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LVOTO caused by downwards tilted mitral-valve-bioprosthesis Part 1
about 30 y old patient with condition after implantation of bioprosthesis in mitral-valve- and aortic-valve-position in africa (NO documents available; indication isn´t known: mitral-valve- and aortic stenosis caused by rheumatic fever?? The patient told that the cardiac valves were very stiff.). The patient was admitted to our ER with recurrent subfebrile fever and dyspnoea, In TTE we found a very interesting result: the mitral-valve bioprosthesis seemed to be downwards tilted into the LVOT with obstruction of LVOT (PG mean 45 mmHg!!). The aortic valve was presented tenuous without pathological gradient but a little bit to small in its diameter.
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about 30 y old patient with condition after implantation of bioprosthesis in mitral-valve- and aortic-valve-position in africa (NO documents available; indication isn´t known: mitral-valve- and aortic stenosis caused by rheumatic fever?? The patient told that the cardiac valves were very stiff.). The patient was admitted to our ER with recurrent subfebrile fever and dyspnoea, In TTE we found a very interesting result: the mitral-valve bioprosthesis seemed to be downwards tilted into the LVOT with obstruction of LVOT (PG mean 45 mmHg!!). The aortic valve was presented tenuous without pathological gradient but a little bit to small in its diameter.
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acute pulmonary embolism
about 90 y old patient with sudden drop down without dyspnoea but hypotension, tachycardia. In TTE I could visualize that echocardiographic picture of RV-ballooning with D-sign of LV. New high grade tricuspid valve insufficiency (PAPs ca. 40 mmHg + CVP) in comparison with prior echocardiographic results. Unfortunately the patient had also a fracture of the right leg with bleeding complication caused by the drop.
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about 90 y old patient with sudden drop down without dyspnoea but hypotension, tachycardia. In TTE I could visualize that echocardiographic picture of RV-ballooning with D-sign of LV. New high grade tricuspid valve insufficiency (PAPs ca. 40 mmHg + CVP) in comparison with prior echocardiographic results. Unfortunately the patient had also a fracture of the right leg with bleeding complication caused by the drop.
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Another HOCM Part 2
here the TEE of further patient with severe HOCM with SAM of AMS and following high grade mitral valve insufficiency and fluttering aortic valve respectively mesosystolic closure of aortiv valve (unfortunately I still can´t convert my M-Mode-pictures of SAM and mesosystolic closure of aortic valve).
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here the TEE of further patient with severe HOCM with SAM of AMS and following high grade mitral valve insufficiency and fluttering aortic valve respectively mesosystolic closure of aortiv valve (unfortunately I still can´t convert my M-Mode-pictures of SAM and mesosystolic closure of aortic valve).
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infected malignant pericardial and pleural effusion
about 60 y old patient with known metastasised lung cancer with condition after radiatio and chemotherapy but with distinct progress under that therapy. The patient was admitted to our ER with severe dyspnoe, tachykardia, hypotension, \"kussmaul\"-sign (inspiratory dilated jugular veins) and peripheral low voltage in ECG. In TTE we could see a pleural and pericardial severe effusion with signs of tampoonade (collapse of RA and RV, undulation of transtricuspidal flow > 45%) and dilated IVC. The results of tapping showed an infection (> 500 leucocytes/µl and malignant cells).
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about 60 y old patient with known metastasised lung cancer with condition after radiatio and chemotherapy but with distinct progress under that therapy. The patient was admitted to our ER with severe dyspnoe, tachykardia, hypotension, \"kussmaul\"-sign (inspiratory dilated jugular veins) and peripheral low voltage in ECG. In TTE we could see a pleural and pericardial severe effusion with signs of tampoonade (collapse of RA and RV, undulation of transtricuspidal flow > 45%) and dilated IVC. The results of tapping showed an infection (> 500 leucocytes/µl and malignant cells).
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Another HOCM
Abozt 70 y old patient with suspicioon of sinu-atriale bradycardia and dyspnoea. In TTE we found a distinct lv-hypertrophy with LVOTO (PGmax. 110 mmHg) at rest!! and a consecutive high grade mitral valve insufficiency.
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Abozt 70 y old patient with suspicioon of sinu-atriale bradycardia and dyspnoea. In TTE we found a distinct lv-hypertrophy with LVOTO (PGmax. 110 mmHg) at rest!! and a consecutive high grade mitral valve insufficiency.
