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Smadar Kort

Publications and source records attributed to Smadar Kort.

At least 19 recordsLinked to original sources
PubMed2006

Real-time 3-dimensional echocardiography for prosthetic valve endocarditis: initial experience.

Real-time 3-dimensional echocardiography is a relatively new technology with rapidly growing potential applications. Prosthetic valve endocarditis is still a challenging diagnosis despite improvements in image qualities obtained by both transthoracic and transesophageal echocardiograms. The purpose of this article is to present 4 cases of suggested prosthetic valve endocarditis, in which real-time 3-dimensional echocardiography was performed, and to discuss the potential use of real-time 3-dimensional echocardiography for this application.

Adult↗
PubMed2006

Biventricular pacing using dual-site right ventricular stimulation: is it placebo effect?

Alternate site lead placement in cardiac resynchronization therapy has been used successfully but remains to be validated. A 62-year-old heart failure patient in whom coronary sinus lead placement was not possible underwent implantation of the lead in the right ventricular outflow tract (RVOT) and demonstrated clinical improvement as measured by New York Heart Association class and noninvasive parameters. When heart failure recurred, it was determined that his RVOT electrode had been pulled back (Twiddler's syndrome). Repositioning again improved his clinical status and noninvasive hemodynamic measurements. With dual-site right ventricular (RV) pacing there was no echocardiographic measurable intraventricular dyssynchrony. Tissue Doppler imaging correlated with clinical improvement using dual-site RV pacing, providing evidence that this technique may represent a viable alternative in cardiac resynchronization therapy.

Cardiac Pacing, Artificial↗
PubMed2005

Contrast echocardiography improves the diagnostic yield of transthoracic studies performed in the intensive care setting by novice sonographers.

BACKGROUND: Bedside portable echocardiography in the intensive care department (ICU) is technically difficult, but crucial for directing patient care. Prior studies have shown contrast echocardiography (CE) in the ICU clarifies left ventricular wall motion when performed by experienced sonographers (ESO). However, in most hospitals, ESO are unavailable around the clock, and less experienced cardiovascular fellows or trainees may be asked to perform these examinations. METHODS: Transthoracic echocardiograms were retrospectively evaluated by level III trained echocardiographers for 213 patients in the ICU. Most were performed to assess left ventricular function (65% or 139 of 213) and were scanned by cardiology fellows (70% or 149 of 213) with less than 3 months echocardiography experience. Contrast agent was used in 29% (62 of 213) of all patients. RESULTS: The conversion of suboptimal or diagnostically inadequate apical 4- and 2-chamber views to diagnostically adequate with contrast was statistically significant when performed by both cardiology fellows and ESO (Fischer exact test, P < .0002). CONCLUSIONS: CE is effective in improving the diagnostic yield of transthoracic echocardiographic ICU studies performed by both novice sonographers and ESO. Using cardiology fellows to perform CE in this setting can be appropriate, particularly in after-hour situations, when ESO are not always available and the clinical question is left ventricular function. Results also suggest cardiology fellows can easily learn CE.

Aged↗
PubMed2005

Right-sided Myxomas.

Primary tumors of the heart are rare with an incidence of 0.0017% to 0.19% in unselected patients at autopsy. Of those tumors, cardiac myxomas are the most commonly seen and account for about 50% of primary cardiac tumors. About 75% to 85% of myxomas originate in the left atrium, 15% to 20% in the right atrium, and only rare cases have been reported of myxomas originating in the left and right ventricles (5%). We present 3 cases in which right-sided myxomas were diagnosed echocardiographically and review the literature on primary cardiac myxomas.

Adult↗
PubMed2005

A rare case of Lactobacillus acidophilus presenting as mitral valve bacterial endocarditis.

Lactobacillus acidophilus is a gram-positive rod that is a commensal of human mucosal tissues. They are usually considered nonpathogenic flora of the mouth, gut, and female genital tract. Lactobacillus is a rare cause of endocarditis with less than 50 cases reported in the world literature to date. We report the case of a 63-year-old woman who developed native mitral valve endocarditis secondary to L. acidophilus, and examine the literature regarding this rare entity.

Anti-Bacterial Agents↗
PubMed2004

Assessment of intracardiac anomalies in two adults with Ivemark's syndrome.

