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   Table of Contents - Current issue
May-August 2018
Volume 2 | Issue 2
Page Nos. 89-142

Online since Thursday, September 6, 2018

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Longitudinal strain versus exercise treadmill testing in chronic stable angina Highly accessed article p. 89
Renu Bala, V Ramnath Iyer, Prabhat Kumar Dash, Srikanth Sola
Background: Longitudinal strain analysis has been shown to be useful in patients with acute coronary syndromes and in stress echocardiography. The objective of this study is to identify the incremental diagnostic value of longitudinal strain analysis at rest, when added to routine treadmill testing (TMT), in identifying the presence of coronary artery disease in patients presenting with chronic stable angina (CSA). Methodology: We conducted a prospective study in which adult patients presenting with CSA and normal systolic function were enrolled. All patients were examined by 2-D echocardiography, longitudinal strain analysis, TMT, and either conventional coronary angiography and/ or coronary computed tomography angiography. Results: We enrolled a total of 150 subjects (54±7.8 years, 63% male). The sensitivity and specificity of TMT was 60.2% and 65.5% respectively. In comparison, global longitudinal strain (GLS) alone had better sensitivity (72.7%) and specificity (74.2%). Post-systolic shortening (PSS) had similar sensitivity for early detection of significant CAD. The combination of TMT and GLS provided the best overall diagnostic accuracy with a sensitivity of 85.4% and specificity of 87.5%, respectively. The optimal cut off for GLS for identification of coronary artery disease was −17.75%. Conclusions: In patients presenting with chronic stable angina and normal systolic function, global longitudinal strain and post systolic shortening assessed at rest have excellent diagnostic accuracy for coronary artery disease. Longitudinal strain analysis is superior to conventional TMT and adds to its diagnostic performance.
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Echocardiographic evaluation of pulmonary hypertension Highly accessed article p. 95
Rajesh Krishnachandra Shah
Pulmonary hypertension (PH) is the end result of nearly all cardiac and some noncardiac conditions. It is an important marker of mortality and morbidity. It is also the deciding factor in the management of the etiological conditions, such as the timing of surgery in valvular heart disease, follow-up of pulmonary arterial hypertension, diuretic therapy for diastolic dysfunction, and so on. To add to the problems, early signs and symptoms are nonspecific, and so the diagnosis is attained at a later and advanced stage. Although clinical evaluation is always essential, echocardiography is now the main tool for the evaluation of PH. The aims of echocardiography in PH are: (1) to identify the etiology, (2) assess the effects of PH on the right ventricle, (3) estimation of the severity of the PH, (4) monitoring the progression and therapeutic response in PH, and finally (5) predicting the prognosis. It is hence very important that one measures the pulmonary pressures accurately for proper patient management. The aim of this article is to provide a detailed information of the different parameters of PH in the different echocardiographic views and the technique of measuring these parameters.
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Reversible cardiomyopathies Highly accessed article p. 106
Anjaneyulu V Anne
Cardiac muscle dysfunction resulting in heart failure can be reversed with appropriate diagnosis and therapy in nearly 25%8211;50% of all nonischemic cardiomyopathies. Diverse etiologies such as congenital, metabolic, toxic, infective, inflammatory, infiltrative, stress induced, and arrhythmia induced can cause myocardial dysfunction which can be restored to normal. All morphologic types including dilated, hypertrophic, and restrictive cardiomyopathies can have an underlying reversible cause. Imaging modalities such as echocardiography, cardiac computed tomography (CT), positron-emission tomography-CT, and cardiac magnetic resonance along with appropriate biochemical tests can help diagnose these varied etiologies. Recognizing reversible myocardial dysfunction at an early stage of the disease helps avoid inappropriate prolonged therapy for heart failure and repeated hospital admissions and may result in a cure in a significant number of cases.
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Quadricuspid pulmonary valve p. 112
Gnanavelu Ganesan, Hariharakrishnan Ramamoorthy, Venkatesan Sangareddi
Quadricuspid pulmonary valve (QPV) is a rare congenital cardiac malformation which is notable for its asymptomatic behavior. With only a few hundred cases reported in literature, its clinical significance is not exactly known, although many authors have placed its implications on the Ross procedure. We report a case of QPV which was detected on routine cardiac screening.
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Early detection of a potentially fatal complication of coronary stent implantation using transthoracic two-dimensional-echocardiography p. 115
Jaywant M Nawale, Kshitij R Bedmutha, Rajendra Vishwambhar Chavan, Ajay S Chaurasia
The number of coronary stent (CS) implantation has significantly increased since its introduction in 1987. CS infection is a rare but potentially fatal complication. No imaging modality is confirmatory for diagnosing CS infection. Positive blood cultures, two-dimensional-echocardiography (especially transesophageal echocardiography), transthoracic echocardiography (TTE), coronary angiography, computed tomography-scan, and magnetic resonance imaging are useful. We report a case of a 65-year-old male who presented within a month of CS implantation with high-grade fever and chest pain. TTE showed a localized collection in the right atrioventricular groove clinching the diagnosis to CS infection. The patient responded to higher doses of broad-spectrum antibiotics which were continued for 6 weeks.
