterization in children are usually performed at rest. This could result in exercise-induced right-to-left-shunts being overlooked. The use of PtcO2 monitoring during exercise tests is a non-invasive means of exposing these shunts.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/15. Peripartum cardiomyopathy and biventricular thrombi.Peripartum cardiomyopathy is a rare cardiac disorder characterized by the development of heart failure in the last month of pregnancy or up to 5 months postpartum in women without other determinable causes of cardiac failure. Intracardiac thrombi have been found at autopsy in some patients with this condition and have been demonstrated in the left or right ventricles on 2-dimensional echocardiography. A 23-year-old woman presented with peripartum cardiomyopathy and biventricular thrombi on echocardiography. The thrombi were spherical, pedunculate, shaggy and irregular in configuration, and freely mobile, suggesting that they were fresh. She was treated with conventional heart failure therapy and anticoagulants. Four days later, the apical thrombi within both ventricles had disappeared and there was no evidence of embolism on physical examination. The hypercoagulable state of the peripartum period and the severe biventricular dysfunction most likely led to the formation of biventricular thrombi.- - - - - - - - - - ranking = 11.302029136316keywords = physical examination, physical (Clic here for more details about this article) |
6/15. Rare case of pulmonary arteriovenous fistula simulating residual defect after transcatheter closure of patent foramen ovale for recurrent paradoxical embolism.We report on a patient suffering from recurrent cerebrovascular events despite previous transcatheter closure of persistent foramen ovale (PFO) with a Helex occluder. There was evidence of persistent left-to-right atrial shunt shown by transesophageal contrast echocardiography and the patient was admitted to our institution for interventional closure of the supposed residual defect. However, the PFO was completely closed by the device and left pulmonary artery injections showed a pulmonary arteriovenous fistula in the left lower lobe. This rare malformation may well explain the recurrent paradoxical embolism. Transcatheter fistula closure with coils was performed successfully. This case underlines that the existence of an isolated pulmonary arteriovenous fistula as a right-to-left shunt in patients with cryptogenic stroke should not be overlooked, even if a PFO is present and pulmonary arteriovenous fistula is not suggested by the initial physical findings or chest X-ray.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/15. U.S. navy diver/aviator/skydiver with AGE from a previously unknown PFO.A 32 year old US Naval aerospace physiologist with dive, jump and flight qualifications presented to a US Navy hyperbaric medicine department complaining of nausea, unsteadiness and left hand and forearm paresthesia that began almost immediately after completing a 28ft/ 40min recreational dive. Following an abbreviated history and physical examination the patient was diagnosed to be suffering from an arterial gas embolism. He was treated with hyperbaric therapy during which his symptoms resolved. Follow-on transesophageal echocardiography revealed an atrial septal aneurysm with a patent foramen ovale resulting in a right-to-left shunt after valsalva maneuver, but no evidence of ventricular dysfunction, wall motion abnormalities, or abnormal ejection. His episode was attributed to paradoxical air embolism and he was disqualified from further special duty. In order to regain his dive, jump and flight qualifications, the patient elected to undergo repair of the cardiac defect with a device that is relatively new in the operational military setting. The procedure was a success, he was granted waivers for his prior qualifications, and remains in that status to this day. This is the first known case where an atrial septal occluder has been used to preserve these special duty qualifications.- - - - - - - - - - ranking = 11.302029136316keywords = physical examination, physical (Clic here for more details about this article) |
8/15. brain abscess associated with isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect.A previously healthy 12-year-old girl presented with severe headache for 2 weeks. On physical examination, there was finger clubbing without apparent cyanosis. Neurological examination revealed only papiledema without focal neurologic signs. Cerebral magnetic resonance imaging showed the characteristic features of brain abscess in the left frontal lobe. Cardiologic workup to exclude a right-to-left shunt showed an abnormality of the systemic venous drainage: presence of isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. This anomaly is rare, because only a few other cases have been reported.- - - - - - - - - - ranking = 11.302029136316keywords = physical examination, physical (Clic here for more details about this article) |
9/15. 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) |
10/15. Cardiac perforation 6 weeks after percutaneous atrial septal defect repair using an Amplatzer septal occluder.A 14-year-old boy presented to the emergency department unaccompanied by his parents with a decreased level of consciousness, bradycardia, and hypotension after a syncopal episode. The patient's electronic chart revealed a percutaneous closure of a secundum atrial septal defect using an Amplatzer septal occluder (AGA Medical, Golden Valley, MN) 6 weeks before this presentation. An urgent echocardiogram revealed a moderate pericardial effusion, and 320 mL of fresh blood was evacuated by subxiphoid pericardiocentesis. The child underwent surgical exploration and was found to have a perforation in the superior-posterior aspect of the right atrium, which was corrected. The septal occluder was extracted, and the atrial septal defect was closed with a pericardial patch. This case illustrates a rare but life-threatening complication of percutaneous closure of atrial septal defect using an Amplatzer septal occluder and the importance of timely access to patient records when available history and physical examination are limited.- - - - - - - - - - ranking = 11.302029136316keywords = physical examination, physical (Clic here for more details about this article) |
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