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  Citation statistics : Table of Contents
   2017| October-December  | Volume 27 | Issue 4  
    Online since October 12, 2017

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Left ventricle relative apical sparing in cardiac amyloidosis
Marianna Nardozza, Elisabetta Chiodi, Donato Mele
October-December 2017, 27(4):141-142
DOI:10.4103/jcecho.jcecho_22_17  PMID:29142812
Amyloidosis is a disease characterized by the extracellular deposition of the protein amyloid. It is a multiorgan disease, and cardiac involvement is not uncommon, generally in the form of a restrictive cardiomyopathy. Typical aspects of cardiac amyloidosis have been described at echocardiography and magnetic resonance imaging (MRI). In particular, the relative apical sparing at two-dimensional speckle-tracking echocardiography has been reported to be specific for cardiac amyloidosis. In our case, we report for the first time that this echocardiographic sign is related to lack of hyperenhancement at late gadolinium enhancement imaging in cardiac MRI.
  3 3,009 168
Carotid artery stiffness and development of hypertension in people with paraplegia and no overt cardiovascular disease: A 7-year follow-up study
Olga Vriz, Nicole Bertin, Arianna Ius, Emiliana Bizzarini, Eduardo Bossone, Francesco Antonini-Canterin
October-December 2017, 27(4):132-140
DOI:10.4103/jcecho.jcecho_43_17  PMID:29142811
Objectives: The aim of this study was to compare arterial stiffness between people with paraplegia and able-bodied persons (ABPs) and to assess cardiovascular markers that may be predictive of the development of arterial hypertension in people with spinal cord injury (SCI). Setting: This study was conducted at rehabilitation Hospital, Udine (Italy). Methods: Fifty-seven patients with SCI were prospectively enrolled and compared with 88 healthy ABPs. All patients underwent comprehensive transthoracic echocardiography, and one-point left common carotid artery (CCA) color-Doppler study for arterial stiffness. Results: Patients with SCI had significantly lower body mass index (BMI) and diastolic blood pressure (BP) compared with ABPs, and significantly higher carotid stiffness values (and lower arterial compliance) (P < 0.05) after adjustment for age, sex, BMI, physical activity, and heart rate. The SCI patients had lower values of the right ventricular function parameters (tricuspid annular plane systolic excursion and right Sm; P < 0.0001), increased wall thickness, and impaired diastolic function. At 7-year follow-up, 10.5% of SCI patients showed high BP; they were significantly heavier with a tendency toward increased abdominal obesity after adjustment for age and systolic BP. BMI was found to be an independent predictor of the development of hypertension. Conclusions: Patients with posttraumatic chronic SCI and no overt cardiovascular disease exhibit higher CCA stiffness along with the left and right ventricular involvement, compared with ABPs. People with paraplegia who develop arterial hypertension show increased CCA stiffness mediated by obesity. Lifestyle modifications and weight control should be promoted in all patients with SCI, even at a very early stage.
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A membranous septal aneurysm causing right ventricular outflow tract obstruction in an adult
Fiorella Privitera, Ines Paola Monte, Antonino Indelicato, Corrado Tamburino
October-December 2017, 27(4):145-148
DOI:10.4103/jcecho.jcecho_21_17  PMID:29142814
We describe a case of a 69-year-old female referred for the evaluation of exertional dyspnea, with a small membranous ventricular septal defect (VSD) and right ventricle (RV) outflow tract obstruction. Using transthoracic echo was diagnosed VSD with left to right shunting and transesophageal echo (TEE) was used to a better anatomical characterization. TEE showed a perimembranous subaortic VSD that developed a high-velocity flow in RV. Pulmonary valve appears normal and right ventricular infundibular hypertrophy or double-chambered RV was excluded from the study. Furthermore, TEE showed a malaligned VSD and the presence of perimembranous mobile tissue protruding in RV. We hypothesized that this tissue can be attributed to broken septum aneurysm and protruding during systole, it causes a dynamic RV output tract obstruction.
