Junko Arakawa

Primary Mural Endocarditis Without Valvular Involvement

Primary mural endocarditis is an extremely rare infection in which nonvalvular endocardial involvement is seen without any cardiac structural abnormalities such as ventricular septal defects. The rapid and precise diagnosis of this disease remains challenging. We present 2 cases (67‐ and 47‐year‐old male patients) of pathologically confirmed primary mural endocarditis that could have been detected by initial transthoracic echocardiography in the emergency department. Transthoracic echocardiography and transesophageal echocardiography play critical roles in the early recognition and confirmation of primary mural endocarditis.

Successful diagnosis of an atypical prosthetic vascular graft infection without perivascular abscess: luminal vegetation as the hidden septic source.

A 62-year-old woman with a vascular prosthesis for a common hepatic artery aneurysm (3 years ago) was hospitalized because of a 2-week history of lumbago and fever. Six months previously, she was hospitalized at another medical facility for 1 month because of a fever of unknown pathogenesis. Laboratory examination revealed moderate inflammation with an elevated C-reactive protein level of 6.5 mg/dL and a white blood cell count of 7070/mm3. Initial 8-row multi-detector computed tomography (CT) with contrast agent in the emergency department did not show any focus for the origin of the fever. She was referred to the orthopedic surgery department, and MRI of the pelvis revealed inflammation of the left sacroiliac joint (Figure 1). Her first 2 sets of blood cultures were positive for Streptococcus anginosus . Intravenous administration of ampicillin/cloxacillin sodium was started. She was then transferred to the cardiology department for the evaluation of septicemia, which could have been caused by infectious endocarditis. A transthoracic echocardiogram showed severe aortic regurgitation, which was not seen at the time of previous surgery for the vascular prosthesis (Figure 2A). However, a transesophageal echocardiogram only detected a small degenerative change in the right coronary cusp of the aortic valve, which could be healed …

Synchronicity of echocardiography and cardiac nuclear medicine in mid-ventricular ballooning syndrome: paired ‘ring signs’ on polar maps

A 74-year-old woman was hospitalized for chest pain. A coronary angiogram showed no organic stenosis in the coronary arteries. However, a left ventriculogram showed akinesis in the middle portion of the left ventricle (Supplementary data online, Movie S1 ). A transthoracic echocardiography (TTE) was performed, and two-dimensional longitudinal strain images obtained on the apical four-chamber view, …

‘Honeycomb appearance’ on three-dimensional transthoracic echocardiography as the landmark of left ventricular non-compaction: two case reports

IntroductionLeft ventricular non-compaction is a rare congenital heart disease, and is most commonly diagnosed via two-dimensional echocardiography according to echocardiographic criteria. Recently, transthoracic three-dimensional echocardiography has become available in the clinical setting.Case presentationWe present two isolated cases of left ventricular non-compaction from Japan (in an 84-year-old woman and 47-year-old man) that were confirmed by two-dimensional echocardiography, contrast-enhanced two-dimensional echocardiography, three-dimensional echocardiography and cardiac magnetic resonance imaging. In both cases, three-dimensional echocardiography successfully demonstrated the trabecular meshwork of the left ventricle, referred to as a ‘honeycomb appearance’.ConclusionsThree-dimensional echocardiography has the advantage of visualizing an en-face view of the trabecular meshwork, which is not possible with two-dimensional echocardiography. We further emphasize the clinical utility of three-dimensional echocardiography, which is not limited to just the observation of the trabeculations and inter-trabecular recesses, but can also visualize the trabecular meshwork with a ‘honeycomb appearance’.

Newly developed mobile mass superimposed on mitral annulus calcification in patient with cerebral infarction: Documentation of a unique embolic source

Mitral annulus calcification (MAC) has been recognized as a potent risk factor to cause cerebral infarction. There has been suggested possible linkage between mass on MAC and systemic embolic events. We report a case of cerebral infarction with newly developed mobile mass superimposed on MAC.

