Left atrial dissection is a rare complication of cardiac surgery and percutaneous cardiac procedures. It is defined as a false blood-filled cavity or lumen from mitral annular area to the left atrial free wall or into the atrial septum thereby creating a new chamber with or without communications with the true left atrium [1]. We have reviewed literature and describe a case where echocardiography led to early recognition of this rare entity.

Purpose: Peripartum cardiomyopathy (PPCM) is a rare complication of pregnancy manifesting with acute cardiac failure. Coronavirus Disease 2019 (COVID-19) can be complicated by cardiomyopathy, which can be difficult to differentiate from PPCM. The aim of this publication is to investigate different outcomes of cases with cardiomyopathy during pregnancy. Methods: Here, we report 4 peripartum cases with COVID-19 and acute cardiac failure due to cardiomyopathy. Moreover, to find previous similar cases, a comprehensive review on PPCM and COVID-19 associated cardiomyopathy was conducted in PubMed, Scopus, Embase, and Google Scholar. Results: Out of 4 cases we had, two cases deceased and one became a candidate for heart transplant. Despite advanced diagnostic approaches, differentiating COVID-19 associated cardiomyopathy from PPCM was challenging. According to the literature review, 7 cases with similar conditions were found. Conclusion: Pregnant women with COVID-19 may develop acute cardiac failure associated with PPCM or COVID-19 associated cardiomyopathy or both. This condition may be deadly due to rapid disease progression, atypical manifestations, and limited treatment options.

The aim of this study was to evaluate the consistency between transesophageal echocardiography (TEE) and angiography in grading of paravalvular regurgitation (PVR) during transcatheter aortic valve replacement (TAVR) according to the Valve Academic Research Consortium 3 (VARC-3) criteria. 31 patients who underwent TEE and angiography during TAVR were retrospectively included. Circumferential extent of PVR, regurgitation volume, regurgitation fraction, and the effective regurgitant orifice area were measured by TEE. Weighted kappa coefficient was used to analyze the consistency of the two techniques. PVR was found in 16 of 31 patients. TEE assessed mild PVR in 14 cases and moderate PVR in 2 cases. Angiography assessed mild PVR in 12 cases and moderate PVR in 2 cases. The grading of TEE and angiography were the same in 29 cases, of which 15 were absent, 12 were mild, and 2 were moderate. The weighted kappa coefficient for both techniques was 0.88 (P < 0.001). The Kendall’s W coefficient of the circumferential extent of PVR, regurgitation volume, regurgitation fraction, and the effective regurgitant orifice area was 0.285 (P<0.005). TEE and angiography had strong consistency in the grading (using the VARC-3 criteria) of PVR during TAVR. TEE was a potential diagnostic tool for classifying PVR.

Retrospective analysis of echocardiograms was performed in 756 children who received endovascular device or surgical ASD closure from 2006 to 2016 in the Cardiac Center in Tomsk Russia. 564 patients had an endovascular closure and 192 had surgical correction. Follow-up duration was from 1 day to 10 years, mean 3.6 yrs for the device group and 4.2 yrs for the surgery group. The control group consisted of 3393 age-matched healthy patients. In patients with endovascular closure of an ASD, 35% had a change in the shape of the left atrium in early follow-up. Changes in the shape of the left atrium at early follow-up were more often observed in the device group and in children of a younger age. The left atrial changes were a decrease in sphericity and an increase in ellipsoidy. Changes in the shape of the left atrium persisted in 22% after transcatheter correction in the long-term. The change in shape of the left atrium after the placement of ASD devices was accompanied by activation of the mechanical function of the atrium and an increase in the filling pressure of the left ventricle. These changes were not accompanied by any disturbance in the contractility and volume of the heart chambers. In the group with surgical correction of ASD, the contractility and volume of the heart chambers did not significantly differ from those in the device closure group.

We illustrate a case of atrioventricular valve stenosis associated with insufficiency detected in fetal echocardiography performed in a pregnant woman (22 gestational weeks) of 3rd gravida. The early prenatal diagnosis demonstrated, isolated bilateral atrioventricular value stenosis and insufficiency in the absence of any other associated complex congenital heart diseases such as tricuspid atresia, hypoplastic left heart syndrome, endocardial cushion defect. However, the mother of the affected foetus was found to be normal with no risk factors. Thus, fetal echocardiography plays a pivotal role even in low risk pregnancies for early detection of prenatal cardiac anomalies that guide the obstetricians in determining the risk stratification, therapeutic strategies and prognosis.

