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REVIEW ARTICLES
Echocardiographic assessment of heart valve prostheses
Chiara Sordelli, Sergio Severino, Luigi Ascione, Pasquale Coppolino, Pio Caso
October-December 2014, 24(4):103-113
DOI:10.4103/2211-4122.147201  
Patients submitted to valve replacement with mechanical or biological prosthesis, may present symptoms related either to valvular malfunction or ventricular dysfunction from other causes. Because a clinical examination is not sufficient to evaluate a prosthetic valve, several diagnostic methods have been proposed to assess the functional status of a prosthetic valve. This review provides an overview of echocardiographic and Doppler techniques useful in evaluation of prosthetic heart valves. Compared to native valves, echocardiographic evaluation of prosthetic valves is certainly more complex, both for the examination and the interpretation. Echocardiography also allows discriminating between intra- and/or peri-prosthetic regurgitation, present in the majority of mechanical valves. Transthoracic echocardiography (TTE) requires different angles of the probe with unconventional views. Transesophageal echocardiography (TEE) is the method of choice in presence of technical difficulties. Three-dimensional (3D)-TEE seems to be superior to 2D-TEE, especially in the assessment of paravalvular leak regurgitation (PVL) that it provides improved localization and analysis of the PVL size and shape.
  12,973 1,331 -
Pulmonary regurgitation after tetralogy of fallot repair: A diagnostic and therapeutic challenge
Selvi Senthilnathan, Andreea Dragulescu, Luc Mertens
January-March 2013, 23(1):1-9
DOI:10.4103/2211-4122.117975  
Background: Pulmonary regurgitation is the key hemodynamically significant lesion in repaired tetralogy of Fallot contributing to progressive right ventricular (RV) dilatation and biventricular dysfunction. The timing for pulmonary valve replacement remains a controversial topic, and the decision to intervene depends on assessment of RV size and RV function. Objectives: This review aims to discuss the echocardiographic techniques that can be used to assess patients with pulmonary regurgitation after the repair of tetralogy of Fallot defect. While cardiac magnetic resonance (CMR) imaging is the clinical reference method, there is an important role of echocardiography in identifying patients with significant pulmonary regurgitation and assessing the RV size and function. The different echocardiographic techniques that can be used in this context are discussed. Newer techniques for assessing RV size and function include three-dimensional (3D) echocardiography, tissue Doppler and strain imaging. 3D RV volumetric reconstruction based on two-dimensional imaging is a promising new technique that could potentially replace CMR for RV volumetric assessment. Conclusions: Developments in echocardiographic techniques provide new insights into the impact of pulmonary regurgitation on RV structure and function. Echocardiography and CMR are complementary modalities and further research is required to define the optimal use of both techniques for this indication.
  8,917 393 1
REVIEW ARTICLE
Sudden cardiac death: A review focused on cardiovascular imaging
Valentina Barletta, Iacopo Fabiani, Conte Lorenzo, Irene Nicastro, Vitantonio Di Bello
April-June 2014, 24(2):41-51
DOI:10.4103/2211-4122.135611  
Sudden cardiac death (SCD) is defined as natural death due to cardiac causes, heralded by abrupt loss of consciousness within 1 h of the onset of acute symptoms; pre-existing heart disease may have been known to be present but the time and mode of death are unexpected. Prediction and prevention of SCD is an area of active investigation, but considerable challenges persist that limit the efficacy and cost-effectiveness of available methodologies. It was well-recognized that optimization of SCD risk stratification would require integration of multi-disciplinary efforts at the bench and bedside, with studies in the general population. This integration has yet to be effectively accomplished. There is also increasing awareness that more investigation needs to be directed toward the identification of early predictors of SCD. Significant advancements have recently occurred for risk prediction in the inherited channelopathies and other inherited conditions that predispose to SCD, but there is much to be accomplished in this regard for the more common complex phenotypes, such as SCD among patients with coronary artery disease. A multimodality imaging approach is actually the most important tool to provide comprehensive information on different pathophysiological mechanisms related to SCD.
  8,036 396 3
Transcranial Doppler ultrasound: Physical principles and principal applications in Neurocritical care unit
Antonello D'Andrea, Marianna Conte, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Massimo Cavallaro, Andreina Carbone, Francesco Natale, Maria Giovanna Russo, Giovanni Gregorio, Raffaele Calabṛ
April-June 2016, 26(2):28-41
DOI:10.4103/2211-4122.183746  
Transcranial Doppler (TCD) ultrasonography is a noninvasive ultrasound study, which has been extensively applied on both outpatient and inpatient settings. It involves the use of a low-frequency (≤2 MHz) transducer, placed on the scalp, to insonate the basal cerebral arteries through relatively thin bone windows and to measure the cerebral blood flow velocity and its alteration in many different conditions. In neurointensive care setting, TCD is useful for both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, and brain stem death. It also allows to investigate the cerebrovascular autoregulation in setting of carotid disease and syncope. In this review, we will describe physical principles underlying TCD, flow indices most frequently used in clinical practice and critical care applications in Neurocritical Unit care.