The impact of left ventricular deformation and dyssynchrony on improvement of left ventricular ejection fraction following radiofrequency catheter ablation in Wolff‐Parkinson‐White syndrome: A comprehensive study by speckle tracking echocardiography

The purpose of this study was to evaluate left ventricular (LV) deformation and LV dyssynchrony in patients with Wolff‐Parkinson‐White (WPW) syndrome and to identify the factors that affect the efficacy of radiofrequency catheter ablation (RFCA).

Systolic collapse of aortic composite graft after Bentall operation: A sign of pseudoaneurysm formation

Although aortic root replacement using a composite graft including the Bentall operation is the treatment of choice for a diseased aortic valve and root dilatation, composite graft endocarditis can occur as a life‐threatening complication with a high mortality rate. When aortic pseudoaneurysm occurs due to composite graft endocarditis, it usually indicates that saccular bulging of the surrounding tissue of the composite graft is present. Furthermore, another sign and a clue of the diagnosis of pseudoaneurysm is the collapse of the composite graft due to the outer compression pressure of the leaking blood flow. Additionally, right parasternal view is useful to get the clear images of this phenomenon. Echocardiographic evaluation will contribute to the early recognition of this highly critical pathology.

Visualization of Recanalized Coronary Occlusion with Dissection by Optical Frequency Domain Imaging

A 43-year-old asymptomatic male patient with a positive stress myocardial perfusion imaging result was admitted to our institution. Although no organic lesion was detected by 64-row coronary computed tomography angiography (CCTA), invasive coronary angiography revealed a unique anatomy with a long lesion in the middle of the left anterior descending artery. Optical frequency domain imaging (OFDI) demonstrated the details of the recanalized occlusion with coronary dissection. OFDI provides in vivo coronary images with high spatial resolution and better three-dimensional reconstructions and supports invasive coronary angiography to elucidate infinitesimal and complicated intraluminal morphology that might be missed by CCTA alone.

Cardiac Asystole Triggered by Temporal Lobe Epilepsy with Amygdala Enlargement

A 25-year-old previously healthy man was hospitalized for syncope. While standing, he suddenly lost consciousness, followed by a generalized tonic clonic seizure. An electrocardiogram demonstrated asystole. No cardiac abnormalities were detected on the echocardiogram, cardiac magnetic resonance imaging (MRI), positron emission tomography, or a coronary angiogram. An electrophysiological study showed normal sinus node and atrioventricular node function. An electroencephalogram revealed small spike waves in the fronto-temporal region. Brain MRI demonstrated a left-sided amygdala enlargement. To the best of our knowledge, this is the first case of temporal lobe epilepsy with an amygdala enlargement that induced cardiac asystole.

Rapid Swelling of Infarcted Myocardium Soon after Primary Percutaneous Coronary Intervention: A Sign of Critical Reperfusion Hemorrhage

A 64-year-old man with a history of diabetes mellitus presented with acute myocardial infarction. He received successful primary percutaneous coronary intervention (PPCI) of the circumflex coronary artery, with good reflow at 8 hours after the onset of chest pain (Fig. 1A–C, movie clip S1). Intravascular ultrasound images at the site of occlusion denied the existence of coronary dissection. He had received oral prasugrel and aspirin along with intravenous heparin prior to the PPCI. Six hours after the PPCI, echocardiography revealed a massively thickened, infarcted myocardium from the lateral to the posterior wall, with granular echoes (Fig. 2B), as compared to the images before PPCI (Fig. 2A). On day 2, he developed cardiac tamponade (Fig. 3) and was treated with open pericardiocentesis. We postulated that the cause of cardiac tamponade might be bleeding from the infarcted myocardium, because the pericardial effusion was bloody. Cardiac magnetic resonance imaging (CMR) was performed on day 6, and T2* imaging clearly confirmed the presence of a massive intramyocardial hemorrhage (IMH) with transmural hypointensity in the infarcted myocardium (Fig. 4, arrowheads). Thereafter, the patient’s course was uneventful. Rapid swelling of infarcted myocardium after PPCI is a rare phenomenon on echocardiography. The mechanism might be a massive transmural IMH as