bluuebunny/crossref_metadata_2025_split huggingface dataset:
If echo or magnetic resonance are not enough to assess a patient with congenital heart disease, think of ECG gated computed tomography. Case series from a second level hospital
Authors: Sanz Ortega I , Sadaba Sagredo M , Armendariz Tellitu K , Velasco Del Castillo S , Ullate De La Torre A , Onaindia Gandarias JJ , Urkullu Naveda A , Salcedo Arruti A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Congenital heart disease (CHD) is evaluated by echocardiogram, and if doubts, there may be necessary other exams, generally magnetic resonance (MRI). Due to radiation concerns, computed tomography (CT) is seldom performed. Depending of different cardiac procedures, radiation exposure to the patients varies, ranged from almost 4 mSv approx. for coronariography alone to 15 mSv approx. if stenting and ventriculography are added. ECG-gated CT can be used in cases of CHD because of its better spatial resolution if other examinations are not enough.

Methods
We reviewed ECG-gated CT performed at our institution to evaluate patients with CHD (suspected or previously known). Characteristics of the patients and the exams were reported, including other cardiovascular or extracardiac findings.

Results
There were 5 exams in 4 patients, all of them with contrast. 2 patients were women, 1 of them with two exams (cases No 4 and 5). Mean age was 45.4 years (range 17-59). CT was chosen due to better spatial resolution (including 1 patient which previous MRI was inconclusive), except in one patient, that was performed because of cardiac device that contraindicated MRI. This patient had repeated exams. All of them were in sinusal rhythm. The patient with repeated exams was previously diagnosed of CHD, whereas, in the rest of cases the final diagnosis was made by CT. 3 examinations were retrospective. Coronary arteries were also evaluated in 3 cases (in all prospective studies and one retrospective). Mean radiation exposure was 6.22 mSv (1.2 to 10.7). In prospective studies, it was 1.85 mSv (1.6 and 2.1 mSv) and in retrospective ones were 9.13 mSv (8.2 to 10.7 mSv). There were no complications. In all cases, other cardiovascular findings other than CHD were reported.
In 3 cases, other extracardiovascular findings were noted. Characteristics of patients are listed in figure 1 and images from the studies are shown in figure 2. Yellow arrows show the congenital defects.

Conclusions
Although patients with congenital heart disease are generally evaluated by other imaging techniques, they can be evaluated by ECG-gated CT if necessary, with similar radiation exposure to other cardiac interventional procedures, and coronary angiography and other cardiovascular or extravascular findings can also be assessed. Abstract Table: Characteristics of patients Abstract Figure. Images from exams
Predictive factors of outcome in patients with Tetralogy of Fallot (TOF) after pulmonary valve replacement: preliminary data of our Centre experience (2010-2020)
Authors: Cavaliere A , Vivian LM , Puricelli F , Reffo E , Di Salvo G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
TOF patients undergo multiple surgical procedures during their life. The improvement in surgical techniques and patient’s clinical management led to longer life expectancy, creating an adult TOF population that experiences specific adverse events, such as atrial/ventricular arrythmias, heart failure and sudden cardiac death. In selected patients, pulmonary valve replacement (PVR) is mandatory to reduce right ventricular (RV) volume; therefore, careful patients’ selection but also correct timing of PVR are crucial.

Purpose
Current guidelines are based on pre-PVR threshold values of indexed RV end-diastolic volume (RVEDVi) calculated with cardiac magnetic resonance (CMR), to achieve normalization of RV size after valve implantation, but recent studies demonstrated that post-PVR RV dilatation is not so tightly connected with adverse clinical outcomes. Therefore, our aim is to identify new possible predictive factors of post-PVR outcome to provide tailored PVR on the correct cohort of patients, at the correct time.

Methods: The inclusion criteria of this retrospective and partially prospective cohort study were
i) repaired TOF; ii) available CMR data pre- and post-PVR; iii) PVR performed between 2010 and 2020; iv) clinical and ECG available pre- and post-PVR; v) complete echocardiographic examination pre- and post-PVR. Multivariate analysis was applied. Primary outcomes were considered death, resuscitated death, atrial/ventricular arrhythmias. NYHA class was considered to evaluate patients’ clinical status. CMR Late Gadolinium Enhancement (LGE) score was calculated pre- and post-PVR.

