Jhansi L. Ganji

Symptomatic pericardial cyst: a case series

Pericardial cysts are most commonly located at the cardiophrenic angle or, rarely, in the posterior or anterior superior mediastinum. The majority of pericardial cysts are asymptomatic and are found incidentally. Symptomatic pericardial cysts present with dyspnoea, chest pain, or persistent cough. We describe four patients with symptomatic pericardial cysts who were treated with either echocardiographically guided percutaneous aspiration or video-assisted thoracoscopic surgery, or both; thoracotomy; or conservative therapy.

Valvular heart disease in patients with osteogenesis imperfecta.

Osteogenesis imperfecta (OI) or “brittle bone disease” is a rare connective tissue hereditary disorder. The most common clinical presentation of OI is bone fractures. OI also involves extraskeletal structures; however, cardiovascular manifestations are rare. In this report, we describe the cardiovascular anomalies of patients with OI who underwent valve surgery and review the literature on this subject. doi: 10.1111/jocs.12064 (J Card Surg 2013;28:139–143)

Takotsubo cardiomyopathy in a patient with pulmonary embolism

Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient regional wall motion abnormalities of the left ventricular apex or midventricle. Patients often present with chest pain or dyspnoea, ST-segment elevation, and minor elevations of cardiac enzyme levels. Takotsubo cardiomyopathy has been associated with severe emotional or physical stress such as severe burns, spinal cord injury, subarachnoid haemorrhage, and multiple traumas. We report a case of takotsubo cardiomyopathy in a 79-year-old woman with pulmonary embolism. Although pulmonary embolism has been listed as a potential cause of takotsubo cardiomyopathy, this is the first case reported with this association.

Coronary Arteriovenous Fistula in a Patient with Aortic Valve Regurgitation

Case Report: A 25-year-old man with a 3-month history of infective endocarditis (streptococcal organism) successfully treated with 6 weeks of intravenous antibiotics was evaluated for known aortic valve regurgitation. Transthoracic echocardiography (Sonos 7500, Hewlett Packard, Palo Alto, CA, USA) demonstrated healed aortic valve vegetations, with severe regurgitation and moderate to severe left ventricular enlargement and normal left ventricular systolic function. An echolucent structure in the posterior atrioventricular groove in the region of coronary sinus with abnormal Doppler flow (Fig. 1A–D; movie clips S1–S3) indicated probable coronary fistula or coronary anomaly.

Visualization of atrial septal aneurysm and patent foramen ovale by three-dimensional transesophageal echocardiography

: Transesophageal echocardiography is frequently performed for further evaluation of sources of embolism and better evaluation of atrial septum in patients with cerebral ishemic events. Although two-dimensional transesophageal echocardiography can depict atrial septal aneurysm and patent foramen ovale, the full extent of the patent foramen ovale cannot be easily discerned in some cases. We describe a patient with transient cerebral ischemia where three-dimensional echocardiography provided incremental value when compared to two-dimensional transesophageal echocardiography in the assessment of atrial septal aneurysm and patent foramen ovale.

An Unusual Case of Left Atrial Myxoma and Papillary Fibroelastoma

A 76-year-old woman with new-onset atrial flutter underwent transesophageal echocardiography. Findings at cardioversion in the 4-chamber view included a large left atrial (LA) mass (4.8 9 2 cm) (Fig. 1A; movie clip 1) consistent with myxoma (arrow) attached to the atrial septum and prolapsing into the left ventricle (LV) during diastole without mitral inflow obstruction, and a “shimmering”mobile mass (0.7 9 0.6 cm) (Fig. 1B; movie clip 2) in the long-axis view on the aortic (Ao) side of the right coronary cusp, with fronds consistent with a papillary fibroelastoma (arrow). The patient underwent cardiac surgery for removal of the left atrial myxoma (Fig. 1C [arrows]; movie clip 3) and the papillary fibroelastoma (Fig. 1D; movie clip 4). Final diagnoses of both masses were confirmed by histopathology. Such concurrent primary cardiac tumors of different histology are rare.

Case of an elevated right hemidiaphragm appearing as a mass adjacent to the right atrium

An 80-year-old man with prior renal cancer and non-ischaemic cardiomyopathy sought care at our institution for the evaluation of obstructive jaundice. He had reported abdominal pain to his family members a few weeks previously. Transthoracic echocardiography performed for the evaluation of cardiomyopathy showed decreased left ventricular systolic function (ejection fraction, 19%). In addition, there was a large mass compressing the right atrium …

Aortic Leaflet Thinning Can Mimick Leaflet Perforation on Transesophageal Echocardiogram

Aortic Leaflet Thinning Can Mimick Leaflet Perforation on Transesophageal Echocardiogram Mohammad Q. Najib, M.D.,* Roger L. Click, M.D., Ph.D.,y Jhansi L. Ganji, M.B.B.S.,* Hartzell V. Schaff, M.D.,z and Hari P. Chaliki, M.D.* Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona; yDivision of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; and zDivision of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota

Transoesophageal echocardiographic Doppler colour flow patterns of a normally functioning third-generation centrifugal left ventricular assist device

A 75-year-old man with history of atrial fibrillation, ischaemic cardiomyopathy, and biventricular pacemaker implantable cardioverter-defibrillator presented with automated implantable cardioverter-defibrillator (AICD) discharge and worsened exertional dyspnoea and lower extremity oedema. Six months previously, he received a left ventricular assist device (LVAD) (HeartWare International Inc., Framingham, MA, USA), a third-generation, continuous flow centrifugal pump, for destination therapy. AICD interrogation revealed development of atrial flutter coincident with worsening heart failure symptoms. Power consumption and pump diagnostics showed no LVAD malfunction. Cardioversion of atrial flutter followed transoesophageal echocardiography (TEE) showing no intracardiac thrombus. Real-time three-dimensional TEE ( Panel A ; Supplementary data online, …