appendage and extended to the left atrium. Moreover, this one contained an important spontaneous contrast. The subvalvular chordae were thickened and shortcut but without calcifications. With the presence of severe mitral stenosis, an enlarged atrium, and an atrial fibrillation, we thought that it was a thrombus. So, the patient had benefited from an e ﬃ cient anticoagulant treatment for 4 weeks. But, on the echocardiographic control, we noted the persistence of the mass. A transthoracic tomography was performed to identify the mass limits and connections (Figure 3). It showed the presence of a tissular mass in the left atrium, measuring 6 cm of long axis, with an ovular form and regular borderlines. Therefore, a surgical resection of the mass and a mitral valve replacement were indicated. Because our patient was aged more than 40, an angiographic coronary was done before surgery. There werenot coronary lesions but we discovered neovascularizations arising from a branch of the left circumflex artery (LCX) with fistula formation manifested by a dense mass stain and squiring of contrast material into the leftatrial cavity (Figure 4). Considering the clinical and paraclinical data, we suggested two diagnoses: a thrombus or a vascular tumor mainly myxoma since it was ovular, well circumscribed, and located on the left atrium. Given the systemic embolism risk, a decision to carry out an emergency operation was taken. The surgery was accomplished through a conventional median sternotomy and full cardiopulmonary bypass with ascending aortic perfusion and bicaval drainages. A standard leftatrial incision through the interatrial groove was performed after aortic clamping. The mass has a dark red colour and it was enucleated and friable. It measured 65 mm ∗ 30 mm (Figure 5). The fistula opened at the atrium and raised from circumflex artery. So, it was sutured. The mitral valve was replaced with mechanic prosthesis. Mitral valve repair was not undertaken because of excessive leaflet thickening and shortness of chordae to both the anterior and posterior leaflets. Postoperatively, the patient made an uncomplicated recovery. The histological exam led to the conclusion that there was an organized thrombus associated with rheumatic mitral disease.
Conventional and speckle-tracking echocardiography All patients were examined by transthoracic echocardiog- raphy at rest using a Vivid 7 or Vivid E9 ultrasound system (GE-Healthcare) followed by an offline analysis using 2DSTE (Echo-Pac 113.0) in the week prior to CA. The echo- cardiographic measurements and analyses were performed within 7 days prior to CA and during an episode of persistent AF. Left ventricular (LV) diameters, LV volumes, LV mass, LV hypertrophy and LVEF (Simpson's method), and LA diameter, area, volume and LA enlargement (ie, LA diameter >40 mm, LA area >20 cm², LA volume >58 mL and LA volume index (LAVI) >28 mL/m²) were assessed and defined as recommended by the American Society of Echocardiography (ASE). 19 The measurement of LA strain
ischemic heart disease, osteoarthritis and deep vein thrombosis. Clinical examination, blood tests and chest x ray were unremarkable. Her echocardiogram showed a large 4.2 × 5 cm echogenic mass in left atrium with mod- erate mitral regurgitation. Coronary angiography showed single vessel disease affecting the right coronary artery. A CT scan of the chest ruled out pulmonary embolism. A provisional diagnosis of leftatrial myxoma or a thrombus was made and patient taken to theatre for an urgent sur- gery. The entire leftatrial cavity was found to be filled with jelly like mass, which was diffusely infiltrating the leftatrial wall. A curative resection was deemed impossible and debulking was performed. The patient made an une- ventful recovery with significant improvement of symp- toms. Histology confirmed the tumour to be undifferentiated pleomorphic sarcoma [figure 1]. Due to her advanced age and frailty she was not considered to be a suitable candidate for further treatment. Four months later she developed a metastatic pathological fracture of left femur requiring internal fixation. She developed severe bronchopneumonia postoperatively and suc- cumbed to it. Her relatives declined post mortem exami- nation.
