bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1413 Complexity of changes in right ventricular function in patients undergoing cardiac surgery
Authors: Wejner-Mik P , Kasprzak J D , Szymczyk E , Wdowiak-Okrojek K , Ammer A , Religa G , Lipiec P 
Published: January 2020

Abstract

Background
An impairment of certain echocardiographic parameters of right ventricular (RV) function, such as tricuspid annular peak systolic excursion (TAPSE), is a known phenomenon in patients undergoing cardiac surgery. However, little is known about significance of these alterations with regard to other aspects of RV function. The aim of our study was to clarify this issue using parameters based on 3D echocardiography and speckle tracking technique.

Methods
The study population comprised 105 patients (76 men, mean age 65 ± 16 years), referred for coronary artery bypass grafting and/or replacement of mitral or aortic valve. Patients undergoing tricuspid annuloplasty and with baseline suboptimal image quality were excluded from the study group. Transthoracic echocardiographic examination was performed on average 2 ± 2 days prior to surgery (TTE1) , and 7 ± 4 days after surgery (TTE2), whereas follow-up TTE (TTE3) was performed on average 12 ± 2months after the surgery. Parameters measured during these examinations included both standard and advanced indices of RV size and function, such as TAPSE, systolic velocity of tricuspid annulus (S"), fractional area change (FAC), RV ejection fraction (EF) and RV global longitudinal systolic strain (GLS).

Results
Echocardiographic measurements were completed for TTE1, TTE2 and TTE3 in 95% of patients. We noticed a significant postoperative (TTE2) impairment of parameters of RV longitudinal function (TAPSE, S’ and GLS; p &lt; 0,0001). However, neither RV size assessed by both 2D and 3D technique changed, nor the global RV function measured with the use of FAC and EF. After 12 months (TTE3) we observed an improvement in the parameters of the longitudinal RV function.

Conclusion
Cardiac surgery results in an impairment of the longitudinal systolic RV function, with no influence on the global RV function. After 12 months, an improvement of the longitudinal function can be observed.
P1430 Analysis of echocardiographic study findings prior to an allogeneic hematopoietic stem cell transplantation
Authors: Vallejo Garcia V , Martin Garcia A , Castro Garay J C , Lopez Corral L , Martin Garcia A C , Cabanillas Cabral A , Diaz Pelaez E , Barreiro Perez M , Rodriguez Estevez L , Castillo Y , Avila D , Sanchez Pablo C , Cambronero Cortinas E , Caballero Barrigon D , Sanchez Fernandez P L 
Published: January 2020

Abstract
Allogenic hematopoietic stem cell transplant (Alo-HSTP)has been a therapeutic revolution for patients with hematologic malignancies. Even though this therapy is associated with a high risk of cardiovascular (CV) events during follow-up, a baseline cardiology study is currently not standardised in most centers. Our aim was to analyse transthoracic echocardiogram (TTE) findings in patients candidates to Alo-HSTP.
We undertook a retrospective and descriptive analysis that included all patients treated with Alo-HSTP in our center between 2016-2019. Baseline characteristics and TTE findings including global longitudinal strain (GLS) were analysed.
We analyzed 144 patients (mean age 50 years, 60% males). Acute myeloblastic leucemia (38%) and non-Hodgkins lymphoma (18%) were the most frequent diseases. Figure. 18 patients (13%) had hypertension, 13% had dyslipidemia and 6% diabetes mellitus. Almost 10% had previous CV history. TTE found left ventricle systolic dysfunction (LVEF&lt; 53%) in 10% of patients, diastolic dysfunction in 12%, valvular heart disease in 4 patients (5,5%) and GLS was abnormal (&gt;-19%) in 35 patients (24%). Up to 47 (33%) patients studied has an abnormal TTE finding. Table.
More than one third of patients candidates to Alo-HSTP had an abnormal TTE finding, increasing the risk for CV events during follow-up. A cardiologic study by the Cardio-Onco-Hematology team in these patients before Alo-HSTP could improve their prognosis.
Age (years) 50 ± 18 Male (n,%) 86 (60%) Hypertension (n,%) 18 (13%) Diabetes mellitus (n,%) 8 (5,6%) Dyslipidemia (n, %) 18 (13%) Past or current smoking (n, %) 25 (18%) Previous cardiovascular history (n, %) 13 (9,3%) Abnormal TTE (n, %) 47 (33%) LVEDV(ml) 99 ± 29 LVESV (ml) 37 ± 16 LVEF (%) LV dysfunction (n, %) 63 ± 8 15 (10,4%) e/e´ Elevated filling pressures (n, %) 8,2 ± 7,3 4 (3%) Valvular heart disease (≥moderate) (n, %) Mitral Aortic Tricuspid 3 (2%) 4 (3%) 1 (1%) GLS (%) abnormal GLS , &gt;-19% (n, %) -20,4 ± 2,8 35 (24%) LVEDV: Left ventricle end-systolic volume, LVESV: Left ventricle end-systolic volume, LVEF: Left ventricle ejection fraction, GLS: global longitudinal strain
Abstract P1430 Figure. Haematologic malignancies
P1436 Diagnostic yield and accuracy of CT coronary angiography compared to invasive coronary angiography: real world data from a district general hospital in the United Kingdom
Authors: Masoud A M , Topping W T , Lynch M L 
Published: January 2020

