bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1457 Septic and aseptic valvular involvement in hypocomplementemic urticarial vasculitis syndrome
Authors: Scheggi V , Olivotto I , Alterini B 
Published: January 2020

Abstract

Background
Hypocomplementemic Urticarial Vasculitis Syndrome (HUVS) is a very rare disease involving small vessels and characterized by chronic urticarial vasculitis, arthralgia, arthritis, and activation of the classical complement pathway. To our knowledge, just other seven cases of HUVS with cardiac valvular involvement have been reported in the literature. Unlike previous cases, ours shows a broader antibody positivity, (but no anti-C1q antibodies) with an early and serious cardiovascular involvement.

Case summary
A 32 years old woman was brought to the emergency department because of sudden onset of right hemiplegia and global aphasia due to cerebral haemorrage.
She suffered from a severe HUVS form with cardiac valvular involvement and she was cronically treated with immunosuppressant drugs.
During previous years she had already undergone cardiac surgery twice for chronic aseptic inflammatory process involving aortic and mitral valves.
Right hemiplegia and global aphasia were caused by septic embolism to left cerebral artery complicated by cerebral haemorrage.
The patient underwent neurosurgical intervention followed by antibiotic therapy.
This condition was secondary to Listeria monocytogenes aortic infective endocarditis in an immunosuppressed patient.
Transesophageal echocardiogram showed periaortic abscess with internal colliquation.
A further surgical intervention would have been necessary, but operative risk was judged to high and the patient died one year later.

Discussion
The association between HUVS, Jaccaud"s arthropathy and cardiac valvular disease is rarely described in the literature. The presence of valvular involvement is a negative prognostic factor.
Unlike most cases, it is interesting to note that our patient was negative for anti-C1q antibodies and exhibited an extremely severe cardiac involvement.
The case was complicated by L monocytogenes endocarditis, that is also a rare condition associated with a high mortality rate.
Abstract P1457 Figure. Abscess
P1463 Severe stenosis due to obstructive prosthetic thrombosis with truevue, a new echocardiographic tool
Authors: Merino Argos C , Lopez Fernandez T , Eiros Bachiller R , Valbuena Lopez S C , Caro Codon J , Dalmau Gonzalez-Gallarza R , Dominguez Melcon F , Rosillo Rodriguez S O , Guzman Martinez G , Marco Clement I , Martin Polo L , Martinez Marin L , Rodriguez Sotelo L , Poveda Pinedo I D , Lopez-Sendon J L 
Published: January 2020

Abstract
A 70-year-old woman was admitted to the emergency department because of cardiogenic syncope and acute heart failure. She had a mechanical mitral prosthesis (MMP) (ATS Open Pivot 25 mm) implanted in August 2018, due to degenerative rupture of posterior leaflet. One month before admission anticoagulation was temporally interrupted due to humerus surgery. At admission, a transthoracic echocardiogram demonstrated a significant increase in MMP gradient with preserved ejection fraction and a pulmonary artery pressure of 50mmHg. To improve the assessment of MMP a transesophageal echocardiogram (TEE) was performed showing a restricted mobility of the mitral anterior prosthetic lens and a complete block of the mitral posterior lens leading to a severe mitral stenosis (mean pressure gradient 21 mmHg, peak pressure gradient 34 mmHg and peak velocity 2.9 meters/second) with a CW pattern that simulate an aortic morphology (Image 1A). MMP three-dimensional (3D) images were processed using a dedicated transillumination technology that uses a freely movable virtual light to enhance image details and depth (Image 1B and 1C). This rendering tool allows us to characterize tissue consistency and boundary delimitation, confirming the presence of a large thrombus that surrounded the entire posterior region of the prosthetic ring leading to a MMP 3D effective area of 0.49 cm2. After discussing the case with the valvular Heart Team an urgent surgery was performed to replace MMP.
This case shows how the transillumination rendering tools enhance specific image features in prosthetic cardiac valves in critical clinical scenarios as symptomatic MMP thrombosis.
Abstract P1463 Figure. Image 1
P1492 A rare case of a spontaneous rupture of a congenital inter ventricular septum diverticulum in an adult
Authors: Khalifa E A , Helmy S , Mohamed S F , Ghareep A , Alkuwari M 
Published: January 2020

Abstract

Introduction
A ventricular diverticulum is a rare cardiac anomaly with its true incidence is likely to be underestimated, as most patients are thought to be asymptomatic. Possible known complications include conduction abnormalities, rupture, bacterial endocarditis, and thromboembolism. We report a case of inter ventricular septum diverticulum detected incidentally in an adult during echocardiography and which ruptured spontaneously after 3 years of follow up.

