Archives of Cardiovascular Imaging Archives of Cardiovascular Imaging Arch Cardiovasc Imaging http://www.cardiovascimaging.com 2322-5327 2322-5319 10.5812/acvi en jalali 2016 8 10 gregorian 2016 8 10 2 1
en 10.5812/acvi.17357 Efficacy and Safety of Sedation in Cardiac Imaging Efficacy and Safety of Sedation in Cardiac Imaging editorial editorial Deep Sedation; Cardiac Imaging Techniques; Echocardiography Deep Sedation; Cardiac Imaging Techniques; Echocardiography http://www.cardiovascimaging.com/index.php?page=article&article_id=17357 Mohsen Ziyaeifard Mohsen Ziyaeifard Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Rasoul Azarfarin Rasoul Azarfarin Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2123922017, Fax: +98-22663293 Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2123922017, Fax: +98-22663293
en 10.5812/acvi.16081 Comparison of Left Atrial Function between Hypertensive Patients with Normal Atrial Size and Normotensive Subjects Using Strain Rate Imaging Technique Comparison of Left Atrial Function between Hypertensive Patients with Normal Atrial Size and Normotensive Subjects Using Strain Rate Imaging Technique research-article research-article Conclusions

In our subjects, with a normal value of LA size, the effect of hypertension on LA reservoir function was independent of age, sex, heart rate, left ventricular mass index, and left ventricular ejection fraction. Additionally, heart rate independently correlated with reduced TVI and SRI parameters in the patients with hypertension.

Background

Patients with hypertension are at risk of structural and functional changes in the left atrium (LA). There are only a few studies on the impact of hypertension on LA function, especially in hypertensive patients with a normal LA size. We, therefore, designed this study to evaluate LA function in patients with a normal LA size via deformation imaging.

Objectives

We assessed regional longitudinal strain rate imaging (SRI) profiles along with tissue velocity imaging (TVI) in the LA walls to quantify LA reservoir function and explore changes in LA function in hypertensive patients with a normal value of LA size.

Patients and Methods

One hundred twenty-four subjects with normal angiography (mean age = 56.28 ± 8.91 years, 46% male), who were referred to the Echocardiography Laboratory of our institution, were enrolled in this study. These subjects were categorized into two groups: hypertensive (75 cases) and age-matched normotensive (49 cases) groups. All the cases of the patient and control groups had a normal LA size. SRI parameters included strain (ST, %) and strain rate (SR, s-1), and tissue imaging parameters such as peak systolic velocity (Sm, m/s) were measured in four septal, lateral, anterior, and inferior LA walls at the mid-level.

Results

Compared with the controls, the patients with a history of hypertension showed significantly lower values of Sm, ST, and SR in each segment of the LA. There was no effect of age on these indices. Also, no differences regarding Sm, ST, and SR were found between the septal, lateral, anterior, and inferior LA walls in each group. By multivariate linear regression analysis, a history of hypertension was the only independent determinant of average LA strain rate in the all the individuals (P < 0.001). When this analysis was repeated in the patients with a history of hypertension, the only independent determinant of average LA strain rate was heart rate (P = 0.026).

Conclusions

In our subjects, with a normal value of LA size, the effect of hypertension on LA reservoir function was independent of age, sex, heart rate, left ventricular mass index, and left ventricular ejection fraction. Additionally, heart rate independently correlated with reduced TVI and SRI parameters in the patients with hypertension.

Background

Patients with hypertension are at risk of structural and functional changes in the left atrium (LA). There are only a few studies on the impact of hypertension on LA function, especially in hypertensive patients with a normal LA size. We, therefore, designed this study to evaluate LA function in patients with a normal LA size via deformation imaging.

Objectives

We assessed regional longitudinal strain rate imaging (SRI) profiles along with tissue velocity imaging (TVI) in the LA walls to quantify LA reservoir function and explore changes in LA function in hypertensive patients with a normal value of LA size.

