bluuebunny/crossref_metadata_2025_split huggingface dataset:
P866 Mitraaortic intervalvular fibrosa pseudoaneurysm with aortic paravalvular regurgitation in a marfan-like syndrome patient diagnosed with multimodality imaging
Authors: Ozden Tok O , Abdelnabi M , Almaghraby A , Bingol G , Bakan S , Guden M , Goktekin O 
Published: January 2020

Abstract

Introduction
The fibrous area. between the mitral and aortic valves described as the mitral-aortic intervalvular fibrosa (MAIF). The MAIF can be damaged by endocarditis, degenerative calcification or mitral and aortic valve surgery . Damage caused by replacement of the aortic valve can lead to the formation of pseudoaneurysms (MAIF) or other complications

Case
A 64-year-old male admitted to our outpatient department with complaints of dyspnea fatique and atypical chest pain. He has Marfan like syndrome and had a history of mechanical aortic valve replacement 16 years ago and upon dysfunciton of the prosthetic valve and significant ascending aorta aneurysm he had undergone a second Bentall operation 6 years after the first operation.
We performed a transthoracic echocardiography and a transesophageal echocariography to clarify the underlying pathology. Transesophageal echocardiography revealed a moderate to severe paravalvular regurgitation, a mitraaortic intervalvular fibrosa pseudoaneurysm and a functional moderate-severe mitral regurgitation. The echocardiographic appearence of MAIF pseudoaneurysm cavity demontrates marked pulsatilty with systolic expansion and diastolic collapse.
In order to show the pathology truly and exclude a coronary artery disease, we decided to perform a cardiac CT (CCT). Cardiac CT confirmed mitraaortic intervalvular fibrosa pseudoaneurysm and paravalvular defect clearly with patent coronary arteries.
After our heart team meeting, we decided to give the patient to the cardiovascular surgery for the complete treatment of aortic valve, pseudoaneurysm and mitral valve. The patient underwent his 3rd surgery succesfully with a new bioprosthetic aortic valve replacement, repair of the pseudoaneurysm and mitral valve and his potoperative course was uneventful.

Conclusion
Combination of MAIVF pseudoaneurysm and paravalvular leak together in a connective tissue disorder patient is quite rare. TEE is more sensitive than TTE in accurately predicting this complication but to combine TOE with cardiac CT facilitates the diagnosis and gives a more accurate anatomic description of the defects to cardiologists and cardiovascular surgeons which is very helpful in terms of orientation.
Abstract P866 Figure. 2D,3D TOE and CCT images of MAFP and PVL
P876 I may still steal you : huge coronary cameral fistula (non-dominant right coronary artery to right ventricle) in a neonate causing heart failure
Authors: Naganur S 
Published: January 2020

Abstract

Funding Acknowledgements
Not applicable

OnBehalf
Not applicable
A 25 days old neonate, weighing 2.8kg was brought with complaints of feeding difficulties, not gaining birth weight and rapid breathing. The parents had not noticed any cyanosis. He was further referred to us as the treating paediatrician heard a pansystolic murmur over the left sternal border.
When examined, baby was afebrile, tachypnoea (70 per minute), regularly tachycardia(180bpm). We did not appreciate any dysmorphism. On cardiovascular examination we found a mild cardiomegaly, RV S3, mild hepatomegaly with no signs of active infection. Systemic saturations were 98% in all limbs. Other systemic examinations were essentially normal.
12 lead ECG showed, physiological RV dominance, with no signs of LV volume overload.
Chest radiograph showed cardiomegaly of RV type with adequate PBF.
2 D echocardiogram : The intra-cardiac structures were found to be normal. A huge coronary-cameral fistula originating from RCA, traversing in right AV groove and draining into the RV with mild RV enlargement. No signs of PAH. Biventricular function was preserved.
CT coronary angiogram : CT confirmed the presence and anatomy of the RCA—RV fistulous tract seen on echocardiography. The fistula measured ∼ 6mm at the origin and 3.5mm at the point of entry into RV. As we could not see any PDA arising from RCA and a twig from LCX traversing in interventricular groove, we thought it’s a left dominant coronary circulation.
Hemodynamics in the index case
The symptoms of heart failure in the index neonate is due to the volume overload on the RV. The non-dominance of RCA is probably a blessing in disguise for this baby in preventing coronary steal. The "steal phenomenon" will be apparent once the physiological (high) PVR comes down.
Plan
Baby is on diuretics and nutritional support, under weekly follow up. We will be performing catheter study (around 12 weeks of life or as per clinical indications) to look for dominance and need/feasibility of device closure.
Abstract P876 Figure.
P886 Shoots from the whip: catheter tip migration and tromboembolic comlications of ventriculoatrial shunt for hydrocephalus in von Hippel Lindau disease - multimodality findings
Authors: Gosciniak P , Larysz B , Kurzyna M 
Published: January 2020

