Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Sep 1992
Case ReportsTransthoracic echocardiography documents prompt resolution of right atrial thrombus after thrombolytic therapy.
Right atrial thrombi represent pulmonary emboli in transit, and they may be fatal in patients treated conservatively with anticoagulation. This case provides an opportunity to review echocardiographic findings and management decisions in this disease entity. As the literature now favors thrombolytic therapy in suitable patients, we present a case in which transthoracic echocardiography provided rapid assessment of the outcome of this form of therapy.
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J Am Soc Echocardiogr · Sep 1992
Contrast transesophageal echocardiographic demonstration of coronary artery fistula within left atrial appendage thrombus in mitral stenosis.
Coronary neovascularization and fistula formation arising from the left circumflex artery demonstrated by coronary angiography is a specific sign for the presence of left atrial appendage thrombus in patients with mitral stenosis. However, the fistula drainage site in the left atrium in relation to the thrombus cannot be ascertained by the angiographic method. ⋯ In these three patients, the transesophageal echocardiography confirmed the presence of a coronary fistula by identifying contrast exuding from the surface of the thrombus. Thus we have shown for the first time the usefulness of contrast transesophageal echocardiography in imaging the exact drainage site of coronary artery fistula from left atrial appendage thrombus.
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J Am Soc Echocardiogr · Mar 1992
Case ReportsUse of transesophageal echocardiography during thrombolysis with tissue plasminogen activator of a thrombosed prosthetic mitral valve.
Inadequate anticoagulation in patients with mechanical prosthetic heart valves can result in a significant incidence of thromboembolic complications. An even more life-threatening complication is massive thrombosis of the valve itself. Thrombolytic therapy was given to a moribund 22-year-old woman with intractable heart failure caused by a thrombosed St. ⋯ Serial imaging during thrombolysis displayed progressive dissolution of the thrombus and progressive improvement in valve function. Transesophageal echocardiography is helpful in the diagnosis of prosthetic valve thrombosis and has the ability to monitor continually the effect of treatment with thrombolysis. Although thrombolytic therapy with recombinant tissue plasminogen activator is effective in treating prosthetic valve thrombosis, it carries a high risk for serious thromboembolic complications and thus should be reserved for critically ill patients who are too sick to undergo immediate surgery.
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J Am Soc Echocardiogr · Mar 1992
Case ReportsSpontaneous closure of a traumatic ventricular septal defect after blunt trauma documented by serial echocardiography.
A ventricular septal defect (caused by blunt chest trauma) that closed spontaneously over a period of 5 years was documented by serial echo-Doppler examinations. The shunt was relatively small and the patient was without symptoms from the time the lesion was discovered until its closure. In the absence of cardiac decompensation or pulmonary hypertension, a conservative approach, including serial echo-Doppler examinations, can be justified.
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J Am Soc Echocardiogr · Mar 1992
Transesophageal echocardiography in the evaluation of mediastinal masses.
To assess the diagnostic impact of transesophageal echocardiography in the evaluation of mediastinal masses, 30 patients with mediastinal abnormalities detected by routine chest roentgenogram underwent transthoracic and transesophageal echocardiography. Subsequently, 29 of the patients underwent computed tomography and 16 underwent magnetic resonance imaging. The location and structure of the masses as well as their relationship to the surrounding structures were assessed. ⋯ Computed tomography correctly diagnosed the location, structure, and relationships in all patients but one; magnetic resonance imaging correctly evaluated the mediastinal masses in all 16 patients. Our study suggests that transesophageal echocardiography is a valuable and safe complementary method of evaluating mediastinal masses. Moreover, this technique allows the obstruction of vessels and heart cavities, valve regurgitation, and right and left ventricular function to be easily assessed.