  5,944 382 13
REVIEW ARTICLES
How to understand patent foramen ovale clinical significance: Part I
Gabriella Falanga, Scipione Carerj, Giuseppe Oreto, Bijoy K Khandheria, Concetta Zito
October-December 2014, 24(4):114-121
DOI:10.4103/2211-4122.147202  
Patent foramen ovale (PFO) is a remnant of fetal circulation commonly found in healthy population. However, a large number of clinical conditions have been linked to PFO, the most important being ischemic strokes of undetermined cause (cryptogenic strokes) and migraine, especially migraine with aura. Coexistent atrial septal aneurysm, size of PFO, degree of the shunt, shunt at rest, pelvic deep vein thrombosis, and prothrombotic states (G20210A prothrombin gene mutation, Factor V Leiden mutation, MTHFR: C677T, basal homocystine, recent surgery, trauma, or use of contraceptives) could enhance stroke risk in subjects with PFO. Owing to the complexity of this issue, for any individual presenting with a PFO, particularly in the setting of cryptogenic stroke, it is not clear whether the PFO is pathogenically related to the neurological event or an incidental finding. Thus, a heart-brain team, which individually plans the best strategy, in accordance with neuroimaging findings and anatomical characteristics of PFO, is strongly recommended. In the first part of this review, we discuss the embryologic and anatomic features of PFO, the diagnostic techniques for its identification and evaluation, and the relationship between PFO and neurological syndromes. A special attention is made to provide some key points, useful in a daily clinical practice, which summarize how better we understand PFO clinical significance
  5,329 400 2
The ventricular-arterial coupling: From basic pathophysiology to clinical application in the echocardiography laboratory
Francesco Antonini-Canterin, Stefano Poli, Olga Vriz, Daniela Pavan, Vitantonio Di Bello, Gian Luigi Nicolosi
October-December 2013, 23(4):91-95
DOI:10.4103/2211-4122.127408  
The interplay between cardiac function and arterial system, which in turn affects ventricular performance, is defined commonly ventricular-arterial coupling and is an expression of global cardiovascular efficiency. This relation can be expressed in mathematical terms as the ratio between arterial elastance (EA) and end-systolic elastance (EES) of the left ventricle (LV). The noninvasive calculation requires complicated formulae, which can be, however, easily implemented in computerized algorithms, allowing the adoption of this index in the clinical evaluation of patients. This review summarizes the up-to-date literature on the topic, with particular focus on the main clinical studies, which range over different clinical scenarios, namely hypertension, heart failure, coronary artery disease, and valvular heart disease.
  4,663 621 13
Dynamic ischaemic mitral regurgitation and the role of stress echocardiography
Raluca Dulgheru, Julien Magne, Patrizio Lancellotti, Luc A Pierard
January-March 2013, 23(1):10-17
DOI:10.4103/2211-4122.117979  
Objective: This paper aims to explain the main mechanisms that cause ischaemic mitral regurgitation (MR), the pathophysiology, and the role played by stress echocardiography in the evaluation of the dynamic component of MR. Introduction: Chronic ischaemic MR is a frequent complication of myocardial infarction (MI), and is associated with a poor prognosis and outcome. The more the severity of ischaemic MR, the lower is the survival rate. In recent times, improvements in the management of the acute phase of MI, has increased the survival rate after MI. This, combined with an increase in the incidence of MI, will probably lead to a higher prevalence of ischemic MR in the next decades. As a consequence, ischaemic MR should be thoroughly understood and promptly identified. Furthermore, it is well recognized that ischaemic MR is dynamic. The best way to explore the dynamic nature of ischaemic MR is exercise stress echocardiography, and this test should probably be integrated in the evaluation and the management of patients with chronic ischaemic MR. Conclusion: Based on our experience, exercise stress echocardiography might be of interest in the following subsets of patients: 1) in patients with left ventricular (LV) dysfunction who present exertional dyspnea out of proportion to the severity of resting LV dysfunction or MR severity, 2) in patients in whom acute pulmonary oedema occurs without any obvious cause; 3) to unmask patients at high risk of mortality and heart failure 4) before surgical revascularization in patients with moderate ischaemic MR and, 5) following surgery, to identify persistence of pulmonary hypertension and explain the absence of functional class improvement.
