Myocardial contrast and transesophageal echocardiographic study of the left coronary artery from the main pulmonary artery.

A case of a 26-year-old woman with thoracic pain and anomalous origin of the left coronary artery from the main pulmonary artery is described. The diagnosis was by coronary angiography and complemented with Doppler and transesophageal myocardial contrast.

[Transthoracic and transesophageal echocardiography in the study of adults with congenital cardiopathy and infectious endocarditis]. / La ecocardiografía transtorácica y transesofágica en el estudio de adultos con cardiopatía congénita y endocarditis infecciosa.

Twenty-four adults (average age 28 years) patients with congenital heart disease were examined; infective endocarditis was diagnosed in all of them by Duke criteria and was confirmed in 18 by surgery and/or pathology. Patients were divided into 2 groups. Group A was made up of 13 patients with left ventricular outflow obstruction, including ten with bicuspid aorta. Group B was made up of 11 patients with shunts (PDA or VSD), either isolated or associated with other abnormalities. The principal alterations associated with the infectious processes were trauma to the endocardium or vascular endothelium from accelerated turbulent flow (jet lesion) and valvular deformities. The principally transesophageal echocardiographic recordings showed infective vegetations on the four cardiac valves, mural endocarditis in both ventricles and right atrium, perivalvular abscesses and fistulae. The echocardiographic information aided in selecting the type of treatment in this group of patients with high intrahospital mortality (25%).

[Transesophageal echocardiography in the study of infected valve prostheses]. / La ecocardiografía transesofágica en el estudio de prótesis valvulares infectadas.

UNLABELLED: Prosthetic valve endocarditis is considered to be associated with more severe prognosis than native valve endocarditis due to inappropriate visualization of vegetations in prosthetics valves by transthoracic echocardiography. OBJECTIVE: The aim of this study was to describe our experience in prosthetic valve endocarditis and compare our results with those published in the literature. The valve of transesophageal approach in the detection of vegetations and complications associated with endocarditis was also assessed. RESULTS: 30 patients with infective endocarditis of prosthetic valve were studied between 1990 and 1997. The infection was located in prosthetic mitral valve in the 70% of the patients, in the aortic prosthetic valve in 24% and in pulmonary valve in one case. Transoesophageal echocardiography showed only vegetations in 22 patients, vegetations complicated with abscess in six patients and only abscess in 2 patients. In 70% of patients (21) surgical treatment was performed and the 30% (9 patients) received only medical treatment. CONCLUSIONS: Prosthetic valve endocarditis carries worse prognosis than native valve endocarditis, with mortality near 23%. Transoesophageal echocardiography is the indicated approach in the diagnosis of prosthetic valve endocarditis.