The right atrium (RA) plays a pivotal role in electromechanical and endocrine regulation of the heart. Its peculiar anatomical features and phasic mechanical function make it distinct from ventricles. Various invasive and noninvasive techniques have been used to elucidate RA structure and function. Of these modalities, echocardiography has distinct advantages over others. Several conventional measures of RA function through echocardiography have been described in the literature, but they are load dependent. A relatively new technique is speckle tracking-derived strain, which is relatively less dependent on loading conditions. Speckle tracking echocardiography tracks acoustic scatters (speckles) of myocardium frame-by-frame to calculate strain or deformation of the myocardium. Speckle tracking echocardiography has been used extensively for strain assessment of the right and left ventricle to detect subtle disease pathology, to gain mechanistic insight, as a marker of ischemic metabolic memory, as an endpoint in clinical trials, and as a functional assessment tool. The RA is a relatively neglected chamber, as it is mostly studied for assessment of atrial mass lesions, for electrophysiological studies, and in animal models for physiological assessment. However, its role in the systolic and diastolic function of the right heart, pulmonary vascular pathology, congenital heart diseases, and combined electromechanical activation phenomena has been less explored or unexplored. Speckle tracking echocardiography is an ideal tool for the assessment of the RA because of its regional and global functional characterization, angle independence, and high temporal resolution. IntroductionThe right atrium (RA) is located on the anterosuperior aspect of the heart and lies anterior to the left atrium (LA), which forms the most posterior chamber of the heart. The interatrial septum is oblique (at 65 degrees) to the cardiac axis and the tricuspid and mitral valves are located at different levels; therefore, the RA lies anterior and inferior to the LA.

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Objective: Hepatic venous outflow obstruction, due to hepatic venous thrombosis is hallmark of Budd-Chiari Syndrome(BCS), a relatively uncommon disorder. The scope of the study, was to explore imaging details and causes, and define invasive and non-invasive interventions for achieving successful portosystemic shunting (PSS). Methods: Fifty-three BCS cases, diagnosed on sonographic and clinical evaluation during past twenty months were studied. The cases underwent dynamic contrast enhanced computed tomography, variations in imaging topology and associated risk factors were studies. Results: Of 53 cases [32 males,21 females; mean age:34.4±13.5 years; Child-Pugh Score (CPS)-A 12, CPS-B 36 and CPS-C 5; median MELD-Na:10], five cases were Hepatitis-B virus(HBV) positive, twelve HCV positive and six were co-infected. Imaging features included mottled cirrhotic / nutmeg hepatic parenchyma(median size:19.8cm; range:16-24.6cm), thrombosed hepatic veins with/without portal vein and/or IVC thrombosis, left lobe atrophy, caudate hypertrophy, splenomegaly, portosystemic varices and ascites. Three cases had subacute onset, two had acute while rest were chronic BCS. 13 cases had hepatocellular carcinoma with Alpha-Fetoprotein(AFP) range:1125-20,000 ng/ml, rest had AFP<6ng/ml. Thrombosis of main portal vein and its tributaries was seen in nine and cavernous transformation in seven cases. The etiology was protein C, S and anti-thrombin deficiency(45%), JAK2 mutation(6%), lupus antibody with increased homocysteine levels (9%) and cryptogenic in 40%. 12 cases were offered liver transplantation; 20 were planned to undergo TIPS; rest were optimized medically. Continuous....