Silent pulmonary artery dissection in a patient with old pulmonary balloon valvuloplasty

Percutaneous pulmonary balloon valvuloplasty [PBV] remains the treatment of choice for pulmonary stenosis [PS]. This procedure is effective, safe and gives excellent results. Pulmonary artery [PA] dissection is a rare complication of PBV. This report is a case of an asymptomatic 17-year-old male with a history of PBV due to severe PS dating back to fifteen years ago. During recent echocardiography, an intimal flap was detected in the main PA and entry site was clearly seen by contrast study

role of echocardiography in coronary artery disease and acute myocardial infarction

Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardia! effusion. Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary per fusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea. This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction

Obvious or subclinical right ventricular dysfunction in diabetes mellitus [type II]: an echocardiographic tissue deformation study

Diabetes mellitus is capable of impairing the myocardial function. Several studies have documented the influential impact of diabetes mellitus on the left ventricular function. The right ventricular function plays a significant role in the overall myocardial contractility; hence, this study was undertaken to evaluate the effect of diabetes mellitus type II on the right ventricular function. Twenty-two diabetic patients without any coronary artery disease, hypertension, or left ventricular dysfunction were studied. The right ventricular end diastolic diameter, tricuspid plane systolic excursion, right ventricular inflow Doppler parameters, longitudinal myocardial velocities, and deformation indices from the basal and apical segments of the right ventricular free wall of the case group were measured. The control group consisted of 22 healthy individuals. The tricuspid annular plane systolic excursion [TAPSE] and tricuspid peak early to peak late diastolic flow velocities ratio [E/A] in the diabetic patients were significantly lower than those of the control group patients [18.9 vs. 23.2, p value < 0.001 and 0.96 vs. 1.21, p value = 0.012], but there were no significant differences in the right ventricular end diastolic diameter and the right ventricular Tei index between the two groups [p value = 0.72]. The right ventricular basal peak myocardial systolic velocity [SM] [12 cm/sec vs. 13.4 cm/sec; p value = 0.03], basal and apical right ventricular free wall systolic strain [-13.3% and -18.7% vs. -20.2% and -25.7%; p value = 0.001], and apical strain rate [-1.2 1/s vs. -1.6 1/s; p value = 0.008] were significantly lower in the study group. There was a weak correlation between the right ventricular function and HbA1c as well as the duration of diabetes mellitus and C-reactive protein. Our results suggest that diabetes mellitus type II can influence the right ventricular function in the absence of coronary artery disease, diastolic dysfunction, and pulmonary hypertension

What do we know about the cardiac CAT? [a case report]

We present a 16-year-old male whose chief complaints were exertional dyspnea, atypical chest pain, and a weight loss of about 5 kg of recent onset. His past medical history and laboratory tests were unremarkable. Echocardiography showed a calcified and mobile mass with irregular borders, measuring 3 X 2 cm in the left atrium. Grossly, the specimen was creamy-yellow and fragmented with a firm to hard consistency. Microscopically, multiple calcium deposits were seen within a dense background of fibrocollagenous tissue. Based on these findings, a diagnosis of cardiac calcified amorphous tumor [CAT] was made

Hydatid cyst mimicking heart tumor

We present two women who lived in a rural community. The presence of a semi-solid mass, a hydatid cyst or tumor, in the heart was diagnosed by echocardiography, computed tomography, and Magnetic Resonance Imaging. The hydatid cyst was seen during surgery. Pathological examination confirmed an infected hydatid cyst

Prosthetic pulmonary valve malfunction

Prosthetic heart valve thrombosis is a serious complication in which systemic thrombolysis has emerged as a suitable alternative to surgery, especially for right-sided prosthetic valve thrombosis. We report the case of a thrombosed Carbomedics Medical prosthetic valve placed in the pulmonary position in a patient who had undergone total repair of tetralogy of Fallot, which was successfully treated with intravenous thrombolytic therapy with streptokinase

