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

Correlation between aortic valve sclerosis and coronary artery disease: a cross - sectional study

Aortic valve sclerosis considered as a manifestation of coronary atherosclerosis. Recent studies demonstrated an association between aortic valve sclerosis and obstructive coronary artery disease. The purpose of this study was to evaluatethe correlation betweenaortic valve sclerosis andobstructive coronary artery disease and the extent of coronary artery disease in patients hospitalized for chest pain. A total of 230 consecutive patients were referred to the coronary angiography of GhaemMedical Center and were subjected to transthorasic echocardiography for screening of aortic valve sclerosis and coronary risk assessment. The diagnostic value of obstructive coronary artery disease for aortic valve sclerosis was calculated. The patients with obstructive coronary artery disease had a higher prevalence of aortic valve sclerosis compared to those with no coronary artery disease [P< 0.05]. Aortic valve sclerosis was an independent predictor for obstructive coronary artery disease by multivariate analysis [P< 0.05]. Aortic valve sclerosis had sensitivity of 47% and specificity of 79% and positive predictor value of 92%. Aortic valve sclerosis was an independent predictor for obstructive coronary artery disease in patients with chest pain and was strongly interrelated with the extent of coronary artery disease in these patients

[ case report of arrhythmogenic right ventricular dysplasia presenting syncope]

Patients with arrhythmogenic right ventricular cardiomyopathy have Ventricular Tachycardia [VT] and left bundle branch block contours with right-axis deviation and T-waves inversion in pericardial leads. Presenting case was a 28 years old man admitted with palpitation and syncope. The electrocardiography showed Ventricular tachycardia with left bundle branch block contour and T wave inversions in V[1] to V[6] and incomplete right bundle branch block and T wave inversions in V[1] to V[3]. Echocardiography revealed right ventricular [RV] dilatation. RV function was abnormal, and aneurismal formation in free wall was seen in 3D echocardiography. Arrhythmogenic right ventricular cardiomyopathy remains as a primary diagnoses, in case of patients with ventricular tachycardia, left bundle branch block contour and T waves inversion in pericardial leads and without any history of ischemic heart disease

Incidental finding of Cor triatriatum sinistrum in a middle-aged man candidated for coronary bypass grafting [with three-D imaging]

Cor triatriatum sinistrum is a rare congenital cardiac malformation, accounting for about 0.1-0.4% of all congenital heart diseases and characterized by the presence of a fibromuscular membrane that subdivides the left atrium into two chambers in the classical form. While classic cor triatriatum in most patients can be observed during the neonatal period or early infancy, it is very rare in adults. We herein present an incidental finding of cor triatriatum sinistrum in a middle-aged man with coronary artery disease scheduled for coronary artery bypass graft surgery. The patient was admitted for exertional dyspnea and chest pain of a three-month duration. He had a past medical history of mild hyperlipidemia and mild hypertension. Transthoracic two-D echocardiography [TTE] demonstrated a visible presence of a membranous band in the mid portion of the left atrium with obvious obstruction by color and Doppler flow measurements, confirmed by three-D echocardiography. Selective coronary angiography also revealed a severe ostioproximal stenosis of the left anterior descending artery of up to 99%. On-pump coronary artery bypass grafting was performed without complications, during which the anastomosis of the left internal mammary artery to the left anterior descending artery and the removal of the membrane were done

Patent foramen ovale in young adults with cyptogenic stroke or transient ischemic attack

Stroke, one of the most important causes of morbidity and mortality in the world, is of great importance in young adults [15-45 years], amongst whom the causes of stroke and transient ischemic attack [TIA] are different from those in older ages and a significant portion of them have no known etiology. Patent foramen ovale [PFO] is considered a probable cause in this group. Patients between 15 and 45 years of age with TIA or stroke were examined and evaluated for causes of cerebrovascular accidents. Patients with no definite cause for stroke or TIA, except for PFO, despite our extensive evaluations were categorized as cyptogenic. The controls wee comprised of those between 15 and 45 years old who underwent transesophageal echocardiography [TEE] for reasons other than stroke. The frequency of PFO and its characteristics were compared between the two groups. The case group comprised 48 patients with cryptogenic stroke [n=31] and TIA [n=17], and the control group consisted of 57 patients. The age distribution of the groups was normal, and there was no significant difference between eh age and gender of the two groups. The frequency of PFO in the case and control groups was 52% and 25% respectively [p value= 0.003, odds ration= 3.33, confidence interval= 1.46-7.63]. The exaggerated motion of the interatrial septum [IAS] in the case and control groups was 18.8% and 0%, respectively. Right-to-left shunt at rest in the case and control groups was 78% and 28%, respectively [significant differences]. The differences in terms of PFO size, number of bubbles, and atrial septal aneurysm were not significant between the two groups. PFO had a relation with stroke and TIA in the young adults, and right-to-left shunt at rest and exaggerated motion of the IAS could increase the possibility of paradoxical emboli. It seems that the presence of atrial septal aneurysm, number of bubbles, and PFO size did not increase the risk of cerebrovascular accidents

Relation Between Capillary Wedge Pressure Measured by Echocardiography Through Tissue Doppler Imaging [TDI] Method and Catheterism in Patients with Mitral Valve Stenosis

Considering suggested formula in the references and PCWP measured by catheterism, in the present study the relation between pulmonary capillary wedge pressure [PCWP] measured the flow velocity of mitral valve and mitral annulus motion through tissue doppler imaging is evaluated. 52 cases of severe MS were admitted for Balloon Mitral Valvolotomy [BMV] are included in this study. Mean age was 35 +/- 5 years consisting of 40 females and 12 males. Valve area, Pulmonary artery systolic pressure [PAP], E [Maximum Velocity of mitral valve at the beginning of diastole] and Em [Maximum rate of mitral annular motion at the beginning of diastole which is recorded through septal or lateral wall cumulus site] velocity and left atrial [LA] size were also measured by echocardiography and PCWP and PAP through catheterism. All patients had normal ejection fraction [EF] and coronary arteries; there was no other valvular diseases and shunts. There was a significant correlation between PAP in echocardiography and catheterism. Mean PAP was 53 +/- 19 mmHg in echocardiography and 53.9 +/- 17.8mmHg in catheterism. There wasn't any correlation between PCWP in echocardiography and catheterism [P=0.33] and also no relation between PCWP and mitral valve area [MVA] or LA size [P=0.2]. E/Em ratio increased in severe MS cases. E/Em ratio and suggested formula would overestimate the wedge pressure so echocardiography is not a reliable method for measuring PCWP in severe MS. Em velocity and E/Em ratio may be used for estimating MS severity