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Dynamic imaging of heart valves and specifically prosthetic valves is a central benefit of echocardiography. Most bioprosthetic heart valves degenerate over a given time and hence require repeat valve replacement which carries a significant risk of morbidity and mortality. Reoperation is the standard of care and may still be required after the first successful surgery due to complications disrupting either mechanical or bioprosthetic valves. Such complications can be delayed or even prevented if optimal prosthesis selection is individualized according to patients' medical and postimplantation follow-up. We present the case of an 84-year-old woman where an open-heart valve-in-valve approach, implanting a mechanical valve in a failed bioprosthetic valve, produced a unique image on transthoracic echocardiography which needs to be recognized by imagers for appropriate patient diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: Few studies have rigorously assessed the impact of red blood cell (RBC) transfusion on oxygen delivery. Several large trials demonstrated no clinical outcome differences between transfusion of shorter‐storage vs prolonged‐storage RBCs. These trials did not directly assess functional measures of oxygen delivery. Therefore, it is not clear if 42‐day stored RBCs deliver oxygen as effectively as 7‐day stored RBCs. Study Design and Methods: Leukocyte‐reduced RBCs were collected by apheresis in AS‐3. Thirty subjects were randomized (1:1:1) to receive 2 units of autologous RBCs at either 7, 28, or 42 days following donation. VO2 max testing, using a standardized protocol to exhaustion, was performed 2 days before (Monday) and 2 days after (Friday) the transfusion visit (Wednesday). The primary endpoint was the percent increase in VO2 max between Monday and Friday. The secondary endpoint was the percent change in duration of exercise for the same time points. Results: Hemoglobin levels decreased by 2.8 ± 1.4 g/dL after donation and increased by 2.1 ± 0.6 g/dL after transfusion. This change in hemoglobin was associated with expected decreases (then increases after transfusion) in VO2 max and exercise duration. No differences were observed between 7‐day and 42‐day RBC transfusion for percent increase in median [IQR] VO2 max (10.5 [0.2‐17.3] vs 10.9 [5.7‐16.8], P =.41) or for percent increase in exercise duration (5.4 [4.1‐6.9] vs 4.9 [2.0‐7.2], P =.91), respectively. Results were similar for 28‐day RBCs and were consistent across the ITT and per‐protocol analysis populations. Conclusion: These data indicate that 42‐day, 28‐day, and 7‐day RBCs have similar ability to deliver oxygen. See editorial on page 657–659, in this issue [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES For older adults with acute hip fracture, use of preoperative noninvasive cardiac testing may lead to delays in surgery, thereby contributing to worse outcomes. Our study objective was to evaluate the preoperative use of pharmacologic stress testing and transthoracic echocardiogram (TTE) in older adults hospitalized with hip fracture. DESIGN Retrospective chart review. SETTING Seven hospitals (three tertiary, four community) within a large health system. PARTICIPANTS Patients, aged 65 years and older, hospitalized with hip fracture (n = 1,079; mean age = 84.2 years; 75% female; 82% white; 36% married). MEASUREMENTS Data were extracted from electronic medical records. The study evaluated associations between patient factors as well as clinical outcomes (time to surgery [TTS], length of stay [LOS], and in‐hospital mortality) and the use of preoperative noninvasive cardiac testing (pharmacologic stress tests or TTE). Descriptive statistics were calculated. Cox regression was performed for both TTS and LOS (evaluated as time‐dependent variable); logistic regression was used for in‐hospital mortality. RESULTS: Although 34.3% (n = 370) had a preoperative TTE,.7% (n = 8) underwent a nuclear stress test and none had a dobutamine stress echocardiogram. Median TTS was 1.1 days (IQR [interquartile range] =.8‐1.8 days), median LOS was 5.3 days (IQR = 4.2‐7.2 days), and in‐hospital mortality was 3% (n = 32). Patients admitted to the medical service had 3.5 times greater odds of undergoing a TTE compared with those on the orthopedic service (P <.001). Community hospitals had almost three times greater odds of preoperative TTE than tertiary centers (P <.001). In multivariable analysis, preoperative TTE was significantly associated with increased TTS (P <.001). No difference in mortality was found between patients with and without a preoperative TTE. CONCLUSION: This study highlights the high rate of TTE in preoperative assessment of older adults with acute hip fracture. Given the association between TTE and longer TTS, further studies must clarify the role of preoperative TTE in this population. J Am Geriatr Soc 68:1690‐1697, 2020. See related Special Series On Orthogeriatrics by Wolfe et al. in this issue. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: While it has long been supported that faculty development programmes serve as a means to improving practical knowledge, professional skills, and identity formation for faculty, significantly less research is focused on how learning that occurs in faculty development programmes is actually employed in the workplace and ingrained in day‐to‐day activities. The present study qualitatively explored the long‐term impact of the Mentoring and Professionalism in Training (MAP‐IT) programme, a longitudinal, interprofessional faculty development curriculum designed to enhance clinicians' humanistic mentoring skills, specifically nurses and physicians. Method: Participants included 21 former high‐potential mentors and facilitator leaders who had graduated from the MAP‐IT programme from 2014 to 2016. Semi‐structured focus groups and interviews were conducted between August and September of 2017 to collect participant experiences of the impact of MAP‐IT skills on their professional roles (with colleagues and patients) in their clinical environments. Qualitative data were analysed using content analysis methodology. Results: Qualitative analyses using an editing analysis style resulted in nine major themes, including incorporation into clinical practice, self‐care, team building and conflict resolution, mindfulness, mentorship, professionalism, interprofessional collaboration, humanism, and appreciative inquiry. Conclusion: The personal and professional development instilled through the MAP‐IT programme was found to remain important over time, years after participation in the programme had concluded, supporting its "durability." Implications are also discussed. [ABSTRACT FROM AUTHOR]

