When opportunity knocks

Constrictive pericarditis remains a common medical problem in developing countries where it frequently complicates tuberculous pericarditis. In addition, it is not infrequently seen in the developed world in the context of previous cardiac surgery, chest irradiation and even idiopathic pericarditis.(1) The diagnosis of pericardial constriction is often elusive and delays between the onset of symptoms and final diagnosis is the norm. Given the potential curability of this cause of heart failure and the fact that various features of chronicity in the disease portend a poor prognosis, recognising the disease early is of paramount importance.(1) The haemodynamics of constriction, particularly in more pronounced cases, produces a set of interesting clinical findings that the vigilant physician can elicit. A useful, and often neglected clinical feature, is that of a diastolic precordial or epigastric impulse, the palpable equivalent of an audible diastolic pericardial knock. This short report illustrates this unique clinical finding and explains the haemodynamics responsible for it. We also briefly review other commonly found clinical findings that assist in making the diagnosis of constrictive pericarditis

Tri-leafl et mitral valves – when lightning strikes thrice

Mitral valves are well known to be bi-leaflet structures with attachments from both leaflets (anterior and posterior) to both papillary muscles (anterolateral and posteromedial). Congenital abnormalities of the mitral valve, although well described, are quite rare. These abnormalities can involve either the leaflet (cleft mitral valve) or the subvalvular apparatus (parachute mitral valve) or even occur as accessory mitral valve tissue (accessory mitral valve leaflet). These can occur in isolation, or in association with other congenital abnormalities. A tri-leaflet mitral valve is a novel echocardiographic finding that has only been described in 6 patients in 4 different case reports.(1-4) Wereport on 3 patients recently found to have trileaflet mitral valves in the setting of atrioventricular concordance and normal offset of the AV valves at our out-patient clinic

A retrospective analysis of mitral valve pathology in the setting of bicuspid aortic valves

CITATION: Van Rensburg, A., Herbst, P. & Doubell, A. 2017. A retrospective analysis of mitral valve pathology in the setting of bicuspid aortic valves. Echo Research and Practice, 4(2):21-28, doi:10.1530/ERP-17-0016.The original publication is available at http://www.echorespract.comThe therapeutic implications of bicuspid aortic valve associations have come under scrutiny in the transcatheter aortic valve implantation era. We evaluate the spectrum of mitral valve disease in patients with bicuspid aortic valves to determine the need for closer echocardiographic scrutiny/follow-up of the mitral valve. A retrospective analysis of echocardiograms done at a referral hospital over five years was conducted in patients with bicuspid aortic valves with special attention to congenital abnormalities of the mitral valve. One hundred and forty patients with a bicuspid aortic valve were included. A congenital mitral valve abnormality was present in eight (5.7%, P = 0.01) with a parachute mitral valve in four (2.8%), an accessory mitral valve leaflet in one (0.7%), mitral valve prolapse in one, a cleft in one and the novel finding of a trileaflet mitral valve in one. Minor abnormalities included an elongated anterior mitral valve leaflet (P < 0.001), the increased incidence of physiological mitral regurgitation (P < 0.001), abnormal papillary muscles (P = 0.002) and an additional chord or tendon in the left ventricle cavity (P = 0.007). Mitral valve abnormalities occur more commonly in patients with bicuspid aortic valves than matched healthy individuals. The study confirms that abnormalities in these patients extend beyond the aorta. These abnormalities did not have a significant functional effect.http://www.echorespract.com/content/4/2/21Publisher's versio

Speckle tracking echocardiography in acute lupus myocarditis : comparison to conventional echocardiography

CITATION: Du Toit, R., et al. 2017. Speckle tracking echocardiography in acute lupus myocarditis : comparison to conventional echocardiography. Echo Research and Practice, 4(2):9-19, doi:10.1530/ERP-17-0005.The original publication is available at http://www.echorespract.comAims: Lupus myocarditis occurs in 5–10% of patients with systemic lupus erythematosus (SLE). No single feature is diagnostic of lupus myocarditis. Speckle tracking echocardiography (STE) can detect subclinical left ventricular dysfunction in SLE patients, with limited research on its utility in clinical lupus myocarditis. We report on STE in comparison to conventional echocardiography in patients with clinical lupus myocarditis. Methods and results: A retrospective study was done at a tertiary referral hospital in South Africa. SLE patients with lupus myocarditis were included and compared to healthy controls. Echocardiographic images were reanalyzed, including global longitudinal strain through STE. A poor echocardiographic outcome was defined as final left ventricular ejection fraction (LVEF) <40%. 28 SLE patients fulfilled the criteria. Global longitudinal strain correlated with global (LVEF: r = −0.808; P = 0.001) and regional (wall motion score: r = 0.715; P < 0.001) function. In patients presenting with a LVEF ≥50%, global longitudinal strain (P = 0.023), wall motion score (P = 0.005) and diastolic function (P = 0.004) were significantly impaired vs controls. Following treatment, LVEF (35–47% (P = 0.023)) and wall motion score (1.88–1.5 (P = 0.017)) improved but not global longitudinal strain. Initial LVEF (34%; P = 0.046) and global longitudinal strain (−9.5%; P = 0.095) were lower in patients with a final LVEF <40%. Conclusions: This is the first known report on STE in a series of patients with clinical lupus myocarditis. Global longitudinal strain correlated with regional and global left ventricular function. Global longitudinal strain, wall motion score and diastolic parameters may be more sensitive markers of lupus myocarditis in patients presenting with a preserved LVEF ≥50%. A poor initial LVEF and global longitudinal strain were associated with a persistent LVEF <40%. Echocardiography is a non-invasive tool with diagnostic and prognostic value in lupus myocarditis.http://www.echorespract.com/content/4/2/9.full?sid=c26dad46-d821-4592-8805-ad0bba805a46Publisher's versio

An unusual cause for a dilated right heart 33-years post-surgical repair of aortic coarctation

CITATION: Kyriakakis, C. G., et al. 2018. An unusual cause for a dilated right heart 33-years post-surgical repair of aortic coarctation. SA Heart, 15(3):220-224, doi:10.24170/15-3-3193.The original publication is available at https://www.journals.ac.za/index.php/SAHJPrior to planning for the surgical correction of a congenital cardiac defect it is of the utmost importance that additional defects, which themselves might also require surgical correction, be sought and identified. Of these, those leading to volume overload of the right heart, and particularly those that are not easily identified on transthoracic echocardiography, may go unnoticed during initial evaluation in childhood. We describe the approach to such a clinical problem, highlighting the value of multimodality imaging in this context, and outline the options available for surgical correction.https://www.journals.ac.za/index.php/SAHJ/article/view/3193Publisher's versio