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   2016| July-September  | Volume 26 | Issue 3  
    Online since August 8, 2016

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Transcranial doppler ultrasound: Incremental diagnostic role in cryptogenic stroke part II
Antonello D'Andrea, Marianna Conte, Lucia Riegler, Raffaella Scarafile, Rosangela Cocchia, Enrica Pezzullo, Massimo Cavallaro, Marco Di Maio, Francesco Natale, Giuseppe Santoro, Maria Giovanna Russo, Marino Scherillo, Raffaele Calabrò
July-September 2016, 26(3):71-77
Transcranial Doppler (TCD) ultrasonography is a noninvasive ultrasound study, which has been extensively applied in both outpatient and inpatient settings. Its main use in current clinical practice is the research for "Paradoxical Embolism," due to migration of thromboembolic material from systemic venous circulation to the left cardiac chambers and arterial circulation through cardiopulmonary shunts such as patent foramen ovale which represents an important cause of cryptogenic stroke, especially in patients under 55 years of age. In this review, we shall describe the incremental diagnostic role in cryptogenic stroke for this imaging modality. TCD not only can be used to detect right-left cardiopulmonary shunts but it also allows to classify the grade of severity of such shunts using the so-called "Microembolic Signals grading score."
  2,670 131 2
Lower body weight in men, an epidemiological predictor of enlarged left atrium in sinus rhythm patients with dilated heart
Aurora Bakalli, Ljubica Georgievska-Ismail, Nebi Musliu, Dardan Koçinaj
July-September 2016, 26(3):83-88
Background/Aims: The source of thrombi in patients with dilated cardiomyopathy is not necessarily from the dilated left ventricle. Left atrium (LA) and left atrial appendage (LAA) might be in charge for relatively high rate of systemic embolizations in these patients. The main aim of our study was to identify epidemiological predictors in sinus rhythm patients with dilated heart for LA and LAA dilation and/or dysfunction. Patients and Methods: This was a prospective cross-sectional study conducted from 2009 to 2014 in 101 sinus rhythm patients with dilated heart. We excluded patients with swallowing problems, acute myocardial infarction, atrial fibrillation/flutter, severe systolic dysfunction, mechanical valves, oral anticoagulation therapy, and/or patients with a history of stroke/systemic thromboembolic event. Results: Mean patient age was 58.13 ± 12.66 years and 69.3% were men. Hypertension was encountered in 51% of our patients, 56% of them had a history of coronary artery disease, 30% had diabetes, 25% had dyslipidemia, 30% were smokers, whereas 10% were alcoholics. Mean LA dimensions resulted higher than reference values, whereas 86% of our patients had LAA dysfunction. Male gender was an independent predictor for LA diameter dilation (95% confidence interval [CI]: 1.765-9.078, P = 0.005), while lower body weight was a predictor for enlargement of LA area (95% CI: 0.044-0.351, P = 0.014) and LA volume (95% CI: 0.160-2.067, P = 0.024). Conclusion: Male patients with dilated cardiomyopathy at sinus rhythm with lower body weight tend to have larger LA and consequently might be at higher risk of developing atrial thrombus and its subsequent consequences.
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Study of vitamin D status in patients with dilated cardiomyopathy at a teaching hospital in North India
S Priya, Zeba Siddiqi, Ritu Karoli, Jalees Fatima, Saumya Gupta, Ritu Mishra
July-September 2016, 26(3):89-93
Background/Introduction: Recent studies have indicated a much broader role to Vitamin D than simply the regulation of calcium metabolism alone. Vitamin D likely confers physiologically relevant pleiotropic functions that include cardioprotective and immunomodulatory effect, and its deficiency could lead to increased risk of cardiovascular disease and heart failure. Aim: The aim of our work was to evaluate the presence of hypovitaminosis D in patients with dilated cardiomyopathy (DCMP) and to study any correlation of echocardiographic parameters with Vitamin D deficiency. Patients and Methods: In an observational case-control hospital-based study, 56 patients diagnosed to have DCMP and 60 age-, gender-, and body mass index-matched controls who were patients of other medical illnesses were included in the study. Each subject underwent transthoracic two-dimensional guided M-mode echocardiography, and Vitamin D, parathyroid hormone (PTH), and N-terminal pro-B-type natriuretic peptide (NT-ProBNP) were assessed. Results: Mean 25-hydroxyvitamin D3 [25(OH) D3] levels were significantly lower (14.5 ± 7.4 ng/ml vs. 28.2 ± 12 ng/ml, P = 0.001), whereas PTH (90.5 ± 28.5 pg/ml vs. 57 ± 20.2 pg/ml, P = 0.02) and NT-proBNP levels were significantly greater in patients with DCMP than controls. In DCMP group, 24/56 patients had severe Vitamin D deficiency, whereas in control group, 10/60 patients had severe hypovitaminosis D. There was a significant negative correlation between 25(OH) D3 concentrations and left ventricular (LV) end-diastolic and LV end-systolic dimensions. Conclusion: Patients with DCMP had lower Vitamin D levels than controls, and Vitamin D deficiency had a significant correlation with cardiac function. Therefore, screening for Vitamin D deficiency along with prompt treatment is recommended in patients with DCMP.