Atrial fibrillation (AF) is a complex condition with several possible contributing factors. The rapid and irregular heartbeat produced by AF increases the risk of blood clot formation inside the heart. These clots may eventually become dislodged, causing embolism, stroke and other disorders. AF occurs in up to 15% of patients with hyperthyroidism compared to 4% of people in the general population and is more common in men and in patients with triiodothyronine (T 3 ) toxicosis. The incidence of AF increases with advancing age. Also, subclinical hyperthyroidism is a risk factor associated with a 3-fold increase in development of AF. Thyrotoxicosis exerts marked influences on electrical impulse generation (chronotropic effect) and conduction (dromotropic effect). Several potential mechanisms could be invoked for the effect of thyroid hormones on AF risk, including elevation of leftatrial pressure secondary to increased left ventricular mass and impaired ventricular relaxation, ischemia resulting from increased resting heart rate, and increased atrial eopic activity. Reentry has been postulated as one of the main mechanisms leading to AF. AF is more likely if effective refractory periods are short and conduction is slow. Hyperthyroidism is associated with shortening of action potential duration which may also contribute to AF.
Genetic factors have been suggested to be one of the determinants of the variation of left ventricular (LV) structure and function. However, the heritability range of LV structure varies across studies and the influence of genetics on LV function is not well established, especially in Asian populations. Study subjects were 1,642 healthy Korean adults from 426 families, consisting of 298 pairs of monozygotic twins, 62 pairs of dizygotic twins, one set of triplets, 567 siblings, and 354 parents. LV structure and function were measured by M-mode and 2D echocardiography, and conventional and tissue Doppler imaging (TDI). Pairwise intra-class correlations for various familial relationships and heritability were estimated for LV structure and function. The heritability of LV mass, LV ejection fraction (LVEF), leftatrial volume index, the ratio between early and late diastolic velocity of mitral inflow (E/A ratio), and the ratio between early diastolic velocity of mitral inflow and early diastolic mitral annular velocities (E/Ea ratio) was 0.44, 0.27, 0.44, 0.25, and 0.33, respectively. Bivariate genetic analysis showed that LV structural and functional traits had significant genetic correlations with cardiovascular risk factors. Additive genetic correlation ( G) of LV
A 36 -year old woman IV drug abuser admitted with Right-Sided Infective Endocarditis (RSIE) as demonstrated by transthoracic echocardiogram. Patient was admitted 8 weeks later with recurrence of symptoms, moreover signs of systemic embolization were noted. Transthoracic and Transesophageal Echocardiograms revealed tricuspid valve vegetation, severe tricuspid regurgitation, leftatrialmass, Patent Foramen Ovale (PFO), severely dilated right atrium and prominent Chiari's network. Systemic embolization included brain and Left iliacus abscesses. Patent Foramen ovale is the proposed mechanism leading to extensive systemic embolization in the present case.
IVSd: Interventricular septum thickness at end diastole; IVSs: Interventricular septum thickness at end systole; LA: Left atrium; LAV: Leftatrial volume; LAVI: Leftatrial volume index; LV FS: Left ventricular fractional shortening; LVEF: Left ventricular ejection fraction; LVIDd: Left ventricular internal diameter end diastole; LVIDs: Left ventricular internal diameter end systole; LVM: Left ventricular mass; LVMI: Left ventricular mass index; LVOT: Left ventricular outflow tract; LVPWd: Left ventricular posterior wall end diastole; LVPWs: Left ventricular posterior wall end systole; MV A duration: Mitral inflow duration at atrial contraction; MV A Peak: Peak velocity flow in late diastole by atrial contraction A; MV E Peak: Peak velocity flow in early diastole E; PASP: Pulmonary artery systolic pressure; PV-Ar: Pulmonary vein flow at atrial contraction; PV-D: Pulmonary vein diastolic velocity; PV- S: Pulmonary vein systolic velocity; Septal A ’ : Septal mitral annular velocity during atrial contraction; Septal E ’ : Peak early diastolic septal mitral annular velocity; Septal S ′ : Peak systolic septal mitral annular velocity; sUPAR: soluble urokinase plasminogen activator receptor
Case presentation: We present a case of 63-year-old man who presented with progressively worsening dyspnea on exertion and lower leg edema, and was diagnosed with heart failure. Transesophageal echocardiography (TEE) revealed that the left atrium was filled with a 2.7 cm × 2.6 cm mass. The patient, who had no signs of infection or related risk factors, was suspected of having a leftatrial myxoma clinically. After excising the mass, the histopathology suggested thrombus with no myxocytes. Postoperatively, a fever appeared and C. striatum was isolated from the blood cultures. Although antibiotics were used, the symptoms of heart failure worsened gradually and echocardiography revealed valve vegetation. The patient underwent a second operation because of IE. Surprisingly, the mass was confirmed to be a bacterial vegetation due to C. striatum based on Gram staining at a 1000× magnification, although this was not noted on routine pathological examination of the two surgical specimens.