Results
22 patients were selected (12 males, median age ± SD 28,25 ± 11,2 years). After PVR, the only primary outcome observed was sustained ventricular tachycardia in 4 patients. Multivariate analysis showed that patients with later PVR, lower Fractional Area Change (FAC) at pre-PVR echocardiogram and higher LGE score post-PVR (LGE &gt; 3) showed higher post-PVR RVEDVi. On the contrary, patients with class I NYHA post-PVR showed lower RVEDVi.

Conclusion
Our study demonstrates that lower age at PVR and careful patient’s selection, guided by echocardiographic and CMR findings, lead to greater benefit in terms of good volumetric recovery of the RV and better performance status post-PVR (NYHA class I) in TOF patients after PVR.
Severe MAC increases shear stresses on particles traversing the mitral valve: an in vitro study
Authors: Pressman GS , Darwish A , Friend EJ , Wiener PC , Kadem L 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Mitral annular calcification (MAC) is a strong predictor of stroke but mechanism(s) are poorly defined. Severe MAC can produce a gradient across the mitral valve (MV) and, when studied in vitro, disturbs normal flow across the valve resulting in increased viscous energy dissipation.

Purpose
We hypothesized that severe MAC would increase shear stress on particles traveling across the MV into the left ventricle (LV). Given that shear stresses cause platelet activation this might represent a mechanism by which MAC could increase stroke risk.

Methods
A silicone model MV was created using a 3D TEE dataset. 3D printed calcium phantoms were incorporated into the valve simulate severe MAC. The valve was tested in a left heart duplicator under rest and exercise conditions and compared with a duplicate valve without the calcium phantoms. Fine particles suspended in a water/glycerol blood analogue allowed for measurement of vortex formation and shear stresses using particle image velocimetry (PIV). Particle residence time (PRT) maps were created to assess how long blood particles would remain in the LV. Particle residence index (PRI - ratio of remaining particles in LV/initial number of particles) is a more quantitative measure of how fast particles leave the LV. These calculations were used to approximate viscous shear stresses on blood particles. For each particle the induced viscous shear stress was evaluated for the entire duration of residence in the LV.

Results
For the normal MV all released particles left the LV by the 3rd cycle; with severe MAC particles completely left the LV shortly after the 7th cycle. PRI measurements confirmed that particles remained longer in the LV in the presence of severe MAC (figure 1). MAC also induced a shift in the accumulated shear stress levels from the high range &gt; 0.4 Pa.s and the low range &lt; 0.1 towards the middle region (0.16-0.32 Pa.s, figure 2). As shear stress is reported for one cycle, one may expect MAC to lead to higher accumulated higher viscous stresses as particles reside in the LV for a longer time.

Conclusions
In the presence of severe MAC blood particles remain longer in the LV and are exposed to greater cumulative shear stresses vs the normal situation. Given that shear stress is known to cause platelet activation this may be a mechanism by which MAC increases risk of ischemic stroke. Abstract Figure 1 Abstract Figure 2
Global longitudinal strain and its association with quantitative and qualitative analyses of myocardial perfusion correlate in patients with abnormal SPECT results
Authors: Espinola-Zavaleta NG , Caballero-Guadarrama YCG , Guerra ECG , Antonio-Villa NAV , Garcia-Cardenas MGC , Lopez-Mendez ALM , Gonzalez-Hernandez MGH , Alexanderson-Rosas EAR 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Global longitudinal strain (GLS) is being used more commonly in the evaluation of patients with ischemic heart disease (IHD). Even though GLS is known to be associated with infarct size, its relationship with parameters derived from myocardial perfusion studies (MPS) has not been explored enough.

AIMS
We assessed the correlation of GLS measured with echocardiography with quantitative and qualitive analyses parameters of SPECT-MPS, particularly stress and rest total perfusion deficits (TPDS and TPDR) and summed stress and summed rest scores (SSS and SRS) respectively.

METHODS
A cross-sectional cohort of patients classified with an abnormal nuclear medicine result using SPECT were tested with doppler echocardiography in a center of reference in Mexico City. Pearson correlation tests and polynomial regression models were used to extract the correlation coefficient and the explained variability for each variable.