Fungal endocarditis: review of our cases over a four-year period

Over a 4-year period, we studied six cases of fungal endocarditis, four of which were caused by Aspergillus sp. And the other two were candidal in origin. Both sides of the heart showed involvement by these infections. The vegetations of infective endocarditis tend to vary in size, but fungal lesions are often large. Our youngest patient was four months old and the oldest one was 62 years old. A high index of clinical suspicion, together with histopathological and microbiological studies, can be used as tools to diagnose and treat such patient in due course. It is important to send fresh specimens for tissue culture studies in sterile normal saline and not in fixatives such as formaladehyde. Pathologically, not only are the special staining methods such as Periodic acid-Schiff useful in the demonstration of fungal elements in tissue or vegetation sections, but also the routine hematoxylin and eosin stain is capable of showing these structures clearly

Evaluation of longitudinal right ventricular mechanical dyssynchrony before and early after cardiac resynchronization therapy: a strain imaging study

The right ventricular [RV] dyssynchrony has not been extensively and the existing literature has established the effect of cardiac resynchronization therapy [CRT] on the left ventricular [LV] dyssynchrony, but there is a death of data on the effect of CRT on the forgotten ventricle. We sought to evaluate the presence of mechanical right ventricular dyssynchrony in patients with systolic heart failure, selected for CRT, and track the changes early afterward utilizing the longitudinal strain analysis. Thirty-six patients with severe left ventricular systolic dysfunction, candidated for CRT, were enrolled in this study. Mechanical dyssynchrony was assessed using tissue Doppler echocardiography. The time interval between the onset delay was calculated as the absolute value of the difference in the time-to-peak measurements between the RV and spetum. The RV dyssynchrony was defined as the calculated delay in strain imaging, which was +/- 2 SD above the mean value for the control subjects [20 cases]. The RV function was evaluated using the RV fractional area change [RVFAC], tricuspid annulus plane systolic excursion [TAPSE], and peak systolic strain values of the RV free wall. Four to 7 days after CRT implantation, echocardiographic reevaluations were done. The calculated cut-off value for the RV dyssynchrony was 41.5 msec, according to which the pre-CRT analysis specified two patient groups: Group 1 [16 cases] with RV dyssynchrony and Group 2 [20 patients] without RV dyssynchrony. Significant improvement in the RV dyssynchrony was noted in Group 1 after CRT [30 +/- 28.9 msec vs. 68.8 +/- 21 msec; p value <0.01 vs. 14 +/- 10 msec vs. 19 +/- 16.5 msec; p value = 0.18 respectively]. A significant correlation was found between the severity of the RV dyssynchrony and peak systolic strain in the RV free wall [r = -0.5; p value <0.05]. No significant relation was found between the RV dyssynchrony and right ventricle fractional area change [RVFAC], LV mechanical dyssynchrony, time-to-peak systolic strain in the RV free wall, QRS width, or morphology. In group I, the peak systolic strain increased insignificantly [p value = 0.15 for the basal segment; p value = 0.20 for the mid segment]. A moderately significant correlation was found between the RV mechanical delay before CRT vs. the post-CRT values [r = 0.4; p value = 0.01]. Early after CRT, the RV mechanical delay can improve and the significant improvement is seen in patients with baseline RV mechanical dyssynchrony

Evaluation of the relation between anterior mitral valve leaflet motion based on height-to-length ratio and the immediate outcome of percutaneous balloon mitral valvuloplasty

