Complex ebstein's anomaly in an 86-year-old iranian man: a case report

Ebstein's anomaly is defined as the significant apical displacement of the tricuspid valve causing tricuspid regurgitation. Although a variety of concomitant lesions have been previously described, we herein introduce an unusual presentation. Our patient was an 86-year-old man with a primary presentation of typical chest pain in the setting of recently diagnosed coronary artery disease with concomitant Ebstein's anomaly. We found mild-to-moderate tricuspid regurgitation, bicuspid aortic valve, persistent left superior vena cava, and patent foramen ovale. The patient had suffered from chest discomfort on exertion for 2 months with good functional capacity prior to diagnosis. Coronary angiography revealed two-vessel disease. The patient refused surgery. He was treated with medical anti-ischemic therapy. He had good exercise tolerance with relief of chest pain at the latest follow-up

The features demonstrated in this case report suggest that there may be several adult survivors of complex congenital heart diseases requiring individualized surgical treatment plans

Conservative Management of Left Atrial Intramural Hematoma after Catheter Ablation

Left atrial intramural hematoma is a very rare complication of radiofrequency ablation procedures. A patient with tachyarrhythmia underwent radiofrequency catheter ablation. Echocardiography performed the following morning showed a large mass in the left atrium, suggestive of intramural hematoma formation. The patient was in a stable condition; therefore, it was decided that follow-up should be conservative and her anticoagulation therapy was continued. The size of the hematoma decreased significantly over the following 50 days. This case highlights a rare complication of a complex catheter ablation procedure in the left atrium that was managed via a noninvasive approach, with which all interventionists should be familiar.

Non invasive estimation of left ventricular normalized torsion angle in healthy persons by echo tracking algorithm: short axis view

Left ventricular [LV] torsion angle is a key parameter of cardiac performance but is difficult to measure. The purpose of this study is to describe a noninvasive imaging method for the assessment of these complex cardiac motions. In this study, left ventricular torsion angle and normalized torsion angle were estimated in the short axis view for healthy persons. We acquired basal and apical short axis left ventricular LV images in the short axis view for 14 healthy men to estimate LV torsion angle by echo tracking under a block-matching [BM] algorithm. By extracting the instantaneous changes in total displacement vector in the short axis view throughout a cardiac cycle, we calculated the instantaneous rotation and torsion angles in the short axis view. To account for differences in heart size, normalized torsion was calculated based on the radius of both the apical and basal slices in the end diastolic frame. Apical and basal rotation was measured from short axis images by automatic frame-to-frame tracking of grayscale echo patterns. The vertical and horizontal displacements of the apical level were more than those of the basal level. All data are expressed as mean +/- standard deviation [SD]. Data was tested for normal distribution and homogeneity of variance by the Kolmogorov-Smirnov test [K-S] and Levene's test respectively. The peak rotation angles of the basal and apical levels and LV torsion angle in the short axis view were 8.0 +/- 1.6°, 9.5 +/- 1.8°, and 17.3 +/- 2.5°, respectively. The normalized torsion was calculated as 7.8 +/- 1.3°, based on the basal maximum radius, the apical maximum radius, and the distance between the apical and basal levels. We conclude that the normalized torsion angle is an important biome-chanical parameter, because it is independent of heart size and distorted geometries in pathological ventricles