Patients and Methods

One hundred twenty-four subjects with normal angiography (mean age = 56.28 ± 8.91 years, 46% male), who were referred to the Echocardiography Laboratory of our institution, were enrolled in this study. These subjects were categorized into two groups: hypertensive (75 cases) and age-matched normotensive (49 cases) groups. All the cases of the patient and control groups had a normal LA size. SRI parameters included strain (ST, %) and strain rate (SR, s-1), and tissue imaging parameters such as peak systolic velocity (Sm, m/s) were measured in four septal, lateral, anterior, and inferior LA walls at the mid-level.

Results

Compared with the controls, the patients with a history of hypertension showed significantly lower values of Sm, ST, and SR in each segment of the LA. There was no effect of age on these indices. Also, no differences regarding Sm, ST, and SR were found between the septal, lateral, anterior, and inferior LA walls in each group. By multivariate linear regression analysis, a history of hypertension was the only independent determinant of average LA strain rate in the all the individuals (P < 0.001). When this analysis was repeated in the patients with a history of hypertension, the only independent determinant of average LA strain rate was heart rate (P = 0.026).

Heart Atria;Echocardiography;Hypertension Heart Atria;Echocardiography;Hypertension http://www.cardiovascimaging.com/index.php?page=article&article_id=16081 Mohammad Sahebjam Mohammad Sahebjam Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran; Tehran Heart Center, North Kargar Street, Tehran, IR Iran. Tel: +98-2188029257, Fax: +98-2188029256 Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran; Tehran Heart Center, North Kargar Street, Tehran, IR Iran. Tel: +98-2188029257, Fax: +98-2188029256 Asghar Mazareei Asghar Mazareei Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran Masoumeh Lotfi-Tokaldany Masoumeh Lotfi-Tokaldany Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran Neda Ghaffari Neda Ghaffari Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran Arezoo Zoroufian Arezoo Zoroufian Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran Mahmood Sheikhfatollahi Mahmood Sheikhfatollahi Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran Tehran Heart Center, Cardiology Department, Tehran University of Medical Sciences, Tehran, IR Iran
en 10.5812/acvi.17123 Tissue Doppler Imaging Findings Including Prominent S Wave in Patients With Mitral Valve Prolapse Syndrome Tissue Doppler Imaging Findings Including Prominent S Wave in Patients With Mitral Valve Prolapse Syndrome research-article research-article Conclusions

Sm wave in TDI is prominent and significantly high in MVP syndrome. Also, our study showed some degree of diastolic dysfunction in MVP patients.

Results

Seventy-five patients (48 females) at a mean age of 26.5 ± 9.4 years and 50 individuals (32 females) at a mean age of 27.1 ± 8.3 years were enrolled in the study. As the important results of our study, Sm wave was much more prominent and much higher in the MVP group (P = 0.00); Em was lower (P = 0.00) and Am was slightly higher (P = 0.12). Furthermore, the E waves of MV inflow for the MVP and control groups were similar and E/Em was significantly higher in the MVP group (P = 0.00); taken together with a higher left atrial volume in this group, this finding revealed a relatively higher left ventricular end-diastolic pressure.

Objectives

We aimed to evaluate the findings of TDI in MVP syndrome.

Patients and Methods

Seventy-five patients with MVP syndrome and 50 normal individuals as the control group were evaluated. The general characteristics and echocardiographic findings, especially TDI results, were evaluated and compared between the two groups. Mitral annular TDI velocities (Sm, Em, and Am) were measured at the lateral corner of the MV in the apical four-chamber view of transthoracic echocardiography.

Background

Mitral valve prolapse (MVP) is allied to a variety of echocardiographic and pathologic findings, not least courtesy of the advent of novel and stringent echocardiographic criteria. MVP enjoys definite and clear-cut characteristics and is, as such, a fertile ground for research. Tissue Doppler imaging (TDI) is a relatively new imaging technique, and there is currently a dearth of information on this modality in patients with MVP syndrome.

Conclusions

Sm wave in TDI is prominent and significantly high in MVP syndrome. Also, our study showed some degree of diastolic dysfunction in MVP patients.

