We evaluated the potential usefulness of three-dimensional (3D) transesophageal echocardiography (TEE) in assessing individual scallop/segment prolapse in 36 adult patients with mitral valve prolapse (MVP) undergoing surgical correction. Intraoperative 3D TEE correctly identified the location of scallop/segment prolapse in 34 of 36 patients (94%). However, in 6 of these patients 3D TEE images revealed more scallops or segments with prolapse than the surgeon noted intraoperatively. Prolapse of these areas was less prominent and this could possibly explain the lack of correlation with the surgical findings in these patients. In another 2 patients areas of prolapse seen by the surgeon were missed by 3D TEE because some of those scallops/segments could not be well imaged due to image "drop out" and artifacts. Thus, perfect correlation between 3D TEE and surgery was noted in 28 of 36 (78%) patients. Noncoaptation of the MV was also identified in 2 patients. The prolapsed area of posterior (n = 28 observations) and anterior (n = 9 observations) MV leaflets ranged from 1 cm2 to 9 cm2 (mean 3.50 cm2+/- 2.14) and 1.20 cm2 to 5.99 cm2 (mean 3.21 cm2+/- 1.33), respectively. Interobserver and intraobserver agreement for location and area of MVP was excellent (r = 0.97 and r = 0.99, respectively; all P values are <0.0001). In conclusion, 3D TEE is useful in identifying the location of MVP. It may also be potentially useful in assessing the extent of individual scallop/segment prolapse and identifying sites of MV noncoaptation. This information could aid the surgeon in deciding the extent of MV resection.

The innovation of the implantable cardioverter defibrillator (ICD) represents a modern medical achievement with substantial life-saving benefits for patients at risk for potentially life-threatening arrhythmias. Over a decade of research resulted in the first ICD implantation in 1980, dramatically changing the face of cardiac care. The introduction of the device was met by skepticism and outright rejection by some, yet large-scale clinical trials clearly demonstrated the mortality benefit of the ICD. Today, specific challenges for this technology have emerged, including barriers to individual and social acceptance of the ICD as a viable form of technology, as well as psychosocial adjustment difficulties and fears in patients. To address these challenges, scientific research, improved communication regarding devices and psychosocial interventions have been developed and extended to this patient population. As such, it is hypothesized that the future will hold expanding indications for ICD implantation, while further meeting patients' medical and psychosocial adjustment needs. The purposes of this paper are to review the history of ICD innovation, describe past and present research on psychosocial adjustment to the ICD, and corresponding psychosocial interventions, analyze individual and social acceptance and utilization of device technology, and forecast future applications and developments of the ICD.

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A unicuspid aortic valve (UAV) is a rare congenital defect that may manifest clinically as severe aortic stenosis or regurgitation in the third to fifth decade of life. This report describes two cases of UAV stenosis in adult patients diagnosed by transesophageal echocardiography (TEE). The utility of three-dimensional TEE in confirming valve morphology and its relevance to transcatheter valve replacement are discussed.

IntroductionSpontaneous coronary artery dissection is a rare but important cause of acute coronary syndrome. It can cause unstable angina, acute myocardial infarction, and sudden death. The condition commonly affects young females with about one-third of the cases occurring during pregnancy and the peripartum period. The diagnosis may occasionally be overlooked as the patients are often young and have no risk factors for coronary artery disease.Case presentationHere we report the case of a 29-year-old African American woman who presented with acute coronary syndrome due to spontaneous dissection of the first obtuse marginal branch of the left circumflex coronary artery at three weeks post-partum and recovered requiring only medical management, possibly by longitudinal distribution of the intramural hematoma leading to good distal flow.ConclusionsSpontaneous coronary artery dissection should be suspected in all young multiparous females presenting with chest pain in the peripartum period even in the absence of risk factors. Urgent diagnosis by angiography is required. It is recommended that treatment should be tailored to meet individual circumstances. Patients who present with single-vessel disease and hemodynamic stability, and who receive medical treatment with anticoagulation, nitrates and a beta-blocker, should experience good results.

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We present a technique for transpharyngeal imaging of the bilateral carotid arteries completed towards the end of a transesophageal echocardiogram. To our knowledge, this is the first report that demonstrates the bifurcation of the right common carotid artery into the right internal and external carotid arteries with a transesophageal echocardiographic probe.

We present two- and three-dimensional transesophageal echocardiographic findings of two adult patients who presented for reoperation after previous repair of a partial atrioventricular (AV) septal defect. Both patients had a cleft in the left AV valve with severe regurgitation. One patient had an additional 10 x 5 mm defect connecting the left ventricle to the right atrium through the AV junction. Three-dimensional echocardiography was superior to two-dimensional echocardiography in comprehensively delineating the anatomical defects in the left AV valve and the AV junction.