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Incidental echocardiographic finding:Fractured inferior vena cava filter

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World Journal of Clinical Cases 2017年第4期5卷 148-152页

作者： Bhradeev Sivasambu Deepa Kabirdas assad movahed Vidant Medical Center East Carolina University Department of Cardio- vascular Sciences Brody School of MedicineEast Carolina University

Inferior vena cava filters have gained increasing popularity in recent decades and knowledge on rare complications becomes vital to practicing physicians. A 30-year-old African American male with diabetes mellitus, hypertension, end-stage renal disease, history of deep venous thrombosis and placement of venacaval filter who was seen in the cardiology clinic for cardiac risks stratification prior to renal transplant. Patient denied any cardiac symptoms. A transthoracic echocardiogram was performed and showed two linear echoes bright densities in the right atrium and right ventricle embedded which was later found to be fractured filter struts by computed tomography. We discuss the various outcomes associated with nonretrieval of retrievable inferior vena cava filters.

关键词： Inferior vena cava filter Fractured inferior vena cava filter Cardiac foreign body Metal in heart Incidental echocardiographic finding

Elusive left ventricular thrombus:Diagnostic role of cardiac magnetic resonance imaging-A case report and review of the literature

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World Journal of Clinical Cases 2018年第6期6卷 127-131页

作者： Irfan Siddiqui Tin Nguyen assad movahed Deepa Kabirdas Department of Cardiovascular Sciences East Carolina UniversityBrody School of MedicineEast Carolina Heart Institute

Identification of left ventricular mural thrombus(LVT) may be challenging depending on the imaging modality used. We present a case of LVT which was incidentally identified on cine cardiac magnetic resonance imaging(CMR). A sixty-four years old female presented with worsening dyspnea on exertion with troponin elevation. Transthoracic echocardiography(TTE) revealed a dilated left ventricle(LV) and ejection fraction(EF 30%) with thinning and akinesis of inferior/inferolateral wall was noted with basal and mid inferior wall aneurysm, and thrombus was not identified. CMR done to ascertain viability of myocardium revealed a mural thrombus within basal inferior aneurysm. This was not visualized on transthoracic echocardiography with and without use of contrast. She underwent coronary artery bypass grafting, bioprosthetic mitral valve replacement, resection and plication of posterior left ventricular aneurysm with removal of mural thrombus, and was started on anticoagulation with warfarin postoperatively for the apical thrombi. Cardiac magnetic resonance is a well suited imaging modality in detecting LVT due to its high resolution images and is more reproducible than TTE. In our patient, conventional TTE despite administration of echo-contrast agents failed to diagnose the presence of LVT in the basal inferior aneurysm as well as the apical thrombi. Delayedenhancement CMR provides the greatest sensitivity for detection of left ventricular thrombus, superiorto standard transthoracic and contrast-enhanced transthoracic echocardiography.

关键词： Left ventricular thrombus Cardiovascular magnetic resonance Transthoracic echocardiogram

Saphenous graft on transesophageal echocardiogram masquerading as an abnormal vascular communication into the right atrium

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World Journal of Clinical Cases 2013年第1期1卷 28-30页

作者： Long Cao Mohammed Ataullah Farooqui William Wood John Cahill assad movahed Department of Cardiovascular Sciences East Carolina University Brody School of Medicine East Carolina Heart Institute Greenville NC 27858 United States

An unknown aberrant f low in the right atrium observed on doppler with transesophageal echocardiogram(TEE) in a patient with prior coronary bypass. TEE revealed normal size left ventricle with severely dilated left atrium. There was moderate aortic regurgitation and moderate aortic stenosis noted. Patient was incidentally found to have an abnormal vascular communication noted to the right atrium. To further evaluate this f inding, the patient underwent cardiac magnetic resonance angiography which revealed that the tubular structure noted on TEE was actually a graft that was abutting onto the coronary sinus, and the f low anomaly was really the graft coming up and running adjacent to the coronary sinus.

关键词： Vascular Communication Echocardiogram Saphenous vein graft Magnetic resonance imaging

Incidental findings of pericardial calcification

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World Journal of Clinical Cases 2014年第9期2卷 455-458页

作者： Tin Nguyen Charles Phillips assad movahed Department of Cardiovascular Sciences East Carolina University Brody School of Medicine East Carolina Heart InstituteGreenville NC 27834 United States

Calcification of the pericardium is a relatively rare finding and often has an uncertain etiology. Incidental findings of pericardial calcification may increase due to widespread application of cardiac computed tomography for the assessment of coronary atherosclerosis in the appropriate clinical setting using coronary artery calcium scoring and/or coronary angiography. Pericardial calcification alone is asymptomatic and is neither necessary nor sufficient for the diagnosis of pericardial constriction. Its presence may suggest of diffused pericardial scarring and consequently, its pathological involvement with pericardial constriction. Calcification of the pericardium must be evaluated with full clinical knowledge to facilitate an accurate diagnosis and an appropriate therapy when required. Our objective is to present a case of asymptomatic pericardial calcification and to discuss the importance of its clinical implications.

