Iranian Heart Journal
Volume:10 Issue: 2, summer 2009

Mechanical dyssynchrony is common in patients with heart failure and its presence predicts patient response to cardiac resynchronization therapy (CRT).The quantification of left ventricular dyssynchrony using tissue Doppler imaging (TDI) may improve the selection of these patients. We aimed to evaluate the prevalence of dyssynchrony in patients with heart failure and valvular heart disease with either normal or prolonged QRS durations. Patients with left ventricular (LV) systolic dysfunction and significant organic valvular heart disease were evaluated. Using conventional and tissue Doppler echocardiography, an interventricular mechanical delay >40 ms was defined as significant interventricular dyssynchrony. Intraventricular dyssynchrony was evaluated using the calculation of the septal-to-lateral wall delay, the SD of the time from the Q wave to the peak systolic wave of 6 basal and 6 mid segments, and the maximum difference in the time from the Q wave to the peak systolic wave of all 12 segments. Forty-four patients (22 female, mean age 47 ± 15.2 years) were evaluated. Interventricular dyssynchrony was present in 12 (27%) patients. Intraventricular dyssynchrony was present in 17 (39%) to 19 (43%) patients, depending on the method used. Interventricular and intraventricular mechanical dyssynchrony had a significant association with LV volume and QRS duration (independent of the type of valvular heart disease). We found almost perfect agreement between maximum difference and total dyssynchrony index (kappa = 0.91), and the overall agreement among septum-to-lateral delay, maximum difference, and total dyssynchrony index was good (kappa = 0.72). Although ventricular dyssynchrony in patients with valvular heart disease and LV dysfunction is not highly prevalent, it has a significant association with QRS duration and LV size

Left ventricular non-compaction (LVNC) is a reportedly uncommon genetic disorder of endocardial morphogenesis and is being increasingly recognized. The purpose of this study was to evaluate the echocardiographic features, including mechanical dyssynchrony indices of patients with LVNC versus idiopathic dilated cardiomyopathy (IDC).Between December 2004 and February 2006, we evaluated 116 patients with dilated cardiomyopathy candidated for cardiac resynchronization therapy (CRT) at our institution. The patients were divided into LVNC and IDC without LVNC groups, according to the diagnostic criteria for LVNC. Transthoracic echocardiography was done for all the patients, and pre-ejection periods as well as inter- and intra-ventricular delays were measured and the asynchrony index was calculated. Seventy-seven patients were male. LVNC was diagnosed in 23% of the patients. There was no significant difference in the patients’ age and mean age of the patients (46±16.5 years in LVNC vs. 51.13±16.43 years in IDC). Mean left ventricular ejection fraction in the LVNC group was 16.65%±6.6% and in the IDC group it was 18.91%±7.2%; mean age in the LVNC group was 46±16.5 years and 51.13±16.43 years in the IDC group, with no significant difference between the two groups. LVNC is increasingly being reported and has become an important differential diagnosis in heart failure patients. Our study showed that there was no significant difference in the mechanical dyssynchrony indices between the two groups

The purpose of this study was to determine how frequently prosthetic valve nonobstructive thrombosis is associated with prosthetic mitral and aortic valves and to assess their correlation with the anticoagulant status and symptoms of patients. From January 2006 to April 2007, all the patients with prosthetic heart valves who were referred for clinically-indicated transesophageal echocardiography (TEE) were evaluated for the presence of non-obstructive thrombosis. Clinical information was collected through patient interviews. Non-obstructive thrombosis was defined as a distinct mass (more than 1 mm in width and 2 - 15 mm in length) with abnormal echoes attached to the normally functioning prosthesis and clearly seen throughout the cardiac cycle via two-dimensional, Doppler, and cinefluoroscopy studies. Masses were classified according to their size as small (<5 mm), moderate (5-10 mm), and large (>10 mm). The study recruited 102 consecutive patients (64 female) with a mean age of 51 ±11.4 years with non-obstructive thrombosis. There were 132 prosthetic valves (PVs), of which 94 were prosthetic mitral valves (PMVs) and 38 were prosthetic aortic valves (PAVs). The mean time between surgery and TEE examination (age of the prosthesis) was 12 ± 7 years. INR value was less than 1.5 in 50 (49%) cases, between 1.5 – 2.5 in 42 (41.2%) patients, and more than 2.5 in 10 (9.8%). Additionally, 34 (33.3%) patients had recent systemic emboli, 32 (31.9%) had exacerbation of dyspnea, and 14 (13.7%) were asymptomatic. Sub-therapeutic anticoagulation (INR values < 2.5), systemic emboli, and dyspnea are the key factors for the detection of non-obstructive thrombosis. Moreover, TEE is particularly useful when the thrombus is not visualized by TTE