  4,685 278 1
Strain echocardiography and myocardial mechanics: From basics to clinical applications
Giovanni Di Salvo, Valeria Pergola, Bahaa Fadel, Ziad Al Bulbul, Pio Caso
January-March 2015, 25(1):1-8
DOI:10.4103/2211-4122.158415  
The aim of this review is to summarize the recent developments in strain imaging, an evolving technique - from tissue Doppler to 3D echocardiography - for resolving the complex left ventricular mechanics. Following a brief overview of the different used technique to extract myocardial deformation data, the authors summarize the role of the technique in the assessment of cardiac mechanics and its role in the clinical arena.
  4,315 597 4
CASE REPORTS
An uncommon pericardial cyst in the central mediastinum: Incremental diagnosis with contrast-enhanced three-dimensional transesophageal echocardiography
Ennio Michelotto, Nicola Tarantino, Vittoria Ostuni, Pasquale Pedote, Paolo Colonna, Riccardo Guglielmi
October-December 2013, 23(4):106-110
DOI:10.4103/2211-4122.127412  
We report a case of a 76-year-old man, with the occasional finding of a mediastinal cyst because of subtle chronic dysphagia associated to sore throat, belching, and dysphonia. The paraesophageal cyst in the central mediastinum was studied with computed tomography (CT) scan and transesophageal three-dimensional (3D) echocardiography with contrast echo. In order to clarify doubts about localization (intra- versus extrapericardial) of the mediastinal cystic lesion the 3D transesophageal echocardiography (TEE) confirmed the presence of a large round cystic mass located contiguous to the esophagus, the left atrium and the aortic root/pulmonary trunk (located at the front of the lesion), as well as located intrapericardial. The cystic mass showed no blood flow at color Doppler mode and at ultrasound contrast echo with SonoVue agent. Due to the paucity of symptoms and to the definite imaging information of this intrapericardial cyst of nonvascular nature, due to pericardial cyst in an extremely unusual location, surgery was not performed. At follow-up of 1 month echocardiogram and 3 month CT scan the cyst appeared unchanged in dimensions.
  3,567 77 -
REVIEW ARTICLE
Three-dimensional echocardiography: Advancements in qualitative and quantitative analyses of mitral valve morphology in mitral valve prolapse
Paola Gripari, Manuela Muratori, Laura Fusini, Gloria Tamborini, Mauro Pepi
January-March 2014, 24(1):1-9
DOI:10.4103/2211-4122.131985  
Degenerative mitral valve disease (MVD) is the leading cause of organic mitral regurgitation (MR), one of the most common valvular heart disease in western countries. Substantial progresses in the surgical treatment of degenerative MVD have improved life expectancy of patients with significant MR. However, prognosis, surgical decision and timing of surgery strongly depend on the accurate characterization of mitral valve (MV) anatomy and pathology and on the precise quantification of MR. Three-dimensional (3D) echocardiography, a major technological breakthrough in the field of cardiovascular imaging, provides several advantages over two-dimensional (2D) imaging in the qualitative and quantitative evaluations of MV apparatus. In this review, we focus on the contribution of this new modality to the diagnosis of degenerative MVD, the quantitative assessment of MR severity, the selection and monitoring of surgical and percutaneous procedures, the evaluation of procedural outcomes. The results of a systematic and exhaustive search of the existing literature, restricted to real-time 3D echocardiography in adults, are here reported.
  3,297 261 1
CASE REPORTS
Giant proximal aorta aneurysm: A successfully managed time bomb
Alberto Milan, Eleonora Avenatti, Diego Naso, Franco Veglio
October-December 2013, 23(4):102-105
DOI:10.4103/2211-4122.127411  
Management of aortic aneurismatic disease is often care of specialists, from vascular to cardiac surgeons. However, initial diagnosis and management are not unfrequently responsibility of an emergency staff as the disease presentation may be dramatically acute. Thoracic aortic aneurysms (TAA) in particular have a silent clinical history until they become evident with dissection or rupture with a high global mortality rate. The importance of a rapid diagnosis and of correct management in such a subsetting is clear, but recent guidelines where published with the declared rationale of emphasizing the importance of an early detection of the disease. The goal is to reduce morbidity and mortality and improvement of quality of life of such patients. We present a case of successfully managed asymptomatic giant proximal aortic aneurysm in a healthy young man. On a routine transthoracic echocardiogram, severe dilatation of the proximal aorta was detected, with severe aortic regurgitation in a normal tricuspid valve determining left ventricle (LV) dilatation and impaired contractility. Computed tomography scan was scheduled, confirming the findings and open heart surgery performed within 1 week. Clinical and echocardiographical follow-up was started; after 2 months imaging studies showed good surgical results with well-functioning, non-regurgitant prosthetic aortic valve and initial recovery of left ventricular dilatation; at the last control, 14 months later, LV mass and dimensions where markedly improved, with no more signs of hypertrophy nor dilatation. TAA needs a rapid diagnosis and appropriate management. Clinicians should be aware of proper diagnostic tools and of applicable therapeutic strategies in order to grant the better assistance to the patient. In this setting, the role of echocardiography remains pivotal.
