1/7. Abnormal venous connection between the left upper pulmonary vein and the left brachiocephalic vein, associated with rheumatic combined valvular heart disease.A case of partial anomalous pulmonary venous return (PAPVR) associated with mitral stenosis and aortic regurgitation is described. The diagnostic clue was radiocardiography using radioiodide serum albumin (RISA), our routine procedure before cardiac catheterization. The abnormal vessel connected with both the left upper pulmonary vein (PV) and the left brachiocephalic vein, without a stenotic lesion. aortic valve replacement, open mitral commissurotomy, and simple ligation of the anomalous vein were successfully performed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. cerebral infarction due to systemic necrotizing vasculitis in a patient with rheumatic heart disease, subacute bacterial endocarditis and status epilepticus.Systemic necrotizing vasculitis involving cerebral blood vessels is described in a 30-year-old man with rheumatic heart disease and subacute bacterial endocarditis. Fever, anaemia, splenomegaly and positive blood cultures for gram-negative bacteria were found on admission. The fever resolved with antibiotic therapy on the third hospital day but he then developed hemiplegia and multifocal seizures. The seizures progressed to uncontrollable status epilepticus accompanied by congestive heart failure and the patient died 20 d after admission. At autopsy, exudative and necrotizing vasculitis involving medium- to small-sized arteries was seen in the brain, the heart and the skeletal muscles. Rheumatic myocarditis and endocarditis and old rheumatic mitral valve deformities were also present. In addition, verrucous endocarditis in the mitral valve and Lohlein's focal glomerulonephritis were noted. We discuss the possible mechanism of the systemic necrotizing vasculitis in relation to rheumatic fever.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/7. Percutaneous mitral valvotomy in rheumatic mitral stenosis: a new approach.Three patients with rheumatic mitral stenosis were treated with percutaneous mitral valvotomy. A Brockenbrough catheter was advanced transseptally into the left atrium and then into the left ventricle over a long guide wire. An angle wire loop retriever was advanced through a 10 Fr straight catheter via the femoral artery into the left ventricle. The retriever was used to catch the flexible end of the long guide wire. This end of the long guide wire was then drawn out of the right femoral artery by the retriever through the straight catheter. The straight catheter was left in the descending aorta; the Brockenbrough catheter was removed and a 7 Fr balloon catheter was introduced percutaneously over the long guide wire through the femoral vein. This balloon catheter was used for interatrial septal dilatation and right femoral venous dilatation. In two patients this catheter was replaced over the long guide wire with a 9 Fr Schneider-Medintag Gruntzig catheter (3 X 12 mm diameter when inflated) and in the other by a Mansfield (18 mm diameter when inflated). The procedure was well tolerated in these three patients and there were no complications. Haemodynamic function improved, there was appreciable decrease in dyspnoea, and exercise tolerance was increased. This procedure has several advantages: the balloon is more easily positioned through the mitral valve; the stability of the balloon during inflation is improved by traction at both ends of the long guide wire; and there is the option of rapidly exchanging one balloon for a larger one over the long guide wire. This technique seems to be less arrhythmogenic and results in less blood loss because manual compression of the femoral vessels after the procedure is easier.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/7. Diagnostic value of pulsed Doppler echocardiography in combined heart defects.26 patients with combined heart defects were examined by means of ultrasound methods (one-dimensional, two-dimensional and Doppler echocardiography). The results were compared with the results of clinical and roentgenological examinations. Taking into account literary data on high sensitivity and specificity of Doppler echocardiography, its informative value was assessed in cases when affection of two or more valves results in a balancing of haemodynamic changes. It was documented that pulsed Doppler EchoCG makes possible to assess the character and the direction of blood flow in different phases of the cardiac cycle in the heart cavities and the great vessels, and thereby provides additional information on the involvement of the valvular apparatus and on the state of haemodynamics. The sensitivity of this method is particularly high in the detection of regurgitant flow.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/7. Bacterial invasion of pulmonary vessels. Pseudomonas bacteremia mimicking pulmonary thromboembolism with infarction.pseudomonas aeruginosa displays a curious propensity for invading blood vessels and causing vessel wall necrosis. This bacteremia-related "vasculitis" is often associated with hemorrhagic necrosis and infarction of surrounding organ parenchyma. With the exception of skin lesions, however, clinical manifestations of Ps. aeruginosa vasculitis seldom occur. In the patient we describe, fatal Ps. aeruginosa bacteremia was first manifested by a syndrome indistinguishable from pulmonary thromboembolism with infarction.- - - - - - - - - - ranking = 6keywords = vessel (Clic here for more details about this article) |
6/7. Multiplane transesophageal echocardiography: our initial experience.We present our experience in the diagnostic assessment of a wide spectrum of cardiovascular disorders using multiplane transesophageal echocardiography (MP-TEE). Two hundred and seventeen patients in the age range of 11-71 years were subjected to MP-TEE from January to November 1993. The male:female ratio was 1.1:1. One hundred and ten patients had predominantly mitral valve disease of rheumatic origin, eleven had mitral valve prolapse, twenty patients had aortic valve disease and thirty seven patients had more than one valve involvement. Six patients with suspected prosthetic heart valve dysfunction and ten patients of hypertrophic cardiomyopathy were also studied. Two patients had unexplained pulmonary hypertension, three had pericardial disease and three had proximal aortic dissections. Twenty six patients with congenital heart disease were studied of which nineteen had atrial septal defects, one had corrected transposition of great vessels with pulmonic stenosis and one adult had Ebstein's anomaly of the tricuspid valve. In our experience, MP-TEE enhances the versatility of TEE by providing incremental diagnostic information and enhancing delineation of pathology. The procedure was well-tolerated and no complications occurred.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/7. Bilateral corkscrew episcleral veins from tricuspid incompetence.PURPOSE: To use color Doppler imaging in examining a patient with clinically diagnosed low-flow carotid-cavernous sinus fistula and a history of rheumatic heart disease. METHOD: The flow characteristics of the orbital vessels and the internal jugular veins were studied with a 7.0-MHz transducer. RESULTS: Episodic arterialization and reversal of blood flow was demonstrated in both superior ophthalmic veins. This similar waveform was also seen in both jugular veins. CONCLUSION: The presence of tricuspid regurgitation and pulmonary hypertension caused increased episcleral venous pressure and the corkscrew appearance, which is more commonly associated with carotid-cavernous sinus fistula.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |