bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1726 A case of double chamber right ventricle with membranous ventricular septal defect: multimodality approach before and after surgical repair
Authors: Mehtap Yeni M Y , Ibrahim Basarici İ B , Nermin Bayar N B , Sakir Arslan S A 
Published: January 2020

Abstract
21 year old male admitted with progressive dyspnea. Transthoracic echocardiogram(TTE) showed membranous type ventricular septal defect(VSD).Additionally there was an evident turbulence and nearly 120mm Hg (5.5m/s maximal velocity) gradient in the mid region of right ventricle(RV) a muscle bundle was restricting the flow. Double chamber right ventricle(DCRV) and VSD have been confirmed also with right heart catheterisation.Measured RV pressures were 90/0/5 mmHg and pulmonary artery pressures were 17/4(mean:8mmHg).Qp/Qs was 1.3. Cardiac magnetic resonance imaging (CMRİ) excluded other congenital defects like atrial septal defect,abnormal pulmonary venous return or aortic coarctation. Cardiac BT also clearly showed the hypertrophied muscular bundle which is close to the apex; was dividing the right ventricle cavity into two parts. Patient has been referred for surgery.On follow up, patient was doing well and TTE nicely showed a clear decrease of gradient as measured maximal velocity was 2m/s and no residual shunt of VSD. Control CMRİ also showed good RV function with a mild residual muscle structure.
Our case was a nice example of VSD without pulmonary hypertension because of restricted blood flow of pulmonary artery by a muscle bundle. If VSD is presented with a restricted RV outflow ; instead of a dilated RV chamber as been expected; a concomitant DCRV should be kept in mind.
Abstract P1726 Figure. video 1
P1728 Pulmonary hypertension in a pregnant Women - a rare anatomical aetiology
Authors: Grade Santos J , Ferreira F , Loureiro M , Almeida A , Pereira A , Repolho D , Sebaiti D , Alegria S , Sousa L , Almeida S , Pereira H 
Published: January 2020

Abstract
A 32 year old female patient, with a medical history of an ill-characterized Pulmonary Arterial Hypertension associated with congenital heart disease, lost in the follow up with no medical therapy, attended an emergency department for a gynecological hemorrhage at 16 weeks of pregnancy. Due to high maternity mortality risk, informed consent was obtained, and termination of pregnancy was performed. She was then referred to our pulmonary hypertension center.
At our center she had complains of fatigue with moderate intensity exertion, classified in a class II of the World Health Organization (WHO) classification, but was otherwise asymptomatic, with no history of dyspnea, angina or syncope. There was allusion to a self-limited episode of hemoptysis in the past. On physical examination she had an increased pulmonary component of the second heart sound, continuous heart murmur in left sternal border and no cyanosis (O2 peripheral saturation in the upper and lower limbs of 99% at room air).
The performed echocardiograms (both transthoracic and transesophageal) showed an estimated systolic pulmonary artery pressure of 120 mmHg with severe right ventricular hypertrophy and systolic dysfunction. There was dilatation of the trunk and right pulmonary artery. The left pulmonary artery was not seen.
Biochemical evaluation and viral serologies were unremarkable. The pulmonary function tests and the arterial blood gases were normal.
Cardiac MRI demonstrated the presence of a right aortic arch and a right patent arterial duct. An anomalous origin of the left pulmonary artery from the ascending thoracic aorta could be noted. Associated congenital cardiac defects were excluded.
A right heart catheterization confirmed the presence of severe pulmonary hypertension with mean pulmonary artery pressure of 86 mmHg and Pulmonary vascular resistance of 11 Wood Units. A large persistent arterial duct to the right pulmonary artery was confirmed with persistent left to right shunt. The left pulmonary artery was visualized when injection was performed in the aortic root. Coronary arteries were normally implanted.
The patient was started on Sildenafil and Bosentan (later replaced by Macitentan due to hepatic toxicity). After 3 years of follow up, there was an improvement in symptoms and in the 6 minutes walking test, remaining in a low risk category and on a WHO class I.
This case reports a very rare congenital abnormality identified in an adult patient. Despite the complex anatomy and severe pulmonary hypertension, the patient is reasonably well under medical therapy and close follow up.
Abstract P1728 Figure. Cardiac MRI Cine Sequences
P1730 Multimodality assessment of complex ventricular septal defect
Authors: Morrison M L , Kabir S , Salih C , Valverde I , Tometzki A , Simpson J M 
Published: January 2020

