bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1596 Pulmonary hypertension in cardiology practice: clinical echocardiographic evaluation
Authors: Legkonogov A 
Published: January 2020

Abstract

Purpose
To study the clinical echocardiographic features of various variants of pulmonary hypertension (PH).
Methods of research. Clinical evaluation and analysis of the results of 45,000 Doppler echocardiographic studies were performed. Moderate PH corresponded to the mean pulmonary artery pressure (MPAP) level up to 50 mm Hg, severe PH was characterized by MPAP above 50 mm Hg.

Results
Clinically significant moderate and severe PH was established in 283 patients, which was 0.63% of the examined patients. Severe PH was detected in 106 patients, including 30 men and 76 women, whose average age was 43.1 ± 1.7 years in the age range of 14-75 years. Patients with congenital heart disease (CHD) represented the majority of the patients with severe pulmonary arterial hypertension (PAH) - 49 people (10 men and 39 women, mean age 43.0 ± 1.8 years in the age range of 14-69 years), including 16 with ventricular septal defect, 9 with an atrial septal defect, 7 with transposition of the great arteries, 6 with complete common atrioventricular canal defect, 3 with congenitally corrected transposition of the great arteries, 3 with a double outlet right ventricle, 3 with a common arterial trunk, 2 with the Ebstein anomaly. Severe PH was also established in 12 patients with idiopathic PAH, 21 patients with recurrent pulmonary embolism (PE), 10 with acquired valvular heart disease (AVHD) (in 7 cases with severe mitral stenosis, 3 with severe aortic stenosis), in 7 patients with postinfarction left ventricular aneurysm, 4 patients with chronic obstructive pulmonary disease (COPD), 3 with dilated cardiomyopathy. Moderate PH was diagnosed in 177 patients (97 men and 80 women, mean age 60.3 ± 1.3 years in the age range of 21-87 years), including 54 patients with dilated, 26 - ischemic cardiomyopathy, 38 with AVHD, 26 with PE, 17 post-MI patients, 9 with CHD, and 7 with COPD. PAH-specific therapy with bosentan and / or sildenafil was performed in 9 patients with idiopathic PAH and 7 patients with CHD without significant clinical effect; in other cases, nonspecific therapy was continued with diuretics, positive inotropic agents, and anticoagulants.

Conclusions
The most pronounced manifestations of PH were observed predominantly in CHD patients with advanced left-to-right and right-to-left shunting of blood, idiopathic PAH and thromboembolic PH. For prevailing venous PH, the less pronounced clinical manifestations were observed in patients with ischemic, non-coronary and valvular heart lesions, as well as with COPD accompanied by hypoxemia.
P1598 Ruptured Sinus of Valsalva: clinical and echocardiographic features at presentation and long-term results after surgical and percutaneous repair
Authors: Fusco F , Castro M , Rigby M , Shore D , Scognamiglio G , Gatzoulis M , Li W 
Published: January 2020

Abstract

Background
Rupture of Sinus of Valsalva (rSOV) is a rare and potentially life-threatening condition often misdiagnosed. Percutaneous device closure has been replacing surgical repair as a treatment of choice. However, long-term outcome is poorly documented.

Methods
Echo database (2001-2019) was searched for patients &gt;16y with rSOV. Clinical data were collected from ACHD database. Marfan Syndrome patients were excluded.

Results
Fifteen patients (42.2y, 10M) were diagnosed with rSOVbetween 1979 and 2019. HF symptoms at initial presentation were reported in 50%. All cases were diagnosed by TTE with finding of high velocity continuous flow from SOV to right heart. Two were initially misdiagnosed as VSD. Digital imaging recordings of 10/15 were available. The aortic root was dilated in 8/10. Four had asymmetrical SOV dilatation. LV and LA were dilated in 7/10 and 9/10. Significant aortic regurgitation was in 4. Two had RVOTO. RVSP was always raised. Echo findings are summarised in the Table.
Mean FU after repair was 10,7y (0,9-39). Ten patients had surgical repair and 5 device closure. Seven had repair of concomitant lesions (4 VSD closure and 3 AVR) at the time of the procedure. One redo device closure was performed. During FU 1 died from Cardiomyopathy. At the latest FU significant improvement in functional class, LV and LA size and RVSP was found.