Case report
A 36-year-old asymptomatic gentleman was referred for cardiac evaluation as a part of pre employment general check-up. He was controlled hypertensive on medical treatment. He had no history myocardial infarction (MI), arrhythmias, or stroke. He had never experienced exertional dyspnoea or chest pain. Physical examination was unremarkable.
Transthoracic echocardiography revealed mild left ventricle hypertrophy with normal global and regional contractility with an ejection fraction of 58%. In addition, it showed a myocardial out-pouching (11x9 mm) localized at the basal third of the posterior inter-ventricular septum and bulging into the right ventricle and moving in synchrony with the rest of the left ventricle with no shunt (figures A&B&C).
The patient’s history allowed us to exclude a post-ischemic LV aneurysm and an infective genesis of the lesion.
Contrast enhanced EKG gated cardiac computed tomography confirmed the presence of a blind ended diverticulum of the interventricular septum which was stretching and protruding into the right ventricle. The septum and the diverticulum were intact with no evidence of associated septal defects, (figures D&E&F).
Three years later, during his regular follow up, a loud pan-systolic murmur was heard along the left sternal border. His repeated echocardiographic study revealed a rupture of the inter ventricular septal diverticulum into the right ventricle, with a left to right shunt of a peak systolic gradient of 71 mmHg, (Fig G). His blood pressure was 100/60.
Cardiac magnetic resonance confirmed the rupture of the interventricular septum diverticulum. It revealed a tiny defect with a left to right shunt and the calculated QP/QS was 1.3, (fig H&I).
As the patient was asymptomatic and the shunt was insignificant, the decision was made to be managed conservatively and not to intervene with surgery at this point. This was to avoid the potential of surgical complications as disruption of the patient’s conduction system and the chance of post-operative arrhythmia.
Abstract P1492 Figure.
P1500 Reptilian heart in a man
Authors: Ozpelit E O , Ozcan E E O , Ozpelit M E O , Ozgul N O 
Published: January 2020

Abstract
40 year old man admitted to hospital due to tachycardia episode. His normal ECG was consistent with RBBB with a QRS duration of 200msec. He had undergone a VSD operation when he was 6. He had a 3/6 systolic murmor . On TTE, there was a VSD patch and a residual tiny VSD with a L-R shunt. The maximum systolic gradient of VSD shunt was measured as 92mmHg .There was also moderate tricuspid regurgitation (TR) with a peak velocity of 5.1m/sec and estimated sPAP of 103mmHg. Considering the measured sPAP and the VSD shunt gradients, his systolic blood pressure (SBP)should approximately be equal to sum of those two ( 103+ 92 = 195mmHg). However his BP was 140/90mmHg.When we examined his heart for a possible explanation for this inconsistency, we noticed a systolic aliasing inside the RV with a maximum velocity of 3.1m/sec and systolic gradient of 38mmHg. However the chamber with lower pressure (P) was the one to which the VSD shunt was directed, and this chamber was in direct continuity with pulmonary artery. So to confirm the P in this chamber we also used pulmonary regurgitation flow and measured a peak diastolic velocity of 3.8m/sec, meaning a mean PAP of 60mmHg .Cardiac catheterization also confirmed a sPAP of 116mmHg and mPAP of 65mmHg. The systolic aortic P was 145mmHg and systolic LV P was 152mmHg. So the unexpectedly high gradient of VSD shunt was still a mystery for us. While searching the literature to explain this , we noticed that the patients’ heart was resembling the reptilian heart model. The reptilian heart has two atria and one ventricle with 3 segments seperated via muscular ridges. In our patients’ heart ,the small chamber with high P in the RV was the cavum venosum, the larger chamber of RV with VSD was the cavum pulmonale, and the left ventricle was the cavum arteriosum. (Fig) The reptilian hearts typically have noncompacted myocardium which was actually the case in our patient. The reptilian hearts also have unique conduction system with no AV node and His bundle, and slow depolarization of ventricle from left to right. When we performed EPS, we found that the patient had no AV node and His bundle. Bringing together all these findings, we conclude that the patient has a reptilian heart with all anatomical, electrical and physiological features. And the answer to the mystery of inconsistent P recordings was hidden in ECG. The RBBB with very long QRS duration causes a delay between contraction of ventricles resulting in a dynamic P gradient between ventricles. We demonstrated this dinamic bidirectional shunt on CW recording when we obtained a more optimal recording of the shunt flow.This case demonstrates us one more evidence of human evolution; arising from single cell and developing to fish, to reptiles and to mammals. The evolution takes place again and again during neonatal life. If there is an embryological arrest, as occured in our patient, we can easily see the clues of this amazing human evolution.
Abstract P1500 Figure
P1521 Prosthetic heart valve-related stroke: a single center experience
Authors: Almaghraby A , Abdelnabi M , Saleh Y , Abdelkarim O , Ozden Tok O , Laymouna R , Shehata H , Shehata M , Badran H 
Published: January 2020

