bluuebunny/crossref_metadata_2025_split huggingface dataset:
P626 Peripartum cardiomyopathy with persistent ventricular dysfunction and intracavitary thrombosis despite treatment with dopamine receptors agonist. The role of the three-dimensional echocardiography
Authors: Vasquez-Ortiz Z Y , Gonzalez-Varela R , Navarrete Garcia J , Hernandez-Reyes P , Oseguera Moguel J 
Published: January 2020

Abstract

Introduction
Peripartum cardiomyopathy (MPP) is a type of cardiomyopathy characterized by heart failure secondary to left ventricular systolic dysfunction during the last month of pregnancy or in the first 5 months of puerperium without other apparent etiology, being a diagnosis of exclusion. The left ventricle is not always dilated, but the fraction of left ventricular ejection is always less than 45%. The natural history and prognosis of the disease is diverse. Ventricular dysfunction is usually transient and normalizes at 3-6 months in up to 60% of cases. Mortality is variable, with reports ranging from 0 to 28%, affecting more certain ethnic groups, in patients with persistent ventricular dysfunction, evidence of the efficacy of a specific treatment beyond optimal medical therapy for heart failure is limited.

Clinical case
We present the clinical case of a 22-year-old woman, who was referred to the our institute with an acute heart failure syndrome two months after the end of her first pregnancy. On admission to the hospital, dilated cardiomyopathy and intracavitary thrombi were documented by transthoracic echocardiography (TTE) with dilatation and eccentric left ventricular hypertrophy, generalized hypokinesia and mobile thrombi inside, the largest of 34x16mm with severe left ventricular dysfunction 3D LVEF of 28% and global longitudinal strain (GLS) of -5.8%, pulmonary hypertension and right ventricular dysfunction with severe functional tricuspid regurgitation. Other specific etiologies of dilated cardiomyopathy were investigated and discarded, finally establishing the diagnosis of peripartum cardiomyopathy. The support management was carried with inotropic, diuretic, supplemental oxygen and parenteral anticoagulation was initiated, with gradual improvement. Subsequently, optimal medical treatment was started for heart failure, cabergoline and vitamin K antagonist. He was released to his home on II NYHA. Two months later she presented with progressive dyspnea, increased abdominal perimeter. On March 14, 2018, a TTE was performed, with absence of improvement in conventional and advanced ventricular function parameters. Apical thrombi of smaller size compared with previous study, severe left ventricular dysfunction, which worsened with respect to the previous echocardiogram, with 3D LVEF of 25% and GLS 3.7%

Discussion
We present the case of a woman with MPP, in whom persistent left ventricular dysfunction after 6 months of diagnosis, although cabergoline scheme in addition to optimal medical management for heart failure, with no improvement. In patients who dont present an adequate response to the management, it is necessary to consider enlisting for heart transplantation.
Abstract P626 Figure. TTE, severe ventricular dysfunction
P633 Murmuring the diagnosis
Authors: Tiucu G , Ait Yahia F 
Published: January 2020

Abstract

INTRODUCTION
Coronary-cameral fistulas (CCF) are mostly congenital, rarely acquired malformations that create a communication between one or more coronary arteries and one of the cardiac chambers resulting in arterio-venous or arterio-arterial connections, giving rise to left-right or left-left shunts.
CASE REPORT
A 64 year-old man with history of heart transplant in September 2018 for severe post-ischemic heart failure, was transferred in our cardiology service after a three months cardiac reeducation program. The patient was to be discharged on the same day but the accidental discovery of a myocardial septo-apical infarction with ST segment elevation motivated his admission for urgent coronary angiography. The patient did not present any thoracic pain, only a slight numbness in his right shoulder. Troponin T value was 1735pg/ml. The coronary angiography showed a recent occlusion in the distal segment of the left anterior descending artery presenting with an aneurismal dilatation and CCF.
Further we completed the exam with a transthoracic echocardiography showing an akinetic apex in the presence of a fistula between the left anterior descending artery and the apex of the right ventricle with a high velocity flowing (Vmax = 1.8m/s) preferentially directional to the right ventricle.
Reviewing the medical history we found out that the patient had had a endomyocardial biopsy three days before this episode. Clinically a continuous cardiac murmur could be heard and the patient presented NYHA II dyspnea. Following this clinical presentation we decided to discuss the case within a heart team reunion and the decision taken was to place a covered stent in the distal segment of the left descending artery so as to permit the occlusion of the fistula. The evolution was favorable and the patient was discharged five days later.
DISCUSSION
Diagnosis of acquired CCF is suspected by clinical history and recurrence of symptoms, occurrence of a new continuous machinery cardiac murmur and a palpable thrill. Normally conservative medical management is sufficient to relieve symptoms in these acquired fistulas and spontaneous resolution is very common in CCF acquired following endomyocardial biopsy.
In our case report we noted the occurrence of a systolo-diastolic murmur following endomyocardial biopsy with a patient who was symptomatic of myocardial infraction. The literature describes report cases of symptomatic patients who needed a surgical or endovascular occlusion of the acquired CCF following endomyocardial biopsy by implanting a covered stent or with a covered balloon.