Abstract

Background
Cost-effectiveness is imperative for a sustainable healthcare service. Non-invasive testing is used to risk stratify patients and reduce the need for invasive investigations in cardiology. The National Institute for Health and Care Excellence (NICE) Clinical Guideline for evaluation of chest pain was updated in 2016 when NICE recommended CT coronary angiography (CTCA) as the first-line investigation for patients with suspected stable coronary artery disease (CAD).

Purpose
To evaluate the accuracy of CTCA in real life daily practice in a district general hospital outside the strict environment of clinical trials.

Methods
A retrospective analysis of all CTCA studies carried out between June and December 2017 was performed. Graft studies were excluded. Potentially obstructive CAD on CTCA was defined as any luminal stenosis ≥50% of a major epicardial coronary artery. On invasive coronary angiography (ICA), clinically significant CAD was defined as a luminal stenosis of ≥50% in the left main stem or a stenosis of ≥70% of any other major epicardial coronary artery.

Results
Out of a total of 528 CTCA studies, 109 patients (mean age 64.2 ± 10.4; 67.9% male) showed potentially significant CAD in at least one major epicardial coronary artery. The median calcium score was 379.7 (IQR = 86-929). 61 (56%) patients had ICA, 20 (18.3%) patients had non-invasive functional coronary assessment (19 stress echocardiogram and 1 stress perfusion cardiac magnetic resonance) and 3 (2.8%) patients had both. The remaining patients were managed medically without further investigation.
Correlation between potentially obstructive CAD on CTCA and clinically significant CAD on ICA showed a sensitivity of 95.8% (95% CI: 85.8%-99.5%), specificity of 68.0% (95% CI: 61.0%-74.5%), positive predictive value of 42.2% (95% CI: 37.1%-47.4%), negative predictive value of 98.5% (95% CI: 94.5%-99.6%) and overall accuracy of 73.5% (95% CI: 67.5%-78.9%). Among patients who had ICA, 21 patients (34.4%) required coronary revascularization (16 percutaneous coronary intervention and 5 coronary artery bypass grafting) and 40 (65.6%) patients were treated medically. Only 1 patient (4.3% of 23 patients) showed evidence of inducible ischemia on non-invasive functional testing.

Conclusion
CTCA in a real world practice has high sensitivity and high negative predictive value compared to the gold standard ICA. CTCA improved patient selection for ICA to those most likely to have significant CAD.
P1455 Succesfully surgical management of "transit thrombus"
Authors: Vera Sainz A , Bastante T , Gonzalez E , De La Cuerda F , Jimenez C , De Rueda C , Montes A , Cecconi A , Rojas A , Diego G , Benedicto A , Dominguez L , Monguio E , Jimenez Borreguero L J , Alfonso F 
Published: January 2020