Abstract
We report a rare nowadays case of 35 yo patient with von Hippel Lindau (VHL) disease and pulmonary hypertension as a severe complication of ventriculo-atrial (VA) shunt insertion in the treatment of hydrocephalus.
The patient was admitted to our department with signs of heart failure such as large decrease in exercise tolerance, increasing dyspnea, fatigue, ankle swelling manifested since few months.
In the past, the patient was diagnosed with multiple cerebral hemangiomas of the cerebellum and the spinal cord and increased intracranial pressure due to obstructive hydrocephalus as a sequel to a mass effect from haemangioblastoma. He underwent surgery of the posterior cranial cavity tumor and ventriculo-atrial shunting.
Electrocardiogram showed sinus tachycardia, right axis deviation, and right ventricle hypertrophy.
Particular transthoracic and 3D transesophageal echocardiography showed enlarged right chambers with right overload (A) and severe tricuspid regurgitation (B) with pulmonary hypertension. The distal end of the VA shunt was seen in the right atrium (C). The tip was migrating in some cycles of the heart into the right ventricle inflow tract (D). It moved like a cracking whip and was knocking against the tricuspid leaflets.
A pulmonary scan (230 MBq of the Tc99m intravenously) was then undertaken to confirm the presence of the pulmonary embolism and showed in both lungs numerous segmental and subsegmental perfusion deficits.
Multidetector CT pulmonary angiogram revealed marked mosaic attenuation in bilateral lung fields as well as abridgment of subsegmental pulmonary arteries (E).
Conventional pulmonary angiography showed on the right side arteries A9 and A10 obstructed, A4 amputated, A6 bifurcation at division into subsegmental branches (F).
All the diagnostic tests confirmed CTEPH and medical therapy, including anticoagulation, was started. Removal of the catheter was planned. After 3 months The patient was qualified for pulmonary artery angioplasty.
In conclusion, however, VA shunts inserted for the treatment of hydrocephalus are known to be a risk factor for pulmonary hypertension the pathogenetic process that causes pulmonary hypertension after shunt insertion is unclear. Therefore routine echocardiography and/or lung scanning is necessary for early diagnosis and treatment.
Abstract P886 FIGURES A-F
P899 Reduced right ventricular longitudinal function in patients with chronic left ventricular disease can be due to left ventricular forward failure and not right ventricular dysfunction
Authors: Fredholm M , Ricksten S E , Karason K , Bartfay S E , Dellgren G , Bech-Hanssen O 
Published: January 2020

Abstract

Background and aim
The occurrence of right ventricular failure (RVF) in patients with chronic left heart disease (LHD) has important therapeutic and prognostic consequences. Echocardiography (Echo) parameters describing the RV longitudinal function (tricuspid annular plane systolic excursion, TAPSE; peak systolic free wall longitudinal strain, RV-Str; tricuspid annulus peak systolic velocity, TAPSm) are today commonly used to define RV dysfunction. In the present study we hypothesised that these parameters are load dependent.