Ivemark's syndrome consists of intracardiac anomalies, abnormal lobation of the lungs, and abdominal heterotaxy. A frequent intracardiac anomaly seen in Ivemark's syndrome is a common atrium, which is associated with left-to-right shunting. The increased blood flow and resistance within the pulmonary vasculature creates pulmonary hypertension and eventual reversal of the shunt physiology. In the absence of additional cyanotic malformations, survival into adulthood without prior surgical septation of the common atrium depends on the extent of pulmonary hypertension and intracardiac right-to-left shunting. We present two patients with a common atrium in the setting of Ivemark's syndrome who survived into adulthood without prior operation. Two-dimensional echocardiography assessed their intracardiac structures. One patient had right atrial isomerism manifested by asplenia and a common atrium, into which the hepatic veins drained directly, and the other patient had left atrial isomerism manifested by polysplenia, a common atrium, and a ventricular septal defect with a single atrioventricular valve. Neither patient had additional cyanotic malformations, including obstruction to pulmonary venous return, transposition of the great vessels, or pulmonic valve stenosis. The 2-dimensional echocardiogram guides the clinician to refer patients for surgical septation of the common atrium before the right-to-left shunt physiology predominates. The medical and surgical treatment of these patients is discussed.

Abnormalities, Multiple↗
PubMed2004

Diagnosis of suspected cardiac echinococcosis with negative serologies: role of transthoracic, transesophageal, and contrast echocardiography.

The early recognition and treatment of hydatid disease of the heart is important as it can result in potentially lethal complications. We present the clinical and echocardiographic features of a 71 year old Afghanistani man who presented with left-sided chest pain. Transthoracic (TTE), transesophageal (TEE), and contrast echo demonstrated a calcified cystic structure within the distal anterior septum consistent with an echinococcal cyst, despite negative serologies. Treatment strategies for this patient are discussed.

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PubMed2004

A rare case of Listeria monocytogenes presenting as prosthetic valve bacterial endocarditis and aortic root abscess.

Listeria monocytogenes is a gram-positive bacillus that is rarely associated with infections in the general population. Those susceptible to this pathogen include neonates, pregnant women, and the immunocompromised. The most common clinical manifestations of listeriosis are bacteremia and meningitis. Endocarditis caused by L. monocytogenes is rare with less than 60 cases reported in the world literature. We report the case of an 81-year-old man who suffered aortic prosthetic valve listeria endocarditis, and examine the literature regarding this rare manifestation of human listeriosis.

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PubMed2004

Pericardial cyst: case reports and a literature review.

Pericardial cysts are rare mediastinal abnormalities, which are usually congenital but may also be acquired after cardiothoracic surgery. Cysts frequently occur in the right cardiophrenic angle and their diagnosis is usually suspected after an abnormal chest X ray is obtained. The presence of a pericardial cyst in this typical location or, less frequently, in an unusual location, poses a diagnostic challenge in distinguishing it from other intracardiac or mediastinal abnormalities. Two-dimensional echocardiography and transesophageal echocardiography are extremely valuable in diagnosing the presence of a pericardial cyst. Although most pericardial cysts are asymptomatic, patients may present with chest pain and dyspnea. In addition, life-threatening complications such as pericardial tamponade have been reported in association with pericardial cysts. The following cases illustrate the usefulness of two-dimensional echocardiography in making an accurate diagnosis of a pericardial cyst, as well as in follow-up of these patients for the development of possible complications.

Adult↗
PubMed2003

Multiple fibroelastomas: a case report and review of the literature.

Cardiac papillary fibroelastoma is a rare primary cardiac tumor that usually involves the heart valves. Multiple fibroelastomas found in a single patient is an even more rare occurrence. We describe the case of a 41-year-old woman who presented with an acute cerebrovascular accident, and was found to have 4 separate fibroelastoma tumors involving the aortic and mitral valves. The role of echocardiography in the diagnosis of this unusual tumor and its therapy is discussed.

Adult↗
PubMed2003

Echocardiographic features of patients with heart failure who may benefit from biventricular pacing.

BACKGROUND: Recent studies suggest that cardiac resynchronization therapy through biventricular pacing (BVP) may be a promising new treatment for patients with advanced congestive heart failure (CHF). This method involves implantation of pacer leads into the right atrium (RA), right ventricle (RV), and coronary sinus (CS) in patients with ventricular dyssynchrony as evidenced by a bundle branch block pattern on electrocardiogram (ECG). Clinical trials are enrolling stable patients with ejection fractions (EF) </= 35%, left ventricular end-diastolic diameters (LVIDd) >/= 54 mm, and QRS duration >/=140 msec. We compared echocardiography features of these patients (group 1) with other patients with EF </= 35%, LVIDd >/= 54 mm, and QRS < 140 msec (group 2 = presumably no dyssynchrony). METHODS: Nine hundred fifty-one patients with CHF, LVID 54 mm, EF 35% by echocardiography were retrospectively evaluated. One hundred forty-five patients remained after those with primary valvular disease, prior pacing systems, or chronic atrial arrhythmias were excluded. From this group of 145 patients, a subset of 50 randomly selected patients were further studied (25 patients [7 females, 18 males] from group 1, and 25 patients [7 females, 18 males] from group 2). Mean age group 1 = 75 years old, mean age group 2 = 67 years old. Mean QRS group 1 = 161 msec, mean QRS group 2 = 110 msec. Each group was compared for presence of paradoxical septal motion, atrial and ventricular chamber sizes, LV mass, LVEF, and RV systolic function. RESULTS: Of the initial group of 951 patients, 145 (15%) met inclusion criteria. In the substudy, 20/25 (80%) of group l and 7/25 (28%) of group 2 subjects had paradoxical septal motion on echo (Fisher's exact test, P = 0.0005). The t-tests performed on the other echocardiography variables demonstrated no differences in chamber size, function, or LV mass. CONCLUSIONS: Cardiac resynchronization therapy with BVP appears to target a relatively small population of our advanced CHF patients (15% or less). Although increasing QRS duration on ECG is associated with more frequent paradoxical septal motion on echo, it is not entirely predictive. Paradoxical septal motion on echo may therefore be more sensitive at identifying patients who respond to BVP. Further prospective studies are needed.

