Ber-Ren Fang

Doppler and two-dimensional echocardiographic features of sinus of Valsalva aneurysm

Doppler, contrast, and two-dimensional echocardiograms of 12 aneurysms of the sinus of Valsalva in 10 consecutive patients were analyzed in order to highlight the diagnostic features. The diagnosis were confirmed by surgical and/or catheterization findings. The aneurysms had ruptured in 7 of 12 (58%). Two-dimensional echocardiography prior to the contrast studies was able to delineate the aneurysms in 7 of 12 (58%). The contrast studies outlined two additional aneurysms. The right aneurysms directed anteriorly and caudally. The noncoronary aneurysms formed an extraneous lumen at the posterior part of the aortic root, mimicking aortic dissection. Doppler examinations showed systolic and diastolic turbulence in five of six (83%) of the right aneurysms rupturing into the right ventricular outflow tract. Color Doppler echocardiography showed a left ventricular diastolic turbulence emanating from the aneurysm in a case with a noncoronary aneurysm rupturing into the left ventricle. It is concluded that the principal Doppler, contrast, and two-dimensional echocardiographic features usually allow a rapid correct diagnosis of sinus of Valsalva aneurysm.

Cardiac myxoma - clinical experience in 24 patients

We reviewed our clinical experience in 24 patients with cardiac myxoma. There were 8 males and 16 females, their ages ranged from 14 to 73 (mean, 48) years. Prior to echocardiographic examination, cardiac myxoma was suspected clinically in only 2 cases. The remaining patients were initially diagnosed as having mitral valvar disease (9 cases), infective endocarditis (3 cases), congestive cardiomyopathy (4 cases), pericardial effusion (1 case), systemic embolism of unknown cause (1 case), cerebrovascular accident (2 cases), ventricular septal defect (1 case) and Ebsteins malformation (1 case). The tumor was in the left atrium in 16, in the right atrium in 2, in the biatrium in 1, while one was in the right ventricle and peripheral arterial occlusion had been produced by myxoma without demonstrable cardiac tumors in the other two. Twenty-two patients underwent open heart surgery for excision of myxoma and there was no surgical mortality. Abdominal embolectomy was carried out in 2 patients; one of these 2 patients survived and 1 died. Follow-up for a mean period of 32 months (range 2 to 99 months) was possible in in 18 patients with no evidence of recurrence. We conclude that cardiac myxoma may mimic many cardiovascular diseases, so a high index of suspicion is important for its diagnosis. Echocardiography is the most useful diagnostic screening tool.

Diagnostic accuracy of two-dimensional echocardiography for detection of left atrial thrombus in patients with mitral stenosis.

Two‐dimensional echocardiograms of 56 patients with mitral stenosis, who subsequently underwent operation, were analyzed to evaluate the accuracy for the detection of left atrial thrombi. From left parasternal, apical, and subcostal cardiac windows, multiple planes (including standard planes and their derived scanning planes) were assessed for the presence or absence of mass echoes in the left atrium. The results showed 63% sensitivity, 95% specificity, 87% positive predictive value, 84% negative predictive value, and 83% overall diagnostic accuracy. Most of the false‐negative cases had their thrombi confined to the left atrial appendage. We conclude that in patients with mitral stenosis, two‐dimensional echocardiography is promising for the diagnosis of left atrial thrombi, particularly when they locate or extend to the main left atrial cavity (not confined to atrial appendage).

Echocardiographic Detection of Reversible Right Ventricular Strain in Patients with Acute Pulmonary Embolism: Report of 2 Cases

This report presents serial echocardiographic changes recorded before and after anticoagulant therapy was administered to 2 patients with acute pulmonary embolism. Dilatation of the right ventricle, abnormal motion of the interventricular septum and mild tricuspid regurgitation were noted in both patients. The results of the echocardiogram suggested that the patients had right ventricular pressure overload resulting from pulmonary hypertension caused by an acute pulmonary embolism. Echocardiograms performed after the patients had received anticoagulant therapy revealed a normalization of the echocardiographic parameters in both patients. The reversal of the right ventricular strain pattern revealed by an echocardiogram occurred as the result of the regression of pulmonary hypertension after anticoagulant therapy. In conclusion, echocardiographic detection of right ventricular strain in patients who present acute cardiopulmonary manifestations with no previous history of severe pulmonary disease may indicate the possibility of a pulmonary embolism.

Recurrent cerebral embolism and impending detachment of a previous nonmobile left atrial thrombus following initiation of anticoagulant therapy in a patient with nonvalvular atrial fibrillation.

A 65‐year‐old female with nonvalvular atrial fibrillation who presented with a transient ischemic attack was admitted to our hospital. Transesophageal echocardiography (TEE) revealed a nonmobile thrombus attached to the wall of the left atrial appendage. She suffered from a new episode of syncope on the 8th day following initiation of anticoagulant therapy. Follow‐up TEE indicated not only that the left atrial (LA) thrombus decreased in size but also that the previous nonmobile thrombus became mobile and showed impending detachment. Urgent surgery was subsequently performed to remove the LA thrombus, and the patient recovered uneventfully. In conclusion, anticoagulant therapy may precipitate partial fragmentation or partial detachment of LA thrombus.

“Sand-drift” echoes and thrombus formation in the left atrium

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Two-dimensional and Doppler echocardiographic features of coronary arteriovenous fistula. Report of three cases.

Two‐dimensional (2‐D) and Doppler echocardiographic features of three cases of coronary arteriovenous fistula (CAVF) were analyzed. The final diagnosis was confirmed by coronary angiography in each case. In cases 1 and 2, the CAVF arose from the right coronary artery and drained into the right atrium and right ventricle, respectively. The origin and draining site of the CAVF could be visualized by 2‐D echocardiograms. The Doppler studies revealed a unidirectional flow within the lumen of the CAVF. In case 3, with a small CAVF originating from both the right coronary artery and left circumflex artery draining into the main pulmonary artery, no abnormal vascular structure could be detected by the 2‐D echocardiogram; with Doppler study, a diastolic as well as systolic flow signal directed toward the distal pulmonary artery could be detected.

Blunt chest trauma causing right atrial tear, hemopericardium and cardiac tamponade successfully treated with cardiorrhaphy

A 26-year-old female was involved in a car accident with impaction of the steering wheel to the anterior chest. She became unconscious immediately. Blood pressure was unmeasurable, central venous pressure was measured at 25 cm H2O. Cross-sectional echocardiography revealed pericardial effusion and a band-like blood clot in the posterior inferior aspect of the heart. At operation, a right atrial tear measuring 1 cm in length was noted and was repaired with cardiorrhaphy. She recovered uneventfully.

Diagnosis of recurrent rupture of interventricular septum during acute myocardial infarction by Doppler color flow mapping

This report presents a 60-year-old female who had acute anteroseptal myocardial infarction and a grade 3/6 pansystolic murmur at left lower sternal border. Color Doppler echocardiographic examination revealed the presence of a ventricular septal defect which was later confirmed by contrast left ventriculography and at the time of operation. Urgent operation with closure of ventricular septum was performed and the cardiac murmur disappeared. One day after operation a grade 3/6 pansystolic murmur at left lower sternal border was heard and hypotension was noted. Color Doppler echocardiographic examination demonstrated another ventricular septal defect. The patient underwent re-operation due to hemodynamic instability. At operation, a new ventricular septal defect was noted while the previous patch was intact.