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Transesophageal echo

Prakash Aroor Sarvotham Rao, S N Nagendra Prakash, Somanath Vasudev, M Girish, Arun Srinivas, H P Guru Prasad, P Jayakumar, Venu Gopal Anandaswamy
We present a 62-year-old lady admitted in our hospital with two episodes of acute ischemic stroke about 2 weeks apart. She was evaluated for acute ischemic stroke and was thrombolysed for recent stroke in right MCA territory first time. On further evaluation, she was found to have a RVOT mass. A transthoracic and transesophageal echocardiogram revealed a PFO and a large, 5.1cm×2.3cm, ovoid, well circumscribed, echogenic mass in the right ventricle outflow tract attached by small pedicle to the ventricular side of anterior tricuspid leaflet, partly obstructing the right ventricular outflow tract and protruding through the pulmonic valve during systole...
September 2016: Indian Heart Journal
Geetesh Manik, John Jose, B Hygriv Rao
Intra-cardiac extension of tumour thrombus of follicular carcinoma of thyroid is uncommon. We report a case of advanced thyroid carcinoma where tumour thrombus was well profiled with CT scan and transesophageal echo images and extension was noted from SVC into right atrium, with clinical features of superior vena cava syndrome. The clinical significance of the "ring sign" is discussed.
September 2016: Indian Heart Journal
Lin Wang, Madhavi Kadiyala, Elana Koss, Abhimanyu Yarramaneni, Kathleen Rapelje, Stephanie Kampfer, Nathaniel Reichek, David Hoch, Vinay Jayam, Joseph Levine, Jie J Cao
BACKGROUND: We investigated CT angiography (CTA) in assessment of left atrial appendage (LAA) stasis and thrombus in pre-procedural evaluation for atrial fibrillation (AF) ablation in a large community cohort. METHODS AND RESULTS: We reviewed CTA and transesophageal echocardiographic images obtained in 861 consecutive patients with a history of AF undergoing same-day CTA and transesophageal echocardiogram (TEE) before AF ablation at a single hospital (2006-2013)...
October 12, 2016: Pacing and Clinical Electrophysiology: PACE
Fouad Ghazi Souki, Michael Demos, Lilibeth Fermin, Gaetano Ciancio
Advanced renal cell carcinoma (RCC) resection has important anesthetic management implications, particularly when tumor extends, suprahepatic, into the right atrium. Use of transesophageal echocardiogram (TEE) is essential in identifying tumor extension and guiding resection. Latest surgical approach avoids venovenous and cardiopulmonary bypass yet requires special precautions and interventions on the anesthesiologist's part. We present a case of Level IV RCC resected without cardiopulmonary bypass and salvaged by TEE guidance and detection of residual intracardiac tumor...
October 2016: Annals of Cardiac Anaesthesia
Hugo Andr S Mantilla, Felix Ramón Montes, William F Amaya
Stress cardiomyopathy, or Takotsubo syndrome, is a widely recognized cardiac pathology with a clinical presentation similar to acute coronary syndrome and related to physical or emotional stress. Perioperatively, it is challenging to identify it given the variety of forms and scenarios in which it can present. We describe a 22-year-old patient with an atypical presentation of Takotsubo syndrome during anesthesia induction, which highlights the usefulness of transesophageal echocardiography for the initial diagnosis...
October 2016: Annals of Cardiac Anaesthesia
Martin Lombardero, Ruth Henquin, Gabriel Perea, Mariana Corneli, Carlos Izurieta
INTRODUCTION: Quantification of mitral regurgitation (MR) by two-dimensional (2D) transthoracic echocardiography (TTE) is based on the analysis of the proximal flow convergence (PFC) and the "vena contracta" (VC). This method assumes geometries and can be misleading. In contrast, three-dimensional (3D) echocardiography directly measures flow volumes and does not assume geometries, which allows for more accurate MR evaluation. AIMS: To report the 3D transesophageal echocardiography (3DTEE) feasibility for MR quantification and evaluate its concordance with 2D echo...
October 4, 2016: Echocardiography
Shinya Unai, My-Le Nguyen, Daizo Tanaka, Nataliya Gorbachuk, Gregary D Marhefka, Hitoshi Hirose, Nicholas C Cavarocchi
BACKGROUND: Spontaneous echo contrast (SEC) is known to be a predisposition to thromboembolism and cerebrovascular accident. The aim of this study was to investigate the risk factors and the consequences of SEC in patients who were placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) because of cardiogenic shock. METHODS: Between January 2011 and December 2014, 98 patients underwent the insertion of VA-ECMO because of cardiogenic shock in our institution...