Abstract
A 74-year-old woman was admitted in the emergency department in November 2018 for dyspnea, sudden chest pain and hemodynamic instability. Se had a previous history of pelvic fracture in September 2018, complicated with subdural hematoma secondary to therapeutic anticoagulation that wassurgically managed in October 2018. A through pulmonary arteries CT revealed massive pulmonary thromboembolism with right ventricle overload and pulmonary infarction. Because of history of cerebral hemorrhage, fibrinolytic treatment was ruled out and surgical approach of pulmonary embolism was decided. An intraoperative transesophageal echocardiogram demonstrates a thrombus in the right atrium (Figure 1A, yellow arrow), with invasion through the interatrial septum through a patent foramen ovale (Figure 1B, yellow arrow) with extension to mitral valve plane in the left ventricle (Figure 1C, yellow arrow). "Transit thrombus" was removed, patent foramen ovale was closed and bilateral pulmonary embolectomy was performed. In postoperative transesophageal echocardiography, no residual thrombus in cardiac chambers was seen and the closure of the foramen ovale was checked (Figure 1D). During the postoperative period, the patient presented cardiac tamponade, treated with pericardial drainage. Once this complication was overcome, the evolution was satisfactory and the patient could be discharged.
This case demonstrates that performing a transesophageal echocardiogram before a surgical embolectomy in the setting of pulmonary embolism is essential. It allows detect the presence of cardiac thrombi, assess the interatrial septum integrity (where the CT has limitations), and allows to guide the surgical treatment.
Abstract P1455 Figure.
P1468 a rare cause of chest pain:sudden rupture of aortic valsalva sinus aneurysm
Authors: Shaaban N , Shehata H , Abdelnabi M , Maghraby A , Othman N 
Published: January 2020

Abstract

Introduction
Sinus of Valsalva aneurysms (SOVAs) occur when there is a congenital defect in the aortic media and incomplete fusion of distal bulbar septum (primitive bulbus cordis) and truncal ridges. These aneurysms usually rupture into the right side of the heart, with the right ventricle being the most common.

Case Presentation
A 32 year old male patient who presented to our facility with an attack of ulcerative colitis activity ,elevated inflammatory markers and thrombocytosis. During hospital stay, he developed sudden onset of retrosternal compressing chest pain. On examination he was afebrile with a blood pressure of 130/80 mm Hg and pulse rate 110 beats per minute. He had soft systolic and early diastolic murmurs with normal chest auscultation; there was no haemodynamic discrepancy between left and right sides or stigmata of endocarditis.
His ECG showed sinus rhythm with no ST segment changes, and chest x ray was normal. Full blood count revealed thrombocytosis & normochromic normocytic anemia , cardiac enzymes were normal, blood cultures were sterile.
A 2D transthoracic echocardiography (TTE) revealed dilated left ventricular dimensions , there is an aneurysm of the right sinus of Valsalva which is communicating with the right ventricle (RV)confirmed by color Doppler and negative contrast seen inside RV during bubble study.
3D TTE showed a small fistulous track between the right sinus and RV.
The patient refused surgical or percutaneous closure.

Conclusion
Congenital RSVAs account for 0.1–3.5% of congenital heart defects.It has a higher incidence in Asian versus Western populations with male to female ratio 3:1. SOVAs arise from the right sinus of Valsalva in 80–85% of these cases and from the noncoronary sinus in 5–15%. They rarely arise from the left sinus, as the left coronary cusp embryologically is not derived from bulbar septum. This is distinct from acquired SOVAs, which can occur in any of the sinuses Traditionally, surgical closure has been the mainstay of treatment for RSOVAs, with an operative mortality rate of &lt;5% and excellent long-term outcomes.
Abstract P1468 Figure. RSOVA
P1470 Rare cause of papillary muscle rupture post cardiac surgery
Authors: Lopez Rodriguez E , Calvo Iglesias F , Blanco Gonzalez E , Varela Martinez M A , Legarra Calderon J J 
Published: January 2020

Abstract

Introduction
Papillary muscle rupture (PMR) secondary to mitral valve repair surgery is a rare complication in the postoperative period of cardiac surgery

Purpose
We present a case of PMR with fatal outcome after mitral valve repair with a rigid ring secondary to accidental ligature of the circumflex artery (CA).

