BACKGROUNDCongenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR). The diagnosis and treatment of the disease were reported in 11 cases.

METHODSEleven patients (nine men and two women, mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated. Medical records, echocardiograms and surgical treatment were reviewed.

RESULTSIn accordance with the Hurwitz and Roberts classification, the patients were classified as type A (n = 2), type B (n = 7), type F (n = 1) and type G (n = 1). Three patients were associated with other heart diseases, including infective endocarditis and mitral prolaps, left superior vena cava, aortic aneurysm. All had aortic regurgitation (AR) except two with aortic stenosis (AS), detected by color-flow Doppler echocardiography. The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography. All patients underwent successful aortic valve replacement.

CONCLUSIONQuadricuspid aortic valve is a rare cause of aortic insufficiency, while echocardiography plays an important role in diagnosing the disease. Aortic valve replacement is the major therapy for the disease.

Adolescent ; Adult ; Aortic Valve ; abnormalities ; Aortic Valve Insufficiency ; diagnosis ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Young Adult

BACKGROUND: Aortic valve endocarditis(AVE) may produce secondary involvement of the mitral aortic-intervalvular fibrosa(MAIVF) and the anterior mitral valve leaflets(AMVL). These complications may result in the systolic regurgitation of blood from the left ventricular outflow tract into the left atrium, or formation of an aneurysm or perforation of the AMVL. Early recognition of these complications is important for optimal management and corrective surgery. The aims of the persent study were to examine the utility of transesophageal echocardiography(TEE) in the diagnosis of these subaortic complications compared to conventional transthoracic echocardiography(TTE) and to observe the prevalence and pattern of these complications. METHOD: Both TTE and TEE were performed in patients with AVE from June 1991 to June 1993. A 2.5 MHz probe was used for TTE and a 5 MHz biplane one for TEE with Hewlett Packard SONOS 1,000 All procedures were recorded in super VHS tape and reviewed by two experienced cardiologist. AVE was diagnosed clinically by the presence of continuous bacteremia or demonstration of vegetations during open heart surgery. RESULT: Ten consecutive patients with AVE underwent TTE and TEE of these patients, 6(60%) had involvement of subaortic structures, including one with an abscess in the MAIVF, two with perforation of the MAIVF into the left atrium, one with multiple vegetations in the AMVL, and two with pseudoaneurysm formation and perforation of the AMVL, TEE visualized all these lesions with high resolution images, whereas TTE detected only multiple vegetations in the AMVL in one patients and eccentric mitral regurgitation of unknown etiology in 2 patients. In 4 patients, corrective surgery was performed in which the TEE findings were confirmed. CONCLUSION: The results implicate that 1) involvement of the subaortic structures would be a common complication in patients with AVE, 2) TEE is superior to conventional TTE in the detection of these complications, and 3) routine screening with TEE would be necessary in patients with AVE to diagnose or exclude these subaortic complications.
Abscess ; Aneurysm ; Aneurysm, False ; Aortic Valve* ; Bacteremia ; Diagnosis ; Echocardiography* ; Echocardiography, Transesophageal ; Endocarditis* ; Heart Atria ; Humans ; Mass Screening ; Mitral Valve ; Mitral Valve Insufficiency ; Prevalence ; Thoracic Surgery

OBJECTIVETo determine whether preoperative contrast delay-enhanced cardiovascular magnetic resonance imaging (DE-CMR) could help predict long-term survival of patients with severe chronic aortic regurgitation and extremely dilated left ventricular chamber after aortic valve replacement.

METHODSTotally 37 patients enrolled between February 2008 and November 2010 with severe chronic aortic regurgitation and extremely dilated left ventricular chamber, who met the echo criteria, that was left ventricular end diastolic dimension > 70 mm or left ventricular end systolic dimension > 55 mm, and were scheduled to the surgery. The 2-dimensional echocardiographic examinations and CMR with late gadolinium-enhancement (LGE) were performed routinely preoperatively. According to the results of CMR, the patients were divided into 2 groups: the LGE positive(+) group and LGE negative(-) group. The association of LGE with event free survival, postoperative cardiac function and postoperative hospital stay time was investigated. Fifteen patients had significant LGE signals in CMR films, while the other twenty-two were silent. All of them received the operative procedures, including aortic valve replacement in 28 cases, Bentall procedure in 3 cases, aortic valve replacement and ascending aorta replacement in 6 cases, and concomitant mitral valve repair in 11 cases.

RESULTSOver a follow-up of 33.6 months, 1-year, 2-year and 3-year event free survival rates in LGE(-) group were 94.7%, 88.4%, and 72.6%, respectively, compared to 80.0%, 48.9%, and 32.6%, respectively in LGE(+) group (χ(2) = 7.244, P = 0.007). The postoperative hospital stay time of LGE(-) group was (9 ± 2) days, which of LGE(+) group was (10 ± 3) days (t = 1.175, P = 0.248).

