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   Table of Contents - Current issue
Coverpage
September-December 2019
Volume 3 | Issue 3
Page Nos. 127-199

Online since Wednesday, December 18, 2019

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ORIGINAL RESEARCH  

Impact of Ventricular Morphology on Myocardial Deformation in Patients with Single Ventricle p. 127
Dina Adel Ezzeldin, Abd El Razek Yasmin, Khaled Shouman, Heba Atteya
DOI:10.4103/jiae.jiae_42_19  
Introduction: Functional single ventricle represent a heterogeneous group of anomalies sharing a common feature which is a functional single cardiac chamber. (1) In different series of congenital heart disease patients, cases of UVH represent about 1–2% of total congenital heart diseases. (2) Two-dimensional speckle-tracking echocardiography has recently emerged as a novel technique for objective and quantitative evaluation of global and regional myocardial function. Objectives: To determine impact of ventricular morphology on myocardial deformation in patients with single ventricle. Patients and Methods: The study included 47 patients with functional single ventricle whether they underwent cavopulmonary anastomosis or not. All patients were referred for elective cardiac catheterization or follow up echocardiography in Ain Shams university hospitals, Cardiology department, from November 2017 to July 2018. All patients underwent full echocardiographic assessment including assessment of the dominant ventricular function by STE. Results: The study included 47 patients, 30 males (63.8%) and 17 females (36.2%). Their age ranged between 6-12 years, with mean age of 8.22 ± 1.94. The morphology of the dominant ventricle determined ventricular function by both 2D parameters and STE. Patients with a dominant LV had higher strain values. Patients who underwent a cavopulmonary shunt also had better ventricular functions. All patients included in the study showed impaired dominant ventricular function by STE even those who had normal EF by standard 2D TTE suggesting that subtle ventricular dysfunction in patients with single ventricle can be unmasked by STE.
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Conventional Two-Dimensional Echocardiography Versus Contrast Echocardiography in the Assessment of Left Ventricular Volumes and Function in Patients with Poor Acoustic Window p. 135
Maulik Parekh, Chandrashekhar Ponde, Mohsin Ansari
DOI:10.4103/jiae.jiae_27_19  
Aim: To compare the number of left ventricular (LV) segments visualized, detection of regional wall motion, and LV volumes and function with conventional two-dimensional echocardiography versus that with contrast echocardiography in patients with poor acoustic windows. Materials and Methods: This was a prospective study done over a duration of 1 year, on 50 consenting patients with poor echocardiographic image quality. Basic information and baseline echocardiograms were recorded. SonoVue contrast was administered intravenously as per a preset protocol through a peripheral line, and LV endocardial border delineation was recorded in various comparable views. Results: There was a significant change in the quality of the echocardiographic images postcontrast enhancement, with no study images remaining uninterpretable and only 16% remaining technically difficult. The remaining studies became adequate in terms of endocardial border delineation. Myocardial segment visualization changed significantly after contrast, with the number of well-visualized segments per patient improving from 10.66 before contrast to 16.26 after contrast, on average. There was a significant change in the estimation of LV volumes after contrast administration. The biplane ejection fraction was also significantly different after contrast. The study detected new regional wall motion abnormalities in 10 (20%) patients out of the total 50. There was only one case of an adverse event in terms of three isolated ventricular premature complexes in one of the patients after contrast administration. Conclusion: Contrast echo appears to be an easy, safe, and reliable investigation in patients with poor echo windows. Our study shows that endocardial border delineation is best with contrast enhancement, which improves physician's confidence and hence can impact the overall diagnosis, management, and prognosis of patients based on the better and reliable echo findings.
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Prognostic Significance of Right Ventricular Ejection Fraction Assessed by Two-Dimensional Echocardiography in Hospitalized Patients with Dilated Cardiomyopathy p. 141
G. Ravi Kiran, Ch. Sarath Chandra, P. Chandrasekhar, Mohammed Ali
DOI:10.4103/jiae.jiae_34_18  
Background: The aim of this study was to evaluate the prognostic significance of two-dimensional transthoracic echocardiography right ventricle ejection fraction (2D-TTE-RV-EF) calculated using 2D-TTE and compare the results with conventional RV function parameters such as tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RV-FAC) in hospitalized dilated cardiomyopathy (DCMP) patients. Methods: This is a prospective, observational study that includes 122 DCMP patients. RV was modeled as a part of an ellipsoid enabling calculation of RV volume by combining three echo measurements. RVEF is then calculated (2D-TTE-RV-EF). P < 0.05 is considered statistically significant, and multivariate logistic regression analysis was done to determine the predictors of inhospital outcomes. Results: The mean age of study population was 51.2 ± 9.2 years with male: female ratio of 1.8:1. Mean value of LV-EF (Simpson biplane model) and 2D-TTE-RV-EF (ellipsoid model) was 33.6% ± 7.1% and 38.1% ± 11.2%, respectively. About 41 (33.6%) patients experienced inhospital major adverse cardiac events (MACE). In multivariate regression analysis, New York Heart Association class III or IV status, reduced LV-EF, reduced 2D-TTE-RV-EF, and cardiogenic shock at presentation were found to be independent predictors of in MACE. Analysis of receiver operator characteristic curve demonstrated that the optimal cutoff value of 2D-TTE-RV-EF for predicting inhospital MACE was 32.8%. Conclusion: Quantitative assessment of RV function with 2D-TTE-RV-EF improves the risk stratification beyond provided by LV-EF; the prognostic value may be better than that provided by TAPSE and RV-FAC.
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Echocardiographic Study of Left Ventricular False Tendons p. 150
Z. Sajan Ahmad, Cherian Koshy, George A. Koshy
DOI:10.4103/jiae.jiae_40_19  
Introduction: Left ventricular false tendons (LVFTs) are discrete, fibromuscular structures of varying length and thickness that traverse the left ventricular (LV) cavity. The aim of the present study was to describe the echocardiographic characteristics and associations of 100 consecutive cases of LVFTs that presented to the echocardiography laboratory at a tertiary care teaching hospital in India. Subjects and Methods: One hundred consecutive patients with LVFTs were studied. They were classified based on the number (single and multiple), morphology (simple and complex), and location (apical, mid, and basal). The individuals were divided into three groups (Group 1: with LV dilatation and/or LV hypertrophy [LVH], Group 2: abnormal echocardiogram other than Group 1, and Group 3: normal echocardiogram). Analysis was done using SPSS 15 software. Results: A total of 121 LVFTs were identified in the 100 individuals. The LVFTs were more commonly single (81%), simple (92.56%), and apically located (52.90%). Complex LVFTs and apical location were more common among males, while multiple LVFTs and mid location were more common among females. LVFTs were most commonly visualized in the apical four-chamber view. There was a preponderance of males (67%), patients with structural heart disease (79%), and patients with LVH and/or dilatation (44%) in the study group. Conclusions: LVFTs are readily identifiable on echocardiography and can be characterized based on their number, location, and morphology. Their relationship to structurally abnormal hearts, male gender, LVH, and dilatation requires further study.
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CONTEMPORARY TOPIC Top

