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   Table of Contents - Current issue
July-September 2022
Volume 32 | Issue 3
Page Nos. 137-191

Online since Wednesday, November 16, 2022

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Chest shape influences ventricular-arterial coupling parameters in infants with pectus excavatum Highly accessed article p. 137
Andrea Sonaglioni, Gian Luigi Nicolosi, Marta Braga, Maria Cristina Villa, Claudio Migliori, Michele Lombardo
Background: The present study was designed to investigate the possible influence of chest shape, noninvasively assessed by modified Haller index (MHI), on ventricular-arterial coupling (VAC) parameters in a population of term infants with pectus excavatum (PE). Methods: Sixteen consecutive PE infants (MHI >2.5) and 44 infants with normal chest shape (MHI ≤2.5) were prospectively analyzed. All infants underwent evaluation by a neonatologist, transthoracic echocardiography, and MHI assessment (ratio of chest transverse diameter over the distance between sternum and spine) within 3 days of life. Arterial elastance index (EaI) was determined as end-systolic pressure (ESP)/stroke volume index, whereas end-systolic elastance index (EesI) was measured as ESP/left ventricular end-systolic volume index. Finally, VAC was derived by the Ea/Ees ratio. Results: At 2.1 ± 1 days after birth, compared to controls (MHI = 2.01 ± 0.2), PE infants (MHI = 2.76 ± 0.2) were diagnosed with significantly smaller size of all cardiac chambers. Biventricular systolic function, left ventricular filling pressures, and pulmonary hemodynamics were similar in both the groups of infants. Both EaI (4.4 ± 1.0 mmHg/ml/m2 vs. 3.4 ± 0.6 mmHg/ml/m2, P < 0.001) and EesI (15.1 ± 3.0 mmHg/ml/m2 vs. 12.7 ± 2.5 mmHg/ml/m2, P = 0.003) were significantly increased in PE infants than controls. The resultant VAC (0.30 ± 0.10 vs. 0.30 ± 0.08, P > 0.99) was similar in both the groups of infants. Both EaI (r = 0.93) and EesI (r = 0.87) were linearly correlated with MHI in PE infants, but not in controls. On the other hand, no correlation was found between MHI and VAC in both the groups of infants. Conclusions: Chest deformity strongly influences both Ea and Ees in PE infants, due to extrinsic cardiac compression, in the absence of any intrinsic cardiovascular dysfunction.
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Evaluation of left atrium/left atrial appendage function in cases with systemic embolization in the setting of normal transthoracic echocardiography and normal sinus rhythm Highly accessed article p. 145
Niloufar Samiei, Abdolali Ehsani, Behshid Ghadrdoost, Mohaddeseh Behjati
Background: Various left atrium (LA) and left atrial appendage (LAA) anatomies and functions could be associated with embolic events. Aims and Objectives: We aimed to investigate the impact of variation in LAA and LA functions on the occurrence of systemic embolization in normal sinus rhythm and normal echocardiography findings. Materials and Methods: This cross-sectional study was performed on 22 patients with documented peripheral emboli versus 32 control subjects. Results: LA area, LAA area, ejection fraction (EF) of LA/LAA, LAA velocity and tissue Doppler imaging (TDI) of LA walls, left ventricular diastolic function, and EF were determined. There were statistically significant differences between LAA area, LAA EF, TDI of lateral LA wall, and TDI of anterior LA wall in cases versus controls. Conclusion: Echocardiography findings in LAA and LA functions could help to identify high-risk patients for embolic events in normal sinus rhythm cases.
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Left atrial volumetric and functional properties in hemophilia – insights from a three-dimensional speckle-tracking echocardiographic MAGYAR-Path study Highly accessed article p. 148
Attila Nemes, Árpád Kormányos, Klára Vezendi, Imelda Marton, Zita Borbényi
Introduction: Hemophilia is an inherited disorder due to deficiencies in factor VIII (type A) and factor IX (type B). Abnormalities in myocardial mechanics could be theorized due to hemophilia-associated hypocoagubility and related quantitative and qualitative changes of the blood. The present study aimed a detailed assessment of left atrial (LA) volumetric and functional properties in patients with hemophilia using three-dimensional speckle-tracking echocardiography (3DSTE). Materials and Methods: The study consisted of 12 subjects with hemophilia type A and 2 cases with hemophilia type B (mean age: 40.8 ± 19.1 years, all males). Results of hemophilia patients were compared to that of 23 age-, gender- and risk factor-matched controls (42.4 ± 9.0 years, all males). Routine two-dimensional Doppler echocardiography and 3DSTE were performed in all subjects. Results: LA volumes respecting cardiac cycle did not differ between controls and hemophilia patients. From LA volume-based functional properties, LA stroke volumes were similar between the groups examined in all phases of LA function. While total atrial emptying fraction featuring LA reservoir function was reduced in patients with hemophilia compared to that of controls, passive and active atrial emptying fraction characterizing LA conduit and booster pump functions were similar between the groups. From LA strains, peak mean segmental circumferential and longitudinal LA strains were impaired in patients with hemophilia, other peak LA strains were similar between the groups. LA strains at atrial contraction did not differ between groups of hemophilia patients and controls. Conclusions: Hemophilia is not associated with LA volumetric changes, but mild LA functional abnormalities are present.