  2,138 137 1
Echo changes in hypertensive disorder of pregnancy
Chaitra Shivananjiah, Ashwini Nayak, Asha Swarup
July-September 2016, 26(3):94-96
Aim: Acute preeclampsia is associated with significantly higher prevalence of asymptomatic global left ventricular (LV) abnormal function and myocardial injury than uneventful pregnancy. Hence, this study was undertaken to evaluate the LV changes in preeclamptic women and to compare with normotensive women. Materials and Methods: This study was conducted in the Department of Obstetrics and Gynaecology, M. S. Ramaiah Medical College and Teaching Hospital, Bengaluru. Two-hundred women were in each group: 200 patients with preeclampsia as cases and 200 normotensive patients as controls. Results: The mean LV end-systolic volume (LV ESV) in preeclamptic women was 33.45 ± 2.8, LV end-diastolic volume (LV EDV) was 106 ± 3.01, and LV systolic mass (LV Ms) was 87.1 ± 1.65 when compared to normotensive women LV ESV - 27 ± 0.74, (P < 0.0001) LV EDV - 106.2 ± 0.43, (P - 0.3528), and LV Ms - 84 ± 0.56 (P < 0.0001). Conclusion: This study emphasizes the importance of identifying this subset of preeclamptic patients with echo changes who are at higher risk of developing cardiovascular complications later in life by undergoing echocardiography.
  2,025 139 5
Rare subvalvular left ventricular aneurysm
Monish S Raut, Arun Maheshwari, Sujay Shad
July-September 2016, 26(3):106-107
  2,016 66 1
Incidental finding of an isolated double-orifice mitral valve in an asymptomatic man
Gianluigi Laccetta, Anna Maria Napoli
July-September 2016, 26(3):100-103
Double-orifice mitral valve (DOMV) is a very rare congenital anomaly that usually presents as mitral regurgitation. We present the case of a 39-year-old asymptomatic, healthy man with no previous medical history who was affected by isolated complete bridge type DOMV, incidentally detected by two-dimensional echocardiographic examination in the parasternal short-axis view. The mitral valve of the patient was normally functioning without any other coexistent cardiac abnormalities. Isolated DOMV was also confirmed by cardiac magnetic resonance imaging. The patient is now followed up to detect possible complications.
  1,964 95 -
Late echocardiographic study of aortic valve and aortic root after surgery for type a acute aortic dissection
Martina Molteni, Benedetta De Chiara, Francesca Casadei, Luca Botta, Bruno Merlanti, Claudio Francesco Russo, Cristina Giannattasio, Antonella Moreo
July-September 2016, 26(3):78-82
Objective: In case of concomitant aortic regurgitation (AR) valve, sparing operation is considered the first choice in selected patients. The aim of this retrospective clinical and echocardiographic study was to evaluate the long-term survival results of conservative approach and the determinants of recurrent AR. Methods: From 2000 to 2011, fifty patients (median: 63 years and interquartile range: 53-72) underwent an aortic valve-sparing procedure for acute aortic dissection, and discharged alive. The long-term clinical and echocardiographic outcome was analyzed. Results: Late all-causes mortality was 18% (nine patients) at a median follow-up of 55.8 months. Ten patients (20%) underwent re-operations, five of them for aortic valve/root recurrent disease; freedom from proximal re-operation was 90%. Two-third of the patients had a preoperative AR grade <3; a non-negligible number of patients with acute significant AR (23% with grade ≥3) at the time of surgery underwent conservative aortic valve surgery. At a median echocardiographic follow-up of 50.5 months, we found no significant correlation between late recurrent AR and AR grade at the time of surgery and the aortic root diameter. Late recurrent AR grade was significantly higher in patients who underwent aortic commissures and cusps resuspension than those who underwent lone ascending aorta replacement (2.29 ± 1.05 vs. 1.58 ± 1.03, P = 0.028). Conclusions: Preoperative AR and late aortic root diameter were not the predictors of late AR. Late AR is higher in patients who underwent aortic commissures and cusps resuspension compared to the only replacement of the ascending aorta.
  1,774 82 -
Multiple strokes secondary to an early thrombosis of aortic bioprosthesis on aspirin therapy
Quentin Fischer, Philippe Garçon
July-September 2016, 26(3):97-99
We describe here a rare case of a 74-year-old man with essential thrombocythemia who presented an early nonobstructive thrombosis of aortic porcine bioprosthesis complicated by multiple ischemic strokes 14 days after the primary operation.Transesophageal echocardiography on the postoperative day (POD) 17 revealed a mobile, nonobstructive thrombosis inserted on the anterior cusp right of the bioprosthesis. Anticoagulation by intravenous unfractionated heparin was effective with disappearance of the thrombus with good aortic prosthesis function on the POD 20 without requiring reoperation. The patient had a complete recovery of neurological disorders and was discharged on POD 26.
  1,761 65 -
Aortic stenosis: A routine diagnosis with a rare cause
Afsoon Fazlinejad, Atooshe Rohani, Malihe Layeghian, Shahram Kargar, Mohammad Reza Arefifar
July-September 2016, 26(3):104-105
A 40-year-old male patient presented with dyspnea on exertion and palpitation from 2 months ago. Physical examination revealed normal vital sign and a systolic murmur grade 3/6 in aortic area. Echocardiography revealed unicuspid aortic valve with an eccentric orifice, calcification, and aortic valve area of 0.9 cm 2 . This case report highlights the usefulness of three-dimensional echocardiography for the determination of number of aortic valve cusps, presence of raphe and morphology of valve.
  1,293 66 -