Our study showed that children with overweight/obe- sity present with elevated values of central aortic systolic pressure, pulse wave velocity, left ventricular mass index, leftatrial diameter and cardiac output. The risk of these abnormalities is further increased due to concomitant arterial hypertension. The abovementioned changes may correspond to early stages of unfavorable remodel- ing of the cardiovascular system in young patients. This substantiates routine determination of central systolic aortic pressure, PWV and selected echocardiographic parameters (IVS, LAD) in overweight/obese children. Such attitude could be helpful in the identification of pa- tients at increased risk of cardiovascular dysfunction and its complications, and would result in an intensification of preventive and therapeutic measures in this group.
Horten, Norway) equipped with a 2.5-3.5 MHz phased- array sector scan probe, second harmonic technology, and coupled with tissue Doppler imaging (TDI). Left ventricular (LV) end-diastolic and end-systolic diame- ters were measured from the internal dimensions ob- tained from parasternal long axis view. LA diameters were measured from the apical four-chamber view. LA areas and volumes were measured using the biplane method of disks (modified Simpson’s rule), in the apical 4- and 2-chamber view at end-systole (maximum LA size), and a mean value of area and volume was obtained . LA volumes were subsequently indexed to body sur- face area (BSA). LV mass was calculated by the Devereux formula and then indexed to body surface area . Mitral regurgitation was assessed semi-quantitatively (0 = absent or trivial, 1 = mild, 2 = moderate, 3 = severe), including evaluation of vena contracta, regurgitant volume and ef- fective regurgitant orifice area, when indicated . TDI was evaluated, as previously described, in the pulsed-wave Doppler mode, to assess longitudinal myocardial regional LV function. A volume was sampled centrally to the basal segment of infero-septal and antero-lateral wall for the LV, and then the mean value of the velocity profiles was re- corded. Gain and filters were adjusted as needed, to elim- inate background noise and to obtain a clear tissue signal. TDI signals were recorded at a sweep of 100 mm/s. Each parameter was measured as the average of at least three consecutive beats. LV diastolic function was determined from the pattern of mitral flow velocity by pulsed Doppler echocardiography, complemented by mitral annular vel- ocity by TDI and LA volumes. Diastolic dysfunction was graded as “absent” (grade 0), “mild” (grade 1, impaired re- laxation), “moderate” (grade 2, pseudonormalized filling pattern), and “severe” (grade 3, restrictive filling pattern) . Pulmonary artery systolic pressure (PASP) was esti- mated from peak tricuspid regurgitation jet velocities, adding right atrial pressure estimated from inferior vena cava diameter and respiratory changes . All measure- ments were performed according to the recommenda- tions of the European Association of Echocardiography/ American Society of Echocardiography [16-20].
Given a typical presentation, Echocardiography is virtually diagnostic of myxoma. The ability to detect atrial myxoma of the heart by means of echocardiography was first reported more than two decades ago by Effert and Domanig. 2D echocardiography is the non invasive procedure of choice for the diagnosis of leftatrial myxoma. The virtual pathognomonic finding of an atrial myxoma is that of a large pedunculated tumor mass traversing through the AV valves in a to-and-fro motion. Large atrial myxomas have been classified by echo appearance as follows .
