A Triple Threat: Takayasu Arteritis, Bicuspid Aortic Valve, and Triplets.

Takayasu arteritis is a vasculitis affecting women of reproductive age. Appropriate care of these patients requires a multidisciplinary approach and close monitoring. We present the case of a woman with a triplet gestation and Takayasu arteritis complicated by an ascending aortic aneurysm, aortic regurgitation, and bicuspid aortic valve.

Aortic stenosis catheterization revisited: a long sheath single-puncture technique.

OBJECTIVES: To evaluate the accuracy of a new long sheath single-puncture technique in obtaining accurate transvalvular gradients in aortic stenosis. BACKGROUND: Despite advances in echo Doppler, the evaluation of aortic stenosis continues to be a common procedure in the cardiac catheterization laboratory. Experts agree that simultaneous evaluation of the proximal aortic and left ventricular pressures yields the most accurate data; however, this is difficult to achieve unless two arterial punctures are performed. METHODS: We postulated that using a 4 Fr pigtail catheter inside a 55-cm long 6 Fr sheath would provide accurate simultaneous pressure data, yet avoid the complications of two arterial punctures. We performed this technique in 13 male patients, and placed a second arterial catheter in the aortic root as a control aortic pressure. We then performed this technique in 55 other male patients without placing an additional control arterial catheter. RESULTS: In the test population, correlation of aortic valve areas and transvalvular gradients was excellent. In the larger population, adequate hemodynamic data was obtained in 52 patients, with no difficulty engaging coronary arteries or grafts via the long sheath, and with an acceptable major complication rate of 1.5%. CONCLUSIONS: Using a 4 Fr pigtail catheter with a 55-cm long 6 Fr sheath is a safe, efficient way to obtain excellent hemodynamic data in an aortic stenosis catheterization procedure.

Use of an outcomes research collaborative training curriculum to enhance entry-level dietitians' and established professionals' self-reported understanding of research.

This project pilot tests a unique outcomes research training curriculum that prepares entry-level dietitians (goal 1) and provides established dietetics professionals with the resources to successfully execute an outcomes research plan (goal 2). The learning objectives for each goal were met via lectures and assignments in two courses, one taught in the fall and one in the winter semester of the second (senior) year of the Coordinated Program at the University of Missouri. At their respective healthcare facilities, registered dietitian (RD) preceptors along with the students progressed through all stages of the research process, from proposal development to data presentation. At the completion of the process, a questionnaire was administered to students and preceptors to evaluate the curriculum. Fourteen of the 15 possible student respondents and four of the five possible RD preceptors returned their questionnaires. Salient findings as well as actions to be taken in subsequent course offerings include: (a) clarify expectations, (b) limit geographical distance, (c) increase in-class time, (d) limit project scope, (e) add more statistics training/practice, (f) introduce outcomes research earlier, (g) preceptors' participation was positive. This endeavor allowed us to acquire the information and experience required to make outcomes research training a more significant component of dietetics education.

Comparison of real-time coherent contrast imaging to dipyridamole thallium-201 single-photon emission computed tomography for assessment of myocardial perfusion and left ventricular wall motion.

Real-time coherent contrast imaging (CCI) echocardiography has the ability to evaluate wall motion and myocardial perfusion simultaneously, but its clinical applicability in the diagnosis of coronary artery disease (CAD) remains to be determined. This study examines the level of agreement between real-time CCI echocardiography and thallium-201 single-photon emission computed tomography (SPECT) following stress vasodilation. Forty-two patients with known or suspected CAD underwent real-time CCI using octafluoropropane-filled microspheres infusion before and after dipyridamole and thallium-201 injections. The apical 4- and 2-chamber views were each divided into 6 segments to assess wall motion and perfusion. Real-time CCI and SPECT were interpreted independently. Thirty-eight patients successfully completed tests, and 4 had suboptimal contrast images. Each vascular territory was classified as normal or abnormal by CCI perfusion, wall motion, and SPECT at baseline and at stress. Of the 114 territories (3 in each of the 38 patients), 3 (3.5%) were not analyzed; however, all territories corresponding to the left anterior descending artery were suitable for analysis. Concordance between CCI echocardiography and thallium-201 SPECT perfusion for left anterior descending, left circumflex, and right coronary artery territories were 91%, 86%, and 69%, respectively; between CCI perfusion and wall motion, the correlations were 93%, 93%, and 91%, respectively. When CCI perfusion and wall motion analysis were combined, their concordance to thallium-201 SPECT uptake improved to 94%, 89%, and 79%, respectively. In conclusion, real-time CCI echocardiography agrees very closely with thallium-201 SPECT in assessing myocardial perfusion following vasodilatory stress. Assessment of myocardial perfusion, in addition to segmental wall motion analysis, during stress echocardiography may be a significant contribution to the noninvasive evaluation of patients with ischemic heart disease.