Prognostic value of strain and strain rate in the prediction of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting: a systematic literature review

Introduction: Atrial fibrillation [AF] is a common dysrhythmia postoperatively after coronary artery bypass grafting [CABG]. Myocardial strain and strain-rate imaging is used for the assessment of postoperative atrial fibrillation [POAF] as a new echocardiographic method

Methods: PubMed and Scopus were searched thoroughly using the following search terms: [strain and strain rate] AND [atrial fibrillation OR AF] on March 2015 to find English articles in which the strain and strain-rate echocardiographic imaging had been used for the evaluation of AF in patients undergone CABG. Full text of the relevant papers was fully reviewed for data extraction

Result: Of overall 6 articles found in PubMed, 10 records found in Scopus and 4 articles found through reference list search, only 6 papers fully met the inclusion criteria for further assessment and data extraction. The results of strain and strain-rate assessment showed that in total of 542 patients undergoing CABG, POAF occurred in 106 patients. Studies showed that the reduction of left atrial [LA] strain rate is correlated with AF. Consistently, the results of present review showed that LA strain and strain-rate in patients who developed AF postoperatively after CABG are significantly reduced, suggesting that strain and strain-rate could be a predictor of POAF

Conclusion: Based on the obtained results, strain and strain-rate is a suitable and accurate echocardiographic technique in the assessment of left atrial function, and it might be helpful to detect the patients who are at high risk of POAF

An Unusual Biatrial Cardiac Myxoma in a Young Patient

This is a report of a biatrial cardiac myxoma in a young man with a 10-month history of exertional dyspnea and palpitation. The echocardiogram revealed biatrial myxoma prolapsing through the mitral and tricuspid valves during diastole. All cardiac chambers were enlarged and dysfunctional. The electrocardiogram revealed a rapid ventricular response with atrial flutter rhythm. The masses were resected and diagnosed as myxoma by a histological examination. The follow-up echocardiogram revealed significant improvement in ventricular function and reduction in the cardiac chambers' volume. There was no evidence of myxoma recurrence. The most probable cause of the patient's heart failure was considered to be tachycardia-induced cardiomyopathy.

improvement of the atrial flutter rhythm upon the removal of the infected permanent pacemaker lead

Pacemaker infection has multiple risk factors. Its presentation is most often similar to infected endocarditis and the diagnosis is made through studying blood cultures. Transesophageal echocardiography can confirm the diagnosis. The most common microorganisms are staphylococcus speciesis. As a matter of fact, complete pacemaker removal appears to be the only definite treatment. We presented a case of infected pacemaker lead which was firstly referred with fever and nephritic syndrome. She had intermittent atrial flutter rhythm. Therefore, a total infected pacemaker system was removed under cardiopulmonary bypass support. Yet, the lead was firmly attached to the septal leaflet of tricuspid valve while leaflet repair was needed. As a result, atrial flutter rhythm was converted into sinus rhythm after an incidental interruption of the macroreentrant circuit in the process of the tricuspid leaflet surgery

An Improved Technique for Pulmonary Endarterectomy

We report a modified technique for pulmonary endarterectomy (PEA) on a 67-year-old man with chronic thromboembolic pulmonary hypertension (CTEPH) who presented with dyspnea. He was referred to our medical center for coronary artery bypass grafting. CTEPH had not been detected in his first visit to another medical center, but upon re-evaluation, the diagnosis was confirmed. PEA was performed with a modified method, which seems to be safe and suitable for the removal of clot and fibrotic materials. Iatrogenic dissection was performed with normal saline injection in the pulmonary artery, and then, the clot was removed completely. Although the technique may not be applicable for all cases, it can be used as an alternative to using an aspirating dissector and a pair of forceps.