Abstract

Case Summary
A 16 month old, 8.2 kg patient came forward for evaluation of complex cardiac anatomy with multimodality imaging assessment to ascertain suitability for biventricular repair. A large ventricular septal defect was diagnosed before birth but possible straddling of the tricuspid valve identified postnatally.
The patient developed symptoms of congestive cardiac failure and was palliated with a pulmonary artery band. In view of the difficult nature of the defect they were reviewed with 3D-transthoracic echo, transoesophageal echo and cardiac MRI.
Their transthoracic echo confirmed situs solitus with levocardia, atrioventricular and ventriculoarterial concordance. There was a well placed pulmonary artery band with peak velocity of 5 m/s. Biventricular systolic function appeared good. There was a large ventricular septal defect at the inlet extending to the muscular septum. There were 2 prominent muscle bundles arising from the ventricular apex and it was difficult to distinguish on echocardiography which of these formed the true ventricular septum (Figures A & B). Although the tricuspid valve opened normally, there were multiple chords extending to overlie the right ventricular aspect of the ventricular septal defect (Figure C), some of which appeared to cross the through defect (*) and attach to the more leftward of the apical trabeculations (Figure D white dotted line illustrates the true plane of ventricular septum which overlies the attachments. Red dotted line represents the plane followed by the leftward apical trabeculation). Cardiac MRI showed that the trabeculation positioned to the left was the true ventricular septum, as it seemed to be in line with the plane of the atrial septum at the crux of the heart (Figure E & F). At surgery her heart was found to be unseptatable due to multiple straddling chords from the tricuspid valve inserting into multiple papillary muscle heads with the left ventricle.

Conclusions
The key issue in this case is which of the muscular structures positioned at the ventricular apex is considered to be the true ventricular septum as this determines whether on not there is straddle of the tricuspid valve. In addition the complex and multiple nature of the chordal attachments below the valve made accessing and closing the defect not feasible.
Even in the present era with wide availability of advanced, multimodality imaging techniques demonstrating anatomy can still prove challenging in planning surgical repair, especially within the setting of complex congenital heart disease. Many aspects of such cases still only become apparent at the time of surgery and this remains a key issue when counselling parents.
Abstract P1730 Figure.
P1735 Jellyfish sign, not all echocardiographic findings are related to heart disease
Authors: Lambarri Izaguirre A , Codina Prat M , Ugedo Alzaga K , Candina Urizar R , Castellanos Alcalde M , Aurrekoetxea Bajeneta G , Bravo Martinez I , Mendoza Cuartero P M , Asla Ormaza C , Caballero Alvarez D , Manzanal Rey A , Ibarrondo Garcia N , Ramirez-Escudero Ugalde G , Ruiz Gomez L , Ormaetxe Merodio J M 
Published: January 2020

Abstract
We report the case of a 71-year-old man, without any previous history of cardiovascular disease, who was derived to our echocardiography laboratory because of a six-month period of dyspnoea.
In the echocardiographic examination, various pleural masses which depended from the left visceral pleura were found, surrounded by, what it seemed, an abnormally located severe anterior pleural effusion, which caused left lung atelectasis (jellyfish sign, complete atelectasis of a lung lobe which floats above a massive pleural effusion) with a less important pericardial effusion (Figure 1). After the echocardiographic findings, a total body Computed Axial Tomography (CAT) scan and a Positron Emission Tomography (PET) were performed, confirming various left pleural implants and a severe left pleural effusion causing a big left lung atelectasis with widespread cervical, thoracic and abdominopelvic adenophaties, suggestive of advanced lymphoma. The cytological exam of the pleural liquid obtained by the thoracentesis procedure, showed a monotonous population of predominantly medium size cells with signs of nuclear indentation compatible with a pleural affection by a germinal center follicular lymphoma.
Pleural effusion is a common complication of lymphomas (20-30%) and is considered as one of the factors adversely influencing overall survival, as in most of the cases, serous cavity involvement is part of a disseminated disease process. The thoracic duct obstruction and impaired lymphatic drainage appear to be the primary mechanism for pathogenesis of pleural effusion in Hodgkin´s disease and direct pleural infiltration is the predominant cause in non-Hodgkin´s lymphoma. Because the descending thoracic aorta is interposed between the pericardium anteriorly and the pleura posteriorly, echocardiography may be a useful landmark in the differentiation of posterior effusions. However, sometimes due to the abnormal position of the effusion, it might be difficult to differentiate between pericardial and pleural effusions, with the need, as in our case, to perform a multi-modality imaging study with a CAT and PET scan, followed by a cytological exam, to confirm the diagnosis and to guide the posterior treatment. Finally, we would like to underline the importance of familiarizing ourselves on the basics of pulmonary echocardiography, as these findings are frequent during the performance of echocardiography in our daily practice.
Abstract P1735 Figure. Jellyfish sign in pleural effusion
P1759 How an echocariologist can work off-line in a personal computer on the echocardiography images at the level of mitral valve?
Authors: Karvandi M , Ranjbar S 
Published: January 2020