  3,366 96 1
ORIGINAL ARTICLES
Long-term results after percutaneous closure of atrial septal defect: Cardiac remodeling and quality of life
Sarah Mangiafico, Ines Paola Monte, Lucio Tropea, Vincenzo Lavanco, Wanda Deste, Corrado Tamburino
April-June 2013, 23(2):53-59
DOI:10.4103/2211-4122.123028  
Background: Atrial septal defect (ASD) represents a common congenital heart malformation, cause of right ventricle (RV) volume overload, pulmonary hypertension, atrial arrhythmias, and paradoxical emboli. Percutaneous closure represents the treatment of choice for ASD. However, it is still difficult to associate symptoms to the success of ASD treatment. Objective: To investigate any possible correlation between transthoracic echocardiography (TTE) findings and patients' symptoms after ASD treatment. Materials and Methods: Thirty patients (mean age 49 ± 17 years; 10 younger ≤40 years and 20 > 40 years) underwent percutaneous closure of ASD type ostium secundum. Every patient underwent clinical examination, electrocardiogram (ECG) and TTE before procedure and at 1, 6, and 12 months after procedure and a multichoice questionnaire to collect patients' symptoms and complain severity. Statistical analysis: Continuous variables were summarized by means and standard deviation. Estimates of occurrence of events were expressed as percentages. Comparison between mean follow-ups was achieved using paired t-test sample. Results: At end of follow-up, TTE showed a decrease of RV dimensions (34.4 vs 37.5 mm preclosure; P = 0.01), pulmonary artery systolic pressure (PAPs 28.4 vs 39.5 mmHg; P = 0.00003), atrial dimensions (51 vs 56 mm; P = 0.085), and of right myocardial performance index (MPI; 0.39 vs 0.42; P = 0.05). PAPs was significantly reduced in group more than 40-years-old (P = 0.00004), while the reduction was not significant in the less or equal than 40 years of age (P = 0.08) group because the baseline value was significantly lower. Many patients after procedure complained headache, insomnia, palpitations, fatigue, and dyspnea; but no cardiac morphological abnormalities related to symptoms were found. Conclusions: Our data showed a great improvement in symptoms and positive cardiac remodeling after closure of ASD, more effective in elderly patients compared to younger patients. The symptoms are not correlated with the principal disease or procedure.
  3,075 110 1
ORIGINAL ARTICLE
Early detection of left ventricular dysfunction in diabetes mellitus patients with normal ejection fraction, stratified by BMI: A preliminary speckle tracking echocardiography study
Lorenzo Conte, Iacopo Fabiani, Valentina Barletta, Cristina Bianchi, Ciccarone Anna Maria, Cuono Cucco, Marianna De Filippi, Roberto Miccoli, Stefano Del Prato, Carlo Palombo, Vitantonio Di Bello
July-September 2013, 23(3):73-80
DOI:10.4103/2211-4122.123953  
Background: Diabetes mellitus (DM) represents by itself a major risk factor for cardiovascular events and the coexistence of obesity with consequent left ventricular volumetric overload could be responsible for further damages on left ventricular function. Aim of this study was to demonstrate the effect of body mass index (BMI) on left ventricular function in diabetes patients with no cardiovascular complications and with normal ejection fraction (EF). Materials and Methods: We evaluated 71 stable asymptomatic diabetes patients in optimal medical treatment and 24 healthy controls (C) (45% females; mean age: 58.4 +/− 9.4 years; BMI: 23.5 +/− 1.5). We stratified diabetes patients into two groups according to BMI: BMI <30 kg/m 2 (A: 44 patients; 47% females; mean age: 60.9 +/− 6.6 years; BMI: 25.7 +/− 1.9; Diabetes duration: 9.1 +/− 9.5 years); BMI >30 kg/m 2 (B: 27 patients; 37% females; mean age: 56.2 +/− 7.8 years; BMI: 33.0 +/− 2.1; Diabetes duration: 8.5 +/− 5.2 years). The following parameters were evaluated by conventional two dimensional (2D) echocardiography (GE VIVID 7) and tissue Doppler imaging (TDI): left ventricular dimensions (LVIDd; PWTd; IVSd), Left Ventricular Volumes (EDV, ESV), EF (by biplane Simpson's method), Left Ventricular Mass (by ASE formula), peak mitral annular velocity at septal and lateral levels (Sm and Sl). Global longitudinal strain (GLS) was obtained off line by Speckle tracking imaging method using Echopac 10 software. Results: Groups A, B were comparable for diabetes duration and glycated hemoglobin