Methods
An 83-year-old male referred for valvular surgery for symptomatic mitral regurgitation (MR). In the last echocardiography LVEF was mildly depressed (45-50%), severe organic MR (A2 chord rupture), functional TR, and moderate degenerative AR. With these findings and together with a normal coronary angiography, he was presenting at the Heart Team for triple valvular surgery. The procedure consisted of implanting aortic biological prosthesis, mitral and tricuspid annuloplasty. During the pump output, he presented ventricular arrhythmias, but in the intraoperative transesophageal echocardiography (TEE) a good result was demonstrated. At 24h postoperatively the patient enters arrhythmic storm, ischemia data appear on ECG (ST-segment depression of V1-V3 and DI-aVL) and elevation of markers of myocardial damage (TnIc 450 ng/mL), which point to complication postsurgical cardiology is contacted for urgent echocardiography.

Results
The echocardiography showed a massive MI due to postero-medial PMR, inferior and inferolateral akinesia and severe biventricular dysfunction. With these findings and with the suspicion of accidental ligation of CA during the implantation of the mitral annulus, urgent catheterization is considered. Given the evolution of the ischemic event and the delicate hemodynamic situation, this option is discarded, so that angiographic confirmation is not achieved. Finally, the patient undergoes cardiac revision surgery as a last option. After performing sternotomy, cardiac rupture at a lower level is evidenced, patch closure is attempted but due to tissue friability it is not achieved and the patient dies in the surgical act.

Conclusion
RMP after mitral valve surgery is a very rare complication. The majority of published cases are related to increased tension forces after mitral replacement with preservation of the subvalvular apparatus. Our case would be the first described of MPR secondary to accidental ligation of AC after mitral annuloplasty.
P1486 An unexpected case of paediatric heart failure
Authors: Theocharis P , Morrison M L , Storring N , Adhavaryu K , Jivanji S , Rosenthal E , Miller O , Mathur S , Speggiorin S 
Published: January 2020

Abstract
A 9-month-old male presented in heart failure with a 2-day history vomiting that followed a viral upper respiratory tract infection 10 days previously. Echocardiography demonstrated a normally connected heart with a severely dilated and poorly functioning left ventricle with bright mitral valve papillary muscles. It was difficult to demonstrate the origin of the left coronary artery and retrograde flow was seen in the vessel (Fig 1, Panel A). The right coronary artery appeared normal. A gated cardiac CT was performed and showed a normal right coronary origin and no clear connection of the LCA to Ao and there was suspicion of retrograde filling. Images of the left coronary origin did not show clear connection of the LCA to Ao (Fig 1, Panel B). As the case was extremely unusual coronary angiography was performed which confirmed the suspicion of a dominant right coronary system with collateral connection to the left coronary system and retrograde filling and no antegrade filling of the LCA from the Ao (Fig 1, Panel C). This was consistent with atresia of the left coronary ostium, which was confirmed at operation. The left coronary sinus was opened, as was the roof of the left coronary artery and an anastomosis was performed to aorta using an autologous patch. The post operative TOE showed good flow into the LCA (Fig 1, Panel D). There was good and quick post op clinical recovery but the left ventricular function remains still poor at the moment with slow recovery as expected. The cardiac function will be monitored echocardiographically and the reconstructed coronary artery with CT.
Abstract P1486 Figure 1
P1487 Anomalous right coronary artery from mid left anterior descending artery
Authors: Fyyaz S A , Katsigris A , David S , Alfakih K 
Published: January 2020

Abstract
55-year-old male with history of transient ischaemic attack, excised gastro-intestinal stromal tumour, and osteoarthritis presented to rapid access chest pain clinic with history of atypical chest pain. There were no resting electrocardiographic changes. In accordance with NICE stable chest pain guidelines, a CT coronary angiogram was requested to further assess for any underlying coronary artery disease. This showed normal origin of left main stem (LMS) from left coronary sinus of aorta, however there was an anomalous origin of the right coronary artery (RCA) as a branch from the mid portion of left anterior descending artery (LAD). This was deemed to be an incidental finding with a benign course and not the cause of his symptoms.
Coronary anomalies have a reported incidence of 1.3% at invasive coronary angiography (1), and a reported incidence of 0.014-0.066% of single coronary artery (2). Anomalous RCA usually courses from the LMS and courses between the aorta and pulmonary artery. We present an extremely rare variant of single coronary artery arising from the mid LAD without any associated congenital or structural abnormality, on CT coronary angiography (the gold standard for demonstrating coronary anatomy). This is rarely reported in the literature and is a benign coronary anomaly.
Abstract P1487 Figure.
P1490 Congenital right coronary artery fistula into right atrium diagnosed with help of multimodality imaging
Authors: Erciyes D , Ozden Tok O , Yurdakul S , Bakan S , Goktekin O 
Published: January 2020

