A Case of Nonbacterial Thrombotic Endocarditis in Small Ventricular Septal Defect

Nonbacterial thrombotic endocarditis is characterized by the presence of valve-leaflet or endocardial vegetation composed chiefly of fibrin and trapped platelets, without an associated inflammatory reaction or evidence of microorganism. Recent emphasis has been affixed to the significant morbidity and mortality rates as a results of major systemic arterial embolization and infective endocarditis. It is seen most commonly in patients with malignant neoplasms, disseminated intravascular coagulopathy, uremia, burn, SLE, cardiac valve disease. We experienced a case of nonbacterial thrombotic endocarditis developed in patient with small congenital ventricular septal defect, and vegetation on the left ventricular septum other than right ventricle as known most commonly affected.

Persistent Left Superior Vena Cava Diagnosed by Contrast Transthoracic Echocardiography in Patient with Chronic Atrial Fibrillation

Presence of persistent left superior vena cava(PLSVC) is considered to be one of the most frequently encountered anomalies of the systemic venous return. The incidence of PLSVC is reported to be 0.3% to 0.5% in the general population, and in 3% to 10% of patients with congenital heart disease. The presence of PLSVC draining into the coronary sinus is of no hemodynamic significance. However, it is important to recognize this condition, as it can have important clinical implications. The diagnosis can be established by two demensional echocardiography. It should be suspected by the presence of dilated coronary sinus, and confirmed by contrast echocardiography. A 61-year-old man with chronic atrial fibrillation was diagnosed as PLSVC by contrast transthoracic echocardiography(TTE) using agitated saline. Contrast TTE allowed visualization of the time sequence of the echo-contrast within the right atrium first following injection of right antecubital vein. Following injection of left antecubital vein, opacification of the dilated coronary sinus first and then the right atrium was seen.

Comparison between Mitral Flow and Mitral Annulus Velocity by Doppler Tissue Imaging according to Increment of Heart Rate

BACKGROUND AND OBJECTIVES: The utility of Doppler mitral flow pattems for the indirect assessment of left ventricular diastolic function is valid and widely used. One of the most common variables affecting mitral flow is heart rate. The aim of this study was to compare between mitral flow and mitral annulus velocity by Doppler tissue imaging (DTI) according to increment of heart rate. MATERIALS AND METHODS: 17 healthy volunteers (M: F=10: 7, mean age 27+/-2 years) comprised this study. They were free of any acute or chronic illness. The heart rate was elevated by increments of 10 beats (baseline, 80, 90, 100, 110, 120) by transesophageal atrial pacing. We measured mitral flow parameters (E and A velocity, E/A ratio, IVRT, DT of E) and mitral annulus velocity by DTI (e and a velocity, e/a ratio, RIVRT). We gave the score of visual estimation at baseline and each heart rate. The definition of the score was as follows, 1: well visualization of each envelope 2: summation of velocity wave forms 3: no differentiation, completely fused. RESULTS: 1) The E of mitral flow was significantly increased from 100 to 120 BPM and A velocity was significantly increased from 80 to 100 BPM (p<0.05). E/A ratio was significantly decreased from 90 to 100 BPM than baseline (p<0.05). 2) The e and e/a ratio of mitral annulus velocity were significantly increased from above 110, 100 BPM than baseline, respectively (p<0.05). But a velocity was little changed. 3) The score was all significantly higher in mitral annulus velocity pattern by DTI than mitral flow at each heart rate. CONCLUSIONS: The mitral annulus velocity by DTI is less affected by heart rate and visualized better than mitral fiow in increased heart rate. Therefore the assessment of mitral annulus velocity may be helpful for evaluating diastolic function during heart rates of physiologic range.