1/79. Echocardiographic manifestations of postinfarction ventricular septal rupture.The echocardiographic features of three patients with postinfarction ventricular spectal rupture are described. All patients showed a decreased or paradoxical motion on the ventricular septum, and two of the patients demonstrated an unusual motion of the tricuspid valve. There were no abnormalities in mitral valve motion. The echocardiogram can be helpful in the diagnosis of postinfarction ventricular septal rupture and can assist in distinguishing this condition from acute disruption of the mitral valve complex.- - - - - - - - - - ranking = 1keywords = mitral valve, valve (Clic here for more details about this article) |
2/79. Exceptional survival of a patient with large ventricular septal defect, bidirectional shunt, and severe pulmonary valve stenosis.A 74-year-old man has survived in good health for an exceptionally long time despite the presence of a moderate-to-large-sized membranous ventricular septal defect (VSD). He has remained acyanotic with new york Heart association class I function. Transthoracic and transesophageal echocardiography with color flow Doppler demonstrated a membranous VSD with left-to-right and right-to-left bidirectional shunts during ventricular systole and diastole, respectively, with an right ventricular systolic pressure of 93 mm Hg, dilation of the atria and the right ventricle, and right ventricular hypertrophy. The pulmonary valve was severely stenotic with transpulmonary valve peak velocity of 6.1 m/s and a peak pressure gradient of 147 mm Hg. The pulmonary artery and inferior vena cava were mildly dilated, and the left ventricular dimension and systolic function were normal. Transesophageal echocardiography with saline solution microbubble injection demonstrated positive contrast effect in the left ventricle in diastole confirming a right-to-left shunt at the ventricular level. This man is currently the oldest survivor with a moderate-to-large-sized membranous VSD reported in the literature.- - - - - - - - - - ranking = 0.33022873375568keywords = valve, stenosis (Clic here for more details about this article) |
3/79. Noninvasive diagnosis of complications of the mitral bioprosthesis.The echophonocardiographic diagnoses of valvular and paravalvular insufficiency, calcific stenosis, and thrombolic occlusion of the stent-mounted aortic homograft or heterograft in the mitral position are described. Paravalvular and valvular insufficiency were associated with apical systolic murmurs which decreased in intensity after amyl nitrite inhalation and with echocardiograms which showed initial diastolic slopes of the stents in excess of the normal range (1.9 to 3.3 cm. per second). In clinically improved and stable patients, amyl nitrite inhalation resulted in increased intensity of the commonly heard systolic ejection type murmur at the left sternal border and echocardiographic evidence of further narrowing of the outflow tract measured between the interventricular septum and the anterior portion of the stent. Calcific homograpft stenosis was associated with a decreased diastolic stent slope (0.4 cm. per second) and increased echo density from the tissue leaflets. Thrombus formation on the sewing ring caused fatal inflow occlusion in 2 patients. The condition was characterized by an echocardiogram showing decreased ratio of internal-to-external stent diameter, 0.47 (normal range 0.56 to 0.74), decreased diastolic stent slope, and decreased leaflet excursion.- - - - - - - - - - ranking = 0.043241755436352keywords = stenosis (Clic here for more details about this article) |
4/79. Native valve endocarditis with aorta-to-left atrial fistula due to corynebacterium amycolatum.Infective endocarditis remains a pathology with a high rate of complications and mortality. One of the most dramatic complications is abscess formation. A rare evolution of abscess formation is the development of fistula. We describe an 88-year-old woman with an aortic root abscess and aorta-to-left atrial fistula. To our knowledge this has only been described with streptococcus species as causative micro-organism. In this case the abscess was caused by corynebacterium amycolatum, which is an infrequently found micro-organism.- - - - - - - - - - ranking = 0.16249681525532keywords = valve (Clic here for more details about this article) |
5/79. Silent mitral regurgitation.The occurrence of significant mitral regurgitation whithout the characteristic auscultatory signs, particularly the holosystolic murmur and the third heart sound, is unusual. It becomes of considerable importance when it occurs in combined lesions of the mitral valve, and more so in those areas where the treatment of mitral stenosis is by closed mitral valvotomy. Two cases of silent mitral incompetence are presented. The features that should have indicated the coexistence of regurgitation with mitral stenosis were cardiomegaly with considerable dilatation of the left atrium, and lesser degrees of right ventricular hypertrophy on electrocardiography for the severity of mitral stenosis and evidence of biventricular hypertrophy.- - - - - - - - - - ranking = 0.84047740967274keywords = mitral valve, mitral stenosis, valve, stenosis (Clic here for more details about this article) |
