Congenital absence of left pericardium.

The authors present a clinical case of right chamber dilatation in a 34-year-old patient with no symptoms, investigation of which led to a diagnosis of congenital absence of left pericardium, established by magnetic resonance imaging (MRI). They also present a review on absence of the pericardium, and discuss associated congenital abnormalities, the clinical presentations and findings in diagnostic tests, with particular emphasis on MRI.

Native valve endocarditis due to Pichia ohmeri.

Candida species can cause clinical manifestations in various organs of the cardiovascular system, i.e., the pericardium, myocardium, and endocardium, with endocarditis being the best-known clinical entity. Endocarditis is seen primarily in intravenous drug users and in individuals with damaged native valves, especially in congenital heart disease or rheumatic valvular diseases, and in prosthetic heart valves. The authors present a case of Pichia ohmeri endocarditis in an intravenous drug user, with an unusual presentation form. This is a case of a 42-year-old man, an intravenous heroin user, who was admitted to our Vascular Surgery Department because of fever and acute serious ischemia of the left inferior limb. He presented with fever (39 degrees C), a pale and cold left limb, absence of the left popliteal pulse, and a pansystolic murmur at the cardiac apex. The transthoracic echocardiogram showed a large vegetation on the anterior leaflet of the mitral valve and severe mitral regurgitation with good left ventricular systolic function. Empirical antibiotic therapy was started. Six days after admission, embolectomy was performed with partial clinical recovery. Three blood cultures and the embolus showed a teleomorphic form of Candida guilliermondii - Pichia ohmeri. Therapy with intravenous liposomal amphotericin B, fluocitosin, imipenem, and aztreonam was started. Two weeks later, his clinical condition deteriorated with acute heart failure refractory to medical therapy, mandating mechanical ventilation and high-dose vasopressor and inotropic amine support. He underwent urgent mitral valve replacement with a biologic prosthetic valve. Rapid stabilization of the cardiac status occurred, but ischemic limb lesions required further vascular interventions.

Valve orifice area in aortic stenosis evaluated by planimetry, Gorlin and continuity equations: a prospective study.

UNLABELLED: In evaluation of the severity of aortic valve stenosis, multiple parameters can be determined. All of them, except valve orifice area, are influenced by other factors such as cardiac output, heart rate or aortic insufficiency. OBJECTIVES: This is a prospective study which proposes, in the determination of the valve orifice area in aortic stenosis, to evaluate the accuracy of and correlation between three methods--planimetry by multiplane transesophageal echocardiography, the continuity equation by transthoracic echocardiography, and invasive measurement using the Gorlin formula. METHODS: Forty-five patients with known calcified valvular aortic stenosis 27 men, mean age 70 +/- 10 years, (range 27-82), were studied. In all patients the area was determined by planimetry and by the continuity equation. In 25 (56%) patients invasive measurements were obtained using the Gorlin formula. RESULTS: Evaluation of the valve orifice area by planimetry was easily performed and did not prolong the duration of the exam, except in five patients (11%). The area determined by the continuity equation had a mean value of 0.74 +/- 0.25 cm2, by planimetry 0.74 +/- 0.24 cm2 and by the Gorlin formula 0.65 +/- 0.17 cm2. Correlations between areas obtained by the three methods used were: continuity equation and planimetry 0.82; continuity equation and Gorlin formula 0.51; and planimetry and Gorlin formula 0.80. Concordance analysis (Bland and Altman's method) gave mean (Mn) values for the differences in the areas determined by the Gorlin formula and the continuity equation of 0.01 +/- 0.15 cm2 (Mn - 2SD = -0.29, Mn + 2SD = 0.30). The estimated value by the Gorlin formula and planimetry was 0.02 +/- 0.10 (Mn - 2SD = -0.19, Mn + 2SD = 0.23). CONCLUSIONS: 1) Planimetry of the valve orifice area by transesophageal echocardiography is feasible and does not prolong the duration of the exam in the majority of patients. 2) The strong correlation and the results of concordance analysis, in the determination of valve orifice area, between traditional invasive methods and planimetry, support the use of this noninvasive method in clinical practice.