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   2017| January-April  | Volume 1 | Issue 1  
    Online since April 7, 2017

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Fetal echocardiography: A systematic approach
Atul Karande, Shweta Nagar
January-April 2017, 1(1):47-54
Congenital heart disease (CHD) is the most common birth defect worldwide. The optimal timing for performance of a comprehensive transabdominal fetal echocardiogram is 18–22 weeks gestation. All radiologists should perform screening of the heart during all obstetrical ultrasound studies beyond 18 weeks of gestation. Detailed fetal echocardiography can be performed only with the help of a technically well-quipped ultrasound machine. Skilled expertise and appropriate knowledge are required to perform detailed fetal echocardiography. Despite of limitations, fetal echocardiography can identify most of the CHDs which have major pre- and post-natal implications. This is necessary to delineate the high-risk group of fetuses who are suffering from complex cardiac defects and would require tertiary hospital setup for delivery. This further aids in appropriate postnatal medical as well as surgical management, antenatal parent counseling, and explaining risk factors as well as postnatal outcome.
  2,548 482 -
Indian academy of echocardiography performance standards and recommendations for a comprehensive transthoracic echocardiographic study in adults
Nitin Burkule, Manish Bansal, Rahul Mehrotra, Ashwin Venkateshvaran
January-April 2017, 1(1):1-17
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Carotid ultrasound for cardiovascular risk prediction: From intima-media thickness to carotid plaques
Ravi R Kasliwal, Mansi Kaushik, Hardeep Kaur Grewal, Manish Bansal
January-April 2017, 1(1):39-46
Carotid intima-media thickness (CIMT) and nonstenotic carotid plaques are established measures of subclinical atherosclerosis and are useful for prediction of future cardiovascular disease (CVD) risk. Compared with CIMT, the incremental predictive value of carotid plaques is more robust. Although the guidelines differ, carotid ultrasound-based assessment of CIMT and carotid plaques has a role in risk stratification and management of asymptomatic individuals who present with one or more CVD risk factors. The presence of significantly elevated CIMT or carotid plaque burden should lead to reclassification of the individuals into high-risk category with the appropriate intensification of the risk reduction measures. In addition, demonstration of increased CIMT and/or presence of the plaques may also help in improving patients' health behavior and their compliance toward antiatherosclerotic measures. In future, plaque progression/regression assessment by three-dimensional ultrasound and the use of contrast agents may further enhance the utility of carotid ultrasound for monitoring the clinical course of atherosclerotic vascular disease.
  2,220 252 -
Assessment of myocardial viability by echocardiography
Nitin J Burkule
January-April 2017, 1(1):32-38
Clinical application of myocardial viability testing to improve patient outcome is still a concept in evaluation. The various echocardiographic, nuclear, and magnetic resonance imaging techniques of assessment of myocardial viability evaluate different aspects of ischemic pathophysiology and have certain distinct advantages and limitations. A clinical algorithm combining “anatomic” and “flow/function” imaging gives more specific result of myocardial viability. Different modalities of echocardiography form the basic and cost-effective tools to assess the anatomic and functional aspect of viability.
  1,387 294 -
Evaluation of coronary arteries by transthoracic echocardiography
AV Anjaneyulu
January-April 2017, 1(1):27-31
Though several new cardiac imaging techniques have emerged, invasive coronary angiography remains the gold standard in evaluating coronary arteries for measuring anatomic severity of the stenotic lesion and assisting in intracoronary interventions. Several workers have attempted to image the coronary arteries by echocardiography. With improvements in ultrasound machines and introduction of harmonic imaging and high frequency transducers, direct visualization of long segments of all three coronary arteries is now possible. Though the entire artery cannot be reconstructed, multiple segments can be visualized, flow velocity can be measured, thus enabling us to obtain useful anatomic and physiologic information. Careful evaluation of coronary flows can translate into a wide variety of clinical applications.
  1,191 277 -
Three-dimensional versus two-dimensional strain for the assessment of myocardial function: A case series
Monica Vinesh Dillikar, Ashwin Venkateshvaran, Banajit Barooah, Reeta Varyani, Prayaag Kini, PK Dash, Srikanth Sola
January-April 2017, 1(1):18-23
Introduction: Two-dimensional (2D) strain assessment is an important diagnostic and prognostic tool in various clinical conditions, particularly coronary artery disease (CAD). However, these measurements are limited in that the information is obtained in only a single plane (2D). Three-dimensional (3D) strain tracks the myocardium in all 3D, potentially overcoming the limitation of 2D strain. The objective of this study was to establish normal values for 3D strain in a population of healthy, normal controls and to compare these values with 2D strain values. In addition, we sought to evaluate the utility of 3D strain in patients with known or suspected CAD. Methods: We conducted a prospective study at a single major tertiary care center. Individuals were recruited for the study and divided into two groups: a normal control group and a CAD group. Global longitudinal strain (GLS) and global circumferential and global radial strain were calculated by both 2D and 3D strain methods. In addition, 3D was used to calculate area strain. Results: We enrolled a total of 43 individuals (20 normal control group, mean age 33 ± 2.7 years, and 23 CAD group, mean age 57 ± 2.8 years, 80% male). Values for 3D strain were consistently lower for GLS and global circumferential strain in both groups compared with 2D measurements. In the control group, the mean 2D GLS was −20 ± 1.6% versus −17.5 ± 1.5% for 3D GLS (P < 0.001). Similarly, the mean 2D circumferential strain was −17.7 ± 2.3% versus −15.6 ± 2.1% for 3D circumferential strain (P < 0.001). Combining both groups, the sensitivity of GLS for CAD was 80% for 2D versus 93% for 3D. Similar findings were seen for global circumferential strain (sensitivity 87% for 2D vs. 100% for 3D). However, the sensitivity of 3D global radial strain was lower (93% for 2D vs. 47% for 3D). 3D strain data were acquired in a shorter time span compared with 2D (2.2 ± 1 min vs. 3 ± 1 min). Conclusions: 3D strain assessment of longitudinal and circumferential strain is similar but mildly reduced compared with 2D techniques, with similar sensitivity for CAD. Radial strain measurements by 3D, however, are not accurate and correlate poorly with 2D.
