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2021| January-March | Volume 31 | Issue 1
Online since
May 21, 2021
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REVIEW ARTICLE
COVID-19-related pericarditis with pericardial clotting as a hallmark: Two cases and a review
Vito Maurizio Parato, Camilla Notaristefani, Simone D’Agostino, Vittorio D’Emilio, Sara Colella, Madhavi Kadiyala, Silvia Pierantozzi, Tiziana Principi
January-March 2021, 31(1):1-5
DOI
:10.4103/jcecho.jcecho_124_20
The prevalence of pericardial effusion and its clinical significance is not well understood in COVID-19 patients. We report two cases of COVID-19-related pericardial effusion complicated by intrapericardial clot formation. The final outcome was favorable, but intrapericardial clot remained mostly unchanged at 6-month follow-up. The treatment approach and the long-term consequences are still unclear. We propose a review of this particular cardiovascular complication in COVID-19 patients.
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ORIGINAL ARTICLES
Assessment of pulmonary arterial hemodynamic and vascular changes by pulmonary pulse transit time in patients with human immunodeficiency virus infection
Mehmet Akif Erdol, Burak Acar, Ahmet Goktug Ertem, Mustafa Karanfil, Çagri Yayla, Koray Demirtas, Pelin Aladag, Meliha Çagla Sönmezer, Esra Kaya Kiliç, Çigdem Ataman Hatipoglu, Fatma Sebnem Erdinc, Necla Tulek, Adnan Burak Akcay
January-March 2021, 31(1):6-10
DOI
:10.4103/jcecho.jcecho_103_20
Introduction:
Pulmonary arterial hypertension and human immunodeficiency virus (HIV) infection is a well-known association. Pulmonary pulse transit time (pPTT) is a recent echocardiographic marker that might be used for evaluation of pulmonary arterial stiffness (PAS) in patients with HIV infection. We aimed to investigate whether pPTT elevated in patients with HIV infection compared to healthy controls and its association with echocardiographic indices of right ventricular functions.
Materials and Methods:
Fifty HIV (+) patients from infectious disease outpatient clinics and fifty age- and sex-matched HIV (−) healthy volunteers were enrolled in this study. pPTT was measured from pulmonary vein flow velocity as the time interval between the R-wave in the electrocardiography and corresponding peak late systolic was then calculated as the mean from two separate pw-Doppler measurements.
Results:
pPTT, tricuspid annular peak systolic excursion (TAPSE) and right ventricle fractional area change (FAC) were significantly lower in patients with HIV than control patients (177.1 ± 34.9 vs. 215.7 ± 35.7 msn,
P
< 0.001; 2.33 ± 0.28 vs. 2.19 ± 0.22,
P
= 0.039; 45 [4.25] vs. 41.1 [4.0],
P
= 0.032, respectively). pPTT was positively correlated with FAC, TAPSE and cluster of differentiation 4 count (
r
= 0.210;
P
= 0.036,
r
= 0.256;
P
= 0.041,
r
= 0.304;
P
= 0.044, respectively).
Conclusion:
Our study showed that pPTT, TAPSE, and right ventricle FAC levels were lower in patients with HIV infection. pPTT is an important predictor in patients with HIV expected to develop pulmonary vascular pathology.
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Two-dimensional transesophageal echocardiography assessment of the major aortic annulus diameter in patients undergoing transcatheter aortic valve replacement
Mariateresa Librera, Guido Carlomagno, Stefania Paolillo, Maurizio Romano, Francesco Antonini-Canterin, Michele D’Alto, Giuseppe De Martino, Carlo Briguori
January-March 2021, 31(1):23-28
DOI
:10.4103/jcecho.jcecho_110_20
Background:
Multidetector computed tomography (MDCT) is the gold standard in annulus sizing before transcatheter aortic valve replacement (TAVR). However, MDCT has limited applicability in specific subgroups of patients, such as those with atrial fibrillation and chronic kidney disease. Two-dimensional transesophageal echocardiography (2DTEE) has traditionally been limited to the long-axis measurement of the anteroposterior diameter of the aortic annulus. We describe a new 2DTEE approach for the measurement of the major diameter of the aortic annulus.
Methods:
Seventy-six patients with symptomatic severe aortic valve stenosis and high surgical risk underwent MDCT and 2DTEE before TAVR. A modified five-chamber view was used to measure the major aortic annulus diameter. This was obtained starting from a mid-esophageal four chamber and retracting the TEE probe up until the left ventricular outflow tract and the left and noncoronary aortic cusps were visualized: major aortic annulus diameter was measured as the distance between their insertion points in systole.
