Association of Left Atrial Deformation Analysis by Speckle Tracking Echocardiography With Left Atrial Appendage Thrombus in Patients With Primary Valvular Heart Disease.

BACKGROUND: This study aimed to investigate the correlation between the functional parameters of the left atrium (LA) derived from deformation imaging, two-dimensional (2D) speckle tracking echocardiography (STE), and tissue Doppler imaging (TDI) strain and strain rate (SR) and the function of the left atrial appendage (LAA) as measured by transesophageal echocardiography (TEE) in patients with primary valvular heart disease. METHODS: This cross-sectional research included 200 primary valvular heart disease cases, categorized into Group I (n = 74) with thrombus and Group II (n = 126) without thrombus. All patients were subjected to standard 12 lead electrocardiography, transthoracic echocardiography (TTE), strain and SR imaging of the LA by TDI and 2D speckle tracking, and TEE. RESULTS: At a cut-off value of <10.50%, peak atrial longitudinal strain (PALS) is a predictor of thrombus with an area under the curve (AUC) of 0.975 (95% CI: 0.957-0.993), sensitivity of 94.6%, specificity of 93.7%, positive predictive value (PPV) of 89.7%, negative predictive value (NPV) of 96.7%, and accuracy of 94%. At a cut-off value of <0.295 m/s, LAA emptying velocity is a predictor of thrombus with an AUC of 0.967 (95% CI: 0.944-0.989), sensitivity of 94.6%, specificity of 90.5%, PPV of 85.4%, NPV of 96.6%, and accuracy of 92%. The PALS (<10.50%) and LAA velocity (<0.295 m/s) are significant predictors of thrombus (P = 0.001, ß = 2.745, SE = 0.804, OR = 15.56, and 95% CI: 3.219-75.245; and P = 0.002, ß = 2.499, SE = 0.799, OR = 12.17, and 95% CI: 2.543-58.201, respectively). Peak systolic strain < 12.55% and SR < 1.065/s are insignificant predictors of thrombus (ß = 1.167, SE = 0.996, OR = 3.21, and 95% CI: 0.456-22.631; and ß = 1.443, SE = 0.929, OR = 4.23, and 95% CI: 0.685-26.141, respectively). CONCLUSIONS: Among LA deformation parameters derived from TTE, PALS is the best predictor of reduced LAA emptying velocity and LAA thrombus in primary valvular heart disease, regardless of the rhythm.

A Comparison Between Two-Dimensional and Three-Dimensional Regional and Global Longitudinal Strain Echocardiography to Evaluate Complex Coronary Lesions in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome.

Introduction A preliminary assessment of patients who suffer from severe and complex coronary artery lesions, such as three-vessel disease and/or a left main (LM) artery lesion, plays a critical contribution in determining prognosis and treatment plans for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Therefore, a pre-angiography (i.e., before angiography) predictor was required to cost-effectively evaluate severe and complex coronary lesions to efficiently direct our subsequent dealing. Aim This study aimed to compare two-dimensional (2D) and three-dimensional (3D) global longitudinal strain (GLS) at the regional level to assess extremely complicated coronary lesions using the SYNTAX score as a standard of reference in 100 patients with NSTE-ACS. Materials and methods This research included 100 patients with non-ST-segment elevation acute coronary syndrome who presented at the Cardiology Department at Fayoum University from December 2019 to July 2020. All patients underwent a complete history and physical examination, hemoglobin A1c (HbA1c), lipid profile, creatinine assessment, 12-lead electrocardiogram (ECG), and transthoracic echocardiography (TTE) to detect global and regional longitudinal strain by 2D and 3D speckle-tracking echocardiography (STE). Coronary angiography was done on all patients within 24 hours of admission after acquiring echo images. Then, the results of 2D and 3D regional and global longitudinal strain (GLS) to predict the severity and coronary lesion complexity in terms of the SYNTAX score were compared. Results This study revealed that 2D GLS was -12.10 ± 3.51, which is significantly higher than 3D GLS of -11.64 ± 4.05 (p < 0. 001). The left anterior descending coronary artery (LAD) and left circumflex artery (LCX) territories revealed a significantly higher value using 2D regional longitudinal strain (-11.13 ± 4.47 and -12.54 ± 4.11, respectively) than using 3D regional longitudinal strain (-10.84 ± 5.18 and -12.05 ± 4.29, respectively) (p= 0.017 and p < 0.001, respectively). There were significantly lower 2D GLS, 3D GLS, global circumferential strain (GCS), area strain, and global radial strain (GRS) in the intermediate and high score group than in the low score group of patients (p < 0.001 for all). Conclusion 2D and 3D strain echocardiography including GLS, GCS, GRS, and area strain are a noninvasive and rapid tool with clinical utility for evaluating coronary lesions in patients with NSTE-ACS. They can be routinely used to diagnose and stratify high-risk patients with NSTE-ACS, thereby potentially resulting in improved patient assessment. GLS as measured by 2D and 3D STE at minimal effort is a significant risk factor for patients with complex NSTE-ACS. In NSTE-ACS cases, the GLS absolute value is significantly associated with the degree of complexity of coronary artery lesions.