After CPB, the partial pressure of oxygen in artery (PaO 2 ) was 68 mmHg with FiO 2 100% and PEEP 6 cmH 2 O and was increased from that before tumor resection (48 mmHg). After excluding bronchospasm and acute lung injury, we assumed that this was due to unrelieved cardiogenic pulmonary edema and pulmonary hypertension, as well as residual tumor in the pulmonary vessels. Inotropic agents including epinephrine 0.05 μ g/kg/min, dopamine 5 μ g/kg/min, and nitroglycerin 0.5–0.8 μ g/kg/min were continuously used to improve cardiac output and facilitate stable hemodynamics, so as to alleviate pulmonary edema. Hyperventilation was applied to decrease PaCO 2 and prevent acidosis. Hypoxia pulmonary vasoconstric- tion may have been partially inhibited, and pulmonary artery systolic pressure was decreased from 67 to ,35 mmHg (post- operative TTE). The patient was transferred to the intensive care unit with BP 110/71 mmHg, HR 110 bpm, and SpO 2 95% during admission. Oxygenation was improved compared to the level before leftatrial tumor resection (91 vs 48 mmHg), and HR was decreased (103 vs 111 bpm), indicating that pulmonary edema was partially relieved. Increasing FiO 2 , decreasing O 2 con- sumption, and optimizing acid–base balance and hemoglobin, together with protective ventilation, were provided and resulted in oxygenation improvement. Vasoactive medications and mechanical ventilation were gradually weaned, and vital signs remained stable. Chest X-ray performed 3 h postoperatively revealed significantly relieved pulmonary edema (Figure 1B). The patient was extubated on postoperative day 4 while he was conscious, and the vital signs showed BP 121/72 mmHg, HR 72 bpm, and SpO 2 95%–97% with FiO 2 85%. He was dis- charged 10 days after the surgery with symptoms ameliorated and SpO 2 97% with FiO 2 21%. Histopathological examina- tion of the resected lesion revealed features consistent with leiomyosarcoma. Further management of the lung metastasis of leiomyosarcoma and possible radiation therapy are needed. 9
The proposed mechanisms for LAE in obese patients are illustrated in Figure 1. Obesity causes an increase in total blood volume and cardiac output and is associated with elevated cardiac filling pressures. This hypercircu- lation leads to LV dilatation or can cause compensatory LVH and diastolic dysfunction. The LV dilatation can lead to increased wall stress which can lead to secondary or eccentric hypertrophy of the left ventricle. Presence of chronically elevated wall stress can lead to LV systolic dysfunction which in the presence of increased cardiac work load (exceeding the compensatory hypertrophy) can result in LAE. The strong association of LV wall thickness, LV chamber size and LV systolic function with LAE in our study suggests that LAE likely resulted from the effects of obesity on LV geometry.
Patients with severe MS and AF are at high risk of de- veloping intracardiac thrombi. Based on the findings by TTE, TEE, and the presence of risk factors (AF), his RA mass was likely to be a thrombus as described earlier. Similar features were found in LA mass and it was thought to be a thrombus as well. However, the charac- teristic of LA mass adhering to atrial septum mimics atrial myxoma, which is the most common benign car- diac tumor . The shape, mobility, and location of the LA mass made it difficult to rule out atrial myxoma with absolute certainty. Therefore, our patient underwent CMR for additional noninvasive characterization of the biatrial mass. CMR showed a giant right atrialmass meas- uring 5.3×3.2×3.9 cm and a large leftatrial lesion measur- ing 5.0×2.4×5.1 cm adhering to interatrial septum (Fig. 2). Both lesions were intermediate in signal on cine CMR, and not enhanced during early and delayed enhancement CMR. The morphology, location, and avascular character- istics made thrombi the most likely diagnosis. The CMR result was in agreement with TTE and TEE findings.
