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2017| January-March | Volume 27 | Issue 1
Online since
January 25, 2017
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ORIGINAL ARTICLES
Left atrial size and heart failure hospitalization in patients with diastolic dysfunction and preserved ejection fraction
Omar Issa, Julio G Peguero, Carlos Podesta, Denisse Diaz, Javier De La Cruz, Daniela Pirela, Juan Carlos Brenes
January-March 2017, 27(1):1-6
DOI
:10.4103/2211-4122.199064
PMID
:28465981
Context:
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome associated with diastolic function abnormalities. It remains unclear which factors, if any, can predict the transition from asymptomatic diastolic dysfunction to an overt symptomatic phase.
Materials and Methods:
Patients hospitalized with suspected heart failure between January 2012 and November 2014 with a transthoracic echocardiogram demonstrating preserved systolic function were screened (
n
= 425). Patients meeting the American College of Cardiology Foundation/American Heart Association definition for HFpEF (
n
= 40) were matched in a 1:1 fashion to individuals admitted for hypertensive urgency with diastolic dysfunction and neither pulmonary edema nor history of heart failure (
n
= 40). The clinical records and echocardiograms of all eighty patients included in this retrospective study were reviewed.
Results:
Patients with HFpEF had higher body mass index (BMI), creatinine, beta-blocker use, and Grade 2 diastolic dysfunction when compared to the hypertensive control population. Echocardiographic analysis demonstrated higher right ventricular systolic pressures, left ventricular mass index, E/A, and E/e' in patients with HFpEF. Similarly, differences were observed in most left atrial (LA) parameters including larger LA maximum and minimum volume indices, as well as smaller LA-emptying fractions in the heart failure group. Multivariate logistic regression analysis revealed LA minimum volume index (odds ratio [OR]: 1.23 [1.09–1.38],
P
= 0.001) to have the strongest association with heart failure hospitalization after adjustment for creatinine (OR: 7.09 [1.43–35.07],
P
= 0.016) and BMI (OR: 1.11 [0.99–1.25],
P
= 0.074).
Conclusion:
LA minimum volume index best correlated with HFpEF in this patient cohort with diastolic dysfunction.
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15
CASE REPORTS
Role of echocardiograghy in treating a case of double chamber right ventricle with delayed presentation
Ramachandra Barik
January-March 2017, 27(1):10-13
DOI
:10.4103/2211-4122.199058
PMID
:28465983
The clinical diagnosis of double chamber right ventricle (DCRV) is not straightforward. Clinical history, clinical examination, 12-lead electrocardiogram, chest X-ray, and Echocardiography (echo) contribute to morphological diagnosis. Cardiac catheterization is essential for hemodynamic evaluation. A thorough presurgical workup helps the cardiac surgeon to choose the appropriate surgical approach and timing of surgery in an individual case. We present a case of a DCRV who presented to us in the fifth decade of life. Echo confirmed the morphological diagnosis and cardiac catheterization complemented the exact pull back gradient across the obstruction in the right ventricle. This patient was suggested muscle bundle resection and ventricular septal defect closure using right atrial approach.
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3,680
168
1
ORIGINAL ARTICLES
A detailed study of multiple vascular variations in the upper part of abdomen
Prakashchandra Shetty, Satheesha B Nayak
January-March 2017, 27(1):7-9
DOI
:10.4103/2211-4122.199060
PMID
:28465982
Introduction:
Knowledge of vascular variations near the kidney is of importance to many clinical disciplines such as nephrologists, radiologists, gastroenterologists, and general surgeons. Variant branches of the abdominal aorta and renal arteries are the victims of iatrogenic bleeding during surgery. We found multiple vascular variations in the upper part of the abdomen during our dissection classes.
Methods:
During the dissection classes of the abdomen for undergraduate medical students, we observed multiple vascular variations in the abdomen of an adult male cadaver. The vessels and surrounding viscera were cleaned using dissection instruments. Variations observed were photographed.
Results:
The right kidney had its hilum directed posteriorly. There were two right renal veins and a partially doubled left renal vein (LRV). The left suprarenal and gonadal veins drained into the upper LRV. There were two right renal arteries. Upper right renal artery gave origin to the right inferior phrenic and middle suprarenal arteries. There were two renal arteries on the left side also. The left upper renal artery gave a polar branch to the left kidney and divided into two branches before entering the kidney. The left inferior phrenic artery (IPA) gave two gastric branches to the fundus of the stomach.
Conclusions:
The variations noted by us are of tremendous surgical application. The variant vessels might get damaged during surgical procedures if the surgeons are not aware of these variations. The most important among the variations reported here is the gastric branch of the IPA, which has not been reported yet.
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2
CASE REPORTS
A ruptured mitral valve aneurysm as complication of a bicuspid aortic valve endocarditis
Francesca Muscente, Michele Scarano, Daniela Clemente, Franco Pezzuoli, Vito Maurizio Parato
January-March 2017, 27(1):23-25
DOI
:10.4103/2211-4122.199063
PMID
:28465987
We present a case of a ruptured mitral valve (MV) aneurysm as a complication of a bicuspid aortic valve (BAV) endocarditis. It is about a young 35-year-old man, admitted to Cardiology Unit because of unexpected heart failure picture. We found a BAV endocarditis complicated by anterior MV-anterior leaflet aneurysm formation and subsequent severe MV regurgitation caused by aneurysm perforation. It was a particular and rare situation characterized by an infection of anterior mitral leaflet secondary to an infected regurgitant jet of a primary aortic infective endocarditis due to a BAV. A resulting aneurysm formation on the atrial side of the mitral anterior leaflet leads later to mitral perforation. In this article, we review the more relevant medical literature on this topic.
[ABSTRACT]
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2,941
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2
Uncommon cardiac manifestations of left-sided
Pseudomonas
endocarditis in an intravenous drug abuser with an undiagnosed atrial septal defect
Prashanth Panduranga, Seif Al-Abri, Mamatha Punjee Rajarao
January-March 2017, 27(1):14-16
DOI
:10.4103/2211-4122.199059
PMID
:28465984
A 56-year-old male, who is an active intravenous drug abuser (IVDA) (heroin) with a history of diabetes, hypertension, chronic kidney disease, and hepatitis C-related liver cirrhosis, presented with generalized anasarca, bilateral pneumonic infiltrations, and heart failure. His blood cultures were positive for
Pseudomonas aeruginosa
and were treated with antibiotics. Echocardiogram showed multiple uncommon manifestations of left-sided endocarditis. Surprisingly, he did not have right-sided involvement. Furthermore, echocardiogram revealed undiagnosed large atrial septal defect suggesting a paradoxical seeding of infective vegetation. This case illustrates the uncommon manifestations of
Pseudomonas
endocarditis in an IVDA and indicates that it is very important to check comprehensively for an atrial septal defect or patent foramen ovale or any shunt in such high-risk patients who may be at risk for left-sided endocarditis which is catastrophic when compared to right-sided endocarditis. If detected early in IVDA patients, these shunts need to be closed to prevent paradoxical embolism of vegetation.
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2,751
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2
Thrombotic risk after a major bleeding during anticoagulation: A clinical case
Serenella Conti, Marco Ciuffetti, Maria Cristina Vedovati
January-March 2017, 27(1):26-28
DOI
:10.4103/2211-4122.199065
PMID
:28465988
We report on a 81-year-old female admitted to the emergency department for the occurrence of abdominal pain after a minor trauma. She was on treatment with warfarin for atrial fibrillation. The abdominal computed tomography (CT) angiography revealed a retroperitoneal hematoma (RH) of the left iliopsoas muscle with no evidence of active bleeding. The international normalized ratio exceeded the upper recommended anticoagulation limit. Prothrombin complex concentrates (PCCs) were used for anticoagulation reversal. Two days later, the patient presented acute dyspnea and a pulmonary CT angiography showed an embolus in the right pulmonary artery. Enoxaparin was started. Thoracic symptoms improved and a second abdominal CT angiography revealed a reduction in RH. Apixaban was started from day 11. No further bleedings occurred and clinical conditions improved. Anticoagulation reversal with PCCs rapidly restores hemostasis, but, on the other side, the thrombotic risk due to their procoagulant effect should be considered.
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2,715
143
1
Congenital pulmonary vein stenosis and pulmonary artery branch stenosis: A rare combination
Jayanta Saha, Rammohan Roy, Sudhakar Singh, Satyendra Nath Dutta
January-March 2017, 27(1):20-22
DOI
:10.4103/2211-4122.199062
PMID
:28465986
Congenital pulmonary vein stenosis is a rare entity caused due to failed incorporation of common right and/or left pulmonary vein into the left atrium. Below is a case report of a combination of predominantly left-sided pulmonary vein stenosis with right pulmonary artery branch stenosis. The patient was an adolescent boy with mild symptoms. Clinical examination revealed features of pulmonary artery hypertension. Echocardiography and computed tomography scan were done to confirm the disease.
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2,666
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1
Subclavian artery pseudoaneurysm in an unusual case of digital gangrene
Bhuban Majhi, Nandita Pal
January-March 2017, 27(1):17-19
DOI
:10.4103/2211-4122.199061
PMID
:28465985
A young male patient presented at a tertiary care hospital with cold and bluish left upper limb accompanied with digital gangrene arousing suspicion of peripheral vascular disease. History did not reveal any high-risk behavior. Clinical examination and subsequent investigations lead to the diagnosis of acute infective endocarditis of native aortic valve along with peripheral embolism caused by methicillin-resistant
Staphylococcus aureus
. Fogarty's balloon embolectomy was done following which patient developed pseudoaneurysm of the left subclavian artery. These iatrogenic sequelae were managed with the resection of the pseudoaneurysm and prolonged antibiotic therapy as per the culture and sensitivity report.
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COMMENTARY
Submitral congenital left ventricular aneurysm: You recognize only what you know
Giovanni Corrado
January-March 2017, 27(1):29-29
DOI
:10.4103/2211-4122.199057
PMID
:28465989
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2,247
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1
LETTER TO EDITOR
Translational cardiovascular imaging: A new integrated approach to target myocardial fibrosis turnover in different forms of cardiac remodeling
Vitantonio Di Bello, Nicola Riccardo Pugliese, Riccardo Liga, Valentina Barletta, Veronica Santini, Lorenzo Conte, Iacopo Fabiani
January-March 2017, 27(1):30-31
DOI
:10.4103/2211-4122.199066
PMID
:28465990
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2,259
109
1
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© Journal of Cardiovascular Echography | Published by Wolters Kluwer -
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Online since 08 August, 2013