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Comprehensive Echocardiography Case Studies
Patient presents with a loud murmur but no functional limitation. Echo shows severe posteriorly directed mitral regurgitation. TEE shows ruptured chord. Patient became increasingly short of breath and ultimately had a robotic mitral valve repair.
Patient presents with retinal embolization. TEE shows Lambl excrescences on the aortic valve. There was a history of atrial fibrillation and the patient was taking Xarelto. TEE did not show left atrial thrombus or aortic atheroma. Patient underwent open aortic valve replacement.
64 year old presents with exertional shortness of breath. Transthoracic echocardiogram reveals thick and calcified aortic valve leaflets with restricted motion. Peak transaortic gradient 99 mmHg and aortic valve area of 0.5 cm2. TAVR performed with excellent result.
26 yo M presents with history of valve disease but details are uncertain. Exam reveals 3/6 systolic ejection murmur at the left sternal border radiating to the upper left sternal border. No cyanosis, clubbing, or edema of the extremities. Continuous wave Doppler in the short axis projection across the pulmonary valve demonstrates a gradient of 67 mmHg.
55 year old with recent non-STEMI and complex stenting of the circumflex requiring multiple stents. Transthoracic echocardiogram revealed aortic regurgitation at the base of the leaflet rather than at the commissures where it is usually found. TEE demonstrates aortic regurgitation behind the aortic leaflet. We suspect aortic insufficiency was secondary to trauma to the leaflet at the time of complex PCI.
76 year old female presents with stroke. CTA shows occlusion of right - sided M2 vessel affecting flow to M3 and M4. Carotids are normal. Transthoracic echocardiography demonstrates papillary fibroelastoma.
87 yo presents with severe lower extremity edema. Fixed splitting of S2 with accentuated P2. No rales. Severe lower extremity edema does not respond to aldoctone 100 mg POQD and torsemide 40 mg POBID and metolazone 2.5 mg 3 times per week. Transthoracic echocardiogram shows flattening of the septum in systole and diastole, consistent with pulmonary hypertension. Pulmonary artery systolic pressure is 82 millimeters of mercury.
62 year old presents with history of stroke and lower extremity edema. Physical exam is unremarkable. Transthoracic echocardiography reveals calcified mass along the posterior mitral annulus. Mass was removed by thoracic surgery who placed a bioprosthetic mitral valve.
25 year old presents with shortness of breath and murmur. Physical exam shows to and fro murmur across the left sternal border. Transthoracic echocardiography demonstrates a bicuspid aortic valve with moderate to severe aortic insufficiency. Patient does not want a prosthetic aortic valve and finds a surgeon who is willing to repair the valve.
No clinical history. Bicuspid aortic valve with incidentally detected aortic dissection. Patient treated with aortic valve replacement and replacement of the aortic root.
66 year old male with 80 pack year history of cigarettes presents with shortness of breath and coughing. Chest X-ray shows bilateral pleural effusions. CT scan shows 17 mm pericardial effusion. Physical exam showed JVD to the ankle of the jaw. Transthoracic echocardiogram shows right ventricular diastolic collapse and right atrial diastolic collapse. Doppler mitral valve inflow shows a 25% collapse with inspiration. 450 cc of pericardial fluid removed.
69 year old female with worsening shortness of breath. Physical exam demonstrated a typical mitral stenosis murmur. ECHO showed severe mitral stenosis with a Wilkins score of 4. Patient underwent mitral valvuloplasty with an Inoue balloon. Submitted by Abdelkader Almanfi, M.D., Houston, TX
51 year old male presents with palpitations but no chest pain or shortness of breath. Transthoracic echocardiogram shows a large left atrial myxoma attached to the posterior atrial septum, prolapsing through the mitral valve. Submitted by Jinesh Shah, M.D., Webster, TX
22 year old male who is completely asymptomatic. Non-compaction cardiomyopathy is picked up incidentally by echocardiogram. MRI with gadolinium showed no enhancement. Treated with carvedilol and lisinopril. Submitted by Martin O’Riordan, Darby, PA
Stage IV congestive heart failure, unresponsive to diuretics, severe mitral regurgitation, referred to HCA Houston for mitral clip, arrested on the catheterization table, TEE during mitral clip Video courtesy of Pranav Loyalka at HCA Houston
Patient presents with vertigo and nausea. MRI confirms posterior circulation CVA. 14 day monitor shows no atrial fibrillation. Bubble study confirms right to left shunt.udy
86 year old with intermittent shortness of breath and nonpitting lower extremity edema. Transthoracic echocardiogram in apical four chamber view shows normal sized right and left ventricles with large atria. Criteria for restrictive cardiomyopathy from the Mayo Clinic presented.
76 year old who presents with lower extremity edema. Difficult to manage fluid status without causing syncope. 2D imaging of the myocardium shows "speckling". Polar strain map demonstrates apical sparing typical of amyloidosis.