What's That in the Aorta? A Case of Asymptomatic Dislodged Ostial Right Coronary Artery Stent That Was Noted as an Echodense Material in the Aortic Valve on Transesophageal Echocardiogram.

A 58-year-old female with a history of coronary artery disease (CAD) with remote percutaneous intervention (PCI) to ostial right coronary artery (RCA) with a bare-metal stent represented with unstable angina. Left heart catheterization (LHC) showed 90% stenosis of the previously stented ostial RCA with a moderate disease in the circumflex and left anterior descending arteries (LAD). LHC had also demonstrated that the previously placed ostial RCA stent, 19 years ago, was dislodged with only 3-4 mm within RCA and the remainder 10-12 mm in the ascending aorta. The patient miraculously had remained largely asymptomatic of this dislodged RCA stent for many years. Subsequent transthoracic echo (TTE) showed moderate-severe mitral regurgitation (MR). Therefore, she was worked up for a possible single-vessel coronary artery bypass graft surgery (CABG) with mitral valve replacement/repair. However, on transesophageal echo (TEE), MR was noted to be moderate in severity. Also, an echodense material was noted on the right coronary cusp (RCC) of the aortic valve, which was deemed to be the dislodged RCA stent. As the MR was moderate, the patient underwent successful complex PCI of ostial RCA.

Successful Transfemoral Transcatheter Aortic Valve Replacement in a Patient with Double Aortic Arch: An Interesting Imaging Case.

Transcatheter aortic valve replacement (TAVR) has become a mainstay of treatment in the management of severe aortic stenosis. It is a challenging procedure that requires expertise in obtaining proper access, delivery of catheters to and beyond the aortic valve, and finally accurate deployment of the aortic bioprosthesis. Patients with aortic anomalies portend an added challenge in performing TAVR procedures. We present the case of a patient incidentally found to have a right dominant double aortic arch who underwent successful TAVR for severe aortic stenosis.

Physician Variability in Diastology Reporting in Patients With Preserved Ejection Fraction: A Single Center Experience.

To help standardize the assessment of diastolic dysfunction in the United States, the American Society of Echocardiography (ASE) released criteria for the assessment of diastology in patients with normal and abnormal ejection fraction. As heart failure with preserved ejection fraction (HFpEF) is a leading cause of morbidity and mortality in cardiac patients, it is imperative to assess diastology appropriately. Echocardiography is the mainstay in the assessment of diastolic function; with the new ASE guidelines, diagnosis is simplified especially in patients that have preserved baseline ejection fraction. Our study aimed to determine the extent of physician variability in diastology reporting at our medical center after the release of the new ASE criteria.

The Chicken or the Egg? An Interesting Case Presentation of Spontaneous Coronary Artery Dissection Versus Takotsubo Cardiomyopathy.

This is an interesting cardiovascular imaging and coronary angiography case of a 67-year-old female patient who presented with chest pain, abnormal electrocardiogram (EKG), and heart failure who was subsequently found to have spontaneous coronary artery dissection (SCAD) and Takotsubo cardiomyopathy (TCM) on imaging studies. The case presentation highlights the importance of imaging studies and prompt diagnosis in these patients. This study may also highlight the need for early medical intervention in patients with suspected systolic dysfunction due to either of these pathophysiologic processes.