Frequency of ischemic mitral regurgitation after first-time acute myocardial infarction and its relation to infarct location and in-hospital mortality

Ischemic mitral regurgitation [IMR] is a common complication after acute myocardial infarction [AMI]. We aimed to investigate the frequency of IMR following first-time AMI and its association with infarct location, in-hospital mortality, and complications. From September 2011 to November 2012, all patients with a diagnosis of first-time acute ST-elevation MI were enrolled in the study. Patients with previous MI and heart failure, organic mitral valve disorders, and previous mitral surgery were excluded from the study. The patients' baseline characteristic, echocardiographic parameters, and complications were recorded. The frequency of IMR after AMI and its relation to infarct location and in-hospital mortality were evaluated. Altogether, 250 patients [180 male] at a mean age of 60.21 +/- 12.90 years were studied. IMR was detected in 114 [45%] patients. There was no association between the presence of MR and gender, systemic hypertension, smoking, diabetes mellitus, or body mass index; however, serum LDL-cholesterol and triglyceride levels were significantly higher in the patients with IMR. The most frequent territory of MI was anterior in the patients without MR, while the anterolateral territory was the most common one in the patients with IMR. The patients with IMR had more reduced left ventricular ejection fraction, more elevated left ventricular end-diastolic pressure, and higher pulmonary arterial pressure [p values < 0.001, < 0.001, and < 0.001, respectively]. Stage III diastolic dysfunction was more frequent in the patients with IMR. All the deaths occurred in the IMR patients, who also had more complicated AMI. IMR following AMI is highly prevalent, and it complicates about half of the patients. Regarding its relation to the AMI complications, assessment of the MR severity is necessary to make an appropriate decision for treatment

Carcinoid heart disease and the utility of 3D trans-thoracic and trans-esophageal echocardiography: two clinical cases

Carcinoid tumors are rare neuroendocrine malignancies. We present two cases of metastatic carcinoid tumors, complicated by carcinoid syndrome and by cardiac valve involvement. Carcinoid syndrome is characterized by secretory diarrhea, episodic flushing, and bronchospasm. Cardiac involvement occurs in up to 50% of patients with metastatic carcinoid tumors which commonly causes abnormalities of the right sided valves. Echocardiography is the best available and non invasive technique for diagnosis. Characteristic features of carcinoid heart disease are thickened, shortened, retracted, and fixed or partially fixed valve leaflets. Three-dimensional [3D] echocardiography provided an en face view of pulmonary and tricuspid valve, not obtainable by two-dimensional echocardiography, and improved delineation of the relationship between these structures and cardiac chambers

Role of transthoracic echocardiography in the evaluation of patients with retinal vein occlusion

Introduction: Retinal vein occlusion is a common vascular disorder disrupting vision. Two basic types of RVO are branch retinal vein occlusion and central retinal vein occlusion [CRVO]. Retinal vein occlusion is a multifactor process including systemic illness and local retinal factors. RVO may be associated with atherosclerotic risk factors. We analyzed the role of 2 dimensional transthoracic echocardiography [TTE] for detecting the cardiac disease in patients with retinal veins occlusion

Materials and Methods: In this cross-sectional study 70 recently diagnosed patients with RVO enrolled in the study. The clinical diagnosis of retinal vein occlusion and its type was confirmed by a vitreoretinal specialist. The Patients were then referred for performing complete TTE

Results: The prevalence of RVO increased with age, but did not vary by sex. The most frequent cardiovascular risk factor was hypertension. The findings of our study revealed that a variety of echocardiographic abnormalities may be presented in patients with RVO. Diastolic dysfunction was the most frequent echocardiographic finding and we found positive correlation between diastolic dysfunction with increasing age and the presence of hypertension. Other findings included mitral regurgitation [52.9%], mitral stenosis [2.9%], mitral annulus calcification [1.4%], mitral valve prolapse [8.6%], aortic insufficiency [22.9%], sclerotic aortic valve [27.1%], tricuspid regurgitation [45.7%], pulmonary insufficiency [8.6%], mild pulmonary hypertension [8.6%], and moderate to severe pulmonary hypertension [4.3%] Mild LVH [11.4%], Moderate LVH [8.6%]. Abnormality on IAS was defined in these patients, including paten foramen ovale, lipomatosis IAS, exaggerated motion of IAS, and aneurysm of IAS

Conclusion: In our study, the most common echocardiographic finding was diastolic dysfunction which was compatible with the patients' age and the fact that the most prevalent risk factor was hypertension. Other findings were not more prevalent than general population. We think that a routine workup for structural heart diseases is unwarranted in these patients

Acute myocardial infarction in a 17-year-old boy secondary to lightning strike

Although lightning is an uncommon phenomenon in nature; it can cause many destructive incidents. In the event of a lightning strike, multiple organs particularly the cardiovascular systems are at risk of injury. Short-term mortality depends on its cardiac effects. In this paper, the authors report the development of myocardial infarction and pericardial effusion after lightning injury, a typical example of "side splash"