Conclusion
Patients with rSOV may present with acute HF. High velocity continuous flow from SOV to right heart on TTE is characteristic feature for diagnosis. Percutaneous closure is an attractive alternative to surgery in patients with isolated lesion. Significant haemodynamic improvement can be achieved with good long-term haemodynamic results
Tot = 15 Initial findings Latest FU NYHA class 4 class I 2 class II 2 class III 4 class IV 3 unknown 11 class I 2 class II 1 class III 0 class IV* SOV (mm) 38.2 (33-44) STJ (mm) 36.2 (26-42 Asc Ao (mm) 30.3 (25-34) rupture site 8 RC sinus, 2 NC sinus Shunt to 8 RVOT, 1 RA, 1 RVOT + RA LVEDV (ml) 169.7 (114-330) 120 (67-230)* LVESV (ml) 66(42-130) 46 (28-80)* LAVi (ml/m2) 53.1 (30-129) 35 (24-53)* LV EF% 61.2 (57-65) 60.4 (50-70) RVSP (mmHg) 53.2 (37-130) 24.06 (15-32)** Pre VS post procedure p-value: * P &lt; 0,05 **P &lt; 0,01
Abstract P1598 Figure. PLAX in patient with ruptured RC sinus
P1687 When the easiest answer is the right one
Authors: Olaru-Lego G , Predescu L , Achim C , Radu D N , Ginghina C , Enache R 
Published: January 2020

Abstract
A 42 year-old woman presented with moderate exertion dyspnea within the past months. She was hypertensive, with end stage-chronic kidney disease (CKD) on hemodialysis for 8 years, initially by arteriovenous fistula and then by central venous catheter. She associated thrombosis of both common femoral veins.
Clinical examination revealed mild leg edema, hepatomegaly, III/VI systolic murmur, left brachiocephalic arteriovenous fistula with aneurismal dilation and subclavian central venous catheter. Resting ECG showed atrial flutter with variable block and biventricular hypertrophy. Lab studies highlighted mild anemia, glomerular filtration rate (MDRD) 13.5 ml/min/1.73m2, hyperhomocysteinemia.
Transthoracic echocardiography revealed left ventricle (LV) with normal diameters and mild concentric hypertrophy, mild systolic LV dysfunction and diastolic dysfunction (Fig A), dilation of both atria, mild mitral regurgitation, dilated RV with moderate global dysfunction, moderate tricuspid regurgitation and secondary pulmonary hypertension (PH) with estimated systolic pulmonary artery pressure of 79 mmHg (Fig C), moderate pulmonary regurgitation, moderate dilatation of pulmonary artery. Vascular Doppler ultrasonography showed thrombosis of the arteriovenous fistula and of right jugular vein. To confirm PH, right heart catheterization was necessary. The intervention could not be realized on femoral approach due to thrombosis of both common femoral veins. We considered the jugular approach, but weighing the risks/benefits balance, with one functional jugular vein, we decided not going for it, as the jugular approach was the only vascular approach for dialysis. We performed left catheterization right after a dialysis session and an LV end-diastolic pressure of 13 mmHg was measured. The possible causes of PH considered in this case were the CKD by itself, a pulmonary thromboembolic component in a patient with hyperhomocisteinemia and thrombosis of both femoral veins and a left heart component given the borderline value of LV end-diastolic pressure.
The patient received treatment with beta-blockers, blockers of the renin-angiotenins-aldosterone system, calcium channel blockers and oral anticoagulation. She was evaluated after two months describing improvement of symptoms. The resting ECG showed sinus rhythm and the echocardiography revealed improved parameters of LV diastolic function (Fig B), with reduction of systolic pulmonary artery pressure (Fig D) and improvement of right heart parameters.
PH is a frequent complication in patients with CKD on hemodialysis. Possible mechanism of its development include RV overload with increased pulmonary flow or creating a fistula with an increased flow through arteriovenous shunt. Thromboembolic complications and hyperhomocysteinemia are other frequent findings in these patients. Despite all the above, the left heart involvement with LV diastolic dysfunction remains a common and amendable cause of PH in this setting.
Abstract P1687 Figure.
P1699 A case of atrial myxoma presenting with acute stroke
Authors: Gray R , Brassil J , Jepson N 
Published: January 2020

