Case Report Thrombus in Transit through Patent Foramen Ovale

A thrombus in transit through a patent foramen ovale (PFO) with impending paradoxical embolism is an extremely rare event. Due to its transient nature, it is unable to identify the thrombus, and most of the cases have been reported at autopsy. We are reporting a case of thrombus straddling the foramen ovale which was diagnosed by echocardiography and treated surgically. Through this personal case, an exhaustive review of the literature was performed. There were 88 cases reported. We concluded that there is no medical consensus about the best option for treatment. Nevertheless, surgery, which is associated with fewer complications of recurrent embolic events than those of thrombolysis and anticoagulation, appeared to be the best approach in patients who are not at a high surgical risk. Anticoagulant treatment appears to be an acceptable therapeutic alternative to surgery, particularly in patients with comorbidities who are at high surgical risk and for patients with small PFO. Thrombolysis is linked to the highest mortality, which could be explained by the severity of the patient's initial presentation. In conclusion, and after the cumulative effects of these case reports, we propose a diagram consisting of the use of the three therapeutic options in the different clinical scenarios

Combination of contrast with stress echocardiography: A practical guide to methods and interpretation

Contrast echocardiography has an established role for enhancement of the right heart Doppler signals, the detection of intra-cardiac shunts, and most recently for left ventricular cavity opacification (LVO). The use of intravenously administered micro-bubbles to traverse the myocardial microcirculation in order to outline myocardial viability and perfusion has been the source of research studies for a number of years. Despite the enthusiasm of investigators, myocardial contrast echocardiography (MCE) has not attained routine clinical use and LV opacification during stress has been less widely adopted than the data would support. The purpose of this review is to facilitate an understanding of the involved imaging technologies that have made this technique more feasible for clinical practice, and to guide its introduction into the practice of the non-expert user

Fulminant thrombosis of mechanical mitral valve prosthesis

In patients with prosthetic heart valves non-cardiac surgery may require temporary discontinuation of oral anticoagulation. Although the risk of valve related thromboembolic complications may generally be only slightly increased during the short perioperative period, in the presence of certain risk factors, replacement of oral anticoagulation with heparin is recommended. In the presented patient, unusually fulminant and finally fatal thrombosis of a mechanical mitral valve prosthesis developed within only 48 hours after non-cardiac surgery despite heparin treatment. The thrombosis was triggered by clinical conditions favouring a hypercoagulable state. This report dramatically shows that despite improvements in prosthetic heart valve design and in the management of anticoagulation, thrombosis remains one of the most dangerous complications after valve replacement with a mechanical prosthesis.


Keywords: complications; mitral valve; mechanical prosthesis; thrombosi

Myocardial Contrast Echocardiography in Acute Myocardial Infarction Using Aortic Root Injections of Microbubbles in Conjunction With Harmonic Imaging: Potential Application in the Cardiac Catheterization Laboratory

AbstractObjectives. The aim of this study was to evaluate myocardial contrast echocardiography using aortic root injections with harmonic imaging in experimental acute myocardial infarction to determine the potential of this approach in the cardiac catheterization laboratory.Background. It would be desirable to have an adjunctive procedure that could evaluate myocardial perfusion at the time of cardiac catheterization in patients with acute myocardial infarction. A single injection of contrast medium in the aortic root would provide complete information on myocardial perfusion in a cross section of the heart. High quality images would provide on-line assessment of myocardial perfusion without recourse to image processing. These data could be very valuable for determining patient management.Methods. Perfusion defects on myocardial contrast echocardiography were measured during coronary occlusion and reflow, using fundamental and harmonic imaging in both continuous and intermittent modes in nine open chest dogs. These defects were compared with risk area on technetium-99m autoradiography and infarct size on tissue staining.Results. Whereas harmonic imaging increased myocardial video intensity by more than twofold (p < 0.001) compared with fundamental imaging after aortic root injection of contrast medium, intermittent imaging was not superior to continuous imaging. The improved signal to noise ratio of harmonic imaging allowed on-line definition of risk area (r = 0.98) and infarct size (r = 0.93) without recourse to off-line processing. Similar results could be obtained with fundamental imaging only after off-line processing.Conclusions. Aortic root injections of contrast medium coupled with harmonic imaging can be used to provide accurate on-line assessment of risk area and infarct size during acute myocardial infarction. These results have important implications for the catheterization laboratory.(J Am Coll Cardiol 1997;29:207–16)