  997 149 -
Morphology of right heart thrombi in pulmonary embolism: A case series and analysis
Nisamudeen Kajamohideen, N Swaminathan, G Palanisamy, G Gnanavelu, Venkatesan Sangareddi
January-April 2017, 1(1):24-26
Introduction: The occurrence of right heart thrombus (RiHT) in pulmonary embolism (PE) carries poor prognosis. Type A Thrombi are serpiginous, highly mobile with high mortality. Type B Thrombi are less mobile and have better prognosis. Type C is intermediate in all characteristics. Methods: This is an observational study done in patients presenting with RiHT with PE to the emergency unit of our institute from March to August 2016. A total of seven patient's clinical and electrocardiographic data were collected with a history of deep vein thrombosis or hypercoagulability. Results: This case series of seven patients with right heart thrombi in pulmonary embolism showed a predominance of male patients, with right ventricle dysfunction and pulmonary hypertension in all cases. Conclusion: Early fibrinolysis in type A thrombus had a favourable outcome. Mortality was 29% in our series.
  829 133 -
Biventricular endomyocardial fibrosis with severe aortic stenosis: A rare combination
Suman Omana Soman, G Vijayaraghavan, Ramakrishna Pillai, AR Muneer, MV Teena
January-April 2017, 1(1):60-62
Endomyocardial fibrosis is the most common form of restrictive cardiomyopathy worldwide. Primarily it is a disease of the young with apical fibrosis, endocardial thickening with involvement of the papillary muscles and atrio-ventriclar valves. Its association with valvular heart disease of other etiology is rather uncommon. We are reporting a case of 65year old lady with classical features of biventricular Endomyocardial fibrosis and valvular aortic stenosis.
  799 79 -
Large left atrial myxoma causing significant mitral regurgitation
Raj Kumar, Amit Jaiswal, Rahul Mehrotra
January-April 2017, 1(1):55-56
Myxomas are the most common primary cardiac tumors, usually arising in the left atrium. Large myxomas usually produce mitral valve obstruction and stenosis such as manifestations. We present a rare case where a large left atrial myxoma caused a significant mitral regurgitation due to mechanical damage to the leaflets necessitating mitral valve replacement along with tumor resection.
  769 74 -
Carcinoid heart disease: A case discussion with reappraisalcarcinoid heart disease: A case discussion with reappraisal
Rohit Tandon, Ravinder Pal Singh
January-April 2017, 1(1):57-59
Carcinoid tumors are malignant neuroendocrine tumors arising from Kulchitsky cell. The most common site of primary carcinoid tumors is gastrointestinal tract (64%) followed by respiratory tract (28%). Carcinoid tumors metastasize to the liver in approximately 5%–10% of cases. Up to 20% of patients with carcinoid syndrome present with carcinoid heart disease at diagnosis, which leads to features of right heart failure. In this case, we highlight the importance of echocardiography in patients presenting with a triad of jaundice, pulsatile hepatomegaly, and raised jugular venous pressure.
  721 65 -
Carcinoid heart disease: A pictorial report
Amit Kumar, Bharat Bansal, Raj Kumar, Rahul Mehrotra
January-April 2017, 1(1):69-69
Carcinoid tumors are rare, mostly seen in gastrointestinal tract and bronchus. Carcinoid heart disease occurs in up to half of these patients with characteristic involvement of right-sided valves.
  659 87 -
An interesting case of left ventricular diverticulum
S Manivelan, D Kathirvel, G Gnanavelu, N Swaminathan, S Venkatesan
January-April 2017, 1(1):66-68
Left ventricular (LV) diverticulum is defined as a protrusion of the free wall of the ventricle, including endocardium, myocardium, and pericardium. It is classified into fibrous and muscular types. Most of the patients are asymptomatic. It is mainly diagnosed by echocardiography, magnetic resonance imaging, and ventriculography. Surgery is the treatment of choice if the patient is symptomatic associated with other cardiac anomalies. In asymptomatic patient with isolated LV diverticulum, the treatment is controversial. Our patient is a 35-year-old male presented with progressive dyspnea on exertion for the past 1 month. Clinical examination was normal. His electrocardiogram revealed sinus tachycardia. There was no evidence of ischemic changes. Echocardiogram revealed aneurysmal outpouching of the posterolateral basal segment of the left ventricle adjacent to the posterior mitral leaflet [Figure 1]. Ejection fraction was 50% with trivial mitral regurgitation. His coronary angiogram showed normal epicardial coronaries. The patient was treated with furosemide, enalapril, metoprolol, and spironolactone. Then, the patient was referred to the cardiothoracic surgery department for further management.
  665 71 -
Intracardiac mass: A rare case report
ST Yavagal
January-April 2017, 1(1):63-65
Intracardiac thrombus is seen in many circumstances. Rarely it is found in left atrium in the absence of mitral stenosis. Here we are reporting a case of Cardiomyopathy with thrombus in left ventricle and left atrium.
  603 57 -