Abstract

Introduction
Coronary artery fistula (CAF) is an anomaly in which abnormal connections are present between the coronary artery and the cardiac chambers or a major vessel. It is an uncommon anomaly with an estimated incidence of 1 in 50,000 live births and usually occurs in isolation.
We report a case of CAF into right atrium in a patient who admitted to our outpatient department with dyspnea and fatique. With help of transthoracic echocardiography (TTE), transesophageal echocardiography (TOE) and cardiac computerized tomography (CCT) we put the definite diagnosis and decided to close this fistula percutaneously with a PDA occluder.

Case
A 43-year- old male admitted to our outpatient department with complaints of exertional dyspnea and fatique for 5 years. His physical examination revealed a holosystolic murmur on the aortic valve area. His TTE showed enlarged right heart chambers with a high pulmonary artery systolic pressure (50 mmHg) and a suspicious flow from the aortic root into right atrium. Qp/Qs was 2.1. TOE depicted a shunt between aorta and right atrium as well, we couldn’t truly demonstrate the connection though .
In order to define the defect precisely, we performed a cardiac CT. Cardiac CT clearly showed a markedly dilated and mildly tortuous and calcified fistula arising from the osteal part of right coronary artery draining into right atrium. Right coronary artery was thin and there was no stenosis. Cardiac CT helped us to exclude coronary arter disease as well.
As it was suitable to close percutaneously, we decided to close it with a PDA occluder.

Conclusion
CAF is a rare, generally congenital anomaly and may cause right heart chamber dilatation and pulmonary hypertension if the diagnosis is missed. It is important to support and clarify the underlying pathology with help of other cardiovascular imaging modalities like cardiac CT and cardiac magnetic resonance imaging (CMR), if TTE and TOE cannot demonstrate us the exact pathology.In our case our choice of extra method was cardiac CT, as we wanted to exclude accompanying coronary artery disease at the same time. In today’s era, the use of multimodality imaging is increasing with a tremendous rate and it helps clinical cardiologists, cardiovascular imaging specialists and interventional cardiologists all.
Abstract P1490 Figure. 2D,3D TOE and CCT images of CAF
P1496 Congenital anomalous origin of the left coronary system
Authors: Ahmad S , Ahmed I , Jibran R , Raimondo C 
Published: January 2020

Abstract
A 62 year old gentleman presented with a history of recurrent central chest pains radiating to the left arm and jaw lasting up to 15-20 minutes and relieved with GTN. He had numerous admissions to hospital over a period of three years with negative Troponins and normal ECGs. There were several cardiovascular risk factors including obesity, diabetes, hypertension and dyslipidaemia. He also had a family history of ischaemic heart disease, with his mother and brother having heart attacks in their 60s.
He was referred for outpatient investigations on multiple occasions but did not attend. This lead to a delay in a formal diagnosis until we eventually convinced him to undergo invasive diagnostic coronary angiography in June 2018. Prior to this, an Echocardiogram was done and showed reasonably preserved cardiac systolic function.
Coronary angiography demonstrated unique anatomical distribution of the three main coronary vessels, with an anomalous origin of the left main system (LMS) and left sided arteries arising from the right coronary cusp. The right coronary artery stemmed from its natural position and was the dominant vessel. Hence, all the coronary arteries arose from the same cusp. The LMS was anomalous and hypoplastic; an exceedingly rare occurrence of less than 0.03%. These unusual findings were then confirmed on CT Coronary Angiogram.
Although a surgical opinion was sought, the decision was a non-operative approach in view of no significant obstructive lesions and given the technical difficulties of undertaking coronary bypass. Viability imaging and ischaemia testing were then pursued with nuclear modalities. Ultimately, it was proven that the lesions did not show any significant reversible ischaemia and so a continued aggressive secondary prevention strategy was adopted. The patient is stable and doing well on optimal medical therapy.
Abstract P1496 Figure. LMS Arising From Right Coronary Cusp