Objectives —We sought to investigate the technical feasibility, fidelity and the potential applications of three-dimensional(3D) printed atrial septal defect (ASD) models based on three-dimensional transesophageal echocardiography (3D-TEE) images preliminarily. Methods—We retrospectively collected 40 ASD patients’ 3D-TEE images. The 3D-TEE data were imported into post-processing software to create printable 3D digital models, the patient-specific models were then printed by the 3D printer. Fidelity of the 3D printed models were quantitatively evaluated by comparing the measurements from 3D ASD models and echocardiographic data. Results —Ultrasound-derived 3D ASD models were acquired in all the forty cases successfully. There was good consistency and no significant differences in ASD size parameters among 3D printed models, 2D-TEE images and 3D-TEE images（all P>0.05）. Also, it showed small difference among 3D printed models, 2D-TEE images and 3D-TEE images in the absolute difference value of ASD size parameters. There’s a highly significant correlation between the ASD parameters including the maximal diameter, the minimal diameter and circumference measured by 3D ASD printed models and the corresponding parameters of ASD occluders applied in actual surgical procedure. Simulation exercises in the 3D ASD printed models had an impressive effect based on the comprehensive assessment of the ASD parameters. Conclusions—It is feasible to use 3D-TEE images as the data source of ASD 3D printed models. Ultrasound-derived ASD 3D printed models show highly fidelity, which contributes to provide evidence for the clinical application of 3D printing technology in decision of ASD occlusion.

Intramyocardial dissection following cardiac tumor excision is uncommon. The evidence available is limited to few case reports. 1 Herein,we report an infant with large cardiac fibrosarcoma arising from the interventricular septum and underwent surgical excision.One month after surgery echocardiography revealed a cystic dissection located in the interventricular septum with residual shunts within the ventricular chambers. we performed conservative strategy due to the high surgical risk, difficulty of interventional therapy and hemodynamic stability.

Background: Pulmonary hypertension is a significant yet rare disease that can have many long-term consequences, including death. Cardiac catheterization is the gold standard for measuring pulmonary artery mean pressures (PAMP), but is invasive and risks potentially serious complications. This study aimed to create a semi-quantitative, non-invasive measure of PAMP using septal positioning. Methods: This study was a retrospective study of patients with and without pulmonary hypertension who had a transthoracic echocardiogram and cardiac catheterization. Patients undergoing atrial septal defect closure represented controls. Two blinded readers calculated the “Echocardiographically-Derived Septal Positional Angle (EDSPA)” which was compared to corresponding catheterization data including mean pulmonary artery pressures. Results: A total of 159 children were included, of which 151 had useable echocardiographic data. 40 children were identified as having pulmonary hypertension while 111 children had an atrial septal defect. Patient age ranged from a minimum of 54 days and maximum of 19 years [mean 7.1 years (SD=5.30)]. Inter-observer variability between two readers [Pearson correlation coefficient of 0.939 (p <0.001)] and intra-observer variability were low [intraclass correlation coefficient (ICC) of 0.95 and 0.96 for each observer respectively]. An EDSPA of ≤39° predicted a PAMP>20 mmHg (as measured by cardiac catheterization) with a 76% sensitivity and 76% specificity (AUC 0.846). Conclusions: EDSPA is a useful, non-invasive, and reproducible echocardiographic measure of PAMP that is easy to perform. With a sensitivity and specificity near 80%, it has significant utility in screening for pulmonary hypertension and determining which patients should undergo further invasive diagnostic testing.

Aims. The management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. Prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. In particular, left atrial (LA) function has been shown to be an important determinant of morbimortality. The purpose of this study was to analyze the prognostic significance of diastolic function in asymptomatic patients with sAR. Methods and results. A total of 126 patients with asymptomatic sAR were included. Conventional echocardiographic systolic and diastolic function parameters were assessed. LA auto-strain analysis was performed in a subgroup of 57 patients. During a mean follow up of 33±19 months, 25 (19,8%) patients reached the combined end-point. Univariate analysis showed that LV volumes, LVEF, E wave, E/e’ ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events. Multivariate model 1 that tested all echocardiographic variables statistically significant in the univariate model showed that LVEDV [HR=1,02;95% CI:1,01-1,03 (p<0,001)] and E/e’ ratio [HR=1,12;95% CI:1,03-1,23 (p=0,01)] were significant predictors of events. In the subgroup of patients with LA auto-strain analyzed, a second multivariate model including the previous significant variables for the first model as well as LASr, showed that LVEDV [HR=1,05;95% CI:1,01-1,08 (p=0,016)] and LASr [HR=0,8;95% CI:0,65-0,98 (p<0,035)] were the most significant predictors of cardiovascular events. Conclusions. In this population of asymptomatic patients with sAR and normal LV systolic function, baseline diastolic parameters were prognostic markers of cardiovascular events; among them, LASr played a strong independent predictor role.

A rare autosomal recessive condition, Arterial tortuosity syndrome (ATS) presents with ectactic blood vessels, cutaneous laxity, and bowel rupture. We report a case of an asymptomatic infant with arterial tortuosity syndrome who presented with left ventricular hypertrophy without any obvious obstruction to the outflow tract.

