Biomedical subjects
Publications and source records attributed to Marcello Manfrin.
We report a case of delayed detachment of the right coronary cusp, occurring 12 days after a motorcycle crash. Echocardiographic findings mimicked a type I De Bakey aortic dissection. A brief discussion of cause, evolution, diagnosis, and treatment is included.
The association of a bicuspid aortic valve (BAV) with abnormalities of the proximal thoracic aorta, including dilatation, aneurysm and dissection, has been previously described, leading to the hypothesis of a common underlying developmental defect involving the aortic valve and the aortic wall. Consequently, any patient with BAV should receive a careful assessment not only of the valve function, but also of the aortic root and the ascending aorta. Dilatation of the proximal thoracic aorta is a common finding in patients with BAV and is believed to be related to aortic rupture and dissection. Because progressive dilatation can occur, careful long-term surveillance of the aortic dimensions is required. Prophylactic surgical repair of the dilated aorta should be recommended more aggressively for patients with BAV than for those with a tricuspid aortic valve. However, the optimal timing of aortic surgery in BAV patients remains uncertain because of the limited data available on the natural history of asymptomatic aortic dilatation.
The dimensions of the entire aorta at different anatomic levels were measured by transthoracic 2-dimensional echocardiography in 162 consecutive patients with isolated bicuspid aortic valves (BAVs) without significant aortic valve dysfunction. Aortic dilation involved the aortic root and the ascending aorta but was not present in the descending and abdominal aorta. A significant increase in the dimensions of the aortic arch was found in patients with BAVs aged >40 years. Ascending aortic diameter and the extension of aortic dilation were significantly correlated with age, but no correlation was found between aortic dimensions and aortic valve morphology.
Patients with a left atrial thrombus are considered as being at high risk for thromboembolic events. Although embolization may be asymptomatic, embolic events related to large thrombi are usually clinically manifest and tend to be associated with a worse prognosis. We describe the very unusual case of a patient with atrial fibrillation in whom two-dimensional echocardiography revealed a large, pedunculated, highly mobile left atrial thrombus attached by a thin stalk to the interatrial septum. Because of the high risk of embolism the patient was submitted to urgent surgery. At surgery, only the stalk was found. No mass was visualized at intraoperative transesophageal echocardiography. The patient had an uneventful postoperative course without signs of embolism. Computed tomography of the brain did not reveal any cerebral infarction.
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