Results

Seventy-five patients (48 females) at a mean age of 26.5 ± 9.4 years and 50 individuals (32 females) at a mean age of 27.1 ± 8.3 years were enrolled in the study. As the important results of our study, Sm wave was much more prominent and much higher in the MVP group (P = 0.00); Em was lower (P = 0.00) and Am was slightly higher (P = 0.12). Furthermore, the E waves of MV inflow for the MVP and control groups were similar and E/Em was significantly higher in the MVP group (P = 0.00); taken together with a higher left atrial volume in this group, this finding revealed a relatively higher left ventricular end-diastolic pressure.

Objectives

We aimed to evaluate the findings of TDI in MVP syndrome.

Patients and Methods

Seventy-five patients with MVP syndrome and 50 normal individuals as the control group were evaluated. The general characteristics and echocardiographic findings, especially TDI results, were evaluated and compared between the two groups. Mitral annular TDI velocities (Sm, Em, and Am) were measured at the lateral corner of the MV in the apical four-chamber view of transthoracic echocardiography.

Background

Mitral valve prolapse (MVP) is allied to a variety of echocardiographic and pathologic findings, not least courtesy of the advent of novel and stringent echocardiographic criteria. MVP enjoys definite and clear-cut characteristics and is, as such, a fertile ground for research. Tissue Doppler imaging (TDI) is a relatively new imaging technique, and there is currently a dearth of information on this modality in patients with MVP syndrome.

Mitral Valve Prolapse;Echocardiography;Elasticity Imaging Techniques;S wave Mitral Valve Prolapse;Echocardiography;Elasticity Imaging Techniques;S wave http://www.cardiovascimaging.com/index.php?page=article&article_id=17123 Azin Alizadehasl Azin Alizadehasl Echocardiography Department, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Echocardiography Department, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Rasoul Azarfarin Rasoul Azarfarin Cardiac Anesthesia Department, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; FACC; Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2123922017, Fax: +98-2122663293 Cardiac Anesthesia Department, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; FACC; Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2123922017, Fax: +98-2122663293
en 10.5812/acvi.14534 Echocardiographic Abnormalities in Patients with Sleep Apnea Syndrome Echocardiographic Abnormalities in Patients with Sleep Apnea Syndrome research-article research-article Background

Obstructive sleep apnea (OSA) is a common sleep disease. It is associated not only with hypertension but also with other cardiac complications. Thus, the early detection of cardiac disorders is very useful.

Objectives

We sought to evaluate different echocardiographic parameters.

Patients and Methods

This cross-sectional study was done on 55 patients with OSA. The patients were divided into three groups: mild, moderate, and severe according to the apnea hypopnea index (AHI) and all underwent echocardiography. Analysis was done by SPSS 18 as well as the chi-squared and one-way ANOVA tests.

Results

The mean age of the study population was 51.16 ± 12.88 years old and 36 (65.5%) patients were male. Right Tei index mean was 0.383 ± 0.213, which was abnormal in 19.1% of the patients. Left Tei index mean was 0.378 ± 0.230 and was abnormal in 52.9% of the patients. Pulmonary artery pressure mean was 18.32 ± 8.91 and was normal in 39 (70.9%) patients. Only basal septum strain (P = 0.015) and basal septum strain rate (P = 0.005) changes were associated with OSA severity.

Conclusions

The main findings of this study were relative left ventricular systolic and diastolic dysfunction as well as dysfunction in some parameters of the right ventricle. The prevalence of these disorders and what constitutes the best echocardiographic parameter for their diagnosis are controversial and require further research.

Background

Obstructive sleep apnea (OSA) is a common sleep disease. It is associated not only with hypertension but also with other cardiac complications. Thus, the early detection of cardiac disorders is very useful.

Objectives

We sought to evaluate different echocardiographic parameters.

Patients and Methods

This cross-sectional study was done on 55 patients with OSA. The patients were divided into three groups: mild, moderate, and severe according to the apnea hypopnea index (AHI) and all underwent echocardiography. Analysis was done by SPSS 18 as well as the chi-squared and one-way ANOVA tests.