关键词： Pericardial calcification Constrictive pericarditis Cardiac computed tomography

Low ADAMTS-13 in plavix induced thrombotic thrombocytopenic purpura

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World Journal of Clinical Cases 2013年第1期1卷 31-33页

作者： Long Bao Cao Christopher Jones assad movahed Department of Cardiovascular Sciences Brody School of MedicineEast Carolina University Greenville NC 27834 United States

Thrombotic thrombocytopenia purpura(TTP) was fi rst described in 1924 as a "pathologic alteration of the microvasculature, with detachment or swelling of the endothelium, amorphous material in the sub-endothelial space, and luminal platelet aggregation leading to compromise of the microcirculation". Ticlopidine induced TTP has been highly associated with autoimmune induced reduction in ADAMTS-13 activity. These findings, to a lesser extent, have also been found in clopidogrel induced TTP. We report a case of clopidogrel associated TTP in a patient that presented with acute stroke, renal failure, and non-ST elevation myocardial infarction.

关键词： Plavix Thrombotic thrombocytopenic purpura Antiplatelet therapy

Noncoronary sinus of Valsalva rupture into the right atrium with a coexisting perimembranous ventricular septal defect

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World Journal of Clinical Cases 2013年第4期1卷 146-148页

作者： Long-Bao Cao David Hannon assad movahed Department of Cardiovascular Sciences East Carolina University Brody School of Medicine East Carolina Heart Institute Greenville NC 27858 United States

Ruptured sinus of Valsalva is very uncommon,and is < 1% of all congenital *** incidence ranges from 0.1%-3.5%.There is a male to female predominance of 4:1,with the highest incidence in the Asian *** incidence is also seen in patients with Marfan's syndrome and Ehlers Danlos *** is a higher association of ruptured sinus of Valsalva with ventricular septal defect(VSD),aortic stenosis,and bicuspid valve *** most patients with VSD often have rupture of their right coronary sinus of Valsalva into the right ventricle due to poor structural integrity,we present a rare case of a patient with VSD who had rupture of his noncoronary sinus of Valsalva into the right atrium.

关键词： Sinus of Valsalva Rupture Ventricular septal defect Wind sock deformity

Side matters: An intriguing case of persistent left superior vena-cava

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World Journal of Clinical Cases 2013年第5期1卷 159-161页

作者： Adeel M Siddiqui Long-Bao Cao assad movahed Department of Cardiovascular Sciences East Carolina University Brody School of Medicine East Carolina Heart Institute GreenvilleNC 27834 United States

Persistent left superior vena cava, usually an incidental finding, is the most common thoracic vein anatomical variation draining into the coronary sinus. Central venous catheter procedures may be complicated secondary to the presence of a persistent left superior vena cava, leading to life-threatening complications such as arrhythmias, cardiogenic shock, and cardiac arrest. We present a case of persistent superior vena cava diagnosed on transthoracic echocardiogram(TTE) in a patient with congestive heart failure. A dilated coronary sinus was identified on TTE, followed by injection of agitated saline into the left antecubital vein resulting in filling of the coronary sinus prior to the right atrium-an indication of persistent left superior vena-cava. This also was confirmed on cardiac computed tomography. Such a diagnosis is critical in patients who may undergo central venous catheter procedures such as our patient's potential requirement for an implantable cardiovertor defibrillator due to severe global left ventricular systolic dysfunction. The presence of a persistent left superior vena cava should always be suspected when the guidewire takes a left-sided downward course towards the rightatrium at the level of the coronary sinus. Therefore, special attention should be paid to the imaging work-up prior to central venous catheter procedures.

关键词： Persistent superior vena-cava Thoracic vein anomaly Central venous catheter Coronary sinus Left cardinal vein

Contrast induced neurotoxicity following coronary angiogram with Iohexol in an end stage renal disease patient

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World Journal of Clinical Cases 2015年第11期3卷 942-945页

作者： Narasimha Swamy Gollol Raju Deepak Joshi Ramesh Daggubati assad movahed Department of Internal Medicine East Carolina University-Brody School of Medicine Department of Cardiovascular Sciences East Carolina University-Brody School of Medicine

Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol(Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.

关键词： Coronary angiogram End stage renal disease Hemodialysis Iodinated contrast agent Neurotoxicity

Coumadin ridge: An incidental finding of a left atrial pseudotumor on transthoracic echocardiography

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World Journal of Clinical Cases 2015年第9期3卷 831-834页

作者： Aadil Mubeen Lodhi Tin Nguyen Christopher Bianco assad movahed Department of Cardiovascular Sciences East Carolina UniversityBrody School of MedicineEast Carolina Heart Institute

Coumadin ridge is a normal anatomic variant that is occasionally found in the left atrium. It can present as a linear or nodular mass which can undulate with cardiac motion and if particularly prominent, can easily be mistaken for a tumor or thrombus. Careful evaluation and consideration of the common variants discussed in this review can help limit misdiagnosis, as well as unnecessary workup and treatment. We present a case of coumadin ridge that was found on a patient using two-dimensional transthoracic echocardiography.

关键词： Coumadin ridge Pseudotumor Warfarin ridge Left atrial pseudotumor