MS patients have subclinical LV and RV systolic dysfunction by GLS despite normal ejection fraction and fractional area change. BMV results in marked improvement in LV and RV GLS immediately post-BMV with trend towards normalization at follow-up after 3 months. A mixed aetiology theory involving a myocardial as well as a haemodynamic factor is believed to be the cause for this subclinical biventricular dysfunction and its improvement at short-term follow-up post-BMV.
Background Congenital left atrium (LA) aneurysms are extremely rare entities in clinical practice and most frequently involve the atrial appendage and rarely arise from the body of LA, We report a case of giant LA aneurysm compressing heart and presenting in a very late stage. Case summary A 31-year-old male, who was diagnosed to have dextrocardia, rheumatic heart disease, and atrial fibrillation and was kept on medical treatment long time ago, presented with congestive heart failure symptoms and cardiogenic shock. Emergency transthoracic echocardiography was done revealing situs solitus with aneurysmally dilated LA pushing heart to the right side (dextro-posed heart), moderate mitral regurgitation, and severe pulmonary hypertension, however, pulmonary artery anatomy could not be properly visualized so computed tomography (CT) was preformed confirming diagnosis and revealing compressed pulmonary arterial tree by the dilated LA, unfortunately patient died before proceeding to surgical intervention. Discussion Congenital left atrial aneurysms are extremely rare anomaly and may be associated with significant morbidity. And, therefore, should be remembered as a potential anatomic cause of atrial arrhythmias or embolic phenomena, or both. The diagnosis may be easily established through non-invasive complementary techniques, such as echocardiography, CT, and cardiac magnetic resonance imaging. Symptomatic patients, those with large aneurysm or compelling indications for surgery should undergo surgical resection.
A 32-year-old man referred to the cardiology clinic for palpitations was found to have paroxysmal supraventricular tachycardia (SVT) on 24-hour Holter monitoring. His general and cardiac examinations were unremarkable. A transthoracic echocardiographic study to exclude structural heart disease was performed and showed an abnormal structure in relation to the right ventricular (RV) free wall; however, poor echocardiographic windows precluded proper characterisation. Cardiac MR (CMR) was therefore performed. Cine images (figure 1 and online supplementary videos 1 and 2) demonstrated the abnormal structure. Dynamic pass of contrast (rest perfusion module) showed the sequence of intracavitary enhancement across different cardiac chambers in the horizontal long-axis plane (figure 1 and online supplementary video 3).heartjnl;103/18/1472/F1F1F1Figure 1Still frames from balanced steady state free precession images in the horizontal long-axis plane (A,B). Still frames from the dynamic pass of contrast in the horizontal long-axis and the short axis following contrast injection into the right arm (C,D). Images in the horizontal long-axis plane at the basal level using T2-weighted short-tau inversion recovery (E) and half Fourier single-shot turbo spin echo (F).DC1SP110.1136/heartjnl-2017-311485.supp1Supplementary data DC2SP210.1136/heartjnl-2017-311485.supp2Supplementary data DC3SP310.1136/heartjnl-2017-311485.supp3Supplementary data QUESTION: The abnormal structure is most likely which of the following?Pericardial cystRight atrial appendage aneurysmRight ventricular aneurysmJuxtaposed left atrial appendageAccessory right ventricular chamber.
Childrens with ventricular septal defect (VSD) and large systemic-to-pulmonary shunts eventually develop pulmonary hypertension (PH). The perioperative management of patients with VSD and PH is quite troublesome and still debatable, especially in developing countries where the different management options and standardization of treatment is not available. Oral phosphodiesterase type 5(PDE-5) inhibitors are good treatment option being widely available, cheap, of easy administration and does not require extensive monitoring. The aim of our study was to evaluate the effect of the PDE-5 inhibitors when given orally, early pre-operative and continued for 3 months postoperative on controlling post-operative PH with its effect on right ventricle (RV) functions. Fifty-one patients were randomly assigned to either Sildenafil or Tadalafil, 1 week before and continued for 3 months after corrective surgery. The control group received a placebo. There was no significant difference in the improvement in the RVSP between both groups, early in the post operative period (P = 0.255) and on follow up (P = 0.259). there was also no significant difference in the changes in mPAP, post-operatively and on follow up (P = 0.788 and 0.059 respectively). There was a drop in RV functions in both groups post-operatively which improved on follow up, however it was not significant between both groups. The length of ICU stay was similar between both groups (P = 0.143). Peri-operative administration of PDE-5 inhibitors does not have an impact on the clinical course as regard improvement in PA pressure, ventricular functions and ICU stay.
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