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   Table of Contents - Current issue
September-December 2017
Volume 1 | Issue 3
Page Nos. 177-244

Online since Tuesday, December 12, 2017

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Speckle-Tracking echocardiography to assess global and regional left ventricular function in acute myocardial infarction Highly accessed article p. 177
Gopi Aniyathodiyil, Sunil S Bohra, Anup Mottengar, Satish C Govind
Speckle tracking is a useful tool in assessing global & regional myocardial function in patients with acute myocardial infarction undergoing primary PCI. Global Longitudinal Strain (GLS) is a robust parameter to assess regional and global LV function. Global longitudinal strain helps in predicting short term outcomes in these patients and has shown to be better than ejection fraction, and as good as wall motion scoring, wall motion scoring index and myocardial performance index. A Lower global longitudinal strain parallels the rise in troponin T and CPKMB in acute myocardial infarction. Global longitudinal strain may have the potential to be an echocardiographic parameter which is useful in identifying multivessel disease. Assessment of regional myocardial function by speckle tracking echocardiography, particularly GLS, can be useful in ACS patients undergoing PCI in predicting short term recovery of the affected segments. Speckle tracking echocardiography can be used independent of the conventional markers to assess regional and global LV function.
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Transverse left ventricular band p. 185
Manoj Kumar Dubey, Avinash Mani, Punam Dubey, Vineeta Ojha
Left ventricular band has been considered a vestigial entity for quite a long time. Their incidence is quite common in our day to day practise but their real function is yet to be understood. We performed a case series of 5 patients with left ventricular band and studied the characteristics of the band along with their hemodynamic effects. The study showed that the characteristics of the band depend on the degree of left ventricular outflow obstruction and varies among people of different age groups. The ventricular band also play a role in sequestration of blood in the left ventricle and they are also involved in maintaining the geometry of the left ventricle in diseased conditions.
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Journey from two-dimensional to four-dimensional strain and left ventricle torsion in the evaluation of coronary artery disease p. 189
V. Amuthan, R. V. A. Ananthcal
The use of echocardiography in the diagnosis of suspected myocardial infarction has been classified as appropriate. The use of regional strain which is a dimensionless measurement of deformation, expressed as a fractional or percentage change from an object's original dimension, greatly enhances the accuracy of detecting the regional wall motion abnormality in a scale (-20 to +20) ten times that of eye balling. Speckle-tracking echocardiography (STE) is a novel technique which has emerged as one of the best methods that analyses motion and strain by tracking natural acoustic reflections and interference patterns within an ultrasonic window. In patients with acute myocardial infarctions (MIs), accuracy for the prediction of global functional improvement as well as LV remodelling by 2D STE is comparable with that of late gadolinium enhancement cardiac magnetic resonance (CMR) imaging. Global longitudinal strain (GLS) has evolved as one of the most robust parameter, and this has been shown to identify subclinical LV dysfunction.3D STE has emerged as an alternative non -invasive technique to assess LV rotation. In anterior wall myocardial infarction, systolic twist is decreased, and diastolic untwisting is depressed in accordance with LV systolic dysfunction. These results suggest the significant impact of global LV systolic function on LV twist and twist-displacement loops in patients with anterior wall MI. Although to date, no prognostic information exists on the role of rotational parameters of LV function, further ongoing studies would shed more light on this important technique.
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How to assess mitral stenosis by echo - A step-by-step approach Highly accessed article p. 197
Gnanavelu Ganesan
Rheumatic mitral stenosis is the commonest valvular heart disease in developing countries. Other causes include congenital abnormalities and degenerative mitral valve disease. Mitral stenosis when it is due to rheumatic process, can be managed by percutaneous transvenous mitral commissurotomy. Echocardiography remains the most important investigation in diagnosing and planning the managemnt of mitral stenosis. This review highlights stepwise approach for comprehensive assessment of mitral stenosis by echocardiography.
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Demystifying three-dimensional echocardiography: Keeping it simple for the sonographer p. 206
Eric John Kruse, Roberto M Lang
Three-dimensional echocardiography (3DE) is a new echocardiographic tool that enables echocardiographers visualization of cardiac structures from any anatomical view. Furthermore, the recent development of new transducer technology and software allows the easy acquisition and analysis of datasets for sonographers. A few common applications of 3DE consist of the left and right ventricle for chamber quantification, mitral valve stenosis and regurgitation assessment, and the guidance of catheter placement during interventional procedures. Despite current literature illustrating the importance of 3DE, it fails to demonstrate how to acquire 3D datasets from the sonographer's perspective. Understanding 3DE data acquisition technique and applications are paramount to implement it as standard of care. Acquisition of 3DE should be accomplished in three steps (1) optimization, (2) acquisition, and (3) cropping of 3D images.