RESULTS
122 subjects with abnormal nuclear medicine results were assessed. 87 (71.3%) were male with a mean left ventricular GLS of -16 (±5), SRS of 12.9 (±14.5), SSS of 18 (±15.8), TPDR of 12 (±14.3) and TPDS of 17.7 (±15.6). We observed a negative cubic adjusted correlation between GLS and TPDR (r = 0.501, 95% CI: 0.336-0.637, p= &lt;0.001), TPDS (r = 0.470, 95% CI: 0.300-0.612, p= &lt;0.001), SRS (r = 0.472, 95% CI: 0.302-0.613, p= &lt;0.001) and SSS (r = 0.460, 95% CI: 0.288-0.603, p= &lt;0.001).

CONCLUSION
GLS has a moderate cubic correlation with a negative leading coefficient with TPDR, TPDS, SRS and SSS. This data suggests that GLS may be an adequate parameter for assessing patients with IHD. Abstract Figure. Scatter plot with regression model
Prognostic value of the liver stiffness in patients with acute decompensated heart failure
Authors: Tereshina O 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background.
Shear wave elastography (SWE) is a novel ultrasound technique for charactering tissues stiffness and widely used in liver diseases. In patients with heart failure (HF) liver stiffness (LS) seems directly influenced by central venous pressure. However, clinical implication of liver SWE for prognosis in heart failure remains unknown. Study aimed to evaluate the prognostic value of assessing liver stiffness by SWE in HF.

Methods
We enrolled 214 consecutive patients with acute decompensated heart failure, but 33 of them were excluded due to the presence of other factors that could influence the LS measurement. In addition to traditional cardiac test, all patients were undergone liver stiffness measurement by point shear wave elastography at admission and at discharge. The remaining 181 patients were divided into three groups: 1. LS value &gt; 8.8 kPa at admission and delta decrease in LS value at discharge &lt; 4 kPa (n = 67); 2. LS value &gt; 8.8 kPa at admission, and delta decrease in LS value at discharge &gt; 4 kPa (n = 78); 3. LS value &lt; 8.8 kPa at admission, and in LS value by pSWE at discharge &gt; 4 kPa (n = 36). A median follow up period was 12 month.
Results. Adverse cardiac events, i.e., death or readmission to hospital, occurred in 54% of patients in first group, 34% of patients in second group and 15 % of patients in third group (P = 0.001). After adjusting for age, sex, left ventricle ejection fraction a LS ≥ 8.8 kPa and lack of decrease LS during admission was still significantly associated with cardiac events.
Conclusion. Liver stiffness by SWE in patients with HF can be used as a prognostic marker to predict cardiac events.
Case report: asymptomatic pseudoaneurysm of the native coronary soon after the graft anastomosis treated with off-pump repair
Authors: Ruggerini Sara , Pavasini Rita , Quagliara Teresa A P , Fiorani Vinicio 
Published: February 2022

Abstract

Background
Pseudoaneurysms (PSAs) of native coronary arteries are rare but potentially lethal complications occurring after coronary artery graft anastomosis mainly secondary to median sternotomy.

Case summary
A 61-year-old man underwent coronary artery bypass grafting because of stable angina. After the surgery, the patient was asymptomatic. A routine pre-discharge transthoracic echocardiogram was performed showing a haematoma of the apex partially involving the right ventricle with systolic colour Doppler flow going from the left ventricle to the pericardium. A coronary computed tomography scan was ordered and it revealed the presence of a PSA of the left anterior descending (LAD) artery distal to the graft anastomosis with the left internal mammary artery. An off-pump direct suture of the LAD injury through a redo sternotomy was successfully performed.

Discussion
The development of a PSA of a native coronary artery after bypass grafting is a very rare and potentially fatal condition. A correct and prompt diagnosis is crucial to avoid lethal complication.
Amphetamine-induced cardiomyopathy complicated by embolic stroke: a case report
Authors: Chapman Lucy , Tahir Ismail , Sheriff Neha , Colwell Niall 
Published: February 2022

Abstract

Background
Amphetamine use causes cardiomyopathy via catecholamine-mediated effects such as tachycardia, hypertension, vasoconstriction, and direct cardio-toxic effects. Traditionally, an increased risk of haemorrhagic stroke is associated with amphetamine use. However, up to one-third of stimulant-associated cardiomyopathy patients have left ventricular (LV) thrombus formation leading to an increased risk of systemic embolization. We report a case of amphetamine-induced cardiomyopathy complicated by embolic stroke secondary to LV thrombus.