Abstract

Background
The objective of this presentation is to provide an educational survey on the mitral valve geometrical indices measurements using MATLAB software offline in a personal computer as an echo desk for further information and recommendation before mitral valve repairs or the other treatments.
Methods and Results:
Utilizing mathematical equation and MATLAB software (a simple echo desk) to measure the geometrical mitral valve variables offline based on 2D or 3D conventional echocardiographic images.

MATLAB software as an echocardiography desk
Open the MATLAB software. Write down the command pic = imread(‘’) in the command window. You can use this command to read an echocardiographic image from your computer and in a variable like a put. You must write the image address, image name and photo extensions in parentheses. For example, your echocardiographic image is in the following address: C:\Users\USER\Desktop\echo image 1.jpg. You should write the above command like this: pic = imread(‘C:\Users\USER\Desktop\echo image 1.jpg’); Finally, call that image by imshow(pic) command and then save the program and click the RUN bottom. You will see that a new window is opened and the image you are looking for is displayed. You can edit or measure the distances of the image using the menus above this observed image (Figure A). You can also extract frames from an echocardiography video clip of a patient by writing down the command Avi2frame (‘1.avi’, ‘OutputFolder’,’jpg’) in the command window and then you can work offline on echocardiography images frame by frame to calculate quantitative data (Figures B and C).

Conclusion
In spite of the introduced methods applied for echocardiographic datasets at the level of mitral valve for practical applications and clinical verifications. The most important applications, however, may be pedagogical. A computer desk (online or offline) can help an Echocardiologist to work on the echocardiographic images to evaluate the data.
Abstract P1759 Figure. working offline on echo images
P1762 Natural history and outcome of adults with bicuspid aortic valve: a middle-aged french cohort of 541 patients
Authors: Bohbot Y , Cheng C , Fay F , Elmkies F , Gugeinheim A L , Tribouilloy C 
Published: January 2020

Abstract

Funding Acknowledgements
none

Background
No data are available regarding the natural history and outcomes of middle-aged European patients with bicuspid aortic valve(BAV), as the only 2 large studies were conducted on the other side of the Atlantic.

Purpose
To determine the frequency of cardiovascular events and to assess the survival relative to that of the general population(GP) in a large population of adults diagnosed with BAV according to the presence or the absence of a surgical indication at baseline.

Methods
Between 2005 and 2017, 350 patients without surgical indication (mean age 53, 71% men) and 191 patients with surgical indication (mean age 59, 71% men) at baseline were included. Median follow-up was 80 months.

Results
In the medical group, 34 deaths(9.7%) were recorded(10 cardiovascular). The 10-years survival rate was 88 ± 2% with a relative survival compared to the age-and-sex matched population of 98.8%. Nine patients(2.6%) were diagnosed with infective endocarditis (IE) and no aortic dissection occurred. Aortic valve and/or ascending aorta surgery was performed in 102 patients(29%) during follow-up. In the surgical group, 12 deaths(6.3%) were recorded(5 cardiovascular). The 10-years survival rate was 90 ± 3% with a relative survival compared to the matched population of 99.2%. Five patients(2.6%) were diagnosed with IE and no aortic dissection occurred.

