Atrial Standstill: A Rare Case

We introduce a 32-year-old man who was evaluated for a dizziness and headache of unknown origin for at least two months and was referred to our center after ECG findings. He was finally diagnosed as a case of idiopathic, familial, diffuse, persistent atrial standstill, which is a rare arrhythmogenic condition characterized by the absence of electrical and mechanical activity in the atria. He successfully received a single-chamber permanent pacemaker

Late Diagnosis of Large Left Ventricular Pseudoaneurysm after Mitral Valve Replacement and Coronary Artery Bypass Surgery by Real-Time Three-Dimensional Echocardiography

One of the most serious complications of mitral valve replacement is left ventricular rupture and pseudoaneurysm formation, which is rare but potentially lethal. We herein present a late type of post mitral valve replacement and coronary artery bypass surgery pseudoaneurysm in a 74-year-old female, who was admitted to our hospital with a recent history of exertional dyspnea. She had the above-mentioned operation 10 months before. The diagnosis was made via two-dimensional and real-time three-dimensional transthoracic echocardiography. The prosthetic mitral valve was removed, and the large orifice of the pseudoaneurysm was closed by surgery. At one year's follow-up, the patient was in good condition

Percutaneous aortic valve implantation in bicuspid aortic valve: A case report

BACKGROUND: Transcatheter aortic valve implantation (TAVI) was known as an alternative technique for treatment of severe aortic stenosis (AS). This technique is controversial in bicuspid aortic valve (BAV). Here, we report TAVI for severe AS in a BAV setting in a patient with serious lung disease. CASE REPORT: A 68-year-old woman with a history of coronary artery bypass graft, BAV and severe AS, asthma, who had repeatedly denied any suggestion for open heart surgery, was our volunteer candidate for TAVI. The peak and mean pressure gradient decreased from 53 and 43 mm Hg to 13and 6 mm Hg respectively. CONCLUSION: TAVI could be a viable option for highly selected patients with AS and BAV who have a prohibitive risk for open heart surgery.&nbsp; </span

Transesophageal Echocardiographic Characteristics of Secundum-Type Atrial-Septal Defect in Adult Patients

Background: Given the dearth of data in the existing literature on the size and morphologic variability of secundumtype atrial-septal defect (ASD-II) in adult patients, we aimed to address this issue in a series of consecutive adult patients evaluated by transesophageal echocardiography (TEE).Methods: A total of 50 patients (68.0% female) with isolated ASD-II underwent TEE for the evaluation of the defect. The morphological characteristics of the defect were evaluated, and the largest defect size was measured. The ASD rim wasdivided into 6 sectors: the superior-anterior, superior-posterior, superior, inferior-anterior, inferior-posterior, and inferior.The minimal length of the defect rims was determined.Results: Mean age at the time of evaluation was 33.62±14.48 years. Mean defect diameter in the all the study patients was 20.80±8.17 mm. Thirteen morphological variations were detected. Deficiency of one rim was detected in 14 (28%) patients,two in 16 (32%), three in 2 (4%), and four in 2 (4%). Deficiency of the superior anterior rim was found in 24% of the patients as the most frequent morphology. There was a significant correlation between the defect size and number of deficient rims (γ=0.558, P value<0.001). Forty-eight (96%) patients emerged for defect closure: 22 (46.2%) suitable for percutaneousclosure and 26 (53.8%) for surgical closure. Two patients with small defects were recommended for medical treatment and follow-up.Conclusion: ASD-II is larger and more morphologically variable in adults than in children. Based on the findings of the present and previous studies and given the advantages of percutaneous treatment, it is advisable to make a decision on ASD-II closure as soon as possible before it outgrows the transcatheter closure suitability criteria

Induced Myocardial Infarction Using Ligation of the Left Anterior Descending Coronary Artery Major Diagonal Branch: Development of an Ovine Model

Background: We report experimental myocardial infarction by occluding coronary arteries in ovine models. Methods: Twelve ewes were included in the study. After the chest was opened by left lateral thoracotomy incision, the second diagonal branch of the left anterior descending coronary artery was ligated at a point approximately 40% distant from its base. Prophylactic antiarrhythmics were administered. Animals were mechanically ventilated during surgery and stayed in the ICU for 24h afterwards. Experiments were then evaluated by echocardiographic, electrocardiographic, hemodynamic, serologic and morphologic investigations. Echocardiographic measurements were repeated after two months and animals were then sacrificed for postmortem cardiac examinations. Results: All animals survived the surgical procedure. Cyanotic discoloration and hypokinesia in the cardiac tissue in an area of 3×4 cm plus ST-segment elevations was detected immediately after vessel ligation. More over, there were pathologic Q- waves 2 months later. Echocardiographic evaluations revealed an average of 22% relative decrease in cardiac ejection fraction. Wall motion analysis demonstrated anteroapical hypokinesia and akinesia in all animals one day and two months after operation. Thin walled infarcted areas with tissue fibrosis were evident in pathologic investigations two months after surgery. Conclusion: In conclusion, we developed a practical and safe method of producing myocardial infarction in large animal models

Post-Traumatic Chordae Rupture of Tricuspid Valve

Blunt injury to the chest can affect any one or all components of the chest wall and thoracic cavity. The clinical presentation of patients with blunt chest trauma varies widely and ranges from minor reports of pain to florid shock. Traumatic tricuspid valve regurgitation is a rare cardiovascular complication of blunt chest trauma. Tricuspid valve regurgitation is usually begotten by disorders that cause the right ventricle to enlarge. Diagnosis is made by physical examination findings and is confirmed by echocardiography. We report two cases of severe tricuspid regurgitation secondary to the rupture of the chordae tendineae of the anterior leaflet following non-penetrating chest trauma. Both patients had uneventful postoperative courses