Abstract
A 73-year-old female presented with sudden reduced level of consciousness on the background of rheumatoid arthritis and dyslipidaemia. On examination she had a Glascow Coma Score of 12 and an irregularly irregular pulse. The electrocardiograph confirmed atrial fibrillation and showed widespread T wave inversion. A computed tomography cerebral angiogram showed an acute basilar artery occlusion. She was transferred to a tertiary centre where she had successful endovascular clot retrieval. An urgent transthoracic echocardiogram (figure 1) showed apical hypertrophy, normal systolic function and a large right atrial mass. The left atrial size was normal. A transoesophageal echocardiogram (figure 3) confirmed a large pedunculated mobile mass with a hypermobile septum consistent with a patent foramen ovale. There was no right to left doppler flow, however the atrial mass obstructed the course, and a bubble study was positive. The cardiac magnetic resonance image (figure 2) showed a 47 x 48 mm pedunculated lesion within the right atrium, arising from the intraventricular septum, demonstrating moderate T2 signal intensity, and intermediate T1 signal intensity, with avid enhancement, consistent with a right atrial myxoma. There was increased apical wall thickening at 15mm which confirmed apical hypertrophic cardiomyopathy. An open surgical resection and left atrial appendage ligation was performed on day 11 of admission. Histopathology confirmed an atrial myxoma. She had an excellent neurological recovery with only mild diplopia. The mechanism of stroke was likely atrial fibrillation secondary to increased left atrial pressure from apical hypertrophic cardiomyopathy. However, the unexpected finding of a right atrial myxoma with a corresponding patent foramen ovale provides a second possible mechanism.
Abstract P1699 Figure. Right atrial Myxoma
P1709 Left atrial strain: a novel prognostic marker in patients with chronic kidney disease
Authors: Gan G , Kadappu K , Bhat A , Fernandez F , Gu K , Cai L , Eshoo S , Thomas L 
Published: January 2020

Abstract

Funding Acknowledgements
Nil

Background and objectives
Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events that are underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients.

Methods
Stage 3 and 4 CKD patients without previous cardiac disease underwent a comprehensive transthoracic and stress echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for the primary end point of a composite of all-cause death and major adverse cardiovascular events (MACE). The secondary end point was a composite of cardiovascular death and MACE.

Results
243 patients (male 63%; mean age 59.2 ± 14.4 years) were followed for a median of 3.9 ± 2.7 years. 69 patients met the primary endpoint and 58 the secondary end point. Age (p &lt; 0.01), history of diabetes mellitus (p &lt; 0.01), indexed LV mass(LVMI) (p &lt; 0.01), LV global longitudinal strain(GLS) (p &lt; 0.01), indexed LA volume(LAVI) (p &lt; 0.01), E/e’ ratio (p &lt; 0.01) and LA strain (LAs) (p &lt; 0.01) were independent predictors of death and MACE. On Cox proportional hazards regression analysis, LAs (p &lt; 0.01) was the only independent predictor for the primary end point in a model accounting for age, diabetes mellitus, LVMI, LVGLS, E/e’ and LAVI. LAs remained an independent predictor for the secondary end point.

Conclusions
LAs is an independent predictor of death and MACE in CKD patients, in whom the predominant cardiac abnormality is diastolic impairment. LAs is a prognostic biomarker, reflecting alterations in diastolic function in CKD.
Abstract P1709 Figure. Kaplan Meier curve of LAs
P1714 When the mechanism of mitral regurgitation is unclear, 3D Trans-esophageal echocardiography is the solution
Authors: Thabet N , Labib D , Nagy S , Mahmoud-Elsayed H 
Published: January 2020

Abstract

Introduction
Assessment of mitral regurgitation (MR) mechanism is not always easy and may require advanced imaging techniques.
A 28-year-old male presented with significant MR three years following surgical mitral valve repair for severe MR due to mitral valve prolapse. During surgery, he underwent artificial chordal implantation on A2 scallop and Gore-Tex posterior band annuloplasty. Early post-operative transthoracic echocardiography (TTE) showed mild to moderate eccentric, posteriorly directed MR of unknown mechanism. Since the patient was asymptomatic, only regular follow-up was advised. He missed his follow-up for three years after which presented complaining of exertional dyspnea NYHA class II.
TTE showed dilated left ventricular dimensions with moderate to severe MR of unknown mechanism.
2D trans-esophageal echocardiography (TEE) (figure 1, panel A& B) showed severe, posteriorly directed mitral regurgitation, with a mass (arrow head) at the level of the mitral annulus.
3D TEE (figure 1,panel C, 3D zoom mode and panel D, true view mode) showed dehiscence (arrow head) of the annuloplasty band from the posterior mitral annulus with a wide gap measuring 83 mm² in 3D planimetred area. The patient was referred for re-do surgery.