6/79. Prolapsing mitral valve leaflet syndrome. A spectrum that includes cleft posterior mitral valve.Two patients with a prolapse and cleft posterior mitral leaflet were studied. The first case had an associated ostium secundum type atrial septal defect. In both cases, the pansystolic regurgitation of contrast material during angiography corresponded to the pansystolic configuration of the murmur. In each instance, the systolic murmurs displayed a late systolic accentuation during the maximal prolapse of the mitral valve. The echocardiographic studies demonstrated only a late systolic prolapse which in both patients corresponded angiocardiographically to the maximum buckling of the pansystolic prolapse. Echocardiographic and angiocardiographic features of cleft posterior mitral valve leaflet are discussed.- - - - - - - - - - ranking = 4.7968789809308keywords = mitral valve, valve (Clic here for more details about this article) |
7/79. eponyms and the diagnosis of aortic regurgitation: what says the evidence?BACKGROUND: Chronic aortic regurgitation can lead to significant morbidity and mortality. For more than a century, numerous eponymous signs of aortic regurgitation have been described in textbooks and the literature. PURPOSE: To compare current textbook content with the peer-reviewed literature on the eponymous signs of aortic regurgitation and to assess the role of these signs in clinical practice. DATA SOURCES: 11 textbooks, medline (1966 through October 2002), and bibliographies of textbooks and relevant papers. STUDY SELECTION: English-language reports that were related to the properties of a sign on physical examination, incorporated more than 10 adults, and did not involve prosthetic heart valves or acute aortic regurgitation. DATA EXTRACTION: Three investigators independently analyzed relevant textbook extracts and 27 reports, using predetermined qualitative review criteria. Data relating to diagnostic accuracy and properties of the index test were also extracted. DATA SYNTHESIS: Twelve eponymous signs were described as having varying degrees of importance by textbook authors. Only the Austin Flint murmur, the Corrigan pulse, the Duroziez sign, and the Hill sign had sufficient original literature for detailed review. Most reports were low quality, with varying sensitivities for all signs. Except for the Hill sign, specificity tended to be poor. Evidence for the Hill sign also suggested a correlation between the popliteal-brachial gradient and aortic regurgitation severity. CONCLUSIONS: Prominent textbook support of the eponymous signs of aortic regurgitation is not matched by the literature. Clinicians and educators should update and improve the evidence for these signs to ensure their relevance in current medical practice.- - - - - - - - - - ranking = 0.04062420381383keywords = valve (Clic here for more details about this article) |
8/79. Transesophageal echocardiographic evaluation of perioperative systolic murmur in aortic pathology.Development of a new systolic murmur in patients following a Bental procedure with a prosthetic or homograft aortic valve usually indicates an aortic valve-related complication. Here, we report new etiologies of a loud systolic murmur in patients with aortic disease. One patient developed a new loud systolic murmur as an initial manifestation of acute type A aortic dissection without any complication, and two patients developed a loud systolic murmur as the major manifestation of aortic graft failure following aortic root surgery. auscultation of a new loud systolic murmur in the upper chest in patients with known aortic disease should alert one to a complication within the ascending aorta.- - - - - - - - - - ranking = 0.08124840762766keywords = valve (Clic here for more details about this article) |
9/79. Systemic arteriovenous fistula simulating severe valvular aortic stenosis.A patient with a renal arteriovenous fistula is described. She was though to have valvular aortic stenosis because of a history of rheumatic fever, symptoms of congestive heart failure and syncope, and the presence of a harsh systolic murmur with a thrill in the aortic area. cardiac catheterization revealed a left-to-right shunt of 8.7 L/min. ligation of the fistula resulted in complete relief of the symptoms and attenuation of the murmur.- - - - - - - - - - ranking = 0.10810438859088keywords = stenosis (Clic here for more details about this article) |
10/79. The heart as a bass organ.Many florid physical signs of aortic regurgitation have been described. We describe a florid investigational finding of virtually monotonous intracardiac reverberation originating at the aortic valve leaflets.- - - - - - - - - - ranking = 0.04062420381383keywords = valve (Clic here for more details about this article) |
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