Intramural Ventricular Septal Defect

Intramural ventricular septal defects (VSDs) are less frequently encountered but clinically significant type of residual interventricular communications seen after complex congenital heart surgeries. Hemodynamically significant intramural VSDs can lead to higher postoperative morbidity and mortality. This case highlights the clinical challenges including the need multiple interventions faced in affected patients

Altered Pulmonary Venous Flow Pattern in Young Adults with Atrial Septal Defect

Introduction: Atrial septal defect (ASD) is a common congenital heart disease and causes left-to-right shunting and significant right ventricular (RV) volume overload. The goal of this study was to evaluate the influence of these hemodynamic changes on pulmonary venous flow pattern in young adults.Methods: Complete echocardiographic examination was performed in a group of 40 young adults (aged < 40 years) who had secundum type ASD and was compared to 40 age-matched individuals in control group who had no cardiac abnormality. Systolic and diastolic flow velocities in pulmonary veins (PV), superior vena cava (SVC), inferior vena cava (IVC) and RV functional parameters were recorded and evaluated.Results: As opposed to healthy young individuals who showed distinct S and D waves with diastolic predominance in pulmonary vein Doppler, in patients with ASD a continuous flow with increased systolic peak that began in systole and continued to the late diastole was observed. The RV systolic function increased compared to the control group.Conclusions: In patients with ASD, the pattern of pulmonary veins flow transforms into a single continuous antegrade wave with systolic dominance due to persistent shunting of left atrial blood in to right heart chambers as well as increased RV pump function on pulmonary vein (by means of ASD), SVC and IVC, and could be used as a screening method for the presence of secundum type ASDs in young adults

Retinal Artery Embolism Considering Bicuspid Aortic Valve

Introduction: The aortic valve has usually three cusps. The aortic valve regulates blood flow, and it opens to let blood flow from the left ventricle to the aorta (systole), and it closes to prevent blood from flowing in the wrong direction (diastole). Material & Methods: Bicuspid aortic valve (BAV) is a common congenital disease in which the aortic valve has only two valves. Due to this disorder and non-parallel opening and closing, the valve will not function properly. However, the function is usually proper that patients have normal clinical conditions for several years without noticing any visible signs or symptoms. This disease is presented as a sporadic or hereditary form, and it has been observed in 9% of the first-degree relatives of the affected. BAV is frequently discovered during the echocardiography performed for another indication or after developing complications. Affected patients are at risk of progressive aortic stenosis, aortic regurgitation, aortopathy with aortic aneurysm or dissection and endocarditis. There are also associated congenital anomalies including coarctation of aorta. Due to the progressive and asymptomatic nature of the disease, annual echocardiography to check valve function and CT scan or magnetic resonance imaging (MRI) to check aortic aneurysm is recommended. (Ethic Code: IR.RHC.REC.1399.083) Findings: Calcium deposits gradually on the valve in patients with different degrees of aortic valve stenosis due to damage to the endothelium and degenerative valvular tissue. One of the uncommon but serious complications of BAV is systemic embolism owing to these deposits to various organs, including cerebral vessels and retinal artery. Embolism may occur even earlier and from a valve that is not yet ready for surgery according to existing signs and symptoms. In these cases, clinical decision-making for early valve replacement can be challenging. Discussion & Conclusion: This study investigated a case of a young athlete male presenting with sudden onset unilateral visual loss. The echocardiography results showed degenerative changes and calcification of the aortic valve considering BAV without severe stenosis that was identified incidentally

Congenital atresia of left main coronary artery

Congenital atresia of the left main coronary artery is a very rare form of coronary anomalies with poor clinical outcomes if left untreated. Patients require surgical correction by coronary bypass grafting after diagnosis. Here we report a case of congenital left main atresia in a 36 years old woman who had previous heart surgery with this anomaly having gone undetected. Keywords: Congenital heart disease, Left main atresia, Coronary abnormalit

Safety and feasibility of simultaneous left and right heart catheterization via single-arm arterial and venous access