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Myocardial work efficiency in physiologic left ventricular hypertrophy of power athletes p. 154
Antonello D'Andrea, Andreina Carbone, Juri Radmilovic, Vincenzo Russo, Dario Fabiani, Marco Di Maio, Federica Ilardi, Francesco Giallauria, Adriano Caputo, Teresa Cirillo, Eduardo Bossone, Eugenio Picano
Aims: The athlete's heart in power training is characterized by physiologic concentric remodeling. Our aim was to analyze left ventricular (LV) myocardial deformation and contractile reserve (CR) in top-level power athletes (PA) at rest and during exercise and their possible correlations with functional capacity. Methods: Standard echo, lung ultrasound, and LV 2D speckle-tracking strain were performed at rest and during exercise in PA and in age- and sex-comparable healthy controls. Results: 250 PA (male: 62%; 33.6 ± 4.8 years) and 180 age- and sex-comparable healthy controls were enrolled. LV ejection fraction (EF) at baseline was comparable between the two groups, while LV global longitudinal strain (GLS) was reduced in PA (GLS: −17.8 ± 2.4 in PA vs. −21.9 ± 3.8 in controls; P < 0.01). Conversely, myocardial work efficiency (MWE) did not show significant difference between the two groups (94.4 ± 3.2 in PA vs. 95.9 ± 4.6% in controls; P NS). At peak exertion during exercise stress echocardiography (ESE), PA showed better exercise capacity and peak VO2 consumption (51.6 ± 10.2 in EA vs. 39.8 ± 8.2 mL/Kg/min in controls, P < 0.0001), associated with augmented pulmonary artery systolic pressure (PASP). By multivariable analysis, MWE at rest was the most predictive factor of maximal watts (P < 0.0001), peak VO2, (P < 0.0001), PASP (P < 0.001), and number of B-lines (P < 0.001), all measured at peak effort. Conclusions: In power athletes, MWE showed less load dependency than GLS. Normal resting values of MWE in PA suggest a physiological LV remodeling, associated with a better exercise capacity and preserved CR during physical stress.
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Assessment of pulmonary pulse transit time with respect to diastolic and left atrial functions p. 160
Ipek Büber, Cihan Ilyas Sevgican, Yigit Davutoglu, Saadet Avunduk, Isik Tekin, Oguz Kiliç, Ismail Dogu Kiliç
Background and Aim: Pulmonary pulse transit time (pPTT) is a new marker of pulmonary hypertension (PH), which shows the time needed for the pulse wave to propagate from the right ventricular outflow tract to the left atrium (LA), but the relationship between pPTT and diastolic-LA function is almost unknown. In this study, we investigated the relationship between pPTT and LA-diastolic functions without PH. Materials and Methods: One hundred and fifty-six patients were included in this prospectively designed study. Comprehensive echocardiographic evaluation was performed and pPTT was recorded as the time from the beginning of the R-wave on the electrocardiogram to the peak of the S-wave in the pulmonary veins. Results: We found a statistically significant correlation between LA total stroke volume, passive stroke volume, LA max area, LA volume (LAV) max and LA volume index (LAVi) max, and pPTT (r = 0.263** P = 0.003, r = 0.240** P = 0.007, (r = 0.339** P < 0.001, r = 0.307** P < 0.001 r = 0.199*, P = 0.024, LA total stroke volume, passive stroke volume, LA max area, LAV max, LAVi max respectively). Heart rate (HRt) and LAVi were detected as independent predictors of pPTT (hazard ratio: −2.290 P < 0.001, 95% confidence interval (CI): −3.274–1.306, HR: 0.461, P = 0.028, 95% CI: 0.050–0.873, HRt and LAVi, respectively). Conclusion: LAVi and HRt also affected pPTT. The dominant effect of HRt on pPTT should be considered in future studies. Larger studies are needed to determine the change and clinical significance of pPTT in left heart disease.
