rare case of congenital heart disease with bifid cardiac apex: a unique finding in left ventricle

Bifid cardiac apex is a rare anomaly of human hearts. We report of the case of a 34-year-old man with a previous history of ventricular septal defect [VSD] and subvalvular pulmonary stenosis. He had undergone pulmonary commissurotomy and VSD closure 22 years before he was referred to our center for evaluation of progressive dyspnea. Transthoracic echocardiography revealed atrial septal defect [ASD], multiple VSDs, severe pulmonary regurgitation, and a bifid cardiac apex. The patient was referred for re-do surgery for ASD and VSD closure along with pulmonary valve replacement, but he refused the surgery

Echocardiographic findings in thalassemia major: a case report and literature review

We introduce a 28-year-old woman with Thalassemia major whose clinical assessment, including two-dimensional Doppler echocardiography demonstrated severe left ventricular hypertrophy with severe biventricular enlargement and systolic dysfunction as well as severe diastolic dysfunction. We hereby address these issues from an echocardiographic point of view.

New aspects of family history of heart disease as a risk factor for coronary artery disease in patients with acute myocardial infarction

This an in-depth investigation of the relationship between some new aspects of positive family history [FH] of coronary artery disease [CAD] and other risk factors related to CAD in patients with acute myocardial infarction [AMI]. The data of 200 patients with AMI and positive FH of CAD [FH Pos.]- as case group- and 200 AMI patients without FH of CAD -as control group- [FH Neg.] were collected. Information about first and second-degree relatives was obtained, including age, occurrence of Ml, and other risk factors related to CAD. We also covered procedures such as coronary angiography [CAG], percutaneous intervention [PCI], and coronary artery bypass grafting [CABG] surgery. AMI with ST-segment elevation in ECG [69.61% vs. 26.76%], heart block [19.47%. vs. 6.34%], and low EF [mean 43 +/- 3.4% vs. 47 +/- 35%] were higher in the FH Pos. group than the FH Neg. group. As well as diabetes [42.71% vs. 11.27%], dyslipidemia [42.19% vs. 14%], and hypertension [73.74% vs. 64.79%] in the FH Pos. group were higher than those in the FH Neg. group. CAG [79.9% vs. 39.9%] and CABG [34.8% vs 14.79%] were higher in the FH Pos. group [all p values<0.05]. More patients in the FH Pos. group were male and younger, in the FH Pos. group, there was 65% positive finding in the second-degree relatives; most of these second-degree relatives came from the father's side [56%]. Also, there were 1.35 times more events in brothers than in sisters. Subjects with a positive family history of CAD were younger and more susceptible to CAD and needed frequent interventional procedures. Also, there was a difference in the power of various kinds of positive FH. In the FH Pos. arm, there was a stronger relationship between the patient and his/her brothers than with sisters and 56% incidence in the second-degree relatives [especially from the father's side]

Fragmented QRS complex in acute anterior myocardial infarction and coronary sinus blood flow: is there any relevance?

Patients with QRS fragmentation following myocardial infarction [MI] are at greater risk of cardiac death. Transthoracic echocardiography [TTE] can be used as a method for evaluating the coronary sinus blood flow [CSBF] and coronary sinus velocity time integral [CSVTI]. The present study reports measurement of CSBF and CSVTI by TTE in 100 acute anterior MI cases, half of them with fragmented QRS. Our study included 100 patients with acute anterior MI in whom CSBF and CSVTI were measured by the use of TTE. Fifty of all the patients had fragmented QRS complex and 50 patients were without fragmented QRS complex, while there was no difference in terms of LVEF in both groups of study. CSBF [303 +/- 126 ml/min vs. 258 +/- 121 ml/min; p-0.001] and CSVTI [14.45 +/- 2.85 ml vs. 10.85 +/- 2.69 ml; p=0.003] were significantly lower in the acute anterior MI patients with fragmented QRS in comparison with the patients with acute anterior MI without fragmented QRS. We conclude that CSBF and CSVTI can be measured by TTE in acute MI patients and these variables are reduced in acute anterior MI patients with fragmented QRS

Short and long-term outcomes after balloon pulmonary valvuloplasty in congenital pulmonary stenosis

Balloon pulmonary valvuloplasty [BPV] has emerged as the treatment of choice for patients with valvular pulmonary stenosis [PS]. We report here our short and long-term outcomes of BPV in 64 patients with isolated native PS. From February 1996 to February 2006, sixty-four patients with PS [pressure gradients ?40 mm Hg] were enrolled in this retrospective study. The hemodynamic data at catheterization revealed that the RV - PA pressure gradient before BPV ranged from 40 to 240 mmHg [mean +/- SD=93.2 +/- 43.4 mmHg]. The above gradient immediately after BPV ranged from 5 to 163 mmHg [mean +/- SD=30.3 +/- 27.7 mmHg], and the difference was significant [p=0.0037]. Twenty-three patients had regular follow-up. The duration of follow- up ranged from 1-120 months with a mean of 38.5 +/- 31.3 months. The transvalvar pressure gradient during the above period ranged from 10 to 140 mmHg with a mean of 35.9 +/- 27.9 mmHg and showed a significant difference [p=0.0032] with the pressure gradients before BPV. BPV provides short and mid-term relief of pulmonary valve obstruction in the majority of patients