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PubMed2003

Extensive neoplastic cardiac infiltration in a patient with acute myelogenous leukemia: role of echocardiography.

We present the case of a 34-year-old man with a history of relapsed acute myelogenous leukemia with extensive metastatic infiltration of the endomyocardium. Transesophageal echocardiography revealed masses within all the cardiac chambers and associated vascular structures. Biopsy of the superior vena cava mass had the histological features of a granulocytic sarcoma (GS, chloroma). Massive involvement of the heart with GS is very rare, and only a few reports have been published in the literature.

Adult↗
PubMed2003

Successful surgical repair of a giant left main coronary artery aneurysm with arteriovenous fistula draining into a persistent left superior vena cava and coronary sinus: role of intraoperative transesophageal echocardiography.

We report the case of a 74-year-old woman with a history of hypertension, hypercholesterolemia, and pacemaker who presented to the hospital with new onset New York Heart Association class IV congestive heart failure. Transthoracic echocardiography revealed a markedly dilated right ventricle with normal right ventricular systolic function. There was moderate pulmonary hypertension with an estimated pulmonary artery systolic pressure of 60 mm Hg. Her echocardiogram 1 year earlier had demonstrated normal right ventricular size and systolic function, and no pulmonary hypertension. Additional transthoracic imaging with saline contrast study through a left peripheral vein demonstrated the presence of a dilated coronary sinus with a persistent left superior vena cava. Color Doppler demonstrated turbulent flow within the coronary sinus with evidence of significant left-to-right shunting. Cardiac catheterization revealed a massively dilated left main coronary artery aneurysm with an arteriovenous fistula into the left superior vena cava and coronary sinus. The calculated Qp/Qs was 2:1. The patient underwent 2 unsuccessful attempts at percutaneous intervention to occlude the arteriovenous fistula. She then underwent successful surgical closure of the coronary arteriovenous fistula. The important role of intraoperative transesophageal echocardiography in guiding this technically challenging surgical case is discussed.

Aged↗
PubMed2003

A rare case of Alström syndrome presenting with rapidly progressive severe dilated cardiomyopathy diagnosed by echocardiography.

Alström Syndrome is an extremely rare, autosomal recessive genetic disorder characterized by a group of signs and symptoms including infantile onset dilated cardiomyopathy, blindness, hearing impairment/loss, and obesity; with diabetes, and hepatic and renal dysfunction later on in life. Since the first description of the syndrome in 1959, there have been fewer than 100 reported cases in the world. We report a case of a 7-month-old girl whose initial presentation of Alström syndrome was a rapidly progressive severe dilated cardiomyopathy, diagnosed by echocardiography. Unique characteristics of the cardiomyopathy in Alström syndrome and the important role of echocardiography in Alström syndrome and other genetically transmitted disorders, especially with known cardiovascular manifestations, is discussed.

Cardiomegaly↗
PubMed2002

The risk of the development of aortic stenosis in patients with "benign" aortic valve thickening.

BACKGROUND: Aortic valve thickening (AVT) without aortic stenosis (AS) is common and was often considered benign. However, it has recently been found to be associated with increased morbidity and mortality. It is unknown whether patients with AVT are at risk for the development of AS. METHODS: Our echocardiography database from 1987 to 1993 was searched for cases of AVT with at least 1 year of echocardiographic follow-up. The risk of the development of AS was compared in patients with and without AVT. RESULTS: There were 2131 patients with AVT and at least 1 year of echocardiographic follow-up. Aortic stenosis developed in 338 patients (15.9%) (mild, 10.5%; moderate, 2.9%; and severe, 2.5%). Multivariate analysis, including age, left ventricular hypertrophy, and mitral annular calcification, revealed that only mitral annular calcification was independently and significantly associated with progression to AS. CONCLUSIONS: Aortic valve thickening without stenosis is common, and it may progress to significant AS. It is possible that this development of AS may be responsible for some of the increased morbidity and mortality in patients with AVT.

Aged↗