Contrast echocardiography in the non-invasive diagnosis of giant aneurysm of the right atrial appendage.

A 57 year-old male patient was admitted to our echocardiography laboratory to rule out thrombus in left atrium before electrical cardioversion of atrial fibrillation. Transoesophageal echocardiography (TEE) demonstrated in the bicaval view, the right atrial appendage measured 10 x 5 cm, area: 42 cm(2), volume: 229 mL (Figure, left). A quick injection of 15 cc of echo-contrast fluid (shaken saline/1 cc air), delivered via an antecubital vein, showed filling the right atrial appendage aneurysm (Figure, right). Idiopathic giant congenital aneurysm of the right atrium appendage is a very rare malformation. TEE with contrast echocardiography is very useful in the non-invasive diagnosis of giant right atrial appendage aneurysm.

Dobutamine stress echocardiography can predict reversible ventricular dysfunction after acute myocardial infarction.

BACKGROUND: The aim of early treatment of acute myocardial infarction (AMI) is to achieve the rapid reperfusion of the culprit artery, which correlates with improvement in ventricular function and survival. With the widespread use of thrombolytic agents or coronary angioplasty as reperfusion strategies for AMI, it is possible to reduce the amount of myocardial necrosis. HYPOTHESIS: The assessment of residual viability with dobutamine stress echocardiography (DSE) in the infarcted area after AMI is relevant to subsequent management and prognosis. METHODS: Thirty-seven patients with AMI (mean age 59 +/- 12, 31 male, 22 with anterior AMI, 15 with inferior AMI) admitted to the coronary care unit within 3.8 +/- 1.8 h of the onset of symptoms were included. Two-dimensional echocardiography (2-D echo) study and DSE were performed at a mean of 4.7 +/- 1.8 days. Follow-up 2-D echo was performed at a mean of 25 +/- 11 days. To assess left ventricular regional systolic function, 2-D echo images were obtained at rest and during dobutamine-induced stress and were analyzed off-line according to the 13-segment model. Improvement in wall motion score (WMS) was defined by a decrease of at least two grades in the score. RESULTS: Wall motion score improved in 13 of the 37 patients after DSE (rest WMS 20.9 +/- 2.0 vs. D-WMS 17.7 +/- 2.2; p<0.001), which correlated with clinical or angiographic signs of reperfusion of the culprit vessel in all cases. Follow-up WMS evidenced a significant correlation with WMS after DSE (r = 0.91; p < 0.001). Sensitivity, specificity, and positive and negative predictive values of DSE in detecting patients whose left ventricular function (LVF) improved at 2-D echo follow-up were 72,96,92.8, and 82.7%, respectively. CONCLUSIONS: (1) Dobutamine stress echocardiography improved WMS in 35% of patients and correlated with signs of patency of the culprit vessel; (2) LVF improvement after dobutamine was predictive of late LVF recovery; (3) DSE can be a useful and safe tool for detecting reversible myocardial dysfunction after AMI.