Introduction: Hepatic veins are the major linking vessels between systemic and portal circulation. Numerical and positional variation of the hepatic veins can play a significant role during surgical interventions on the liver. Materials and Methods: Gross anatomical study regarding the number and arrangement pattern of hepatic veins was undertaken on 88 adult livers which were stored in 10% formalin after the regular dissection classes. Result: Six livers (7%) were found to be drained only by major hepatic veins, whereas 82 out of 88 livers (93%) had accessory (minor) hepatic veins. The total number of persistent hepatic veins ranged from 2 to 10 with the highest prevalence of four hepatic veins (35.2%) followed by 5 (19.3%) and 6 (17%). The presence of three major veins was seen in 45 (51%) livers while 41 (47%) livers had two major hepatic veins. Remaining two livers (2%) showed the presence of four major hepatic veins. In 95% specimens, the minor hepatic veins entered the inferior vena cava below the level of entry of major veins. In 2.5% cases, their entry point was above the major veins and in 2.5% cases, the entry point was below major veins. Conclusion: The data resulting from this study provides a clear idea about the number and drainage pattern of the hepatic veins into the liver. Knowledge of numerical and positional variations of hepatic veins could be useful in normal Doppler ultrasound hepatic vein flow velocities and their variation with respiration in healthy adults as comparable with the similar approach of superior vena cava.

Background: Left atrial (LA) active emptying plays an important role in left ventricular (LV) filling. It not only depends on LA preload but also on LA contractility. Our aim was to assess LA wall contraction velocity (LAWV) and its relation to each of LA active stroke volume index (LAASVI) and LA active emptying fraction (LAAEF) as markers of LA active emptying in patients with ischemic heart disease (IHD) and impaired LV systolic function. Methods: We studied 50 consecutive patients with stable IHD and LV ejection fraction <45% and 50 healthy controls. Standard echocardiography assessed: Biplane LV volumes and ejection fraction, trans-mitral Doppler E and A wave velocities and E/A ratio, indexed biplane LA volumes pre- and post-atrial contraction, LAASVI and LAAEF. LAWV was measured by tissue Doppler imaging. Results: Trans-mitral Doppler A velocity was lower in the study group 60.64 ± 20.6 vs 72.46 ± 17.13 cm/s (P = 0.002). Accordingly, E/A ratio was higher in the study group 1.32 ± 0.78 vs 0.92 ± 0.3 (P < 0.0001). Indexed biplane LAV-pre atrial contraction was larger in the study group 23.61 ± 3.8 vs 17.16 ± 3.57mL/m² (P < 0.0001). Indexed biplane LAV-post atrial contraction was larger in the study group 16.22 ± 4.14 vs 13.19 ± 3.56mL/m² (P=0.0002). Accordingly, biplane LAASVI was higher in the study 53 group 7.9 ± 1.26 vs 3.96 ± 0.63 mL/m² (P<0.0001). LAAEF was larger in the study group 32.37 ± 8.89 vs 24.31 ± 7.12% (P < 0.0001). LAWV was lower in the study group 6.78 ± 0.51 vs 10.58 ± 0.67 cm/sec (P < 0.0001). Conclusion: In patients with IHD and impaired LV systolic function, LA wall contractility is reduced. However, LAASVI and LAAEF are enhanced.

Ostium primum defect is a congenital malformation involving atrial septum contiguous with atrioventricular valve annulus; it is accompanied by abnormalities in the development of the endocardial cushions, often resulting in associated atrioventricular valves malformations. Few cases have been reported in adulthood because these patients frequently come to medical attention at an earlier age when symptoms such as dyspnea, fatigue, cyanosis, and tendency to underweight occur. Various factors affect the timing of clinical presentation, but the most important is the degree of mitral/tricuspid insufficiency; when valve regurgitation remains moderate, the appearance of symptoms may be delayed for decades. In adult patients, deterioration of clinical status and death are mainly due to the development of arrhythmias or heart block. We present the case of a 67-year-old patient, without previous cardiovascular events, with a new onset of atrial fibrillation, who developed dyspnea and fatigue; echocardiography showed a large interatrial defect localized in the basal portion of the septum, associated with anterior mitral valve cleft and moderate regurgitation. The patient underwent surgical closure of the defect (intraoperatory measures 1,9 × 3 cm) with autologous pericardium patch; a permanent epicardial pacemaker was implanted for the development of complete atrioventricular block in the early postoperative period.

We describe a case of an incidental finding of diverticulum in a patient presented to the Emergency Department for atypical chest pain, and we analyze the challenging differential diagnosis with aneurysm, pseudoaneurysm, and ventricular cleft.

Behçet's disease (BD) is a chronic multisystem disease that presents with recurrent oral and genital ulceration and recurrent uveitis. The patients are often diagnosed in the range of 20-30 years of age and BD are more common in men.^[1] BD has a worldwide distribution, but it is mainly observed in Mediterranean areas and Japan.^[2] Involvement of skin, joints, nervous, respiratory, gastrointestinal, and cardiovascular systems is also recognised.^[3],[4] Although the vascular lesions are frequently observed in this disease, the cardiac involvement is rare and is associated with the poor prognosis.^[5]