Results:
Major aortic annulus diameters measured at 2DTEE showed good correlation with MDCT diameter (
r
= 0.79;
P
< 0.001) and perimeter (
r
= 0.87;
P
< 0.0001). Using factsheet-derived sizing criteria, 2DTEE alone would have allowed accurate sizing in 75% of patients, with 21% of oversizing predominantly with smaller annuli.
Conclusions:
We describe a new method for 2DTEE measurement of the major aortic annulus diameter; this approach is simple, correlates with MDCT, and allows adequate TAVR sizing in most patients. These findings may help in the assessment of patients with contraindications to or inadequate MDCT images.
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CASE REPORTS
Acute pulmonary embolism and thrombus entrapped in the patent foramen ovale in a patient with COVID-19
Ahmad Hayek, Michele Flagiello, Matthieu Aubry, Thomas Bochaton
January-March 2021, 31(1):39-41
DOI
:10.4103/jcecho.jcecho_122_20
A 61-year-old patient presented for syncope and a 1-week history of fever. He was diagnosed with a COVID-19 infection without pulmonary injury associated with an intermediate-risk bilateral pulmonary embolism. Computed tomographic scan and transesophageal echography were performed confirming a mobile in-transit embolus, originating from the right cavities and extending to the right ventricle through the patent foramen ovale. The patient underwent a surgical embolectomy without complications. COVID-19 was found to be the only current risk factor in our patient. This could warrant consideration of extending thromboprophylaxis indication to COVID-19 patients with certain criteria even without hospitalization indication or pulmonary injury.
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ORIGINAL ARTICLES
Early impairment of right ventricular morphology and function in transthyretin-related cardiac amyloidosis
Roberto Licordari, Fabio Minutoli, Antonino Recupero, Mariapaola Campisi, Rocco Donato, Anna Mazzeo, Giuseppe Dattilo, Sergio Baldari, Giuseppe Vita, Concetta Zito, Gianluca Di Bella
January-March 2021, 31(1):17-22
DOI
:10.4103/jcecho.jcecho_112_20
Background:
Our study aimed to evaluate right ventricular (RV) morphology and strain (S) in the early stage of familial transthyretin (TTR) cardiac amyloidosis (CA).
Methods and Results:
Thirty-seven patients with transthyretin mutation underwent
99m
Tc-3,3-diphosphono-1,2 propanodicarboxylic acid (
99m
Tc-DPD) scans and/or cardiac magnetic resonance (CMR) to identify TTR CA. Each patient underwent echocardiography to quantify RV dimensions, tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), longitudinal (L) strain of the RV free wall, left ventricular (LV) septal thickness (ST), ejection fraction, E/E', LV global (G) L, radial (R), and circumferential (C) S.
99m
Tc-DPD and CMR revealed the accumulation in 22 of 37 patients (CA group) and no accumulation in 15 patients (no-CA group). Left ventricular (LV) septal thickness (ST) was higher (
P
< 0.0001) while LV ejection fraction and E/E' were lower (
P
< 0.05) in the CA group than the no-CA group. LV-global longitudinal strain (LS) was lower (
P
< 0.0001) in the CA-group than the no CA-group, whereas LV-global circumferential strain and LV-global radial strain were similar. The CA group showed higher values of RV dimensions (
P
< 0.05) and sPAP (0.02) and a lower (
P
= 0.002) TAPSE. Globally, RV-LS was lower (
P
= 0.005) in the CA group than the no-CA group. Basal and mid segments of the RV free wall showed a lower LS in the CA group than the no-CA group (
P
< 0.01), while apical S was similar between groups.
Conclusions:
RV deformation, particularly in basal and mid segments, is early impaired in CA.
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Can Tei index predict high syntax score in patients with chronic coronary syndrome and normal left ventricular systolic function?
Hazem Mansour, Ahmed Ibrahim Nassar, Walaa Adel Abdel Rehim, Alaa Mahmoud Roushdy, Mohamed Abobakr, Hala Mohamed Zaki, Ahmed Mohamed Aboubakr El Missiri
January-March 2021, 31(1):11-16
DOI
:10.4103/jcecho.jcecho_73_20
Objective:
Some patients who had chronic coronary syndrome (CCS) and were recognized as low risk, however, developed cardiovascular events, whereas others who were categorized as high risk did not develop any cardiovascular events. Invasive coronary angiography is the gold standard tool for the assessment of coronary artery disease (CAD) severity. The SYNTAX score (SS) was recently recognized as an invasive angiographic-guided scoring system used in risk stratification of patients who have more than one-vessel CAD and undergoing revascularization with percutaneous cardiovascular intervention. It has a good predictive value of adverse cardiovascular events. Exploration for unique noninvasive modalities that may help in a better way for risk stratification of CCS patients by predicting the severity of CAD (as reflected by SS) would be of a paramount value. Tei index is a promising modality for that objective, which is a Doppler-derived time interval index that combines both systolic and diastolic cardiac performance.