We aimed to evaluate the accuracy of Doppler echocardiography indices in patients with significant recoarctation of the aorta (ReCoA). Thirty-nine consecutive patients (11 females) post-surgical repair of aortic coarctation were included in the study. All the patients underwent complete Doppler echocardiography and clinical evaluation and peak systolic instantaneous pressure gradient (PPG), mean pressure gradient, velocity time integral (VTI) in the descending thoracic aorta, acceleration time (AT), ejection time (ET), and AT/ET of the coarctation repair site were measured. All the patients underwent CT angiography; and in case of significant ReCoA, cardiac catheterization was done. Measured values of ET, AT, AT/ET, and VTI at the repair site and VTI in the descending thoracic aorta were significantly greater in the patients with ReCoA. The average difference between the echocardiographic and angiographic systolic PPG was 16 mmHg. The presence of Doppler PPG greater than 35 mmHg, VTI in the descending thoracic aorta more than 40cm, and AT at the repair site of more than 135 msec had high sensitivity and specificity for the diagnosis of significant ReCoA. Five (0.42) patients with recoarctation had significant hypertension; compared to 7 (0.26) patients without recoarctation (P-value =0.32). After coarctation repair, Doppler PPG should be interpreted with caution but considering other Doppler indices, Doppler echocardiography is a practical and accurate screening method for an evaluation of significant ReCoA, with a low threshold for invasive of aorta investigation if the Doppler PPG in the descending aorta exceeds 35mmHg

Visually distinguishing artery from vein during coronary artery bypass grafting (CABG) can be occasionally challenging and may result in errors in anastomosis. We report an unusual case of on-pump CABG surgery in which the left internal mammary artery (LIMA) was anastomosed to an epicardial vein instead of the left anterior descending LAD) coronary artery erroneously

The Impella®2.5 is a percutaneously placed, left ventricular assist device which provides up to 2.5 liters per minute of flow from the left ventricular cavity directly into the ascending aorta. The 12 Fr. pump is mounted on the distal end of a 9 Fr. catheter and connected to a mobile console. We report a patient undergoing temporary left ventricular support with an Impella ®2.5 for the treatment of refractory pulmonary edema and severe left ventricular dysfunction following extensive myocardial infarction

Effective cardiopulmonary resuscitation (CPR) can sufficiently preserve vital organs even during prolonged cardiac arrest. In the setting of acute myocardial infarction, accurate and wise strategy, including primary percutaneous coronary intervention (PCI) of the culprit lesion can be life-saving, even if complicated by prolonged cardiac arrest unresponsive to CPR. We describe the case of a 53-year-old man who was successfully managed after prolonged refractory cardiac arrest following acute myocardial infarction

Left ventricular hyper-trabeculation (LVHT), also known as left ventricular non-compaction (LVNC), is a rare myocardial abnormality of the apex and is characterized by multiple, myocardial cotyledon-like protrusions and interwoven strings, all lined by the endocardium. It may occur without any other cardiac abnormality (isolated LVNC) or may be associated with congenital cardiac malformations. In three quarters of cases, LVHT is associated with neuromuscular disorders. LVHT usually is congenital, but it was found to also develop later in life (acquired LVHT). We report two cases of aortic aneurysm and severe aortic insufficiency with incidentally-diagnosed LVNC. To the best of our knowledge, there has been no previous report of LVNC associated with aortic aneurysm and/or aortic insufficiency