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severe mitral insufficiency caused by mitral valve prolapse
about 50 y old man with distinct dyspnoea in context of lung oedema. In TTE and TEE we found a severe mitral valve insufficiency with regurgitation in pulmonary veins caused by mitral valve prolapse in context of rupture of chorda tendinea. The reason of the ruptur of chorda tendinea is not clear: no myocardial ischemia (no elevated troponin, no coronary occlusion in cardiac catheter) and no sign of endocarditis (no elevated values of inflammation). Some idea? After recompensation the patient was admitted to cardiac surgery for mitral valve reconstruction.
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about 50 y old man with distinct dyspnoea in context of lung oedema. In TTE and TEE we found a severe mitral valve insufficiency with regurgitation in pulmonary veins caused by mitral valve prolapse in context of rupture of chorda tendinea. The reason of the ruptur of chorda tendinea is not clear: no myocardial ischemia (no elevated troponin, no coronary occlusion in cardiac catheter) and no sign of endocarditis (no elevated values of inflammation). Some idea? After recompensation the patient was admitted to cardiac surgery for mitral valve reconstruction.
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Eustachian Valve on TEE
A linear structure is noted extending from the interatrial septum to the posterior aspect of the RA, consistent with a eustachian valve.
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A linear structure is noted extending from the interatrial septum to the posterior aspect of the RA, consistent with a eustachian valve.
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post-interventional VSD
about 60 y old patient with condition after ablation of high symptomatic ventricular extrasystole in inferior mid-septale position by EPU 2 weeks ago. The patient have had dyspnoea and orthpnoea for 2 weeks: in TTE I could see the echocardiographic picture of a VSD. To evaluate and measure the Qp/ Qs-quotient via VTI in RVOT and LVOT I did a TEE. You can see the echocardiographic picture of an aneurysm in mid-septale inferior position with perforation. The haemodynamic measurement obtained following information: right-ventricular stroke-volumen about 100 ml; LV-stroke-volume about 40 ml, shunt-volume about 60 ml. Qp/ Qs > 2 We have the suspicion of a peri-/postinterventinal VSD caused by ablation in the course of EPU 2 weeks ago.
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about 60 y old patient with condition after ablation of high symptomatic ventricular extrasystole in inferior mid-septale position by EPU 2 weeks ago. The patient have had dyspnoea and orthpnoea for 2 weeks: in TTE I could see the echocardiographic picture of a VSD. To evaluate and measure the Qp/ Qs-quotient via VTI in RVOT and LVOT I did a TEE. You can see the echocardiographic picture of an aneurysm in mid-septale inferior position with perforation. The haemodynamic measurement obtained following information: right-ventricular stroke-volumen about 100 ml; LV-stroke-volume about 40 ml, shunt-volume about 60 ml. Qp/ Qs > 2 We have the suspicion of a peri-/postinterventinal VSD caused by ablation in the course of EPU 2 weeks ago.
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Is it an ARVD?
about 22 y old patient with new oedema of lower limb. In TTE we could see an enlarged right ventricle with good RV-function (TAPSE about 23 mm, TASV about 11 cm/sec) despite of a pulmonary hypertension of about 45 mmHg + CVP. There is no SCD in family history, no syncope, no arrhythmics. In ECG we could see an isolated right-ventrcular prolongation (QRS 1-3/QRS 4-6 = 1,39!!). What do you think could this be an ARVD? Do you know some specific echocardiographic signs of this kind of cardiomyopathy?
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about 22 y old patient with new oedema of lower limb. In TTE we could see an enlarged right ventricle with good RV-function (TAPSE about 23 mm, TASV about 11 cm/sec) despite of a pulmonary hypertension of about 45 mmHg + CVP. There is no SCD in family history, no syncope, no arrhythmics. In ECG we could see an isolated right-ventrcular prolongation (QRS 1-3/QRS 4-6 = 1,39!!). What do you think could this be an ARVD? Do you know some specific echocardiographic signs of this kind of cardiomyopathy?
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pericardial effusion with fibrinous strands
pericardial effusion with fibrinous strands,apical view.etiology:tuberculosis.
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pericardial effusion with fibrinous strands,apical view.etiology:tuberculosis.
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Tachy-Cardiomyopathy
About 50 y old patient with atrial fibrillation (HR about 150-170/min); the patient told clinical afflictions in the course of time of 3 weeks. In TTE we found a distinct LV-motion disorder and decrease of LV-EF. After exclusion of thrombus in LAA by TEE we did the elektrical cardioversion. After 1 week we saw a distinct improvement of LV-function.
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About 50 y old patient with atrial fibrillation (HR about 150-170/min); the patient told clinical afflictions in the course of time of 3 weeks. In TTE we found a distinct LV-motion disorder and decrease of LV-EF. After exclusion of thrombus in LAA by TEE we did the elektrical cardioversion. After 1 week we saw a distinct improvement of LV-function.
