A Short Case Report on Ruptured Sinus of Valsalva Aneurysm.

A 35-year-old woman without any history of congenital heart disease presented to our clinic with dyspnea on exertion. Transthoracic echocardiogram (TTE) showed an eccentric tricuspid regurgitant jet and increased right ventricular systolic pressure. Transesophageal echocardiogram (TEE) revealed a sinus of Valsalva aneurysm (SVA) arising from the noncoronary sinus that ruptured into the right atrium, leading to the formation of an aorto-right atrial fistula. Right heart catheterization confirmed left to right shunt. The fistulous tract was resected, and the aneurysm repaired surgically. The patient made a good recovery.

Factors Associated with Leukoaraiosis Severity in Acute Stroke Patients.

OBJECTIVE: Age-related cerebral white matter abnormalities, commonly termed leukoaraiosis (LA), are frequent manifestation of cerebral microvascular disease. Aging and hypertension are well linked to LA. We compared additional vascular risk factors and socioeconomic factors with LA severity in acute stroke patients. METHODS: We analyzed 271 patients with acute ischemic or hemorrhagic stroke from a hospital registry. We collected clinical and socioeconomic data prospectively with a standardized questionnaire during acute stroke hospitalization. We scored LA severity on all available head computed tomography and magnetic resonance imaging (MRI) scans with the Wahlund LA scale. Mean response modeling analyzed for associations between LA severity and multiple potential predictors. RESULTS: Among 238 patients with CT LA scores, ageing and history of hypertension emerged as independent predictors of LA severity in multivariable analysis. Among 186 patients with MRI LA scores, ageing and severe left ventricular hypertrophy emerged as independent predictors of LA severity in multivariable analysis. We did not find an independent significant association between LA severity and the other factors we tested. CONCLUSIONS: Our study confirms the association of LA severity with ageing, and with hypertension. However, other vascular and socioeconomic factors we tested were not independently associated with LA severity.

When Prosthetic Valves Compete for Space: A Case of Transcatheter Aortic Valve Embolization Due to Prosthetic Mitral Valve.

Transcatheter aortic valve replacement (TAVR) is now the preferred choice of treatment for severe symptomatic aortic stenosis (AS) patients who are at intermediate to high risk for surgery. Rare complications like valve embolization have been described and we report a case with unique cause for such complication. A 79-year-old female presented with new onset dyspnea on exertion for evaluation and work up to the outside hospital and was found to have severe AS and referred to us for TAVR evaluation. She had a history of coronary artery bypass grafts surgery and bioprosthetic mitral valve replacement (MVR) 10 years ago. Preoperative transesophageal echocardiogram (TEE) revealed normally functioning bioprosthetic mitral valve and severe AS with peak/mean gradients of 67/44 mm Hg. She underwent transfemoral TAVR using a 26-mm Edwards Sapien S3 TAVR valve. During the slow deployment of the TAVR valve while rapid pacing, the valve appeared to move a little. Shortly after the removal of the delivery system out of the valve, the TAVR valve embolized to ascending aorta. It was carefully withdrawn into the aortic arch past the great vessels with an inflated balloon aortic valvuloplasty (BAV) catheter. Then, BAV was performed x 2 to plan for TAVR with a second valve, but the BAV balloon water-melon seeded repeatedly. We concluded that in this case, the rigid struts of bioprosthetic mitral valve encroaching on LVOT resulted in TAVR valve embolization and a decision was made to abort further attempts at TAVR valve implantation. This patient later under surgical aortic valve replacement (SAVR) and is clinically doing well at six months of clinical follow-up.

Left ventricular hypertrophy in acute stroke patients with known hypertension.

BACKGROUND: Despite effective treatments, hypertension remains uncontrolled in nearly half of the people with hypertension in the United States. Uncontrolled hypertension leads to end organ damage, such as left ventricular hypertrophy (LVH). To identify reasons for uncontrolled hypertension, we interviewed acute stroke patients with a history of hypertension and evaluated for LVH. METHODS: Using a standardized questionnaire, we collected demographic, socioeconomic, and health-care data in 300 acute ischemic and hemorrhagic stroke patients in one hospital. We also collected relevant clinical data from medical records. We analyzed factors associated with echocardiographic LVH as a marker of uncontrolled hypertension in 190 acute stroke patients with a history of hypertension. RESULTS: Overall, 46% (88/190) of patients had LVH. In univariate analysis, lower household income and self-reported poor adherence to hypertension treatment were significantly associated with increased risk of LVH. In multiple logit modeling, only poor adherence to hypertension treatment remained significantly associated with LVH, odds ratio 1.77 (95% CI: 1.01-3.11), p < 0.05. CONCLUSIONS: In acute stroke patients, poor adherence to hypertension treatment is a significant independent predictor of LVH. A clear reason for poor adherence to treatment is elusive in a large proportion of these patients in our study. Further research is needed to identify and develop strategies to combat the key factors responsible for poor adherence to hypertension treatment.