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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 28 | Issue 4
Page Nos. 207-245

Online since Monday, December 24, 2018

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REVIEW ARTICLES  

Mitral prolapse: An old mysterious entity – The incremental role of multimodality imaging in sports eligibility p. 207
Andreina Carbone, Antonello D’Andrea, Giancarlo Scognamiglio, Raffaella Scarafile, Gianpaolo Tocci, Simona Sperlongano, Francesca Martone, Juri Radmilovic, Marianna D’Amato, Biagio Liccardo, Marino Scherillo, Maurizio Galderisi, Paolo Golino
DOI:10.4103/jcecho.jcecho_42_18  
Mitral valve prolapse is generally a benign condition characterized by fibromyxomatous changes of the mitral leaflet with displacement into the left atrium and late-systolic regurgitation. Although it is an old clinical entity, it still arouses perplexity in diagnosis and clinical management. Complications, such as mitral regurgitation (MR), atrial fibrillation, congestive heart failure, endocarditis, ventricular arrhythmias, and sudden cardiac death (SCD), have been reported. A large proportion of the overall causes of SCD in young competitive athletes is explained by mitral valve prolapse. Recent studies have shown the fibrosis of the papillary muscles and inferobasal left ventricular wall in mitral valve prolapse, suggesting a possible origin of ventricular fatal arrhythmias. Athletes with mitral valve prolapse and MR should undergo annual evaluations including physical examination, echocardiogram, and exercise stress testing to evaluate the cardiovascular risks of competitive sports and obtain the eligibility. In this setting, multimodality imaging techniques – echocardiography, cardiac magnetic resonance, and cardiac computed tomography – should provide a broad spectrum of information, from diagnosis to clinical management of the major clinical profiles of the disease.
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Three-dimensional echographic evaluation of carotid artery disease p. 218
Enrico Calogero, Iacopo Fabiani, Nicola Riccardo Pugliese, Veronica Santini, Lorenzo Ghiadoni, Rossella Di Stefano, Fabio Galetta, Ferdinando Sartucci, Giuseppe Penno, Raffaella Berchiolli, Mauro Ferrari, Dania Cioni, Vinicio Napoli, Raffaele De Caterina, Vitantonio Di Bello, Davide Caramella
DOI:10.4103/jcecho.jcecho_57_18  
The introduction of three-dimensional echography (3D echo) in vascular field is not recent, but it still remains a seldom-used technique because of the costs of ultrasound probe and the need of dedicated laboratories. Therefore, despite significant prognostic implications, the high diagnostic accuracy in plaque definition, and the relative ease of use, 3D echo in vascular field is a niche technique. The purpose of this review is mainly clinical and intends to demonstrate the potential strength of a 3D approach, including technical aspects, in order to present to clinicians and imagers the appealing aspects of a noninvasive and radiation-free methodology with relevant diagnostic and prognostic correlates in the assessment of carotid atherosclerosis. A comprehensive literature search (since 1990s to date) using the PubMed, MEDLINE, and Cochrane libraries databases has been conducted. Articles written in English have been assessed, including reviews, clinical trials, meta-analyses, and interventional/observational studies. Manual cross-referencing was also performed, and relevant references from selected articles were reviewed. The search was limited to studies conducted in humans. Search terms, retrieved also with PubMed Advanced search and AND/OR Boolean operators (mainly in title and abstract), included three-dimensional, echo, stroke/transient ischemic attack, predictors, carotid, imaging, and biomarkers.
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ORIGINAL ARTICLE Top