Methods
We retrospectively included 66 patients with LHD (age 52 ± 13 years, males 79%) that underwent right heart catheterization (RHC) and Echo within 48 hours. RHC was performed as part of diagnostic- or pre-transplant work-up. Fifty-six patients (85%) had left ventricular ejection fraction &lt; 40%. From RHC data the patients were divided into three groups: Patients with RV decompensation and increased right atrial pressure (RAP) ≥10 mmHg (iRAP, n = 21), with normal RAP but reduced stroke volume index (SVI &lt; 35 mL/m2) (rSVI, n = 21) and with normal RAP and normal SVI (nSVI, n = 24).

Results
Patients with iRAP had compared with rSVI/nSVI more advanced LHD with higher PAMP, PCWP and larger RV diastolic area (RVdA). TAPSE, RV-Str and FAC did not differ between iRAP and rSVI patients. The ratio RVdA/RV-Str was significantly higher in iRAP patients compared with rSVI and nSVI. The rSVI and nSVI patients did not differ regarding RAP response during supine exercise (P = 0.84).

Conclusions
Reduced RV longitudinal function in patients with chronic LHD and normal RAP can be due to left ventricular forward failure and not RV systolic dysfunction.
iRAP (n = 21) rSVI (n = 21) nSVI (n = 24) Overall P-value iRAP vs rSVI iRAP vs nSVI rSVI vs nSVI RAP (mmHg) 13 ± 2 5 ± 3 4 ± 2 &lt;0.001 &lt;0.001 &lt;0.001 0.34 PAMP (mmHg) 33 ± 8 24 ± 8 22±] &lt;0.001 0.001 &lt;0.001 0.34 PCWP (mmHg) 22 ± 5 16 ± 8 11 ± 6 &lt;0.001 0.003 &lt;0.001 0.025 CI (l/min/m2) 2.2 ± 0.4 2.2 ± 0.4 2.8 ± 0.5 &lt;0.001 0.75 &lt;0.001 &lt;0.001 PVR (Wood unit) 2.6 ± 1.2 1.5 ± 1.6 1.9 ± 1.0 0.032 0.022 0.035 0.60 RVdA (cm2) 26 ± 7 21 ± 7 21 ± 5 0.012 0.007 0.017 0.63 TAPSE (mm) 12 ± 3 13 ± 3 18 ± 6 &lt;0.001 0.28 &lt;0.001 0.001 TAPSm (cm/s) 8 ± 2 8 ± 2 10 ± 4 0.06 - - - RV-str (%) -15 ± 5 -17 ± 5 -21 ± 6 0.002 0.11 0.001 0.028 FAC (%) 28 ± 9 29 ± 11 39 ± 11 &lt;0.001 0.72 0.001 0.003 RVdA/RV-str (cm2/%) 2.2 ± 1.3 1.3 ± 0.7 1.1 ± 0.6 &lt;0.001 0.013 0.001 0.27
P906 Are all severe Tricuspid Regurgitation the same?
Authors: Vieitez Florez J M , Monteagudo J M , Mahia P , Perez L , Lopez T , Marco I , Carrasco F , Adeba A , De La Hera J M , Hinojar R , Fernandez-Golfin C , Zamorano J L 
Published: January 2020

Abstract

Introduction
Tricuspid regurgitation (TR) importance is growing in the last years. Its presence is associated with a worse prognosis. A new severity classification has been published, adding massive and torrential to the classical TR classification. However, both clinical profile of the patients as well as right chambers morphologic and functional changes have not been described compared to the severe TR patients.

Methods
Consecutive patients undergoing an echocardiographic study in 9 Spanish hospitals within a three-month period with at least moderate TR were prospectively included. All studies with severe TR were selected for analysis. TR assessment was performed as recommended by the European Association of Cardiovascular Imaging. TR severity grades was performed according to Hanh & Zamorano new published classification. Two cohorts were made: patients with severe TR and patients with massive or torrential TR.

