Journal of the Saudi Heart Association最新文献

A 34 year old male who had undergone surgical closure of a ventricular septal defect at the age of 4 years, after a long asymptomatic period, presented with heart failure and was diagnosed with atrial flutter and biventricular dysfunction. Chest X-ray showed a band-like calcification in the atrioventricular groove. Echocardiography revealed dilated atria, focal calcification with constriction at the atrioventricular groove, and biventricular systolic dysfunction. Focal constrictive pericarditis occurring in post-cardiac surgery patients is very rare. Here we report a case of focal variant of constrictive pericarditis manifesting in a young male after 3 decades of ventricular septal defect repair.

Objectives: Evidences indicate positive effect of physical exercise on exercise capacity and quality of life in patients with AF. However, whether it improves cardiac function and reverse cardiac remodeling in AF patients was unknown. We aim to evaluate the effects of exercise intervention on cardiac function and structure, and the risk of AF recurrence in patients with non-permanent AF.

Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Searches were performed in PubMed, ProQuest, Google Scholar, ScienceDirect, and Scopus to identify randomized controlled trials (RCTs) comparing exercise interventions combined with standard AF treatment versus standard treatment alone in patients with non-permanent AF. The outcomes included changes in LVEF, left atrial indexed volume (LAVi), the E/e' ratio (early mitral inflow velocity/early diastolic mitral annular velocity), left ventricular end-diastolic diameter (LVDd), and the incidence of AF recurrence.

Results: A total of ten RCTs involving 1013 participants met the inclusion criteria. The intervention group participated in supervised exercise sessions, with or without additional home-based exercise, alongside routine AF treatment. Exercise modalities varied, mostly included continuous or interval aerobic training ± strength training. The analysis revealed a significant increase in LVEF following exercise intervention (MD = 2.16 %, 95 % CI: 0.27 to 4.05, p = 0.03, I² = 74 %). However, no significant differences were observed in LAVi, LVDd, or the E/e' ratio. Interestingly, exercise intervention was associated with a reduced risk of AF recurrence compared to the control group (RR = 0.82, 95 % CI: 0.68 to 0.99, p = 0.04, I² = 33 %). Subgroup analysis revealed that interval training appears to offer greater benefit in reducing AF recurrence, while continous training results in greater improvement of LVEF.

Conclusion: Exercise intervention improves LVEF and reduces AF recurrence, but does not affect cardiac remodeling. This effect is dependent on the type of exercise regimen.

Introduction: Coronary artery ectasia (CAE) is defined as abnormal dilatation of coronary arteries and may be linked to subclinical myocardial dysfunction. Conventional echocardiographic parameters may not adequately detect early left ventricular (LV) dysfunction. Two-dimensional speckle-tracking echocardiography (2D STE) has shown promise in identifying subtle myocardial changes.

Methods: In this single-center observational study, 90 participants with available coronary angiography were divided into three groups: Group A (controls, n = 30), Group B (single-vessel CAE, n = 30), and Group C (multi-vessel CAE, n = 30). Standard echocardiographic indices including LV ejection fraction (LVEF), volumes, and diastolic function were assessed. Global radial, longitudinal, circumferential, and area strains were measured using 2D STE. Univariate and post-hoc analyses compared measurements across groups.

Results: LVEF was preserved in all groups (p = 0.157), with conventional echocardiography detecting abnormalities only in multi-vessel CAE (Group C). In contrast, 2D STE revealed subclinical dysfunction in both CAE groups. GLS declined from -20.4 % (controls) to -17.3 % (single-vessel) and -14.6 % (multi-vessel; p < 0.001). GCS and GRS followed similar patterns.

Conclusions: 2D STE detected subclinical LV impairment in early CAE, whereas conventional methods revealed dysfunction only in advanced disease. This supports the value of 2D STE for early monitoring in CAE patients.

Streptococcus Agalactiae endocarditis is a rare clinical entity in newborns with a normal structured heart. It is generally characterized by acute onset, the presence of large vegetations, rapid valvular destruction and frequent complications, particularly embolization. Mortality is high with medical therapy alone. We are reporting a rare case of infective endocarditis (IE) with mitral valve vegetation in a 9 days old healthy newborn following Streptococcus Agalactiae sepsis, complicated by meningitis and micro-abscesses. Mitral valve (MV) vegetation was removed surgically; the patient received intravenous antibiotics for six weeks. Transthoracic echocardiography after surgery showed severe MV regurgitation and severe pulmonary hypertension which was successfully managed by conservative care with cardiac medications.

Acute myocardial infarction from a vegetation is a rare complication of infective endocarditis. Thrombolysis, percutaneous coronary intervention with balloon angioplasty, stenting, and thromboaspiration, and surgery have all been described in this challenging clinical scenario. A woman with staphylococcal bioprosthetic aortic valve infective endocarditis developed acute myocardial infarction due to a vegetation invading the left main coronary artery, which was successfully managed with percutaneous thromboaspiration.

Background: Extracorporeal life support (ECLS), including extracorporeal membrane oxygenation (ECMO), is increasingly used in patients post-cardiac surgery. However, cardiopulmonary complications and delayed weaning remain common.

