Traditional contrast echocardiography may fail to demonstrate a patent foramen ovale: negative contrast in the right atrium may be a clue.

We describe a patient who suffered a stroke of unknown origin and presented a patent foramen ovale (PFO) at contrast echocardiography. This PFO was clearly detectable after contrast delivery in the femoral vein, while repeated contrast delivery in an antecubital vein only showed a negative contrast effect, which suggests that the blood crossing the PFO originated from the vena cava inferior. However, enhanced detection of a PFO by femoral contrast delivery, compared to antecubital injection has been published many years ago, this mode is not widely implemented yet. With this case report we would like to illustrate that the negative contrast effect may be used as an indicator that a PFO cannot be excluded and a switch to femoral contrast injection is then mandatory.

Mitral valve repair is not always needed in patients with functional mitral regurgitation undergoing coronary artery bypass grafting and/or aortic valve replacement.

BACKGROUND AND AIM: Functional mitral regurgitation (FMR) is defined as mitral regurgitation in the absence of intrinsic valvular abnormalities. We prospectively evaluated the effect of coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR), without additional mitral valve repair, on the degree of moderate or severe FMR. STUDY DESIGN AND METHODS: From a cohort of 2829 patients undergoing CABG and/or AVR in the St. Antonius Hospital, 67 patients were identified with moderate or severe FMR by transthoracic and transoesophageal Doppler echocardiography. RESULTS: Two out of the 67 patients (3%) died perioperatively. During follow-up (3-18 months) mitral regurgitation decreased by one grade in 29 patients, by two grades in 28, by three grades in five patients and remained unchanged in one patient (p=0.0001). Of all patients, 85% had grade I mitral regurgitation or less. Grade II mitral regurgitation remained in nine patients with a previous large myocardial infarction and/or annular calcifications. NYHA class improved from 3.1+0.5 to 1.4+0.4 (p=0.0001). Ejection fraction increased from 46 to 55% (p=0.0001). Overall, left atrial and left ventricular end-diastolic dimensions decreased significantly. In contrast, no decrease in dimensions was seen in patients with postoperative grade II mitral regurgitation. CONCLUSION: FMR may improve significantly following CABG and/or AVR, although a previous large myocardial infarction and/or annular calcifications may affect outcome.

Organized thrombus in the ascending aorta originating from the ostium of the right coronary artery.

This case report describes the rare finding of a pedunculate thrombus in the ascending aorta originating from the ostium of the right coronary artery (RCA) detected after an inferior wall myocardial infarction in a young female. The thrombus was removed surgically during an emergency cardiopulmonary bypass procedure