Results

The mean age of the study population was 51.16 ± 12.88 years old and 36 (65.5%) patients were male. Right Tei index mean was 0.383 ± 0.213, which was abnormal in 19.1% of the patients. Left Tei index mean was 0.378 ± 0.230 and was abnormal in 52.9% of the patients. Pulmonary artery pressure mean was 18.32 ± 8.91 and was normal in 39 (70.9%) patients. Only basal septum strain (P = 0.015) and basal septum strain rate (P = 0.005) changes were associated with OSA severity.

Conclusions

The main findings of this study were relative left ventricular systolic and diastolic dysfunction as well as dysfunction in some parameters of the right ventricle. The prevalence of these disorders and what constitutes the best echocardiographic parameter for their diagnosis are controversial and require further research.

Obstructive Sleep Apnea;Echocardiography;Cardiovascular Diseases Obstructive Sleep Apnea;Echocardiography;Cardiovascular Diseases http://www.cardiovascimaging.com/index.php?page=article&article_id=14534 Maryam Moshkani Farahani Maryam Moshkani Farahani Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Ensieh Vahedi Ensieh Vahedi Chemical Injury Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Chemical Injury Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Iman Lotfian Iman Lotfian Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran; MD; Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2182482394, Fax: +98-2181263420 Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran; MD; Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2182482394, Fax: +98-2181263420 Mahdi Motashaker-Arani Mahdi Motashaker-Arani Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
en 10.5812/acvi.13737 Assessment of Right Ventricular Function by Tissue Doppler, Strain and Strain Rate Imaging in Patients with Left-Sided Valvular Heart Disease and Pulmonary Hypertension Assessment of Right Ventricular Function by Tissue Doppler, Strain and Strain Rate Imaging in Patients with Left-Sided Valvular Heart Disease and Pulmonary Hypertension research-article research-article Background

Pulmonary artery hypertension is the presentation of various types of cardiovascular and systematic diseases. There are different kinds of noninvasive methods to determine right ventricular function, pulmonary artery pressure, and effect of pulmonary hypertension on right ventricular function. These methods include the tissue Doppler imaging (TDI) of the tricuspid annulus and the longitudinal deformation indices of the right ventricular free wall.

Objectives

In some patients, the echocardiogram cannot help estimate pulmonary artery pressure. In this study, we evaluated the effect of pulmonary hypertension on the TDI of the tricuspid annulus and the longitudinal strain and strain rate of the basal segment of the right ventricular free wall in patients with left-sided valvular heart disease and pulmonary hypertension. Indeed, we sought to investigate whether we can guess the presence of pulmonary hypertension through the measurement of the TDI of the tricuspid annulus and the deformity indices of the basal segment of the right ventricular free wall.

Patients and Methods

Eighty consecutive patients with left-sided valvular disease and pulmonary artery hypertension (V/PH Group) and 80 healthy matched controls (H Group) were enrolled in this research. The TDI parameters were obtained in the tissue velocity imaging mode during systole (S, S VTI), early relaxation (E), atrial systole (A), and isovolemic relaxation time (IVRT). The deformation indices included peak systolic longitudinal strain and strain rate measured from the basal segment of the right ventricular free wall and were calculated as the relative magnitude of segmental deformation.

Results

S, E, and S VTI were reduced significantly in the V/PH Group, and there was a significant negative correlation between S velocity, S VTI with pulmonary artery systolic pressure (PASP), and right ventricular diameter (RVD). According to the ROC curve, S velocity ˂ 10.5 cm/s had 65% sensitivity and 40% specificity for the prediction of pulmonary hypertension. E velocity had only a negative significant correlation with RVD and no significant correlation with tricuspid annular plane systolic excursion (TAPSE) and PASP. There was no significant difference in A velocity and E/A ratio between the two groups (P = 0.455 and P = 0.070, respectively), and these parameters had no significant correlation with RVD and TAPSE. IVRT was significantly increased in the V/PH Group versus the H Group, and IVRT > 40 ms had 78% sensitivity and 67% specificity for the prediction of pulmonary hypertension. In comparison with the H Group, RV longitudinal peak systolic strain (-14/35 ± 4%) and strain rate (-0.65 ± 0.12) at the basal segment of the right ventricular free wall were significantly lower in the V/PH Group (P < 0.001 and P < 0.001).

