Diagnosis of the Malfunctioning Bioprosthetic Mitral Valve in Patient with Congestive Heart Failure after Remote Implantation. The Characteristics of Transthoracic and Transesophageal Echocardiography in Comparison with Operative Findings

BACKGROUND: Early diagnosis and proper therapy of malfunctioning prosthetic heart valves remain a challange. Transthoracic echocardiography(TTE) is the diagnostic procedure of choice for the evaluation of malfunctioning prosthetic heart valves. Howerver, TTE may be limited owing to poor acoustic windows. Some of these limitations can be overcome by transesophageal echocardiography(TTE). METHODS: The study comprised 33 consecutive patients(20 male and 13 famale patients, age range 20 to 59) in congestive heart failure after remote mitral valve replacement with bioprosthesis. The patients were examined between 1987 and 1994. All the 33 patients were studied by TTE and 19 patients among these patients furthermore by TEE. The morphology of the explanted bioprosthesis was confirmed by surgery in all cases. RESULTS: The abnormalities of the bioprosthesis were diagnosed correctly by TTE in 32 cases. The more detailed morphology of the valves could be observed by TEE(19 cases). Only in one case a small thrombus in left atrium was overlooked in TTE examination, on the otherhand it was detectedd by TEE. The severity grade of mitral regurgitation was estimatedca. I' severer by TEE in 8 cases. In all TEE examination spontaneous echocontrast was observed in left atrium. The bioprostheses from CE(Carpentier-Edwards) showed higher tendency to cuspal tearing and perforation. CONCLUSION: TTE is the diagnostic procedure of choice on patients with bioprosthetic mitral valve replacement. TTE examination confirms immediately clinical diagnosis of bioprosthetic failure. The transesophageal approach promises more detailed informations about lesions of the degenerated bioprosthetic valves and left atrium.

Intraoperative detection of patent foramen ovale by transesophageal echocardiography

No abstract available.

Conventional and Transesophageal Echocardiographic Demonstration of a Ventricular Septal Perforation with Bilateral Shunt and Chordae Rupture of Tricuspid Septal Leaflet Caused by Nonpenetrating Chest Trauma: A Case Report

Blunt thorax trauma may produce a variety of cardiac lesions, which may occur alone or in combination. Nonpenetrating perforation of interventricular septum with chordae rupture of tricuspid valve is a infrequent pathologic event. A 40-years-old worker was transfered to hospital with increasing symptoms of right heart failure following a blunt compressing chest trauma with a huge overolling cement pipe(Wt.680kg) 6 weeks ago. The immediately diagnosed serial rib fracture of the left thorax cage and dislocation of the left acromoclavicular joint were treat conservatively. A conventional transthoracic color Doppler and two dimensional echocardiogram detected traumatic ventricular septal defect with bilatral shunt and tricuspid regurgitation. An additional transesophageal color echocardiopraphic demonstrated the ruptured chordae tendineae of the tricuspid septal leafet, which prolapsed deeply into the right atrium. The conventional color Doppler echocardiopraphy enhances the ability to detect the presence of a ventricular septal perforation and valve dysfunction in a patient with cardiac contusion. The transesophageal echocardiopraphy is a useful semiinvasive tool for the detailed morphological evaluation of atrioventricular valves and their substructure.

Various 12-Lead Electrocardiographic Findings of Diffuse Three Vessel Coronary Artery Spasm

No abstract available.

Intravenous Verapamil for Reversal of Refractory Coronary Vasospasm and Cardiac Arrest

No abstract available.

Congenital Anomalies of the Coronary Arteries

The coronary arteries are also subject to congenital anomalies of both minor and major consequence. Hemodynamically significant primary anomalies of the coronary arteries are those which alter myocardial perfusion. There are four major types : coronary artery fistula, origin of the left voronary artery from the pulmonary artery, congenital coronary stenosis or atresia and origin of the left or right coronary artery from the opposite sinus of Valsalva with subsequent passage of the vessel between the aorta and right ventricular infundibulum. Minor anomlies are the variation of the origin of the coronary arteries from the aorta with normal distal circulation. We can see more coronary anomalies associated with congenital cardiac anomalies, probably representing a circulatory response to the primary intracardiac defect. We present a total of 76 cases of congenital coronary anomalies, reviewing 3946 cases of angiocardiography or selective coronary arteriography, performed during last 8 years at Sejong General Hospital.

Intraaortic Balloon Counterpulsation Support in Cardiogenic Shock due to Ventricular Septal Perforation and Huge Inferior Myocardial Infarction

A 63 year old male suffered from a acute huge inferolateral and posterior myocardial infarction with vertricular septal perforation(1x1.5cm). Cardiogenic shock and ventricular tachycardia occured on the 3rd day in hospital. After cardiopulmonary resuscitation the deteriorated condition of the patient was improved by intraaortic balloon counterpulsation(IABP). The invasive diagnostic procedure(LV angiography and coronary angiogram) was carried out under the employment of IABP and artificial ventrilation. The patients has recovered from the operation(coronary artery bypass graft and VSD patch op) and myocardial infarction. Because of recurrent aspiration pneumonia the patient was nourished per gastrostomy. He died 3 month later due to upper gastrointestinal bleeding.

Confirmation of an Anomalous Origin of the Right Coronary Artery from the Left Sinus of Valsalva Using a Transesophageal Echocardiography

No abstract available.

Usefulness of a Transesophageal Echocardiography in Patients with Isolated Coronary Ostial Stenosis during a Surgical Angioplasty

No abstract available.

Coronary Neovascularity and Fistula Formation in Left Atrial Thrombosis

In mitral valve disease, mural thrombus in the left atrium is common, particulary in the atrial appendage in patients with atrial fibrillation. Occasionally, the angiographic sign of "neovascularity" and "fistula" in the region of the left atrial appendage during coronary arteriography has been reported to indicate the presence of thrombus in the left atrium, which might not even be revealed by transthoracic two-dimensional echocardiography. We observed coronary neovascularity and fistula formation in two pateints with mitral stenosis and these findings were due to organized mural thrombus that was adherent to the wall of the left atrial appendage. So we report 2 cases with brief review of literature.

Advances in Bioengineering and Holter Monitoring in Future ; System Validation of Ambulatory EKG-Analysis System HP(Hewlett Packard) 43420A

In a systemvalidation of a ambulatory EKG analysis system we examined the HP 43420A ambulatory EKG analysis system(Fa.Hewlett packard, USA). The complete capture module 43405A with the applied software is able to record 24 hours events without single beat lable. Model 43400B patient analyzer records intermittant the EKG events and represents these in the Ambulatory EKG report. By means of the devices 31 patients were examined. Beat-to-beat analysis of the complete full disclosure is visually carried out. Sensitivity and postitve predictive value were 94(96)% and 100% for ventricular ectopic beat(VEB). The sensitivity amounted to 87% in the detecting of VEB pair(couplet), the positive predictive value 94%. VEB Run/VT(ventriular tachycardia) resulted in a sensitivity of 82% and in positive predictive value of 93%. The automatically edited Ambulatory EKG report with his EKG strips is representative of full disclosure and reliable in comparison with the analyzed results of full disclosure. The HP 43420A Ambulatory EKG Analysis system, a new and developed device with all digital recording system and full disclosure capability is found comparable to the best ones of the presently available Holter monitoring system.