Lev Bloch

Implantation of Permanent Dual Chamber Pacemaker in a Pregnant Woman by Transesophageal Echocardiographic Guidance

A 37‐year‐old woman complained of fatigue and dizziness because of intermittent sinus arrest and asystole up to 5.2 seconds. She was 3 months into her pregnancy and a dual chamber permanent pacemaker was implanted by transesophageal echocardiographic guidance.

Anginal syndrome due to giant unruptured sinus of Valsalva aneurysm

This paper presents a rare cause of angina pectoris in a 43-year-old woman. Her evaluation revealed a compressed and proximally occluded right coronary artery by a giant, unruptured, right sinus of Valsalva aneurysm. The aneurysm was surgically resected and the sinus was successfully reconstructed. On follow-up the patient is asymptomatic.This paper presents a rare cause of angina pectoris in a 43-year-old woman. Her evaluation revealed a compressed and proximally occluded right coronary artery by a giant, unruptured, right sinus of Valsalva aneurysm. The aneurysm was surgically resected and the sinus was successfully reconstructed. On follow-up the patient is asymptomatic.

Cardiovascular Involvement in Behçet Disease: Clinical Implications

Behçet disease (BD) is a multisystem disorder, with vasculitis as its underlying pathological process, in contrast to the classic triad of recurrent oral and genital ulcerations, with uveitis. Vascular involvement in BD includes venous thrombosis, arterial occlusion, and pulmonary artery and aortic aneurysm formation. Cardiac involvement is rare and often obscure. It includes intracardiac thrombi formation, and is associated with a poor prognosis. Our objectives are to describe two cases with BD, complicated with vascular and cardiac involvement, and to raise awareness of these rare complications, the needed routine surveillance, and thus to prevent inappropriate interventions, serious outcomes, and mortality. We present two male patients from the Mediterranean Basin with BD. The first was diagnosed early as a BD patient. The second was diagnosed at the time of cardiovascular (CV) involvement. We recommend that patients who are diagnosed, or even suspected of suffering from BD, especially in endemic areas along the Silk Route pathway, should be followed up routinely for CV involvement, even if rare, obscure, or with a bizarre presentation.

Percutaneous balloon mitral valvuloplasty in patients with severe mitral stenosis and low transmitral diastolic pressure gradient

An elevated left atrial pressure and high diastolic pressure gradient (DPG) across the mitral valve are the major hemodynamic abnormalities in mitral stenosis (MS). However, a subgroup of patients with severe MS is characterized by low initial DPG. The authors reviewed the clinical, echocardiographic and hemodynamic data as well as procedural results in 180 patients who underwent percutaneous balloon mitral valvuloplasty (PBMV). An initial mean DPG > 10 mmHg was found in 144 patients (80%) (group A) and mean DPG ≤ 10 mmHg in 36 patients (20%) (group B). Patients in group A had higher left ventricular ejection fraction (LVEF) than in group B (61 ± 5% versus 42 ± 6%, respectively) and higher cardiac index (2.8 ± 0.4 versus 2.0 ± 0.3 l/min/m 2 ). In group B 12 patients (33%) had normal LVEF, whereas 24/36 (67%) had reduced LVEF. All the latter had wall motion abnormalities on ventriculography. Unlike group A, intraprocedural echocardiography was essential for monitoring and evaluating immediate results of PBMV in group B. On follow‐up of three years, 75% of group A patients and 55% in group B were in functional class I (p < 0.05). PBMV did not significantly improve symptoms in patients in group B who had preprocedure LVEF ≤ 35%. (Int J Cardiac Intervent 2003; 5: 200–205)