Abstract

OnBehalf
YIG-CVR

Introduction
Thromboembolic events or bleeding are by far the most frequent complications of prosthetic heart valves. Cerebrovascular stroke is one of the major thromboembolic complications of anticoagulation-related issues of prosthetic heart valves.

Aim of the work
To determine the pattern and risk factors of acute stroke in patients with prosthetic heart valves.

Methods and Patients
A retrospective single-center analysis of the database registry of consecutive acute stroke patients with mitral or aortic heart valve prostheses admitted to a tertiary care stroke specialized center from 01/01/2012 to 01/12/2017.
All patients were examined by a certified neurologist and underwent a complete work-up evaluation (Computed Tomography or Magnetic Resonance Imaging, Carotid Doppler ultrasound examination, complete blood tests, and electrocardiogram) and a transthoracic echocardiography (TTE) examination as well as transesophageal echocardiography (TOE) if valve dysfunction or thrombosis were suspected.

Results
214 patients with mitral or aortic valve prostheses were admitted by acute stroke in the duration from 01/01/2012 to 01/12/2017 with a mean age of 44 ± 15 years, 132 were males (61.7%) and 178 patients had mechanical valves (83.2%). 135 patients had mitral prosthesis (63.1%) and ischemic stroke was encountered in 151 patients (70.6%).

Conclusion
In a single center experience, mechanical prosthesis at the mitral valve position was associated with higher incidence of ischemic stroke. Proper close follow-up of INR levels as well as the surgical shift to biological instead of mechanical valve should decrease significantly the incidence of prosthetic valve related strokes.
Baseline, clinical and other parameters Patients (n = 214) Age (years) 44 ± 15 Mechanical valve 178 (83.2%) Atrial Fibrillation 101 (47.2%) Rheumatic Heart Disease 175 (81.8%) Left ventricular ejection fraction (%) 54 ±13 Mitral Only 135 (63.1%) Aortic Only 51 (23.8%) Double Valve Prosthesis 28 (13.1%) Ischemic stroke 151 (70.6%) Hemorrhagic stroke 47 (22%) Both ischemic and hemorrhagic stroke 16 (7.4%) Data are represented as mean(±SD) or number (Percentage)
Abstract P1521 Figure. Valve sites
P1522 Long term follow-up after early mitral valve surgery. Role of 3D echocardiographic right chambers evaluation in predicting tricuspid regurgitation development
Authors: Volpato V , Mantegazza V , Manfredonia L , Fusini L , Gripari P , Tamborini G , Pepi M 
Published: January 2020

Abstract

Background
Combined mitral and tricuspid surgery is recommended in patients diagnosed with significant tricuspid regurgitation (TR) or dilatation of tricuspid annulus (TA) undergoing mitral valve (MV) surgery. Despite the prognostic value of significant TR is well known, the role of TA is still debated, due to inaccuracy of 2D measurements. Data about the role of 3D echocardiographic evaluation of TA and right chambers in predicting TR development after early MV surgery are lacking.

Purpose
To test whether a comprehensive 3D evaluation of right chambers and TA may predict TR development after early surgery in patients with MV prolapse, at a long term follow-up.

Methods
Between 2012 and 2015, 100 patients diagnosed with MV prolapse and severe mitral regurgitation, who underwent early MV repair were retrospectively studied. All patients underwent 3D transthoracic examination before surgery; for each patient right atrial (RA) volume and right ventricular (RV) volumes, function and strain were derived. 3D dimensions and function of TA were also measured using commercial software. The median follow-up was 48 months.