Methods:
We examined the relationship between the severity of CAD as assessed by the SS and Tei index in 100 patients with CCS and normal left ventricular systolic function.
Results:
All the studied 100 patients had a normal ejection fraction with mean = 58.92 ± 7.88; the mean value of Tei index was 0.84 ± 0.26. There was a statistically significant positive association between Tei index and SS (
P
= 0.0001); moreover, there was a correlation between left anterior descending (LAD) affection and Tei index (
P
= 0.0001).The cutoff point of Tei index to detect SS above 22 was >0.93 (with specificity of 86.5% and sensitivity of 42.4%).
Conclusion:
Tei index significantly correlates with SS and LAD affection. Moreover, it is a cheap, radiation-free, noninvasive technique and may be used as a further risk stratification modality beyond others.
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CASE REPORTS
Syncope and cardiac tamponade: Multimodality imaging of primary cardiac lymphoma
Virginia Serra, Francesco De Luca, Ketty Savino, Maurizio Del Pinto, Claudia Castellani, Paola Fiaschini, Laura Tomasello, Claudio Cavallini
January-March 2021, 31(1):42-44
DOI
:10.4103/jcecho.jcecho_109_20
Primary cardiac lymphoma (PCL) is among the rarest heart neoplasms. Its estimated incidence is about 1%–2% among primary cardiac tumor and 0.5% of extranodal lymphoma. It usually causes heart failure, pericardial effusion, tamponade, and arrhythmias. Prognosis is poor; treatment is combined medical and surgical. We described the case of a 62-year-old male with PLC that presented with syncope and cardiac tamponade, submitted to R-CHOP therapy because of failure of surgery. Clinical state is stable 3 months after diagnosis and first chemotherapy cycle.
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CASE SERIES
Severe aortic regurgitation of early degenerated mitroflow bioprosthesis: From echocardiographic diagnosis to treatment with valve-in-valve transcatheter aortic valve implantation
Matteo Pernigo, Marco Triggiani, Marianna Adamo, Gian Franco Pasini
January-March 2021, 31(1):51-54
DOI
:10.4103/jcecho.jcecho_129_20
Valve-in-Valve transcatheter aortic valve implantation (ViV TAVI) is emerging as an effective therapeutic option for bioprosthetic valve failure. Recently, concern has been raised for early valve deterioration of Mitroflow (Sorin) aortic bioprosthesis, with the development of prevalent stenosis. We report cases of pure severe aortic regurgitation (AR) due to early and mid-term prosthesis degeneration. From June 2018 to October 2019, three patients were treated in our division for the new appearance of severe intraprosthetic regurgitation. Patient 1 (man, 85-year-old) and patient 3 (woman, 83-year-old) had a Mitroflow n. 25 and n. 21 implanted, respectively, in 2012 and 2013 for severe aortic stenosis. Patient 2, a 67-year-old woman with Marfan syndrome underwent a Mitroflow n. 25 implant in 2008 for severe AR and presented chronic type-B aortic dissection. Patient 1 was diagnosed with severe AR in the ambulatory setting, while the other patients presented acute heart failure, requiring inotrope support and high doses intravenous diuretics, and in case 3, temporary extracorporeal ultrafiltration. All patients appeared at high surgical risk and were successfully treated with ViV TAVI, through the right axillary artery in patient 2, and through the femoral artery in patients 1 and 3. Results were good at short- and mid-term follow-up. In conclusion, early and midterm bioprosthesis degeneration with the development of severe AR is a possible complication of the Mitroflow aortic valve. ViV TAVI has been confirmed as a safe and effective therapeutic option in our cases.
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ORIGINAL ARTICLES
Bicuspid aortic valve disease from infancy to older age: A 25-year experience from an Italian referral center
Annachiara Benini, Giovanni Benfari, Mara Pilati, Giovanni Battista Luciani, Flavio Luciano Ribichini, Maria Antonia Prioli
January-March 2021, 31(1):29-34
DOI
:10.4103/jcecho.jcecho_115_20
Aim:
Bicuspid aortic valve (BAV) is the most common congenital heart defect, with considerable risk of morbidity and mortality. The purpose of the study was to analyze clinical and echocardiographic presentation of BAV in a large-volume tertiary Italian center and to test their interaction with full age span, sex, and first diagnosis versus second referral.
Methods:
Consecutive patients of all ages diagnosed with BAV at our center from January 1988 to December 2012 were retrospectively included. Exclusion criteria were as follows: associated complex congenital cardiac disease, systemic syndrome, and previous cardiac surgery.