Conclusions

We observed a significant reduction in S, E velocity, and S VTI of the tricuspid annulus. Moreover, the strain/strain rate of the basal segment of the right ventricular free wall had a marked decrease in the V/PH Group in comparison with the healthy subjects.

Background

Pulmonary artery hypertension is the presentation of various types of cardiovascular and systematic diseases. There are different kinds of noninvasive methods to determine right ventricular function, pulmonary artery pressure, and effect of pulmonary hypertension on right ventricular function. These methods include the tissue Doppler imaging (TDI) of the tricuspid annulus and the longitudinal deformation indices of the right ventricular free wall.

Objectives

In some patients, the echocardiogram cannot help estimate pulmonary artery pressure. In this study, we evaluated the effect of pulmonary hypertension on the TDI of the tricuspid annulus and the longitudinal strain and strain rate of the basal segment of the right ventricular free wall in patients with left-sided valvular heart disease and pulmonary hypertension. Indeed, we sought to investigate whether we can guess the presence of pulmonary hypertension through the measurement of the TDI of the tricuspid annulus and the deformity indices of the basal segment of the right ventricular free wall.

Patients and Methods

Eighty consecutive patients with left-sided valvular disease and pulmonary artery hypertension (V/PH Group) and 80 healthy matched controls (H Group) were enrolled in this research. The TDI parameters were obtained in the tissue velocity imaging mode during systole (S, S VTI), early relaxation (E), atrial systole (A), and isovolemic relaxation time (IVRT). The deformation indices included peak systolic longitudinal strain and strain rate measured from the basal segment of the right ventricular free wall and were calculated as the relative magnitude of segmental deformation.

Results

S, E, and S VTI were reduced significantly in the V/PH Group, and there was a significant negative correlation between S velocity, S VTI with pulmonary artery systolic pressure (PASP), and right ventricular diameter (RVD). According to the ROC curve, S velocity ˂ 10.5 cm/s had 65% sensitivity and 40% specificity for the prediction of pulmonary hypertension. E velocity had only a negative significant correlation with RVD and no significant correlation with tricuspid annular plane systolic excursion (TAPSE) and PASP. There was no significant difference in A velocity and E/A ratio between the two groups (P = 0.455 and P = 0.070, respectively), and these parameters had no significant correlation with RVD and TAPSE. IVRT was significantly increased in the V/PH Group versus the H Group, and IVRT > 40 ms had 78% sensitivity and 67% specificity for the prediction of pulmonary hypertension. In comparison with the H Group, RV longitudinal peak systolic strain (-14/35 ± 4%) and strain rate (-0.65 ± 0.12) at the basal segment of the right ventricular free wall were significantly lower in the V/PH Group (P < 0.001 and P < 0.001).

Conclusions

We observed a significant reduction in S, E velocity, and S VTI of the tricuspid annulus. Moreover, the strain/strain rate of the basal segment of the right ventricular free wall had a marked decrease in the V/PH Group in comparison with the healthy subjects.

Hypertension; Lung; Heart Ventricles; Tricuspid Valve; Elasticity Imaging Techniques; Sprains and Strains Hypertension; Lung; Heart Ventricles; Tricuspid Valve; Elasticity Imaging Techniques; Sprains and Strains http://www.cardiovascimaging.com/index.php?page=article&article_id=13737 Leila Bigdelu Leila Bigdelu Department of Cardiology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, IR Iran Department of Cardiology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, IR Iran Ali Azari Ali Azari Department of Cardiac Surgery, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Department of Cardiac Surgery, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Afsoon Fazlinezhad Afsoon Fazlinezhad Department of Cardiology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, IR Iran; Department of Cardiology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, IR Iran Department of Cardiology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, IR Iran; Department of Cardiology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, IR Iran
en 10.5812/acvi.15633 Left Atrial and Left Atrial Appendage Mass Diagnosed by Cardiac Imaging: A Case Report Left Atrial and Left Atrial Appendage Mass Diagnosed by Cardiac Imaging: A Case Report case-report case-report Introduction

Left atrial thrombi are present in one third of patients with severe rheumatic mitral stenosis and atrial fibrillation. A left atrial mass can be diagnosed as a thrombus by transthoracic echocardiography in the presence of the predisposing factors for a thrombus such as mitral stenosis and atrial fibrillation. The sensitivity of transthoracic echocardiography for detecting left atrial appendage thrombi is low, and only a few case reports have been described in the literature.