CONCLUSION
The termination site of acquired iatrogenic CCF following endomyocardial biopsy in the heart transplant population is usually the right ventricle with an elevated ratio of spontaneous resolution of this coronary-cameral communications. However in sysmptomatic patients a surgical or endo-vascular occlusion may be needed.
Abstract P633 Figure. Transthoracic echography findings
P643 A case of Fabry cardiomyopathy refractory to enzyme replacement therapy; the importance of early diagnosis and treatment in Fabry cardiomyopathy
Authors: Park S H , Jung K T , Choi Y J , Kim W H , Chin J Y , Kang K W 
Published: January 2020

Abstract
A 56-year-old male was referred in order to identify Fabry disease after his older brother was confirmed as Fabry disease of cardiac variant type. He had been treated with hypertrophic cardiomyopathy (HCMP) five years ago. He didn’t have a history of hypertension. Blood pressure was 118/65 mmHg and pulse rate was 75 beats per minute. Serum creatinine was 1.07 mg/dl and estimated glomerular filtration rate was 75.2 ml/min. Cardiac enzymes including CK-MB and troponin-T were normal. There was no proteinuria on urinalysis. A 12-leads electrocardiogram revealed normal sinus rhythm with severe left ventricular hypertrophy (LVH) and strain pattern. Transthoracic echocardiogram (TTE) showed diffuse severe concentric hypertrophy of the left ventricle (LV) of an average ventricular wall thickness of 17 mm with normal systolic function (left ventricular ejection fraction (LVEF), 56%). TTE also revealed left ventricular outflow tract obstruction with systolic anterior motion of mitral valve. Right ventricle (RV) was also hypertrophied (RV free wall thickness, 7mm). Also, echocardiography revealed findings of diastolic dysfunction; left atrial enlargement, mitral inflow of a pseudo-normal pattern on pulsed wave Doppler image and an increased left ventricular filling pressure on tissue Doppler image (E/e’=20). Cardiac magnetic resonance imaging (MRI) revealed diffuse LV and RV hypertrophy and preserved LV systolic function with hypokinesia of mid-septal LV wall. Delayed hyper-enhancement (DHE) was not found within entire myocardium. A coronary CT angiography was performed because of regional wall motion abnormality but did not show any significant stenoses. He was confirmed as Fabry disease with the same genetic mutation as his brother. He did not present symptoms and signs of any other organs besides only myocardial hypertrophy. He received enzyme replacement therapy (ERT) with intravenous agalsidase-beta every other week via outpatient department for 3 years. Recently, TTE was performed and showed diffuse severe concentric LVH of an average ventricular wall thickness increased to 19 mm despite regularly ERT. Focal intramural and subepicardial DHE was newly developed at LV basal lateral and septal wall on cardiac MRI. Neutralizing antibody against agalsidase -beta was not found in serum.
Fabry disease of cardiac variant type can be delayed in diagnostic aspect because of absence of typical symptoms and signs. Despite the absence of neutralizing antibody, ERT did not prevent both further myocardial hypertrophy and myocardial fibrosis in patient with advanced myocardial hypertrophy caused by delayed diagnosis of Fabry disease. Suspicion of Fabry disease through detailed history taking including family history in patients with diffuse ventricular hypertrophy on an echocardiography can lead to early diagnosis and treatment and can result in improvement in a clinical outcome.
P646 Cardiac tamponade as initial manifestation of small cell lung carcinoma
Authors: Murdila M-C-T , Zamfirescu B , Popescu A C 
Published: January 2020

