Background and Objectives: The goal was to evaluate the association of dynamic retinal vessel analysis (DVA) with echocardiographic parameters assessing systolic and diastolic function of the left ventricle in hypertension (HT) patients with preserved left ventricle ejection fraction. Materials and Methods: This observational retrospective study recruited 36 patients with HT and 28 healthy controls. Retinal vessel diameter and reactions to flicker light were examined. Each patient was examined with echocardiography to assess left ventricular systolic and diastolic function. Results: Multivariate analysis revealed that hypertension was an independent factor associated with lower flicker-induced arterial vasodilatation (β = −0.31, p = 0.029). In the HT group, there was a significant positive association between left ventricular ejection fraction and flicker-induced arterial vasodilation (Rs = +0.31, p = 0.007). Additionally, end-diastolic left ventricular diameter negatively correlated with both arterial (Rs = −0.26, p = 0.02) and venous (Rs = −0.27, p = 0.02) flicker responses. Additionally, the echocardiographic characteristics of the left atrium (LA) remodeling in the course of HT, including the area of the LA and its antero-posterior dimension, were both negatively correlated with the arterial flicker response (Rs = −0.34, p = 0.003; Rs = −0.33, p = 0.004, respectively). From tissue Doppler parameters, the left ventricular filling index E/e’ negatively correlated with AVR (arteriovenous ratio) values (Rs = −0.36, p = 0.002). Conclusions: We revealed that systolic and diastolic function of the left ventricle in hypertensive patients is associated with retinal microvascular function.

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Persistent left superior vena cava (PLSVC) is a congenital anomaly of the thoracic venous system found in 0.3%-2% of the general population [1, 2]. In approx. 0.1% of cases, it coexists with the absence of the right superior vena cava (RSVC; isolated PLSVC [IPLSVC]). In 90% of cases PLVSC drains to the right atrium through a dilated coronary sinus (CS) [2, 3]. PLVSC is a potential factor triggering atrial fibrillation (AF) [1, 4]. We report two cases of patients with IPLSVC who underwent pulmonary vein (PV) electrical isolation (PVI) using cryoablation. Case 1 was a 62-year-old man with paroxysmal AF, with typical topography of PVs on computed tomography (CT). Transthoracic echocardiography (TTE) revealed a dilated CS. Intraoperative angiography showed PLVSC draining into the CS (Fig. 1A) and no RSVC (Fig. 1B). Because of difficulties with the transseptal puncture (TSP), cardiac tamponade occurred but was successfully treated with pericardiocentesis. During a second procedure TSP was done under transoesophageal echocardiography (TEE) guidance. Case 2 was a 69-year-old woman after surgical repair of atrial septal defect type II 20 years earlier, without right superior PV and RSVC (Fig. 1C) on CT. Intraoperative imaging also showed IPLSVC draining into a dilated CS. TSP was done under TEE guidance. A circular mapping catheter was used to confirm complete PVI. In both patients a 28-mm cryoballoon catheter was used and the temperatures were up to-59°C. Because of the absence of the RSVC, cryoablations of right PVs were performed without stimulation of the right phrenic nerve (PN), and only the respiratory movements of the diaphragm were monitored. After 12-and nine-month follow-up, respectively, patients were free from AF. The presence of IPLVSC increases the risk of complications during left atrial (LA) ablations. The absence of the RSVC creates problems with TSP because it is impossible to position a transseptal needle in the RSVC for a safe movement down into the fossa ovalis, and TSP should be performed with TEE or intracardiac echocardiography guidance [1, 4]. The stimulation of the right PN is also impossible. To reduce the risk of PN palsy, the cryoablation of right PVs should be performed while carefully monitoring the respiratory movements of the diaphragm. This is the only possible solution because, for example, monitoring of diaphragmatic compound motor action potential requires pacing of the PN through a catheter placed in the RSVC [5]. PLVSC should always be suspected when a dilated CS is detected on TTE [2]. Nevertheless, when IPLVSC is suspected, magnetic resonance imaging or CT are recommended. PLSVC may be a source of ectopic activity triggering AF, and then the ablative strategy should include PLSVC isolation [1, 4]. PLSVC isolation could be complicated by the left PN palsy. Sometimes multiple ablation procedures are necessary because there may be an electrical connection between PLSVC and the LA or the left superior PV; thus, even if PVI is completed, AF may be triggered by a PLSVC focus or ectopie...

Polymyositis (PM) is an autoimmune disease characterized by the involvement of multiple internal organs, including the cardiovascular system. The involvement of heart is observed in up to 75% of patients with PM. Conduction and rhythm disorders are one of the most common cardiological abnormalities in these patients. The presented clinical case is the patient where ventricular arrhythmia (in the form of multiple premature ventricular extrasystoles) was the first symptom of polymyositis.

Figure 1 A -fluoroscopic image of the rotated LenusPro pump; B -twisted catheter for intravenous infusion of treprostinil, found during a reoperation 84 days after pump implantation (arrow) A B