Levoatrial cardinal vein (LACV) is anomalous connection between the left atrium or pulmonary veins and any systemic vein which is derived from cardinal venous system. Presence of the levoatrial cardinal vein without a cardiac anomaly is a very rare congenital anomaly of the systemic venous return. In the literature, no LACV anomaly was found in two siblings who were asymptomatic and did not have an additional cardiac anomaly. Therefore, we present two cases ( two siblings ) the symptoms, diagnosis (the echocardiographic finding, computed tomography (CT) and aniographic images ) and treatment modalities of isolated levoatrial cardinal vein.
Fetal cardiac rhabdomyoma should trigger the awareness of potential coexisting tuberous sclerosis complex that can lead to a poor neurological outcome. This condition is not only uncommon but can be easily unrecognized prenatally in the absence of a meticulous neurosonogram and MRI. We emphasize that careful consideration of all prenatal facilities is needed to confirm the diagnosis of tuberous sclerosis complex as early as possible during pregnancy. Key words: cardiac rhabdomyoma; tuberous sclerosis; prenatal diagnosis
Objective: Predictors for post-operative reverse remodeling in patients with severe aortic regurgitation (AR) and reduced left ventricular ejection fraction (LVEF) are unknown. We performed low-dose dobutamine stress echocardiography (DSE) in patients with severe AR and reduced LVEF to evaluate the relationship between contractile reserve (CR) and reverse remodeling after surgery. Methods: In 31 patients with chronic severe AR and reduced LVEF (LVEF < 50%), we performed pre-operative DSE, assessed CR and examined whether changes in preoperative DSE were associated with improvement of post-operative LVEF after aortic valve surgery. Results: The pre-operative echocardiographic findings were as follows: left ventricular (LV) end-diastolic dimension: 67 ± 10 mm, LV end-systolic dimension: 52 ± 13 mm and LVEF: 42% ± 8%. All patients underwent aortic valve surgery. Patients with pre-operative LVEF of >45% exhibited a significant increase in LVEF; however, patients with pre-operative LVEF of <45% showed no significant change. When we examined the results of DSE performed in patients with pre-operative LVEF of <45%, ΔLVEF of ≥6% (with CR) during DSE was related to an improvement in post-operative LVEF; ΔLVEF of ≥6% during DSE predicted an improvement in post-operative LVEF, with a sensitivity and specificity of 80% and 85%, respectively. Conclusions: DSE may be a helpful tool for predicting post-operative reverse remodeling in patients with severe AR and moderately reduced LVEF.
Objectives. We sought to evaluate the ability of left atrial strain and derived index to discriminate patients with HFpEF from individuals with risk factors of HFpEF. Methods and results. A total of n=389 patients with risk factors for HFpEF finally was prospectively enrolled into the study, 51 of them were diagnosed with HFpEF by ESC diagnostic criteria. 55 patients were undergone left ventricular catheterization, 35 of them with LVEDP elevated. Left atrial strain was measured in all patients. Compared patients without HFpEF, LASr and LASr/(E/e’) was lower in HFpEF; E/LASr, LAVi/LASr and LVMI/LASrwas higher in patients with HFpEF. After adjusted for hypertension, diabetes, chronic kidney disease, LVEF and NT-proBNP, multivariate logistic regression analyses showed that LASr and derived indexes(E/LASr, LASr/(E/e’), LAVi/LASr and LVMI/LASr) were still the predictors of HFpEF in their respective models. LASr had good diagnostic accuracy for HFpEF. Of the left atrial strain derived parameters, LVMI/LASr was the best discriminatory ability for HFpEF (AUC 0.796, cutoff value 5.2, specificity 82%, sensitivity 73%). LASr, LASr/(E/e’), LAVi/LASr and LVMI/LASr with higher AUC was superior to conventional echocardiographic measures of diagnosing HFpEF. LASr and derived indexes were incorporated into the ESC diagnostic criteria, LASr-HFA-PEF score system (AUC=0.804) had a higher detection rate of LVEDP≥16mmHg than the HFA-PEF score system (AUC=0.781). Conclusion. LASr and derived indexes with good accuracy beyond conventional echocardiographic parameters discriminate HFpEF from patients with risk factors of HFpEF. LASr and derived indexes incorporated into the ESC diagnostic criteria will improve the diagnostic efficiency.