Abstract

We report the case of a 69 years old woman, ex-smoker, with a history of hypertension, dyslipidemia, diabetes and right leg partial amputation after childhood osteomyelitis, presented at the emergency department for dyspnoea, posterior thoracic pain and progressive distention of the abdomen. She was tachycardic, slightly hypoxemic but normotensive. Electrocardiography: sinus tachycardia, normal axis, diffuse microvoltage and electric alternans. Chest X-ray showed enlarged cardiac silouhette, bilateral pleural effusion and upper right pulmonary lobe consolidation. Transthoracic echocardiography revealed large pericardial effusion, swinging heart, right atrial and right ventricular colapse, significant respiratory variation of transmitral and transtricuspidian flow, dilated inferior vena cava without respiratory variation, all suggesting cardiac tamponade. Computed tomography showed a mediastinal and pulmonary mass in the upper right pulmonary lobe, invading the posterior right thoracic wall and multiple mediastinal voluminous lymphadenopaty and ascites. She became hypotensive and was transferred to a tertiary hospital for urgent drainage of pericardial effusion. Over 1200 mL of serohematic fluid was evacuated with the removal of the drainage catheter in the following 48 hours. A biopsy was performed through bronchoscopy and small cell carcinoma of the lung was diagnosed. Considering the advanced stage of the carcinoma the option of pallative treatment was pursued.

Discussions
Chronic accumulation of large amounts of pericardial fluid is well tolerated, especially in patients that have limited physical activity. Ecocardiography allows early detection of cardiac tamponade. Development of cardiac tamponade in the evolution of malignancy confers a poor prognosis.

The particularity of the case
Cardiac tamponade as initial manifestation of lung cancer is a very rare occurrence and only limited data exist in literature.

Conclusion
Simultaneous presence of ascites, pleural and pericardial effusion should rise the suspicion of malignancy.
Abstract P646 Figure.
P648 Right heart volume overload after surgical correction of atrial septal defect sinus venosus type with partial anomalous pulmonary veins drainage
Authors: Ruiz-Zamora I , Alvarez-Roy L , Pinillos-Francia G , Gutierrez-Fernandez A , Gomez-Llorente M , Alonso-Perez L , Bastarrika-Aleman G , Azcarate-Aguero P 
Published: January 2020

Abstract

40 year-old male with history of congenital heart disease. Atrial septal defect (ASD) sinus venosus type associated with partial anomalous pulmonary venous drainage (PAPVD) was diagnosed during childhood and surgically repaired at the age of three.
Since then the patient was asymptomatic and he was lost to follow up when reached adulthood. A transthorathic echocardiogram was performed during a hospitalization because of a complicated pneumonia. A severe dilatation of right chambers and main pulmonary artery was observed. The estimated Qp:Qs by this technique was 2.0 but the atrial septum seemed to be intact. Agitated saline was administered in this procedure and no passage of microbubbles was observed. A cardiac MRI was performed because of suspicion of anomalous pulmonary venous drainage. The findings observed in the echocardiogram were confirmed and an uncommon PAPVD was demonstrated by this technique: the superior left pulmonary vein drainaged into a dilated innominated vein. Also, a small pulmonary vein from the right upper lobe emptied into a "venous conduct" (yellow circle) located posterior to the superior cava vein (SCV) that later drainaged into the right atrium under the mouth of the SVC, posterior to the interatrial septum. Surgically correctioin of the PAPVD was performed.

Discussion
PAPVD is a congenital heart disease characterized by the drainage of one or several pulmonary veins –but not all of them- into the right atrium or systemic veins, which leads to left-to-right shunting. The estimated incidence of this disease ranges between 0.1 and 0.2% of the general population. The right superior pulmonary vein is the most frequently involved and is commonly associated to ASD sinus venosus type. Bilateral anomalous drainage, as occurred in this case, is exceptional.
Furhermore, this case highlights the importance of long-term follow-up in patients with congenital heart disease due to the fact that, even when the disease is considered to be cured, long term complications could appear compromising the prognosis of the patient.
Abstract P648 Figure. Unusual PAPVD
P654 Prognostic evaluation of simplified echocardiographic parameters in acute myocardial infarction
Authors: Fonseca Goncalves F , Guimaraes J P , Borges S C , Monteiro J J , Mateus P S , Moreira J I 
Published: January 2020

Abstract

Introduction
In an era where prognostic evaluation is increasingly being improved by echocardiography in acute myocardial infarction (MI), there are also classic 2D echocardiographic parameters that may have potential and practical utility in this area. The aim of this study was to evaluate the prognostic impact of left ventricular end-diastolic diameter (LVEDD), indexed left atrium volume (VOL) and indexed left ventricular mass (LVM) in ST-segment elevation myocardial infarction (STEMI) patients.

