Delayed Tamponade After Transseptal Puncture: Focus on the Mechanism of a Rare But Life-Threatening Complication.

Transseptal puncture (TSP) has evolved into a key step during various percutaneous interventions. We present a case of delayed TSP-related tamponade, which underscores the importance of vigilance even during commonly performed procedures. TSP is safest when the puncture is through the fossa ovalis, with increased risk in patients with certain anatomic features (eg, small or diminutive fossa).

Large Free-Floating Left Atrial Ball Thrombus With Intermittent Mitral Valve Occlusion.

An 83-year-old man with known history of atrial fibrillation presented for preoperative evaluation for elective left nephrectomy for cancer. Transthoracic echocardiogram revealed a large, free-floating, left atrial mass. Further profiling with transesophageal echocardiogram showed a free-floating mass intermittently obstructing the mitral valve.

Spontaneous Migration of Ventriculoperitoneal Shunt Into the Right Heart and Pulmonary Vasculature.

A 73-year-old woman with ventriculoperitoneal (VP) shunt presented for stress echocardiogram for evaluation of chest pain. Transthoracic echocardiogram revealed an incidental right heart mass representing a migrated VP shunt. This case highlights the role of multimodality cardiac imaging in diagnosing right heart masses and the multidisciplinary approach to management.

Electrocardiogram Criteria to Diagnose Cardiac Amyloidosis in Men With a Bundle Branch Block.

Diagnosing cardiac amyloidosis is challenging and requires a high index of suspicion in patients with an increased left ventricular wall thickness (LVWT). Low QRS voltage on electrocardiogram (ECG) has been regarded as the hallmark ECG finding in cardiac amyloidosis; however, the presence of low voltage can range from 20-74% and the voltage/mass ratio carries a greater diagnostic accuracy than QRS voltage alone. Patients with cardiac amyloidosis can have conduction system infiltration and this may result in a BBB.

Congenital Double-Chambered Left Ventricle Presenting as Monomorphic Ventricular Tachycardia.

• DCLV is a rare congenital defect. • Echocardiographic findings include a muscular ridge in the left ventricle. • Cardiac MRI can differentiate DCLV from pseudoaneurysm or aneurysm.

Impedance to retrograde and forward flow in chronic mitral regurgitation and the physiology of a double outlet ventricle.

Objective: Mitral regurgitation (MR) is generally characterised as exhibiting a 'low impedance leak into the left atrium'. This notion is widely accepted without measured impedance data. The aim of this study was to define the impedance to retrograde and forward blood flow and to examine hydraulic (pressure-volume) and mechanical (stress-shortening) function in chronic severe MR.

Mycotic aneurysms of the ascending aorta in the absence of endocarditis.

Mycotic aneurysm formation is a rare and potentially fatal sequela of bacteremia. We present the cases of 2 octogenarians who had surgically confirmed mycotic aneurysms that involved the ascending aorta, with contained rupture (pseudoaneurysm). Neither patient had evidence of valvular endocarditis.

Differential effects of dobutamine versus treadmill exercise on left ventricular volume and wall stress.

Background: Dobutamine and exercise echocardiography are well-validated modalities used for the evaluation of patients with suspected myocardial ischemia. Patients undergoing dobutamine stress echocardiography (DSE), however, experience less angina, ST-segment depressions, and wall motion abnormalities. Other than the effect on heart rate, the physiologic and volumetric differences between pharmacologic and exercise-induced stress that affect myocardial oxygen demand are not well defined.

Cardiac events in patients with negative maximal versus negative submaximal dobutamine echocardiograms undergoing noncardiac surgery: importance of resting wall motion abnormalities.

Objectives: This study sought to evaluate the negative predictive value (NPV) of preoperative dobutamine stress echocardiography (DSE) in patients who fail to achieve target heart rate (HR) and assess the influence of resting wall motion abnormalities (WMAs) without demonstrable ischemia on perioperative events.

Background: The prognostic value of a negative-submaximal DSE study before noncardiac surgery is unknown.

Methods: Consecutive patients (n = 429) who underwent surgery over a three-year period, preceded by DSE, were included.

Paradoxical embolism in the left main coronary artery: diagnosis by transesophageal echocardiography.

We describe a patient with a paradoxical coronary embolism diagnosed by transesophageal echocardiography. The patient developed a stroke followed by a myocardial infarction. Coronary angiography showed an obstruction of the left main coronary artery.