The purpose of this study was to investigate whether there is any relation between mitral leaflet motion based on height-to-length ratio of the anterior mitral valve leaflet doming in diastole and the immediate outcome of balloon mitral valvuloplasty,. The study population consisted of 49 patients [47 women, mean age: 43.7 +/- 13.35 years] with symptomatic rheumatic mitral stenosis who underwent balloon valvuloplasty. Complete transthoracic and transesophageal studies were performed in all the patients before valvuloplasty, and transthoracic study was repeated 24-48 hours after valvuloplasty. The severity of the restriction of the mitral valve leaflet motion was classified based on the heightto- length ratio of the anterior mitral valve leaflet doming. Mitral valve thickness, calcification, subvalvular thickening, and mobility were scored according to the Wilkins system. Optimal immediate outcome of balloon mitral valvuloplasty was defined as a valve area improvement of 50% or more or a final mitral valve area of >/= 1.5 cm[2] and mitral regurgitation Sellers' grade >/= 2. There was a significant relation between the total mitral valve score and its thickness with the optimal immediate post-balloon mitral valvuloplasty results [p value=0.03 and 0.04, respectively], but no relation was found between the Wilkins score and its components with the anterior mitral valve leaflet height-to-length ratio. There was no significant relationship between the amount of increase in the mitral valve area, decrease in trans-mitral pressure gradients, decrease in pulmonary artery pressure, and anterior mitral leaflet height-to-length ratio [all p values>0.05; all the correlation coefficients<0.2]. Our study showed that post-balloon mitral valvuloplasty results are mainly affected by valve thickness and the total Wilkins score. In addition, the severity of mitral leaflet motion restriction in terms of the height-to-length ratio of the anterior mitral valve leaflet has no significant relation with the immediate result of balloon mitral valvuloplasty

Is the peak-to-mean pressure gradient ratio useful for assessment of aortic valve prosthesis obstruction?

The evaluation of prosthetic valves is very difficult with two-dimensional transthoracic echocardiography alone. Doppler and color flow imaging as well as transesophageal echocardiography are more reliable to detect prosthetic valve dysfunction. However, Doppler study sometimes tends to be misleading due to the load-depending characteristics of peak and mean pressure gradients. The peak-to-mean pressure decrease ratio is a load-independent measure, which was previously used for the detecting and grading of aortic valve stenosis. We assessed the usefulness of this method for the evaluation of aortic valve prosthesis obstruction. One hundred fifty-four patients with aortic valve prostheses were included in this study. Transthoracic and transesophageal echocardiographic examinations were performed in all the patients. Peak velocity and velocity time integral of the aortic valve and left ventricular outflow tract, peak and mean aortic valve pressure gradients, peak-to-mean pressure gradient ratio, and time velocity integral [TVI] index were measured. There was a significant relation between the TVI index [p value<0.001] and aortic prosthesis obstruction. A TVI index<0.2 had a sensitivity of 71% and specificity of 100% for the detection of aortic valve prosthesis obstruction. However, no significant relation was found between the peak-to-mean pressure ratio and aortic valve prosthesis obstruction [p value=0.09]. Although the peak-to-mean pressure gradient [PG/MG] ratio is a simple, quick, and load-independent method which may be useful for the grading of aortic valve stenosis, it is poorly associated with aortic valve prosthesis obstruction. The TVI index is a useful measure for the detection of aortic prosthesis obstruction

Quantification of aortic regurgitation severity by left ventricular to right ventricular stroke volume ratio

Echocardiography is the most common test used for the evaluation of aortic regurgitation [AR]. However, the role of echocardiography as an available and inexpensive method in the quantification of AR by the left ventricle to right ventricle stroke volume ratio [LV/RV SV ratio] has not been completely investigated. Between June 2005 and December 2007, 132 consecutive patients with AR [mean age: 44.7 +/- 14.6 years, 52.3% male] were enrolled in the study. All the patients underwent echocardiography; and aortography, if indicated, was performed as well. Fifty-two percent of the patients had severe AR. There was almost a perfect agreement between echocardiography and cardiac catheterization in determining the severity of AR [Kappa=0.81]. Associated valvular disease was found in 81.8% of the patients, the most common disease being mitral regurgitation [61%]. The results of our bivariate and multivariate analyses showed a significant relation between the LV/RV SV ratio and the AR severity via either echocardiography or cardiac catheterization [both P=0.001]. The receiver operating characteristic [ROC] curve analysis showed that the LV/RV SV ratio was very accurate in the detection of severe AR utilizing cardiac catheterization as the gold standard [AUC=0.71]. The cut point value of the LV/RV SV ratio