ABSTRACT Background Identifying risk factors for cancer therapeutics-related cardiac dysfunction (CTRCD) is essential for early detection and prompt initiation of medial therapy for CTRCD. There has been no study investigating whether the sigmoid septum is a risk factor for anthracycline-induced CTRCD. Methods We enrolled 167 patients with malignant lymphoma who received a CHOP-like regimen from January 2008 to December 2017 and underwent both baseline and follow-up echocardiography. Patients with LVEF ≤ 50% were excluded. CTRCD was defined as ≥ 10% decline in LVEF and LVEF < 50% after chemotherapy. The angle between the anterior-wall of the aorta and the ventricular septal surface (ASA) was measured to quantify the sigmoid septum. Results CTRCD was observed in 36 patients (22%). The average LVEF and GLS were lower (61.6 vs. 65.0%, 18.7 vs. 20.3), LV mass index was higher (101.1 vs. 92.8 g/m2), and ASA was smaller (112.1 vs. 119.4 degree) in patients with CTRCD. In a multivariable Cox proportional hazard analysis, GLS (HR per 1% decrease 1.20, 95% CI 1.07-1.35, P = 0.002), ASA (HR per 1 degree increase 0.97, 95% CI 0.95-0.99, P = 0.003) and the history of ischemic heart disease (HR 5.13, 95% CI 1.94-13.56, P = 0.001) were identified as the independent determinants of CTRCD. C-statistics analysis and integrated discrimination improvement proved the significant incremental value of ASA for developing CTRCD. Conclusion Smaller ASA was the independent risk factor and had significant incremental value for CTRCD in patients with malignant lymphoma who received the CHOP-like regimen.
Abstract: Abstract Background: We aimed to investigate whether changes occur in the subcarinal angle (SCA) in chronic obstructive pulmonary disease (COPD) and examine the effects of such changes on mortality rates. Materials and Methods: The study included 108 COPD patients; who were followed up in the intensive care unit (ICU) in the period between January 2018 and December 2018 and who had available posterior-anterior chest X-rays (PA-CXRs), APACHE-II (Acute Physiology and Chronic Health Evaluation-II) scores, and laboratory values in the electronic archiving system. SCA values on PA-CXRs were recorded in the Picture Archiving and Communication System (PACS). Patients were divided into two groups as survivors and nonsurvivors. Results: In our study; congestive heart failure, as one of the comorbid diseases with COPD, was found to be associated with mortality (p: 0.011). Furthermore; APACHE-II scores (p: 0.001), SCA values (p: 0.025), elevated CRP levels (p: 0.01), hypoalbuminemia (p: 0.018), and high creatinine values (p: 0.034) were associated with mortality. Conclusions: Our results are compatible with those of previous studies in the literature demonstrating that advanced age, elevated CRP levels, APACHE-II scores, hypoalbuminemia, and high creatinine values were all associated with mortality in COPD patients. Furthermore, SCA was found to be narrower in nonsurvivors in our study. We think that our study results will contribute to the literature because this is the first study that demonstrated the association between SCA and mortality in COPD patients.
We report a case of left ventricular apical thrombus induce embolic stroke in patient with stress cardiomyopathy. In this case, although we initiated anticoagulant treatment after finding apical thrombus on time, stroke occurred. However, favorable clinical results were achieved with prompt percutaneous mechanical thrombectomy after early suspicion and accurate diagnosis. This case emphasized the need for a follow-up echocardiography during SCMP recovery period to evaluate possible complications such as LV thrombus.
Background Acute dyspnea (AD) is one of the main reasons for admission to the Emergency Department (ED). In the last years integrated ultrasound examination (IUE) of lung, heart and inferior vena cava be-come an extension of clinical examination for a fast differential diagnosis. The aim of present study is to assess the feasibility and diagnostic accuracy of diastolic function evaluation for diagnosing acute heart failure (aHF) in patients with acute dyspnea. Methods We included 113 patients presenting to the ED of CTO Hospital in Naples (Italy) for AD. All pa-tients underwent IUE of lung-heart-IVC with a portable ultrasound device. Left ventricle diastolic function was assessed using pulse wave doppler at the tips of the mitral valve and E wave velocity and E/A ratio were recorded. The FINAL diagnosis determined by two expert reviewers: acute HF or non-acute HF (non-aHF). We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive predictive and negative predictive value of ultrasound parameters for the diagnosis of AD, comparing with the FINAL diagnosis. Results Lung ultrasound (LUS) showed high sensitivity, good specificity and accuracy in identification of patients with HF. However the highest accuracy was obtained by diastolic function parameters. The E/A ratio, detected in patients in sinus rhythm, showed the highest diagnostic performance with an AUC for aHF of 0.913. Conclusion In patients presenting with AD E/A ratio is easy to obtain in a fast ultrasound protocol and showed an excellent accuracy for diagnosis of acute HF.