Evaluation of in-Hospital NT-ProBNP Changes in Heart Failure Patients to Identify the Six-Month Clinical Response Following Cardiac Resynchronization Therapy

N-terminal pro β-type natriuretic peptide (NT-proBNP) is a valuable marker for monitoring the response to treatment in patients with heart failure. Based on the clinically observed improvement of heart failure symptoms early after cardiac resynchronization therapy (CRT), we sought to investigate whether CRT induce any significant reduction in the plasma level of NT-proBNP in three days after implantation and whether it is correlated with patients' response at six months. In this prospective study, 21 consecutive patients with severe heart failure (New York Heart Association class 3.19±0.40) who underwent CRT were enrolled. Being alive, no hospitalization due to decompensated heart failure, and improvement of at least one NYHA functional class at six months were classified as clinical responsiveness. The plasma level of NT-proBNP was measured before, three days, and six months after CRT. Clinical evaluation, echocardiographic study, and six-minute walking test were performed before and six months after the procedure. At six months' follow-up, 16 (76.2%) patients were responders. The plasma level of NT-proBNP at three days after CRT increased almost equally in both responder and non-responder groups of patients (∆NT-proBNP was 40.94±135.74 vs. 54.80±88.98); however, at six months' follow-up, the NT-proBNP changes statistically differed across the two groups of patients (P=0.005). According to our findings, NT-proBNP percent deviation from baseline to three days after CRT appears to be not correlated with the patients' clinical response after six months, which was incongruent to the patients' clinical improvement after CRT

Tricuspid Regurgitation Improvement in Relation to the Amount of Pulmonary Artery Pressure Reduction

Background: Given the common concomitance of tricuspid regurgitation (TR) with significant mitral stenosis, we aimed at exploring the relation between TR severity and pulmonary artery hypertension (PAH) in patients who underwent mitral balloon valvotomy (MBV).Methods: We analyzed the echocardiography data of 133 consecutive patients (82.0% female, mean age 44.68 ± 12.56 years) with different degrees of TR severity that underwent MBV between April 2006 and March 2008. The pulmonary artery systolic pressure (PAPs) > 35 mmHg was considered as PAH.Results: Before MBV, 36.20% of the patients had moderate to severe TR, 92.5% PAH, and 18.0% right ventricular (RV)dilation (RV dimension ≥ 33 mm). After MBV, TR severity improved in 41.4%, worsened in 8.3%, and did not change in 50.4%. Before and after MBV, PAPs was significantly correlated with TR severity, and the mean PAPs change in patients with improved TR was significantly more than that of patients without TR improvement (p value = 0.042). Tricuspid regurgitation severity and mean PAPs (from 52.83 ± 18.82 to 35.89 ± 9.39 mmHg) decreased significantly after MBV (both p values <0.001); this reduction was significantly correlated to the amount of PAPs decrease. A cut-off point of ≥ 19 mmHg reductionin PAPs had a specificity of 71.79% and sensitivity of 52.73% to show TR severity improvement (by Receiver-Operative-Characteristics analysis). The mean of RV dimension decreased from 28.94 ± 5.43 to 27.95 ± 4.67 mm (p value < 0.001). In contrast to patients with RV dilation, TR reduced significantly in patients without RV dilation (p value < 0.001).Conclusion: Improvement in TR severity was directly correlated with the amount of PAPs reduction after MBV. Morestudies are needed to better define a cut-off value for PAPs reduction related to TR severity improvement

Correlation between Mitral Regurgitation and Myocardial Mechanical Dyssynchrony and QRS Duration in Patients with Cardiomyopathy

Background: Several competing geometric and hemodynamic factors are suggested as contributing mechanisms for functional mitral regurgitation (MR) in heart failure patients. We aimed to study the relationships between the severity of MR and the QRS duration and dyssynchrony markers in patients with ischemic or dilated cardiomyopathy. Methods: We prospectively evaluated 251 heart failure patients with indications for echocardiographic evaluation of possible cardiac resynchronization therapy. All the patients were subjected to transthoracic echocardiography and tissue Doppler imaging to evaluate the left ventricular (LV) synchronicity. The patients were divided into two groups according to the severity of MR: ≤ mild MR and ≥ moderate MR. The effects of different dyssynchrony indices were adjusted for global and regional left ventricular remodeling parameters. Results: From the 251 patients (74.5% male, mean age = 53.38 ± 16.68 years), 130 had ≤ mild MR and 121 had ≥ moderate MR. There were no differences between the groups regarding the mean age, frequency of sex, and etiology of cardiomyopathy. The LV systolic and diastolic dimensions were greater in the patients with ≥ moderate MR (all p values < 0.001). Among the different echocardiographic factors, the QRS duration (150.75 ± 34.66 vs. 126.77 ± 29.044 ms; p value =0.050) and interventricular mechanical delay (41.60 ± 29.50 vs. 35.00 ms ± 22.01; p value = 0.045) were significantly longer in the patients with ≤ mild MR in the univariate analysis. After adjusting the effect of these parameters on the severity of MR for the regional and global LV remodeling parameters, no significant impact of the QRS duration and dyssynchrony indices was observed. Conclusion: Our results showed that the degree of functional MR was not associated with the QRS duration and inter- and intraventricular dyssynchrony in our patients with cardiomyopathy. No association was found between the severity of MR and the ischemic or dilated etiology for cardiomyopath