Sinus of Valsalva aneurysm (SVA) is a rare cardiac condition occurring in about 0.09% of the general population, with potential for grave complications. Unruptured sinus of Valsalva aneurysms of all three sinuses in the same patient are even more rare. There are congenital, inherited, or acquired causes. Noninvasive cross-sectional imaging modalities, consisting of color Doppler echocardiography, cardiac computed tomographic angiography (CCTA), and cardiac magnetic resonance imaging (MRI), make the diagnosis. Treatment is mainly by open surgical reconstruction. However, transcatheter techniques are gaining popularity with noninferior outcomes in selected cases. We report the diagnosis and successful management of a patient with an unusual presentation of multiple unruptured SVAs of all three sinuses, and we conducted a review of the English medical literature. [ABSTRACT FROM AUTHOR]

We present a case of an extensive aortic dissection (AD) identified in a woman with atypical symptoms. Transthoracic echocardiography (TTE) allowed the identification of an intimal flap in multiple locations and resulted in rapid diagnosis and treatment. In most cases, CT angiography is the imaging modality of choice for diagnosis of AD. TTE is rapid and accurate and can be used in kidney failure. Our case highlights the important role of bedside echocardiography in the diagnosis of AD, especially in the patient with a typical symptoms in whom this diagnosis of AD may not be entertained and actually missed leading to negative and possibly deadly consequences. [ABSTRACT FROM AUTHOR]

Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) are a rare finding that are most often discovered incidentally either upon echocardiography or invasive cardiovascular procedures. In total, less than 50 known cases have been reported since first being discovered over 30 years ago. They are typically benign lesions; however, there has been a reported case of cardiac MICE being responsible for severe cardiopulmonary compromise and another case of the lesion embolizing leading to cerebral infarctions and ultimately death. Cardiac papillary fibroelastomas are also uncommon lesions found in the heart though they are not as rare as cardiac MICE. They are also benign and are typically attached to valvular surfaces; however, they also can be found as mobile masses. Just as cardiac MICE, they are capable of causing turbulent flow and thrombus formation and have been reported as the cause of ischemic events due to their ability to embolize. We present a case of cardiac MICE and cardiac papillary fibroelastoma in an individual who initially presented with neurologic symptoms concerning for a cerebrovascular accident. The patient was found to have a left ventricular mass composed of both cardiac MICE and cardiac papillary fibroelastomas. [ABSTRACT FROM AUTHOR]