Case summary
A 38-year-old man with 6-month history of sustained amphetamine use presented to the emergency department with left-sided weakness, facial droop, and dysarthria. Angiography confirmed right middle cerebral artery thrombus. Prompt mechanical thrombectomy yielded full neurological recovery. Dyspnoea prompted transthoracic echocardiography showing dilated cardiomyopathy with an ejection fraction of 5% and LV thrombus. Anticoagulation was initiated with warfarin as well as pharmacological therapy for heart failure with reduced ejection fraction including bisoprolol, spironolactone, loop diuretic, and sacubitril/valsartan. He was discharged successfully following resolution of ventricular thrombus and medical management of heart failure. Clinical recovery was hampered by psychosocial factors resulting in non-adherence to medical therapy and continued amphetamine use.

Conclusion
Sustained amphetamine use can result in severe dilated cardiomyopathy with LV thrombus formation and embolic complications such as ischaemic stroke. Avoidance of amphetamines in conjunction with guideline-directed pharmacological management are key components of therapy. However, psychosocial factors can exert significant influence on recovery.
An uncommon case of congenital thoracic venous anomaly and extracardiac sinus venosus defect in an asymptomatic adult first presenting with brain abscesses: a case report
Authors: Pettersson Staffan , Trzebiatowska-Krzynska Aleksandra , Engvall Jan 
Published: February 2022

Abstract

Background
Congenital thoracic venous anomalies (CTVAs) with right-to-left shunt constitute an uncommon source of paradoxical embolization in adults. We present a case of a healthy and physically fit individual with a rare asymptomatic anomaly first presenting with brain abscesses after a visit to the dental office; persistent left superior vena cavae (PLSVC) without bridging vein, over-riding right-sided superior vena cavae (RSVC) connected to the left atrium (LA), and an extracardiac sinus venosus defect.

Case summary
A 29-year-old male presented to the neurosurgical unit due to intracranial abscesses requiring intervention following a visit to his dentist. The abscess cultures isolated bacteria commonly found in the normal oral flora. Transthoracic echocardiography revealed an enlarged coronary sinus consistent with PLSVC. An agitated saline study was performed and raised suspicion of simultaneous extra- and intracardiac shunting. Magnetic resonance angiography confirmed the presence of a PLSVC and revealed an RSVC connected to the LA; however, no intracardiac shunt was evident. Electrocardiogram-gated computed tomography was therefore conducted and discovered the rudimentary remains of the physiologic RSVC forming a connection to the right atrium, explaining the bilateral contrast loading seen on the agitated saline study and diagnosing an extracardiac sinus venosus defect (SVD). The patient recovered and has been referred for surgery.

Discussion
This case illustrates a CTVA and a forme fruste type SVD resulting in a severe complication in a healthy adult. We highlight the diagnostic challenges posed, suggest early usage of agitated saline studies, and discuss the rationale for surgical correction of this patient.
Contribution of imaging modalities to eosinophilic myocarditis diagnosis: a case report
Authors: Farhat Nesrine , Bouhabib Maya , Joye Raphael , Vallée Jean-Paul , Beghetti Maurice 
Published: February 2022

Abstract

Background
Eosinophilic myocarditis (EM) is a relatively rare form of myocarditis that could progress to restrictive cardiomyopathy and might be fatal if left untreated. Although myocardial biopsy is considered to be the gold standard for the diagnosis of myocarditis, its use in paediatrics remains controversial and not easily applicable in routine practice.

Case summary
A 10-year-old girl with no prior medical history presented to the emergency department for fever, odynophagia, and gastrointestinal symptoms despite 48 h of antibiotics (Cefaclor). Physical examination revealed diffuse petechiae and abdominal tenderness but was otherwise unremarkable. Her vital signs were normal. She was found to have hypereosinophilia and increased cardiac markers on laboratory testing. Echocardiography showed diffuse left ventricular (LV) myocardial infiltrates, moderate LV dilatation, and mild systolic dysfunction. Bone marrow biopsy confirmed B cell acute lymphoblastic leukaemia. The diagnosis of EM was made. High doses of steroids and chemotherapy were initiated. Cardiac magnetic resonance imaging (MRI) identified eosinophilic infiltrates and sub-endocardial enhancement strongly suggestive of EM. Left ventricular function was slightly decreased. Intra-ventricular micro-thrombi were suspected, and warfarin was started. The outcome was favourable. Leucocyte and eosinophil counts were normalized within a month. At 6 months, cardiac MRI demonstrated a significant decrease in eosinophilic infiltration and micro-thrombi, normalization of LV function, and of sub-endocardial enhancement.