Conclusion
Middle-aged adults with BAV have a high likelihood of surgery but a survival comparable to the GP. The rate of IE is low and no aortic dissection occurred in our study.
Abstract P1762 Figure. a) survival curves B) surgery incidence
P1763 Impact of disproportionate functional mitral regurgitation
Authors: Bartko P E , Heitzinger G , Arfsten H , Pavo N , Spinka G , Prausmueller S , Andreas M , Mascherbauer J , Hengstenberg C , Huelsmann M , Goliasch G 
Published: January 2020

Abstract

Background
Application of the effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) is potentially limited as such lesion-focused metrics inevitably lack flexibility to account for the heterogeneity of left ventricular size and function. A recently proposed conceptual framework seeks to rearrange EROA and RegVol cut-offs according to left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF), introducing the novel term "disproportionate FMR" to describe clinically meaningful FMR.

Methods
To test the impact of disproportionate FMR, we embedded data of 291 heart failure patients with reduced ejection fraction (HFrEF) under guideline directed therapy (GDT) into this framework. Regurgitant Volume and EROA were plotted against LVEDV using bubble plots that also account for the heterogeneity of EF (Figure 1 A and C). The black lines depict a regurgitant fraction (RegFrac) of 50% at the median EF (25%) or Vmax (4.3m/s) of the study population. Thus, above individual center lines (illustrated by different bubble sizes) FMR severity is disproportionate, within the area of measurement uncertainty it is proportionate to LV dilation and below, it is likely non-severe. The degree of uncertainty of proportionate FMR is determined by the imprecision of the measurements defined as 2SDs of regurgitant fraction (±6.6%) per Bland-Altmann analysis.

Results
During a median follow-up of 84 months (IQR 84-136), 166 patients died. Disproportionate FMR was associated with excess mortality (RegVol: HR 1.97, 95%CI 1.38-2.81, P &lt; 0.001; EROA: HR 2.22, 95%CI 1.52-3.22), whereas proportionate FMR was not associated with increased long-term mortality (RegVol: HR 1.04, 95%CI 0.71-1.53, P = 0.83; EROA: HR 1.06, 95%CI 0.71-1.58, P = 0.79; Figure 1B&D).

Conclusions
In this contemporary HFrEF cohort every fifth patient has disproportionate FMR which conveys a two-fold increased risk of mortality which provides evidence for the validity of the conceptual framework. Advancement of the proposed framework to clinical practice has several implications: 1)EROA and RegVol are metrics that do not account for the contextual variability of LVEDV and EF. 2)The RegFrac -not incorporated in ESC guidelines but integrated in AHA/ACC definitions- provides a metric proportionated to left ventricular size and function supporting its use to define relevant FMR. However, technical limits suggest its complementary use on top of more robust metrics such as EROA and RegVol. Future studies need to clarify whether disproportionate FMR reflects the subgroup of patients that benefit from mitral valve repair, and provide a robust algorithm that integrates the metrics of FMR severity in a complementary manner.
Abstract P1763 Figure.
P1764 A unifying concept for the quantitative definition of functional mitral regurgitation
Authors: Bartko P , Arfsten H , Heitzinger G , Pavo N , Toma A , Strunk G , Hengstenberg C , Huelsmann M , Goliasch G 
Published: January 2020

Abstract

Background
Diverging guideline definitions for the quantitative assessment of severe secondary mitral regurgitation (sMR) reflect the lacking link of the sMR spectrum to mortality and has introduced a source of uncertainty and continuing debate.

Objectives
The current study aimed to define improved risk-thresholds specifically tailored to the complex nature of sMR that provide a unifying solution to the ongoing guideline-controversy.

Methods
We enrolled 423 heart failure patients under guideline directed medical therapy and assessed sMR by effective regurgitant orifice area (EROA), regurgitant volume (RegVol) and regurgitant fraction (RegFrac).

Results
Measures of sMR severity were consistently associated with 5-year mortality with a HR for a 1-SD increase of 1.42 (95%CI 1.25-1.63, P &lt; 0.001) for EROA, 1.37 (95%CI 1.20-1.56, P &lt; 0.001) for RegVol and 1.50 (95%CI 1.30-1.73, P &lt; 0.001) for RegFrac. Results remained statistically significant after bootstrap- or clinical confounder-based adjustment. Spline-curve analyses (Figure 1A-C) showed a linearly increasing risk enabling to stratify in low-risk (EROA &lt; 20mm2 and RegVol &lt; 30ml), intermediate-risk (EROA 20-30mm2 and RegVol 30-45ml) and, high-risk (EROA≥30mm2 and RegVol≥45ml). In the intermediate-risk group, a RegFrac ≥50% as indicator for hemodynamic severe sMR was associated with poor outcome (P = 0.017). A unifying concept based on combined assessment of the EROA, the RegVol, and the RegFrac (Figure 1D) showed a significantly better discrimination compared to the currently established algorithms (Table 1).

