ABSTRACT
A 62-year-old male presented to the emergency department with acute viral bronchitis and worsening of his chronic dyspnea on exertion. Incidentally, a murmur was detected on physical examination. Extensive work-up, including coronary computed tomography angiography, revealed a rare combination and potential association between severe bicuspid aortic valve stenosis and coronary-pulmonary artery fistulas.
Subject(s)
Aortic Valve Stenosis , Bicuspid Aortic Valve Disease , Coronary Artery Disease , Fistula , Heart Defects, Congenital , Male , Humans , Middle Aged , Pulmonary Artery/diagnostic imaging , Constriction, Pathologic , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve/diagnostic imaging , Aortic Valve/surgeryABSTRACT
Tissue Doppler imaging (TDI) patterns from the left atrial appendage (LAA) were evaluated by transesophageal echocardiography. Reproducible, characteristic triphasic or biphasic tissue velocities similar to Doppler flow of the LAA were obtained. Patient peak TDI velocities correlated well with flow and were measurable in atrial fibrillation. Patients with an embolic cerebrovascular accident and in sinus rhythm had higher tissue TDI velocities from the LAA compared with patients without an event, and the groups had similar flow velocities. Hence, Doppler tissue contraction dynamics determined by TDI may complement flow velocities in evaluating LAA function for risk assessment of thromboembolism.
