Journal of Cardiovascular Echography最新文献

A 76-year-old man with history of previous coronary artery bypass grafting, permanent atrial fibrillation in novel oral anticoagulation therapy, and gastrointestinal bleedings underwent percutaneous left atrial appendage closure. The procedure was complicated by intraoperative device embolization, which caused a dynamic obstruction of the left ventricular outflow tract leading to severe hemodynamic instability. Transesophageal echocardiography showed a device in the ventricle site of the mitral anterior leaflet. The coronary angiography showed also patency of both arterial grafts in stable coronary artery disease. After failing the percutaneous retrieval with a snare, emergent surgery was planned. A moderate calcified aortic valve stenosis was also found, but in consideration of the unstable clinical conditions of the patient, we thought of performing a transcatheter aortic valve replacement (TAVR) in a second time. We have carefully planned the surgical retrieval of the device embolized paying attention of his several comorbidities. The strategy to remove the device with cardiopulmonary bypass without cross-clamping the aorta through a right mini-thoracotomy has been preferred.

Background: Human immunodeficiency virus (HIV) affects many organ systems in the body including the cardiovascular system, often manifesting as a subclinical left ventricular (LV) systolic dysfunction that may progress to heart failure.

Aim: This study assessed the prevalence of LV systolic dysfunction in children on highly active antiretroviral therapy (HAART) with established clinical stage 1 HIV-disease.

Materials and methods: The study was a cross-sectional comparative study conducted in Aminu Kano Teaching Hospital from April to August 2019 on 200. It involved study participants comprising 100 WHO clinical stage 1 HIV-infected children and 100 control subjects, aged between 1 and 18 years selected using systematic sampling method. Echocardiography was carried out on the study participants who had already completed a pretested questionnaire.

Results: Out of 100 HIV-infected children studied, 49 were males and 51 females (Male: Female ratio; 0.96:1.0). The mean age at diagnosis of HIV infection was 2.6 (±2.6 years) and the median viral load was 35 copies/ml. The mean ejection and shortening fractions in HIV-infected children were 59.0% and 31.0%, respectively, compared to 64.4% and 34.0% in control subjects, respectively, and were statistically significant (P = 0.000). The prevalence of LV systolic dysfunction was 8.0% (8 out of 100) in HIV-infected children while the control groups had zero prevalence (P = 0.002). The age at diagnosis correlated negatively with LV systolic dysfunction (r = 0.23, P = 0.02).

Conclusion: This study found a subclinical LV systolic dysfunction in an HAART-established clinical stage 1 HIV-infected children. The age at diagnosis was negatively correlated with the LV systolic function. This study, therefore, support the inclusion of routine echocardiography into the evaluation of HIV-infected children.

Background: The relationship between visual assessment and longitudinal strain during dobutamine stress echocardiography (DSE) remains poorly investigated. This study assessed wall motion segments visually graded as normokinetic, hypokinetic, and akinetic at baseline and the peak of DSE and compared with longitudinal strain between segments with and without induced impaired contractility and improved contractility during DSE.

Methods: This study included 112 patients examined by DSE, consisting of 58 patients referred for diagnostic study and 54 patients referred for viability study. Regional left ventricular (LV) contractility was assessed visually and longitudinal strain was measured using echocardiography transthoracic.

Results: At baseline, the strain of LV segments was -16.33 ± 6.26 in visually normokinetic, 13.05 ± 6.44 in visually hypokinetic, and -8.46 ± 5.69 in visually akinetic segments. During peak dose, the strain of LV segments was -15.37 ± 6.89 in visually normokinetic, -11.37 ± 5.11 in visually hypokinetic, and -7.37 ± 3.92 in visually akinetic segments. In segments with visually observed impaired contractility, the median longitudinal strain was significantly lower than in segments without impaired contractility. For segments with visually observed improved contractility, the median longitudinal strain was significantly higher than for segments without improved contractility. In diagnostic study, sensitivity of visual assessment for absolute decrease of >2% longitudinal strain was 77%, respectively. In the viability study, the sensitivity was 82% for an absolute decrease of ≥2% longitudinal strain.

Conclusions: There is good association between strain analysis value and visually assessed wall motion contractility.