Results
9 patients underwent TVR for moderate TR and were excluded. At baseline, our patients showed more than moderate TR, normal 3D RV volumes and function (EDV 67 ±16ml/m2, EF 56 ± 6%, GLS free wall 28 ± 5 %) and RA volume (54 ± 15 ml/m2). Pulmonary artery pressure was 36 ±9 mmHg. Based on 2D evaluation, dilatation of TA (more than 21 mm/m2) was measured in 21 patients over 91. 3D analysis of TA showed a function of 38 ± 12% and a major axis of 46 ± 6 mm no significant differences in 3D values were noted between patients with normal and dilated annuli. Based on 2D. Over the follow-up, none of our patients developed clinically significant TR (more than moderate)

Conclusion
Patients who underwent early MV repair with normal 3D values of right chambers have a low risk of developing TR, regardless of 2D dimensions of TA.
P1546 Reproducibility of right atrial myocardial deformation by two-dimensional speckle tracking
Authors: Shiino K , Mori Y , Kawasaki N , Nakashima C , Nakashima M , Nagahara Y , Kan S 
Published: January 2020

Abstract

Background
Right atrial (RA) deformation by two-dimensional speckle tracking echocardiography has a relatively new technique to evaluate right heart function with pulmonary hypertension and cardiomyopathy. Reproducibility between observers of this technique is important to develop into a robust and reliable tool. Experience may pose significant challenges.

Purpose
The aim of this study is to evaluate reproducibility of RA strain (global and regional) between novice and expert.

Methods
One hundred thirty-three patients (n = 133) underwent 2D-Speckle tracking derived RA strain analysis by 3 independent blinded readers (expert and 2 novices). The novice observers were medical interns with no prior experience in performing strain analysis. Echocardiographic images were acquired from iE33 (Philips Medical System) but were analysed offline using single vendor dependent software (QLAB version 11.0; Philips Medical System). The result of novice observer was calculated by the average of novice observers. RA strain parameters were assessed: global RA strain and segmental (Basal, Mid, Roof). Intraobserver and interobserver analyses were performed using intra class correlation coefficients (ICC) between expert and novice.

Results
Expert and novice observer demonstrated good interobserver reproducibility of global RA strain (ICC 0.88) and segmental parameters (Basal: ICC 0.89, Mid: ICC 0.87, Roof: ICC 0.84). Of all parameters, the basal segment of RA strain showed the greatest interobserver agreement. Intraobserver agreement for novice observer was excellent for global RA strain and segmental parameters (ICC &gt; 0.88).

Conclusions
Global RA strain and segmental parameters were highly reproducible by novice and expert strain observer.
P1547 Left ventricular papillary muscle strain as an indicator of hypertrophic cardiomyopathy
Authors: Ikeda M , Kajikawa Y , Hirota M , Ueda A 
Published: January 2020

Abstract

Background
Although recognized as part of the mitral valve complex, few studies have assessed the left ventricular papillary muscle.
We confirmed during autopsy that papillary muscle consists of longitudinal aligned muscle fibers, and that the papillary muscle originated from the left ventricular oblique muscle. Therefore, papillary muscle contraction was considered only in the longitudinal direction.
Purpose
We previously reported that left ventricular papillary muscle strain (LV-PMS) in 100 patients without organic heart disease was correlated with multiple left ventricular function assessment parameters.
This study aimed to determine whether left ventricular papillary muscle strain (LV-PMS) in patients with hypertrophic cardiomyopathy (HCM) is correlated　with left ventricular function parameters as in non-HCM patients.
Methods
We measured left ventricular papillary muscle strain (LV-PMS) between two points on papillary muscles except where chordae adhere and the left ventricular wall, and compared values between patients without organic heart disease and with hypertrophic cardiomyopathy (HCM).
Among 1,344 patients who were assessed by echocardiography at our hospital between January and June 2018, we selected 42 (mean age, 68.9 ± 17.4 years; male, 67%) who did not have coronary heart disease and in whom left ventricular papillary muscle contraction strain (LV-PMS) could be determined. Obvious anterior and posterior papillary muscles were evaluated. We also analyzed age, EF, e’, s’, E/e’, E/A, left atrial volume index (LAV-I) and global longitudinal strain (GLS) as possibly relevant factors.

