bluuebunny/crossref_metadata_2025_split huggingface dataset:
P695 Is reference value of left atrial strain using 2D echocardiography really reliable?
Authors: Takeuchi M , Negishi K , Nabeshima Y , Otani K , Otsuji Y 
Published: January 2020

Abstract

Funding Acknowledgements
MT received research grant from GE Healthcare.

Background
Left atrial (LA) longitudinal strain (LALS) assessed by two-dimensional echocardiography (2DE) speckle tracking analysis is increasingly popular for the estimation of left ventricular diastolic dysfunction and the prediction of adverse outcome. Since standard apical 4-chamber and 2-chamber views often maximize the long-axis of the left ventricle, and the long axis of the left ventricle and that of the left atrium do not lie on the same 2D cutting plane, these views have a risk for the foreshortening of the left atrium. It may cause overestimation of LALS due to the reduction of initial perimeter of region of interest that is a denominator for the strain calculation.

Purpose
The aim of this study was to compare LALS values between 2DE and 3D echocardiography (3DE) in healthy subjects, and investigate whether 2DE speckle tracking analysis overestimates reference value of LALS.

Methods
LALS and LA longitudinal length were measured by both 2DE and 3DE in 105 healthy subjects (median age, 42 years; 59 men). For 2DE, LA longitudinal length from the mitral annulus to the roof of the left atrium were measured on apical 4-chamber and 2-chamber views at end-diastole and at end-systole, and the values were averaged. Apical 4-chamber and 2-chamber LALS was also measured using 2DE speckle tracking software (EchoPac PC, GE Healthcare) for calculating biplane LALS. 3DE LALS was measured using new 3DE LA strain software (4D Auto LAQ, GE Healthcare). 3DE determined LA longitudinal length at both end-diastole and end-systole was also measured using the same 3DE datasets.

Results
Mean values of biplane LALS was 39.6 ± 11.8%. 2DE LA longitudinal length at both end-diastole (r=-0.43) and end-systole (r=-0.54) was negatively correlated with biplane LALS. Multivariable regression analysis revealed that both end-diastolic and end-systolic LA longitudinal length had a significant negative association for biplane LALS after adjusting anthropometric and echocardiography image quality parameters. 3DE LALS analysis was not possible in 11 subjects due to the erroneous LA border determination (Feasibility: 90%). 3DE LALS (23.7 ± 7.6%) was significantly lower than biplane LALS (39.5 ± 12.0%, p &lt; 0.001) with a weak correlation (r = 0.33) in 94 subjects who were possible in both analyses. Paired comparison of LA longitudinal length between 2DE and 3DE revealed that 2DE determined LA length at end-diastole (3.51 ± 0.72 cm vs. 4.85 ± 0.56 cm, p &lt; 0.001) and at end-systole (4.63 ± 0.69 cm vs. 5.84 ± 0.54 cm, p &lt; 0.001) was significantly shorter than that obtained from 3DE.

Conclusions
Our results highlighted that LA cavity visualizing on the standard apical 4-chamber and 2-chamber views are often longitudinally foreshortened, and this is a potential cause for the overestimation of LALS. 3DE may overcome this limitation.
P701 Usefulness of echocardiography in diagnosis and monitoring in patient with pulmonary embolism during pregnancy, a case report
Authors: Starzyk K , Dybich P , Ciuraszkiewicz K , Rokita W , Wozakowska-Kaplon B 
Published: January 2020

Abstract
Pulmonary embolism is one of the leading causes of maternal mortality despite a low incidence of during pregnancy. We present 32-year-old woman, in the 35 week of first pregnancy, admitted to the Intensive Care Unit with dyspnea, tachycardia, cyanosis. Echocardiography confirmed the presence of embolic material in the main trunk of pulmonary artery, spreading to the right pulmonary artery. D-dimer and troponin T level were elevated, BNP remained within the normal range. The risk in PESI scale was assumed as intermediate high. LMWH therapy was initiated, the patient was constantly monitored. Venous thrombotic disease in lower extremities was excluded by ultrasonography. The treatment was carried out under obstetric supervision. The clinical state gradually improved, the patient was hemodynamically stable. Serial echocardiographic testing, revealed gradual regression of changes in the pulmonary trunk. Normalization of troponins and lowering of BNP levels were observed. The pregnancy was terminated in 39 week, by cesarean section (obstetric indications). The LMWH was continued few days after delivery, as the patient started lactation. She decided to terminate lactation in a first week after delivery so the therapy was switched into rivaroxaban for at least 3 months. Echocardiography after 3 month confirmed lack of changes in pulmonary trunk, the risk of pulmonary hypertension was low. Echocardiography can be a method of choice for confirming and monitoring pulmonary embolism during pregnancy, in a situation of high or intermediate clinical risk and good visualization of changes in pulmonary arteries
Abstract P701 Figure. Embolism of pulmonary trunk and RPA
P702 An unusual echocardiographic finding of protrusive vegetation caused by perivalvular abscess perforation into the left atrium
Authors: Suzuki S , Takeuchi Y , Hiramatsu N , Tsuneyoshi H , Shimada T 
Published: January 2020