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Severe mitral regurgitation following partial rupture of papillary muscle: The role of intraoperative transesophageal echocardiography p. 165
Christos Chamos, Paul Balfour
Papillary muscle rupture (PMR) is an uncommon mechanical complication of myocardial infarction which warrants timely diagnosis and urgent surgical intervention to maximize survival chances. Echocardiography is an essential diagnostic tool, whereas transesophageal echocardiography can provide accurate diagnosis and guide decision-making. We hereby present the case of a patient with partial PMR that presented for cardiac surgery in our institution, with the respective intraoperative echocardiographic findings.
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Aortic biological prosthetic valve dysfunction secondary to endocarditis: Is percutaneous valve-in-valve an option? p. 168
Bottaro Giuseppe, Wanda Deste, Paolo Zappulla, Giulia Passaniti, Marco Barbanti, Enrico Criscione, Carmelo Sgroi, Corrado Tamburino
We present the case of a 69-year-old man with an aortic biological prosthetic valve. In May 2019, the patient experienced increasing dyspnea and fatigue: A diagnosis of prosthetic aortic valve dysfunction was made, leading to severe valvular insufficiency. The dysfunction of the prosthetic valve seemed to be linked to a previous infective endocarditis: after ruling out active endocarditis, the patient was treated with an off-label valve-in-valve transcatheter aortic valve implantation.
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Concomitant multiple coronary artery embolizations and bilateral lower limb ischemia due to dislodged left atrial myxoma-like thrombus p. 172
Mehmet Koray Adali, Ipek Buber
The differential diagnosis of intracardiac masses is challenging. Cardiac myxomas are benign primary heart tumors and most often are confused with thrombi in diagnosis. In some cases, the embolic complication of intracardiac masses can be fatal. We present a patient who had two nightmare complications simultaneously. A mobile left atrial mass detected and decided surgical excision. But the mass had vanished one day after and caused ST-elevation myocardial infarction (STEMI) and bilateral lower limb ischemia.
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Global longitudinal strain in wellens' syndrome p. 175
Rakesh Agarwal, Aditya Verma
We present the case of a young man with “noncardiac” chest pain, subsequently diagnosed as Wellens' syndrome. We report the early changes in left ventricular global longitudinal strain imaging findings in these patients despite preserved ejection fraction, and review the features associated with this stereotypical cardiac condition. The patient underwent a successful percutaneous coronary intervention.
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Echocardiographic evolution of posterolateral left ventricular aneurysm with normal coronary arteries in patient recently COVID-19 vaccinated: A complicated atypical case of takotsubo syndrome vaccine-related? Highly accessed article p. 177
Fabrizio Ceresa, Antonio Micari, Maria Paola TrifirÃ, Francesco Costa, Giampiero Vizzari, Alessio Vite Giuseppe, Francesco Patanè
A 72-year-old woman, recently COVID-19 vaccinated with a third dose, was referred to our center for acute chest pain and dyspnea. On admission, the electrocardiography showed a STEMI on inferior derivations and the dyskinesia of the inferior wall was found at the first transthoracic echocardiogram. The coronary angiography did not show coronary artery disease. After 1 week, a huge posterolateral left ventricular (LV) aneurysm with initial signs of rupture was found and the patient underwent a Dor's procedure to exclude the LV aneurysm. As far as we know, this is the first reported case of Takotsubo following the COVID-19 vaccination requiring cardiac surgery.
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Paradoxical pulmonary embolism in a patient with bilateral renal infarction: The role of contrast-enhanced ultrasound imaging p. 180
Francesco Negri, Massimo Burelli, Linda Pagura, Camilla Sachs, Massimo Imazio, Gianfranco Sinagra
We present the case of a 52-year-old male who was admitted to the hospital for a bilateral pulmonary embolism. On the 5th day of hospitalization, an acute kidney injury (AKI) occurred. A transesophageal echocardiogram was performed and it demonstrated a large patent foramen ovale with a consistent right-to-left shunt. Contrast-enhanced ultrasound (CEUS) was performed and it demonstrated multiple bilateral renal ischemic areas. CEUS represents a valid alternative to computed tomography or magnetic resonance to confirm the diagnosis of bilateral kidney infarction, especially in patients who experience an AKI.
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Dramatic massive arterial embolization from a left atrial myxoma in a patient with takotsubo syndrome p. 183
Davide Ermacora, Andrea Comunello, Tommaso Gorgatti, Carmen Ladurner, Roberto Cemin
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Beware of making the diagnosis of hypertrophic cardiomyopathy in patients with takotsubo syndrome based on early imaging p. 185
John E Madias
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Endovascular management of acute postprocedural abdominal aortic – Iliac limb endograft occlusions: A case series p. 187
Cataldo Palmieri, Francesco Sbrana, Antonio Rizza
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Usual echo parameters versus global longitudinal strain for measuring infarct size and left ventricular functional remodeling after primary percutaneous coronary intervention p. 191
Sidhi Laksono
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