Few cases of diastolic mitral regurgitation (MR) and tricuspid regurgitation (TR) have been reported in the world literature. We report the case of a 63-year-old woman admitted for syncope, with a permanent pacemaker following complete heart block. Echocardiography revealed that the timing of the diastolic TR (and noted MR) coincided with the second phase of the pulmonic insufficiency (PI) jet. The respirometer revealed that the diastolic TR and the second phase of the PI are highly sensitive to respiration (attenuated with inspiration and exacerbated with expiration). The uniqueness of this case is the rare occurrence of the exacerbation of PI as the result of diastolic TR. [ABSTRACT FROM AUTHOR]

The incidence of hypertension is increasing every year. Blood pressure (BP) control is an important therapeutic goal for the slowing of progression as well as for the prevention of Cardiovascular disease. The management of hypertension in the high cardiovascular risk population remains a real challenge as the population continues to age, the incidence of diabetes increases, and more andmore people survive acute myocardial infarction.We will review hypertension management in the high cardiovascular risk population: patients with coronary heart disease (CHD) and heart failure (HF) as well as in diabetic patients. [ABSTRACT FROM AUTHOR]

(ECHOCARDIOGRAPHY, Volume 21, April 2004) [ABSTRACT FROM AUTHOR]

Sleep plays a vital role in an individual’s mental, emotional, and physiological well-being. Not only does sleep deficiency lead to neurological and psychological disorders, but also the literature has explored the adverse effects of sleep deficiency on the cardiovascular system. Decreased quantity and quality of sleep have been linked to cardiovascular disease (CVD) risk factors, such as hypertension, obesity, diabetes, and dyslipidemia. We explore the literature correlating primary sleep deficiency and deprivation as a cause for cardiovascular disease and cite endothelial dysfunction as a common underlying mechanism. [ABSTRACT FROM AUTHOR]

Discusses an echocardiography case about the atrial septal ventricularization of a patient that occurred after reoperation for mitrial valve replacement. Background on the cardiac examination of the patient; Findings regarding the patient's postoperative course; Important role of the transesophageal echocardiogram in the case.

Epicarditis (visceral pericardial inflammation) is a very unique and rare diagnosis. It is almost always associated with parietal pericardial involvement and may occur in medical conditions such as viral, bacterial (mycobacterial) infections and uremia or postoperatively in the setting of cardiac surgery. Frequently, no etiology is found. Most cases are associated with constrictive physiology, and patients present with symptoms and signs of right-sided heart failure. Effusive epicarditis is often present, and the clinical features may easily be confused with those of pericardial effusion with tamponade. We report a unique case of isolated subacute effusive and nonconstrictive epicarditis mimicking a right atrial mass in a 72-year-old patient who was diagnosed with nonmetastatic gastric adenocarcinoma. Our case is unique for several reasons: inflammation was limited to the epicardium (very few cases have been described to date); the patient was asymptomatic, with no clinical or echocardiographic evidence of constriction (this represents a novel finding, explained in part by the more limited extent of inflammation, with no significant fibrotic component and no parietal pericardial involvement); and this is the first report of epicarditis occurring in association with a malignancy, which we hypothesize may represent an inflammatory paraneoplastic process. [ABSTRACT FROM AUTHOR]

