Transthoracic Echocardiography for the Identification of Acute Aortic Regurgitation in the Intensive Care Unit

Saranteas, Theodosios; Christodoulaki, Kalliopi; Rinaki, Dimitra; Kostopanagiotou, Georgia

doi:10.1053/j.jvca.2009.11.015

Cited by 5 publications

(1 citation statement)

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“…The diagnosis of acute aortic regurgitation was confirmed by the typical echocardiography findings, including a pressure half-time >200 ms, due to rapid equalisation of diastolic pressures in the aorta and left ventricle, and the presence of holodiastolic flow reversal in the descending thoracic aorta, with normal ventricular size and function 4 – 6. The transoesophageal imaging and the thoracic CT scan excluded the main causes of native-aortic-valve acute insufficiency (dissection or endocarditis), and provided an important clue to an uncommon aetiology: a diffuse and inflammatory non-specific process, aortitis.…”

Section: Discussionmentioning

confidence: 98%

Pulmonary oedema in the emergency room: what is hidden beyond an apparently common presentation

2014

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Cardiogenic flash pulmonary oedema is a common and potentially fatal cause of acute respiratory distress. Although it often results from acute decompensated heart failure, abrupt-onset aortic regurgitation can sharply rise cardiac filling pressure and, consequently, pulmonary venous pressure, leading to rapid fluid accumulation in the interstitial and alveolar spaces. We report a case of a 64-year-old woman admitted to the emergency department with a flash pulmonary oedema; a careful clinical investigation subsequently revealed a rare aetiology for this 'common' presentation. After a detailed auscultation that unmasked a diastolic cardiac murmur, an acute severe aortic insufficiency was further confirmed by echocardiography, showing inflammation and thickening of the entire aorta wall. The patient was submitted to valve replacement surgery, and histological examination, to our surprise, showed features of aortitis, remarkable for the presence of giant cells. A diagnosis of idiopathic aortitis versus inaugural giant cell arteritis was proposed and treatment started with corticosteroids.

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Section: Discussionmentioning

confidence: 98%