Background: Pulmonary hypertension is a significant yet rare disease that can have many long-term consequences, including death. Cardiac catheterization is the gold standard for measuring pulmonary artery mean pressures (PAMP), but is invasive and risks potentially serious complications. This study aimed to create a semi-quantitative, non-invasive measure of PAMP using septal positioning. Methods: This study was a retrospective study of patients with and without pulmonary hypertension who had a transthoracic echocardiogram and cardiac catheterization. Patients undergoing atrial septal defect closure represented controls. Two blinded readers calculated the “Echocardiographically-Derived Septal Positional Angle (EDSPA)” which was compared to corresponding catheterization data including mean pulmonary artery pressures. Results: A total of 159 children were included, of which 151 had useable echocardiographic data. 40 children were identified as having pulmonary hypertension while 111 children had an atrial septal defect. Patient age ranged from a minimum of 54 days and maximum of 19 years [mean 7.1 years (SD=5.30)]. Inter-observer variability between two readers [Pearson correlation coefficient of 0.939 (p <0.001)] and intra-observer variability were low [intraclass correlation coefficient (ICC) of 0.95 and 0.96 for each observer respectively]. An EDSPA of ≤39° predicted a PAMP>20 mmHg (as measured by cardiac catheterization) with a 76% sensitivity and 76% specificity (AUC 0.846). Conclusions: EDSPA is a useful, non-invasive, and reproducible echocardiographic measure of PAMP that is easy to perform. With a sensitivity and specificity near 80%, it has significant utility in screening for pulmonary hypertension and determining which patients should undergo further invasive diagnostic testing.
Background: Right ventricular-pulmonary artery coupling (RVPAC) is a predictor of outcome in pulmonary hypertension. However, the role of this parameter in dilated cardiomyopathy (DCM) remains to be established. The aim of this study was to assess the contribution of RVPAC to the occurrence of severe heart failure (HF) symptoms in patients with DCM using three-dimensional (3D) echocardiography. Methods: We prospectively screened 139 outpatients with DCM, 105 of whom were enrolled and underwent 3D echocardiographic assessment. RVPAC was estimated non-invasively as the 3D right ventricular stroke volume (SV) to end-systolic volume (ESV) ratio. Severe HF symptoms were defined by New York Heart Association (NYHA) class III or IV. We evaluated differences in RVPAC across NYHA classes and the ability of RVPAC to predict severe symptoms. Results: Mean left ventricular (LV) ejection fraction was 28±7%. Mean RVPAC was 0.77±0.30 and it was significantly more impaired with increasing symptom severity (p=0.001). RVPAC was the only independent correlate of severe HF symptoms, after adjusting for age, diuretic use, LV systolic function, LV diastolic function and pulmonary artery systolic pressure (OR 0.035 [95% CI, 0.004 – 0.312], p=0.003). By receiver-operating characteristic analysis, the RVPAC cut-off value for predicting severely symptomatic status was 0.54 (area under the curve=0.712, p<0.001). Conclusion: 3D echocardiographic SV/ESV ratio is an independent correlate of severe HF symptoms in patients with DCM. 3D RVPAC might prove to be a useful risk stratification tool for these patients, should it be further validated in larger studies.
Abstract Objective: To investigate the metastatic tumor with tricuspid valve involvement, and to improve the understanding of the disease and the level of diagnosis and treatment. Method: This article mainly reports a case of a metastatic squamous carcinoma of cervix(SCC) with tricuspid valve involvement patient treated with surgical treatment and followed up one year after surgery . Result: The prognosis of the case was good after surgery.But The short-term effect of the patient was not ideal. Conclusion: Metastatic tumor of tricuspid valve is infrequent,which is difficult to diagnose and treat because of the lack of specific clinical manifestations.To achieve better therapeutic effect, the multi-mode treatment strategy should be considered.
