Valvular involvement in brucellosis

Introduction: Brucella endocarditis, although an uncommon complication of brucellosis, is the main cause of the mortality related to this disease. The best therapy is a combination of antibiotic administration with valve replacement. After treatment of the first episode of endocarditis, new infection may be occurred as a relapse or reinfection. Case Presentation: In this report, we described a patient with brucella endocarditis complicated with a reinfection of the mechanical prosthetic valve after one year of follow-up. Conclusions: Both medical and surgical management should be done for better treatment of brucella endocarditis. Repeat infection is a problem during follow-up

A Rare Case of Right-Sided Heart Failure after Bentall Procedure

Pseudoaneurysms of the ascending aorta, which are rare and life-threatening complications in cardiovascular surgeries, can be caused by the Bentall procedure. We describe a 44-year-old woman, who had a medical history of acute aortic dissection (Type A) and the Bentall procedure and was admitted because of exertional dyspnea, edema of the lower extremities, ascites, and holosystolic murmur in the left lower sternal border. Preoperative echocardiography revealed a pseudoaneurysm of the ascending aorta and fistulization of the pseudoaneurysm to the right atrium. Multi-slice computed tomographic scan also showed a large pseudoaneurysm of the ascending aorta around the tube graft. The patient underwent surgery, during which the pseudoaneurysm was resected, the ostium of the right coronary artery was reimplanted, and the orifice of the right atrial fistula was sutured. Intraoperative transesophageal echocardiography revealed the perfect result of the surgery. The patient was discharged uneventfully

Quantification of Left Ventricle Function in Stress Echocardiography Using Endocardial Area Centroid Trajectory

Coronary artery occlusion has a direct effect on cardiac activity and is a well-known reason for ventricular motion disorder, specifically left ventricle (LV) wall motion dysfunction. In stress echocardiography, wall motion abnormality is exaggerated when stress is applied to the heart, and therefore, it is easier to diagnose abnormality in ventricular motion. In this study, we have presented a new parameter that measures LV function. We have shown that LV function can be measured using a variation of endocard borders during a cardiac cycle in standard stress echocardiography frames. This parameter shows a meaningful difference between ischemic and normal hearts and is calculated at different heart rates (HRs). In conclusion, ischemic hearts cannot keep up with the required increase in activity when reaching peak levels of stress

Echocardiographic right ventricular deformation indices before and after atrial septal defect closure: A scomparison between device and surgical closure

Background: Secundum atrial septal defects (ASD2) are one of the most common congenital disorders in children which includes about 10%–20% of congenital heart defects. In recent years, closure of secundum ASD percutaneously has been proposed to reduce mortality, morbidity, and become the standard method in both pediatric and young adults. The aim of this study was to determine the right ventricular (RV) function by strain and strain rate echocardiography parameters in children who underwent surgically versus percutaneous ASD2 device closure. Methods: In this cohort study, all children underwent ASD2 treatment from May 2014 to April 2016 were enrolled in this study. Echocardiography was performed 24 h after transcatheter closure and 3 days after surgical closure. MyLab 60 echo machine (Esoate, Florance, Italy) equipped with a multi-frequency 5 MHz transducer was used, and all echocardiographic data were collected by same pediatric cardiologist. All demographic characteristics and echocardiography indices were compared using SPSS version 18 between two groups. Results: Thirty-six patients (63.2%) were treated by the transcatheter closure and 21 (36.8%) underwent surgery. Longitudinal RV strain (S), longitudinal RV strain rate (S'), and early diastolic longitudinal RV strain rate (E') were improved significantly in device patients in comparison with surgical patients (P 0.05). However, tricuspid valve annular diameter was significantly decreased in patients who underwent ASD percutaneous device closure in comparison with a surgical group (P = 0.004). Conclusion: The results of this study showed that percutaneous ASD2 device closure will results in better RV function in comparison to surgical closur

Improvement in left ventricular deformational indices following radiofrequency ablation in patients with tachycardia: A comparative study between AVRT and AVNRT regarding left ventricular strain and strain rates

Background: Ablation will efficiently lead to sinus rhythm preservation, which consequently improves left ventricular function; however, the strain rate and its indices as functional systolic factors of the left ventricle have not been studied. Objectives: To assess the improvements in different patterns of radial, longitudinal, and circumferential strain rates separately. Methods: In this case series, 31 patients with symptomatic tachycardia who were candidates for ablation between october 2011 and March 2012 in our tertiary cardiovascular center in Iran were enrolled. Patients underwent trans-thoracic echocardiography 24 hours before and 24 hours and three months after ablation, and left ventricular ejection fraction deformation indices were assessed using the two-dimensional (2D) speckle tracking method during normal sinus rhythm. Results: Strain and strain rate indices in different aspects (radial and circumferential in the short axis view, and for longitudinal in the long axis view) improved remarkably during the three-month follow-up period (P< 0.05). The improvements in ventricular indices were usually between 24 hours to three months after ablation. The systolic strain rate (SR) and strain (SN) were significantly different at echocardiographic views before and 24 hours after ablation (P< 0.05), which revealed that myocardial function developed in the first 24 hours of ablation. Conclusions: Echocardiography and 2D speckle tracking strain imaging shows improvements in left ventricular deformation indices in atrioventricular reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) patients for the mean systolic strain and strain rate at 24 hours and the three-month follow-up. In spite of the normal LVEF, even during sinus rhythm, deformation indices maybe abnormal before and after ablation

Comparison of gated SPECT myocardial perfusion imaging with echocardiography for the measurement of left ventricular volumes and ejection fraction in patients with severe heart failure

Background: Gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is known as a feasible tool for the measurement of left ventricular ejection fraction (EF) and volumes, which are of great importance in the management and follow-up of patients with coronary artery diseases. However, considering the technical shortcomings of SPECT in the presence of perfusion defect, the accuracy of this method in heart failure patients is still controversial. Objectives: The aim of the present study was to compare the results from gated SPECT MPI with those from echocardiography in heart failure patients to compare echocardiographically-derived left ventricular dimension and function data to those from gated SPECT MPI in heart failure patients. Patients and Methods: Forty-one patients with severely reduced left ventricular systolic function (EF< 35%) who were referred for gated SPECT MPI were prospectively enrolled. Quantification of EF, end-diastolic volume (EDV), and end-systolic volume (ESV) was performed by using quantitative gated spect (QGS) (QGS, version 0.4, May 2009) and emory cardiac toolbox (ECTb) (ECTb, revision 1.0, copyright 2007) software packages. EF, EDV, and ESV were also measured with two-dimensional echocardiography within 3 days after MPI. Results: A good correlation was found between echocardiographically-derived EF, EDV, and ESV and the values derived using QGS (r = 0.67, r = 0.78, and r = 0.80 for EF, EDV, and ESV, respectively; P < 0.001) and ECTb (r = 0.68, 0.79, and r = 0.80 for EF, EDV, and ESV, respectively; P < 0.001). However, Bland-Altman plots indicated significantly different mean values for EF, 11.4 and 20.9 using QGS and ECTb, respectively, as compared with echocardiography. ECTb-derived EDV was also significantly higher than the EDV measured with echocardiography and QGS. The highest correlation between echocardiography and gated SPECT MPI was found for mean values of ESV different. Conclusions: Gated SPECT MPI has a good correlation with echocardiography for the measurement of left ventricular EF, EDV, and ESV in patients with severe heart failure. However, the absolute values of these functional parameters from echocardiography and gated SPECT MPI measured with different software packages should not be used interchangeably