Introduction: Revascularization is an important strategy for reducing stroke risk in patients with severe carotid atherosclerosis. Magnetic resonance angiography (MRA) and/or carotid ultrasound have traditionally been used as the only diagnostic modalities prior to revascularization. Patients undergoing CEA frequently have no further assessments of carotid anatomy prior to surgery. Evaluation with carotid ultrasound and MRA can often overestimate the degree of stenosis. We sought to determine if noninvasive imaging was sufficient for determining whether a patient should be referred for carotid intervention. Methods: We performed an analysis of 101 patients referred for carotid artery stenting (CAS). All patients had previously been evaluated with carotid ultrasound and 94% had undergone MRA as well. We sought to determine if noninvasive diagnostic imaging for carotid stenosis was sufficient to determine the necessity for endovascular intervention. Results: Of the 101 patients referred for carotid intervention, 36 (36%) were shown to have <70% stenoses and did not require intervention. Of those who had significant disease, 49 (75%) underwent successful CAS, 15 (23%) underwent CEA, and 1 patient was treated medically for a total occlusion. Three of the 36 patients not requiring carotid intervention were found to have subclavian stenosis. Two (4%) of the patients undergoing CAS and 4 (27%) of the patients undergoing CEA had minor complications. No patients suffered a major stroke, MI, or death at follow-up. Conclusion: This analysis demonstrates that 36% of patients referred for endovascular intervention based on noninvasive imaging did not meet criteria by angiography. This emphasizes the need for carotid angiography prior to carotid intervention. [ABSTRACT FROM AUTHOR]

The treatment of acute coronary syndrome (ACS) in patients with documented cocaine abuse has always presented significant challenges. Issues related to medication compliance, the potential risks of beta adrenergic blockade, and possible continued cocaine abuse postmyocardial infarction necessitate a unique, individualized approach to these patients. Recent data in the era of extensive percutaneous coronary interventions (PCI) and intracoronary stent (ICS) implantation have raised questions regarding the safety of ICS in patients who may revert to cocaine abuse postacute coronary syndrome as a result of the potentially higher risk of stent thrombosis in these patients. While the precise reason as to why cocaine use may increase the risk of stent thrombosis is not fully understood, it is likely the result of a confluence of factors, including coronary vessel vasoconstriction, impaired vascular compliance, as well as the platelet-activating effect of cocaine. We present the case a 46-year-old male with a history of cocaine abuse who presented with an acute stent thrombosis 2 days post-PCI likely as a result of cocaine abuse on the day of discharge following initial stent implantation for a non-ST-elevation myocardial infarction (NSTEMI). We also review the literature regarding the safety of PCI in cocaine abusers. [ABSTRACT FROM AUTHOR]

The authors assessed the relationship between glycemia and length of hospital stay (LOS) in a prospective cohort study of patients with diabetes mellitus and heart failure (HF). Of 212 patients with acute HF exacerbation, 119 (56%) also had diabetes. The mean age of the cohort was 63±0.87 years, and the mean body mass index was 29.3 kg/m2. Diabetic patients had significantly longer LOS compared with the nondiabetics (5.0±0.29 vs 3.4±0.19; P <.001). In patients with diabetes, the mean glycated hemoglobin A1c was 8.3%, admission blood glucose (BG) was 169±7.7 mg/dL, and average BG was 196±8.1 mg/dL. After adjusting for age, sex, weight, hypertension, renal function, and anemia, LOS was significantly correlated with admission BG (r =0.31; P <.001) and average BG ( r=0.34; P =.001). In patients with acute HF exacerbation, diabetes significantly prolonged LOS. Hyperglycemia correlated with LOS. [ABSTRACT FROM AUTHOR]

Eisenmenger's syndrome occurs when a large congenital or surgically created shunt between the left and right sides of the heart causes an increase in pulmonary vascular resistance that equals or surpasses systemic resistance, resulting in a reversal of the shunt from a left-to-right shunt to a right-to-left or bidirectional shunt. The maternal mortality rate of pregnancy in the presence of Eisenmenger's syndrome is reported to be as high as 50 - 65% with cesarean section. We present the case of a 32-year-old woman with Eisenmenger's syndrome who gave birth at 29 weeks of gestation via C-section to a healthy baby boy, and we review the literature regarding the management of such patients. [ABSTRACT FROM AUTHOR]

The pathophysiology of neurocardiogenic syncope (NCS) is multifactorial. Recurrent syncopal episodes can result in injury and can provoke substantial anxiety among patients. Although an abundance of descriptions of various forms of syncope have been reported in the literature, few articles to date address a documented case due to emotional stress or sound. This is a report of a 31-year-old woman who fainted after being startled by someone sneezing. Review of the episode on her event recorder revealed a transient cardiac asystole of 10 seconds. We discuss the incidence of NCS and the proposed mechanism by which this syncopal event occurred. [ABSTRACT FROM AUTHOR]

