RESUMO
Capturing a paradoxical embolism in real-time has been a challenge in recent literature. We present the unique case of a 33-year-old, G3P2 female at 8 weeks gestation presenting with dyspnea. An active thrombus through an undiagnosed patent foramen ovale was found requiring emergent surgical intervention with a positive outcome. The presence of a deep vein thrombosis, inferior vena caval thrombus, patent foramen ovale, and pulmonary artery thrombi was contemporarily documented. To our knowledge, there is minimal literature with this presentation.
Assuntos
Embolia Paradoxal , Forame Oval Patente , Embolia Pulmonar , Trombose , Adulto , Embolia Paradoxal/complicações , Embolia Paradoxal/diagnóstico por imagem , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Trombose/cirurgiaRESUMO
A 52-year-old woman presented with dysarthria and right-sided weakness in her upper and lower extremities prompting thrombolytic therapy with mild resolution of symptoms. Further work-up revealed (the source) a left ventricular myxoma on the chordae tendinae of the posterior medial papillary muscle, confirmed with transesophageal echocardiography and pathology. Herein, we present a rare case of embolic stroke from a myxoma originating on the chordae tendinae. To the best of our knowledge, the literature on the location and presentation of this tumor as seen in our patient is sparse in contemporary findings.
Assuntos
Neoplasias Cardíacas , Mixoma , Acidente Vascular Cerebral , Cordas Tendinosas/diagnóstico por imagem , Feminino , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Pessoa de Meia-Idade , Mixoma/complicações , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologiaRESUMO
The diagnosis of paradoxical emboli remains elusive in many cases. The causal association between the thrombotic source, the intracardiac shunt, and the final emboli location is seldom demonstrated. We present the case of a 42-year-old woman admitted to the hospital with a third stroke. The presence of a thrombus in transit through a patent foramen ovale (PFO), a deep vein thrombosis (DVT), bilateral pulmonary emboli, and an acute cerebral infarct were concurrently documented.
Assuntos
Forame Oval Patente , Embolia Pulmonar , Acidente Vascular Cerebral , Trombose , Trombose Venosa , Adulto , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagemRESUMO
An asymptomatic 30-year-old male was referred for a transthoracic echocardiogram because of a systolic murmur that was noted on a pre-employment physical exam. Transthoracic imaging demonstrated a single papillary muscle from which the chordae of both mitral valve leaflets were attached. The mitral valve was seen to have a parachute-like configuration. Given the benign nature of the presentation, the patient did not seek further investigation.
Assuntos
Insuficiência da Valva Mitral , Valva Mitral , Adulto , Testes Diagnósticos de Rotina , Ecocardiografia , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Músculos Papilares/diagnóstico por imagem , Encaminhamento e ConsultaRESUMO
A 67-year-old female with recent hospitalization for pneumonia was transferred to our facility for high fevers and positive blood cultures for staph aureus. During her treatment for pneumonia, central venous catheter was placed. A systolic murmur was found in conjunction with fever and notable premature ventricular contractions on telemetry monitoring. Chest x-ray and transesophageal echocardiography were then performed, and a free guidewire was identified which was later successfully removed under interventional radiology.
Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Endocardite Bacteriana , Idoso , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico por imagem , Feminino , HumanosRESUMO
The diagnosis of an apical left ventricular thrombus in the setting of a dilated cardiomyopathy is not uncommon. However, biventricular apical thrombi in this setting is unusual. We present a case of a 67-year-old man who was admitted with new onset heart failure with biventricular apical thrombus formation in the absence of a hypercoagulable state.
Assuntos
Cardiomiopatia Dilatada , Insuficiência Cardíaca , Trombose , Idoso , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Humanos , Masculino , Trombose/complicações , Trombose/diagnóstico por imagemRESUMO
A 53-year-old male status post pacemaker placement three months prior for sinus bradycardia presented with worsening dyspnea, holosystolic murmur, and a ventricular-paced right bundle branch block on electrocardiogram. Transesophageal echocardiography demonstrated a pacer wire in the right atrium coursing into the left atrium and ventricle through an undiagnosed patent foramen ovale. The patient underwent surgical repair and repositioning of the pacemaker lead without complication. Although rare, it should be suspected after recent lead placement.
Assuntos
Forame Oval Patente , Marca-Passo Artificial , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/terapia , Ecocardiografia Transesofagiana , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A unicuspid aortic valve is a very rare valvular lesion. Its physical manifestations vary and are associated with other cardiovascular abnormalities such as aortic stenosis/insufficiency and aortopathy. Echocardiography remains the modality of choice, with computerized tomography or cardiac magnetic resonance used as adjunctive imaging. Herein, we present a case series of three patients with unicuspid aortic valves treated at our institution, with a focus on 2D and 3D echocardiographic imaging.
Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Doenças das Valvas Cardíacas , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , HumanosRESUMO
A 65-year-old female presenting with worsening dyspnea and notable weight loss were found to have a systolic murmur on physical examination. On workup with computed tomography (CT) angiogram, a solid mass was found extending from the inferior vena cava into the right ventricle. Transesophageal echocardiography demonstrated this mass extension causing right ventricular outflow tract obstruction. After surgical removal, the pathology of the mass was endometrial leiomyosarcoma.
Assuntos
Ecocardiografia/métodos , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Leiomiossarcoma/complicações , Leiomiossarcoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Obstrução do Fluxo Ventricular Externo/etiologia , Idoso , Feminino , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Leiomiossarcoma/cirurgia , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/cirurgiaRESUMO
Possible stent migration was suspected in this case and confirmed on transesophageal echocardiography. The patient underwent successful stent removal with snaring, as well as subsequent placement of another stent in the superior vena cava without further complications.
Assuntos
Migração de Corpo Estranho , Átrios do Coração , Stents , Veia Cava Superior , Remoção de Dispositivo , Ecocardiografia Transesofagiana , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Humanos , Stents/efeitos adversos , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/cirurgiaRESUMO
An 18-year-old male with an unknown medical history presented with palpitations and paroxysmal episodes of shortness of breath over a 7-year period. Transthoracic echocardiography displayed a univentricle with an ejection fraction of 45%. The patient refused treatment and was lost to follow-up.
Assuntos
Ecocardiografia/métodos , Coração Univentricular , Adolescente , Flutter Atrial/diagnóstico , Flutter Atrial/etiologia , Dispneia/diagnóstico , Dispneia/etiologia , Eletrocardiografia/métodos , Humanos , Perda de Seguimento , Masculino , Volume Sistólico , Coração Univentricular/diagnóstico por imagem , Coração Univentricular/fisiopatologiaRESUMO
A 75-year-old female was admitted due to a syncopal episode. Transesophageal echocardiography demonstrated severe mitral stenosis with a 5 cm, free-floating, left atrial thrombus intermittently obstructing the mitral valve orifice; she underwent thrombus removal and mitral valve replacement.
Assuntos
Ecocardiografia Transesofagiana/métodos , Átrios do Coração/diagnóstico por imagem , Estenose da Valva Mitral , Síncope , Trombose , Idoso , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico , Estenose da Valva Mitral/fisiopatologia , Índice de Gravidade de Doença , Síncope/diagnóstico , Síncope/etiologia , Trombectomia/métodos , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Resultado do TratamentoRESUMO
Epidural anaesthesia is an effective form of pain relief during vaginal deliveries. However, neuraxial anaesthesia may slow the progression of labour. The assumption that epidurals lead to increased caesarean sections is also a topic of current debate. A holistic approach with the use of a birthing ball has been advocated as a potential modality to decrease labouring times and, therefore, reduce progression to caesarean section. Birthing balls aim to increase pelvic outlet opening, which facilitates labouring. Our aim is to review recent literature pertaining to birthing balls and their role in improving quality and outcomes of vaginal deliveries in patients with epidurals.IMPACT STATEMENTWhat is already known on the subject? Epidural anaesthesia may slow the progression of labour. It has been hypothesised that slowing progression of labour is associated with increased rates of vacuum and forceps delivery. Most common clinical indication for caesarean section is failure to progress during labour. Birthing Balls have been shown to quicken the progression of labour, theoretically reducing caesarean sections with those with epidurals.What do the results of the study add? Several studies have demonstrated a reduced duration of first and second stage of labour among women with epidural anaesthesia, but the existing literature is limited, and interpretation of results may be restricted by generalizability and inherent study biases. The objective of this article is to review existing literature and highlight the potential clinical utility of birthing balls in current obstetric practice.What are the implications of these findings for clinical practice and further research? Use of birthing balls has been advocated to decrease labouring time and therefore reduce progression to caesarean section. Larger studies or meta-analysis would be required to confirm potential benefits of birthing ball use.