Raised Prosthetic Valve Gradients: What Should be the Approach? p. 156
Debika Chatterjee
DOI:10.4103/jiae.jiae_11_19  
The introduction of valve replacement surgery has dramatically improved the outcome of patients with valvular heart disease. Echocardiography plays an important role to determine the outcome of the surgery and follow up of these patients with prosthetic heart valve. Flow across the prosthesis is determined by using Doppler echocardiography. Whenever there is a high gradient across a prosthetic valve, echocardiography becomes challenging, as there are many causes, which may give rise to high prosthetic valve gradient. Some of these causes are prosthesis-related which need urgent intervention and some are non-prosthesis-related. A careful systematic echocardiographic approach, using 2D, 3D, Doppler and transesophageal echocardiography is crucial to find out the exact cause of high gradient.
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REVIEW ARTICLE Top

Three-Dimensional Echo and Three-Dimensional Transesophageal Echocardiography for Mitral Valve Disease p. 163
Ashok Kumar Omar, Vinay Sharma, Vivek Kumar, Arif Mustaqueem, Sameer Shrivastava
DOI:10.4103/jiae.jiae_50_18  
Three-dimensional (3D) echocardiography is one of the greatest technologies, which has a significant contribution in the field of valvular heart disease, especially after the development of real-time (RT) capability in transthoracic as well as transesophageal imaging during the past decade. RT 3D transesophageal echo has provided a simplified imaging tool for the anatomy of mitral valve (MV), including the MV annulus, leaflets, and subvalvular apparatus. Three scallops of anterior and posterior leaflets are easily recognized. This helps in localizing the MV abnormality, for example, MV prolapse and flail MV. This also helps in localizing the mitral regurgitation (MR). Even the quantification of MR has also seen a novel understanding of RT 3D planimetry of MR jet, which is possible by newer machines. Commissural inequality and calcification is well identified, and it helps in choosing the cases for percutaneous balloon mitral valvuloplasty. More recently, this technology with RT 3D transesophageal echocardiography has found a role in interventional procedure, for example, balloon mitral valvuloplasty, paravalvular leak closure, and edge-to-edge (MitraClip) repair of degenerative MV.
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INTERESTING CASE REPORTS Top

