Primary synovial sarcoma of the right atrium

A 27-year-old man presented with exertional dyspnea and productive cough as well as weight gain. Transthoracic echocardiography revealed severe right ventricular enlargement with moderate systolic dysfunction and a large right atrial mass protruding into the right ventricular cavity with severe functional tricuspid stenosis. An urgent surgical operation was done, and the tumor was totally excised. The histological findings were those of a biphasic tumor, consistent with synovial sarcoma. This was also confirmed by an immunohistochemistry panel. The patient's chest CT scan showed multiple small peripheral nodules, suggestive of lung metastases. Chemotherapy was administered and several months afterwards, the patient was asymptomatic with no residual mass on echocardiography

Assessment of statistical relationship of ejection time and acceleration time with the severity of valvular aortic stenosis

Valvular aortic stenosis is a relatively common disease among valvular heart diseases and can be rheumatic, degenerative or congenital. Evaluation of the severity of the disease is sometimes challenging and problematic. Besides, the use of more parameters of non-invasive methods for the assessment of valvular disease and its severity seems attractive and helpful. Transthoracic echocardiography [TTE] is an appropriate modality for the evaluation of the aortic valve. In this study, TTE was performed for 80 patients with valvular aortic stenosis. The goals were to assess the statistical relationships between ejection time [ET] and acceleration time [AT] and their ratio [AT/ET] with the four traditional parameters of the echocardiographic severity of aortic valvular stenosis [aortic jet velocity, aortic valve area, mean pressure gradient and LVOT VTI/aortic VTI ratio]. There was a meaningful relationship between adjusted ET with the four above-mentioned parameters, d. ET [ET-adjusted ET according to heart rate and stroke volume] was inversely related with the aortic valve area [calculated with continuity equation]. AT/ET was significantly correlated with the four mentioned parameters. The regression equations were calculated. The cut-off value of AT/ET for the echocardiographic diagnosis of severe valvular stenosis was 0.36 [with 95% level of confidence]

Rare form of large pericardial cyst in 73 years old with atypical chest pain

We are reporting a case of 73 year- old gentleman with atypical chest pain and history of hypertension who underwent clinical evaluation at our center. He was ultimately diagnosed with rare presentation of pericardial cyst .His echocardiographic data and Chest CT scan data were unique because most pericardial cysts are seen in right side of the heart unlike our patient who had suffered from large left sided form of the disease which is very rare

Prevalence of left ventricular diastolic asynchrony in patient with systolic heart failure

To study the occurence of left ventricular [LV] diastolic asynchrony in patients with systolic heart failure [HP] and its relationship to diastolic function regardless of QRS duration. Recent work has demonstrated that intraventricular asynchrony is a common finding in patients with systolic heart failure. Little attention has been paid to diastolic asynchrony in patients with systolic heart failure. We have therefore decided to determine the extent to whuch patients with systolic heart failure have evidence of diastolic asynchrony and wheather or not diastolic asynchrony is correlated with diastolic dycfunction. Tissue Doppler echocardiography was performed in 50 HF patients [LV EF=23 +/- 8%]. Diastolic and systolic asynchrony was determined by tissue synchronization imaging using a 6 basal, 6 mid-segmental model. Systolic and diastolic asynchrony were assessed by the maximal difference in time to peak systolic and early diastolic velocities between any two of 12 LV segments, and the standard deviation of time to peak systolic and early diastolic velocities of the 12 LV segments. The mean +/- SD maximal difference in time to peak systolic velocity [controls: 17.2 +/- 9.6 ms versus narrow QRS: 66.7 +/- 38.0 ms versus wide QRS: 76.5 +/- 34.6 ms, both P<0.05 versus controls] and in standard deviation of time to peak systolic velocity of 12 LV segments [controls: 15 +/- 6.1 ms versus narrow QRS: 25.9 +/- 15.3 ms versus wide QRS: 28.6 +/- 14.4ms, both P<0.05 versus controls] was prolonged in both the narrow and wide QRS groups compared with normal controls. Similarly, the maximal difference in time to peak diastolic velocity [controls: 39 +/- 16.8 ms versus narrow QRS: 73.1 +/- 58ms versus wide QRS: 108.5 +/- 168 ms, both P<0.05 versus controls] and in standard deviation of time to peak early diastolic velocity of 12 LV segments [controls: 15.3 +/- 5.8ms versus narrow QRS: 25.1 +/- .13.8ms versus wide QRS: 25.5 +/- 14.9ms, both P<0.05 versus controls] was prolonged in both the narrow and wide QRS groups. The respective prevalence of systolic and diastolic asynchrony was 31.4% and 20%, in the narrow QRS group, and 40% and 28.6%, in the wide QRS group respectively.Stepwise multiple regression analysis showed that low ejection fraction and low mitral annular early diastolic velocity were independent predictors of both systolic and diastolic asynchrony. QRS complex duration was found to correlate only with diastolic asynchrony. LV systolic and diastolic mechanical asynchrony is common in patients with HF regardless of QRS duration. Selection for cardiac resynchronization treatment should also be based on information about systolic and diastolic synchronicity