1/9. Angiographic demonstration of spontaneous occlusion of systemic arterial supply in pulmonary sequestration.We describe the first angiographic demonstration of spontaneous occlusion of the arterial supply of a right lower lobe pulmonary sequestration. Intralobar pulmonary sequestration was first diagnosed by cardiac catheterization and aortography in a 1-year-old female. Systemic arterial supply was from a branch of the infra-diaphragmatic aorta and venous drainage was to the left atrium. Conservative management was elected, and the patient was followed up with annual exams. Repeat catheterization and aortography, performed to evaluate complaints of chest pain at age 13 years, showed no flow through the previously demonstrated systemic arterial supply from the aorta.- - - - - - - - - - ranking = 1keywords = complaint (Clic here for more details about this article) |
2/9. Case report: aortic dissection and cystic medial degeneration in a 24-year-old without marfan syndrome.The effective management of aortic dissection relies heavily on a high index of suspicion followed by timely definitive diagnosis. Young adults without a history of blunt trauma who are not at risk for atherosclerotic disease may lower this suspicion. We present a 24-year-old patient with complaints of chest pain who presented in multiple urgent care clinics and emergency departments. With a normal chest radiograph, he was repeatedly discharged home on analgesics until a loud murmur was heard. An echocardiogram revealed a dilated aortic root with an intimal flap consistent with a type II dissection. After surgical aortic repair with a Bentall procedure, he was discharged with complete relief of symptoms. Histologic reports revealed cystic medial degeneration. Physical examinations did not demonstrate the phenotypic manifestations of marfan syndrome. This case illustrates the importance of cardiac auscultation when assessing an individual with chest pain, even with a low likelihood for alteration in arterial structure, and the maintenance of a high index of clinical suspicion despite a normal chest radiograph. We consider this case to be of interest because of its rarity in a 24-year-old.- - - - - - - - - - ranking = 1keywords = complaint (Clic here for more details about this article) |
3/9. Dilated cardiomyopathy in a 7-year-old girl.Pediatric patients with dilated cardiomyopathy can initially be present for medical attention with non-specific and misleading signs and symptoms. We present the case of a 7-year-old girl with vague complaints of fever, vomiting, and abdominal pain and cardiac murmur on physical exam who progressed to congestive heart failure before her dilated cardiomyopathy was diagnosed. Clinicians should maintain a high index of suspicion for dilated cardiomyopathy in any patient with cardiac murmur and systematic symptoms.- - - - - - - - - - ranking = 1keywords = complaint (Clic here for more details about this article) |
4/9. patients' observations of bioprosthetic valve failure: "my heart is honking, doctor".Audible cardiac murmurs are uncommon and may indicate severe native valve dysfunction. In six patients with bioprosthetic mitral valves audible honking systolic murmurs suddenly developed. Doppler echocardiography showed characteristic striated regurgitant signals. At operation each prosthesis had torn cusps. New audible murmurs and striated Doppler signals originating from mitral bioprosthetic valves are indicators of cusp tears. Recognition of this is important because early detection of prosthetic valve dysfunction may improve subsequent surgical outcome.- - - - - - - - - - ranking = 2.3670643214142keywords = observation (Clic here for more details about this article) |
5/9. aneurysm of patent ductus arteriosus in an adult case: findings of cardiac catheterization, angiography, and pathology.A 42-year-old male was admitted to our hospital for evaluation of a left precordial continuous murmur. Results of catheterization revealed a step-up of oxygen content in the pulmonary arteries and the calculated left-to-right shunt flow was 40% of the pulmonary arterial flow. Furthermore, aortography unexpectedly revealed an aneurysm of the patent ductus arteriosus. During surgery, the aneurysm was discovered to arise from the frontal wall of the ductus arteriosus, and histological observation showed focal necrosis and mucoid degeneration of the media of the aneurysmal wall in contrast to a thickened intimal fibroelastosis of the adjacent ductal wall. This is presumed to be the first adult case of patent ductal aneurysm ever reported in which antemortem diagnosis and surgical treatment were successfully conducted. Our case may suggest that the fragility of the ductal wall following the structural change in an incomplete closing process is considered as a potential pathogenesis of ductal aneurysm formation.- - - - - - - - - - ranking = 0.59176608035355keywords = observation (Clic here for more details about this article) |