Conclusions

Transthoracic echocardiography was sufficient to establish the diagnosis and to decide its management.

Case Presentation

This report describes the case of a 65-year-old female with severe rheumatic mitral stenosis and chronic atrial fibrillation presenting with congestive heart failure. This patient was shown, by means of transthoracic echocardiography, to have a large immobile left atrium cavity mass (6.5 × 3.4 × 2.3 cm) and a large left atrial appendage mass (1.7 cm) identified as a thrombus. Contrast computed tomography of the chest confirmed the diagnosis.

Introduction

Left atrial thrombi are present in one third of patients with severe rheumatic mitral stenosis and atrial fibrillation. A left atrial mass can be diagnosed as a thrombus by transthoracic echocardiography in the presence of the predisposing factors for a thrombus such as mitral stenosis and atrial fibrillation. The sensitivity of transthoracic echocardiography for detecting left atrial appendage thrombi is low, and only a few case reports have been described in the literature.

Conclusions

Transthoracic echocardiography was sufficient to establish the diagnosis and to decide its management.

Case Presentation

This report describes the case of a 65-year-old female with severe rheumatic mitral stenosis and chronic atrial fibrillation presenting with congestive heart failure. This patient was shown, by means of transthoracic echocardiography, to have a large immobile left atrium cavity mass (6.5 × 3.4 × 2.3 cm) and a large left atrial appendage mass (1.7 cm) identified as a thrombus. Contrast computed tomography of the chest confirmed the diagnosis.

Atrial Function;Left Atrial Appendage;Thrombosis;Echocardiography Atrial Function;Left Atrial Appendage;Thrombosis;Echocardiography http://www.cardiovascimaging.com/index.php?page=article&article_id=15633 Marija Kotevska-Angjushev Marija Kotevska-Angjushev Cardiology Department, "8th of September" City Hospital, Skopje, Macedonia; Cardiology Department, "8th of September" City Hospital, Skopje, Macedonia. Tel: +389-2779277, Fax: +389-23112502 Cardiology Department, "8th of September" City Hospital, Skopje, Macedonia; Cardiology Department, "8th of September" City Hospital, Skopje, Macedonia. Tel: +389-2779277, Fax: +389-23112502 Menka Lazarevska Menka Lazarevska University Clinic of Radiology, Saints Cyril and Methodius University of Skopje, Skopje, Macedonia University Clinic of Radiology, Saints Cyril and Methodius University of Skopje, Skopje, Macedonia
en 10.5812/acvi.14557 Tuberculous Effusive-Constrictive Pericarditis Tuberculous Effusive-Constrictive Pericarditis case-report case-report Discussion

Transthoracic echocardiography disclosed massive pericardial effusion, respiratory variation in mitral and tricuspid inflow E velocity, increased diastolic flow reversal with expiration in the hepatic vein, septum deviation in inspiration toward the left ventricle (LV), preserved LV function, and inferior vena caval (IVC) dilation without any collapse in inspiration. Chest computed tomography (CT) revealed a large amount of pericardial effusion and bilateral pleural effusion.

Introduction

Tuberculosis (TB) is a serious disease in developing countries. Tuberculous pericarditis is a rare but life-threatening condition and may lead to cardiac tamponade and constrictive pericarditis.

Case Presentation

An 82-year-old man was referred for cardiac consultation. He was suffering from dyspnea, malaise, weight loss, night sweat, and fever for four months duration.

