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Eosinophilic Endocarditis and Strongyloides stercoralis
A 40-year-old woman from El Salvador presented with 3 months of abdominal pain and diarrhea followed by 2 weeks of atypical chest pain and exertional dyspnea and was diagnosed with eosinophilic endocarditis secondary to Strongyloides stercoralis infection. Transthoracic echocardiogram revealed apical masses in the left and right ventricles and a thickened posterior mitral valve leaflet and cardiac magnetic resonance imaging confirmed the presence of a left ventricular apical mass with diffuse subendocardial delayed enhancement consistent with endocardial fibrosis.“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.All-Cause Mortality in Patients With Unprotected Left Main Coronary Disease: Comparison Between Stenting and Coronary Artery Bypass Grafting
The interventions aimed at patients with unprotected left main coronary disease are supported by a vast amount of data, the interpretation of which is increasingly difficult. For this purpose, studies using traditional meta-analysis1–3 and/or metaregression analysis4 are helpful, because they effectively synthesize the available information.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).Circumferential Strut Fracture as a Mechanism of “Crush” Bifurcation Restenosis
The “Crush” procedure is a 2-stent technique for the treatment of bifurcation lesions with greater rates of in-stent restenosis than the Culotte technique. In conclusion, we report a possible mechanism for this discrepancy in the case of severe Crush stent fracture with associated focal restenosis identified by postmortem microcomputed tomography and histologic examination.Isolated Left Ventricular Noncompaction in Identical Twins
The investigators describe 35-year-old monozygotic twins who presented 6 months apart with heart failure. In conclusion, this is the first report of adult monozygotic twins with isolated left ventricular noncompaction who presented with similar clinical and echocardiographic features and abnormal twist mechanics.Disruption of Atherosclerotic Neointima as a Cause of Very Late Stent Thrombosis After Bare Metal Stent Implantation
A male who were implanted bare metal stent 11 years ago were admitted for acute coronay syndrome. Optical coherence tomography showed a neointimal disruption and integrated backscatter intravascular ultrasound revealed a lipid pool around the disrupted neointima, suggesting newly formed atherosclerotic neointima developed after bare metal stent implantation. The disruption of atherosclerotic neointima may represent a new potential mechanism of very late stent thrombosis after bare metal stent implantation.Hypertrophic Cardiomyopathy With Left Ventricular Apical Aneurysm in Brothers
The investigators report similar phenotypes of hypertrophic cardiomyopathy with left ventricular apical aneurysm and thrombus in 2 brothers aged 8 years apart. This report highlights the genetic predisposition for this unique, high-risk phenotype, the issue of prophylactic anticoagulation, and the importance of nonstandard echocardiographic imaging views in the assessment of these patients.Isolated Left Ventricular Basal Ballooning Phenotype of Transient Cardiomyopathy in Young Women
This report describes a variant of transient regional left ventricular dysfunction in which isolated basal left ventricular akinesia with normal mid-ventricular (papillary-level) wall motion and apical hypercontractility were noted in young women (mean age 31 years). This finding was demonstrated in 3 consecutive patients; the first patient was experiencing emotional life-altering events, and the second presented with an acute flare of multiple sclerosis. The third patient presented <24 hours after methamphetamine use.Standard versus user-interactive assessment of significant coronary stenoses with multislice computed tomography coronary angiography
Forty-four patients in sinus rhythm with suspected coronary artery disease underwent 16-row multislice computed tomography coronary angiography and conventional coronary angiography. Two protocols for image analysis were applied to the multislice computed tomographic images: standard projections versus interactive postprocessing. The diagnostic accuracy of both methods for the detection of significant lesions (>50% lumen reduction) was compared with quantitative coronary angiography. Sensitivity and specificity were 58% and 96% and 96% and 97%, for standard projections and interactive postprocessing protocol, respectively.
