Cardiology Grand Rounds Research Articles

Partial Papillary Muscle Rupture: A Cause of Acute Mitral Regurgitation

A 56-year-old woman presented to the cardiology clinic with a 7-day history of dyspnea and chest pressure. An echocardiogram showed a flail posterior mitral valve leaflet, and subsequent left heart catheterization showed complete occlusion of the first obtuse marginal coronary artery. Further investigation demonstrated the culprit lesion to be ischemic partial rupture of the posteromedial papillary muscle. Timely recognition of this condition allowed for an optimal clinical outcome. In this Cardiology Grand Rounds, the authors further describe the above presentation of ischemic partial papillary muscle rupture and provide a brief review of the pathophysiology, diagnosis and treatment of this condition.

Ventricular Noncompaction and Associated Cardiac Anomalies

An 80-year-old woman was referred for transcatheter aortic valve implantation for correction of aortic stenosis. An echocardiogram at the author’s institution revealed severe hypertrophy of the left ventricle with deep recesses into the myocardium and hypokinesis involving the left ventricular apex. In addition, there was subaortic stenosis secondary to a muscular ridge. The aortic valve was only mildly stenotic. In this Cardiology Grand Rounds, the authors present a rare case of ventricular noncompaction and review the literature on this subject and its association with other cardiac abnormalities.

Cardiology grand rounds: effect of videoconferencing on educational value

We studied four cardiology grand rounds transmitted by videoconference from a tertiary care centre to four other hospitals in eastern Canada. We collected data with evaluation questionnaires and by video recording participants at the receiving-site and the presentation they received from the presenting site. Receiving-site participants (n=20) rated their satisfaction with all domains significantly lower than did presenting-site participants (n=49). The greatest difference in ratings was in the ability to see slides (receiving sites 2.6/5, presenting site 4.6/5). Review of video recordings revealed that slides showing material copied from print sources was difficult to read at receiving sites. While 56% of discussion time was devoted to questions from receiving sites, participants there rated their ability to participate in discussion lower than those at the presenting site (3.9/5 vs 4.4/5). This may be because some parts of the discussion from the presenting site were not transmitted. Receiving-site participants rated the educational value of the rounds lower than their presenting-site colleagues (3.9/5 vs 4.4/5) but answered a similar percentage of knowledge questions correctly (85 vs 89%).

Cardiology Grand Rounds from The University of North Carolina at Chapel Hill

The prevalence of abdominal aneurysms has increased due to the aging population, and endovascular repair has developed into an effective, less invasive treatment. Two recent cases at the University of Texas-Houston highlight a variety of clinical considerations that allow informed decision-making regarding optimal treatment of abdominal aneurysms. A thorough discussion of recent data summarizes the current understanding and techniques regarding abdominal aortic aneurysm repair. Endovascular repair of abdominal aortic aneurysms has emerged as a viable and a safe alternative to surgical repair and may offer important advantages in a majority of patients with this disease.

Cardiology Grand Rounds from The University of Texas Medical Branch

Cardiology Grand Rounds from The University of Texas Medical Branch

Cardiology Grand Rounds from The University of Texas Medical Branch

Cardiology Grand Rounds from The University of Texas Medical Branch

Cardiology Grand Rounds from The University of Texas Medical Branch FIGURE

Cardiology Grand Rounds from The University of Texas Medical Branch FIGURE

Cardiology Grand Rounds from The University of Texas Medical Branch

Cardiology Grand Rounds from The University of Texas Medical Branch

Cardiology Grand Rounds from The University of Texas Medical Branch

Cardiology Grand Rounds from The University of Texas Medical Branch

Cardiology Grand Rounds from The University of Texas Medical Branch

GP IIb/IIIa inhibitors are one of the most exciting pharmacological advances in the treatment of coronary artery disease to be developed this decade. They have proven benefit in the treatment of patients undergoing high-risk percutaneous interventions and in patients with unstable angina or non-Q-wave myocardial infarction. In all of these patients, they should be used in conjunction with aspirin and heparin. Although bleeding complications are high in initial studies, they are much less common with increased clinical experience and careful attention to heparin dosing. Important questions that will be answered in the next several years include whether there are significant differences between the available agents and whether oral formulations will be safe and effective.