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   Table of Contents - Current issue
Coverpage
January-March 2019
Volume 29 | Issue 1
Page Nos. 1-43

Online since Wednesday, March 20, 2019

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ORIGINAL ARTICLES  

Left atrial volume during stress is associated with increased risk of arrhythmias in patients with hypertrophic cardiomyopathy p. 1
Giuseppe Limongelli, Vincenzo Fioretti, Marco Di Maio, Marina Verrengia, Marta Rubino, Rita Gravino, Daniele Masarone, Antonello D'Andrea, Quirino Ciampi, Eugenio Picano, Perry Elliott, Giuseppe Pacileo
DOI:10.4103/jcecho.jcecho_45_18  PMID:31008030
Introduction: In patients affected by hypertrophic cardiomyopathy (HCM), left atrial volume index (LAVi) is associated with an increased risk of tachyarrhythmias and major clinical events. To date, the clinical meaning of LAVi measured during exercise (stress LAVi [sLAVi]) has not yet been investigated in HCM. This study sought to evaluate the correlation between LAVi/sLAVi and clinical outcome (risk of arrhythmias and heart failure [HF]) in patients with HCM. Methods and Results: We enrolled a total of 51 consecutive patients with HCM (39 men; mean age: 39.41 ± 17.9 years) who underwent standard and stress echocardiography, following a common protocol. During follow-up (median follow-up was 1.82 years), the following composite endpoints were collected: ARRHYT endpoint (atrial fibrillation, paroxysmal supraventricular tachycardia, nonsustained ventricular tachycardia (VT), sustained VT, ventricular fibrillation, syncope of likely cardiogenic nature, and sudden cardiac death) and HF endpoint (worsening of functional class and left ventricular ejection fraction, hospitalization, and death for end-stage HF). Eight patients were lost at follow-up. ARRHYT endpoint occurred in 13 (30.2%) patients (8, 18.6%, supraventricular and 10, 23.2%, ventricular arrhythmias), whereas HF endpoint occurred in 5 (11.6%) patients. sLAVi (mean value of 31.16 ± 10.15 mL/m2) performed better than rLAVi as a predictor of ARRHYT endpoint (Akaike Information Criterion: 48.37 vs. 50.37, if dichotomized according to the median values). A sLAVi value of 30 mL/m2 showed a predictive accuracy of 72.1% (C-statistics of 0.7346), with a high negative predictive value (87.5%). Conclusion: These findings encourage future studies on sLAVi, as a potential predictor of arrhythmias and adverse outcome in patients with HCM.
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StepWise protocols for scoring of mitral valve using three-dimensional transthoracic echocardiography in mitral stenosis p. 7
Ashraf M Anwar, Wael M Attia
DOI:10.4103/jcecho.jcecho_58_18  PMID:31008031
Aim: This study aims to propose protocols that enable scoring of mitral valve (MV) in mitral stenosis using the three-dimensional (3D) scoring system. Methods: A two-staged study was conducted. The first stage was designed to select the best 3D images of MV leaflets and chordae through analysis of 471 images. The second stage was designed to organize the best 3D images into protocols for complete scoring of MV. It included 35 consecutive patients; 23 had sinus rhythm (SR) and 12 had atrial fibrillation (AF). Both single- and multi-beat 3D acquisition from apical and parasternal windows were focused on MV leaflets and chordae using all 3D modalities (live, zoom, and full volume). To propose the protocols, 1563 images were analyzed. Results: In SR with good apical window, 2 protocols were recommended for complete scoring of leaflets and chordae (4 zoom 3D images [1 image for leaflets and 3 images for chordae] and 1 full-volume 3D image) using single- and multi-beat acquisition. In AF, the same 2 protocols using single-beat acquisition were recommended. From parasternal window, complete scoring of leaflets was obtained by 3 recommended protocols (single- or multi-beat zoom 3D images from parasternal short axis [PSAX], multibeat live 3D images from PSAX, and single- or multi-beat full-volume 3D images from parasternal long axis) in SR and 1 protocol in AF (single-beat zoom 3D images from PSAX). Scoring of chordae was incomplete in all patients by all 3D modalities. Conclusions: The proposed 3D-transthoracic echocardiography protocols suit all patients regardless of echo window and heart rhythm and enabled complete MV scoring.
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CASE REPORTS Top

