Ventricular arrhythmia revealing mitochondrial myopathy in a 69-year-old woman

We report a case of mitochondrial myopathy (MM), assessed byhistological and biochemical studies. This illness was diagnosedin a 69-year-old patient with myocardiopathy revealed by ventriculararrhythmias. The originality of this case lies in the patient'sage, the mode of onset and the biochemical features (i.e. normalmitochondrial enzymatic complexes but very low respiration whenusing glutamate as a substrate).     

Right atrial myxoma in an asymptomatic child. Echocardiographic diagnosis

Tumours of the heart in children are rare, particularly myxomas.A case of right atrial myxoma is described in an asymptomaticyoung boy aged seven years. The diagnosis was made by M-Modeechocardiography which was recorded because of a cardiac murmur.Two-dimensional echocardiography confirmed the diagnosis andgave further information (size, morphology of tumour and stalk)which was confirmed by pathological examination. Today, two-dimensionalechocardiography is of great value for visualizing tumours ofthe right side of the heart, and offers the possibility of referringpatients for surgical excision without cardiac catheterization.     

Mobility of the Intimal Flap and Thrombus Formation in Aortic Dissection: A Transesophageal Echocardiographic Study

The mechanisms of the motion of the intimal flap and of thrombus formation in acute or chronic aortic dissection are not definitively elucidated. Transesophageal echocardiography seems to be a technique of choice to analyze the flow in the true and false lumina. Twenty-one consecutive patients were studied in order to define the mobility of the intimal flap, the color Doppler flow patterns, the presence of spontaneous echocardiographic contrast, and thrombus formation at different levels of the aorta. The results suggest that clotted false lumen is more often seen in chronic aortic dissection at the level of the descending thoracic aorta. However, thrombosed false lumen in the aortic arch is suggestive of a retrograde aortic dissection. In cases of complete obliteration of the false lumen, the differentiation between aortic dissection and aortic ectasia with mural thrombus may be extremely difficult.     

Meta-Analysis of Positive Blood Cultures During Transesophageal Echocardiography

We have reviewed ten prospective studies of bacteremia with transesophageal echocardiography (TEE) in 720 patients. The incidence of TEE related positive culture is low, and general recommendation for antibiotic prophylaxis during TEE is not warranted.     

Transesophageal Echocardiographic Visualization of Leaflet Destruction in Two Patients with Suspected Endocarditis

We report two cases of nonvegetant endocarditis, one with a perforated mitral valve aneurysm, the other with a perforated aortic leaflet. In both cases, the diagnosis of perforation was not made by transthoracic Doppler echocardiography but by transesophageal Doppler echocardiography. Transesophageal echocardiography is particularly useful in the context of nonvegetant endocarditis for a rapid diagnosis because an urgent surgical treatment may possibly be needed. (ECHOCARDIOGRAPHY, Volume 8, May 1991)     

Incidence of bacteraemia or fever during transoesophageal echocardiography: a prospective study of 82 patients

The incidence of bacteraemia during transoesophageal echocardiography(TEE) was evaluated in a prospective study of 82 consecutivepatients. Three series of blood cultures were carried out foreach patient: from group 1 (n=44), prior to the examination,at the end of the examination and 15min afterwards. For group2 (n=38), blood cultures were performed prior to the examination,10 min after the start and immediately after the end. A singlepositive blood culture was detected in two patients. For thefirst patient, blood culture at the end of the examination demonstratedCorynebacteria, and for the second, Staphylococcus epidermidiswas identified on cultures taken during the examination. Duringthe first 24 h, a transient subfebrile temperature was recordedin 15% of the patients, including the patient with the Corynebacteriapositiveblood culture. By mid-term (6 months) no patient had developedendocarditis.Ourfindings suggest that antibiotic prophylaxis during TEE isnot warranted.     

Spontaneous Echo Contrast in Patients with Sinus Rhythm but Poor Atrial Contraction

Spontaneous echo contrast in the left atrium in patients with sinus rhythm is unusual. The aim of this study was to assess the mechanism of this phenomenon and any clinical implications. We studied 90 consecutive patients using transesophageal echocardiography. Spontaneous echo contrast was seen within the left atrium in 29 patients, 11 of whom were in sinus rhythm. In patients with spontaneous contrast and sinus rhythm, the underlying diseases were: mitral insufficiency (5), mitral stenosis (1), mitral prostheses (2), congestive cardiomyopathy (1), hypertrophic cardiomyopathy (1), and heart transplantation (1). Spontaneous echo contrast tended to be faint in this group (10/11). The left atrium was enlarged in all, with subjective poor atrial contraction. Furthermore, reduced mitral A wave suggested an impairment of left atrial contractility. Holter monitoring demonstrated paroxysmal atrial fibrillation in five subjects. Two patients had a history of transient ischemic attacks. No atrial thrombus was observed in any patient. The demonstration of spontaneous echo contrast with transesophageal echocardiography does not seem uncommon even in patients in sinus rhythm. This may indicate an increased risk of thromboembolism.