Abstract

Background
It is well-known that Infective endocarditis (IE) caused by S. aureus progresses rapidly and is highly destructive. The most often abscess formation after aortic valve replacement (AVR) is the mitral-aortic intervalvular fibrosa (MAIVF). It is difficult to cure MAIVF radically once infection occurs, and then the abscess tends to spread. After abscess formation is once established, IE tends to be widespread, the prognosis is definitely poor unless surgical repairment is executed, and then an emergency surgery is essential and unavoidable for complete cure. We report an unusual case of aortic valve abscess with perforation of vegetation into the left atrium after aortic valve replacement.

Case report
A 77-year-old man underwent the bioprosthetic AVR for aortic valve stenosis one month ago. On the 9th day after discharge, he visited the hospital for the follow-up. At the time, the body temperature was 36.6 ° C, the blood pressure 133/50 mmHg, white blood cell count 10500/μL, and C-reactive protein 3.31 mg/dL. Transthoracic echocardiography (TTE) demonstrated the perivalvular abscesses on the prosthetic aortic valve and mass structures attached to the MAIVF in the left atrium (Figure A, C). He was hospitalized again and had an emergency re-operation. Intraoperative transesophageal echocardiography (TEE) showed a perivalvular abscess on the prosthetic valve, and a high-intensity structure (vegetation like) protruding from the Valsalva Sinus into the left atrium of the MAIVF (Figure B, D). Surgical findings did not reveal any wart on the native valve itself. One-third of the annulus was disrupted. The subvalvular tissue all around was abscessed. Notably, the abscess cavity between NCC and LCC reached MAIVF of the anterior mitral leaflet, and the structure projecting to the left atrium was vegetation. In this case, TTE pointed out a perivalvular abscess of the aortic valve, IE was suspected at the time of outpatient visit at an early stage after discharge, and the spread of inflammation was observed with a high speed beyond the expectation at the time of operation.

Conclusion
Early after the operation, TTE revealed a mass was protruded into the left atrium. Generally, vegetation is soft and flexible in itself. However, in this case, the vegetation was less mobile, and for that reason, abscesses or tumors were suspected. TEE enabled us to obtain anatomically more detailed information and to foresee the left atrial wall repairment at the time of reoperation. We reported an unusual case of IE with solid vegetation attached to the wall and difficult to diagnose.
Abstract P702 Figure.
P720 Antenatal and postnatal echocardiographic diagnosis of Truncus Arteriosus III (TAIII) complicated by spontaneous PDA (patent ductus arteriosus) closure and LPA (left pulmonary artery) disconnection
Authors: Alabdulkarim N , Asahari A T I F , Alotay A M , Thabet SHERIF , Alqahtani TURKI 
Published: January 2020

Abstract

Introduction
TA III is a rare form of truncus arteriosus when the branch pulmonary arteries originate independently from the common arterial trunk or aortic arch, with origin of one pulmonary artery from the underside of the aortic arch from a ductus arteriosus.
Accurate diagnosis and timing of surgery is essential for survival of neonates affected.

Purpose
Illustration of various imaging modalities utilized to diagnose and manage this lesion and the importance of spontaneous PDA closure.

Results
TAIII diagnosed at 24 weeks gestation by fetal echocardiography images 1,2,3. Baby was spontaneously delivered at term with 3 Kg weight and 8,9 Apgar score. Diagnosis was confirmed by transthoracic echocardiography images 4,5 , however on 7th day of life routine echocardiogram was performed to assess PDA , markedly decreased flow noted in LPA/left pulmonary veins and no PDA could be seen at that time images 5,6.
Spontaneous ductal closure was confirmed by tomography image 7 then cardiac intervention performed to establish LPA patency image 8,9. Successful total repair was done within the neonatal period with excellent results at follow up ( image 10 at 3 years old).