6/9. Venous systolic thrill and murmur in the neck: a consequence of severe tricuspid insufficiency.A palpable venous systolic thrill and murmur at the base of the neck are described as new physical findings in five patients with severe tricuspid regurgitation. In two of these patients, the tricuspid valve had been resected as treatment for infective endocarditis related to intravenous drug abuse. The third patient had severe chronic pulmonary disease with right heart failure. The fourth patient had a complex congenital defect in which the mitral valve served as the venous atrioventricular valve and was severely incompetent. The fifth patient suffered from long-standing rheumatic mitral and tricuspid disease with pulmonary hypertension 10 years after placement of a mitral prosthesis. From these observations, it is apparent that pulsatile retrograde flow in the cervical veins resulting from severe right-sided atrioventricular valve incompetence can produce a palpable systolic thrill and murmur at the base of the neck.- - - - - - - - - - ranking = 0.59176608035355keywords = observation (Clic here for more details about this article) |
7/9. Anomalous origin of the right coronary artery from the pulmonary artery with large left-to-right shunt (anomalous right coronary artery).A coronary arteriovenous fistula was diagnosed in a 20-year-old white male because of a continuous murmur atypically located along the left sternal border. cardiac catheterization revealed a large left-to-right shunt, and selective coronary arteriography established the precise anatomic diagnosis. The patient was treated successfully by surgical reimplantation of the anomalous coronary artery into the aorta and ligation of its origin at the pulmonary artery. The embryological and clinical features of this anomaly are discussed, and mechanisms for its production are suggested. attention is called to our observation of an apparent male sex predilection of this anomaly from review of the literature, in addition to the present patient. This is apparently the fourth patient with this anomaly whose condition was diagnosed antemortem by selective coronary arteriography and the fourth to have been treated by aortocoronary anastomosis providing an additive supply for both the present and the future. This is also the second case in the literature to have the transplanted right anomalous coronary artery demonstrated by selective coronary arteriography. It is likely that, with increasing use of selective coronary arteriography inthe diagnostic work-up of cardiac patients, more cases will be discovered and treated surgically.- - - - - - - - - - ranking = 0.59176608035355keywords = observation (Clic here for more details about this article) |
8/9. The genesis of the diastolic murmur of complete heart block. Phono-echocardiographic observations.A 72-year-old man with calcific aortic stenosis and complete heart block was noted to have an intermittent diastolic murmur. Using combined echocardiography and phonocardiography, it was demonstrated that the murmur occurred while the mitral valve was closing. This suggested that antegrade flow across a closing mitral orifice is of etiologic importance in the production of the murmur. Atrial sounds were also recorded and probably have a similar etiology. It is postulated that reduced ventricular compliance resulting in a more rapid rate of mitral valve closure was of etiologic importance in the genesis of the murmur.- - - - - - - - - - ranking = 2.3670643214142keywords = observation (Clic here for more details about this article) |
9/9. Congenitally corrected transposition of the great vessels: localization of the site of complete atrioventricular block using his bundle electrograms.Complete atrioventricular block proximal to the bundle of his in a patient with congenitally corrected transposition of the great vessels was documented using His bundle electrograms. The spontaneous rhythnm probably originated from the bundle of his and was responsive to carotid sinus massage, atropine and isometric and treadmill exercise. These electrophysiologic observations are consistent with recent anatomic studies of congenitally corrected transposition of the great vessels.- - - - - - - - - - ranking = 0.59176608035355keywords = observation (Clic here for more details about this article) |