September 28, 2016: Annals of Thoracic Surgery
Yashwant Agrawal, Monoj Konda, Jagadeesh K Kalavakunta
Complications of valvular infective endocarditis involving the peri-annular region puts the patient at a significantly high risk of adverse outcomes including heart failure and death. The "mitral-aortic intervalvular fibrosa" is relatively avascular and offers little resistance to the spread of abscesses, aneurysm, and fistula formation. Aorto-cavitary fistulous tract formation in the setting of native valve infective endocarditis is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscesses...
October 2016: Journal of the Saudi Heart Association
Bhaskar Bhardwaj, Ata Bajwa, Amit Sharma, Arooge Towheed, Bakul V Sanghani, A Iain McGhie
A 71-year-old male presented after sudden onset of confusion and expressive aphasia. MRI head revealed multiple ischemic lesions consistent with cardio-embolic pathophysiology. A computed tomography angiography of lung showed peripheral pulmonary emboli. He underwent a transesophageal echocardiogram as a part of the stroke workup and was found to have vegetations on both aortic and tricuspid valves. The blood cultures did not show any growth, and the patient remained afebrile during the course of hospitalization...
September 30, 2016: Echocardiography
Amitoj Singh, Ravindra Sharma, Ashok Garg, Navin C Nanda, Mahmoud Elsayed, Ahmed Taher, Serkan Bulur
We describe an adult female presenting with dyspnea in whom both transthoracic and transesophageal echocardiography detected a mobile sac-like structure in the right ventricular outflow tract (RVOT) containing a heterogenous echogenic mass. This sac-like structure markedly changed its shape and size during the cardiac cycle. These findings and the fact that the patient lived in a rural area raised the possibility that this was a hydatid cyst. A bubble study using normal saline was useful in detecting a contained rupture of the cyst...
September 2016: Echocardiography
Varun Miriyala, Muhammad Umer Awan, Kirmanj Faraj, Bipinpreet Nagra
A 72-year-old male is diagnosed with paradoxical embolus after he presented with concurrent deep vein thrombosis, stroke, and multiple arterial emboli in the presence of a patent foramen ovale (PFO). Paradoxical embolus requires the passage of a thrombus from the venous into the arterial circulation through a right-to-left shunt leading to systemic embolism. But, despite the high incidence of PFO (27.3% across all age groups by autopsy), paradoxical embolism (PDE) is uncommon, representing <2% of all arterial emboli...
2016: Journal of Community Hospital Internal Medicine Perspectives
Masayuki Oshima, Tatsuki Onishi, Hitomi Iwata, Kazuyoshi Aoyama
BACKGROUND: We experienced a rare malposition of a pulmonary artery catheter due to kinking in a 63-year-old male who was scheduled for an off-pump coronary artery by-pass graft. FINDINGS: Given the difficulty to obtain stable pulmonary artery waveform, we discovered that the two waveforms of the distal and proximal ports of the pulmonary artery catheter were completely identical. Subsequent fluoroscopy revealed that because the catheter had formed a kink around the apex of the right ventricle, the distal port faced the proximal port of the catheter...
2016: SpringerPlus
Akira Fujii, Katsuji Inoue, Takayuki Nagai, Teruyoshi Uetani, Kazuhisa Nishimura, Jun Suzuki, Jun-Ichi Funada, Takafumi Okura, Jitsuo Higaki, Akiyoshi Ogimoto
BACKGROUND: In patients who have atrial fibrillation (AF) with CHADS2score of 0-1 (categorized as low-to-intermediate risk), there is little information on stratifying the risk of stroke. This study aimed to determine whether impaired endothelial function assessed by reactive hyperemia-peripheral arterial tonometry (RH-PAT) predicted left atrial blood stagnation in these patients. METHODS AND RESULTS: We enrolled 81 consecutive patients with nonvalvular AF. The reactive hyperemia index (RHI) was measured using RH-PAT...
September 23, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Tapan Kavi, Megan Esch, Brenda Rinsky, Axel Rosengart, Shouri Lahiri, Patrick D Lyden
BACKGROUND: Transcranial Doppler (TCD) has significant implications for neurovascular assessment in patients being treated with venoarterial-extracorporeal membrane oxygenation (VA-ECMO). However, there have been no studies demonstrating the changes in pulsatility indices (PIs) seen in these patients. Nonpulsatile waveforms are seen during on-pump coronary artery bypass graft, but low or low-normal PIs have never been reported. It is important to be aware of these changes, as they can be misinterpreted as cerebral vasodilation, vasoconstriction, increased intracranial pressures (ICPs), or cerebral circulatory arrest...
