Tahir Tak

Exercise stress testing remains one of the most widely used techniques in assessing functional capacity and in confirming a diagnosis of CAD. Its sensitivity and specificity are approximately 63% and 74%, respectively. The technique is safe when administered and supervised by qualified personnel who are trained to recognize contraindications and other reasons for termination of the test. More recently, echocardiography has been combined with exercise stress testing. It is a well-tolerated and valuable procedure for noninvasive evaluation of CAD. The sensitivity and specificity of stress echocardiography are higher than those of exercise stress testing and comparable to those of nuclear perfusion imaging. Continuing improvements in digital image analysis, cost, and the availability of contrast agents promise to make noninvasive stress testing even more useful in the years to come. Newer contrast and concomitant perfusion agents are on the horizon and may prove to be a reality in the echocardiographic laboratories of the future.

Papillary fibroelastomas are benign and rare tumors usually involving the cardiac valves. The diagnosis of this condition has gradually increased over the past few years. This is attributed to the increasing number of echocardiographic and transesophageal procedures that are currently performed. The case is presented of a woman diagnosed with an aortic valve mass, the sessile nature of which in the aortic root was considered a potential source of cerebral and coronary embolism. The mass was surgically removed, with no major complications being encountered perioperatively.

The incidence of infective endocarditis continues to rise with a yearly incidence of around 15,000 to 20,000 new cases in the USA. As a result, rapid diagnosis, effective treatment and prompt recognition of complications are essential to desirable clinical outcomes. Recent guidelines such as the Duke criteria have incorporated echocardiography for diagnosis of infective endocarditis, making this diagnostic test mandatory for patients with suspected infective endocarditis. The diversity of pathogens that can cause infective endocarditis, some of which cannot be cultured easily, makes diagnosis even more difficult. Coagulase-negative staphylococci and viridans streptococci groups continue to be the major causative microorganisms of infective endocarditis. In the case of culture-negative endocarditis or infective endocarditis caused by fastidious microorganisms, the polymerase chain reaction and probe-based diagnostic methods are available to clinical reference laboratories.

The case of a patient who developed a femoral artery pseudoaneurysm (FAP) following cardiac catheterization is described. It is one of the most troublesome complications after various invasive cardiovascular procedures related to the femoral arterial access site. Iatrogenic pseudoaneurysms (IPA) form when an arterial puncture site fails to seal, allowing arterial blood to ooze into the surrounding tissues and form a pulsatile hematoma. The FAP occurs in 0.8% to 2.2% after interventional procedures. This problem has become more significant due to the exponential growth of interventional cardiology.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF) is one of the rare complications of infective endocarditis. Echocardiography plays an important role in the diagnosis of this condition. Transesophageal echocardiography (TEE) is generally superior to the transthoracic approach in the evaluation of the complications resulting from infective endocarditis. In this report, we discuss a case of infective endocarditis complicated by the development of a pseudoaneurysm of the MAIVF. The anatomic relationship of structures contiguous to the MAIVF and the salient echocardiographic findings of this clinical condition are presented. At surgery the diagnosis was confirmed and appropriate treatment instituted. The postoperative course was uncomplicated.