Conclusion
3D TEE has a great added value in elucidating the mechanism of MR in obscure cases and guiding the proper management strategy.
Abstract P1714 Figure 1
P1727 Large coronary artery to pulmonary artery fistula as primary source of pulmonary blood supply in tetralogy of fallot with pulmonary atresia
Authors: Aslam N , Rashid Z , Mohsin M , Chowdhury D , Sultan Hasan B 
Published: January 2020

Abstract

Funding Acknowledgements
Not Applicable

OnBehalf
Not Applicable

Introduction
Pulmonary blood supply in patients of Tetralogy of Fallot with pulmonary atresia is usually from patent arterial duct or major aortopulmonary collaterals (MAPCAs) arising from descending thoracic aorta. We describe a case in which large coronary to pulmonary artery fistula was the primary source of pulmonary blood supply.

Case Report
A 17 years old female was referred to our hospital for diagnostic workup of suspected congenital heart disease. She was previously undiagnosed and now complains of progressive shortness of breath for last few months.
On physical examination she was non-dysmorphic with oxygen saturation of ∼ 77 % in room air, blood pressure of ∼ 117/72 mmHg, pulse rate of ∼ 89 beats per minute and respiratory rate of ∼ 24 breaths per minute. She was clinically cyanosed with grade 3 clubbing and polycythemic. Cardiovascular examination revealed quiet precordium with normally placed apex beat, grade 2 parasternal heave with single second heart sound and grade 3/6 continuous murmur along left mid sternal border.
Twelve lead electrocardiogram (ECG) showed normal sinus rhythm, right axis deviation and right ventricular hypertrophy. There was no evidence of ischemia. Chest X-ray revealed "boat shaped heart" with oligaemic lung fields. Transthoracic echocardiography showed large conoventricular ventricular septal defect with bidirectional flow. There was aortic over-ride with dilated left main coronary artery. No forward flow was seen across right ventricular outflow tract. Considering hugely dilated left main coronary artery, suspicion of coronary to pulmonary artery fistula was made and cardiac computed tomography followed by conventional angiography was done, both confirmed the diagnosis of Tetralogy of Fallot with pulmonary atresia and large coronary artery to main pulmonary artery fistula as a primary pulmonary blood supply. Two small collaterals (MAPCAs) were also identified supplying small part of right and left lungs.

Conclusion
This case highlights unusual source of pulmonary blood supply in Tetralogy of Fallot with pulmonary atresia. Correct pre-operative diagnosis is essential for appropriate surgical planning and better outcome.
Abstract P1727 Figure. TOF-PA with CA to PA Fistula
P1311 A rare case of asymptomatic cyst in interatrial septum longterm observation
Authors: Lewek J , Bielecka-Dabrowa A , Banach M , Maciejewski M 
Published: January 2020

Abstract

Background
Incidental findings in echocardiography performed from other indications are not always able to explain the patient condition as well as the observed pathology. However, review of literature, helps to find the most possible explanation. We present a case study of a patient with our proposal of possible diagnosis.

Case report
28-year old female with hypothyroidism and no other concomitant diseases presented with easy fatigue. Exercise stress test was clinically and ECG negative with 12,8 METs. Transthoracic echocardiography showed normal size of heart structures with preserved systolic and diastolic function of both left and right chamber. The only abnormality was a cystic structure of 44x31x34 cm in interatrial septum which was protruding to both left and right atrium and was not affecting the blood flow with normal gradients. We did not find any signs of inflammation nor infiltration to the heart walls. There was no flow inside the cyst with the use of colour Doppler. The structure had homogenous echolucency with very thin walls and a septum inside. As we did not find any connection between the cyst and the atriums we considered it as not harmful in terms of a risk of embolization. Patient was hemodynamically stable, there was no history of neurological dysfunctions nor atrioventricular conduction disturbances. Taking into account possible diagnoses for that patient we decided to schedule the patient for follow-ups. Ten years observation period confirmed that that our approach was proper. Serial echocardiographic studies showed no change in the cyst. In this year we performed multimodality imaging with CT and MRI, which showed the same views as echocardiography.

