Echocardiography is important for raising the pretest probability of amyloid cardiomyopathy before endomyocardial biopsy and ^99mTc-labeled pyrophosphate scintigraphy. Left ventricular (LV) granular sparkling has been reported to be a typical finding in amyloid cardiomyopathy. However, newer echocardiographic image processing techniques may reduce the granular appearance. Thus, the usefulness of granular sparkling as a discriminating factor remains limited. The combination of increased LV thickness and low-voltage electrocardiographic pattern was known to be typical for amyloid cardiomyopathy. However, the rate of low voltage is relatively low in amyloid cardiomyopathy. Thus, a decreased voltage/mass ratio may be useful to diagnose amyloid cardiomyopathy. LV apical sparing pattern, which is a pattern of regional differences in deformation in which the longitudinal strain (LS) in the basal and middle segments of the LV is more severely impaired than that in the apical segment, is also a useful echocardiographic finding for diagnosing amyloid cardiomyopathy. However, we revealed that half of patients with amyloid cardiomyopathy did not have LV apical sparing. Thus, we should recognize the limitations of echocardiographic findings in the diagnosis of amyloid cardiomyopathy. When amyloid cardiomyopathy is suspected, hypertrophic cardiomyopathy, Fabry disease, and mitochondrial cardiomyopathy should be included in the differential diagnosis. Thus, the typical echocardiographic findings of these diseases should be recognized. Although echocardiography is useful for diagnosing and differentiating amyloid cardiomyopathy, there are several limitations. Thus, it is important to perform echocardiography with medical consultation about medical and familial history. Comprehensive assessment with not only echocardiography but also medical consultation, electrocardiography, and laboratory findings enables us to diagnose amyloid cardiomyopathy accurately.

This case involved a man in his 70s who had been receiving regular epidural block injections for lumbar spondylosis once a month for 4 years. Two days before hospitalization, he presented with polyarthralgia and a body temperature of 38.0°C. An examination suggested a severe inflammatory reaction. Whole-body computerized tomography (CT) indicated an abscess in the right shoulder and right iliopsoas muscle, whereas cranial magnetic resonance imaging indicated an infarction in the left frontal lobe. Infective endocarditis was suspected, leading to the patient’s admission to the hospital. Methicillin-resistant Staphylococcus aureus was detected in his blood culture on days 1 and 2 of hospitalization. Subsequent transthoracic echocardiography indicated string-like vegetation on the left ventricular side of the aortic valve and hypokinesis of the anterior septal wall. On day 3 of hospitalization, transesophageal echocardiography showed vegetation on the aortic valve, leading to a definitive diagnosis of infective endocarditis. Coronary CT performed the same day demonstrated severe stenosis in the left anterior descending artery, possibly caused by vegetation. On day 4 of hospitalization, the patient underwent semi-emergency surgery involving aortic valve replacement and coronary artery bypass surgery. This was a case of infective endocarditis caused by abscesses in the shoulder and iliopsoas muscle, which was complicated by coronary artery embolism caused by atypical vegetation and cerebral infarction.

A woman in her nineties was referred to our laboratory for further examination of her underlying cardiac disease, i.e., atrial fibrillation. Color Doppler echocardiography showed tubular continuous flow coming from between the top of the left atrium and ascending aorta, draining into the right atrium near the fossa ovalis. Doppler examination of this flow showed a continuous flow wave with a prominent systolic flow component (1.9 m/sec), followed by a slow diastolic flow component coincident with the flow profile of the coronary vein. Considering the anatomical bloodstream and Doppler profile of this flow, we diagnosed this flow as anomalous great cardiac venous drainage (AGCVD), which is a rare coronary venous anomaly. This diagnosis was confirmed by the coronary CT findings. Contrast echocardiography from the left arm revealed persistent left superior vena cava. This is the first case report of AGCVD diagnosed using Doppler echocardiography in the literature.

Echocardiography has a considerable impact on the surgical strategy employed during cardiac surgery. However, emergency surgeries generally do not permit the thorough evaluation of patients. The addition of a dedicated perioperative ultrasonographer to our surgical team has allowed for perioperative evaluations such as transthoracic echocardiography (TTE) to easily be performed on patients undergoing elective or emergency surgeries. There are no reports in the literature on the benefit of a dedicated perioperative ultrasonographer performing preoperative TTEs. We herein report a case of a left atrial myxoma and associated mitral valve (MV) prolapse that was detected by the perioperative ultrasonographer preoperatively and treated simultaneously with tumor resection and mitral valve annuloplasty (MVA). A 68-year-old female patient was diagnosed with congestive cardiac failure on admission to a nearby hospital. TTE revealed a massive mass in the left atrium and moderate mitral regurgitation (MR). She was transferred to our hospital for surgery. The perioperative ultrasonographer reviewed the TTE and found a slight deviation of the A3 anterior MV leaflet towards the apex, which had been theorized to be the site of MR. The findings were promptly reported to the anesthesiologist and cardiovascular surgeon; subsequently, tumor resection and MVA were performed. The tumor mass had a stalk attached to the atrial septum. MV degeneration and excessive leaflet tissue of the A3 anterior leaflet were found. Moreover, the diameter of the valvular ring was enlarged, resulting in a defect of the junction between the anterior and posterior leaflets. The regurgitation was stabilized. Left atrial myxoma is frequently correlated with MR, which is challenging to accurately detect and evaluate for the severity thereof. Particularly within the limited time frame, the perioperative ultrasonographer was able to promptly perform the TTE and share the findings with the surgical team. This led to selection of the appropriate preoperative evaluation and surgical procedure.