Results:
Eligible patients were 790, divided by age quartiles. Seventy-two percent of patients had any grade BAV dysfunction. Aortic valve stenosis was more frequent in the first (24%) and fourth (24%) quartiles. This corresponds to a double-peak stenosis severity curve, being more severe at a very young age and in the elderly. Aortic valve regurgitation was more prevalent in each quartile than stenosis, with a prevalence of 72% in the second quartile and 77% in the third quartile. This corresponds to a single-peak regurgitation severity curve, being more severe in the fourth and fifth decades of life. Patients with previously diagnosed BAV had more significant valve dysfunction in comparison to patients with first diagnosis of BAV, either stenosis (15% vs. 21%,
P
= 0.024) or regurgitation (58% vs. 68%,
P
= 0.006).
Conclusion:
The dominant BAV dysfunction in this large Northern Italian community is regurgitation, with higher severity of disease in the fourth and fifth decades of life.
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CASE REPORTS
Heart failure in tetralogy of fallot due to associated hypertrophic obstructive cardiomyopathy: A lesson to learn
Ashwin Kodliwadmath, Yash Shrivastava, Bhanu Duggal, Dibbendhu Khanra, N Nanda
January-March 2021, 31(1):35-38
DOI
:10.4103/jcecho.jcecho_93_20
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Heart failure (HF) in a case of uncomplicated TOF is uncommon but can occur under special circumstances. TOF associated with hypertrophic obstructive cardiomyopathy (HOCM) is a very rare combination of anomalies, and very few cases have been reported in the literature. Here, we report the case of a 2-month-old male infant who presented to us with central cyanosis and features of HF. He was worked up and found to have TOF with HOCM and advised surgical correction. Hence, we propose that HOCM is also one factor which can precipitate HF in a patient of TOF along with the classical causes mentioned in the literature. Furthermore, the left ventricular outflow tract obstruction of HOCM in a patient of TOF has an inverse relation with the degree of cyanosis.
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Cardiac remodeling after surgical mitral valvuloplasty for Barlow's Disease: Is it the time to look to the load?
Nicolino Esposito, Maria Vincenza Polito, Giacomo Mattiello, Maurizio Galderisi
January-March 2021, 31(1):48-50
DOI
:10.4103/jcecho.jcecho_108_20
We present the case of a 48-year-old man referred for a reduced exercise tolerance in whom a bileaflet mitral prolapse (Barlow's disease), associated with flail motion of posterior mitral leaflet and ruptured chordae tendineae and complicated by eccentric severe regurgitation, was incidentally diagnosed. Albeit paucisymptomatic, at echocardiography he showed the signs of LV dysfunction and, accordingly, was underwent surgical mitral valvuloplasty with implantation of the Memo 3D ReChord Ring without complications. We analyzed the changes of echocardiographic parameters of cardiac remodeling from baseline to post operative setting, highlighting the utility of modern imaging tools (strain and myocardial work) in grade to gauge with more sensitivity LV deformation and function in different conditions of pre and afterload and to overcome the limits of ancient ejection fraction. In conclusion, especially LV myocardial work may be a promising and accurate non load dipendent tool to quantify subclinical LV dysfunction, to guide therapeutic decisions and in post-surgical follow up.
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64
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Transthoracic echocardiographic diagnostic accuracy in detecting “Type-B” aortic dissection
Vito Maurizio Parato, Camilla Notaristefani, Germana Gizzi, Simone D’Agostino
January-March 2021, 31(1):45-47
DOI
:10.4103/jcecho.jcecho_106_20
We present a case of a 91-year-old man presenting to the emergency department with a tearing back pain. The patient's history included an endovascular abdominal aortic repair because of an aneurysm. The transthoracic echocardiography (TTE) appeared normal; however, when transducer was positioned to the left of the spine for the posterior paraspinal window, a clear intimal flap was demonstrated in the descending aorta lumen. The multiphasic computed tomography of the aorta confirmed the diagnosis of Stanford Type-B aortic dissection. The patient underwent thoracic endovascular aortic repair, consisting of a descending aorta endoluminal graft placement and realizing a full metal jacket thoracic-abdominal aorta. At 3-month follow-up, the outcome appeared excellent. The case points out the usefulness of TTE via nonconventional windows in detecting Type-B aortic dissection.
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LETTERS TO EDITOR
Right atrial appendage thrombosis in a patient with a history of myocardial infarction
Ali Hosseinsabet, Mojtaba Salarifar
January-March 2021, 31(1):55-56
DOI
:10.4103/jcecho.jcecho_76_20
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Band-like remnant of the embryonic right valve of the sinus venosus as an incidental finding in an elderly woman
Marjan Hadadi, Ali Hosseinsabet
January-March 2021, 31(1):57-58
DOI
:10.4103/jcecho.jcecho_107_20
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Online since 08 August, 2013