  2 2,290 90
The role of ivabradine in diastolic heart failure with preserved ejection fraction. A doppler-echocardiographic study
Federico Cacciapuoti, Valerio Massimo Magro, Michele Caturano, Diana Lama, Fulvio Cacciapuoti
October-December 2017, 27(4):126-131
DOI:10.4103/jcecho.jcecho_6_17  PMID:29142810
Background: Ivabradine (IVA) is effective in patients with coronary artery disease (CAD) or systolic heart failure in sinus rhythm. Its action consists in reducing heart rate (HR) and improving the time of left ventricular (LV) diastolic filling. The aim of this study was to evaluate the effects of IVA added to conventional therapy on patients with diastolic heart failure (DHF) and preserved ejection fraction (HFpEF). Methods: We evaluated 25 patients with DHF in the New York Heart Association (NYHA) Class II-III and sinus rhythm. In these, IVA per os (5 mg/twice a day) was added to the conventional medical therapy and given for 12 weeks. Immediately before the beginning of IVA therapy and 3 months later, patients underwent echocardiographic evaluation by two-dimensional (2D) ultrasound and tissue Doppler imaging (TDI). The patterns of diastolic mitral inflow and pulmonary venous flow were recorded using 2D echocardiography, while the diastolic phase of mitral flow was recorded by TDI, from the lateral mitral annulus. Results: Three months after the addition of IVA to conventional treatment, HR significantly decreased in comparison to the baseline values. On the contrary, the echocardiographic indexes of LV diastolic dysfunction improved. Conclusions: These results testify that the addition of IVA to conventional therapy in patients with HFpEF can improve LV diastolic function evaluated by 2D and tissue Doppler-echocardiographic patterns. These Doppler-echocardiographic results match with the clinical improvement of patients evaluated.
  2 2,653 209
Aortopulmonary window with crisscross pulmonary arteries: Anatomically Type 1, Physiologically Type 2
Neeraj Awasthy, S Ahmad Jawid
October-December 2017, 27(4):143-144
DOI:10.4103/jcecho.jcecho_12_17  PMID:29142813
Aortopulmonary window (APW) is a rare congenital anomaly. We report an association of APW with crisscross pulmonary arteries (hitherto unreported) in a 6-month-old child. There was differential flow to the right pulmonary artery was evident by the chest X-ray. We discuss the pathophysiology of the differential pulmonary blood flow in a case of APW.
  1 2,380 107
Multifactorial genesis of a seeming case of pulmonary hypertension
Rita Leonarda Musci, Lucrezia De Michele, Carlo D'Agostino, Paolo Colonna
October-December 2017, 27(4):149-152
DOI:10.4103/jcecho.jcecho_34_17  PMID:29142815
Herein, we report the case of a 44-year-old female with end-stage renal disease on hemodialysis. She was admitted to our hospital to evaluate if she was eligible for a kidney transplant. Transthoracic echocardiography showed a markedly dilated coronary sinus and an unexpected finding of increased right ventriculoatrial gradient. A saline contrast echocardiography to confirm the presence of persistent left superior vena cava (PLSVC) was not performed because of arteriovenous fistula (FAV) for hemodialysis on the left forearm. Therefore, computed tomography angiography was performed, and it showed the PLSVC. We also proceeded with a transesophageal echocardiography which showed an atrial septal defect (ASD) of the sinus venous type hemodynamically significant. In this case, we identified a rare association of PLSVC with a ASD; therefore, there is a right ventricular volume overload because of the ASD hemodynamically significant and high flow FAV leading to a condition of a seeming pulmonary hypertension.
