Right coronary artery chronic total occlusion in presence of anomalous origin of left coronary artery

Right sinus origin of left coronary artery is a very uncommon congenital coronary anomaly. The presence of an associated totally occluded right coronary artery represents an exceedingly rare picture. An accurate morphologic identification of anomalous arteries, by multi-detector computed tomography, is mandatory before planning any therapeutic intervention. We report an interesting case of chronic total occlusion of the right coronary artery in a young patient with anomalous left coronary arter

Diagnosis of anal human papillomavirus infection: polymerase chain reaction or cytology?

Summary Objectives To investigate the relationship between human immunodeficiency virus (HIV)-positive and HIV-negative patients engaging in promiscuous behaviors and anal human papillomavirus (HPV) infection diagnosed by polymerase chain reaction (PCR) and cytology. Methods Fifty-six HIV-positive patients and 49 HIV-negative patients who engaged in sexually promiscuous behavior were enrolled in the study. We performed cytological exams using the Pap smear and PCR for HPV-DNA detection, with identification of oncogenic strains. The 2001 Bethesda System terminology was used for the cytological exams. We also evaluated the immunologic status of the HIV-infected patients. Results PCR positivity for HPV-DNA was higher in the group of HIV-positive patients than in the group of HIV-negative patients with a statistically significant difference. In contrast we did not find any statistically significant difference by cytological exam. Oncogenic strains were equally distributed in the two groups. Conclusions Our results indicate the importance of the cytological exam for anal HPV screening in the population at high risk of sexually transmitted disease and that HPV-DNA PCR can be used only as adjunct test

Double superior vena cava: Right connected to left atrium and left to coronary sinus

Left persistent superior vena cava connected to coronary sinus may coexist with right superior vena cava connected to left atrium. Surgical correction is not mandatory if there is no cyanosis due to a big interjugular bridging vein. (C) 2007 Elsevier Ireland Ltd. All rights reserved

Multi-slice tomographic diagnosis of isolated right aortic arch in an elderly patient

Occasional report of asyntomatic right aortic arch in a 90-year-old man with any congenital defect associated

Evaluation of subendocardial ischemia by strain Doppler echocardiography in patients with left ventricular outflow tract obstruction.

Background: The purpose of the present study was to assess the subendocardial wall function using tissue Doppler imaging (TDI) and strain rate imaging (SRI) in patients with congenital left ventricular outflow (LVOT) obstruction. Methods: We studied with TDI and SRI 19 pts aged 11-31 years with congenital aortic stenosis (valvular, 12 pts; subvalvular, 6pts; supravalvular, 1pt). 13 age-and sex-matched subjects with no signs of heart disease were selected as normal controls (CTR). On the basis of LVOT pressure gradient, pts were distinguished in two groups: group 1 (10 pts), gradient < 50mmHg; group 2 (9 pts), gradient 50 mmHg. TDI wall velocities during systole (Sw), early relaxation (Ew) and atrial systole (Aw) were measured in both groups in the apical four chambers views. Peak strain (e) and strain rate (SR) were measured during isovolumic contraction (IC), systole (S), isovolumic relaxation (IR), early diastole (E) and late diastole (A) in endocardium (End), myocardium (Myo) and epicardium (Epi) in the same views. Results: TDI measurements of the three myocardial layers showed no statistically significant difference among velocities in both pts groups although there was a trend for End velocities to be higher than those of Epi. There was a significant difference in strain and strain rate between the myocardial layers for both isovolumic contraction and relaxation (End-e -38.1 +/- 12.7%, Myo-e -21.7 +/- 8.9%, Epi-e -10.8 +/- 5.5% during IC; End-e 31.9 +/- 11.3%, Myo-e 20.1 +/- 6.3%, Epi-e 10.4 +/- 4.9% during IR; End-SR -2.9 +/- 1.7 sec-1, Myo-SR -1.7 +/- 0.9 sec-1, Epi-SR -0.8 +/- 0.5 sec-1 during IC; End-SR 1.9 +/- 1.3 sec-1, Myo-SR 1.1 +/- 0.3 sec-1, Epi-SR 0.6 +/- 0.5 sec-1 during IR). There was a significant correlation between endocardial strain rate (during IC) and LVOT pressure gradients (r=0.69, p<0.005). Compared to group 1, group 2 pts showed a significant decrease in endocardial strain and strain rate for both isovolumic contraction and relaxation (p<0.001). Conclusion: Strain and strain rate echocardiography provide a unique insight in evaluating subendocardial wall dysfunction in pts with significant LVOT obstruction

Assessment of biventricular and vascular function using three-dimensional speckle tracking echocardiography in adult patients with surgical repair of tetralogy of Fallot

