Transthoracic echocardiogram of a 3-year-old child showed a hypoechoic cavity in the posterior wall of the left atrium communicating with the left ventricle through an orifice in the mitral annulus, suggestive of pseudoaneurysm (Ps), probably the result of infective endocarditis. Three-dimensional echocardiography was helpful to confirm the diagnosis and assess the anatomical relationship of the Ps.

Background : Several epidemiologic studies have reported that high serum levels of uric acid are strongly associated with prevalent health conditions such as obesity, insulin resistance, metabolic syndrome, essential hypertension and renal disease. This study aimed to investigate the level of serum uric acid in Type 2 diabetes mellitus, pre-diabetics and non diabetics (controls) in south Indian population.Methods : Uric acid level was measured by Uricase-PAP methodology in patients with Diabetes (n=71)/Pre diabetes (n=12)/ Control groups (n=34). Using ANOVA test, uric acid levels in the above three groups were compared based on age, sex and other factors which can affect uric acid level.Results: The mean serum uric acid level was lower in control group (3.84mg/dl), rose in pre-diabetics (4.88mg/dl) and again decreased in diabetics (3.78mg/dl). P value comparing control and pre-diabetes was 0.009, p-value comparing pre-diabetes and diabetes was 0.003 and p-value comparing control and diabetes was 0.982 (p value <0.05 being significant). Conclusion :The serum uric acid level being higher in pre-diabetes than controls and lower in diabetes mellitus than pre-diabetes may serve as a potential inexpensive biomarker of deterioration of glucose metabolism.

Post closed mitral valvotomy left ventricle (LV) pseudoaneurysm is a rare entity and most common presentation is heart failure. We report a case of 48 year old gentleman who underwent closed mitral valvotomy in 1988 elsewhere, presented to our institution with history of sudden onset spontaneous pulsatile swelling of left chest wall. Transthoracic echocardiogram showed contained rupture of LV pseudoaneurysm with mild mitral stenosis and normal LV function. Cardiac MRI showed pseudoaneurysm of LV apex and chest wall mass bilobulated with intrathoracic and extrathoracic communication. Pseudoaneurysm of LV has thin streak of track with chest wall mass. He underwent emergency pseudoaneurysm repair and exploration of track. 300 ml of purulent partly pasty calcific material drained and send for analysis. We report this case for unusual presentation, to highlight importance of cardiac imaging for early diagnosis and early intervention for achieving better outcome.

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A 54-year-old male was admitted to the hospital due to severe chest pain. He suffered from diabetes mellitus for 20 years and was an ex-smoker. The 12 leads electrocardiography showed ST-segment elevation in inferior leads. High sensitivity troponin level was elevated, and underwent coronary angiography. The echocardiogram showed basal inferior hypokinesia with normal left ventricular systolic function. The coronary angiography demonstrated an insignificant stenosis with vague plaque ulceration at the proximal portion of right coronary artery (Figure 1A, asterisk). The automatic motorized pullback of optical coherence tomography (OCT) was performed at 10 mm/sec with simultaneous injection of a