External tissue expansion in head and neck reconstruction.

UNLABELLED: Tissue expansion has been of great value in plastic surgery especially in head and neck reconstruction. This study used external tissue expansion in 40 patients for head and neck reconstruction to avoid the complications associated with internal expansion. The study included 40 patients suffering from lesions in the head and neck, which needed excision and reconstruction. We designed external tissue expanders of different sizes and shapes to be suitable for head and neck application. The external expander was applied to the normal skin on one or both sides of the lesion and a negative pressure (-100 to -200 mbar) was created inside it. When the area of expanded tissue was deemed to be enough to cover the raw area after lesion excision, the expansion process was stopped and the operation was performed. The tissue expansion was achieved in all cases with minimal complications in the form of blisters and red spots in three cases, which were managed by stopping the expansion process until the blisters and spots had disappeared and then starting external expansion again. CONCLUSION: External tissue expansion technique is simple, easy, safe, associated with good results, and avoids the complications of classical expansion in head and neck reconstruction.

Crossed triangular flaps technique for surgical treatment of chronic pilonidal sinus disease.

HYPOTHESIS: Pilonidal disease is a common chronic disorder of the sacrococcygeal region affecting young people. Although many surgical methods have been suggested, an ideal method is still lacking because of significant morbidity and high recurrence rates. However, the crossed triangular flaps technique, which involves excision and primary closure, with less morbidity and low recurrence rates, appears to meet the criteria for an ideal method. DESIGN: Case series. SETTING: This study was conducted in the General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt, from January 2003 to November 2004. PATIENTS: This study included 57 patients with chronic pilonidal sinus disease with a mean age of 29 years. INTERVENTION: Limited and good excision of all diseased tissues was achieved, followed by a zigzag incision to produce triangular flaps on both sides of the wound. Multiple crossed triangular flaps were used to close the wound with a drain. The follow-up period ranged from 18 to 36 months (mean, 30 months). MAIN OUTCOME MEASURES: Length of hospital stay and return to normal activities, early wound complications, and recurrence. RESULTS: The hospital stay for all patients was 24 hours and the mean time to return to work was 9 days (range, 7-12 days). Three cases (5.3%) had early wound complications and 1 case (1.75%) had recurrence. CONCLUSION: The crossed triangular flaps technique for pilonidal disease is simple and easy and has favorable results regarding time to return to work, rate of recurrence, and cosmetically acceptable postoperative appearance.

Surgical correction of main stem reflux in the superficial venous system: does it improve the blood flow of incompetent perforating veins?

Fifty-seven limbs (33 patients) with chronic venous ulceration were selected for this study. The criterion for selection was the presence of isolated superficial venous reflux. Long saphenous vein reflux alone was observed in 39 (68.4%) limbs, short saphenous vein reflux alone in 4 (7.0%) limbs, and both long and short saphenous vein reflux in 14 (24.6%) limbs. Surgical correction of the refluxing saphenous system has allowed 46 (80.7%) ulcers to heal. The healing rates for all the ulcerated legs that had long saphenous vein reflux, short saphenous vein reflux, or a combination of the two were 85.4%, 75.0%, and 66.7%, respectively. Incompetent perforating veins (IPVs) were observed in 51 (89.5%) limbs; 74.5% of them regained their competence postoperatively (189 preoperatively vs. 59 postoperatively; p < 0.001), with a significant reduction in their mean diameter (p < 0.001). IPVs remained in 13 (25.5%) limbs: 3 limbs with persistent reflux in the tributaries of the saphenous system, 1 limb with a fixed ankle joint, and nine limbs with no evidence of macrovascular venous disease. In patients with a competent deep venous system, reflux in perforating veins is often abolished after eradication of saphenous reflux.