Three-dimensional echocardiographic imaging of a Gerbode defect complicating transcatheter aortic valve replacement p. 14
Hani Al Sergani, Domenico Galzerano, Olga Vriz, Jehad Al Buraiki
DOI:10.4103/jcecho.jcecho_56_18  PMID:31008032
We describe a case of a 77-year-old male who underwent transcatheter aortic valve implantation (TAVR) with Edwards SAPIEN XT size 26 mm for severe aortic stenosis. Postprocedural transesophageal echocardiography (TEE) showed left-to-right shunt between the left ventricular outflow tract just below the bioprosthesis and the right atrium across the atrioventricular septum (Gerbode defect). Three-dimensional echocardiography (3DE) allowed a detailed anatomical imaging of the shape and the location of a small, circular, atrioventricular defect that was a type II, direct, supravalvular, Gerbode-type defect. This is the third report of a Gerbode defect after TAVR whose diagnosis has important implications on clinical decision-making. TEE plays a key role; its diagnostic ability is enriched by the additional value of 3DE.
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Ventricular Septal Defect Complicating Inferior Acute Myocardial Infarction: A Case of Percutaneous Closure p. 17
Donatella Ferraioli, Giuseppe Santoro, Michele Bellino, Rodolfo Citro
DOI:10.4103/jcecho.jcecho_60_18  PMID:31008033
Ventricular septal defect (VSD) is one of the most serious mechanical complications of acute myocardial infarction (AMI). Despite the incidence of post-AMI VSD in reperfusion era has reduced from 1%–2% to 0.17%–0.31%, it is a still life-threatening condition with poor prognosis. Surgical VSD closure is considered the best treatment approach since conservative management carries an extremely high mortality rate. Over the last decade, percutaneous transcatheter closure has emerged as an alternative therapeutic strategy for a patient with post-AMI VSD, with outcomes similar to cardiac surgery (30-day mortality 14%–66%). We present a case of inferior AMI complicated by posterobasal VSD and cardiogenic shock successfully treated with percutaneous closure. The role of echocardiography in diagnosis, management, and percutaneous procedure guiding has been emphasized.
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Amniotic fluid embolism in a grown-up congenital heart disease patient p. 20
Elena De Angelis, Costantina Prota, Rosanna Matturro, Rodolfo Citro
DOI:10.4103/jcecho.jcecho_64_18  PMID:31008034
Amniotic fluid embolism (AFE) is a rare but potentially lethal obstetric condition affecting women during labor, delivery, or also in the immediate postpartum period, when amniotic fluid, fetal cells, hair, or other debris could enter the maternal circulation. We present the first case of AFE described in literature in a 33-year-old patient with a complex history of congenital heart disease, where the crucial points for successful course were the prompt recognition and treatment of the disease and the use, for the first time, as diagnostic tool for AFE, of right ventricular free-wall longitudinal speckle-tracking strain.
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Dual coronary-pulmonary fistula firstly found at routine doppler echocardiogram p. 23
Grazia Casavecchia, Stefano Zicchino, Matteo Gravina, Alessandro Martone, Andrea Cuculo, Luca Macarini, Matteo Di Biase, Natale Daniele Brunetti
DOI:10.4103/jcecho.jcecho_47_18  PMID:31008035
Congenital coronary-pulmonary fistulas (CPFs) are defined as an abnormal direct communication between one or more coronary arteries, with a cardiac or thoracic structure bypassing the capillary network. We report the case of a 73-year-old male, with a history of hypertension, asymptomatic for angina and dyspnea, who was referred for routine clinical control. Echocardiogram unexpectedly showed the presence of diastolic flow from the pulmonary trunk in parasternal short-axis view. Pulsed-wave Doppler confirmed the presence of diastolic flow and displayed the typical coronary flow pattern. Coronary angiography hence showed the presence of dual CPFs originating from the second segment of the left anterior descending coronary and the right coronary arteries. Careful routine Doppler echocardiograph examination may raise the suspicion of CPF in case of otherwise unexplained symptoms and may represent a simple, easy, repeatable tool for the first suspected diagnosis and follow-up of CPFs.
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A rare case of left subacute atrial dissection: Multimodality imaging approach p. 26
Alberto Lavorgna, Carmine Villani, Donatello Fabiani, Cosimo Napoletano
DOI:10.4103/jcecho.jcecho_52_18  PMID:31008036