Results
A total of 644 patients with severe or bigger TR were analysed. Severe TR was present in 540 (84%), massive was present in 83 (13%) and torrential in 21 (3%) Baseline characteristics of the study population are shown in table 1.
No differences were found in NYHA class or atrial fibrillation incidence between groups. Pacemaker was more frequent in massive/torrential group (30% vs 19%; 0,014).
Patients with massive/torrential TR presented worst RV remodelling data:
-RV was dilated (RV telediastolic basal diameter &gt;42mm) in 84.2% of patients with massive/torrential TR vs 57% of patients with severe TR (p &lt; 0.001).
-Right atrium was bigger in patients with massive/torrential TR (21 ± 0.8 cm2/m2 vs 17.2 ± 0,3 cm2/m2; p &lt; 0.001)
-Tricuspid annulus diameter was bigger between massive/torrential TR patients (26.7 ± 0.6 cm/m2 vs 23.6 ± 0.3 cm/m2; p &gt; 0.001).
No significant differences in prevalence of RV function (TAPSE &lt; 17 mm) were noted 39% vs 33%, p = 0,273.

Conclusions
In this large multicentre cohort of patients, the presence of massive/torrential TR seems to be associated with a differential RV and RA remodelling, reflecting the greater volume overload seen in these patients. Further studies are needed to define prognosis implication of our findings and its role in clinical decision making.
Table 1 Variable Severe (n = 540) Massive/Torrential (n = 104) Body mass index 26,6 (±0,3) 26.4(±0,6) 0.350 Woman 336 (62%) 69 (66%) 0.438 Atrial firilation 298(55%) 61(59%) 0.514 Age (years) 76,5 (±0,5) 77,5(±1,1) 0.209
P923 Ultrasound follow-up of left atrial appendage occlusion devices
Authors: Molinero D , Cabeza P , Hernandez N , Delgado W , Silva E 
Published: January 2020

Abstract

Background
Left atrial appendage (LAA) occlusion devices represent an important alternative to anticoagulation in patients with atrial fibrillation (AF) with high risk of bleeding and who have suffered any hemorrhagic event. At first, a transesophageal ultrasound is performed to examine cardiac cavities, take measures of LAA and discharge the presence of thrombi. We redo a new transesophageal ultrasound as a control three months later after having installed the device. The purpose of this article is to show our experience in ultrasound follow up of LAA occlusion.

Methodology
All measures of LAA were taken with the transoesophageal ultrasound device by the same operator. According to the size acquired from the appendage of each patient, they were divided into a first group with the implementation of the Watchman device (23 patients) and Amplatzer (6 patients). A transthoracic echocardiography control was performed on each patient to rule out the presence of complications after the intervention, before to be discharged from hospital. After three months, a new transoesophageal study was repeated to assess the correct position of the device and to rule out the presence of any disfunctions or clot formation.

Results
A total of 29 patients with AF (CHADSVASC 4.09 HASBLED 2.96) with a high risk of bleeding and after having suffered any complications (41% brain bleeding, 31% major gastrointestinal bleeding, 27% advanced chronic kidney disease) were presented for the implantation of a LAA closure device. Firstly, LAA size was confirm and the presence of a thrombi was rule out. No patient suffered complications during the procedure that was confirmed with transthoracic echocardiography (discharging the presence of perforation, pericardial effusion or tamponade). At three months later, we performed a new transoesophageal as a control for the assessment of the place and presence of GAPs, if any (80% correct-placed, 15% placed with a gap of 2-4 mm with passage of flow throughout). In a 10-month follow-up, it was found that practically 93% of patients were still without anticoagulation, except two patients, one of them (CHADSVASC 4 HASBLED 2) had to reintroduce oral anticoagulation due to the fact of the clot formation on the device. The second one (CHADSVASC 4 HASBLED 2) had to reintroduce temporarily fractionated heparin due to stent thrombosis in the femoral artery. None of them presented any ischemic complications or new haemorrhagic events.

Conclusions
LAA occlusion devices are an effective and safe alternative to anticoagulation in patients with atrial fibrillation with predisposition to bleeding where ultrasound techniques play an essential role in all stages of procedure (prior to implantation of the device, during and at the follow-up).
P925 An analysis of the impact of etiology vs. impact of hemodynamic variables on the right ventricular free wall deformation in patients with pulmonary hypertension
Authors: Ojrzynska N , Kowalik E , Kowalski M , Klisiewicz A , Demkow M , Witkowski A , Grzybowski J 
Published: January 2020

Abstract

Purpose
Pulmonary hypertension (PH) is a deadly disease leading to right ventricular (RV) failure. The aim of this study was to establish whether aetiology of PH has a greater impact on RV longitudinal deformation than cardiac catherization parameters.