Discussion
The most possible diagnose for our patient is a bronchogenic cyst, a very rare congenital bronchopulmonary malformation of the foregut that is usually found incidentally with mostly asymptomatic benign course. Also the localization of the cyst confirms that diagnosis. Nevertheless the final diagnosis would be possible only in histopathological study.
The differential diagnosis should include a cystic myxoma and echinococcosis. However the structure is not polycystic and seems to have homogenous echolucency. We ruled out the blood cyst because of the lack of typical localization and connection to valves.
As long as the patient remains asymptomatic surgical resection remains controversial.
P268 Epicardial cyst in a three months old baby: a challenging decision
Authors: De Roberto A M , Del Pasqua A , Chinali M , Francalanci P , Esposito C , Iacomino M , Ciliberti P , Secinaro A , Galderisi M , Carotti A , Rinelli G 
Published: January 2020

Abstract
We report a case of a three months old baby, with no history of heart disease, referred to our center for cardiological screening. EKG was normal and a physiologic 1/6 systolic murmur was present. Conversely, echocardiography revealed a thin-walled, echo-free cystic intrapericardic structure adjacent to the posterior wall of the left ventricle; no signs of compression on cardiac structures were evident. CAT scan confirmed the presence of echo-free cystic over-diaphragmatic structure at the crux cordis level. The cyst was described as located between visceral pericardial layer and muscolar ventricular wall and appeared to cause compression on the midbasal wall of the left ventricle, of the interventricular septum and less extensively on the right ventricle. The dimension of the cyst was 2.7x2.5x1.8 cm. Worthy of note, posterior interventricular and posterolateral coronary arteries were very close to the cyst and partially pushed apart one from the other by the mass. Eight months after the diagnosis we detected an increase in mass size, confirmed also by cardiac MRI showing a mass of 4.5x3.4x3 cm with an extimated volume of 23 cm2. Because of significant increase of dimension of the cyst we decided for surgical excision of the mass. The cyst contained clear and translucent fluid and was successfully removed. Pleuropericardial window was created to prevent pericardial effusion. Histopathological report suggested the diagnosis of bronchogenic cyst because of the presence of smooth muscle.
Bronchogenic cyst are closed epithelial-lined sacs developed from the respiratory system as the result of an abnormal budding process during the early development of the foregut. These congenital malformations are usually located in the mediastinum or in the lung parenchyma, but atypical locations such as neck, intramedullary part of the spine, diaphragm or intraabdominal region have been reported. Only a few cases occurring in the heart have been described, but their location in the left ventricle is extremely rare. Bronchogenic cyst are usually asymptomatic: symptoms are related to the interaction with the adjacent structures and therefore depend on the dimensions and the localization of the mass. Surgical approach is mandatory if a complication occurs. Conversely there is not a unique approach for asymptomatic mass as in our case.
The young age of the baby and the absence of symptoms argued in favor of a "watchful waiting" strategy. Nevertheless, the particular localization of the cyst at the crux cordis level, its relatively rapid growth and above all the evidence of a close relationship with the coronary arteries, suggesting a concrete risk of compression with further enlargement, were determinant for the final decision for surgical excision.
Abstract P268 Figure 1
P273 The role of multimodality imaging in the evaluation of arteritis
Authors: Matajira Chia T M , Castineira Busto M , Cespon Fernandez M , Gimena Reyes B , Calvo Iglesias F , Ir A 
Published: January 2020

Abstract
A 61-year-old man was admitted to the hospital with an atypical pain lumbar with oligoanuria. Other comorbidities were: arterial hypertension, diabetes mellitus and smoking .On examination the patient was comfortable at rest, with a heart rate of 89 b.p.m. and a blood pressure of 147/2 mmHg. Normal S1 and S2 heart sounds were present. There were no signs of heart failure present. Patients complained of pain in hypogastrium on palpation. Creatinine 2.33 mg / dL. PCR 72. The immunological studies were normal (including IgG and IgA serological levels, antinuclear antibodies, extractable nuclear antigens, anti-neutrophil cytoplasmic antibodies.
An Body CT was performed, it shows mass that includes the ureters as well as the iliac arteries and parietal thickening in aorta wall.
The positron emission tomography–computed tomography (PET CT) scans was performed that evidences pathological hypermetabolism that surrounds both primitive iliac arteries with maximum SUV 12 g / ml. Pathological hypermetabolism in ascending aorta until reaching arch with maximum SUV of 9.1 mg / ml compatible with periaortitis in the ascending aorta. A study was completed with retroperitoneal mass biopsy that showed areas of retroperitoneal fibrosis with predominantly lymphoplasmacytic areas. IgG4 / IgG&gt; 40% , Obliterative involvement of small venules suggestive of IgG4 disease. A transthoracic echocardiogram was performed which showed normal biventricular function, absence of significant valvular disease and thickening of the aortic wall compatible with periaortitis. The patient started glucocorticoid therapy with favorable response. A PET CT control was performed that showed disappearing retroperitoneal masses around iliac vessels and disappearance of activity in lateral wall of aorta and decrease activity about ascendent aorta.
DIAGNOSIS :
IgG4 -related aortitis
Abstract P273 Figure.