Background: Rheolytic thrombectomy has been used successfully to treat acutely occluded lower-limb vessels, dialysis grafts, intrahepatic portosystemic shunts, and diseased native coronary vessels and saphenous vein grafts. Few studies, however, have examined the efficacy of rheolytic thrombectomy in the acute myocardial infarction (AMI) setting. We sought to determine the efficacy of the AngioJet® Rheolytic™ thrombectomy catheter (Possis Medical, Minneapolis, MN, USA) in patients presenting with AMI either before or after 12 hours of onset of symptoms. Methods: Procedural and angiographic data on 61 consecutive patients (January 2003–December 2003) who presented with an AMI and had rheolytic thrombectomy with the AngioJet® catheter performed were reviewed. Coronary flow was assessed with thrombolysis in myocardial infarction (TIMI) frame counts (TFCs). Of the 61 patients studied, 40 had AngioJet® performed within 12 hours and 21 had it done after 12 hours from the onset of symptoms. Procedural success was measured by TFCs measured before and after the procedure and was defined as a change in the TFC of ≥50%. Statistical significance was considered at a P value of <0.05. Results: Procedural success was achieved in 75% of the patients in the early presentation group (within 12 hours) and 0% of the patients in the late presentation group (after 12 hours). TFC values were statistically different (P < 0.001) in the early group, but not significant (P > 0.1) in the late thrombectomy group. Conclusion: Rheolytic thrombectomy with the AngioJet® catheter is more effective in terms of improvement in coronary blood flow as assessed by TFCs when used less than 12 hours after the onset of clinical symptoms suggestive of AMI. [ABSTRACT FROM AUTHOR]

'Runaway' pacemaker is a rare entity that occurs when a malfunctioning artificial cardiac pacemaker abruptly accelerates its pacing rate above the set upper rate limit. This can result in life-threatening dysrhythmia. Runaway pacemaker used to occur more frequently in older model pacemakers, but now with newer pacemaker generators, runaway pacemaker is a rare entity. We report the case of a runaway pacemaker in a modern CPU-controlled pacemaker in a 79-year-old man presenting with lightheadedness and review the literature regarding this rare entity. [ABSTRACT FROM AUTHOR]

Penetrating chest wounds leading to damage of thoracic structures are common. A rare sequelae of chest trauma is a contained rupture of the left ventricle of the heart leading to the development of a pseudoaneurysm. This complication needs prompt recognition and repair because of the high likelihood of rupture and death. We report the case of a 47-year-old man who underwent repair of a stab wound to the heart 25 years ago and subsequently developed a large left ventricular pseudoaneurysm and presented with angina. (J Interven Cardiol 2005;18:193–200) [ABSTRACT FROM AUTHOR]

Lactobacillus acidophilusis a gram-positive rod that is a commensal of human mucosal tissues. They are usually considered nonpathogenic flora of the mouth, gut, and female genital tract. Lactobacillus is a rare cause of endocarditis with less than 50 cases reported in the world literature to date. We report the case of a 63-year-old woman who developed native mitral valve endocarditis secondary toL. acidophilus,and examine the literature regarding this rare entity.(ECHOCARDIOGRAPHY, Volume 22, May 2005) [ABSTRACT FROM AUTHOR]

Tetralogy of Fallot is the most common cyanotic congenital heart defect during infancy. It is composed of a ventricular septal defect, an overriding aorta, obstruction of right ventricular outflow, and right ventricular hypertrophy. Most patients experience cyanosis at birth and die in childhood without surgical intervention. The rate of survival at 40 years without surgical correction is only 3%. We present the case of a man with tetralogy of Fallot who survived until the age of 52 years without surgical intervention.(ECHOCARDIOGRAPHY, Volume 21, October 2004) [ABSTRACT FROM AUTHOR]