level, history of hypertension, and lipid profile. The EF was similar in the three groups, (A: 64 +/− 6%; B: 63 +/− 4%; C: 61 +/−5%; P= NS). LVMass 2.7 indexed for height was significantly higher in A and B in comparison with C (A: 45.2 +/− 8.1 g/m 2.7 ; B: 46.1 +/− 9.6 g/m 2.7 ; C: 39.5 +/− 4.9 g/m 2.7 ; P < 0.05). The stroke volume index (SVi) was significantly lower in B vs A (B: 35.3 +/− 5.7 ml/m 2 ; A: 39.3 +/ 7.1 ml/m 2 ; P = 0.033). GLS was significantly lower in group B respect A and C (C: 20.9 +/− 1.3%; A: -20.3+/−2.6%; B: -19 +/− 2; P < 0.05; P < 0.01). Conclusions: In uncomplicated asymptomatic DM patients, the presence of first degree obesity plays an incremental role in adversely affecting left ventricular function and remodeling. The conventional echocardiographic methods such as the EF and the TDI are not so sensitive to identify the early LV dysfunction such as the evaluation of GLS by Speckle Tracking echocardiography. The longitudinal subendocardial fibers dysfunction in diabetes/obese patients could be derived by the complex interaction between metabolic (diabetes) and hemodynamic/endocrine abnormalities.
  2,822 219 1
REVIEW ARTICLES
Professional education, training and role of the cardiac sonographer in different countries
Irene Nicastro, Valentina Barletta, Lorenzo Conte, Iacopo Fabiani, Alessandro Morgantini, Giovanna Lastrucci, Vitantonio Di Bello
January-March 2013, 23(1):18-23
DOI:10.4103/2211-4122.117981  
Performing a good echocardiographic examination requires intensive training and highly qualified technical staff personnel, which, in many countries, is represented by the Cardiac Sonographer. Being an operator-dependent diagnostic method, a long debate has been held to help identifying the most appropriate curriculum for the training of this professional profile. Although guidelines for the education of the Cardiac Sonographers have been suggested by the American Society of Echocardiography (ASE) several years ago and many scientific publications have given credibility, trust and enhance to this professional profile in Italy, this figure is not yet recognized by the National Health System. It is encouraging that in the last decade, national authorities, such as the SIEC (Societΰ Italiana di Ecografia Cardiovascolare), have expressed interest in recognizing the Cardiac Sonographers as professionals in our country. Per their guidelines, the Cardiocirculatory Physiopathology Cardiovascular Perfusion technicians (TFCPCs) seem to be, among the professionals, the most suitable, due to their educational training and the role they play. Taking inspiration from the positive experience of this professional figure in the USA and in the Anglo Saxon countries, it could aims to be a valid support in terms of cost and quality for the Italian health system.
  2,859 160 2
ORIGINAL ARTICLES
Chemotherapy-induced cardiotoxicity: Subclinical cardiac dysfunction evidence using speckle tracking echocardiography
Ines Monte, Vera Elena Bottari, Sergio Buccheri, Anita Blundo, Luana Sirugo, Stefano Leggio, Salvatore Licciardi
January-March 2013, 23(1):33-38
DOI:10.4103/2211-4122.117983  
Objectives: In our study, we aimed to identify early markers of cardiac dysfunction in patients treated with mitoxantrone. We also looked at cardiac functional changes during therapy by analyzing longitudinal deformation and by measuring left ventricular (LV) and left atrial (LA) global strain. Materials and Methods: LA and LV global longitudinal strain were analyzed in 20 patients affected by multiple sclerosis and treated with mitoxantrone. Patients underwent echocardiography before treatment, after every drug administration during the 12-months treatment period, and finally after 6 and 12 months of drug discontinuation. Results: Compared with baseline values, patients showed a significant reduction of both LA and LV longitudinal global strain at the end of treatment with mitoxantrone (LA_GS% T10 vs. T0 values: 15,2 ± 12,5 vs. 20,2 ± 11,1; LV_GS%: ─16,4 ± 2,5 vs. ─17,4 ± 3,8). Strain reduction reverted after treatment discontinuation (LA_GS% FU vs. T0 values: 20,4 ± 15,7 vs. 20,2 ± 11,1; LV_GS%: ─17,3 ± 3,3 vs. ─17,4 ± 3,8). Conclusions: Impairment of longitudinal deformation during mitoxantrone therapy may indicate a dysfunction related to early myocardial damage. These findings appear to be reversible after treatment discontinuation.
