Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Mar 1998
Case ReportsPseudoaneurysm of the ascending aorta after aortic valve replacement.
A 58-year-old man with fever and chest wall tenderness was seen 8 weeks after aortic valve replacement. His initial postoperative course had been complicated by mediastinitis, requiring antibiotics and surgical debridement. ⋯ Pseudoaneurysm of the ascending aorta was suspected, based on computerized tomographic and magnetic resonance images of the chest. Intraoperative transesophageal echocardiography confirmed the diagnosis of pseudoaneurysm and was a key component in the patient's operative management.
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J Am Soc Echocardiogr · Feb 1998
Comparative StudyAccurate noninvasive estimation of left ventricular end-diastolic pressure: comparison with catheterization.
We evaluated the accuracy of a new Doppler-based method using the mitral regurgitant velocity at the time of aortic valve opening for the noninvasive estimation of left ventricular end-diastolic pressure. Sixty unselected patients were studied immediately before routine catheterization. Invasive left ventricular end-diastolic pressure was obtained using a fluid-filled pig-tail catheter. ⋯ In patients with a left ventricular end-diastolic pressure greater than 15 mm Hg the yield was 65%. Left ventricular end-diastolic pressures ranged from 4 mm Hg to 30 mm Hg. Bland and Altman analysis revealed no systematic bias and close agreement was found, with individual discrepancies not exceeding 5 mm Hg.
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J Am Soc Echocardiogr · Jan 1998
Case ReportsHypertrophic cardiomyopathy with obstruction: important diagnostic clue provided by the direction of the mitral regurgitation jet.
We present an unusual case of hypertrophic cardiomyopathy complicated by mitral regurgitation resulting from chordal rupture with flail posterior mitral leaflet. The diagnosis was suggested by the presence of an anteriorly directed mitral regurgitation jet on transthoracic color flow imaging, in addition to the typical posterolateral-lateral jet caused by systolic anterior mitral motion. ⋯ This combination of hypertrophic cardiomyopathy and flail mitral leaflet usually requires surgical intervention, and prompt diagnosis is important. The presence of an anteriorly directed mitral regurgitant jet should always raise suspicion of posterior mitral leaflet abnormality.
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J Am Soc Echocardiogr · Jan 1998
Lack of lung hemorrhage in humans after intraoperative transesophageal echocardiography with ultrasound exposure conditions similar to those causing lung hemorrhage in laboratory animals.
This study investigated the phenomenon of ultrasonically induced lung hemorrhage in humans. Multiple experimental laboratories have shown that diagnostic ultrasound exposure can cause hemorrhage in the lungs of laboratory animals. The left lung of 50 patients (6 women, 44 men, mean age 61 years) was observed directly by the surgeon after routine intraoperative transesophageal echocardiography was performed. ⋯ No hemorrhage was noted on any lung surface by the surgeon on gross observation. We conclude that clinical transesophageal echocardiography, even at field levels a little greater than the reported thresholds for lung hemorrhage in laboratory animals, did not cause surface lung hemorrhage apparent on gross observation. These negative results support the conclusion that the human lung is not markedly more sensitive to ultrasound exposure than that of other mammals.
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J Am Soc Echocardiogr · Jan 1998
Case ReportsRetained left atrial catheter: an unusual cardiac source of embolism identified by transesophageal echocardiography.
Embolic events have become a major indication for transesophageal echocardiography. We report three patients with cerebrovascular accident who were discovered to have retained left atrial catheter as a cardiac source of embolism. These radiolucent catheters, placed during previous cardiac surgery, were used for perioperative left atrial monitoring. ⋯ All patients underwent reoperation to remove the retained catheter and have had no recurrent embolic events. Although uncommon, retained catheter in the left atrium is an important potential source of systemic embolism. The diagnosis can be easily made with transesophageal echocardiography and should prompt surgical extraction of the catheter.