Background: In patients late after correction of Tetralogy of Fallot (TF) the combined effects of preoperative hypertrophy and hypoxia, possible intraoperative myocardial damage, type of reconstruction, acquired postoperative lesions such as pulmonary or aortic regurgitation, and congenital vasculopathy may result in impaired right ventricular (RV) as well as left ventricular (LV) function. We hypothesized that a comprehensive assessment of ventricular, aortic and pulmonary artery function could help to better understand the pathophysiology of this complex disease. Methods: Eighteen patients (mean age 37 ± 14 years) with repaired TF and eighteen age-matched healthy subjects selected as controls were studied. LV and RV longitudinal, circumferential, and radial strains were calculated by three-dimensional speckle tracking echocardiography (3DSTE). Global area strain (GAS) was obtained by 3DSTE as the percentage variation in the surface area defined by the longitudinal and circumferential strain vectors. Pulmonary artery (PA) and ascending aorta (Ao) stiffness and strain were determined using M-mode and speckle tracking echocardiography. Data analysis was performed offline. Results: Overall, Ao and PA stiffness were increased (p=0.0003) and Ao and PA strains were decreased (p=0.0002) in TF patients compared to controls. Stiffness index had a negative correlation with Ao (p<0.001) and PA (p<0.005) strain. Ao and PA strains correlated with LV and RV longitudinal strain (p<0.05 and p<0.01 respectively) and LV and RV area strain (p=0.02 and p<0.01 respectively). A significant correlation was found between PA stiffness and pulmonary regurgitant fraction and volume (p=0.004), and between Ao stiffness and aortic regurgitant fraction and volume (p<0.001). Conclusions: In patients with repaired TF increased PA and Ao stiffness are associated with reduced RV and LV 3DSTE parameters. Changes in PA and Ao stiffness and strain are more pronounced in the presence of pulmonary or aortic regurgitation and should be taken into account when evaluating post-operative TF

Assessment of aortic elastic properties by transesophageal strain echocardiography after repair of coarctation of the aorta.

Background: Increased arterial stiffness may participate in the genesis of hypertension and persistent increases in left ventricular mass after surgical correction of coarctation of the aorta (CoA). The purpose of the present study was to assess the aortic elastic properties using tissue Doppler imaging (TDI) and strain echocardiography in patients (pts) after coartectomy. Methods: Transesophageal echocardiography with TDI and strain capabilities (Toshiba corp, Tokyo, Japan) was performed in 10 pts aged 12-39 years who had repair of CoA and residual aortic narrowing <30% and who were not hypertensive at rest. 11 age- and sex-matched subjects with no signs of heart disease were selected as normal controls (CTR). Aortic transverse sections were measured at the level of the proximal, distal and coarctation segments. Transverse aortic stiffness was measured by the elastic modulus (Ep) and stiffness index beta () using previously reported formulas. TDI wall velocities during systole (Sw), early relaxation (Ew) and atrial systole (Aw) were measured in transverse views in both groups. Using dedicated software peak systolic strain (ps ) was measured from the resultant deformation curves in the same views. Results: In the coartectomy pts there was a significant increase of Ep (47.66.5 vs 21.82.9 kPa, p<0.001) and (4.112.51 vs 2.280.65, p<0.005) at the level of the proximal and coarctation segments compared with CTR. At the same level Sw velocities were significantly decreased compared with CTR (4.10.8cm/sec vs 6.90.9cm/sec, p<0.001). There was a significant decrease of ps in the coartectomy pts compared with CTR in the proximal and coarctation segments (71.4% vs 232.5%, p<0.0001). Univariate correlations in the coartectomy group showed significant relationships of and Sw velocities (r=-0.66, p<0.01) and and ps (r=-0.78, p<0.001) Conclusion: Thus, pts with CoA have increased proximal aortic stiffness and reduced wall velocities and wall strain even after successful repair

Transesophageal echocardiographic assessment of thoracic aorta elastic properties by TDI in patients with Marfan syndrome

Background: It has been shown that the presence of aortic dilation is associated with an increased risk of aortic dissection in patients with Marfan disease. The purpose of the study was to establish the value of combined thoracic aorta dilation and decreased aortic elastic properties to assess the severity of aortic disease in patients with Marfan syndrome. Methods: Fifteen patients (pts) with Marfan syndrome (Beighton criteria) aged 13 to 42 years were studied with multiplane transesophageal echocardiography (TEE). 6/15 pts had surgery for aortic dissection. Tissue Doppler imaging (TDI, Toshiba corp.) during TEE was used for the quantification of aortic elastic properties. The descending aorta was visualized in a TEE short axis view at the level of the left atrium and TDI was used for the rates of velocity change (dV/dt) over time. Peak positive dV/dt (dV/dt max, cm2sec-1) was measured. Results: Descending thoracic aorta dilation (>30mm) was present in 11/15 pts. dV/dt max was 7.97±1.82 in pts without surgery and 4.39±1.47 in pts with surgery (p 40 mm was detected in 5/6 pts with surgery and 3/25 pts without surgery. dV/dt max 40 mm had a sensitivity of 91%, specificity of 73% and positive predictive value of 83% for predicting aortic dissection. Conclusion: Our results indicate that these described combined methods are highly predictive for the development of aortic dissection in Marfan syndrome and should suggest aggressive treatment