  2,609 215 1
REVIEW ARTICLE
The evolving role and use of echocardiography in the evaluation of cardiac source of embolism
Fabrizio Celeste, Manuela Muratori, Massimo Mapelli, Mauro Pepi
April-June 2017, 27(2):33-44
DOI:10.4103/jcecho.jcecho_1_17  PMID:28465991
This report will review the role of echocardiography in the diagnosis of cardiac sources of embolism. Embolism of cardiac origin accounts for around 15%–30% of ischemic strokes. The diagnosis of a cardioembolic source of stroke is frequently uncertain and relies on the identification of a potential cardiac source of embolism in the absence of significant autochthonous cerebrovascular occlusive disease. Transthoracic and/or transesophageal echocardiography serves as a cornerstone in the evaluation, diagnosis, and management of these patients. This article reviews potential cardiac sources of embolism and discusses the role of echocardiography in clinical practice. Recommendations for the use of echocardiography in the diagnosis of cardiac sources of embolism are given including major and minor conditions associated with the risk of embolism.
  2,481 305 3
REVIEW ARTICLES
The role of multimodality cardiac imaging for the assessment of sports eligibility in patients with bicuspid aortic valve
Antonello D'Andrea, Alessandro Della Corte, Roberto Padalino, Giuseppe Limongelli, Raffaella Scarafile, Fiorella Fratta, Enrica Pezzullo, Adelaide Fusco, Francesca Pisacane, Guido Coppola, Pio Caso, Raffaele Calabṛ, Maria Giovanna Russo
January-March 2015, 25(1):9-18
DOI:10.4103/2211-4122.158418  
Bicuspid aortic valve (BAV) cannot be considered an innocent finding, but it is not necessarily a life-threatening condition. Athletes with BAV should undergo a thorough staging of the valve anatomy, taking into consideration hemodynamic factors, as well as aortic diameters and looking for other associated significant cardiovascular anomalies by use of a multimodality cardiac imaging approach. Furthermore an accurate follow-up is mandatory with serial cardiological controls in those allowed to continue sports.
  2,696 88 -
CASE REPORTS
Severe midventricular hypertrophic obstructive cardiomyopathy and apical aneurysm
Giuseppe Gibelli, Salvatore Biasi, Valeria Buonamici
July-September 2013, 23(3):81-83
DOI:10.4103/2211-4122.123954  
A 40-year-old man was found to have hypertrophic cardiomyopathy (HCM) with severe mid ventricular obstruction. The obstruction produced two distinct left ventricular chambers with an estimated 60 mmHg continuous wave (CW) Doppler intraventricular gradient. Pulsed wave (PW) Doppler showed high velocity systodiastolic flow from apex to base and flow from base to apex confined mostly to the second half of diastole. Cardiac magnetic resonance (CMR) showed midventricular obstruction, due to septal, parietal, and to an hypertrophic, double posteromedial papillary muscle; an apical aneurysm was detected. Aneurysm is underdiagnosed by echocardiography in HCM and an accurate anatomic definition is needed if surgery is planned; thus, a CMR should always be obtained in these patients.
  2,661 105 -
Persistent left superior vena cava and absent right superior vena cava: Not only an anatomic variant
Giuseppe Gibelli, Salvatore Biasi
January-March 2013, 23(1):42-44
DOI:10.4103/2211-4122.117985  
Introduction: A 71 year old asymptomatic woman came for an echocardiogram because of a left bundle branch block. A much dilated coronary sinus (CS) with an entering large vessel was found along with a mild left ventricular systolic dysfunction. Cardiac Magnetic Resonance (CMR) showed a persistent left superior vena cava (PLSVC), and an absent right superior vena cava (ARSVC). PLSVC drained into the dilated CS. No other cardiac abnormalities were found. Any late Gadolinium enhancement was also not seen. PLSVC and ARSVC are associated with sinus node and conduction tissue maldevelopment and atrial arrhythmias, and thus clinical follow up is indicated. Conclusion: CMR is a useful addition to echocardiogram to search for further cardiac abnormalities, and outline the anatomy with precision in doubtful cases.