Background. Cor triatriatum is a rare congenital cardiac anomaly, represent 0.1% of all congenital cardiac malformations and may be associated with other cardiac diseases in as many as 50% of cases. The natural history of this defect depends on the size of the communicating orifice between the upper and lower atrial chamber. Case Presentation. We reported case of cor triatriatum in a 12 years old girl with chief complaint of shortness of breath, middle chest discomfort and palpitation since 5 days prior admission. The diagnosis was based on clinical features, chest radiography, electrocardiography and transthoracic echocardiography. Chest radiograph showed rounded cardiac apex and double contour appearance. ECG showed sinus rhythm, 75 beat per minute, RAD, CCWR, RVH, RV strain pattern with ST depression and T-wave inversion in II, III, aVF, V1-V5. TTE revealed 2 chambers of left atrium, with restrictive supramitral membrane, dilated right atrium, right ventricle and left atrium, smallish left ventricle, proximal left atrial thrombus (5.96 x 3.44 cm), relative mitral stenosis, severe mitral regurgitation, mild aortic regurgitation and severe tricuspid regurgitation. A diagnosis of cor triatriatum sinister was made. The only treatment is surgical correction. Medical therapy, with ampicillin and heparin, was administered during admission. Conclusion. Cor triatriatum has been reported in a 12-year-old girl. The diagnosis is confirmed by clinical manifestations, chest radiography and echocardiography. The only therapy is surgical correction. From the field of cardiac surgeon, patients are advised to improve their general conditions before underwent surgical procedures.
Aims. The management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. Prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. In particular, left atrial (LA) function has been shown to be an important determinant of morbimortality. The purpose of this study was to analyze the prognostic significance of diastolic function in asymptomatic patients with sAR. Methods and results. A total of 126 patients with asymptomatic sAR were included. Conventional echocardiographic systolic and diastolic function parameters were assessed. LA auto-strain analysis was performed in a subgroup of 57 patients. During a mean follow up of 33±19 months, 25 (19,8%) patients reached the combined end-point. Univariate analysis showed that LV volumes, LVEF, E wave, E/e’ ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events. Multivariate model 1 that tested all echocardiographic variables statistically significant in the univariate model showed that LVEDV [HR=1,02;95% CI:1,01-1,03 (p<0,001)] and E/e’ ratio [HR=1,12;95% CI:1,03-1,23 (p=0,01)] were significant predictors of events. In the subgroup of patients with LA auto-strain analyzed, a second multivariate model including the previous significant variables for the first model as well as LASr, showed that LVEDV [HR=1,05;95% CI:1,01-1,08 (p=0,016)] and LASr [HR=0,8;95% CI:0,65-0,98 (p<0,035)] were the most significant predictors of cardiovascular events. Conclusions. In this population of asymptomatic patients with sAR and normal LV systolic function, baseline diastolic parameters were prognostic markers of cardiovascular events; among them, LASr played a strong independent predictor role.
Objective: According to Bernoulli Equation, systolic pulmonary artery pressure is obtained echocardiographically by adding estimated right atrial pressure (RAP) to the multiply of square of tricuspid regurgitation flow rate by four. RAP is estimated based on inferior vena cava (IVC) diameter and collapse. Our objective is to investigate usability of coronary sinus(CS) diameter and collapse, measured by echocardiography for estimating RAP. Methods: Our study is a single center, prospective study. 136 patients, over 18 years of age and without exclusion criteria, who admitted to Akdeniz University Hospital Cardiology Department between March 2017 and March 2018 and were scheduled to undergo right heart catheterization for any reason were included study. Results: Patients were divided into two groups as invasively measured RAP ≥10 mmHg (n: 57) and RAP <10 mmHg (n: 79). In group with RAP ≥10 mmHg, maximum IVC and CS diameter were higher than group with RAP <10 mmHg, IVC and CS collapse indices were lower (p <0.001). Optimal cut-off value for maximum IVC diameter was 19.6 mm (sensitivity 63.2%, specificity 87.3%), for IVC collapse index was 46.1 (sensitivity 75%, specificity 79.7%), for maximum CS diameter was 11 mm (sensitivity 64.9%, specificity 77%), for CS collapse index was 39.2 (sensitivity 75.4%, specificity 88.6%). Conclusion: Significant relationship was found between invasively measured RAP and maximum IVC diameter, collapse index and maximum CS diameter and collapse index. Results of CS parameters were as significant as results of IVC parameters therefore it shows that CS can also be used for estimating RAP.