Discussion
This case demonstrates that non-invasive multi-modality imaging along with typical laboratory and clinical findings allow for appropriate diagnosis of EM while avoiding biopsy. It also highlights that an early diagnosis, timely treatment, and rigorous follow-up improve disease progression and outcome.
Abnormal wire’s trajectory during edge-to-edge mitral valve repair—a rare case report of inferior vena cava anomaly
Authors: Koren Ofir , Patel Vivek , Koseki Keita , Natanzon Sharon Shalom , Friedman John , Makkar Raj R 
Published: February 2022

Abstract

Background
Inferior vena cava (IVC) anomalies are rare and diagnosed incidentally as most patients are asymptomatic. We present a case where an abnormal course of the wire during percutaneous mitral valve repair revealed abnormal IVC anatomy leading to procedure termination. We summarized all IVC anomalies relevant to cardiovascular physicians and designed a simplified tool to illustrate their course for differential diagnosis.

Case summary
A 78-year-old female presented with severe and symptomatic mitral regurgitation. The heart team decided to proceed with a percutaneous option, considering the patient's high surgical risk. While ascending from the femoral vein, the wire took an abnormal course to the left side of the vertebrae and continued beyond the cardiac silhouette downwards the right atrium (RA). We decided to abort the procedure due to the high risk for vascular complications assuming the need to cross it with the device's delivery system. Retrospective computed tomography analysis revealed an interrupted IVC at the level of the renal vasculature and azygos continuation toward the RA via a dilated superior vena cava. The patient was referred to surgery and had successful mitral and tricuspid valve repair and was discharged home in good health.

Discussion
The increased number of minimally invasive percutaneous procedures, especially for valvular heart disease, mandates a profound understanding of the arterial, and venous system anatomy. Inferior vena cava anomalies represent a group of anomalies with different paths and variations and have a tremendous impact on all aspects of the procedure.
Fulminant Lyme myocarditis without any other signs of Lyme disease in a 37-year-old male patient with microscopic polyangiitis—a case report
Authors: Schroeter Marco R , Klingel Karin , Korsten Peter , Hasenfuß Gerd 
Published: February 2022

Abstract

Background
Lyme disease is a tick-borne multisystem infection. The most common cardiac manifestation is an acute presentation of Lyme carditis, which often manifests as conduction disorder and rarely as myocarditis.

Case summary
We report the case of a 37-year-old male with a history of microscopic polyangiitis receiving immunosuppressive therapy. He was admitted for severe dyspnoea secondary to acute heart failure. Echocardiography and cardiac magnetic resonance imaging indicated a severely reduced left ventricular ejection fraction (LVEF) with global hypokinesia. Coronary heart disease was excluded, and endomyocardial biopsies (EMB) were performed. The left ventricular EMB revealed a rare case of fulminant Lyme carditis with evidence of typical lymphocytic myocarditis. Borrelia afzelii-DNA was detected without any relevant atrioventricular blockage or systemic signs of Lyme disease. The patient had no clinically apparent tick-borne infection or self-reported history of a tick bite. Immunological testing revealed a positive ELISA and Immunoblot for anti-Borrelia immunoglobulin G antibodies. After specific intravenous antibiotic therapy and optimized medical therapy for heart failure, the LVEF recovered, and the patient could be discharged in an improved condition. Repeat EMB a few months later revealed a dramatic regression of the cardiac inflammation and absence of Borrelia DNA in the myocardium.

Discussion
A severely reduced LVEF can be the primary manifestation of Lyme disease even without typical systemic findings and can have a favourable prognosis with antibiotic treatment. A thorough workup for Lyme carditis is required in patients with unexplained heart failure, particularly with EMB, especially in immunosuppressed patients.