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Echocardiographic assessment of diastolic function p. 214
Aniruddha De
The stepwise approach in evaluation of left ventricular (LV) diastolic function is essential in any patients with dyspnea on exertion or heart failure. Many of them have normal to near-normal ejection fractions (EFs). These subsets of patients are labeled as diastolic heart failure or heart failure with preserved EF. It is important to differentiate diastolic dysfunction from dyspnea of pulmonary origin for further management and future prognosis. LV filling pressures is usually synonymous with pulmonary capillary wedge pressure (PCWP), mean left atrial pressure (LAP), mean LV diastolic pressure, and LV end-diastolic pressure (LVEDP). PCWP on the other hand is also an indirect estimate of LV diastolic pressures. LVEDP is often elevated in early diastolic dysfunction because of a large atrial pressure wave, while mean PCWP and LAP remain normal. While mean PCWP and LAP increased during tachycardia and where there is increased LV afterload which is the basis for the diastolic stress test. It is essential that certain Doppler variables correlate well with an increase in LVEDP only and not reflecting the increase in either LAP or LVEDP. Therefore, early evaluation of LV filling pressures and LVEDP are more important than mean LA pressure which is elevated later. Echocardiography is the best evaluation tool to evaluate LV diastolic function. The purpose of this article is to provide the simplest stepwise approach of different diastolic parameters which are used as routine protocol with minimal use of the newer modalities at various clinical settings.
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A rare case of infective endocarditis with multiple vegetations and invasion of papillary muscle p. 222
V Blessvin Jino, J Cecily Mary Majella, C Nageswaran, G Gnanavelu, N Swaminathan, S Venkatesan
Infective endocarditis (IE) is a life threatening infection of cardiac valves leading to high mortality, if it is not recognized earlier and promptly treated. Usually, IE affects single cardiac valve. Angry looking vegetations at multiple sites and vegetations invading the papillary muscles are rare. Such involvement is associated with even higher mortality. Here we present a case of Infective endocarditis with multiple vegetations involving mitral valve, aortic valve and papillary muscle of left ventricle with heart failure who was successfully treated with antibiotics and heart failure drugs and subsequently with double valve replacement. Patient was hemodynamically stable after surgery and is on regular follow-up.
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Giant left ventricular cardiac tumor in a neonate p. 225
Narasimhan Chitra, IB Vijayalakshmi, CN Manjunath
Primary cardiac tumors in the fetuses and neonates are uncommon. The most common are rhabdomyomas. Echocardiography is the primary diagnostic tool for the detection of a cardiac tumor. We report a rare case of neonatal giant intracardiac left ventricular teratoma.
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Single ventricle with infective endocarditis and brain abscess: A rare case report p. 228
K Venkatesan Kongunattan, MS Ravi, N Swaminathan, G Ravishankar, S Venkatesan, S Saravanababu
Right-sided valve endocarditis is usually uncommon. Pulmonary valve endocarditis with septic emboli as the complication of a rare congenital heart disease is even unusual. Herein, we report a case of a 27-year-old male congenital cyanotic heart disease with pulmonary valve endocarditis presenting with 5 days history of fever and headache. Echocardiography demonstrated double-inlet left ventricle with hypoplastic right ventricle with discordant origin of great arteries. In addition, multiple mobile vegetations in the pulmonary valve are also seen. Brain imaging revealed cerebral abscess. The occurrence of pulmonary valve endocarditis and cerebral abscess in a case of single ventricle is very rarely reported.
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Mechanical breakdown and thrombosuction of mobile clot in right ventricular outflow tract causing massive pulmonary embolism in a patient with absolute contraindication to thrombolysis p. 231
Manbir Singh Khurana, Rohit Tandon, Bhupinder Singh, Bishav Mohan
Massive pulmonary embolism (PE) carries high mortality if not treated urgently. Survival depends on rapid recanalization of pulmonary artery and reduction of right ventricular overload. Historically, surgical pulmonary embolectomy has remained as cornerstone of treatment, but in recent times, catheter-directed techniques are gaining popularity especially in centers of expertise and main indication for surgery remains only in few cases in which there is presence of intracardiac mobile clot (in right atrium, right ventricle, or right ventricular outflow tract [RVOT]) or in cases with contraindications to local/systemic thrombolysis or as rescue operation where there is failure of catheter-directed techniques. The role of mechanical breakdown and other catheter-directed therapies as a potential alternative and role in patients with RVOT thrombus is debatable. We report a case where a patient with massive PE with RVOT thrombus having contraindication to thrombolysis managed successfully with catheter-directed mechanical breakdown and thrombosuction.
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A common variant of hypoplastic left heart syndrome p. 235
Ishita Banerji
Hypoplastic left heart syndrome (HLHS) includes a group of closely related anomalies characterized by severe hypoplasia of the left-sided structures of the heart including rudimentary left ventricle, combinations of mitral and aortic valve stenosis, or atresia with diminutive ascending aorta and aortic arch. Here, the case of a 10-day-old male baby with a variant of HLHS is being reported.
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Echocardiographic correlate of subendocardial myocardial infarction p. 238
Sita Ram Mittal
Nontransmural (subendocardial) myocardial infarcts produce classical discomfort. Electrocardiograms usually show localized T wave inversions. Routine echocardiography usually does not show supportive regional wall motion abnormalities. Detailed echocardiography, however, reveals endocardial sear in the affected region. This echocardiographic finding supports the clinical diagnosis of myocardial infarction. We are reporting such eleven cases.
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Critical comments on case report of cor triatriatum dexter p. 242
Biswaranjan Mishra
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Review of Indian academy of echocardiography's “Textbook of Echocardiography” p. 243
Satish Govind
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President's message p. 244
Shanmugasundaram Somasundaram
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