Postoperative regression of clubbing at an unexpected rate in a patient with aortic and mitral valve replacement due to infective endocarditis.

Pulmonary diseases such as malignancies, empyema, bronchiectasis, digestive tract malignancies, inflammatory bowel diseases, cyanotic congenital heart diseases and infective endocarditis can cause clubbing. We present a 63-year-old female patient with infective endocarditis, who had clubbing that resolved very rapidly after cardiac surgery due to rupture of the mitral papillary muscle. She had persistent fever and in her echocardiographic examination rupture of the papillary muscle of the anterior mitral valve and significant aortic regurgitation was noted. She was scheduled for emergency operation and had debridement and replacement of the mitral and the aortic valves. During the follow-up, she had complaints of pain in the distal parts of the fingers. The convex shape of the nails changed and basal portions were apparently thinner and paler than the previous thickened and discoloured, hyperkeratotic nails. This newly growing tissue rapidly replaced the old thick nails in 3 days.

Resolution of a Giant Atrial Thrombus Following Anticoagulation Therapy : Case Report

We report on a patient in whom a giant thrombus in the left atrium was detected by transthoracic echocardiography. Anticoagulant theraphy was started. After two months of therapy; repeat echocardiography showed complete resolution of the thrombus. This case indicates that large and presumably organised thrombi may be treated with anticoagulant the

Prognostic value of viable myocardium in patients with non-Q-wave and Q-wave myocardial infarction.

This study assessed the amount and prognostic value of myocardial viability in patients with non-Q-wave myocardial infarction (NQMI) and Q-wave myocardial infarction (QMI). A total of 175 patients with MI and an ejection fraction < or = 45% underwent dobutamine stress echocardiography. On the basis of clinical criteria and myocardial viability, 110 patients were revascularized. The amount of viable myocardium and the clinical outcome were compared in the NQMI and QMI groups. Patients with NQMI exhibited a larger amount of viable myocardium compared with those with QMI. The mortality rate was 6% in patients with NQMI with viable myocardium and subsequent revascularization, 33% in patients with NQMI without viable myocardium or revascularization, 27% in patients with QMI with viable myocardium and subsequent revascularization, and 33% in patients with QMI without viable myocardium or revascularization. In conclusion, our data suggest that patients with NQMI and viable myocardium have the best prognosis after revascularization.

Tissue Doppler echocardiography and myocardial performance index in patients with scleroderma.

In this study, left and right ventricular functions were examined echocardiographically in 22 patients with scleroderma and 22 healthy volunteers. Conventional and tissue Doppler echocardiography and myocardial performance indexes were used as measures of right and left ventricular global functions. Mitral early diastolic E wave deceleration time, isovolumetric contraction time and left ventricular myocardial performance index and peak tricuspid A wave velocity were significantly higher in the scleroderma group compared with the control group. Mitral and tricuspid E/A ratios were significantly lower in patients with scleroderma. In addition, mitral annular and tricuspid annular isovolumetric relaxation times and the tricuspid E/E' ratio were significantly increased in scleroderma patients compared with the control group. In conclusion, in scleroderma patients the global left ventricular functions were depressed and diastolic function abnormalities were seen in both right and left ventricles. In addition, longitudinal muscle functions of the ventricles were depressed in scleroderma patients, as shown by tissue Doppler imaging parameters.