Methods
We retrospectively analyzed echocardiographic studies and cardiac catherization parameters of 25 patients with pulmonary hypertension : 13 pts with precapillary PH associated with atrial/ventricular septum defect and 12 pts with postcapillary PH due to dilated cardiomyopathy. We measured regional strain and regional systolic and diastolic strain rates (SR) in right ventricular free wall in basal, mid and apical segments.

Results
Aside from TAPSE, echocardiographic parameters indicate no difference. Even though mean pulmonary arterial pressure and pulmonary vascular residence significantly higher in patients with precapillary PH, strain was significantly decreased in patients with postcapillary PH. Statistically significant differences were observed between pre- and postcapillary PH patients" strain in apical and mid myocardial segments. Early diastolic strain rate (SR) in apical RV segment in precapillary PH patients was significantly higher than in patients with postcapillary PH. In other myocardial segments there were no differences between systolic, early diastolic and late diastolic SR.

Conclusion
Our study suggests that RV free wall strain in patients with PH moderately correlate with aetiology of PH. We did not find correlation between higher RA pressure or PVR and worsening of RV function in PH of different aetiologies.
Precapillary PH Postcapillary PH p value PA mean pressure (mmHG) 75,2 ± 17,7 42,0 ± 7,3 &lt;0,05 PWR (WU) 15,8 ± 6,7 4,7 ± 2,6 &lt;0,05 RV wall thickenss (mm) 11,0 ± 2,5 5,5 ± 1,0 NS RVIT (mm) 42,7 ± 10,4 42,8 ± 8,1 NS TAPSE (mm) 19,2 ± 4,2 15,6 ± 4,9 &lt;0,05 S" 10,8 ± 2,0 9,4 ± 2,1 NS basal segment strain -16 ± 7 -17 ± 5 NS mid segment strain -18 ± 8 -15 ± 4 &lt;0,05 apical segment strain -19 ± 8 -14 ± 4 &lt;0,05
P937 Left atrial longitudinal strain as a marker of acute cellular rejection in heart transplant recipients: impact of intervendor variability
Authors: Carnero Montoro L , Ruiz Ortiz M , Rodriguez Diego S , Delgado Ortega M , Rodriguez Almodovar A M , Paredes Hurtado N , Oneto Fernandez M J , Luque Moreno A , Gonzalez Manzanares R , Pericet Rodriguez C , Fernandez Ruiz A , Arizon Del Prado J M , Lopez Granados A , Pan Alvarez-Ossorio M , Mesa Rubio M D 
Published: January 2020

Abstract

Introduction and purpose
Preliminary reports suggests that left atrial longitudinal strain (LALS) variables are a sensitive marker of acute cellular rejection (ACR) in heart transplant recipients (HTxR), discriminating between those studies without rejection and those with any grade of rejection. Intervendor variability is a concern in the widespread use of this technique. Our objective was to compare the LALS evaluated by two different softwares.

Methods
From September 2014 to October 2016 we performed, in 18 consecutive adult HTxR in their first year posttransplantation, serial echocardiographic exams within 3 hours of the routine surveillance endomyocardial biopsies (EMB), in a single centre. Peak average longitudinal strain, and strain rate were measured in the left atrium in the apical four chambers view in all studies, using both softwares, its association with the presence of ACR was investigated, and intervendor variability was evaluated.

Results
a total of 147 pairs of EMB and echo exams were performed, 65 with no rejection (grade 0R), 82 with any grade of ejection (grades 1R and 2R). Intraclass correlation coeficients for intervendor reproducibility for LALS and LALSR were 0.4 (95%CI 0.26 - 0.57) and 0.3 (95%CI -0.06 - 0.52) respectively. The number of segments evaluable by each software was significantly different. Association of LALS with rejection is shown in the table.