Listeria monocytogenes is a gram-positive bacillus that is rarely associated with infections in the general population. Those susceptible to this pathogen include neonates, pregnant women, and the immunocompromised. The most common clinical manifestations of listeriosis are bacteremia and meningitis. Endocarditis caused by L. monocytogenes is rare with less than 60 cases reported in the world literature. We report the case of an 81-year-old man who suffered aortic prosthetic valve listeria endocarditis, and examine the literature regarding this rare manifestation of human listeriosis.(ECHOCARDIOGRAPHY, Volume 21, July 2004) [ABSTRACT FROM AUTHOR]

We present the case of a 34-year-old man with a history of relapsed acute myelogenous leukemia with extensive metastatic infiltration of the endomyocardium. Transesophageal echocardiography revealed masses within all the cardiac chambers and associated vascular structures. Biopsy of the superior vena cava mass had the histological features of a granulocytic sarcoma (GS, chloroma). Massive involvement of the heart with GS is very rare, and only a few reports have been published in the literature. (ECHOCARDIOGRAPHY, Volume 20, August 2003). [ABSTRACT FROM AUTHOR]

Background: Recent studies suggest that cardiac resynchronization therapy through biventricular pacing (BVP) may be a promising new treatment for patients with advanced congestive heart failure (CHF). This method involves implantation of pacer leads into the right atrium (RA), right ventricle (RV), and coronary sinus (CS) in patients with ventricular dyssynchrony as evidenced by a bundle branch block pattern on electrocardiogram (ECG). Clinical trials are enrolling stable patients with ejection fractions (EF) ≤ 35%, left ventricular end-diastolic diameters (LVIDd) ≥ 54 mm, and QRS duration ≥140 msec. We compared echocardiography features of these patients (group 1) with other patients with EF ≤ 35%, LVIDd ≥ 54 mm, and QRS < 140 msec (group 2 = presumably no dyssynchrony). Methods: Nine hundred fifty-one patients with CHF, LVID 54 mm, EF 35% by echocardiography were retrospectively evaluated. One hundred forty-five patients remained after those with primary valvular disease, prior pacing systems, or chronic atrial arrhythmias were excluded. From this group of 145 patients, a subset of 50 randomly selected patients were further studied (25 patients [7 females, 18 males] from group 1, and 25 patients [7 females, 18 males] from group 2). Mean age group 1 = 75 years old, mean age group 2 = 67 years old. Mean QRS group 1 = 161 msec, mean QRS group 2 = 110 msec. Each group was compared for presence of paradoxical septal motion, atrial and ventricular chamber sizes, LV mass, LVEF, and RV systolic function. Results: Of the initial group of 951 patients, 145 (15%) met inclusion criteria. In the substudy, 20/25 (80%) of group l and 7/25 (28%) of group 2 subjects had paradoxical septal motion on echo (Fisher's exact test, P = 0.0005). The t-tests performed on the other echocardiography variables demonstrated no differences in chamber size, function, or LV mass. Conclusions: Cardiac resynchronization therapy with BVP appears to target... [ABSTRACT FROM AUTHOR]

Presents case studies of patients in which echocardiography, with the use of intravenous ultrasound contrast agents, was used in the assessment of left ventricular free wall rupture. Medical history of the patients; Results of transesophageal echocardiography; Background on two-dimensional echocardiography.

Ascending aortic aneurysms involving the proximal aortic arch, arising anywhere from the aortic valve to the innominate artery, represent various problems in which open surgery is generally required. Surgical options include excision of the aortic pathology or wrapping the aneurysm shell with an aortic Dacron graft. Intervention using the latter method can lead to extravasation of blood along the suture lines resulting in continuous bleeding within the periprosthetic space. The Cabrol technique was developed as a method for decompression of postoperative leaks by the formation of a conduit system from the periprosthetic space to the right atrium. The coronary ostia are anastomosed to a second graft in an end-to-end fashion, which is then anastomosed to the ascending aortic conduit side to side. The native aorta is then sewn around the prosthesis, hereby creating a shunt to drain anastomotic leakage. This shunt reduces postsurgical risk of pseudoaneurysm formation and normally closes a few days following surgery. We discuss the case of a patient who underwent Cabrol's variation and six months later was demonstrated to have a patent shunt. [ABSTRACT FROM AUTHOR]