  - 1,511 77
Unilateral pulmonary edema in a patient with worsening tricuspid valve regurgitation: A secret inside pulmonary veins
Elvira Resciniti, Ilaria Caso, Iside Scarfò, Giuseppe Di Pasquale, Giovanni La Canna
October-December 2017, 27(4):153-155
DOI:10.4103/jcecho.jcecho_26_17  PMID:29142816
We present the case of a 69-year-old patient who was referred to the Department of Echocardiography for surgical treatment of severe tricuspid valve regurgitation (TVR) with advanced congestive heart failure. In 2013 the patient underwent unsuccessful percutaneous ablation for permanent atrial fibrillation. In 2015, following numerous episodes of atrial fibrillation and congestive heart failure with left pleural effusion, the patient was admitted to another center. A transthoracic echocardiogram showed severe TVR and moderate precapillary pulmonary hypertension, confirmed at right cardiac catheterization. He showed bilateral ankle swelling, mild systolic cardiac murmur and localized leftmost decreased breath sounds. Chest X-ray revealed left-sided pulmonary edema and ipsilateral large pleural effusion. Following percutaneous drainage of the left pulmonary effusion, the patient underwent transthoracic and transesophageal echocardiography (TEE), confirming severe TVR due to annular dilation, severe pulmonary hypertension (60 mmHg) and right ventricular overload. At TEE, we found a narrowed single left pulmonary vein. Coronary artery angiography showed no critical stenosis. The patient underwent cardiac magnetic resonance and Angiography that confirmed ostial stenosis of a single left pulmonary vein. We performed successful bare-metal stent implantation. After the procedure, we observed progressive improvement in the patient's clinical condition, concomitant with reverse pulmonary hypertension, significant TVR reduction and chest X-ray normalization. This is a rare case of unilateral pulmonary edema following percutaneous ablation of atrial fibrillation.
  - 1,569 99
An unusual case of aortic-right atrium fistula: A diagnostic and therapeutic challenge
Maria Chiara Todaro, Alessandro Aprile, Adriana Ravera, Gaetano Senatore
October-December 2017, 27(4):156-158
DOI:10.4103/jcecho.jcecho_36_17  PMID:29142817
An aorta-to-right atrium (RA) fistula is an anomalous communication between the ascending or descending thoracic aorta and the RA. In this report, we describe a case of an idiopathic aortic root-to-RA fistula occasionally found during a coronary angiography performed in a young patient admitted for acute chest pain with evidence of multivessel coronary artery disease. The anatomical peculiarity of this fistulous communication is that it gave origin to collateral vessels furnishing the inferolateral wall of the left ventricle. The case represented a diagnostic and therapeutic challenge that required a multimodality imaging and a multidisciplinary team approach.
  - 1,581 73
Shortness of breath on exertion: A (Cardiac Magnetic Resonance) picture is worth a thousand words
Chrysanthos Grigoratos, Andrea Barison, Giancarlo Todiere, Giovanni Donato Aquaro
October-December 2017, 27(4):159-160
DOI:10.4103/jcecho.jcecho_25_17  PMID:29142818
This is the case of a 78-year-old male patient that underwent a cardiac magnetic resonance (CMR) due to shortness of breath. An unanticipated diagnosis of a giant pseudoaneurysm with a “guitar-like” appearance was made and patient was sent for urgent ventriculoplasty. CMR offered striking illustrative images allowing for previously unsuspected diagnosis to be made and patient's therapeutic management modified. Moreover, in this case, we emphasize the paramount importance of differentiating between true aneurysms, pseudoaneurysms, clefts, and diverticuli since each pathology has completely different management and prognosis that vary from benign to potentially fatal if not immediately treated.
  - 1,521 74
Is left atrial function affected by coronary slow flow? a two-dimensional speckle-tracking echocardiographic study
Flora Fallah, Sima Narimani, Shima Yarmohammadi, Ali Hosseinsabet, Arash Jalali
October-December 2017, 27(4):121-125
DOI:10.4103/jcecho.jcecho_9_17  PMID:29142809
Background: The coronary slow flow phenomenon (CSFP) is the slow passage of the angiographic contrast agent to the distal portion of the coronary artery in the absence of significant stenosis. We evaluated the left atrial (LA) function in patients with the CSFP using two-dimensional speckle-tracking echocardiography (2DSTE). Methods: The LA function was compared through 2DSTE between 36 patients with the CSFP and 36 participants with a normal coronary flow. The two groups were matched for age, sex, hypertension, diabetes mellitus, and the left ventricular function. Results: There were no statistically significant differences between the CSFP group and the control group regarding longitudinal systolic strain, early and late diastolic strains, and the strain rate of the LA myocardium. Conclusions: The LA function as evaluated with 2DSTE was not different between the CSFP group and the normal coronary flow group when they were matched for age, sex, hypertension, diabetes, and the left ventricular function.
  - 2,635 133