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Mild LV-wall disturbance detected by speckle-pattern
About 45 y old patient with the typical clinical afflictions of acute coronary syndrom. in TTE I couldn´t see a LV-wall-motion-disorder. In Speckle-tracking/-pattern study I found a mild LV-wall-motion-disturbance. Troponin was positive. In coronary study we found a high-grade stenosis of RIVA compatible with the results of speckle-pattern-study. What do you think? Does anybody have any experiences with that kind of stuff? Is it a suitable kind of study?
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About 45 y old patient with the typical clinical afflictions of acute coronary syndrom. in TTE I couldn´t see a LV-wall-motion-disorder. In Speckle-tracking/-pattern study I found a mild LV-wall-motion-disturbance. Troponin was positive. In coronary study we found a high-grade stenosis of RIVA compatible with the results of speckle-pattern-study. What do you think? Does anybody have any experiences with that kind of stuff? Is it a suitable kind of study?
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pda
30y,f,ll edema,eye puffiness,..nephrotic $,cardiomeg in cxr,echo:p.effusion,accidental pda pt is highly echo genic
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30y,f,ll edema,eye puffiness,..nephrotic $,cardiomeg in cxr,echo:p.effusion,accidental pda pt is highly echo genic
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infective endocarditis on mitral stenosis2
infective endocarditis on mitral stenosis:stuck vegetation between the two leaflets of the mitral valve(with eccentric mitral regurgitation and mild aortic regurgitation)
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infective endocarditis on mitral stenosis:stuck vegetation between the two leaflets of the mitral valve(with eccentric mitral regurgitation and mild aortic regurgitation)
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Lambl's excresence?
In this zoom view of the aortic valve in parasternal long axis TTE, a small filamentous structure is visible on the ventricular side of the valve. Would you characterize this as a Lambl's excresence or would you even comment on it in a report?
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In this zoom view of the aortic valve in parasternal long axis TTE, a small filamentous structure is visible on the ventricular side of the valve. Would you characterize this as a Lambl's excresence or would you even comment on it in a report?
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Prominent crista and lipomatous hypertrophy of the interatrial septum
In this apical 4 chamber TTE clip, the interatrial septum is thickened consistent with lipomatous hypertrophy and there is a rounded density in the posterior right atrium consistent with a prominent crista terminalis.
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In this apical 4 chamber TTE clip, the interatrial septum is thickened consistent with lipomatous hypertrophy and there is a rounded density in the posterior right atrium consistent with a prominent crista terminalis.
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Tako Tsubo cardiomyopathy
about 50 y old patient with severe posttraumatic stress disorder caused by death of near relative. The patient was admitted to out ER/ ICU with distinct and typical clinical affliction of acute coronary syndrome. Troponine I 0,8 (normal till 0,023), CK 210 U/l. In ECG we could see repolarisation disturbance without signs of ST-elevations. In TTE you can see myocardial movent disorder of apical LV-wall like an apical ballooning. No disturbance of RV. No US-B-lines, no pleural effusion, no sign of LVOTO despite the echocardiographic picture of hyperdynamic basal LV-wall-segments. In cardiac catheter no sign of coronary disease; we could see in cardiac catheter the typical movement disorder of Tako-Tsubo-CM as we could see in TTE before. One question to the community: Is there ALWAYS a need for cardiac catheter if we see the typical echocardiographic picture of apical ballooning/ Tako-Tsubo-CM?
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about 50 y old patient with severe posttraumatic stress disorder caused by death of near relative. The patient was admitted to out ER/ ICU with distinct and typical clinical affliction of acute coronary syndrome. Troponine I 0,8 (normal till 0,023), CK 210 U/l. In ECG we could see repolarisation disturbance without signs of ST-elevations. In TTE you can see myocardial movent disorder of apical LV-wall like an apical ballooning. No disturbance of RV. No US-B-lines, no pleural effusion, no sign of LVOTO despite the echocardiographic picture of hyperdynamic basal LV-wall-segments. In cardiac catheter no sign of coronary disease; we could see in cardiac catheter the typical movement disorder of Tako-Tsubo-CM as we could see in TTE before. One question to the community: Is there ALWAYS a need for cardiac catheter if we see the typical echocardiographic picture of apical ballooning/ Tako-Tsubo-CM?
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LV False tendon 2
Another example of a LV false tendon in this apical 3 chamber clip.
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Another example of a LV false tendon in this apical 3 chamber clip.
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