August 26, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Nafeesah Fatimah, Ahmad Ussaid, Aflak Rasheed
Undifferentiated connective tissue diseases usually present with arthralgias, sicca symptoms, Raynaud's phenomenon and leucopenia. This case presents the atypical presentation of an undifferentiated connective tissue disease with extensive cutaneous involvement of fingers and toes leading to gangrene with absence of typical rheumatological symptoms. The autoimmune profile showed positive ANA and anti-Ro/SS-A. Thromboembolism was ruled out on the basis of transthoracic and transesophageal echo. She was treated with I/V corticosteroids and cyclophosphamide that halted the disease progression...
August 2016: Oxford Medical Case Reports
Mikko Taina, Ritva Vanninen, Petri Sipola, Antti Muuronen, Pekka Jäkälä, Marja Hedman
BACKGROUND/AIM: The left atrial appendage (LAA) is the most typical origin for a cardioembolic thrombusins' stroke etiology. Although transesophageal echocardiography (TEE) is widely used, this technique encounters difficulties in differentiating solid thrombus from circulatory stasis/spontaneous echo contrast (SEC). We assessed whether cardiac computed tomography (cCT) could more accurately detect LAA thrombi. MATERIALS AND METHODS: A total of 102 patients with suspected acute cardioembolic stroke/ transient ischemic attack (TIA) without chronic atrial fibrillation underwent arterial and venous phase cCT and TEE...
September 2016: In Vivo
Juan Ruiz-García, Irene Canal-Fontcuberta
A 72-year-old woman was admitted to our hospital with fever >38°C of unknown origin. Blood cultures were positive in two sets for Staphylococcus aureus. In the third day of admission, her husband drew attention to the presence of some small punctures in her right foot. Several small and non-tender, erythematous and hemorrhagic macular lesions were found on her sole (Janeway lesions). Besides, we detected some painful and palpable, erythematous nodules involving the pads of her toes (Osler nodes). At this point, according to the modified Duke criteria, the clinical diagnosis of definite infective endocarditis might be established...
October 1, 2016: American Journal of Cardiology
Gaurav Chand, Leonid Shamban, Adam Forman, Prabhat Sinha
Streptococcus gallolyticus subspecies (subsp.) gallolyticus (formerly bovis biotype I) bacteremia has been associated with colonic adenocarcinoma. The bovis species underwent reclassification in 2003. Subtypes of gallolyticus are associated with colonic malignancy but are less frequent, resulting in less awareness. A 71-year-old male admitted with worsening lower back pain and fevers. Initial vital signs and laboratory data were within normal limits. MRI revealed lumbosacral osteomyelitis and antibiotics were initiated...
2016: Case Reports in Gastrointestinal Medicine
Chaim Yosefy, Yulia Azhibekov, Boris Brodkin, Vladimir Khalameizer, Amos Katz, Avishag Laish-Farkash
BACKGROUND: Not all echo laboratories have the capability of measuring direct online 3D images, but do have the capability of turning 3D images into 2D ones "online" for bedside measurements. Thus, we hypothesized that a simple and rapid rotation of the sagittal view (green box, x-plane) that shows all needed left atrial appendage (LAA) number of lobes, orifice area, maximal and minimal diameters and depth parameters on the 3D transesophageal echocardiography (3DTEE) image and LAA measurements after turning the images into 2D (Rotational 3DTEE/"Yosefy Rotation") is as accurate as the direct measurement on real-time-3D image (RT3DTEE)...
2016: Cardiovascular Ultrasound
Peng Liu, Rijing Liu, Yan Zhang, Yingfeng Liu, Xiaoming Tang, Yanzhen Cheng
AIMS AND OBJECTIVES: The objective of this study was to assess the clinical feasibility of generating 3D printing models of left atrial appendage (LAA) using real-time 3D transesophageal echocardiogram (TEE) data for preoperative reference of LAA occlusion. BACKGROUND: Percutaneous LAA occlusion can effectively prevent patients with atrial fibrillation from stroke. However, the anatomical structure of LAA is so complicated that adequate information of its structure is essential for successful LAA occlusion...
August 19, 2016: Cardiology
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