Dimitra D. Kontogianni

A role for transoesophageal echocardiography in the early diagnosis of catastrophic antiphospholipid syndrome

Abstract Zakynthinos EG, Vassilakopoulos T, Kontogianni DD, Roussos C, Zakynthinos SG (Department of Critical Care and Pulmonary Services, University of Athens Medical School, ‘Evangelismos’ Hospital, Athens, Greece). A role for transoesophageal echocardiography in the early diagnosis of catastrophic antiphospholipid syndrome (Case Report). J Intern Med 2000; 248: 521–526.

Ebsteinʼs anomaly: a potential cause of misinterpretation of myocardial perfusion scintigraphy

We present the case of a 43-year-old woman with a history of Ebsteins anomaly, who was referred for a myocardial perfusion single-photon emission computed tomography (SPECT) study due to angina-like symptoms. Dilatation of the right ventricle and right atrium, apical displacement of the septal tricuspid leaflet, small left ventricle with good left ventricular and a moderate degree of tricuspid regurgitation with mild pulmonary hypertension were found on echocardiography. Myocardial SPECT perfusion imaging with [99m Tc]tetrofosmin demonstrated a large defect in the inferior septal wall in the stress study with mild partial reversibility at rest. Coronary angiography revealed normal coronary arteries. Histological studies have shown that these patients develop increased fibrosis in the left ventricular wall and ventricular septum, especially in the basal and middle region of the septum, which adjoins with the atrialized component of the right ventricle. This is in concordance with the findings of the myocardial perfusion scan in the case described.

Right ventricular outflow obstruction caused by non-small cell lung carcinoma.

Although the pericardium is the most usual site for horizontal ST depression (1 mm) in II, III and aVF. metastatic cardiac tumors, myocardial involvement is Transthoracic echocardiography revealed an innot infrequent [1,2]. We report an extracardiac tumor creased distance (6.3 cm) between the transducer and (non-small cell lung carcinoma) compressing the right the heart (Fig. 1), suggesting an anterior mediastinal ventricular outflow tract (RVOT) and the main mass. The RVOT and the MPA were markedly pulmonary artery (MPA), resulting in right heart compressed (Fig. 1). Colour flow mapping could failure. A 45-year-old man was referred to our hospital from his general practitioner because of 8 months duration progressive fatigue, dyspnea on exertion, chest pain and peripheral edema. Coronary angiography performed 4 months earlier had revealed normal vessels while right heart catheterization, based on a precordial sustolic ejection murmur, had shown moderate pulmonary valvular (PV) stenosis (53 mmHg peak gradient). On admission, the jugular veins were distended, the liver was palpable 6 cm below the right costal margin and pitting ankle edema was present. Heart auscultation revealed a harsh, loud systolic ejection murmur at the left sternal border. Lungs were clear to auscultation except for a decrease of breath sounds on the right base. Complete blood count, urinalysis and a chemistry profile were normal. The ECG showed sinus rhythm, right axis deviation, ST-segment eleva-