Background: Catheterization via the radial artery has become the method of choice for evaluation of the coronary arteries; however in patients requiring simultaneous coronary and right heart catheterization upper extremity access is not commonly used. Aims: In the present study we aimed to assess whether simultaneous left and right heart catheterization via the radial artery and antecubital vein might increase the vascular access site complications. Methods: In this prospective cohort study, 49 patients with congenital and valvular heart disease requiring both left and right heart catheterization were enrolled, and rates of vascular access complications, including radial artery obstruction (RAO), were compared to 49 subjects in the control group who underwent catheterization only via radial artery access. Results: No major vascular complications occurred in the study population. Post-procedural radial artery obstruction was detected in 14 patients (28.5%) in the venous-radial artery group and 7 (14.2%) in the control group (P = 0.09). Age, sex, body mass index, wrist circumference, hemoglobin concentrations, and history of smoking, diabetes mellitus, hypertension, and anticoagulant use did not affect the rate of radial pulse perseverance. However, shorter times of radial compression device removal were significantly related to lower rates of radial artery obstruction in both groups. Conclusion: Right and left heart catheterization via an upper-extremity route in patients with congenital and valvular heart disease is safe and practical with greater patient comfort and no serious vascular complications. A longer duration of radial compression is an important predictor of RAO, regardless of using additional upper-extremity venous access

Prosthesis-Patient mismatch after aortic valve replacement: A single-center experience

Background: The impact of prosthesis-patient mismatch (PPM) on early and late outcomes after aortic valve replacement (AVR) remains controversial. In this study, we aimed to investigate the patient and surgery-related factors leading to various severities of PPM following AVR. Methods: Ninety-six patients who had undergone AVR with a prosthetic valve between 2001 and 2013 and later found to have PPM were enrolled. PPM was defined as the indexed effective orifice area (iEOA) of the aortic prosthesis to be ≤0.8 cm2/m2. PPM was considered to be of moderate or severe degrees if the iEOA was between 0.66 and 0.85 cm2/m2 or ≤0.65 cm2/m2, respectively. Results: The mean age of patients was 26 ± 15 years, and 51% of patients were female. Sixteen patients (15.2%) had mild PPM, 40 patients (38.1%) had moderate PPM, and 40 patients (38.1%) had severe PPM. The majority of our patients had surgery due to congenital causes. Prosthetic valve size and preoperative left ventricular outflow tract diameter were factors statistically related to PPM in the three groups (P < 0.05). There was only one death that was in severe PPM group due to severe heart failure. Conclusion: PPM is a substantial yet underrated clinical entity in patients undergoing prosthetic valve replacement surgery. Patients with smaller body surface areas, surgery at earlier age, and underlying congenital heart disease are more commonly prone to the development of PPM. As our center is referral for the patients affected with congenital aortic valve disease, mindful scheduling and performance of the aortic valve replacement surgery in this patient population is highly recommended

Transcatheter closure of large atrial septal defects: A single-center experience

Background: Despite the favorable history of surgical approach to repair secundum type atrial septal defects (ASDs), the transcatheter closure has increasingly become the preferred strategy because of its relatively high efficacy and lower morbidity compared to surgery in selected cases. However, there is some controversy around the preferred strategy and long-term complications of device closure of large ASDs. Here, we evaluated the early and midterm outcomes of adults with large ASDs who underwent transcatheter device closure with devices larger than 28 mm. Methods: A prospective single-center study was conducted encompassing all the patients who were 18 years of age or older and underwent device closure for secundum type ASD from 2006 to 2014 with device size of >28 mm, and early and midterm follow-up data were assessed. Results: The procedure was successful in 93.6% of the scheduled patients. Two and a half percent had nonsignificant residual shunt. Immediate device migration occurred in one patient (1.2%) who underwent surgical retrieval and defect closure. One case of device thrombosis (1.2%) was seen 1 month after the procedure who had successful medical treatment. There was a case of device erosion 1 month after the procedure referred for the surgery. Mild postintervention pericardial effusion was seen in 16.5% and reduced to 7.6% in the first outpatient visit. Conclusions: The study demonstrated that the vast majority of anatomically suitable large ASDs could be closed by using the transcatheter technique with a low complication rate. Therefore, the transcatheter closure could be recommended as the first-line strategy in adults with large ASDs. However, meticulous preprocedural imaging and evaluation by experts are necessary before scheduling patients with large ASDs for the percutaneous alternative