Methods
Retrospective study of consecutive patients with nonfatal STEMI who underwent percutaneous coronary intervention between January/2015 and December/2017. VOL was calculated by the "Area-Length" and LVM by "Cube formula", both indexed to the body surface area. High parameters were considered when: LVEDD &gt;58mm in man or &gt;52mm in woman; VOL &gt;34mL/m2; LVM &gt;115g/m2 in man or &gt;95g/m2 in woman. At a median follow-up of 46 months (IQR 38-58), the endpoints evaluated were acute myocardial infarction (AMI), decompensated heart failure (DHF), and overall mortality. The analysis of events was adjusted for possible confounding factors.

Results
A total of 200 patients were identified, 72% of whom were men and the mean age was 63.7 ± 13.0 years. There was an increase of the LVEDD in 17.5%, VOL in 42% and LVM in 16.5%.
In the multivariate analysis, LVEDD was able to predict significant DHF (HR 2.4, 95% CI 1.2-4.9) and AMI (HR 6.4, CI 95% 1.6-26.0) and VOL only AMI (HR 6.1, 95% CI 1.2-30.1), but not DHF (HR 1.3, 95% CI 0.7-2.6). The presence of increased LVM was not associated with more events of DHF (HR 1.4, IC95% 0.7-3.0) or AMI (HR 3.7, 95% CI 0.9-14.5). None of these parameters reached statistical significance for mortality (LVEDD: HR 1.0, 95% CI 0.3-3.0, VOL: HR 1.9, 95% CI 0.8-4.4, LVM: HR 1.3, 95% CI 0.5-3.5).
In the ROC curve analysis, LVEDD showed an area under the curve (AUC) of 0.7 (95% CI 0.6-0.8) for DHF and 0.6 (95% CI 0.5-0.8) for AMI, whereas VOL demonstrated an AUC of 0.7 (95% CI 0.5-0.9) for AMI.

CONCLUSION
In patients with nonfatal STEMI who underwent percutaneous coronary intervention, LVEDD and VOL are echocardiographic parameters that may still play some role in prognostic evaluation. The presence of elevated LVM was not associated with a significant increase in cardiovascular events.
P657 Deterioration of left ventricular performance in response to pulmonary hypertension, in patients with scleroderma versus patients with coronary artery disease
Authors: Marton E , Hodas R , Blendea C , Cucuruzac R , Pirvu M , Benedek T , Benedek I 
Published: January 2020

Abstract

Funding Acknowledgements
PlaqueImage

Background
The relationship between the degree of pulmonary hypertension (PH) and left ventricular performance in patients with systemic sclerosis is still a controversial issue in the literature. We aimed to conduct a comparative analysis of indexes characterizing left ventricular systolic and diastolic function, in two etiological types of pulmonary hypertension involving different pathophysiological mechanisms: PH caused by systemic sclerosis and PH caused by myocardial ischemia.

Material and method
We performed a prospective study on 83 patients (36 patients with documented PAH with a systolic pulmonary arterial pressure – sPAP of &gt;35 mmHg and 47 subjects with normal sPAP), out of which group 1 – with systemic sclerosis (n = 48); group 2 – significant coronary artery disease - CAD (n = 35). Patients of each group were divided in two subgroups based on the diagnosis of PH: group 1A - subjects with scleroderma and associated PH (n = 20), group 1B - subjects with scleroderma without PH (n = 28), group 2A - ischemic patients with associated PH (n = 16) and subgroup 2B - patients with ischemic disease without PH (n = 19).

Results
Patients in group 1 presented a significantly higher number of female subjects (p = 0.001) and a higher mean age (p = 0.009) compared to group 2. Patients with associated PH presented a significantly lower left ventricular ejection fraction (LVEF) compared to those without PH within the ischemic group (p = 0.023). There was a significant inverse correlation between the sPAP and LVEF in ischemic patients (r=-0.52, p = 0.001) as well as for scleroderma patients without PH (r=-0.51, p = 0.04). Tissue Doppler analysis of the left ventricular function indicated a significant negative correlation between the septal E’ value versus the sPAP and lateral E’ value versus the sPAP (r=-0.49, p = 0.002; r=-0.43, p = 0,008).