Conculsions
1- TAIII can can be diagnosed and assessed by echocardiography.
2- PDA patency to maintain LPA continuity is essential in TAIII management.
3- Successful total surgical repair with good outcomes can be achieved for neonates with this rare complex cyanotic CHD.
Abstract P720 Figure. Images
P723 A dissecting thoracic aortic aneurysm presenting with mild symptoms in a young woman
Authors: Bardos K , Tomoaia R , Mada R , Beyer R , Gurzau D 
Published: January 2020

Abstract

Introduction
Acute aortic dissection is a life-threatening condition associated with high morbidity and mortality rates, and it remains a challenge to diagnose and treat.

Case presentation
We present the case of a 29 years old young woman, brought to the emergency department with mild chest and back pain, shortness of breath on exertion with an onset of 12 days prior to admission. The patient has a history of 3 pregnancies delivered by natural birth and C-section (last one 2 years ago), but no personal cardiovascular disease history. She relates a family history of sudden cardiac death at a young age (mother, grandmother, great-grandmother) and a sister with diagnosed aortic aneurysm associated with a genetic mutation. Physical examination revealed a marfanoid habitus, diastolic heart murmur, low diastolic blood pressure (BP of 90/25 mmHg). Transthoracic echocardiography performed in the ED, discovered an anuloaortic aneurysm with a maximum diameter of 8.7 cm at the aortic root and a dissecting intimal flap of the ascending aorta up to the aortic arch. We also detected a dilated left ventricle with a low ejection fraction (30%) and a severe aortic regurgitation. The findings were confirmed by contrast-enhanced CT Angiography, showing the aneurysm of 8.4/8.7 cm and the intimal dissection flap with patency of both true- and false lumens. At this point we diagnosed an anuloaortic aneurysm with Stanford type A acute aortic dissection and a Marfan syndrome (according to the Ghent Nosology criteria). She immediately underwent surgery, the Bentall procedure was performed, consisting of a composite graft replacement of the entire ascending aorta and aortic valve, followed by direct implantation of the coronary arteries. Histopathological examination of the excised aortic wall reinforced the diagnoses of a connective tissue disorder. The early postoperative evolution was marked by the development of a left-sided hemiparesis and seizures, caused by an acute ischemic stroke. The patient was discharged after the complete resolution of the neurological symptoms under appropriate medication. Recommendations were made for periodic follow-up, genetic testing and the screening of her children after the age of 10 years old.

Conclusion
Discussions evolve around the interesting fact that she managed to survive 3 pregnancies, natural births and a C-section, without developing an aortic dissection or even a possible fatal rupture up until this presentation. It is imperative to mention that the lack of a follow-up from a general practitioner, who could have notice the signs of a possible connective tissue disorder, have possibly led to the development of such aortic sizes. The current guidelines sustain the importance of surgical approach in all types of ascending aortic dissection, the only treatment proven to increase the short- and long term mortality.
Abstract P723 Figure. Imaging studies
P726 Cardiac amyloidosis: unmasking the simulator
Authors: Sanchez Vega J D , Pascual Izco M , Ramos Jimenez J , Alonso Salinas G L , Carvelli A , Jimenez Nacher J J , Moya Mur J L , Garcia A , Hinojar Baydes R , Gonzalez A , Zamorano J L , Fernandez-Golfin C 
Published: January 2020

Abstract

Introduction
A non-invasive diagnosis of cardiac amyloidosis is a challenge, especially in cases of atypical phenotypic presentation. Differential diagnosis includes hypertrophic cardiomyopathy (HCM), hypertensive cardiomyopathy, and other infiltrative disorders. Multimodality imaging is essential to make a final diagnosis.