Conclusions
Risk-based thresholds tailored to the pathophysiological concept of sMR provide a unifying solution to the ongoing guideline controversy. An algorithm based on the combined assessment of the unifying cut-offs for EROA, RegVol and RegFrac improves risk prediction compared to currently established grading.
Table 1 Definition of severe sMR Cox regression analysis ROC analysis IDI analysis HR (95%CI) P-Value ROC P-Value-for-comparison IDI P-Value Unifying concept 3.76 (2.71-5.23) &lt;0.001 0.63 –- –- –- ACC/AHA definition 3.20 (2.14-4.78) &lt;0.001 0.57 &lt;0.001 0.06 &lt;0.001 ESC/EACTS definition 1.52 (1.10-2.09) 0.01 0.55 &lt;0.001 0.13 &lt;0.001 ACC/ASE expert consensus 1.89 (1.40-2.56) &lt;0.001 0.59 0.04 0.08 &lt;0.001 Comparison of the unifying concept with the ACC/AHA, ESC/EACTS and ACC/ASE expert consensus definitions of sMR by Cox regression, ROC, and IDI demonstrated the most powerfull prediction by the unifying concept with significantly higher ROC area under the curve and better discriminatory power by IDI.
Abstract P1764 Figure 1 A-D
P1767 Abnormal longitudinal peak systolic strain in asymptomatic patients with psoriatic arthritis
Authors: Tsigaridas N , Mantzoukis S , Mantzoukis S , Toli E , Toli E , Tsimos K , Tsimos K , Varsamis N , Varsamis N , Gerasimou M , Gerasimou M , Gianniki M , Gianniki M , Patsouras D , Patsouras D , Tsifetaki N , Tsifetaki N 
Published: January 2020

Abstract

Background/Introduction: Psoriatic arthritis (PsA) is a systemic inflammatory disease affecting 15-30% of patients with psoriasis. Patients with PsA present 43% higher risk of cardiovascular disease compared to non-psoriatic patients. However, the probable existence of subclinical myocardial dysfunction in these patients has not been fully elucidated.

Purpose
Purpose of this study is to evaluate systolic and diastolic myocardial function in asymptomatic patients with PsA and no cardiac comorbidities and to reveal the value of speckle tracking echocardiography in this object.

Methods
Sixty patients (29 males, mean age 52.55) and 34 healthy controls (18 males, mean age 50.79) participated the study. They were subjected to TTE to evaluate left ventricular systolic function with conventional indexes such as ejection fraction (EF) and with novel indexes such as global longitudinal strain (GLS); diastolic dysfunction was also assessed in both groups. Blood exams were conducted including crp, esr. Severity scales of the disease such as PASI and DAS 28 scores, and the duration of the disease were also recorded.

Results
Linear regression analysis showed significantly impaired global longitudinal peak systolic strain (GLS) in PsA patients (mean =-19.79, s.d. =4.54) compared to the controls (mean =-23.67, s.d. =3.27). Ejection fraction, on the contrary, did not show any significant difference between the two groups. Left ventricular diastolic function did not present significant difference between the two groups. Comparison of GLS with PASI and DAS 28 scores, disease duration, esr and crp showed no association.

Conclusions
PsA patients present a higher risk of left ventricular systolic dysfunction. GLS is a useful tool in revealing myocardial impairment. Moreover, this high risk for systolic dysfunction did not appear to correlate with disease severity markers.
Systolic and diastolic function indexes GroupStatistics group N Mean Std. Deviation Std. ErrorMean p-value E/A Cases 60 1,1510 ,49319 ,06367 0,971 Controls 34 1,1471 ,53555 ,09185 E/E" (average) Cases 60 8,21 3,016 ,389 0,703 Controls 32 7,95 3,096 ,547 GLS (%) Cases 52 -19,795 4,5495 ,6309 &lt;0,001 Controls 34 -23,671 3,2668 ,5602 EF(%) Cases 59 59,24 3,919 ,510 0,986 Controls 34 59,26 10,880 1,866 Differences between PsA patients and control group
Abstract P1767 Figure. GLS in PsA patients and control group