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“Reverse McConnell's Sign?”: A Unique Right Ventricular Feature of Takotsubo Cardiomyopathy
Bedside echocardiography plays an important role in the first-line diagnosis of Takotsubo cardiomyopathy (TC). Several classic imaging features could aid in the differential diagnosis in patients who have manifestation similar to that of acute coronary syndrome and potentially help in the risk stratification and management, including the decision to use coronary angiography.1,2 Right ventricular (RV) involvement in TC has been previously identified.3,4 However, these abnormal imaging features have never been well characterized and analyzed.Contribution of Three-Dimensional Transesophageal Echocardiography to Diagnosis and Management of Thrombosis of a St. Jude Mechanical Prosthesis in the Aortic Valve Position
Prosthetic valve thrombosis (PVT) is a serious complication after cardiac valve replacement and usually requires urgent management with either thrombolysis or surgery.1 A 38-year-old woman with history of ischemic stroke and multiple valvular surgeries including aortic St. Jude mechanical valve replacement (St. Jude Medical, St. Paul, Minnesota) presented with new-onset dyspnea on exertion. Transthoracic echocardiography and 2-dimensional transesophageal echocardiography (TEE) suggested an abnormally high gradient across the aortic valve (Figure 1) but could not determine the cause of the stenosis (Figure 2, Video 1).