Backround: Spontaneous echo contrast (SEC) is an echocardiographic finding particularly found in left atrium of patients with mitral stenosis (MS) and known as a risk factor for stroke. However, its pathophysiology is not fully understood. Methods: Forty-eight patients with MS scheduled for percutaneous mitral valvuloplasty were included in the study. Blood samples were taken from the aorta and left atrium (LA) during the procedure. Whole blood viscosity (WBV), plasma viscosity (PV) and peripheral blood smears were obtained and analysed separately from these sites. All participants underwent transthoracic and transesophageal echocardiography prior to the procedure Results: Severe SEC (grade 3-4) was found in 23 patients, remaining 25 patients had mild to moderate SEC (grade 0-1-2). Patients with severe SEC had increased LA diameter, area and PV. However, ejection fraction, left atrial appendage (LAA) filling and emptying velocities, LAA lateral wall late systolic velocity, LAA fractional area change and pulmonary vein (PVe) systolic velocity were found to be significantly reduced in patients with severe SEC compared to mild to moderate SEC. On multiple linear regression analysis, atrial fibrillation, left atrium PV and diameter were strongly correlated with SEC grade (Respectively p=0,011, p=0,013, p=0,030). Conclusion: We have shown that AF, systolic dysfunction of LAA and left ventricule, reduced PVe flow velocity, increased LA dimensions and left atrial PV were related with the severity of SEC in patients with mitral stenosis. We demonstrated the relationship between the increase left atrial PV and SEC in addition to impaired hemodynamic determinants in patients with mitral stenosis.
Background: The left ventricle (LV) journey in their transition from hypertrophy to heart failure is marked by many subcellular events partially understood yet. The moment in which the structural abnormalities reach the umbral to induce myocardial dysfunction remains elusive. Aims: To evaluate the anatomic-functional relationship between LV wall thickness and longitudinal systolic dysfunction. Material and Methods: We prospectively performed clinical history and transthoracic echocardiogram on healthy individuals and patients with hypertension, left ventricle ejection fraction (LVEF) ≥50%, and absence of heart failure symptoms. Results: A total of 226 patients and 101 healthy individuals were recruited. The distribution for sex was similar between groups. The mean age was 67±13 years old in the patients, and 44% had concentric LV hypertrophy. LVEF was identical in both groups (63±6%); in contrast, global longitudinal strain (GLS) (-18.8±2.5% vs. -20.4±2%) and mitral annulus plane systolic excursion (MAPSE) (13.8±2.8 vs. 15.5±2mm) were lower. ROC curve classified optimally decreased GLS with LV septum thickness ≥13mm and decreased MAPSE with thickness ≥14mm. Multivariable logistic regression found that LV septum thickness is the only variable associated with longitudinal systolic dysfunction (OR= 1.1, CI95%= 1.05 – 1.15, p= 0.001, R squared= 0.38). Discussion: A progressive increase in LV wall thickness due to myocyte hypertrophy and interstitial expansion is associated with LV systolic longitudinal dysfunction. Conclusions: Patients with moderate or severe ventricular hypertrophy (septum ≥13mm) had longitudinal systolic dysfunction, GLS decreases with minor structural change than MAPSE, and LVEF is insensitive in detecting longitudinal myocardial dysfunction in patients with hypertension.
An 86-year-old man with end-stage renal disease on hemodialysis with an arteriovenous fistula in his left upper extremity presented to his hemodialysis session with thrombosis of his arteriovenous fistula. The patient underwent surgical thrombectomy. The patient later showed evidence of peripheral embolization and livedo reticularis. Transthoracic and transesophageal echocardiograms revealed a large thrombus (5x2 cm) in the left atrium prolapsing to the right atrium via a patent foramen ovale and another thrombus (white arrow) adherent to the apical wall of the right ventricle. The thrombus in the left atrium was intermittently crossing the mitral valve and entering the left ventricle.