Consensus Statement on Interpretation of Troponin Elevation

Link

Coming soon in JACC 2012;60.
See video in ACC website

Aortic Root Normal Values - Nomogram

Normal values derived from 353 children (Paris)

AJC 2010;105:888-94.

Different from other nomogram by Roman MJ, et al. AJC 1989. Also available in this blog. 



Boys



Girls



Solid line - Boys
Dotted line - Girls

Indication for Surgery in Marfan Syndrome

Single institution experience. Take it with "a pinch of salt".
(Mt Sinai Medical Center, New York, NY - Dr. Randall Griepp is the senior author)

Diameter = Diameter at Sinus of Valsalva (SoV)
Ratio (Aortic ratio) = Observed diameter/Predicted diameter at SoV

Predicted diameter of SoV is determined from regression formula ("reportedly" derived from Roman MJ et al. AJC 1989:64:507-12). It "appears" that the regression formulas dervice the expected mean value - not clarified in the referenced article (Leget et al. Heart 1996;75:389-95).
Regression formula for "Predicted diameter of SoV" in cm. are as follows:
Child (< 18 yrs): 1.02 + (0.98 x BSA in m2)
Adult (18-40 yrs): 0.97 + (1.12 x BSA in m2)
Adult (> 40 yrs): 1.92 + (0.74 x BSA in m2)

Ann Thoracic Surg 1999;67:1834-9.

Prosthetic Valve - Valve Orifice Area

For St. Judes Valve: (From Manufacturer's website)

Useful to evaluate for Patient-Prosthesis Mismatch

(Click on the image to enlarge)

DORV classification

DORV types & distribution from a study of 70 specimens.

(From Moss and Adams)

Click on the image to enlarge

EKG: Junctional Rhythm with Retrograde P waves...

The EKG shows Junctional Rhythm with retrograde P wave, but only in alternate beats.

There appears to be a small P before the junctional beats that do not have a retrograde P wave!

What is the explanation for such phenomenon?

(Click on the image to enlarge)

Cath: Double Balloon Size Selection

(Click on the image to enlarge)

(1) Dr. Rao's book p. 49 (Wiley-Liss, New York, 1993)

(2) Table is from Dr. Jim Lock's book 2nd ed. p. 154 (Kluwer Academic Publishers, Boston 2000)

 (3) Further simplified formula:  (Narang R, et al. Cardiology 1997;88:271-276)
Effective Balloon Diameter = 0.82 (D1 + D2)

EKG: Pulmonary Embolism

17 yr old girl, admitted with shortness of breath. CT scan showed multiple pulmonary emboli.

(Click on the image to enlarge)

EKG: Intermittent WPW

Intermittently manifest accessory pathway

Note: Two beats in this rhythm strip have normal PR interval without Delta wave.

(Click on the image to enlarge)

Echo: Tissue Doppler Imaging of MV

(Extracted from JASE 2010;23:465-95)

3 cursor locations for AV valves:

Lateral Mitral Annular Tissue Doppler Tracing:

s' - Ventricular Systole

e' - Ventricular recoil during early diastole

a' - Atrial systole

IVCT' - Isovolumic contraction time (Note: Apostrophe)

IVRT - Isovolumic relaxation time (Note: Apostrophe)