Coronavirus disease 2019 (COVID-19) is characterized by multi-organ involvement, including respiratory and cardiac events. Echocardiography is widely considered the first-choice tool for the evaluation of cardiac structures and function because of its reproducibility, feasibility, easy to use at bedside, and for good cost-effectiveness. The aim of our literature review is to define the utility of echocardiography in the prediction of prognosis and mortality in COVID-19 patients with mild to critical respiratory illness, with or without known cardiovascular disease. Moreover, we focused our attention on classical echocardiographic parameters and the use of speckle tracking to predict the evolution of respiratory involvement. Finally, we tried to explore the possible relationship between pulmonary disease and cardiac manifestations.

Sinus of Valsalva pseudoaneurysm (SVpA) is a rare cause of right ventricular inflow obstruction. We report such a case presented with atrial flutter and cardiogenic shock caused by tricuspid valve obstruction by a narrow-necked right SVpA complicating aortic valve infective endocarditis demonstrated on transesophageal echocardiography and cardiac computed tomography. Despite restoration of sinus rhythm, the patient ran a fatal course due to aneurysmal rupture. We show the value of transesophageal echocardiography in evaluating unstable patients with cardiogenic shock, and the need of urgent surgery in selected patients to avoid a dismal outcome.

Pulmonary hypertension (PHT) is an emerging issue. The prognosis in PHT is usually poor, independently from the etiology, with progressive right ventricle failure. Despite right Heart Catheterism is the gold standard for diagnosis of PHT, echocardiography provides important information about prognosis and is helpful in both follow-up and first evaluation of PHT patients, showing a good correlation with invasively measured parameters by right heart catheterization. However, it is important to understand the limits of this method, particularly in some settings, where transthoracic echocardiography has shown a lack of accuracy. In this case report we documented a case of rapid onset (3 months) idiopathic PHT and we provided a critical analysis of echocardiographic role in PHT.

Heart valve leaflet's aneurysm is a rare finding, and literature about this topic is sparse. Early recognition is important because their rupture can lead to catastrophic valve regurgitation. An 84-year-old male with chronic ischemic cardiomyopathy was admitted to the coronary intensive care unit for non-ST elevation myocardial infarction. Baseline transthoracic echocardiography showed normal biventricular function with inhomogeneous thickening of aortic leaflets with moderate aortic regurgitation. Because the acoustic window was limited, a transesophageal echocardiography was performed, detecting a small mass in the right aortic coronary cusp with moderate regurgitation (orifice regurgitation area: 0.54 cm²; med/max gradient: 16/32 mmHg). Endocarditis was ruled out. Because of the rapid worsening of the patient's conditions, requiring mechanical ventilation and hemofiltration, and the potential hazard of an urgent coronary angiography, a cardiac computed tomographic angiography was performed. Detailed spatial reconstructions highlighted a bilobed cavitation in the aortic leaflets. Diagnosis of aortic leaflets' aneurysm was made. A "wait and see" strategy was chosen, and the patient's general conditions gradually improved and now he is stable and uneventful. To date, no aortic leaflet's aneurysm was described in literature.

Lipomatous atrial septal hypertrophy (LASH) is a histological cardiac benign lesion finding with high prevalence in healthy population, usually detected during imaging procedures for other indications. Nevertheless, it could become clinically significant if it compromises venous return and diastolic left ventricular filling, up to becoming an anatomical substrate for atrial tachyarrhythmias. We present a case of LASH diagnosed in a 54-year-old female patient admitted to our emergency department after ground fall and collateral finding of positive blood cultures leading to transesophageal echocardiography. A giant mass involving the interatrial septum was observed, in the absence of primitive neoplasia evidence after performing a total-body computed tomography scan and abdominal echography. No signs or symptoms of pulmonary venous congestion were observed, and no relevant tachyarrhythmias were detected at continuous electrocardiogram monitoring during the hospitalization period.

Anomalous fibromuscular bands in the left atrium were already described in the 19^th century. Recently, the greater attention to the anatomy of the left atrium and the technological improvement have made their finding more frequent. Here, we present six cases, out of approximately 30,000 unselected echocardiograms, in which the use of the three-dimensional echo allowed a better definition of their anatomy, course, and motility.