VVI-derived strain and SRs may be used as adjunctive, noninvasive parameters in the assessment of subclinical LV dysfunction and its progress during clinical follow-up, in patients with severe AR.
Transesophageal echocardiography (TEE) has become a unique imaging technique that provides improved visualization of aorta because of its proximity to the esophagus. It is a reliable method for the diagnosis of thoracic aorta diseases and detection of protruding atheromas or thrombi as sources of systemic emboli. We report a case in which TEE revealed a floating aortic thrombus located in the ascending aorta in a patient with chronic renal failure.
A 77-year-old male patient was admitted to our institution with 1-year history of progressive dyspnea on exertion, and lower extremity edema. His chest x-ray showed a circumferential pericardial calcification and right-sided pleural effusion. The electrocardiography revealed atrial fibrillation with low voltage in all derivations and diffuse nonspecific T-wave inversions. The transesophageal echocardiography showed a thickened pericardium with biatrial enlargement and normal right and left ventricular systolic functions. A thick echogenic structure that caused impression and narrowing of the ascending aorta was observed. Simultaneous right and left heart catheterization showed elevation and equalization of right-sided and left-sided diastolic filling pressures, with characteristic dip and plateau. Aortic angiogram showed the ascending aorta was impressed and narrowed by calcified pericardium. Cine magnetic resonance imaging showed pericardial calcifications impressing and narrowing of the ascending aorta. All these findings were consistent with constrictive pericarditis. The patient had no history of tuberculosis, cardiac surgery, or mediastinal irradiation. His HIV antibody test was negative. Marked pericardial thickening and calcifications were evident during pericardiectomy. Histological analysis of the pericardium showed dense collageneous matrix, mild chronic inflammation and calcification. The culture of pericardial tissue revealed no identifiable cause including tuberculosis. The patient was diagnosed as idiopathic constrictive pericarditis. The patient's symptoms and edema decreased remarkably after pericardial stripping. He remained well at 1-year follow-up.
LV long-axis functions are important markers of LV contractility in MR patients. Novel echocardiographic techniques may provide additional data on subclinical changes in the LV and give way to the optimal timing for the surgery in severe MR patients.
Mycotic aneurysm is a rare, life-threatening condition with high mortality rates and challenging diagnosis. A 46-year-old man, with a history of subaortic membranectomy, was admitted with a new onset fever and dyspnea. Transesophageal echocardiography and computed tomography demonstrated a mycotic pseudoaneurysm of the ascending aorta and mediastinal abscess due to aneurysm rupture. The patient fully recovered after an immediate diagnose and urgent surgery.
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