Heart failure and severe pulmonary hypertension caused by distal detachment of the valve conduit 16 years after the Cabrol composite graft procedure

We report the case of a patient who underwent Cabrol composite graft procedure for ascending aorta aneurysm and aortic regurgitation. Sixteen years later he developed progressive dyspnea and a left-to-right shunt caused by distal detachment of the valve conduit with persistence of the perigraft space-right atrial fistula visualized with echocardiography. Our case shows that late manifestations of surgical complications of the Cabrol procedure may occur and transesophageal echocardiography may allow a comprehensive assessment in these patients. However, because surgical management of ascending aorta aneurysms has changed in the last decades a detailed knowledge of the surgical technique used is mandatory for adequate interpretation of transesophageal echocardiographic results.

Clinical and hemodynamic implications of supra-annular implant of biological aortic valves

The use of stented bioprostheses in elderly patients with degenerative aortic stenosis, despite being desirable, raises concerns about the harmful effects of residual obstruction to left ventricular outflow. To overcome this limitation new stented and stentless bioprostheses have been designed for supra-annular implant. However, the actual hemodynamic advantage of supra-annular implant over the intra-annular one remains incompletely understood. This review focuses on the geometry of biological valve prostheses designed for supra-annular implant and its implications for the echocardiographic assessment of valve hemodynamics. Available data about the hemodynamic performance of these valves implanted in the supra-annular position in comparison with the usual intra-annular implant are also reviewed. Other issues related to biological heart valve performance, such as biomaterials, tissue mechanics, durability, and clinical outcome are not addressed in this review.

Improved delineation of morphological features of arrhythmogenic right ventricular cardiomyopathy with the use of contrast-enhanced echocardiography

A case of an already diagnosed arrhythmogenic right ventricular cardiomyopathy in which the use of contrast improved the echocardiographic characterization of morphologic abnormalities of the right ventricle is reported.

Additive value of contrast echocardiography for the diagnosis of noncompaction of the left ventricular myocardium

Noncompaction of the left ventricular myocardium is a rare and unclassified cardiomyopathy that remains frequently overlooked, even by experienced echocardiographers. This fact may be due to non-optimal imaging of the lateral and apical myocardium, and/or insufficient disease awareness by echocardiographers. We report a case of a young man with heart failure and severe left ventricular dysfunction, previously diagnosed of ischemic etiology, in which the contrast enhancement of left ventricular endocardium allowed us to reach the correct diagnosis of isolated left ventricular noncompaction.