Objectives: This study aims to investigate the clinical course of post-cardiac surgery and extracorporeal membrane oxygenation patients using lung ultrasound and echocardiography.

Patient and methods: This prospective multicenter observational study was conducted in the intensive care units of King Fahd Military Medical Complex, Saudi Arabia, and Cairo University, Egypt. A total of 103 adult patients requiring ECMO or post-cardiac surgery with cardiopulmonary bypass were enrolled.

Result: Postoperative echocardiographic assessment showed significant reductions in EF, TAPSE, and VTI, with increased VTI variability. Extubation time correlated significantly with EF, LVESD, LA diameter, and postoperative VTI variability. Diaphragmatic ultrasound revealed reduced excursion and thickness fraction postoperatively, both strongly associated with prolonged ventilation. LUS detected atelectasis, pleural effusions, and diaphragmatic dysfunction earlier than conventional imaging.

Conclusion: CCUS is a valuable bedside tool in post-cardiac surgery and ECMO patients. Echocardiographic parameters (EF, LVESD, and VTI variability) and diaphragmatic function indices are strong predictors of weaning success, while LUS facilitates early pulmonary complication detection. Incorporating CCUS into routine monitoring may enhance patient outcomes and optimize weaning strategies.

Lung cancer is among the most diagnosed cancers worldwide, and its co-occurrence with coronary heart disease is life-threatening. Osimertinib is the standard treatment for epidermal growth factor receptor (EGFR) mutations in advanced non-small cell lung cancer (NSCLC). The addition of pemetrexed and carboplatin increases not only the efficacy but also the cardiotoxicity risk. We report a 59-year-old woman with NSCLC alongside brain, liver, and spleen metastases, who developed cardiovascular events following cancer therapy. With advanced imaging and multidisciplinary intervention, remarkable remission was achieved over two years. Reporting this case contributes to the understanding of its presentation and diagnostic challenges.

[This corrects the article DOI: 10.37616/2212-5043.1444.].

Background: The interventricular septum (IVS)/anterior aortic angle is typically measured at 120° in healthy individuals but is more acute in patients with left ventricular outflow tract (LVOT) narrowing, aortic valve anomalies, and discrete subaortic membrane (SAM).

Objectives: This study aimed to assess this angle in pediatric patients with abnormal aortic valves and/or LVOT obstruction and evaluate its association with SAM development.

Methodology: A prospective cohort observational study was conducted in the pediatric cardiology department at PSCC-Qassim from September 2022 to June 2023. Echocardiographic assessments were performed on pediatric patients (neonates to 14 years) with bicuspid aortic valve (BAV), with or without SAM. Patients with ventricular septal defect (VSD), atrioventricular septal defect (AVSD), or single ventricle pathology were excluded. The Aortoseptal angle was measured in the long-axis parasternal view.

Result: Among 319 cases, 153 served as controls with normal cardiac anatomy. The remaining 194 cases included 104 (53 %) with isolated BAV, 51 (26 %) with isolated SAM, and 11 (6 %) with BAV and SAM. The male-to-female ratio was 2.2:1. SAM was observed in 64 (33 %) cases, and significant aortic stenosis in 13 (6.7 %). Cardiac surgery was performed in SAM resection (4.1 %). The Aortoseptal angle ranged from 110° to 135° across groups, with no statistically significant differences between patients with SAM and controls. However, ROC analysis indicated that an angle <116° predicted SAM presence with 97 % sensitivity and 87 % specificity.

Conclusion: While a more acute Aortoseptal angle was common in SAM patients, no statistically significant differences were found. An angle <115° may warrant close monitoring for SAM development.

Background: Primary percutaneous coronary intervention (PPCI) is the gold standard for myocardial reperfusion in ST-segment elevation myocardial infarction (STEMI). Numerous studies have shown that thrombus aspiration can prevent distal embolization and reducing the risk of microvascular obstruction (MVO). Cardiac magnetic resonance (CMR) is considered the gold standard for the evaluation of MVO.

Objectives: The aim of this study was to evaluate the effect of thrombus aspiration in STEMI patients as an adjunctive technique to primary PCI in reducing both incidence and extent of MVO evaluated by CMR.

Methods: Ninety-three patients with heavy thrombus burden were enrolled in this study; sixty-five patients met our inclusion criteria. After failed trial of restore the artery patency, aspiration thrombectomy was done followed by PCI for thirty-one patients (aspiration group), while conventional PCI without aspiration thrombectomy was performed for 34 patients (conventional group). The primary end points were both occurrence and extent of microvascular obstruction (MVO) evaluated mainly by CMR, in addition to angiographic data (MBG and TIMI flow grade).

Results: The incidence of microvascular obstruction (MVO) was significantly higher in conventional group (18 patients, 52.9 %) when compared with aspiration group (7 patients, 22.6 %; p-value = 0.012). Moreover, significant differences existed between the studied groups regarding MVO extent. For instance, MVO extended to >4 segments in only 3 patients (9.7 %) in aspiration group, but in 13 patients in conventional group (38.2 %; p-value = 0.007).

Conclusions: Aspiration thrombectomy substantially reduces both the incidence and extent of microvascular obstruction as an adjunctive technique to PPCI in STEMI patients with heavy thrombus burden.