Results
Among the 42 patients, 22 (52%) and 17 (40%) had hypertension and HCM, respectively. We measured the strength of linear associations among paired variables (LV-PMS, age, EF, e’, s’, E/e’, E/A, LAV-I and GLS) using Pearson product-moment correlation coefficients.
Age (r = 0.64), e’ (r = -0.76), s’ (r = -0.61), LAV-I (r = 0.61) and GLS (r = 0.57; all p &lt; 0.001), as well as E/e’ (r = 0.44, p &lt; 0.05) significantly correlated in patients without HCM, whereas only GLS correlated in patients with HCM (r = 0.723, p &lt; 0.001).
One-way analyses of variance showed that LV-PMS values significantly differed only among patients without HCM when categorized according to age &lt; 50, ≥ 50 &lt; 75 and &gt; 75 years (p &lt; 0.001), whereas these values significantly differed in all patients (p &lt; 0.05) when categorized according to GLS &lt; -20%, ≥ -20 to &lt; -15% and &gt; -15%.

Conclusions
We found that LV-PMS correlated with five factors including age in patients without HCM, but only with GLS in those with HCM. Despite the small study cohort, we considered that LV-PMS and GLS would be useful for evaluating left ventricular function in patients with HCM.
P1560 Acute changes of mitral annular dimensions after transcatheter egde-to-edge repair: an indirect annuloplasty method?
Authors: Papadopoulos K , Ikonomidis I , Chrissoheris M , Chalapas A , Kourkoveli P , Pattakos G , Vardas P , Spargias K 
Published: January 2020

Abstract

Background
Percutaneous edge-to-edge mitral valve repair (PMVR) is a safe and alternative method for treating high-risk patients with severe mitral regurgitation (DMR or FMR). This transcatheter treatment aims at reducing the MR with a so-called "Alfieri stitch" method. However the impact on mitral annular dimensions after the device implantation is not well defined. The purpose of this study is to recognize the acute changes of mitral annular dimensions after transcatheter edge-to-edge repair.

Methods
We retrospectively analyzed 20 consecutive patients (aged 74 ± 10yrs) with degenerative or functional moderate-to-severe and severe mitral regurgitation (EROA 40.8 ± 20.5mm2, RV 52.6 ± 17.5ml) and reduced ejection fraction (EF 36.9 ± 15.4%). These patients were at high surgical risk or even inoperable in certain cases (logistic EuroSCORE 28.9 ± 18.2%) and evaluated by a heart team as candidates for transcatheter repair. All intraoperative transoesophageal echo studies were post processed with EchoPac v.203 or QLAB 9.0. 3D views of the mitral valve before and after the implantation of the device were analyzed with 4D AutoMVQ (GE) or MVQ (Phillips) software.

Results
PMVR was effective in treating the MR at the end of the operation (from 3.8 ± 0.4 to 1.3 ± 0.5 after the implantation, p &lt; 0.05) in all patients. There was a significant reduction of the annulus area (from 12.25 ± 3.0cm2 to 10.18 ± 2.88cm2, p &lt; 0.001) and circumference (from 13.23 ± 1.4cm to 12.18 ± 1.57cm, p &lt; 0.001), in both DMR and FMR cases. The percentage reduction of annulus area and circumference after PMVR was 17.3 ± 0.8% and 8 ± 5% respectively and the number of the clips used for that purpose were 1.55 ± 0.6. Additionally, edge-to-edge repair significantly reduced the anterior-posterior diameter (from 3.49 ± 0.56cm to 3.02 ± 0.55cm, r = 0.86, p &lt; 0.001) and the posteromedial-anterolateral diameter (from 4.15 ± 0.58cm to 3.88 ± 0.60cm, r = 0.9, p &lt; 0.001). The number of the clips used did not play an important role in the percentage difference of the annulus dimensions (20% reduction with one clip vs 14.3 ± 7.6% with two or more, p &lt; 0.05) and one possible explanation could be that patients receiving one clip had smaller annulus area comparing to the patients receiving two or more (11.2 ± 2.9mm2 vs 13.3 ± 2.7mm2 respectively, p &lt; 0.05).

Conclusions
Transcatheter edge-to-edge repair is effective in treating MR in patients with DMR and FMR and has a direct impact on mitral annular dimensions acutely after the implantation.