Jean Luc Vandenbossche

Pulsed Doppler regurgitant flow patterns of normal valves

Although Doppler echocardiography allows recording of regurgitant turbulent flow patterns in normal persons, sparse information is available concerning the incidence, characteristics and mechanism of these flow patterns. Therefore, pulsed Doppler echocardiograms were recorded in 25 normal persons to detect regurgitation. A regurgitant turbulent flow pattern was recorded at the pulmonic valve in 23 subjects (92%), covered up to 81% of the diastole and could never be recorded in early diastole. An early to midsystolic regurgitant flow pattern was recorded at the mitral valve in 10 subjects (40%) and covered up to 60% of systole. A similar regurgitant flow was recorded at the tricuspid valve in 11 subjects (44%) and was holosystolic in 1 subject. An early diastolic regurgitant flow with low maximal velocities and rapid decrease in velocities was recorded at the aortic valve in 8 subjects (33%) and covered up to 26% of the diastole. In no person could those flows be recorded farther than 1 cm proximal to the valve closure. Whatever the still-debated mechanisms of those regurgitant flow patterns in normal subjects, one should be aware of their existence and characteristics when assessing valvular function by Doppler.

Relation between patent foramen ovale and unexplained stroke

To better elucidate the possible role of the patent foramen ovale (PFO) in patients with unexplained stroke, the relation between the incidence of stroke and 3 characteristics of PFO (timing, magnitude of appearance of echocardiographic contrast in the left atrium, and morphology of the atrial septum) was analyzed. Twenty-nine patients with unexplained stroke and 28 without stroke were compared. A significant relation was only found between the incidence of cerebrovascular accident and positive contrast echocardiography in patients with early and massive passage of contrast in the left atrium (6 of 29 [21%] in the stroke group vs 0 of 28 [0%] in the control group; p < 0.05). An abnormal morphology of the foramen ovale was found more frequently in patients with PFO than in those without PFO (9 of 13 [69%] vs 1 of 44 [2%]; p < 0.001). The results suggest the use of timing and quantification of contrast appearance in the left atrium during contrast transesophageal echocardiography, and that paradoxical embolism through a PFO is a possible mechanism of cryptogenic stroke only if there is a massive passage of contrast through an abnormal foramen ovale.

Study of antirestenosis with the BiodivYsio dexamethasone-eluting stent (STRIDE): A first-in-human multicenter pilot trial

The aim of this multicenter pilot study was to evaluate the acute safety and efficacy of the dexamethasone‐eluting stent (0.5 μg/mm2 of stent) implanted in patients with de novo single‐vessel disease. This study included 71 patients, 42% of whom had unstable angina pectoris. An appropriately sized BiodivYsio Matrix Lo stent loaded with a total dexamethasone dose of 0.5 μg/mm2 of stent was used. Technical device success rate was 95%. Six‐month MACE occurred in two patients (3.3%). Binary restenosis rate was 13.3%. Late loss was 0.45. Late loss and percent diameter stenosis were lower in the unstable angina pectoris patients compared to the stable patients (0.32 ± 0.39 vs. 0.60 ± 0.55 mm, P < 0.07, and 26.86 ± 14 vs. 38.40 ± 16%, P < 0.02). This study demonstrated the feasibility and safety of the implantation of a dexamethasone‐eluting stent and its effect on in‐stent neointimal hyperplasia. Catheter Cardiovasc Interv 2003;60:172–178.

Effects of respiration on an atrial septal aneurysm of the fossa ovale shown by echographic study

This report delineates a case of atrial septal aneurysm in which the motion of the aneurysmal septum was related to phasic respiratory variations. Although atrial septal aneurysm is a well-recognized morphologic entity, its rarity explains the lack of echocardiographic reports. There is only one recent study that described such an aneurysm associated with normal atrial pressures, with data concerning the relationship of its motion with cardiac cycle and respiration.

Intracardiac Thrombi Associated with Antiphospholipid Antibodies

Two cases of intracardiac thrombi associated with antiphospholipid antibodies are presented, one in the right atrium and the other in the left ventricle, the latter occurring in the presence of normal left ventricular function. In each, the diagnosis was made by transthoracic echocardiography. Both patients had contraindications to thrombolytic therapy and underwent successful surgical thrombectomy. We suggest that serial transthoracic echocardiography may be warranted in the follow-up of patients with primary hypercoagulable states.

