Acute thoracic aortic thrombosis after intra-aortic balloon pumping

We present two transesophageal echocardiographic images of a patient with acute myocardial infarction, demonstrating a large thrombus attached to the thoracic aortic wall, considered to be a complication of intra-aortic balloon pumping. The patient had received the device because of hemodynamic instability due to an infarct-related ventricular septal defect. Clinical manifestations which led to the diagnosis of thromboembolism were abdominal pain and deterioration of renal function, without signs of limb ischemia. (C) 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved

Changes in aortic root function after valve replacement in patients with aortic stenosis

Background: Aortic elastic properties are compromised in various states that induce functional and histological changes in the aortic wall. Aortic stenosis is frequent and often requires replacement of the stenotic valve. The purpose of this study was to examine the effect of aortic valve replacement on the aortic root function. Methods: 31 patients, mean +/- SD age 67.2 +/- 9.1 years with severe aortic stenosis, who underwent aortic valve replacement with a bileaflet mechanical prosthesis, were studied. Aortic root function indices such as aortic cross-sectional compliance (CSC), aortic root distensibility (ARD), and aortic stiffness index (ASI) were calculated with the use of M-mode echocardiography in three sessions: one preoperatively (pre-op), one on day 7 postoperatively (early post-op), and one 6 months postoperatively (late post-op). Results: Aortic root function deteriorated early post-op (p < 0.001 for all) and returned towards pre-op levels late post-op (p = NS for all). CSC changed from 2.84 +/- 1.98 to 1.37 +/- 0.92, and 2.30 +/- 1.11 cm(2)/mmHg, ARD from 2.21 +/- 5.60 to 1.01 +/- 0.67, and 1.79 +/- 0.96 cm(2)/dyne, and ASI from 9.72 +/- 5.60 to 24.65 +/- 19.10, and 11.51 +/- 7.85, respectively. Correlations were found between early changes in some aortic root indices and the degree of aortic stenosis, denoting that aortic function deteriorated less in more severe cases of aortic stenosis. None of the late changes were related to aortic valve or left ventricular indices. Conclusions: Aortic valve replacement with a mechanical valve results in a significant but transient impairment of aortic distensibility. (c) 2005 Elsevier Ireland Ltd. All rights reserved

Real-time three-dimensional dobutamine stress echocardiography for coronary artery disease diagnosis: validation with coronary angiography

Objective: To compare real-time three-dimensional echocardiography ( RT3DE) with two-dimensional dobutamine stress echocardiography ( 2DE) for the detection of myocardial ischaemia, with angiographic validation of the results. Methods: 56 patients ( mean ( SD) age 64.5 ( 6.2) years, 38 males), referred for coronary angiography, were examined by 2DE and RT3DE during the same dobutamine stress protocol. Results: All 56 patients completed the stress protocol uneventfully. The mean ( SD) acquisition time for the necessary views to evaluate all segments was 26.3 (2.5) s for RT3DE and 58.8 (3.7) s for 2DE ( p < 0.001). At peak stress, RT3DE had a higher wall-motion score index ( 1.25 (0.24) by 2DE, 1.30 (0.27) by RT3DE; p = 0.014). The regional wall-motion score for the four apical segments at peak stress was compared; it was 1.35 (0.55) by 2DE and 1.52 (0.69) by RT3DE ( p = 0.003). The diagnostic parameters of 2DE versus RT3DE were: sensitivity 73% vs 78%, specificity 93% vs 89% and overall accuracy 86% vs 85%, respectively. In the left anterior descending artery territory, in particular, where RT3DE had higher regional wall-motion scores, it showed a tendency towards higher sensitivity ( 85% vs 78%), although this difference did not achieve statistical significance. Conclusion: RT3DE identifies wall- motion abnormalities more readily in the apical region than 2DE, which may explain the tendency towards higher sensitivity in the left anterior descending artery territory. RT3DE results were validated using angiography as reference and findings indicate diagnostic equivalence to 2DE, with the advantage of considerable shorter acquisition times

Atherosclerosis of the Aorta in Patients With Acute Thoracic Aortic Dissection

Background The role of atherosclerosis in thoracic aortic dissection has not been established yet. Transesophageal echocardiography (TEE) is an imaging modality widely used in the diagnostic evaluation of thoracic aortic dissection, and it can detect aortic atherosclerotic plaques and assess their size and specific characteristics. Methods and Results One hundred consecutive patients with thoracic aortic dissection and adequate imaging of the thoracic aorta by TEE were studied. The type of dissection (proximal or distal) and the presence and the degree of aortic atherosclerosis were defined. Proximal aortic dissection (Stanford type A) was found in 64 patients. Patients with proximal dissection were younger than those with distal (type B; 58 +/- 13 vs 67 +/- 11 years, p < 0.001). The prevalence of arterial hypertension was higher in patients with distal dissection compared with those with proximal. Aortic atherosclerosis was present in less patients with proximal than with distal dissection (67% vs 94%, p < 0.002). Logistic regression analysis revealed that patients with severe atherosclerosis were 7.6-fold more probable to have type B than type A dissection (p < 0.001). Conclusion Aortic atherosclerosis is more associated with distal than with proximal aortic dissection. (Circ J 2008; 72: 1773-1776