A Survival Case of Painless Chronic Type A Aortic Dissection with a History of Stroke and Anticoagulant Use

WOS: 000282110700012PubMed ID: 20872939We report the case of a patient with completely painless chronic aortic dissection, who presented to another hospital with a left hemiparesia 3 months ago and received anticoagulation therapy with a diagnosis of ischemic stroke. Most of her symptoms had resolved when she presented to our outpatient clinic except for numbness of her left hand and dysphasia. Physical examination found a diastolic murmur at the left sternal border and a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection with extension into the internal right carotid artery and severe aortic regurgitation. Surgery was performed successfully and the patient was discharged. This case emphasizes that the diagnosis of a completely painless aortic dissection with only neurologic symptoms at presentation can be extremely difficult and should always be considered as a cause of ischemic stroke to avoid catastrophic antithrombolytic or anticoagulation therapy. (C) 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:454-456, 2010; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jcu.2070

Response to the Letter to the Editor: "The correct number of double right coronary artery reported in the literature"

WOS: 000269156200015PubMed ID: 19073355

Subclinical Left Ventricular Dysfunction in Asymptomatic Severe Aortic Regurgitation Patients with Normal Ejection Fraction: A Combined Tissue Doppler and Velocity Vector Imaging Study

WOS: 000275757300008PubMed ID: 20486957Objectives: Our aim was to evaluate subclinical left ventricular (LV) dysfunction, by two novel echocardiographic techniques, velocity vector imaging (VVI)-derived strain imaging and tissue Doppler imaging (TDI), in patients with asymptomatic, severe aortic regurgitation (AR). Methods: Forty patients with severe AR with normal ejection fraction and 30 controls were included to the study. All patients underwent a standard echocardiography extended with TDI and VVI analyses. To evaluate the LV longitudinal and circumferential deformation, segmental systolic peak strain and strain rate (SRs) data were acquired from parasternal short axis, apical four-chamber, two-chamber, and long axis views, and additionally LV myocardial velocities, isovolumic myocardial acceleration (IVA), peak systolic velocity (Sa) and peak myocardial velocity during isovolumic contraction (IVV) assessed by TDI. Results: IVA was the only TDI-derived parameter which was significantly impaired in AR patients (P = 0.0001). Both longitudinal and circumferential strain and SRs of the LV were significantly decreased in patients with severe AR (P = 0.0001). Longitudinal and circumferential strain/SRs and TDI-derived LV IVA were inversely correlated with LV end-diastolic diameter (P = 0.0001) and end-systolic diameter (P = 0.0001). TDI-derived IVA was also very well correlated with longitudinal deformation parameters (P = 0.0001). Conclusions: VVI- derived strain imaging and TDI-derived IVA may be used as adjunctive, reliable, noninvasive parameters for evaluating subclinical ventricular dysfunction in patients with chronic, severe AR. This may help to identify patients for closer follow-up and to determine the need for surgery before developing irreversible, severe heart failure. (Echocardiography 2010;27:260-268)

Preoperative Left Atrial Mechanical Dysfunction Predicts Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Operation - A Velocity Vector Imaging-Based Study -

WOS: 000282562300017PubMed ID: 20818132Background: The aim of the present study was to evaluate pre-existent subclinical mechanical atrial dysfunction in patients with postoperative atrial fibrillation (POAF) by using novel echocardiographic techniques. Methods and Results: Ninety-six patients with sinus rhythm, undergoing coronary artery bypass graft (CABG) operation were prospectively enrolled. Preoperative left atrial (LA) reservoir, conduit and booster functions were evaluated by 3 different methods: conventional echocardiography, tissue Doppler imaging (TDI), and 2-dimensional strain imaging based-velocity vector imaging (VVI). POAF occurred in 25 out of 96 patients (26%). LA volume index (LAVI) was the only conventional parameter associated with POAF. TDI-derived LA velocities were similar in study groups. In VVI analysis, LA systolic strain, strain rate (SRs) and early diastolic strain rate (ESRd) were impaired in patients who developed POAF after CABG (P=0.0001). Age, LAVI, LA peak systolic strain, SRs and ESRd were found to be the independent predictors of POAF. The optimal cut-off point of 44.0% (88.7% sensitivity, 96% specificity) for LA strain, 1.7s(-1) (88% sensitivity, 86.2% specificity) for SRs and 1.95s(-1) (sensitivity 72%, 70.4% specificity) for ESRd predicted POAF in this study. Conclusions: VVI-derived strain imaging could be used as an adjunctive non-invasive method for evaluating subclinical atrial mechanical dysfunction in patients undergoing CABG. This might help us to identify patients with high risk of POAF in clinical practice. (Circ J 2010; 74: 2109-2117