Case
We present the case of a 65 years old woman, with a personal history of resistant arterial hypertension and mild hypertensive cardiomyopathy. She was diagnosed 6 years earlier with multiple myeloma, treated with chemotherapy and allogeneic hematopoietic stem cell transplant, presenting with several relapses and in a stable situation at the moment of our first consult. The patient was referred for heart failure in context of acquired community pneumonia one month earlier.
Transthoracic echocardiography showed severe asymmetric left ventricle (LV) hypertrophy (Image A), systolic anterior motion of the mitral valve and diastolic dysfunction suggestive of HCM, not present in the previous examination. Strain imaging of the LV showed a typical amyloid infiltration pattern, with lower longitudinal strain values in the base compared to the apical segments (Image D). Further characterization of the myocardial tissue established the diagnosis along with performing a cardiac magnetic nuclear imaging (MRI). It showed the presence of inferior septum severe LV hypertrophy along with extensive patchy late gadolinium enhancement (LGE) of the lateral wall involving the endocardium (Image C), with normal LV contractility. There was no pleural effusion, but a small pericardial effusion was seen (Image B). With the suspicion of infiltrative heart disease, probably amyloid with an atypical LGE pattern, an oral mucosal biopsy was performed confirming amyloid diagnosis (Images E1,E2). Heart failure treatment was continued, but clinical evolution was poor with the deceasement of the patient 3 years after diagnosis.

Discussion
This case represents an example of the variety of imaging patterns we can see in cardiac amyloidosis. Despite the classical pattern of cardiac amyloidosis, with concentric LV hypertrophy, up to 8% of cases may present with asymmetrical LV hypertrophy, mimicking HCM. LGE extension and pattern can shows this variability as well: global transmural or subendocardial LGE is the most common, but focal patterns (up to 6% of cases) are described. The complexity of the diagnosis in these cases require a clinical and multimodality image approach.
Abstract P726 Figure. Images of the case
P750 Dynamics of tricuspid regurgitation after right ventricular lead implantation
Authors: Haydar M , Azzam E , Samniah N , Sharif-Rasslan A , Dobrecky Mery I , Sharif D 
Published: January 2020

Abstract
Placement of ICDs, permanent pacemakers, and biventricular devices is performed under fluoroscopic guidance. Implantable device leads can cause tricuspid regurgitation (TR) when they interfere with leaflet motion. In the past, we had the experience of 2 cases with RV lead who had severe TR; one had lead repositioning and the other needed surgery. Aim: Evaluation of TR after right ventricular (RV) permanent lead implantation to check if echocardiographic guidance is needed for adequate lead positioning. Methods: Seventy six patients had trans-thoracic Doppler echocardiographic studies before and after implantation of permanent RV leads. Results: Before RV lead implantation 96% of patients had TR, grade 1 in 57 patients (75%), grade 2 in 12 (16%), grade 3 and 4 in 4 (5%). After RV lead implantation 44 patients with grade 1 TR remained with the same degree (77%) while in 2 (3.5%) TR progressed to grade 2, and in the remainder the TR disappeared. Most of the patients with grade 2 TR before RV lead implantation (75%) remained in grade 2 while 25% the grade decreased to grade 1. In all the patients with grade 3 and 4 TR pre-implantation, the severity of TR decreased by one grade. In 56 patients with non-CRT device implantations, 39 (70%) had grade I TR before procedure and in 28 (72%) of them TR grade did not change and 11(28%) TR grade progressed to grade 2 after implantation. Grade 2 TR before implantation in 8 patients (14%), the TR grade decreased in3 (37.5%) and did not change in the others. In 3 (5.4%) patients with grade 3 and 4 TR before procedure, the TR decreased after procedure. Conclusions: Implantation of permanent RV leads did not worsen TR grade.
P761 Clinical manifestation of bicuspid aortic valve in single center registry
Authors: Nowak M , Marlega J , Strozyk A , Nowak R , Galaska R , Gruchala M , Fijalkowski M 
Published: January 2020

Abstract

INTRODUCTION
Bicuspid aortic valve (BAV) is a congenital cardiac defect which may contribute to aortic stenosis (AS) and regurgitation (AR), aortopathy, endocarditis or in some group of patients remains without echocardiographic deviations. Prognosis of BAV population is hardly predictable. Nevertheless, the population of BAV requires regular medical control.

PURPOSE
The aim of our study was to assess the BAV appearance and characteristics in the Single Center Registry.

METHODS
All patients with recognition of BAV admitted to First Department of Cardiology at Medical University of Gdansk in years 2012-2018 were enrolled to analysis. Echocardiographic data were collected. Anthropometrics and comorbidities were recorded. Patents were categorized depending on BAV phenotype: coronary cusps fusion (Type 1), right-noncoronary cusps fusion (Type 2), left-noncornary cusps fusion (Type 3) and BAV without raphe (True Type).