Neonate in Respiratory Distress with To-and-Fro Shunt from Aorta to Right Ventricle p. 177
S. G. Shyam Lakshman, Gopalan Nair Rajesh, C. G. Sajeev
DOI:10.4103/jiae.jiae_42_18  
A cyanotic newborn in heart failure on diagnostic transthoracic echocardiography revealed pulmonary atresia with intact ventricular septum with a vertical patent ductus arteriosus supplying from the underside of arch of aorta. There was an anomalous origin of right coronary artery from the left coronary artery. It was also associated with a coronary cameral fistula with a continuous to-and-fro shunt from the aorta through the dilated coronary to the right ventricle with a bidirectional shunt. We intend to report this case because because pulmonary atresia with single coronary artery with coronary cameral fistula is uncommon and are sparsely reported, and sparsely reported, and and are best managed by univenventricular repair followed by cardiac transplanatation.
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Unicuspid Unicommissural Aortic Valve in Young Adult: Rare Congenital Abnormality Presenting as Symptomatic and Severe Aortic Stenosis p. 180
Raj Kumar, Showkat Hussain Bhat, Bharat Bansal, Rajesh Karanjiya, Rahul Mehrotra
DOI:10.4103/jiae.jiae_49_18  
Isolated aortic valve stenosis in adults with or without aortic regurgitation is almost always secondary to a congenital valvular malformation. These congenital malformations usually present as a bicuspid, quadricuspid, or unicuspid aortic valve. The unicuspid acommissural valve has no commissures or lateral attachments to the aorta at the level of the orifice and appears as a pinhole on imaging. The unicommissural UAV has one lateral commissural attachment to the aorta at the level of the orifice and appears as a slit-shaped structure. We report the case of a 21-year-old man who presented with dyspnea, palpitations and one episode of syncope on exertion. Transesophageal echocardiography confirmed a stenotic, unicuspid, unicommissural aortic valve with dilated ascending aorta. He underwent successful aortic valve replacement since the ascending aorta was only mildly dilated (40 mm). Postoperative course was uneventful and discharge from the hospital in stable condition.
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Rare Case of Unicuspid Unicommissural Aortic Valve Presenting in an Adult as Infective Endocarditis, Aortic Root Abscess, and Complete Heart Block p. 183
Rahul Subhashrao Chalwade
DOI:10.4103/jiae.jiae_4_19  
Unicuspid aortic valve is a very rare congenital anomaly of aortic valve. Acommissural form usually presents at birth and unicommissural form presents in adulthood. They usually present as dyspnea, angina, and/or syncope. Mostly, it is detected on autopsy or pathological examination of surgically excised valve. Here, we present a rare case of unicuspid unicommissural aortic valve presenting with infective endocarditis with aortic root abscess and complete heart block. The patient was diagnosed on transthoracic echocardiography. Unfortunately, the patient succumbed to illness before surgery.
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Atypical Presentation of Typical Parachute-Like Asymmetrical Mitral Valve p. 185
Pratap Chandra Rath, Md Abdul Azeez Asad, B. V. A. Ranga Reddy, Monica Vinesh Dillikar, C. Rajesh Reddy
DOI:10.4103/jiae.jiae_9_19  
Parachute and parachute-like mitral valve are extremely rare congenital anomalies of mitral valve involving multiple aspects of mitral valve apparatus. It is usually seen in the younger age group. Very few cases of isolated parachute-like mitral valve in the adult age group have been in the literature. We hereby present a case report of 70-year-old elderly man who had presented with recurrent stroke and a routine transthoracic echocardiography had revealed a classical description of asymmetrical mitral valve.
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An Extremely Rare Case of Carcinoma Rectum Metastasizing to the Heart p. 189
Rahul Mehrotra, Raj Kumar, Showkat Hussain Bhat, Bharat Bansal, Jaiveer Singh Khatri, Malay Raj
DOI:10.4103/jiae.jiae_51_18  
The incidence of cardiac metastases has increased over the last 3 decades. The commonest source of cardiac metastasis however remain the lungs and breast. Pericardium is the most commonly involved part of heart in metastatic disease. We report an extremely rare case of carcinoma rectum with metastasis to right ventricle and inferior vena cava through hematogenous route.
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INTERESTING IMAGES Top

Hampton's Hump and Westermark Sign: An Interesting X-Ray View p. 192
Deepak Ramchand Nenwani, G. Ravi Shankar, G. Prathap Kumar, J. Nambi Rajan
DOI:10.4103/jiae.jiae_47_18  
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Tuberculous Constrictive Pericarditis with Pericardial Calcification – An Antique Picture p. 194
Pankaj Jariwala, Kuchukulla Venkatram Reddy
DOI:10.4103/jiae.jiae_6_19  
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Case of Takayasu Arteritis p. 195
Rajesh Krishnachandra Shah
DOI:10.4103/jiae.jiae_7_19  
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COMMENTARY Top

Unicuspid Aortic Valve: Overview of a Rare Congenital Cardiac Anomaly p. 198
Dharamdev Golani
DOI:10.4103/jiae.jiae_jiae_49_18_19  
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