Discussion

Transthoracic echocardiography disclosed massive pericardial effusion, respiratory variation in mitral and tricuspid inflow E velocity, increased diastolic flow reversal with expiration in the hepatic vein, septum deviation in inspiration toward the left ventricle (LV), preserved LV function, and inferior vena caval (IVC) dilation without any collapse in inspiration. Chest computed tomography (CT) revealed a large amount of pericardial effusion and bilateral pleural effusion.

Introduction

Tuberculosis (TB) is a serious disease in developing countries. Tuberculous pericarditis is a rare but life-threatening condition and may lead to cardiac tamponade and constrictive pericarditis.

Case Presentation

An 82-year-old man was referred for cardiac consultation. He was suffering from dyspnea, malaise, weight loss, night sweat, and fever for four months duration.

Mycobacterium Tuberculosis;Pericarditis;Caseating Necrosis Mycobacterium Tuberculosis;Pericarditis;Caseating Necrosis http://www.cardiovascimaging.com/index.php?page=article&article_id=14557 Majid Kyavar Majid Kyavar Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Nehzat Akiash Nehzat Akiash Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2123922930, Fax: +98-2189314714 Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2123922930, Fax: +98-2189314714
en 10.5812/acvi.16315 Ethnicity: A Missing Variable When Defining Normative Values for Reporting Echocardiographic Studies Ethnicity: A Missing Variable When Defining Normative Values for Reporting Echocardiographic Studies letter letter Echocardiography; Reference Values; Ethnicity Echocardiography; Reference Values; Ethnicity http://www.cardiovascimaging.com/index.php?page=article&article_id=16315 Luigi P Badano Luigi P Badano Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine, Padua, Italy; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. Tel: +39-0498218640, Fax: +39-0498211802 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine, Padua, Italy; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. Tel: +39-0498218640, Fax: +39-0498211802
en 10.5812/acvi.15174 Echocardiography in Sleep Apnea Patients: A Long Way to Go Echocardiography in Sleep Apnea Patients: A Long Way to Go letter letter Sleep Apnea Syndromes;Echocardiography;Hypertension, Pulmonary Sleep Apnea Syndromes;Echocardiography;Hypertension, Pulmonary http://www.cardiovascimaging.com/index.php?page=article&article_id=15174 Ahmad Amin Ahmad Amin Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9128098713 Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9128098713
en 10.5812/acvi.17300 Hydrops Fetalis Hydrops Fetalis discussion discussion Hydrops Fetalis;Tachycardia Hydrops Fetalis;Tachycardia http://www.cardiovascimaging.com/index.php?page=article&article_id=17300 Maryam Moradian Maryam Moradian Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2123922170 Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2123922170
en 10.5812/acvi.18044 Cardiac CT in Mixed Type Atrial Septum Defects Cardiac CT in Mixed Type Atrial Septum Defects discussion discussion Secundum Type Atrial Septal Defect (ASD); Sinus Venosus Type ASD; Partial Anomalous Pulmonary Venous Connection (PAPVC) Secundum Type Atrial Septal Defect (ASD); Sinus Venosus Type ASD; Partial Anomalous Pulmonary Venous Connection (PAPVC) http://www.cardiovascimaging.com/index.php?page=article&article_id=18044 Anita Sadeghpour Anita Sadeghpour Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Fatemeh Moudi Fatemeh Moudi Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; Fellowship of Echocardiography, Echocardiography Department, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9155121586 Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran; Fellowship of Echocardiography, Echocardiography Department, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9155121586
en 10.5812/acvi.17231 Impingement of the Occluder on Tricuspid Valve Impingement of the Occluder on Tricuspid Valve discussion discussion VSD;Complication VSD;Complication http://www.cardiovascimaging.com/index.php?page=article&article_id=17231 Zahra khajali Zahra khajali Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran Marzieh Khayatzadeh Marzieh Khayatzadeh Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran; MD, Fellowship of Echocardiography, Echocardiography Department, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran. Tel: +98-9121894993 Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran; MD, Fellowship of Echocardiography, Echocardiography Department, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran. Tel: +98-9121894993