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A rare case of true and pseudoaneurysm of left ventricular wall and incremental value of myocardial contrast p. 118
Gurpreet Singh Kalra, Rohit Tandon, Bhupinder Singh, Bishav Mohan
Coexistence of left ventricular true and pseudoaneurysm together is although rare but can be a possible sequelae of ventricular remodeling postmyocardial infarction. True aneurysm can be suspected on the basis of persistent ST-segment elevation on electrocardiogram several weeks after myocardial infarction while pseudoaneurysm can only be diagnosed after a comprehensive echocardiography examination. We describe a rare case of true aneurysm of the left ventricle apex and pseudoaneurysm of midanterior septum wall confirmed by myocardial contrast echocardiography.
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Recurrent infective endocarditis involving bicuspid aortic valve presenting with a rare complication: The deadly kiss p. 121
Arnab Ghosh Chaudhury, Prabhavathi Bhat, CN Manjunath, CM Satvic
Bicuspid aortic valve, the most common congenital cardiac lesion, is frequently associated with infective endocarditis (IE), and this combination is notoriously associated with increased prevalence of periannular complications. Mitral valve involvement as a “kissing” lesion secondary to aortic valve endocarditis is a very rare entity. Only few case reports are available describing this lesion. We report a case of recurrent IE involving both cusps of bicuspid aortic valve complicated by “kissing” lesion of the anterior mitral leaflet leading to aneurysm formation. The patient presented with severe aortic regurgitation and moderate mitral regurgitation. The patient was treated successfully with surgical aortic valve reconstruction (Ozaki procedure) with mitral valve repair.
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Aneurysm of the saphenous vein graft after coronary artery bypass surgery p. 124
Suman Omana Soman, G Vijayaraghavan, AR Muneer, AS Ankudinov
Aortocoronary graft aneurysms are rare; it develops as a late complication of coronary artery bypass surgery. We report here an incidental finding of a saphenous graft aneurysm detected during routine evaluation by echocardiography and confirmed by computed tomography coronary angiography.
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Anomalous pulmonary artery membrane: A rare membrane obstructing right pulmonary artery orifice p. 127
Saji Philip, K Ganapathy Subramaniam, Sunil Agrawal, Cherian Kotturathu Mammen
Different types of anomalous bands, membrane, tendon, and venous valves have been described in the heart, but not within the great arteries of the heart. Here, we present a 3-year-old female child diagnosed to have a crescentic membrane originating from the superior8211;posterior wall of the pulmonary artery (PA) at bifurcation and obstructing the orifice of right PA producing significant gradient across the artery. Histopathology of this membrane showed fibrous tissue, and possibly this could be a membranous fold forming at the bifurcation of PA during the development of branch pulmonary arteries from the sixth aortic arch.
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Unusual form of partial pulmonary venous connection p. 130
Osman Nuri Tuncer, Mehmet Fatih Ayik, Çagatay Bilen, Yüksel Atay
Success in congenital heart surgery has increased with improvement in surgical technique, anesthesia, and perioperative care. Transthoracic echocardiography (TTE) is regarded as an initial screening and diagnostic method in patients, but it may be limited by lack of an adequate acoustic window and more importantly suboptimal depiction of the extracardiac vasculature. Computed tomography angiography is an important alternative because of its wide availability; short acquisition time can also provide useful information about all anatomical structures. In this article, we present a case of bilateral partial anomalous pulmonary venous connection in which TTE is inadequate to show the left vertical vein.
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Left atrium mass in an infant with complex cyanotic congenital heart disease p. 132
Ishita Banerji
The clinical and echocardiographic findings in a 3-month-old cyanotic infant with congestive cardiac failure are described with stress on segmental approach to diagnosis. Echocardiography reveals dextrocardia, situs inversus, d-loop ventricle, tricuspid atresia, transposition of great vessels, subpulmonic ventricular septal defect (VSD), d-malposed aorta, restrictive atrial septal defect (ASD), and large mass in high-pressure left atrium (LA). Systemic veins drain to left-sided morphological right atrium (RA) and pulmonary veins returned to the right-sided morphological LA. In the presence of tricuspid atresia, blood from the morphological LA has only one outlet into the morphological RA through a restrictive ASD resulting in a high-pressure left atrial chamber. Blood from the morphological RA drains into the left-sided morphological left ventricle. From the left ventricle through the subpulmonic VSD, a portion of blood is directed into the pulmonary artery (PA) by passing the hypoplastic morphological right ventricle (RV) as the PA overrides the VSD. Blood flows from the hypoplastic RV into the aorta. Besides, LA mass seen in this 3 month-old-baby in the given setting is an extremely rare finding and to my knowledge has not been reported in literature before.
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Isolated hypertrophy of the left ventricular papillary muscles p. 137
Sita Ram Mittal
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Tiger stripes sign p. 139
Kailash Kumar Goyal, Divya Eliyan Mukund, Chakanalil Govindan Sajeev
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Stanford type A aortic dissection: Three-dimensional echocardiography p. 141
Pankaj Jariwala
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Giant left ventricular cardiac tumor in a neonate p. 142
Mahmood Dhahir Al-Mendalawi
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