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Mitral Regurgitation in Obstructive Hypertrophic Cardiomyopathy: Systolic Anterior Motion or a More Unusual Cause?
A 52-YEAR-OLD, 100-kg, 191-cm transitioned woman, receiving hormonal therapy, with a history of hypertension, hyperlipidemia, tobacco abuse, and known coronary artery disease, presented to a community hospital with recurrent chest pain and dyspnea. An electrocardiogram demonstrated new ST-segment elevation consistent with an anterior wall myocardial infarction. The patient was taken to the cardiac catheterization laboratory where drug-eluting stents were implanted in the left anterior descending and diagonal coronary arteries.Severe Eccentric Aortic Regurgitation: An Unusual Manifestation of Disease Progression Resulting From Leaflet Prolapse, Perforation, Destruction, or Vegetation?
A 67-year-old man (168 cm, 79 kg) presented to the authors’ institution for evaluation of gradually progressive dyspnea, exercise intolerance, fatigue, and intermittent atypical chest pain unrelated to exertion. He denied fever, chills, malaise, orthopnea, paroxysmal nocturnal dyspnea, palpitations, dizziness, and syncope. The patient had a Stanford type B aortic dissection 9 years before the current admission and underwent successful repair of a large thoracoabdominal aortic aneurysm that developed as a complication of the chronic dissection.Progressive Dyspnea in a Man With Recently Treated Presumed Endocarditis: The Usual Onset of Valvular Incompetence or More Complex Pathology?
A 51-year-old, 85-kg, 170-cm man with coronary artery disease, essential hypertension, hyperlipidemia, tobacco abuse, and obstructive sleep apnea was transferred to the authors’ institution for evaluation of a 2-month history of recurrent fevers, chills, malaise, weakness, myalgia, and generalized arthralgias. The patient denied chest pain, dyspnea at rest or during exercise, palpitations, nausea, vomiting, and urinary symptoms. Two sets of blood cultures were positive for Streptococcus anginosus, but transthoracic echocardiography did not show vegetations.Unexpected Intraoperative Transesophageal Echocardiographic Finding Before Aortic Valve Replacement Surgery
A 78-YEAR-OLD woman (height: 165 cm; weight: 88 kg), with a history of treated aortic valve endocarditis, aortic valve stenosis, and single-vessel coronary artery disease, presented for aortic valve replacement. Transthoracic echocardiography revealed severe calcific aortic valve stenosis (aortic valve area = 0.6 cm2; mean gradient = 37 mmHg), left atrial dilatation, and preserved left ventricular systolic function (ejection fraction = 57%). Intraoperative transesophageal echocardiography (TEE) confirmed the preoperative transthoracic echocardiogram findings but also demonstrated an echolucent space not reported on preoperative imaging (Figs 1–4; Video clip 1).CASE 12—2015: Tropheryma Whipplei Endocarditis
A 50−60-YEAR-OLD MAN with ongoing alcohol and methamphetamine abuse and a suspected history of intravenous drug use presented to the emergency department with a 1-month history of bilateral leg pain. Physical examination was significant for a cold left foot and absent left dorsalis pedis and tibialis posterior pulses. Auscultation revealed a 4/6 crescendo-decrescendo systolic murmur heard loudest over the right upper sternal boarder, and a 3/6 diastolic decrescendo murmur heard loudest over the right lower sternal boarder.“Unicuspid” Aortic Valve Bioprosthesis: A Complication of Surgery for a Left Hip Morel-Lavallée Lesion?
A 68-YEAR-OLD, 115-kg, 183-cm man presented to the authors’ institution for evaluation of rapidly progressive dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, lower extremity swelling, and fatigue. He denied chest pain, fever, chills, night sweats, and weight loss. The patient had undergone an aortic valve replacement and saphenous vein grafting for aortic valve stenosis and right posterior descending coronary artery disease, respectively, 3 years before the current admission. A biventricular permanent pacemaker also was placed shortly after that surgery for complete heart block.Mechanism of Torrential Regurgitation in Mitral Valve Endocarditis: The Usual Chordal Rupture-Leaflet Flail or Another More Dramatic Structural Defect?
A CACHETIC 72-YEAR-OLD, 63-kg, 180-cm man with essential hypertension, chronic obstructive pulmonary disease, chronic anemia, a recent cerebral vascular accident, alcohol abuse, and malnutrition was transferred to the authors’ institution from a rural Veterans Affairs Medical Center for definitive treatment of acute mitral valve endocarditis complicated by sepsis. Blood cultures obtained at the outside hospital were positive for methicillin-sensitive Staphylococcus Aureus. Long-term organism-specific intravenous antibiotic therapy was begun based on culture sensitivities.Manifestation of Aortic Root Abscess From Acute Bacterial Endocarditis
A 71-YEAR-OLD man with a history of coronary artery disease, moderate aortic stenosis, and arterial hypertension was scheduled for aortic valve replacement and possible aortic root replacement. One month before admission, he was treated for methicillin-sensitive Staphylococcus aureus endocarditis. A transthoracic echocardiogram revealed a lesion on the mitral valve that was suspected to be a vegetation associated with mild mitral regurgitation. The patient began a course of intravenous oxacillin as an outpatient.Acquired “Gerbode-like” Defect in Aortic Valve Endocarditis: An Imposter for Tricuspid Regurgitation?
A 59-YEAR-OLD woman with a bioprosthetic aortic valve was referred to the authors' heart and vascular institute for prosthetic valve endocarditis with blood cultures positive for methicillin-sensitive Staphylococcus aureus. The transesophageal echocardiogram (TEE) showed mobile densities on the aortic and ventricular surfaces of the Carpentier-Edwards aortic valve leaflets. The patient was scheduled for an urgent valve replacement with an aortic valve homograft. After an uneventful anesthetic induction, an intraoperative TEE revealed normal ventricular function and verified the prior echocardiographic findings (Fig 1 and Video 1 [supplementary videos are available online]).New Rocking Motion of a Prosthetic Aortic Valve: An Unexpected Echocardiographic Finding 1 Month After Implantation
A 73-YEAR-OLD man returned to the authors' institution for evaluation of a 1-week history of progressively increasing shortness of breath, paroxysmal nocturnal dyspnea, fatigue, and chills with rigors. The patient had undergone an aortic valve replacement with a 23-mm porcine bioprosthesis and 2-vessel coronary artery bypass graft surgery for the treatment of severe aortic stenosis and coronary artery disease, respectively, 1 month before he was readmitted. Except for a brief episode of atrial flutter requiring pharmacologic intervention, his initial postoperative course had been unremarkable until his symptoms began.Sinus of Valsalva Aneurysm?
THE PATIENT WAS a 29-year-old man with a past medical history significant for hypertension, diabetes mellitus, a cerebral vascular accident, and end-stage renal disease on hemodialysis who presented for an aortic root reconstruction with coronary artery reimplantation (Bentall) and mitral valve repair. The perioperative transesophageal echocardiograms are presented (Figs 1-5 and Videos 1-5 [supplementary videos accompanying this article are available online]). The midesophageal long-axis view revealed an echo-free region in the anterior and leftward aspect of the proximal ascending aorta (Fig 1, Video 1).