Natural history of aortic regurgitation following percutaneous mitral valvuloplasty

Background: Little is known about the natural history of aortic regurgitation (AR) in patients undergoing mitral valve procedures for mitral stenosis. Objectives: The aim of this study was to evaluate the short- and long-term effects of percutaneous mitral valvuloplasty (PMV) on coexisting AR. Materials and Methods: A total of 327 patients with rheumatic mitral stenosis (282 females and 45 males; mean age at the time of intervention = 47 ± 11 years) were followed up for between 48 hours and 13 years after PMV. At the time of PMV, 142 (43.3%) patients had no AR, 124 (37.9%) had mild AR, and 61 (18.7%) had moderate AR. After PMV, the follow-up showed that 120 (36.6%) patients had no AR, 103 (31.5%) had mild AR, and 104 (31.8%) had moderate AR. Results: AR progression after PMV and during the follow-up was significant (P < 0.00), but there was no significant increase in aortic valve replacement (AVR) procedures. The rate of AVR was higher in the moderate AR group (3.8%). There were no significant changes in the left atrial size (LA) (P = 0.6), ejection fraction (EF) (P = 0.4), and rhythm (P = 0.4) before and after PMV, respectively. Conclusions: Our findings indicate that among patients with rheumatic mitral stenosis, a considerable number have concurrent AR. Concomitant AR at the time of PMV does not influence procedural success and is not associated with inferior outcomes. Rheumatic aortic insufficiency progresses slowly by nature, and patients with AR and mitral stenosis can safely tolerate PMV without the possibility of undergoing AVR in the near future. Patients with moderate degrees of AR remain good candidates for PMV

The association between increased carotid intima–media thickness and SYNTAX Score in coronary artery disease: A single center study

Background: Carotid artery lesions frequently coexist with coronary arterial disease (CAD). The aim of this study was to investigate the relation between carotid intima-media thickness (CIMT) and the extent of CAD and whether CIMT could be predictive of severity of coronary atherosclerosis. Methods: Coronary angiography and carotid ultrasound evaluations of 100 consecutive patients with CAD who had undergone elective coronary angiography were reviewed. IMT was measured at both carotid arteries. CIMT and severity of CAD relationship based on SYNTAX score was assessed. The relation between CIMT and cardiovascular risk factors was determined. Results: Mean overall SYNTAX score was 15.76 + 4.82. Mean right CIMT was 0.86 ± 0.29 and mean left CIMT was 0.83 ± 0.24. There were no significant correlation between the SYNTAX score and CIMT (r: 10, P: 30). There was significant relationship between hypertension,diabetes and CIMT (P: 0.01). Conclusion: we found no relationship between CIMT and SYNTAX score in patients who underwent coronary angiography. Diabetes mellitus and hypertension are related to increased carotid intima-media thickness. Keywords: Carotid intima-media thickness, Coronary artery disease, SYNTAX scor

Congenital Aortico-Left Ventricular Tunnel: A Case Report of a Rare Cause of Aortic Regurgitation in Adults

The aortico-left ventricular tunnel is a rare congenital abnormality resulting in a pathologic connection between the aorta and the left ventricle. It often presents during infancy or early childhood as a cardiac failure symptom or an incidental finding of a cardiac murmur due to severe aortic regurgitation. It is, however, also occasionally found in asymptomatic adults. We describe a 20-year-old female presenting with palpitations in whom clinical evaluations with echocardiography and computed tomography angiography led to the diagnosis of severe aortic regurgitation caused by a tunnel connecting the right sinus of the aorta to the left ventricle. The patient underwent successful obstruction of the tunnel with an autologous pericardial patch and the repair of the dilated aortic root via the reduction aortoplasty technique. She was discharged on the 5th postoperative day with no complications. At 1 month’s follow-up, she remained asymptomatic and echocardiography showed aortic valve competence with no residual regurgitation