Journal of clinical ultrasound : JCU
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Case Reports
A survival case of painless chronic type A aortic dissection with a history of stroke and anticoagulant use.
We report the case of a patient with completely painless chronic aortic dissection, who presented to another hospital with a left hemiparesia 3 months ago and received anticoagulation therapy with a diagnosis of ischemic stroke. Most of her symptoms had resolved when she presented to our outpatient clinic except for numbness of her left hand and dysphasia. ⋯ Surgery was performed successfully and the patient was discharged. This case emphasizes that the diagnosis of a completely painless aortic dissection with only neurologic symptoms at presentation can be extremely difficult and should always be considered as a cause of ischemic stroke to avoid catastrophic antithrombolytic or anticoagulation therapy.
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Cardiac resynchronization therapy with biventricular pacing has been shown to be beneficial in improving heart failure in patients with prolonged QRS duration (≥120 ms) and low ejection fraction (≤35%). Unsuccessful cannulation of the coronary sinus (CS) has been reported in up to 10% of cases. The feasibility of the transthoracic continuous cardiac imaging for coronary sinus cannulation has not been previously demonstrated. ⋯ We demonstrated the feasibility of using the CONTISON echography transducer for the guidance CS cannulation. This technique could expedite CS cannulation and reduce radiation exposure. Further studies comparing ultrasound versus fluoroscopy for CS cannulation appear warranted.