[2, 3]. The intertrabecular recesses appear to be a favorable substrate for ventricular arrhythmias. There are several case series and reports describing ventricular ectopic beats, ven- tricular tachycardia and/or ventricular fibrillations, and sud- den cardiac deaths in these patients . Atrial arrhythmia usually seen is atrial fibrillation with reported incidence of 5%  to 29% .
receptors was significantly reduced in CHF dogs compared with sham-operated controls. The mechanism for this depressed sensitivity was investigated. Sonomicrometry of the leftatrial appendage indicated a decreased compliance of the leftatrial appendage in the dogs with chronic CHF. In addition, microscope examination of the complex unencapsulated receptor endings taken from the leftatrial endocardium indicated a marked alteration in receptor morphology. A loss of the end arborization was the most typical finding. It is concluded that chronic CHF brought about by an aorto-caval fistula results in a depressed leftatrial stretch receptor response and that […]
Objective: To investigate the relationship between serum level of cystatin C (Cys-C) and AF (atrial fibrillation) and its clinical classification. Method: From January 2017 to April 2019, 168 cases of Xiaogan Central Hospital were chosen as the object of this study. The subjects were divided into 86 patients with AF and 82 patients in the control group. The AF group was divided into paroxysmal AF group (29 cases), persistent AF group (27 cases) and perma- nent AF group (29 cases) according to the European atrial fibrillation man- agement guidelines and the North America Society of Pacing and Electrophy- siology (NASPE) arrhythmia group organized the categorization of AF. Re- sults: Compared with the control group, the level of the serum Cys-C was significantly higher in the AF group, the difference was statistically signifi- cant ( P < 0.05). There was significant difference in Cys-C level in patients with different types of AF ( P < 0.05). The levels of neutrophil percentage, low density lipoprotein cholesterol (LDL-C), left ventricular diameter, leftatrial diameter, C-reactive protein (CRP) and homocysteine in the AF group were significantly higher than those in the control group ( P < 0.05). The difference of neutrophil percentage, LDL-C, left ventricular ejection fraction, leftatrial diameter, CRP and homocysteine levels in patients with different types of atrial fibrillation was statistically significant ( P < 0.05). Logistic analysis showed that the serum Cys-C level, CRP, homocysteine, left ventricular diameter, leftatrial diameter could be used as an independent predictor of atrial fibrillation when other factors were corrected. Conclusion: Serum Cys-C level in atrial fibrillation group is significantly higher than the control group, there are dif- ferences between different atrial fibrillation clinical classification, its level in- creased with duration of atrial fibrillation. Serum Cys-C level and inflamma- tory markers CRP, WBC and neutrophilic granulocyte percentage were posi- tively correlated, indicating that serum cystatin C is associated with chronic inflammation, involved in the occurrence of atrial fibrillation, maintain and recurrence. Logistic analysis showed that the serum cystatin C level could be How to cite this paper: Duan, Y.Q., Xu,
The leftatrial appendage team aims to create an accurate and easy to manufacture 3D printed leftatrial appendage and left atrium. The 3D printed model will be used to size and preview a leftatrial appendage closure procedure. Dr. Chris Porterfield performs this procedure with Boston Scientific’s Watchman product, but he sometimes struggles to choose the right size and procedure pathway since CT scans don’t not offer great visuals of patient anatomy. This project allows physicians to visualize the procedure and properly select which Watchman size best fits the patient. The model and procedure to make the model must be easy for operators to use, reproducible, repeatable, be done in less than a day and accurately model the CT scan. In order to complete this project by the winter quarter deadline, we must achieve certain deliverables on defined dates. We plan to have completed research for the project by Oct. 15th, have completed our algarium and performed the first print by 11/4 and completed our edits by 1/27. The final written procedure should be done by 1/27 as well so all of February cna used to validate the procedure and run an ANOVA test to verify our project is repeatable and reproducible. Our final poster presentation will be prepared for 3/16 and Dr. Porterfield may ask us to present this project at a