We could not find double atrial septum in standard TTE

view however, we could clearly demonstrate double atrial septum with interatrial space in subcostal view. Therefore, routine evaluation of subcostal view of TTE can be useful for the detection of congenital atrial septal malformation. In conclusion, we described firstly in Korea, an extremely rare case of isolated double atrial septum with persistent interatrial space diagnosed by 2 dimensional TTE. We suggest that careful evaluation of interatrial septum at subcostal view is essential for finding rare interatrial septal Inhibitors,research,lifescience,medical anomaly.
Prosthetic valve dysfunction as a result of pannus formation due to fibrous tissue ingrowth is an infrequent and usually BTK inhibitor purchase produces a stenosis of the prosthesis due to obstruction of the left ventricular outflow tract or restriction on the movement Inhibitors,research,lifescience,medical of the opening of the discs of the prosthetic valve. Unlike thrombus formation, pannus is not related to inadequate anticoagulation,7) and more common with prostheses in the aortic than mitral position and is often observed years after implantation of the prosthesis.8)

A single tilting-disc prosthesis seems to be a significant risk factor for pannus formation and the need for reoperation.9) Differentiating pannus formation from thrombus is often difficult; however, the latter tends to be less video-dense and larger in size, and has Inhibitors,research,lifescience,medical increased mobility.7),8) There have been a few case reports of pannus causing intermittent, cyclic or non cyclic severe aortic regurgitation due to intermittent interference of disk closure.1-6) Our case differs from previous reports in that the episodes of intermittent severe aortic regurgitation were

non cyclic with random, short episodes of severe regurgitation Inhibitors,research,lifescience,medical lasting only several cardiac cycles, associated with brief angina pain and short of breath. Incomplete closure of the occluding disk was identified on fluoroscopy and echocardiography, in the absence of restricted systolic excursion. We suspect that pannus ingrowth on the outflow tract aspect of the valve extended slightly beyond Inhibitors,research,lifescience,medical the inner aspect of the prosthesis ring, such that the pannus tissue interfered with disk closure and resulted in severe aortic regurgitation, without altering systolic excursion of the disk. Marginal, especially around hinge contact of the occluding disk and pannus ingrowth and Endonuclease coexistence of thrombosis, in aorto-ventricular pressure differences might account for the intermittent nature of the dysfunction. We report an unusual case of intermittent, non cyclic mechanical aortic prosthesis dysfunction due to pannus formation with thrombus, that presented with intermittent severe aortic regurgitation. Supplementary movie legend Movie 1: Aortogram showed also non cyclic, intermittent incomplete closing of prosthesis with severe aortic regurgitation. Click here to view.(1.