Case 1 - Click here for Text and References
Submitted by: Gayle L. Winters
The patient is a 63 year old man with a history of end- stage renal disease and hypertrophic obstructive cardiomyopathy who presented after several episodes where he felt lightheaded and fell. Additional history includes hypertension, hyperlipidemia and atrial fibrillation for which he had undergone AV node ablation and subsequent pacemaker insertion. Echocardiogram demonstrated a left ventricular ejection fraction of 35% and asymmetric left ventricular hypertrophy (posterior and septal wall thickness of 1.5 cm and 2.4 cm respectively). Fat pad biopsy was negative. Coronary angiography demonstrated a discrete 70% lesion in the second diagonal artery. An endomyocardial biopsy was performed.
Case 2 - Click here for Text and References
Submitted by: James R. Stone
An 80 year-old woman with a history of hypertension, hyperlipidemia, and osteoarthritis was found to have a cardiac murmur on routine physical exam. She underwent echocardiography, which showed aortic regurgitation and a dilated ascending aorta. Computed tomography angiography (CTA) revealed aneurysmal dilation of the ascending aorta up to 6 cm, with involvement of the aortic arch and proximal descending thoracic aorta. In addition there were aneurysmal dilatations of the brachiocephalic artery, hepatic artery and bilateral iliac arteries. She denied headache, vision changes, and jaw claudication. The erythrocyte sedimentation rate (ESR) was elevated at 53 mm/hour (normal 0-17 mm/hour), and serum interleukin-6 (IL-6) was elevated at 15 pg/mL (normal 0.3-5.0 pg/mL). She underwent replacement of the ascending aorta, aortic arch, and aortic valve.
Case 3 - Click here for Text and References
Submitted by: Dylan V. Miller
This 67-year-old woman with progressive dyspnea was referred for echocardiography. This demonstrated a small atrial septal defect as well as this 2.5 cm diameter pedunculated mass in the left atrium. She underwent resection of the mass and atrial septal defect repair. The mass was located near the left atrial appendage. No other cardiac lesions were observed intraoperatively.
Case 4 - Click here for Text and References
Submitted by: Gaetano Thiene
Case 4a. A 53-year-old woman with a one-month history of dyspnea and palpitations. Echocardiographic examination showed a severe aortic regurgitation. She underwent to aortic valve replacement with a bioprosthetic valve. Gross and histological examination are showed.
Case 4b. A 61-year-old man underwent aortic valve replacement due to severe aortic stenosis and multiple coronary artery by-pass for obstructive multivessel coronary atherosclerosis. Gross and histological examination are showed.
Case 4c. 43-year-old woman underwent mitral valve replacement with mechanical prosthesis due to severe mitral stenosis. Gross and histological examination are showed.