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Case Studies
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Problem:
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A
90-year old man had become progressively breathless and fatigued while
walking during the previous six months. The symptoms prevented him
from accompanying clients to inspect construction sites, which was
essential to his business. He had undergone successful bypass grafting more than 10 years before, followed by an angioplasty to relieve obstruction in a coronary artery. Aortic stenosis first became apparent five years prior to development of the symptoms. Breathlessness and fatigue became progressively severe, in spite of medication, preventing the patient from conducting his business. |
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Diagnosis:
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Critically
severe aortic stenosis was detected using an echocardiogram. The diagnosis
was confirmed by catheterization, at which time his bypass grafts were
found to be functioning well. |
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Treatment:
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Aortic
valve replacement was performed. |
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Outcome:
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The patient is now 94, successfully conducting his business. |
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Problem:
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A
31-year old asymptomatic male with severe aortic regurgitation was
referred for evaluation by his internist, after the doctor detected
a heart murmur. |
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Diagnosis:
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Non-invasive
evaluation was performed using radioisotope imaging and an echocardiogram.
Test results showed a leaking aortic valve and evidence of severe
myocardial dysfunction. Even in the absence of symptoms, these results indicated relatively poor near-term survival without surgery. |
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Treatment:
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Valve replacement surgery was performed. Heart function improved quickly
and returned to normal within three years. |
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Outcome:
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The patient currently is asymptomatic and active more than 10 years
after his operation. |
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Problem:
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A
73-year old active woman had recurrent irregular heartbeats but no
other symptoms. |
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Diagnosis:
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Diagnosis
of mitral regurgitation was made by physical examination and confirmed
as severe by echocardiogram. Radioisotope imaging during exercise
indicated that the woman had right ventricular dysfunction, and there
was imminent danger of her developing congestive heart failure. The echocardiogram showed that valve repair would be possible with good likelihood of success. |
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Treatment:
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A
catheterization confirmed the patient's valvular disease and showed
normal coronary arteries. Valve repair was performed successfully.
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Outcome:
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Today, the patient is 74 and has returned to skiing. |
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Problem:
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An
active 50-year old woman, who had contracted rheumatic fever as a
child and had had mitral stenosis for years, found her exercise tolerance
gradually decreasing over a year's time. |
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Diagnosis:
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Using
a non-invasive echocardiogram, it was determined that she had a modest
abnormality of pulmonary artery pressure (blood pressure in the lungs).
The test indicated that the patient had complex valve anatomy, which
was unsuitable for a catheterization-based balloon valvuloplasty. |
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Treatment:
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At
surgery, an open valve repair was performed, widening the opening
through which blood flowed from the atrium to the ventricle. |
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Outcome:
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The patient not only recovered, but also returned to her full exercise
level within three months. |
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In
This Section
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Treatment Recommendations Clinical and Objective Evaluations |