Approximately 1% of adults who undergo cardiac catheterization have coronary anomalies. Patients may present with chest pain, arrhythmias, presyncope, and sometimes sudden cardiac death. Multidetector computed tomography (MDCT) is an excellent tool for identifying coronary artery anomalies and defining their course and relationship to the great vessels and surrounding structures; its value is incremental to conventional angiography. We present a rare case of a coronary anomaly involving three separate ostia at the right sinus of Valsalva for the left and right coronary vessels. (Echocardiography 2012;29:E102-E104) [ABSTRACT FROM AUTHOR]

We describe the case of a 43 year old man with a history of aortic stenosis, for which he had undergone aortic valve replacement in 1991 with a 25-mm Medtronic Hall prosthesis. He presented with several acute episodes of dyspnea and flash pulmonary edema. Transthoracic and transesophageal echocardiography performed to evaluate prosthetic valve function revealed evidence of 'intermittent' episodes of AI, documented on color M-mode flow mapping to have a variable duration of diastolic flow (early vs. pandiastolic) across the left ventricular outflow tract and the pulse wave Doppler in the descending thoracic aorta showed similar variability in the duration of diastolic flow reversal. (ECHOCARDIOGRAPHY, Volume 25, September 2008) [ABSTRACT FROM AUTHOR]

We describe the case of a 43 year old man with a history of aortic stenosis, for which he had undergone aortic valve replacement in 1991 with a 25-mm Medtronic Hall prosthesis. He presented with several acute episodes of dyspnea and flash pulmonary edema. Transthoracic and transesophageal echocardiography performed to evaluate prosthetic valve function revealed evidence of “intermittent” episodes of AI, documented on color M-mode flow mapping to have a variable duration of diastolic flow (early vs. pandiastolic) across the left ventricular outflow tract and the pulse wave Doppler in the descending thoracic aorta showed similar variability in the duration of diastolic flow reversal. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome (GBS) is an autoimmune disease affecting the peripheral nerves, and is frequently associated with triggering events several weeks prior to the onset of symptoms. We report the case of a 68-year-old female who was diagnosed with GBS and subsequently developed myocarditis. She was treated with inotropic support and intravenous immunoglobulin (IVIG), and her condition improved. This presentation of GBS complicated by myocarditis is very rare. We examined the literature regarding this association. [ABSTRACT FROM AUTHOR]

Background: The implantable cardioverter-defibrillator (ICD) is the mainstay of treatment for ventricular tachyarrhythmias due to its impact on mortality. ICD discharges may be appropriate or inappropriate, and identification of patients at risk for ICD discharge is essential. We sought to determine the predictors of appropriate ICD discharge. Methods: We analyzed data from 591 ICD recipients (mean age 67.9 ± 13.0 years; 474 men; mean follow-up 10.9 ± 13.8 months). The association between ICD discharges and multiple clinical variables, including age, gender, hypertension, diabetes, coronary artery bypass graft (CABG) surgery, syncope, atrial fibrillation (AF), prior coronary intervention, left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension, left ventricular end systolic dimension (LVESD), and ambient drug therapy was examined. Results: The rates of appropriate or inappropriate discharges, delivered to 155 patients, were 0.49 per follow-up year (F/Y). The median time-to-first appropriate discharge was 3.4 years. Among the discharges delivered, 97(63%) were appropriate and 58(37%) were inappropriate. Risk factors associated with a trend toward earlier appropriate discharges included age ≤65 years, and diuretic and digitalis use. By multiple variable analysis, no history of CABG and an enlarged LVESD were independent predictors of earlier appropriate ICD discharge. Conclusions: Patients who did not have CABG revascularization were 2.8-fold more likely than those who underwent CABG, and patients with enlarged LVESD were 2.5-fold more likely than those with normal LVESD to receive appropriate ICD discharges. These patients deserve special vigilance and management in order to prevent the occurrence of ventricular tachyarrhythmias triggering ICD discharges. [ABSTRACT FROM AUTHOR]