Faculty Bibliography

Pericardial constriction secondary to metastatic adenocarcinoma is exceedingly rare. We present the first recorded case of pericardial constriction secondary to metastatic signet-ring mucinous adenocarcinoma diagnosed by echocardiography. The cornerstones of echocardiographic diagnosis of constriction are the following: interventricular septal bounce phasic with respiration, M-mode recordings of the inferior vena cava, and the characteristic Doppler velocity patterns recorded from the mitral valve, hepatic veins, and mitral annulus

Takayasu's arteritis (TA) is a granulomatous vasculitis of medium and large arteries, which most often presents as pulseless disease due to widespread arterial stenoses. Only the minority of TA patients have aortic valve insufficiency, which is due to aortic root dilatation following aortitis and aneurysm formation. No other cardiac valve is involved. We report a case of Takayasu's disease-related severe aortic insufficiency (AI) in a Filipino woman, which necessitated aortic valve replacement. It is important to consider TA in the differential diagnosis of AI in young women, particularly those with early-onset systemic hypertension and pulse deficits. Early diagnosis and therapy of TA can improve outcomes

We report a case of a 56-year-old man with traumatic aortic rupture (TAR) sustained in a motor vehicle accident diagnosed by helical computed tomography, aortography, and transesophageal echocardiography. A large majority of patients with TAR never make it to the hospital, and for those who do, a timely diagnosis is critical for survival. We discuss the merits and pitfalls of the three imaging modalities

We present the multidetector CT appearance of a case of isolated dextroversion. Dextroversion is a rare anomaly characterized by extreme right-sided rotation of the heart resulting in dextrocardia with the left ventricle anterior and to the left of the right ventricle. The diagnosis is easily made with ECG-gated multidetector CT

OBJECTIVE: We discuss the CT findings in a case of pulmonary embolism complicated by paradoxical embolism in a patient with a patent foramen ovale and atrial septal aneurysm. CONCLUSION: When confronted with a case of pulmonary embolism on CT, besides evaluating the extent of pulmonary artery occlusion, the radiologist should examine the cardiovascular system to identify any unsuspected underlying or associated conditions

To the best of our knowledge, acute decompensated left-sided heart failure with preserved left ventricular ejection fraction in a patient with scleroderma has not been previously reported. We describe a patient with severe pulmonary hypertension due to limited scleroderma in whom nesiritide led to marked reductions in pulmonary arterial and capillary wedge pressure as well as resolution of symptoms and pulmonary edema. Subsequent epoprostenol use was associated with an increase in pulmonary capillary wedge pressure and a recurrence of pulmonary edema. Thus, nesiritide may be the preferred agent in scleroderma patients with severe pulmonary hypertension and preserved left ventricular systolic function since epoprostenol may lead to adverse hemodynamic effects

We present a case of a 46-year-old man with advanced acquired immunodeficiency syndrome and congenitally bicuspid aortic valve endocarditis caused by methicillin- and gentamicin-resistant Staphylococcus aureus. Endocarditis led to root abscess formation, a complete heart block, and fistulous tract formation between the ascending aorta and the right ventricle. Although perivalvular abscess is not an unusual complication of native valve endocarditis, a fatal fistulous communication between the ascending aorta and the right ventricle is exceedingly rare

Amyloid cardiomyopathy is myocardial infiltrative disorder which mostly has been seen as the consequence of systemic amiloidosis. The diffuse global myocardial infiltration of nonfunctional amyloid displaces the contractile myocites giving rice to relaxation abnormality and diastolic dysfunction of restrictive or congestive type of both ventricles, but more frequently with right-sided congestion, while systolic left ventricular function deteriorates late in disease process. We report a patient with amyloid cardiomyopathy and nephrotic syndrome underlying primary amiloidosis. Our aim is to point out at echocardiographic assessment of diagnosis and prognosis of amyloid cardiomyopathy, which is proven by postmortal endomyocardial biopsy. The hallmark of echocardiographic diagnostics are the findings of the thickened ventricular and septal walls, small ventricular cavities, dilated atria with thickened interatrial septum and atrioventricular valves, and granular-sparkling and hyperrefractile myocardium. Doppler assessment diagnostically gives us the insight in restrictive physiology of both ventricles, and the inverse relation of the left ventricular thickness and voltage on the ECG is high specific. Echocardiographic evaluation of mean left ventricular thickness in amyloid cardiomyopathy is very important prognostic parameter. so that if it is > or =15 mm, median survival is 0.4 years, whereas in our patient with median thickness of 2.76 cm the survival was only three months. The advanced diastolic dysfunction of the left ventricle with an increased transmitral E/A ratio and deceleration time of < or =150 ms is strong predictor of cardiac death. In this case of restrictive transmitral flow E/A was 1.7 and DT 100 ms and they were ominous prognostic signs of survival