Right Heart Thrombus in Transit: Unusual Echocardiographic Finding in a patient with Acute Pulmonary Embolism.

Eighty year old male patient with heart failure preserved ejection fraction (EF), Obstructive sleep apnea, peripherovascular disease admitted with increasing shortness of breath and found with pulmonary emboli. Baseline 2D-echo-cardiogram performed demonstrated preserved ejection fraction and a right thrombus in transit. Anticoagulation with weight based-low molecular weight heparin was given for six days. Follow-up echo performed demonstrated complete dissolution of right heart thrombi. Since there was complete dis- solution of thrombi seen on right atrium, anticoagulation with Rivaroxaban was given instead.

Right Heart Thrombus in Transit: Unusual Echocardiographic Finding in a patient with Acute Pulmonary Embolism.

Eighty year old male patient with heart failure preserved ejection fraction (EF), Obstructive sleep apnea, peripherovascular disease admitted with increasing shortness of breath and found with pulmonary emboli. Baseline 2D-echocardiogram performed demonstrated preserved ejection fraction and a right thrombus in transit. Anticoagulation with weight based-low molecular weight heparin was given for six days. Follow-up echo performed demonstrated complete dissolution of right heart thrombi. Since there was complete dissolution of thrombi seen on right atrium, anticoagulation with Rivaroxaban was given instead.

Case Report: Prothesis-patient mismatch after aortic valve replacement.

Valve replacement is the standard surgical treatment of diseased valves that cannot be repaired. The main goal of replacement is to exchange the diseased valve with one that has the engineering and hemodynamics as close as possible to the disease free native valve. However due to mechanical and fluid dynamic constraints all prosthetic heart valves (PHVs) are smaller than normal and thus are inherently stenotic. This represents a challenge when it comes time to replace a valve. The correct valve with the correct and matching profile has to be selected before the procedure to avoid possible complications. It is well recognized that patients are also prone to patient-prosthesis mismatch at long term which could have consequences in the clinical outcomes (1). The evaluation of patient-prosthesis mismatch (PPM) has not been sufficiently emphasized in common practice. Failure to recognize this fact may lead to significant hemodynamic impairment and worsening of the clinical status over the time. Making efforts to identifying patients at risk may decrease the prevalence of PPM, the economic impact to our health system, the morbidity and mortality involved in these cases as well as creates efforts to standardized pre-operative protocols to minimized risk of PPM. We present a case of a 78 years old male patient who underwent aortic valve replacement due severe aortic stenosis, afterwards his clinical course got complicated with several admissions for shortness of breath and decompensated congestive heart failure (CHF).

Rheumatoid pericardial mass producing right ventricle inflow tract restriction: a case report.

Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints affecting multiple organs in the body. Pericardial disease is a relative common systemic manifestation of RA. A small number of cases are described in the literature related to pericardial involvement in RA. We described a case of a 69 year-old-male with chronic RA who presented with progressively worsening shortness of breath at exertion. Previous echocardiogram performed one year ago had normal ejection fraction and no structural abnormalities. Laboratories showed no significant abnormalities. The echocardiogram and MRI performed at the time of evaluation, revealed a mass in the right ventricle free wall pericardia. On the pathology report the pericardial mass resection showed mild chronic inflammation, extensive fibrosis, fat necrosis and branchial cyst surrounded with mild chronic inflammation. After surgical resection the patient improved clinically.