In patients admitted with multiple comorbidities and markedly elevated BNP values, there is no significant association with clinical evidence of volume overload or LV dysfunction. An elevated BNP level in patients with sepsis was significantly associated with mortality.

No abstract

In-hospital mortality risk among individuals undergoing rescue PCI varies from minimal to extreme and can be easily calculated using the NCDR-RESCUE score. This information can be of value in counseling patients, families, and referring caregivers.

vegetations, mitral valve, three-dimensional echocardiography, endocarditisA 40-year-old woman presented to our institution with acute onset of transient expressive aphasia. Computed tomographic angiography showed an area of subacute hemorrhage due to an aneurysm of a left middle cerebral artery branch. Mitral valve endocarditis was suspected on the basis of an apical pansystolic murmur radiating to the axilla and the suspicion of a cerebral mycotic aneurysm. 1,2 Transthoracic echocardiography (TTE, Fig. 1) and transesophageal echocardiography (TEE, Fig. 2) suggested the presence of at least one mitral vegetation, and moderate to severe mitral regurgitation. It could not be ascertained Figure 1. 2D Transthoracic echocardiography showing the presence of a mitral vegetation possibly consistent with two separate vegetations.whether one or two separate vegetations on the anterior and posterior mitral leaflets were present. Live three-dimensional echocardiography (Sonos 7500, Philips, Andover, MA) was also performed (Fig. 3) and only one vegetation, located at the medial mitral commisure was identified. Streptococcus viridans was isolated from multiple blood cultures and antibiotics were administered. Successful neurosurgical repair of the cerebral aneurysm was performed on the third hospital day. Findings were consistent with a mycotic aneurysm. The presence of large vegetations on the mitral valve placed the patient at increased risk for recurrent embolization. 3,4 Mitral valve replacement was performed after the completion of antibiotic therapy. Intraoperatively, a single vegetation, arising from the medial mitral commissure was found (Fig. 4). The patient was discharged on Vol. 22, No. 4, 2005 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. 361

The percutaneous treatment of renal artery stenosis has become the accepted revascularization strategy by most physicians treating this disorder. Unfortunately, as renal artery angioplasty and stent implantation become increasingly prevalent the Achilles heel of angioplasty, in-stent restenosis, also rises. There are currently no data suggestive of the optimal treatment strategy for renal artery in-stent restenosis. However, given the similarities in the pathophysiology between renal artery and coronary artery in-stent restenosis, brachytherapy is considered a reasonable option. This is the strategy that has been suggested and used by a number of operators. This case report describes two examples of renal artery in-stent restenosis treated with angioplasty and brachytherapy.