RESULTS
323 (25,7% female) patients were enrolled into the Registry. Average age of studied group was 55 ± 16.0. 190 (58.8%) patients were characterized by Type 1 BAV, 75 (23.2%) by Type 2 and 8 (2.4%) by Type 3. There were only 3 patients with True Type. In 14.5% of patients we were unable to clearly identify BAV phenotype. For the further analysis there were included Type 1 and Type 2 groups due to low prevalence of other types. Patients with Type 2 were slightly younger (51.3 ± 16.2 years vs 57.5 ± 13.4 years in Type 1 group; p &lt; 0.01). The aortopathy appeared in 221 patients (68.4% of studied group). Type 1 was associated with larger diameter of aortic root comparing with Type 2 (40.7 ± 6.0 mm vs 38.7 ± 10.6 mm, respectively; p &lt; 0.001), without significant difference in ascending aorta diameter (42.3 ± 7.1 mm in Type 1 and 40.9 ± 6.7 mm in Type 2; p = 0.19). In contrary, Type 2 was correlating with the higher prevalence of severe AR (16% vs 5.7% in Type 1; p &lt; 0.01). Prevalence of AS was similar in both groups (48.4% in Type 1 and 37.85 in Type 2; p = 0.1). In the subgroup with severe AS (75 patients), there was no significant differences in the hemodynamic profile of AS between Type 1 and Type 2 group (respectively; peak transvalvular velocity- 4.5 ± 0.5 m/s2 vs 4.3 ± 0.6 m/s2, p = 0.2; mean transvalvular pressure- 54.2 ± 13.6 mmHg vs 46.6 ± 13.8 mmHg, p = 0.08; aortic valve area- 0.7 ± 0.1 cm2 vs 0.8 ± 0.1 cm2, p = 0.5). 4.3% of studied group were hospitalized due to endocarditis. Average age in that subgroup was 42.3 ± 12.0 years. There was no correlation between BAV phenotype and endocarditis prevalence.

CONCLUSION
Despite higher prevalence of severe AR in patients with Type 2 BAV, Type 1 is more predisposing to aortic root abnormalities. That discrepancy may confirm complex pathophysiology of BAV complications. Prevalence of AS and hemodynamic profile of severe AS does not present correlation with the type of BAV phenotype.
P762 Preserved mitral apparatus dynamics predict the improvement of acute ischemic mitral regurgitation: four-dimensional quantitative echocardiographic study
Authors: Kimura T , Watanabe N , Nishino S , Kuriyama N , Ashikaga K , Nishihira K , Furugen M , Shibata Y 
Published: January 2020

Abstract

Background
We sought to evaluate the predictive value of acute stage mitral apparatus geometry and dynamics for the reduction of ischemic mitral regurgitation (IMR) in the remote phase after successful primary percutaneous coronary intervention (pPCI) by using real-time 3D-transthoracic echocardiography (3D-TTE).

Methods
We performed 2D and 3D-TTE in consecutive 44 first acute MI patients with more than mild IMR within 3 days after successful pPCI. 3DTTE of left ventricle (LV) volumes and mitral apparatus dynamics through the cardiac cycle were quantified offline. We compared the 3D geometric and dynamic parameters in the acute phase between 1)20 remained MR group and 2)24 improved MR group in 6-to-12 months after MI onset.

Results
Ejection fraction (EF) was preserved in the improved MR group compared to the remained MR group (49.0 ± 11.2 vs. 56.5 ± 7.0%, p = 0.013). Mitral valve annulus area, leaflet tenting length and papillary muscles spatial position had no significant difference between the two groups (all p &gt; 0.05) throughout cardiac cycle. In contrast, mitral annulus saddle shape was preserved in the improved MR group than the remained MR group (p = 0.010) and annular area changed dynamically through early- to late-systole in the improved MR group (phasic p = 0.017) despite it was adynamic in remained MR group (phasic p = 0.201). Conclusions: IMR improvement in the remote phase after AMI associated with preserved EF, mitral annulus saddle shape and dynamics during systole in the acute phase of MI. 4D dynamics of the mitral apparatus can be clinically useful predictor of the improvement in acute IMR and may contribute to the clinical decision making including surgical or percutaneous intervention for IMR.