  2,582 139 2
Revisiting non-compaction cardiomyopathy through a case with cyanosis and complete heart block
Achyut Sarkar, Imran Ahmed, Arindam Pande, GS Naveen Chandra
April-June 2014, 24(2):60-63
DOI:10.4103/2211-4122.135620  
Left ventricular non-compaction or "spongy myocardium", is a rare congenital cardiomyopathy that should be considered as a possible diagnosis because of its potential complications. Echocardiography is the diagnostic tool of choice, and cardiomagnetic resonance (CMR) can confirm or rule out this disease. Herein, we report the case of an 8-month-old female child who presented with congestive cardiac failure (CCF) and symptomatic complete heart block (CHB). An echocardiogram established the diagnosis as non-compaction cardiomyopathy (NCCM). An associated double outlet right ventricle with ventricular septal defect and valvular pulmonary stenosis was found. Cardiac magnetic resonance study confirmed the findings. This singular case report of NCCM highlights the importance of clinical awareness of this rare abnormality, its varied presentation and associated cardiac anomalies. The article revisits NCCM and focuses on the practical issues for a proper echodiagnosis.
  2,627 83 -
REVIEW ARTICLES
Left Atrium: Still a neglected chamber?
Maria Chiara Todaro, Bijoy K Khandheria
July-September 2014, 24(3):72-77
DOI:10.4103/2211-4122.143967  
It is widely recognized that an effective cardiovascular system is based upon both a good ventricular-vascular interplay and a good ventricular-atrial interaction in all the phases of cardiac cycle. Moreover, left atrial dysfunction has been identified to be contributory in several common cardiovascular conditions, such as heart failure, atrial fibrillation and valvular heart disease; for instance, a good anatomical and functional assessment of this cardiac chamber is mandatory. For this purpose a multimodality imaging approach - including two-dimensional and three-dimensional echocardiography, speckle tracking technique, cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) - is the most suitable one to achieve the best functional and anatomical evaluation of this cardiac chamber.
  2,469 182 -
ORIGINAL ARTICLE
Assessment of no-reflow phenomenon by myocardial blush grade and pulsed wave tissue doppler imaging in patients with acute coronary syndrome
Giuseppina Novo, Maria Rita Sutera, Daniela Di Lisi, Maria Ausilia Galifi, Benedetta La Fata, Salvatore Giambanco, Luisa Arvigo, Oreste Fabio Triolo, Salvatore Evola, Pasquale Assennato, Salvatore Novo
April-June 2014, 24(2):52-56
DOI:10.4103/2211-4122.135615  
Background: No-refl ow phenomenon is a complication of myocardial revascularization and it is associated with a worse prognosis. Materials and Methods: A prospective study was carried out enrolling patients with acute myocardial infarction (64 patients, 49 male and 15 female, median age 64.9 ± 10.61 years), both STEMI and NSTEMI, who underwent myocardial revascularization with percutaneous coronary intervention (PCI). TIMI fl ow and Myocardial Blush Grade (MBG) were assessed at baseline (T0), in addition to tissue Doppler imaging (TDI) and electrocardiogram. Cardiological evaluation was also performed at T1 (one month after PCI) and T2 (every year after revascularization for a mean follow-up of 24.9 months ± 6.93 months). Patients were divided into two groups on the basis of MBG. Results: In the present study, we found at T1 a signifi cant association between MBG and dyslipidemia (P = 0,038) and NYHA class and MBG (P = 0,040), among clinical variables and cardiovascular risk factors. Moreover, a statistically signifi cant relationship was observed between MBG and a new echocardiographic index of systolic and diastolic dysfunction, the EAS index measured with tissue Doppler imaging (P = 0,013). At T2, the EAS parameter was also signifi cantly impaired in patients with reduced MBG, compared to patients with normal MBG (P = 0,003). Conclusions: This study demonstrates that the combined evaluation of systolic and diastolic dysfunction by EAS index, according to the literature, could detect a subclinical ventricular dysfunction due to a perfusion defect. Therefore, EAS index could be a useful parameter to be measured in the follow-up of patients undergoing revascularization.
