Ventricular preexcitation caused by right-sided accessory pathways can lead to abnormal septal motion and may be associated with LV dysfunction and heart failure, despite the lack of a clinical arrhythmia. We describe a case of a 20-year-old sportive and asymptomatic male presenting with ventricular Type-B preexcitation combined with left ventricular dysfunction. After successful accessory pathway ablation, normalization of left ventricular size and function was demonstrated by echocardiography with a long-termed follow-up of 4 years.

Although rare, periprosthetic valvular regurgitation can cause hemolytic anemia. We present an unusual presentation of hemolytic anemia due to periprosthetic mitral valve regurgitation (PMVR) in the presence of cold agglutinins. Due to high surgical risk, PMVR was percutaneously closed with three Amplatzer devices.

Atrial septal defect (ASD) is a common form of congenital heart disease that often persists well into adulthood before discovery or intervention. The authors report the case of a patient referred for routine percutaneous ASD closure that was found on 3D transesophageal echocardiography to have two large separate ostium secundum defects which were subsequently closed under 3D echocardiographic guidance.

A Gerbode defect is a left ventricle to right atrial communication. The type I defect (direct, acquired) results in a direct shunt through the atrio-ventricular part of membranous septum, while a type II (indirect, congenital) defect results in an indirect shunt through a perimembranous ventricular septal defect and a defect in the septal tricuspid valve leaflet. We report a rare type of Gerbode defect wherein a small perimembranous ventricular septal defect is completely covered by an elongated sail-like anterior tricuspid leaflet forming an aneurysm and directing the shunt into right atrium.

We describe two cases of congenital submitral aneurysms (SMAs) in which three-dimensional transesophageal echocardiography (3D TEE) proved useful to define the spatial extent of these aneurysms. In both cases, rupture into the left atrium was accurately delineated. Imaging from the left atrial perspective allowed the morphology of the mitral leaflets to be accurately defined and enabled detailed anatomical information to be obtained which aids in planning a transatrial surgical repair. 3D TEE is superior to conventional 2D TEE in defining the spatial anatomy of SMAs as well as the mechanisms contributing to mitral regurgitation.

We present two cases of cor triatriatum, a rare congenital anomaly that is composed of a membrane dividing the left atrium into two chambers. The first case is of an older adult man admitted for evaluation for stroke. The second is a case of a middle-aged woman with dyspnea. Both patient's transthoracic echocardiograms revealed abnormal structures in the left atrium, and both subsequently underwent transesophageal echocardiography. During these exams, real time three-dimensional imaging was utilized to more completely define the patient's pathology.

Images of a 54-year-old male patient, with systemic and pulmonary embolisms in which transesophageal echocardiography showed a large thrombus entrapped in a patent foramen ovale. The patient underwent surgery and the thrombus was successfully removed.

We report an atypical echocardiographic presentation of a vegetation in a patient with late infective endocarditis of an ASD occluder device. Transesophageal echocardiography demonstrated a penduculated mass attached to the left atrial side of the occluder device. This mass presented as an oscillating echo free area surrounded by a membrane attached to the device by a thin stalk. At time of surgical excision, the lesion did not present as a spherical cyst. It was assumed that the content of the echofree mass had already emptied into the left atrium. Histopathology diagnosed the mass as a vegetation. The contribution of contrast echocardiography to the evaluation of intracardiac masses is briefly discussed.