M-mode and cross-sectional echocardiographic features of flail aortic leaflets

The echocardiographic features in seven patients with flail aortic leaflets are described and are correlated with the anatomical appearance of the valve at the time of surgery or autopsy. M-mode echocardiography showed coarse and "shaggy" diastolic echoes within the aortic root and thickening of the aortic leaflets during systole in all patients. Six patients had coarse and "shaggy" diastolic echoes within the left ventricular outflow tract in continuity with similar echoes within the aortic root. Cross-sectional echocardiography in three patients revealed a cord-like mass prolapsing into the left ventricular outflow tract during diastole. Three of the patients had no vegetations at the time of surgery. Both modes of echocardiography are of value in demonstrating abnormal echoes prolapsing into the left ventricular outflow tract, characteristic of flail aortic leaflets that can occur in the presence or absence of vegetations.     

Unusual echocardiographic appearance of intracardiac thrombi in a patient with endomyocardial fibrosis.

A five year old girl presented with a four month history of recurrent heart failure, which subsequently proved to be caused by endomyocardial fibrosis. There was no evidence of valvar disease. Echocardiography showed several echogenic masses with echolucent centres within the cardiac cavity. Histological examination showed that these masses were partly organised thrombus.     

Mitral valve aneurysm: M-mode and two-dimensional echocardiographic features

The following report presents M-mode and two-dimensional echocardiographic findings in a case of mitral valve aneurysm. M-mode echocardiography showed abnormal intravalvular echoes during diastole and a linear echo in the left atrium, with a motion pattern similar to that of the anterior mitral valve leaflet. By allowing visualization of the aneurysmal sac, two-dimensional echocardiography proved to be a more specific diagnostic method.     

Unusual echocardiographic appearance of intracardiac thrombi in a patient with endomyocardial fibrosis

A five year old girl presented with a four month history of recurrent heart failure, which subsequently proved to be caused by endomyocardial fibrosis. There was no evidence of valvar disease. Echocardiography showed several echogenic masses with echolucent centres within the cardiac cavity. Histological examination showed that these masses were partly organised thrombus.     

Eosinophilia and endomyocardial fibrosis.

A 12 year old boy died after a 3 year course of recurrent and progressive heart failure. His cardiac symptoms began with a marked leukocytosis (white blood cell count 188,500/mm3) due to eosinophilia (90 percent). In 6 months, the leukocytosis and eosinophilia subsided, but the patient's heart failure progressed over the next 2 1/2 years. At autopsy there was no evidence of leukemia, but a severe endocardial fibrosis extending into the myocardium was found. The origin of endomyocardial fibrosis, although unknown, appears to have been related to the eosinophilia in this patient.     

Clinical course of endomyocardial fibrosis.

The survival pattern, morbidity, and clinical course of 145 patients with endomyocardial fibrosis who were followed up between November 1975 and June 1987 were studied. The diagnosis was confirmed in all cases by cardiac angiography, or echocardiography, or necropsy. Percentage survival at the end of one and 9.5 years was 76.11 and 26.35 respectively. History, physical examination, electrocardiography, and cardiac catheterisation were studied at the first presentation. The determinants of early mortality were studied by univariate Kaplan-Meier estimates compared by the log rank test and Cox proportional hazards multiple regression analysis. Significant univariate predictors of early mortality were QRS axis above +90 degrees, intraventricular conduction delay (QRS duration greater than 0.12 s), duration of symptoms before presentation, New York Heart Association functional classes III and IV, presence of embolic episodes, right atrial mean pressures greater than 20 mm Hg, right ventricular end diastolic pressure greater than 20 mm Hg, and aortic oxygen saturation less than 85%. The significant multivariate predictors of mortality were cyanosis, New York Heart Association functional class at first presentation, and right atrial mean pressure greater than 20 mm Hg. The bleak prognosis of endomyocardial fibrosis did not substantially improve despite advances in the medical management of congestive cardiac failure during the period of the study.     

Loeffler endomyocardial fibrosis

A 58-year-old patient known for an idiopathic hyper-eosinophilicsyndrome, previously treated with interferon, presented withsevere dyspnoea and clinical signs of right ventricular