1/13. Expeditious diagnosis of primary prosthetic valve failure.Primary prosthetic valve failure is a catastrophic complication of prosthetic valves. Expeditious diagnosis of this complication is crucial because survival time is minutes to hours after valvular dysfunction. The only life-saving therapy for primary prosthetic valve failure is immediate surgical intervention for valve replacement. Because primary prosthetic valve failure rarely occurs, most physicians do not have experience with such patients and appropriate diagnosis and management may be delayed. A case is presented of a patient with primary prosthetic valve failure. This case illustrates how rapidly such a patient can deteriorate. This report discusses how recognition of key findings on history, physical examination, and plain chest radiography can lead to a rapid diagnosis.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
2/13. Intermittent electromechanical dissociation due to mechanical prosthetic valve dysfunction.We describe a patient who developed the rare hemodynamic phenomenon of intermittent electromechanical dissociation during normal sinus rhythm at about four months after mitral valve replacement with a Medtronic Hall prosthesis, along with resuspension of the papillary muscles using Gore-Tex sutures. Echocardiographic examination confirmed the presence of a filamentous structure that could be either suture material, tissue tag or thrombus, and was entangling intermittently in the prosthesis. The patient recovered spontaneously after a three-week symptomatic period, with no subsequent evidence of either electromechanical dissociation or the filamentous structure; normal prosthetic valve function was restored. During a subsequent three-month follow up period, the patient was asymptomatic, with normal prosthetic valve function. The diagnostic and hemodynamic aspects of this case are discussed.- - - - - - - - - - ranking = 4keywords = dysfunction (Clic here for more details about this article) |
3/13. Tricuspid dura mater bioprostheses: more than 20-year follow-up of 3 patients.Replacement of the tricuspid valve is sometimes necessary. We report 3 consecutive patients with tricuspid insufficiency who underwent valve replacement with glycerol-preserved, homologous dura mater cardiac bioprostheses between 1971 and 1973. The first 2 patients are well 28 and 27 years later; the last patient was lost to follow-up after 20 years. We conclude that preservation of homologous dura mater bioprostheses in glycerol may reduce rates of thromboembolism, thrombosis, and structural dysfunction during the late postoperative period.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
4/13. giant cell arteritis confined to intramural coronary arteries. Unforeseen hazards myocardial protection.A 74-year-old woman underwent elective double valve replacement (aortic and mitral) for rheumatic valvular disease. She failed to wean from cardiopulmonary bypass due to marked left ventricular dysfunction. At autopsy, severe giant cell arteritis confined to the intramural coronary arteries was seen. Furthermore, there were multiple areas of recent microscopic myocardial infarction around the intramural coronary arteries. This report describes a rare case of giant cell arteritis confined to intramural coronary arteries which lead to inadequate myocardial protection at the time of surgery.- - - - - - - - - - ranking = 305.96113849268keywords = ventricular dysfunction, dysfunction (Clic here for more details about this article) |
5/13. Acute myocardial infarction: an unusual culmination of rheumatic pancarditis and antiphospholipid antibody syndrome.A 29-year-old man with history of antiphospholipid antibody syndrome (APS) and two prior episodes of acute rheumatic fever developed a third episode of acute rheumatic fever. This was complicated by acute myocardial infarction due to spontaneous arterial thrombosis of the left anterior descending and right coronary arteries. We postulate that rheumatic pancarditis created an inflammatory, thrombogenic environment that facilitated coronary artery thrombosis secondary to APS, a novel association. Our patient was left with significant left ventricular dysfunction at a young age, and cases such as this emphasize the need for early recognition and proper treatment of APS. Further, the pathogenesis of thrombosis in APS is incompletely understood, and the cellular and molecular basis for this, including the role of 'second hits', are areas needing further investigation.- - - - - - - - - - ranking = 305.96113849268keywords = ventricular dysfunction, dysfunction (Clic here for more details about this article) |
6/13. Effect of left atrial compliance on pulmonary artery pressure: a case report.BACKGROUND: Left ventricular diastolic dysfunction, with secondary atrial pressure elevation, is a well-known concept. On the contrary, effect of left atrial compliance on pulmonary pressure is rarely considered. CASE PRESENTATION: We report the echocardiographic case of a 9-year-old child who presented severe rheumatic mitral valve regurgitation with a giant left atrium, in contrast to a normal artery pulmonary pressure, testifying of the high left atrial compliance. CONCLUSION: Left atrial compliance is an important determinant of symptoms and pulmonary artery pressure in mitral valve disease.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
7/13. Late endocarditis-associated obstructive dysfunction of a tricuspid ball-cage-type valve. Doppler echocardiographic findings and therapeutic implications.Thrombotic obstruction is rare in bacterial endocarditis involving prosthetic heart valves. A 45-year-old man who had three intracardiac, ball-cage-type prosthetic valves, presented with streptococcal septicemia. Major obstruction of the tricuspid Smeloff-Cutter valve and normal function of the two other prostheses were documented by Doppler echocardiography. Emergency replacement of the tricuspid valve alone was decided on the one basis of this echocardiographic diagnosis, and successfully performed. Operative findings confirmed the noninvasive findings.- - - - - - - - - - ranking = 4keywords = dysfunction (Clic here for more details about this article) |
8/13. Unusual thrombi in the setting of rheumatic heart disease.We report two patients with unusual intracavitary thrombi in association with rheumatic mitral stenosis. One patient had a large free-floating left atrial thrombus immediately after successful closed mitral valvotomy causing recurrent acute pulmonary oedema in the post-operative phase. The other patient was detected to have multiple, discrete and calcified left ventricular thrombi in the presence of severe left ventricular systolic dysfunction. The diagnosis in both cases was made by cross-sectional echocardiography.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
9/13. Thrombotic endocarditis and lupus anticoagulant. A pathogenetic possibility for idiopathic 'rheumatic type' valvular heart disease.Lupus anticoagulant and anti-phospholipid antibodies are well recognized as being associated with thromboembolic disorders in patients both with and without systemic lupus erythematosus (SLE). There have been recent reports of the association of lupus anticoagulant and antiphospholipid antibodies with severe valvular heart disease in patients with SLE and it has been suggested that organizing thrombus on the surface of the valve may be a cause of distortion and subsequent dysfunction. We describe two patients who did not have SLE, but who did have both lupus anticoagulant and antiphospholipid antibodies. Both had severe valvular heart disease, the pathology of which demonstrates valve distortion by layers of organizing thrombus identical to that of previously described patients with SLE. The gross appearance of these valves is similar to that of the valves in "rheumatic" heart disease. We suggest that in some patients with "rheumatic" heart disease, but without a history of rheumatic fever, the prothrombotic tendency associated with lupus anticoagulant and phospholipid antibodies may either contribute to, or be responsible for, the pathogenesis of "rheumatic" type valve deformities.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
10/13. Giant right atrial myxoma with rheumatic mitral valve disease.A patient with a 456 Gram right atrial myxoma is described. Associated rheumatic mitral valvular heart disease obscured the presence of the tumor and only with presentation of bradyarrhythmias leading to pacemaker implantation was the diagnosis suspected. Successful surgical removal of the tumor and correction of the intracardiac valvular dysfunction were performed. The role of echocardiography in the early detection of these tumors is reinforced.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
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