Assuntos
Analgesia Obstétrica , Anestesia Epidural , Parto Obstétrico/métodos , Distocia , Posicionamento do Paciente , Prova de Trabalho de Parto , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Cesárea/métodos , Cesárea/estatística & dados numéricos , Distocia/induzido quimicamente , Distocia/prevenção & controle , Feminino , Humanos , Posicionamento do Paciente/instrumentação , Posicionamento do Paciente/métodos , GravidezRESUMO
Left atrial wall dissection is uncommon. We present this rarity with transesophageal echocardiography in a 71-year-old female diagnosed with infective endocarditis three months following mitral valve repair, which along with the surgical intervention, may have contributed to the dissection.
Assuntos
Endocardite Bacteriana/complicações , Átrios do Coração , Ruptura Cardíaca/diagnóstico , Idoso , Procedimentos Cirúrgicos Cardíacos , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Feminino , Ruptura Cardíaca/etiologia , Ruptura Cardíaca/cirurgia , Humanos , Doenças RarasRESUMO
A 70-year-old female with severe aortic stenosis presented for aortic valve replacement and underwent routine preoperative Swan-Ganz catheter placement. Transesophageal echocardiography demonstrated a dilated coronary sinus with a catheter present. A high suspicion of venous anomaly prompted an agitated saline study. Flow through the coronary sinus into the right atrium was observed, confirming the presence of a persistent left superior vena cava. Although the persistent left superior vena cava has a low prevalence in the general population, it is one of the most common thoracic venous anomalies. During central venous cannulation, the presence of venous anomalies increases procedural complication rates. Fortunately, our patient remained asymptomatic both before and after catheter insertion. Awareness of this anomaly could help clinicians avoid complications.
Assuntos
Ecocardiografia Transesofagiana , Malformações Vasculares/diagnóstico por imagem , Veia Cava Superior/diagnóstico por imagem , Idoso , Feminino , Humanos , Valor Preditivo dos Testes , Veia Cava Superior/anormalidadesRESUMO
A patient presented to our institution for an elective removal of an inferior vena cava (IVC) filter under local anesthesia. Once removed, it was noticed that the filter had a missing secondary leg. The patient had a chest CT done which showed a hyper-attenuating structure in the region of the tricuspid valve highly suspicious for the fractured strut of the filter. Upon these findings, the patient was taken once again to the surgical suite for an endovascular retrieval of the strut. For fear of a possible cardiac injury and a potential need for a sternotomy, the patient received general anesthesia and was placed with appropriate IV access and full cardiac monitors. The strut was removed successfully without any complications. Despite the relative benign nature of this endovascular procedure, one should always be prepared for an appropriate resuscitation in case of an occurrence of a surgical complication.
Assuntos
Remoção de Dispositivo/efeitos adversos , Filtros de Veia Cava/efeitos adversos , Idoso , Anestesiologia , Procedimentos Endovasculares , Feminino , Humanos , Tomografia Computadorizada por Raios X , Valva TricúspideRESUMO
This case involves Swan-Ganz catheter placement in a patient who developed cardiogenic shock, possibly due to the catheter dissecting the intimal lining of the superior vena cava and endocardium.
Assuntos
Cateterismo de Swan-Ganz , Reestenose Coronária/complicações , Ecocardiografia Transesofagiana/métodos , Átrios do Coração , Ventrículos do Coração , Complicações Intraoperatórias , Veia Cava Superior , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/métodos , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/lesões , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/lesões , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Resultado do Tratamento , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/lesõesRESUMO
A 51-year-old male presented with a wound in his right hand that was suspicious for possible septic emboli of cardiac origin. With transesophageal echocardiography, the patient was found to have a rare quadricuspid aortic valve. This quadricuspid valve can present with variable symptoms and physical exam findings. Due to embryological defects, this pathology is associated with several other anatomical defects that are important to recognize prior to surgical intervention. Transesophaegeal echocardiography remains the gold standard in detection of quadricuspid aortic valve and identification of other possible cardiac lesions.
Assuntos
Insuficiência da Valva Aórtica/etiologia , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Ecocardiografia Transesofagiana , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Anestesia Geral/métodos , Fluoretos/efeitos adversos , Debilidade Muscular/induzido quimicamente , Debilidade Muscular/prevenção & controle , Adulto , Anestésicos Intravenosos , Anestésicos Locais , Feminino , Fentanila , Humanos , Lidocaína , Fármacos Neuromusculares Despolarizantes , Propofol , SuccinilcolinaRESUMO
A quadricuspid aortic valve is an uncommon valve lesion. Its physical manifestations vary, and it may be associated with other cardiac lesions. Echocardiography is the imaging modality of choice, with computerized tomography or cardiac magnetic resonance imaging being utilized as adjunctive imaging modalities in certain cases. Herein, we present a case series of three patients with this valvular lesion treated at our institution, as well as a contemporary review of the literature.