CONCLUSIONSLGE positive signal in CMR films is a potential predictor of persistent cardiac failure after aortic valve replacement for patients with severe chronic aortic regurgitation and extremely dilated left ventricular chamber. It has intimate relationship with malignant arrhythmia and sudden death, which makes it a valuable technique in preoperative evaluation and risk stratification.

Aortic Valve Insufficiency ; complications ; diagnosis ; surgery ; Follow-Up Studies ; Humans ; Hypertrophy, Left Ventricular ; complications ; diagnosis ; surgery ; Magnetic Resonance Imaging ; methods ; Postoperative Period ; Prognosis

Infective endocarditis carries high risk of morbidity and mortality. Rapid diagnosis and effective treatment are essential to good patient outcome. However, nonspecific symptoms and various clinical manifestations make early diagnosis difficult. Here we report on an unusual case of infective endocarditis initially presenting as acute pyelonephritis (APN). A 44-year-old female with a history of heart surgery was admitted for fever and both flank pain. The patient had undergone dental extraction 3 weeks prior to admission. Her lab work and physical examination revealed pyuria, positive bacterial culture of both blood and urine, costovertebral knocking tenderness, and CT findings consistent with APN, leading to her initial diagnosis as APN. Despite treatment with antibiotics, her symptoms did not improve while further physical examination revealed newly developed Osler's nodes and Janeway lesions. Echocardiography showed vegetation of the aortic valve with severe aortic regurgitation. She was diagnosed as a case of infective endocarditis and was treated successfully.
Adult ; Anti-Bacterial Agents ; Aortic Valve ; Aortic Valve Insufficiency ; Diagnosis ; Early Diagnosis ; Echocardiography ; Endocarditis* ; Endocarditis, Bacterial ; Female ; Fever ; Flank Pain ; Humans ; Mortality ; Physical Examination ; Pyelonephritis* ; Pyuria ; Staphylococcus aureus ; Thoracic Surgery

BACKGROUND: We evaluated the efficacy of the cardiopulmonary exercise test as an objective indicator of functional status and as a pre-operative prognostic indicator in patients with mitral regurgitation (MR) and aortic regurgitation (AR). METHODS: Cardiopulmonary exercise tests and echocardiography were performed in 47 patients (MR: 30, AR: 15, MR + AR: 2) before surgery and repeated one year after surgery. We compared the New York Heart Association (NYHA) functional class, peak oxygen consumption rate (VO2peak), exercise duration, left ventricular dimension and ejection fraction, before and after surgery. RESULTS: Initial VO2peak and exercise duration were significantly different according to NYHA class. A year later, NYHA functional class improved from 2.1+/-0.1 to 1.4+/-0.1 (p< 0.001). The VO2peak was significantly increased (21.7+/-1.0 to 23.7+/-1.0 mL/kg per min, p=0.008) and exercise duration also increased (521.7+/-35.9 to 623.3+/-35.7 seconds, p< 0.001). When patients were analysed according to their post-operative NYHA functional class, those with class I showed significantly different pre-operative VO2peak (class I: 23.7+/-1.1, II: 18.3+/-1.5 mL/kg per min, p=0.005) and exercise durations (class I: 587.5+/-43.2, II: 415.6+/-55.7 seconds, p=0.02). Patients with higher pre-operative VO2peak (19.0 mL/kg per min) more frequently became NYHA functional class I than those with a lower pre-operative VO2peak (76.7% vs. 35.3%, p=0.02). But baseline left ventricular dimension and ejection fraction by echocardiography were not different between post-operative class I and II group. CONCLUSION: VO2peak and exercise duration are excellent parameters to evaluate the subjective functional class and to predict the post-operative functional class of patients with MR and/or AR. Patients with a pre-operative VO2peak of 19.0 mL/kg per min or more will have a better functional status one year after surgery.
Adult ; Aortic Valve Insufficiency/diagnosis/*surgery ; Chi-Square Distribution ; Cohort Studies ; Exercise Test ; Exercise Tolerance ; Female ; Follow-Up Studies ; Heart Valve Prosthesis Implantation/*methods ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency/diagnosis/*surgery ; Oxygen Consumption ; Postoperative Period ; Preoperative Care ; Probability ; Prospective Studies ; Pulmonary Gas Exchange ; Severity of Illness Index ; Statistics, Nonparametric ; Stroke Volume ; Treatment Outcome

The causes of abnormal T waves on electrocardiography are multiple and varied. Careful clinical history taking and physical examination are necessary for accurate identification of the cause of such abnormalities. Subsequent targeted specialised cardiac investigations, such as echocardiography or coronary angiography, may be of importance in the diagnosis of the underlying cardiac pathology. We present two cases of T wave inversions with markedly different aetiologies.
Aged, 80 and over ; Angioplasty, Balloon, Coronary ; methods ; Aortic Valve Insufficiency ; diagnosis ; diagnostic imaging ; surgery ; Cardiomyopathy, Hypertrophic ; diagnosis ; Coronary Angiography ; methods ; Echocardiography, Doppler ; methods ; Electrocardiography ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; therapy ; Sampling Studies ; Severity of Illness Index ; Treatment Outcome