Today, left atrial dissection is described as a rare complication of cardiac surgery, particularly after a mitral valve replacement. We report a rare case of left subacute atrial dissection occurred as a result of a domestic accidental fall. Transesophageal echocardiogram, angio-computed tomography, and magnetic resonance imaging showed an intramural formation with clear margins and a seamless cleavage with the posterolateral wall of the left atrium, which determined an obstacle to the ventricular filling. The patient was then operated in order to empty the hematoma and reattach the atrial wall.
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Giant right coronary artery aneurysm detected by transthoracic echocardiography p. 29
Matteo Pernigo, Marco Triggiani, Samuele Pentiricci, Graziano Montresor
DOI:10.4103/jcecho.jcecho_59_18  PMID:31008037
Coronary artery aneurysms (CAAs) are rare findings caused by atherosclerosis in about 50% of cases. They are usually diagnosed using coronary angiography, cardiac computed tomography, or magnetic resonance imaging. In this report, we present a rare case of giant, isolated right CAA, detected by transthoracic echocardiography in an adult patient with unstable angina. Diameters of the aneurysm were 3.6 cm × 2.7 cm. Anterior-septal hypokinesia of the left ventricle was also noted. A comprehensive echocardiographic examination, including contrast study, excluded alternative diagnoses and supported the hypothesis of a coronary ectasia. The coronary angiography confirmed the diagnosis of giant coronary aneurysm and revealed a severe three-vessel disease. The patient was treated with cardiac surgery a few days later: two coronary artery bypass grafts and exclusion of the aneurysm by surgical legation were successfully performed.
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A nonfatal massive pulmonary embolism in a very old patient: The protective filter-effect of the Chiari Network p. 32
Andrea Sonaglioni, Gian Luigi Nicolosi, Michele Lombardo, Claudio Anza
DOI:10.4103/jcecho.jcecho_65_18  PMID:31008038
The Chiari network, a net-like structure within the right atrium, has been described as an embryonic remnant of no clinical significance. Its role in facilitating paradoxical arterial embolic events and as a potential site for thrombus formation has been reported in the literature. This case illustrates the protective filter-effect of the Chiari network in a 92-year-old women who presented with the clinical signs and symptoms of acute cor pulmonale. Transthoracic echocardiography revealed a large, S-shaped, and extremely mobile right atrial thrombus within the Chiari network. Here, the authors describe how the Chiari network may have prevented the occurrence of a fatal pulmonary embolism acting as a protective factor.
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Never too grown-up for a congenital heart disease: Diagnosis of transitional atrioventricular canal in a 50-year-old male p. 35
Francesca De Angelis, Ketty Savino, Alessandro Colombo, Mariagrazia Sardone, Giuseppe Ambrosio
DOI:10.4103/jcecho.jcecho_28_18  PMID:31008039
Transitional atrioventricular (AV) septal defects are uncommon congenital heart defects, and diagnosis is usually made in childhood. We present the case of intermediate AV canal diagnosed in a man referring to cardiological examination for the first time in his life at the age of fifty for exertional dyspnea. The absence of medical examination or execution of electrocardiogram or echocardiogram in childhood or in youth and the very late appearance of symptoms lead to a late diagnosis of this congenital heart disease (CHD). This case underlines the importance of including CHD in the differential diagnosis of symptoms such as chronic dyspnea, also in adulthood.
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Dipyridamole-induced Left ventricular “Rigid Body Rotation” (A case from the three-dimensional speckle tracking echocardiographic MAGYAR-stress study) p. 39
Attila Nemes, Gyula Szántó, Anita Kalapos, Péter Domsik, Árpád Kormányos, Nóra Ambrus, Tamás Forster
DOI:10.4103/jcecho.jcecho_9_18  PMID:31008040
Under normal physiological conditions, the direction of systolic rotation of the left ventricular (LV) base is clockwise, and that of the LV apex is counterclockwise resulting in the wringing motion of the LV around its long axis called as LV twist. The present study was designed to present a patient with significant coronary artery disease in whom near absence of LV twist called as LV rigid body rotation could be induced during dipyridamole stress as assessed noninvasively by three-dimensional speckle-tracking echocardiography.
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LETTER TO EDITOR Top

Reference values of longitudinal systolic right and left ventricular function measured by M-mode echocardiography in healthy preterm and term neonates p. 43
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/jcecho.jcecho_67_18  PMID:31008041
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