Electrocatalyst Derived from Waste Cu–Sn Bronze for CO2 Conversion into CO

To sustainably exist within planetary boundaries, we must greatly curtail our extraction of fuels and materials from the Earth. This requires new technologies based on reuse and repurposing of material already available. Electrochemical conversion of CO2 into valuable chemicals and fuels is a promising alternative to deriving them from fossil fuels. But most metals used for electrocatalysis are either endangered or at serious risk of limitation to their future supply. Here, we demonstrate a combined strategy for repurposing of a waste industrial Cu–Sn bronze as a catalyst material precursor and its application toward CO2 reuse. By a simple electrochemical transfer method, waste bronzes with composition Cu14Sn were anodically dissolved and cathodically redeposited under dynamic hydrogen bubble template conditions to yield mesoporous foams with Cu10Sn surface composition. The bimetal foam electrodes exhibited high CO2 electroreduction selectivity toward CO, achieving greater than 85% faradaic efficiency accompanied by a considerable suppression of the competing H2 evolution reaction. The Cu–Sn foam electrodes showed good durability over several hours of continuous electrolysis without any significant change in the composition, morphology, and selectivity for CO as a target product

Analysis of myocardial perfusion or myocardial function for detection of regional myocardial abnormalities. An echocardiographic multicenter comparison study using myocardial contrast echocardiography and 2D echocardiography

Background: Echocardiography based myocardial perfusion imaging and regional wall motion analysis are used for evaluation of coronary artery disease and regional myocardial abnormalities. Aim: This study sought to compare myocardial contrast echocardiography (MCE) and 2D echocardiography with regard to interobserver variability and detection of regional myocardial abnormalities. Methods: In 70 patients evenly distributed between three ejection fraction groups based on biplane cineventriculography (>55%, 35-55%, <35%), unenhanced and contrast enhanced 2D echocardiography and myocardial contrast echocardiography (MCE; SonoVue (R); Bracco) were performed. Regional watt motion and myocardial perfusion were assessed referring to a 16 segment model.. Interobserver agreement (10A) among 2 readers was determined within each imaging modality. To define a standard of truth for the presence of segmental myocardial disease an independent expert-panel decision was obtained based on clinical data, ECG, coronary angiography and blinded information from the imaging modalities. Results: Regional wall motion assessment was possible in 98.1% of segments using contrast enhanced 2D echocardiography and in 87.2% using unenhanced 2D echocardiography (p < 0.001), while perfusion assessment was possible in 90.1% of segments (p < 0.001). 10A on presence of any regional wall motion abnormality expressed as Kappa coefficient was 0.71 (95% Cl 0.53-0.89) for contrast enhanced echocardiography and 0.37 (95% Cl 0.14-0.59) for unenhanced echocardiography. 10A on presence of any perfusion abnormality was 0.53 (95% Cl 0.34-0.73). For MCE there was high 10A for the apical segments (kappa = 0.57) and Lower 10A for the basal segments (kappa = 0.14), while no such gradient was found for the 10A on watt motion abnormalities. Mean accuracy to detect expert-pane[ defined myocardial abnormalities was 80.6% for unenhanced echocardiography, 85.0% for contrast enhanced 2D echocardiography and 80.6% for MCE. Conclusions: MCE is inferior to contrast enhanced 2D echocardiography with regard to visibility of all LV segments and appears slightly inferior with regards to 10A, white both are superior to unenhanced 2D echocardiography. The methods demonstrated high accuracy in detection of panel defined regional myocardial abnormalities. (C) 2006 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved