The great saphenous vein (GSV) is the longest superficial vein in the body extending from the medial malleolus to groin skin crease level. The clinical usage of GSV has made its anatomical variations noteworthy. Since many tributaries accompany it, GSV is often mistaken with the variant vein. Duplication and persistence of accessory GSV are the two major clinically significant anatomical variations of the GSV which is frequently misinterpreted as a synonym. In the present case, we report a unique variation of GSV wherein it bifurcated into anterior and posterior divisions of two uneven calibers at knee region, which then reunited at thigh region to form a single vein before its termination into the femoral vein. Locating such variations of bifurcated GSV is a challenging task for both diagnostic and therapeutic tactics, particularly in venography procedures as it might lead to iatrogenic traumatic injury of the vessel.

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Background: Prediction of the left ventricular remodeling (LVR) after ST-segment elevation myocardial infarction (STEMI) in patients treated with effective myocardial reperfusion is challenging. Methods: Forty-one consecutive patients (36 males, age 59 ± 10 years) with STEMI who underwent effective (TIMI III) primary coronary angioplasty were enrolled. All patients had an echocardiography and cardiac magnetic resonance (CMR) study within 72 h from revascularization. Three echocardiographic parameters including LV ejection fraction (EF), global longitudinal strain (GLS) and severe altered longitudinal strain (SAS) area by two-dimensional speckle-tracking echocardiography (2D-STE) and 3 CMR indices including LV global function index (LV-GFI), myocardial salvage index (MSI), and microvascular obstruction (MVO) were calculated. LVR was defined as an increase in CMR LV end-diastolic volume (EDV) >15% after 6 months. Results: Of 41 patients, 10 (24%) had LVR (LV-EDV from 145.1 ± 29.3 to 185.9 ± 49.8 ml, P < 0.001). A significant correlation with LV-EDV variation was found for baseline SAS area (r = 0.81), LV-GFI (r = −0.56), MVO (r = 0.55), EF (r = −0.42), GLS (r = 0.42), not for MSI (r = −0.25). At the multivariable analysis, a significant correlation remained only for the SAS area. The receiver-operating characteristic curve analysis showed that a baseline SAS area ≥15% predicts LVR with a sensitivity of 80.0% and a specificity of 90.3%. Conclusions: The SAS area evaluated by 2D-STE early in acute STEMI is a valuable predictor of LVR after 6 months. Further investigations are needed to verify its value in predicting patient survival.

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Context: The right ventricle (RV) is neglected in clinical practice although the RV function is the primary determinant of prognosis and effort tolerance in many groups of patients. Aim: The effects of type two diabetes mellitus and hypertension solitary and together were studied on right ventricular systolic and diastolic function by echo-Doppler and tissue Doppler echocardiography. Settings and Design: A cohort of 300 consecutive patients with echocardiographic right ventricular (RV) diastolic dysfunction as determined by Doppler echocardiography were included in this study. Methods and Material: Patients were divided in four groups, patients who were neither diabetic nor hypertensive, hypertensive patients, diabetic patients and those patients suffering from both hypertension and diabetes mellitus. Parameters of right ventricular systolic and diastolic function were compared. Statistical Analysis Used: Analyses were performed with SPSS version 12.0 statistical package (SPSS Inc., Chicago, IL, USA). Results: There was significant statistical difference between the four groups as regards E wave, E/A ratio and deceleration time measured by Doppler echocardiography. By pulsed wave tissue Doppler, S, E' and E/E' showed significant statistical difference between the four groups. All of these parameters were significantly different between the group suffering from both diseases and the group who had neither of them. Conclusions: The combined effect of both, diabetes mellitus and hypertension on right ventricular function is stronger than the effect of one of them alone.

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Takotsubo syndrome (TTS) is an acute and reversible heart failure syndrome, usually occurring in females but rarely in the peripartum period. In women with a history of peripartum TTS, it is unclear how to manage subsequent pregnancies. A 39-year-old female with a history of peripartum TTS complicated by cardiogenic shock became pregnant again. She underwent close cardiological follow-up for monitoring left ventricular systolic function and hemodynamic conditions. Epidural anesthesia was preferred to avoid catecholamine surge during cesarean delivery. After a few days of hospitalization, the patient and the newborn were discharged in good health. In our patient with a history of complicated peripartum TTS, close cardiological follow-up, appropriate management therapy, and anesthesia modality allow us to guide safely a new pregnancy.

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Acute coronary syndrome is an uncommon complication in patients with infective endocarditis, either in the acute phase of infection or later in the course. We describe a case of unusual presentation of infective endocarditis as ST-elevation myocardial infarction secondary to coronary embolization from mitral valve endocarditis.

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Pericardial cysts (PCs) are very rare, often congenital, mediastinal masses. Usually, they are located in the right cardiophrenic angle and only in 8% of cases in the anterior or posterior mediastinum. Computed tomography and/or magnetic resonance imaging are accurate tools for the diagnosis and characterization of mediastinal masses. However, echocardiography is, in many cases, a good screening technique. If asymptomatic, they do not require surgical excision. The authors describe a case of posterior mediastinum PC; in these cases, echocardiography cannot see the mass and three-dimensional imaging techniques are required. The clinical management of this case is discussed.

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Dilated cardiomyopathy (DCM) may be associated with formation of intracardiac thrombi which may embolize and result in life-threatening complications. We present a 19-month-old female child with DCM who presented with a right hemispheric cerebrovascular accident. Urgent echocardiography revealed poor left ventricular systolic function and a thrombus attached to the interventricular septum along the left ventricular outflow tract. There was resolution of the thrombus following the use of warfarin.

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Cardiac shunts are often described in congenital or pediatric populations, but systemic-to-pulmonary venous shunts in adult patients are reported in literature in isolated case reports. We present the case of a 70-year-old female with a left superior vena cava (SVC) draining into the left atrium by the left superior pulmonary vein, with a complete right-to-left shunt of the superior venous circulation caused by a former catheter thrombosis in the right SVC. Diagnosis was suspected after a contrast echocardiography showing an exclusive perfusion of left heart after intravenous injection and confirmed by helical computed tomography with three-dimensional reconstruction. After medico-surgical discussion, a first-line conservative treatment with oxygen therapy was chosen, due to the stability of symptoms and high predicted risk of perioperative mortality. The particularities of this case are that we cannot determine if the origin of this shunt is a latent persistent left SVC becoming symptomatic after the SVC obstruction or an abnormal collateral pathway due to the thrombosis and the unusual indirect communication through a pulmonary vein.

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