A 23-year-old woman with a history of surgery for repair of | Figure 1

Case Presentation

A 23-year-old woman with a history of surgery for repair of aortic coarctation in childhood is referred for echocardiography. Which of the following is most likely to be found in this patient?

Question from Echocardiography Review Guide: Companion to the Textbook of Clinical Echocardiography, 3rd edition, by Catherine M. Otto. ISBN: 9780323227582. Copyright ©2016 Elsevier, Inc.

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Additional Case Details

Case Summary 1

A 73-year-old man with a prior history of bioprosthetic aortic valve replacement for aortic stenosis now presents with fever, chills, and serial blood cultures positive for Streptococcus viridans. He has been successfully initiated on intravenous antibiotic therapy and a TEE is ordered.

Options:

Question from Echocardiography Review Guide, 4th Edition. ISBN: 9780323546522. Copyright ©2020 Elsevier, Inc.

Case Summary 2

Shone complex (SC) is a rare congenital heart disease characterized by four obstructive anomalies, including parachute mitral valve (PMV), left atrial supra-valvular ring, subaortic stenosis, and coarctation of the aorta.

Typically, SC manifests early in life. However, we encountered a 52-year-old female with a history of hypertension diagnosed at 26 years and left-sided weakness post-stroke.

Echocardiography revealed a heavily calcified bicuspid aortic valve with severe aortic stenosis and parachute mitral valve with severe mitral stenosis. Cardiac catheterization revealed abrupt occlusion of the postductal aorta, leading to a diagnosis of incomplete SC at age 52. This case emphasizes the rarity of late presentations of SC and the importance of early diagnosis and intervention.

Case Summary 3

A 33-year-old man with multiple prior cardiac repairs for congenital heart disease was diagnosed with endocarditis of his Melody valve.

Surgery revealed extensive infection and involvement of a previously placed ventricular septal defect patch, which necessitated urgent measures during surgery.

Additional Case Summaries

  1. A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.
  2. A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back, following exposure to rescued dogs.
  3. A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.
  4. A patient in late teens presenting after a collapse, no chest pain or prior cardiac history.