Role of myocardial bridging in the apical localization of stress cardiomyopathy

Background — The apical ballooning syndrome is precipitated by emotional or physical stress but the underlying mechanism remains poorly understood. The contribution of myocardial bridging on the aetiology and the onset of the syndrome is not known. Methods — We observed 8patients with chest pain, T-wave inversion in several leads of the ECG, transient left ventricular apical ballooning and no significant angiographic stenosis. Results — There were 7 women and 1man.The median age was 67.5years. Seven patients had an intense emotional or physical stress (87.5%).All patients presented with chest pain and a T-wave inversion in the precordial leads. The median elevation of creatine-kinase was 171 IU. In all patients, echocardiography showed an alteration of the left ventricular function with a very extensive apical akinesia. Left ventricular hypertrophy was observed in 7patients. A myocardial bridging in the mid segment of the left anterior descending coronary artery was observed in 5patients (62.5%). Recovery was complete in all patients. During follow-up, no patient showed recurrence. Conclusions — Our data suggest that myocardial bridging possibly enhanced by catecholamines during stress may contribute, in association with left ventricular hypertrophy, to the preferential apical localization of the apical ballooning syndrome. Further investigations are necessary to confirm this hypothesis.

Limitations on the prognostic value of predischarge data after myocardial infarction.

Clinical variables and those obtained by non-invasive techniques were studied prospectively in a series of 306 patients discharged from hospital after an acute myocardial infarction. The predictive value of the data at two and 12 months was assessed by univariate and multivariate analyses. The best correlation was found for age, hypertension, bundle branch block, early and late heart failure, x ray cardiothoracic ratio, digoxin use, the number of metabolic equivalents reached during the stress test, echocardiographic wall motion score index, left ventricular end diastolic diameter, left ventricular ejection fraction, and the presence of an aneurysm. The prognostic value of the same data at 12 months was studied in those surviving for two months. There was a noticeable decline in the relative risk of all but two of the factors (number of metabolic equivalents, ventricular arrhythmias). All of the predictive variables except the x ray cardiothoracic ratio, number of metabolic equivalents, and the presence of an aneurysm lost their discriminant power. The explanation for this is the strength of statistical relations of these variables with the outcome at two months. They continued to influence the score at 12 months even when the entire patient series was considered. In conclusion, the study shows that the predictive value of most of the predischarge variables usually taken into account in the assessment of risk in patients one year after infarction does not extend beyond the first two months.

Cardiac calcified amorphous tumor: A systematic review of the literature

Background Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracavitary cardiac mass. Several case reports have been published but large series are lacking. Objective To determine clinical features, current management and outcomes of this rare disease. Design A systematic review of all articles reporting cases of CAT in order to perform a pooled analysis of its clinical features, management and outcomes. Data sources An electronic search of all English articles using PUBMED was performed. Further studies were identified by cross-referencing from relevant papers. Inclusion criteria We restricted inclusion to articles reporting cases of CAT in the English language literature published up to July 2014. Data extraction One author performed data extraction using predefined data fields. Results A total of 27 articles, reporting 42 cases of CAT were found and included in this review. Conclusion In this review, the most frequent presenting symptoms were dyspnea and embolic events. Mitral valve and annulus were the most frequent location of CAT. Surgery was most of the time required to confirm diagnosis, and was relatively safe. Overall outcome after surgical resection was good.

Echocardiographic diagnosis of right and left sinus of Valsalva aneurysms dissecting into the ventricular septum.

We report a case of dissection of the ventricular septum by two aneurysms of the right and left coronary sinuses of Valsalva. Transthoracic and transesophageal echocardiography allowed accurate preoperative assessment and postoperative evaluation.

Ruptured aortic dissection into the left atrium which presented as congestive heart failure and was diagnosed by transoesophageal echocardiography

A 72 year old man was admitted with severe dyspnoea. Ten days before he had had intense thoracic pain with loss of consciousness that was followed by increased dyspnoea. A continuous murmur was heard in the precordial and the left infrascapular regions. Lung auscultation showed stasis over the lower half of both lungs. Transthoracic echocardiography showed a bicuspid aortic valve and a dissection of the proximal aorta, which was considerably enlarged. Transoesophageal echocardiography confirmed dissection of the proximal aorta and showed a communication from the false lumen of the aortic dissection to the left atrium; and colour flow Doppler showed a continuous shunt to the left atrium. After transoesophageal echocardiography the patient had emergency surgical repair, which was successful. He had no complications in the post-operative period.