Early right ventricular dysfunction in highly selected (totally free from cardiovascular risk factors and other comorbidities) human immunodeficiency virus patients: A pilot study with advanced echocardiography p. 228
Martino Deidda, Christian Cadeddu Dessalvi, Selina Campus, Francesco Ortu, Paolo Piano, Pier Paolo Bassareo, Giuseppe Mercuro
DOI:10.4103/jcecho.jcecho_43_18  
Objective: Human immunodeficiency virus (HIV) infection may also be associated with cardiac dysfunction, thus negatively affecting patients' morbidity and mortality. This preliminary study aimed at evaluating whether bi-and three-dimensional (3D) strain echocardiographic facilities were able to identify alterations in the right ventricular (RV) function in highly selected – because free from cardiovascular risk factors and other comorbidities – HIV patients. Materials and Methods: Eight of these specific HIV patients (age: 32.0 ± 3.6 years; 7 months) treated with highly active antiretroviral therapy (HAART) were enrolled and compared with 8 sex-, age-, and cardiovascular risk profile-matched healthy individuals. All underwent clinical evaluation and transthoracic echocardiography coupled with tissue Doppler, two-dimensional (2D), and 3D speckle tracking imaging to examine their RV function. Results: All standard echocardiographic parameters resulted in the normal range, with no significant differences between HIV and controls. On the contrary, 2D longitudinal strain (16.1% ±1.6% vs. 17.8% ±0.9%, P = 0.02) and Global 3D strain (28.5% ±3.6% vs. 33.5% ±1.9%, P = 0.0002) were reduced in the HIV group. Moreover, Global 3D strain values showed a direct correlation with RV fractional area change values (r = 0.66, P = 0.005). Conclusions: 2D longitudinal and 3D Global strain can identify an early asymptomatic RV impairment in HIV patients free from other risk factors and comorbidities. These findings seem to imply that also in treated with HAART and well-controlled HIV patients an early asymptomatic systolic RV dysfunction is present, as a distinctive and separated pathological entity compared with classic HIV-related pulmonary arterial hypertension and left ventricular dysfunction. In these patients, RV dysfunction is not revealed by standard echocardiography.
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CASE REPORTS Top

Transcatheter aortic valve replacement and cardiac resynchronization therapy in cancer-related cardiotoxicity p. 233
Enrico Melillo, Luigi Ascione, Giuseppe Palmiero, Valentina Maria Caso, Pio Caso
DOI:10.4103/jcecho.jcecho_46_18  
Cardiotoxicity related to antineoplastic agents is a rising and growing issue, therefore early recognition and prompt management can impact on the overall prognosis of cancer patients. We report the case of a 70-year-old woman without cardiovascular risk factors, with a medical history of non-Hodgkin lymphoma and chronic myeloid leukemia treated with chemotherapy and radiotherapy, who underwent transcatheter aortic valve replacement for severe aortic stenosis and cardiac resynchronization therapy for further development of complete left bundle branch block, with a significant improvement of her functional status and left ventricle systolic function in a long-term follow-up.
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Tricuspid papillary fibroelastoma at multimodal imaging p. 236
Grazia Casavecchia, Matteo Gravina, Stefano Zicchino, Enrico Moranti, Andrea Cuculo, Luca Macarini, Matteo Di Biase, Natale Daniele Brunetti
DOI:10.4103/jcecho.jcecho_48_18  
Papillary fibroelastoma is a rare benign cardiac tumor, second after cardiac myxoma as more frequent cardiac valvular tumor. The therapy is usually based on surgery according to size, mobility, symptoms, and risks of surgery. We report the case of a 67-year old female with transient ischemic attack. Echocardiography showed the presence of a round mobile formation localized on the atrial side of septal leaflets of tricuspid valve, first identified as an endocarditis vegetation. Cardiac magnetic resonance (cMRI) confirmed the presence of the mass and showed an isointense signal in T1-turbo spin echo sequences, hypointense in cine steady-state free precession and in first-pass sequences, and hyperintense in T2 and phase-sensitive inversion recovery with central hypointense core, with a suspected diagnosis of fibroelastoma. The patient underwent cardiac surgery and histology confirmed the presence of fibroelastic tissue with papillary extroflexions compatible with diagnosis of fibroelastoma. The use of cMRI may be useful in the evaluation of the exact position, dimensions, and nature of cardiac masses and fibroelastomas, diagnostic workup, and preliminary assessment before surgery.
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Dual communication of confluence of total anomalous pulmonary venous connection: An interesting but a rare entity p. 239
Gaurav Agrawal, Sitaraman Radhakrishnan
DOI:10.4103/jcecho.jcecho_29_18  
Here, we describe the case of a 9-month-old male child who was diagnosed with a very unusual and rare variety of mixed total anomalous pulmonary venous connection.
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Thrombus formation in the right atrium after surgical closure of atrial septal defect p. 242
Muzaffer Kahyaoglu, Ahmet Guner, Cetin Gecmen
DOI:10.4103/jcecho.jcecho_34_18  
Atrial septal defect is the most common congenital lesion in adults following bicuspid aortic valve. There are two closure strategies as follows: one surgical and the other percutaneous. Various complications such as atrial arrhythmias and development of thrombus have been reported after surgical closure. Herein, we present a case of right atrial thrombi formed at different localizations in the right atrium in a patient who was asymptomatic and diagnosed late.
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LETTER TO EDITOR Top

Biatrial myxoma and human immunodeficiency virus infection: An association not to be missed p. 245
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/jcecho.jcecho_21_18  
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