Constrictive pericarditis impressing and narrowing the ascending aorta

WOS: 000258400000015PubMed ID: 18754936A 77-year-old male patient was admitted to our institution with 1-year history of progressive dyspnea on exertion, and lower extremity edema. His chest x-ray showed a circumferential pericardial calcification and right-sided pleural effusion. The electrocardiography revealed atrial fibrillation with low voltage in all derivations and diffuse nonspecific T-wave inversions. The transesophageal echocardiography showed a thickened pericardium with biatrial enlargement and normal right and left ventricular systolic functions. A thick echogenic structure that caused impression and narrowing of the ascending aorta was observed. Simultaneous right and left heart catheterization showed elevation and equalization of right-sided and left-sided diastolic filling pressures, with characteristic dip and plateau. Aortic angiogram showed the ascending aorta was impressed and narrowed by calcified pericardium. Cine magnetic resonance imaging showed pericardial calcifications impressing and narrowing of the ascending aorta. All these findings were consistent with constrictive pericarditis. The patient had no history of tuberculosis, cardiac surgery, or mediastinal irradiation. His HIV antibody test was negative. Marked pericardial thickening and calcifications were evident during pericardiectomy. Histological analysis of the pericardium showed dense collageneous matrix, mild chronic inflammation and calcification. The culture of pericardial tissue revealed no identifiable cause including tuberculosis. The patient was diagnosed as idiopathic constrictive pericarditis. The patient's symptoms and edema decreased remarkably after pericardial stripping. He remained well at 1-year follow-up

Evaluation of Right Ventricular Systolic and Diastolic Function in Patients with Newly Diagnosed Obstructive Sleep Apnea Syndrome without Hypertension

WOS: 000263747400006PubMed ID: 19151552Objectives: We investigated right ventricular (RV) structural and functional cardiac alterations in obstructive sleep apnea (OSA) independent of systemic hypertension and their correlation to the severity of OSA. Methods: Forty-one moderate-to-severe OSA but otherwise healthy patients and 30 body mass index-matched control subjects were included. All subjects underwent 24-hour ambulatory blood pressure monitoring, standard and tissue Doppler imaging of the RV. Results: The OSA group had increased RV wall thickness, impaired right ventricular outflow tract fractional shortening (RVOT fs), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI) and RV myocardial acceleration during isovolumic contraction (IVA) (p < 0.001). Apnea hypopnea index (AHI) and mean pulmonary artery (PA) pressure were correlated with all these indices (p < 0.01 for all). RV free wall thickness (p < 0.001) and IVA (p = 0.006) remained significant predictors of AHI after adjusting for age, body mass index, mean PA pressure, RVOT fs, TAPSE and MPI in a multiple stepwise linear regression model. Conclusions: OSA is associated with impaired RV function despite normal systemic blood pressures. The level of RV dysfunction has a direct relationship with the severity of OSA. RV free wall thickness and IVA are independent predictors of AHI in uncomplicated OSA patients. Copyright (C) 2009 S. Karger AG, Base

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

Evaluation of Subdinical Right Ventricular Dysfunction in Obstructive Sleep Apnea Patients Using Velocity Vector Imaging

WOS: 000274099300020PubMed ID: 20009388Background: The aims of this study were to evaluate subclinical regional right ventricular (RV) dysfunction in newly diagnosed obstructive sleep apnea (OSA) patients without systemic and pulmonary arterial (PA) hypertension, and to correlate OSA severity to RV dysfunction, using both velocity vector imaging (VVI)-derived strain imaging and tissue Doppler imaging (TDI). Methods and Results: The OSA group consisted of 27 patients and the control group consisted of 26 healthy participants. All participants underwent 24-h ambulatory blood pressure monitoring. Peak systolic myocardial velocities, strain, and strain rate (SR) were determined at the basal and mid segments of the RV free wall by VVI. Additionally, RV myocardial velocities were assessed by pulsed-wave TDI. Patients with OSA had significantly impaired VVI-derived peak systolic myocardial velocities, strain, and SR (P<0.0001 for all). RV isovolumic acceleration (IVA) was the only TDI-derived parameter that was significantly impaired (P<0.0001). RV IVA (r=-0.512, P<0.0001), RV mid free wall strain (r=0.568, P<0.0001) and SIR (r=0.519, P<0.0001) revealed the best correlations with apnea hypopnea index (AHI). Conclusions: Subclinical RV dysfunction is present in OSA patients despite normal systemic and PA pressures. Tissue Doppler-derived RV IVA and VVI-derived RV deformation can accurately recognize and quantify RV function abnormalities in this subgroup of patients. (Circ J 2010; 74: 312-319

Mycotic Ascending Aortic Pseudoaneurysm Causing a Large Mediastinal Abscess

WOS: 000267659000016PubMed ID: 19594821(ECHOCARDIOGRAPHY, Volume 26, July 2009)

Velocity Vector Imaging in Evaluation of Subclinical Right Ventricular Dysfunction in Obstructive Sleep Apnea Patients without Systemic and Pulmonary Arterial Hypertension

81st Annual Scientific Session of the American-Heart-Association -- NOV 08-12, 2008 -- New Orleans, LAWOS: 000262104502206…Amer Heart Asso

The comparison between the efficiency of different anti-arrhythmic agents in preventing postoperative atrial fibrillation after open heart surgery

WOS: 000256807300006PubMed ID: 18524727Objective: Atrial fibrillation (AF) is one of the most frequent complications that may occur after open-heart surgery. Clinical reports regarding comparison of different anti-arrhythmic agent's usage to maintain,sinus rhythm after open-heart surgery are not conclusive. We examined the effects of different anti-arrhythmic agents administration before operation on postoperative AF incidence, duration of hospitalization and complications. Methods: Overall, 180 patients (130 men and 50 women, mean age 58.13 +/- 11.71 years) who were candidates for open-heart surgery, were included in this prospective, single-blind study. All patients divided into five different groups. All anti-arrhythmic drugs were administered approximately 7 days before the operation. Propafenone was given to Group 1 (G1); sotalol to Group 2 (G2); amiodarone to Group 3 (G3) and diltiazem to Group 4 IN) at doses of 300 mg/day, 80 mg/day, 400 mg/day and 180 mg/day orally respectively. The fifth group (G5) did not receive any of anti-arrhythmic drugs. The medication was continued for ten days postoperatively. Statistical analysis was performed using Chi-Square and one-way ANOVA tests. Results: Atrial fibrillation developed during postoperative period in 18.1% patients in G1, 9.1% patients in G2, 16.2% patients in G3, 28.6% patients in G4 and 38.1 % patients in G5. The prevalence of postoperative AF was significantly higher in G5 as compared with other groups (p=0.026). There were significant differences across groups in duration of hospitalization (p=0.033), with shortest mean duration of hospitalization in G2 (8.9 +/- 2.7 days). Conclusion: Any anti-arrhythmic agent started 7 days before the operation and continued for 10 days, may reduce the prevalence of postoperative AF, morbidity and duration of hospitalization. However, we found that sotalol and amiodarone were more effective than other anti-arrhythmic agents in our patient population

Transesophageal echocardiographic assessment of a floating thrombus located in the ascending aorta

WOS: 000250916200013PubMed ID: 18001364Transesophageal echocardiography (TEE) has become a unique imaging technique that provides improved visualization of aorta because of its proximity to the esophagus. It is a reliable method for the diagnosis of thoracic aorta diseases and detection of protruding atheromas or thrombi as sources of systemic emboli. We report a case in which TEE revealed a floating aortic thrombus located in the ascending aorta in a patient with chronic renal failure