  2,474 116 -
Asymptomatic left ventricular dysfunction and metabolic syndrome: Results from an Italian multicenter study
Salvatore La Carrubba, Maria Chiara Todaro, Concetta Zito, Francesco Antonini-Canterin, Ines Paola Monte, Pio Caso, Paolo Colonna, Cesare de Gregorio, Antonio Pezzano, Frank Benedetto, Giovanni Di Salvo, Scipione Carerj, Vitantonio Di Bello
October-December 2013, 23(4):96-101
DOI:10.4103/2211-4122.127410  
Context: Metabolic syndrome (MS) is a cluster of interrelated common clinical disorders, including obesity, insulin resistance, glucose intolerance, hypertension and dyslipidemia, associated with a greater risk of atherosclerotic cardiovascular disease than any of its individual components. Although MS is associated with increased cardiovascular risk (CVR), its relationship with heart failure (HF) and left ventricular (LV) dysfunction is not fully understood. Aims: We sought to determine whether MS is associated to LV systolic and diastolic dysfunction in a sample of patients with MS and no symptoms for HF. Subjects and Methods: We enrolled 6422 consecutive asymptomatic patients admitted to echo-lab for a routine echocardiogram. We calculated LV systolic and diastolic function, by Simpson biplane method and validated Doppler parameters, respectively. MS was diagnosed if three or more CVR factors were found. Results: LV systolic function was evaluated in 6175 patients (96.2%). In the group of patients without MS (n = 5630), the prevalence of systolic dysfunction was 10.8% (n = 607) while in the group of patients with MS (n = 545) it was 12.5% (n = 87), (RR1.57; CI 95% 1.2-2.0; P < 0.001). Diastolic function was evaluated in 3936 patients (61.3%). In the group of patients without MS (n = 3566) the prevalence of diastolic dysfunction was 33.3% (n = 1187), while in patients with MS (n = 370) it was 45.7% (n = 169), (RR1.68; CI95% 1.3-2.0; P < 0.001). After adjustment for age and gender, MS proved to be an independent predictor of LV systolic and diastolic dysfunction. Conclusions: Our data show that asymptomatic LV systolic and diastolic dysfunction, is correlated with MS and demonstrate that echocardiography is a useful tool to detect patients at high risk for HF. Echocardiography in asymptomatic patients with MS may lead to a therapy initiation at early stages to prevent future cardiovascular events and HF.
  2,402 153 -
CASE REPORTS
Right ventricular overload due to severe pulmonary valve regurgitation in 44-year-old guch
Massimo Bolognesi, Diletta Bolognesi
April-June 2013, 23(2):69-71
DOI:10.4103/2211-4122.123037  
Notoriously, the valvular disease of the right heart have always received less attention than the left heart valvular disease both by echocardiographers and by researchers, probably due to the long period of latent asymptomatic and for the intrinsic difficulties of examination. However, it is increasingly recognized that right-sided valve disease is not a benign lesion and has a significant and independent impact on morbidity and mortality. Pulmonary regurgitation (PR) is common after surgical or percutaneous relief of pulmonary stenosis and following repair of tetralogy of Fallot. This case report describes the natural history of an adult patient with grown-up congenital heart (GUCH) who became competitive athlete and who showed signs of extreme morphological and functional adaptation of the right heart resulting in the outcome of a previous run surgical valvotomy at the age of 5 years for a congenital pulmonary stenosis. These anatomic changes of the right ventricle and pulmonary circulation have requested the replacement of the pulmonary valve for the symptomatic pulmonary hypertension, with subsequent gradual return to sports activity.
  2,445 80 -
ORIGINAL ARTICLES
Accuracy of intraoperative epicardial echocardiography in the assessment of surgical repair of congenital heart defects confirmed
Veeresh F Manvi, Mahadev Dixit, Kini Srinivas, Anand Vagarali, Sharan Patil, Nidhi Goel Manvi
April-June 2013, 23(2):60-65
DOI:10.4103/2211-4122.123032  
Objective: To determine the accuracy of epicardial echocardiography in detecting residual lesions after surgical repair of congenital heart defects. To determine the sensitivity, specificity, positive predictive valve, negative predictive valve, and false negative and false positive percentage of the same. Materials and Methods: One year hospital-based prospective study of epicardial echocardiography in patients undergoing cardiopulmonary bypass for surgical correction of congenital heart defects in children and adults. Results: Epicardial echocardiography was done in 158 patients. Residual lesions were detected in 38 patients by epicardial echocardiography. In 28 of these cases the residual lesions were significant. In 24 of them immediate reoperation was done with good outcome. Epicardial echo has high sensitivity, specificity, positive and negative predictive valve, in detecting residual lesion with congenital heart defects. Conclusion: Routine use of intraoperative epicardial echocardiography allows detection of majority of residual defects. It has high accuracy. There were no complications associated with use of epicardial echocardiography. The use of transesophageal echocardiography (TEE) can be avoided in small children and neonates undergoing cardiac surgery.
  2,368 123 1
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