Pseudoaneurysm of the mitral-aortic intervalvular fibrosa

Mitral- aortic intervalvular fibrosa pseudoaneurysm a rare complication of aortic valve replacement, that was diagnosed in a 55 years-old 2 years after operation

Ruptured sinus of valsalva aneurysm initially misdiagnosed as ventricular septal defect by echocardiography

Aneurysms of sinus of valsalva are rare cardiac lesions and most of them are in congenital origin. The malformation consists of a separation or lack of fusion between the media of the aorta and the annulus fibrosis of the aortic valve. The structure becomes aneurysmal and may rupture to form a fistula. We present a case of ruptured sinus of valasalva aneurysm in a 25-year-old man. The diagnosis was made by echocardiography and confirmed at operation

Role of tissue-doppler imaging to assess left ventricular function in patients with right ventricular pacing

Right ventricular apical [RVA] pacing has been reported to impair diastolic and systolic function. These changes were usually studied by conventional echocardiography, while tissue-doppler imaging [TDI] has provided a new way to evaluate global and regional systolic left ventricular [LV] function and abnormal LV relaxation. We designed this study to evaluate the changes of TDI-derived indices of asynchrony after RVA pacing. We followed 41 patients with LV ejection fraction [LVEF] >/= 45% and LV end-diastolic dimension [LVEDD] œ 56 mm who underwent single- or dual-chamber RVA pacemaker implantation for performing pacemaker analysis and second 2-dimensional [2D] echocardiography and TDI, at least 4.2 months later. 2D measurements included LVEDD, LV end-systolic dimension [LVESD], left atrial [LA] volume and septum to lateral asynchrony, while TDI measurements were the peak velocities of myocardial shortening [Sm] and early myocardial relaxation [Em]. Considering the exclusion criteria, 20 patients entered the study with the mean age of 66.05 years and follow-up of 7.86 months [4.20-12.25]. The reduction of Sm, Em and LVEF, and the increment of LVEDD, LVESD, septum to lat asynchrony and LA volume were statistically significant. Changes of all these parameters, however, were independent of pacing duration, frequency or mode [single- or dual- chamber]. RVA pacing has deleterious effects on both LV systolic and diastolic parameters of not only conventional echocardiography but also TDI even in patients with normal LV function. Furthermore, LA volume increases significantly

Pacemaker twiddler's syndrome

A 76-yr-old man with unipolar ventricular pacemaker, previously implanted in the right ventricular apex, presented with syncopal attack and twitching of the right pectoralis muscle. He finally was diagnosed as having Twiddler's syndrome. The patient had a pulse rate of 36/min and cannon waves in the neck veins. Chest radiography showed a dislodged pacing lead completely wrapped around the pulse generator. After uncoiling the lead it was positioned in the right ventricular apex and the pulse generator implanted and sewed tightly in a smaller pocket. After six months follow-up there was no further twiddling or pacemaker dysfunction