Conclusions
In this monocentric prospective study, left atrial longitudinal strain variables were found to be a sensitive marker of acute cellular rejection in heart transplant recipients. Although intervendor reproducibility was poor, these results were consistent between both software.
Results Software n/N (%)* Variable No ACR ACR≥1 p value Siemens 114/147 (77.5) Peak atrial LS 19.4 ± 7.4 15.5 ± 6.3 0.006 114/147 (77.5) Peak atrial LSR 1.5 ± 0.4 1.3 ± 0.5 0.005 TomTec 131/147 (89.1) Peak atrial LS 19.1 ± 6.2 14.1 ± 5.4 &lt;0.005 131/147 (89.1) Peal atrial LSR 1.0 ± 0.4 0.8 ± 0.3 &lt;0.005 n: number of exams evaluable by each software. N: total numbers of exams. *p = 0.01 for comparison between the proportion of exams evaluable by each software.
P941 Evaluation of right ventricular contractile reserve with exercise stress echocardiography
Authors: Missana A , Azzolini Jacquin M , David C , Baudouy D , Sartre B , Sanfiorenzo C , Wehrlin C , Sermesant M , Ferrari E , Moceri P 
Published: January 2020

Abstract

INTRODUCTION
Right ventricular (RV) contractile reserve reflects the ability of the RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. We aimed, using exercise stress echocardiography (ESE), to assess different RV contractile reserve evaluation methods in a cohort of PAH patients and controls.

METHODS
We prospectively included 12 patients with PAH and 12 healthy volunteers. An ESE (using tilt-table ergometer) was performed in all patients to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. 3D RV function as well as peak systolic strain, pulmonary pressures, TAPSE, pulmonary TVI and pulmonary output (using the right ventricular outflow tract diameter) were assessed in all patients.

RESULTS
Our patient group was composed by PAH patients, 61.5 ± 14.8 years; mean age of our control group was 29.33 ± 5.5 years. PAH patients achieved an exercise with a mean workload of 69.17 ± 26.4 Watts. There was no complication after the exercise test in all patients. Change in TAPSE was not significantly different between patients and controls (p = 0.17), whereas change in pulmonary TVI, pulmonary output and RV peak systolic strain was highly discriminant (respectively p = 0.03, p = 0.009 and p = 0.0009). Regarding RV contractile reserve parameters, RV end-systolic pressure area ratio (peak/rest) was not statistically different between controls and patients (p = 0.14) whereas change in TAPSE/sPAP, RV peak strain/sPAP, 3D RV EF/sPAP were significantly different (p = 0.005, p= 0.0008, p = 0004).

CONCLUSION
Changes in pulmonary output, RV peak systolic strain as well as changes in TAPSE/sPAP but mainly RV peak strain/sPAP, 3D RV EF/sPAP represent consistent and feasible tools to assess RV contractile reserve.
echocardiographic parameters PAH (n = 12) Healthy Controls (n = 12) p value sPAP at rest (mmHg) 40.91 ± 10.7 15.42 ± 4.1 &lt;0.001 sPAP at peak (mmHg) 82.50 ± 21.7 42.50 ± 17.8 &lt;0.001 TAPSE at rest/sPAP at rest (mm/mmHg) 0.62 ± 0.2 1.72 ± 0.6 &lt;0.001 TAPSE at peak /sPAP at peak 0.36 ± 0.1 0.80 ± 0.2 &lt;0.001 ΔStrain (%) 3.43 ± 3.1 8.08 ± 2.8 &lt;0.001 Δ(peak Strain/sPAP) -0.17 ± 0.2 -0.77 ± 0.4 &lt;0.001 Δpulmonary TVI (cm) 3.88 ± 4.0 7.46 ± 3.5 0.03 Δ(RVEF/sPAP) -0.34 ± 0.4 -2.06 ± 1.7 &lt;0.001
Abstract P941 Figure. echography (rest/peak) PAH patient