Conclusions
Intrinsic myocardial damage plays an important role in left ventricular systolic function even in the absence of PAH. Scleroderma patients present a less pronounced deterioration of the LVEF in response to pulmonary hypertension, indicating that in this group, additional compensatory mechanisms could be involved in the complex response of myocardium to elevated pulmonary pressures.
P679 Subpulmonary left ventricular dysfunction is associated with severity of heart failure in patients with systemic right ventricle
Authors: Surkova E , Segura T , Dimopoulos K , Flick C , West C , Senior R , Gatzoulis M , Li W 
Published: January 2020

Abstract

Background
Dysfunction of systemic right ventricle (SRV) in patients with congenitally corrected transposition of great arteries (ccTGA) or simple transposition (TGA) is commonly associated with exercise intolerance, heart failure and death. However, the relevance of subpulmonary left ventricular (LV) function in these settings is unknown.

Purpose
To examine the relation between severity of heart failure and echocardiographic parameters of subpulmonary LV size and function in patients with SRV.

Methods
We identified all patients with SRV from our digital echocardiographic database between 2014 and 2018. The size and function of SRV and subpulmonary LV were assessed in the most recent examination. Clinical data were collected from electronic patient records.

Results
We included 157 patients with SRV, median age 40.6 [33.1; 46.8] years, 57% male. 133 (85%) patients had NYHA functional class 1-2 and 24 (15%) NYHA class 3-4.
Patients with NYHA class 3-4 were older, had larger SRV and subpulmonary LV with poorer function and higher BNP level (Table, Figure A).
LV fractional area change (FAC) had higher sensitivity and specificity in differentiation of patients with severe heart failure than SRV FAC (Figurel B) with LV FAC cut-off value &lt;39.2% showing the highest accuracy in prediction of NYHA class 3-4 (Se 83% and Sp 88%) and 86% Sp in predicting BNP &gt; 100 ng/l.
LV end-diastolic diameter and area, MAPSE and FAC significantly correlated with BNP level (p &lt; 0.0001; p = 0.001; p = 0.007; and p = 0.0002, respectively).
In Multivariate Cox regression analysis LV FAC and RV FAC were the only independent associates of NYHA class 3-4 (HR 0.69 [95%CI 0.55-0.86], p = 0.001 and HR 0.71 [95%CI 0.55-0.93], p = 0.012, respectively), while age, degree of tricuspid regurgitation and BNP were not.

Conclusions
Subpulmonary LV dysfunction is strongly associated with NYHA class 3-4 heart failure in patients with SRV. LV FAC is more accurate than SRV FAC in predicting heart failure symptoms. Subpulmonary LV should be accurately assessed in all SRV patients and be taken into account in clinical decision making and timing for interventions.
Characteristics of 157 patients with SRV Parameter NYHA Class 1-2 (N = 133) NYHA Class 3-4 (N = 24) P value Age, years 39.1 (31.9; 45.7) 46.5 (43.9; 58.1) &lt;0.0001 RV EDAi, cm2/m2 17.4 (15.2; 20.1) 21.8 (17.5; 25.6) 0.0002 RV FAC, % 29.5 (23; 35) 22 (20; 27) &lt;0.0001 LV EDAi, cm2/m2 12.0 (10.1; 14.1) 16.4 (11.6; 19.1) 0.0008 Reduced LV function by eyeballing 3 (2%) 18 (75%) &lt;0.0001 BNP, ng/l 66 (35; 109) 356 (196; 512) &lt;0.0001 Data presented as median (25th; 75th percentiles)
Abstract P679 Figure.
P685 Isolated Large Cardiac Hydatid Cyst in the Interventricular Septum
Authors: Tunca C , Pamukcu H 
Published: January 2020

Abstract
Hydatidosis or cystic echinococcosis is caused by infection with the metacestode stage of the tapeworm Echinococcus . Cardiac hydatid cyst is a rare disease (%0.5-%2) and its symptom is depending on the size and site of infection. The growth of hydatid cyst is usually slow and asymptomatic and just about 10% of patients with cardiac hydatid cyst are symptomatic . The left ventricle is the site of cardiac hydatid cysts in 55% to 60% of cases.Involvement of the interventricular septum is quite rarer.Surgical excision is the preferred treatment. We are reporting a patient with cardiac hydatidosis who was medically treated mass cause of refused the surgery.A 27-year-old woman presented with atypical chest pain and dyspnea. Transthoracic echocardiography revealed a large cyst in the interventricular septum. Thoracic computed tomography showed a cystic lesion in that site, and magnetic resonance imaging confirmed the presence of a 32× 34-mm mass. The patient was treated with albendazole 10 mg/kg for 6 months. After a 6-month follow-up, echocardiography revealed reduction in the size of the cyst. We consider this is the infrequent documented case of cardiac hydatid cyst which regressed with only medical treatment
Abstract P685 Figure. Hydatid Cyst in the IVS