Abstract Background: The aim of this study was to evaluate the potential effect of 6-minute walking distance (6MWD) on exercise tolerance in patients with pulmonary hypertension (PH). To clarify whether 6WMD and right ventricle (RV) function measured by three-dimensional echocardiography (3D-echo) could result in better correlation with exercise capacity. Methods: 72 consecutive patients underwent right heart catheterization (RHC) and diagnosed with PH. Associations between 6WMD and measures of RV function were evaluated using the Pearson correlation coefficient. Receiver operating characteristic (ROC) curve analysis was applied to evaluate the clinical prognosis of patients. Results: RHC-derived parameters were significantly correlated with 6MWD: (RPVR = -0.719, RPAPs = -0.501, RPAPd = -0.404, and RPAPm = -0.468, all P <0.001). Meanwhile, 6MWD was positively correlated with CO (R = 0.54, P <0.001). Good correlations between 6MWD with 3D-echo parameters were shown as follows: R3D-RVEDV = -0.584, R3D-RVESV = -0.598, R3D-RVEF = 0.554, R3D-RV mass = -0.507, all P <0.001. The predictive value from 6MWD was not much inferior to the predictive values of PVR (AUC6MWD = 0.779 vs. AUCPVR = 0.875, both P <0.0001). Conclusions: 6MWD has a significant correlation with hemodynamic parameters obtained by RHC. And RV function obtained by 3D-echo result in better correlation with exercise capacity. 3D-echo might be candidate for RHC to assess right heart function in patients with PH.

A 13-year-old woman was underwent transthoracic two-dimensional echocardiography (2DE), which revealed that only a small anterolateral papillary muscle was observed in the left ventricle (LV). Additional transthoracic three-dimensional echocardiography (3DE) revealed the posteromedial-papillary muscle which has not correctly delaminated from the LV wall and directly connected to the mitral valve leaflets without tendon chordae. She was diagnosed as a parachute-like asymmetric mitral valve rather than a true-parachute mitral valve. It was difficult to understand the precise anatomy evaluated by the 2DE. However, additional 3DE provided helpful information to reveal the exact characteristics of papillary muscle tissue.

Background: Chemotherapy-induced cardiotoxicity (ChC) is an important complication among patients receiving anthracyclines. Biomarkers and imaging parameters have been studied for their ability to identify patients at risk of developing this complication. Left ventricle global longitudinal strain (LV-GLS) has been described as a sensitive parameter for detecting systolic dysfunction, even in the presence of preserved left ventricle ejection fraction (LVEF). Objective: to evaluate the role of the LV-GLS as a predictor of ChC. Methods: This study is a post-hoc analysis of CECCY trial (Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity) that evaluated the primary prevention of cardiotoxicity with carvedilol during doxorubicin chemotherapy in a population with breast cancer. Cardiotoxicity was defined as a reduction >10% in LVEF. LV-GLS was obtained before chemotherapy in patients with no prior cardiovascular disease or echocardiogram abnormalities. Results: Thirty-one patients who had a complete echocardiography study including measurement of LV-GLS before chemotherapy were included in this analysis. An absolute LV-GLS <16.9% before chemotherapy showed 100% sensitivity and 73% specificity for predicting cardiotoxicity (AUC=0.85; 95%CI 0.680 – 0.959, p<0.001). In this population, LVEF values before chemotherapy did not predict ChC (95%CI 0.478 to -0.842, p=0.17). The association of low LV-GLS (<17%) and BNP serum levels (>17 pg/mL) two months after chemotherapy increased the accuracy for detecting early onset ChC (100% sensitivity, 88% specificity, AUC=0.94; 95%CI 0.781 – 0.995, p<0.0001). Conclusions: Our data suggest that LV-GLS is a potential predictor of chemotherapy-induced cardiotoxicity. Larger studies are needed to confirm the relevance of this echocardiographic parameter in this clinical setting.

Abstract: Background: This meta-analysis assessed the relationship between Obstructive Sleep Apnea (OSA) and echocardiographic parameters of diastolic dysfunction (DD), which are used in the assessment of Heart Failure with Preserved Ejection Fraction (HFpEF). Methods: We searched the databases including Ovid MEDLINE, Ovid Embase Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 26th, 2020. The search was not restricted to time, publication status or language. Comparisons were made between patients with OSA, diagnosed in-laboratory polysomnography (PSG) or home sleep apnea testing (HSAT), and patients without OSA in relation to established markers of diastolic dysfunction. Results: Primary search identified 2512 studies. A total of 18 studies including 2509 participants were included. The two groups were free of conventional cardiovascular risk factors. Significant structural changes were observed between the two groups. Patients with OSA exhibited greater LAVI (3.94 CI [0.8, 7.07]; p=0.000) and left ventricular mass index (11.10 CI [2.56,19.65]; p=0.000) as compared to control group. The presence of OSA was also associated with more prolonged DT (10.44 ms CI [0.71,20.16]; p=0.04), IVRT (7.85 ms CI[4.48, 11.22]; p=0.000), and lower E/A ratio (-0.62 CI [-1,-0.24]; p=0.001) suggestive of early DD. The E/e’ ratio (0.94 CI[0.44, 1.45]; p=0.000) was increased. Conclusion: An association between OSA and echocardiographic parameters of DD was detected that was independent of conventional cardiovascular risk factors. OSA may be independently associated with DD perhaps due to higher LV mass. Investigating the role of CPAP therapy in reversing or ameliorating diastolic dysfunction is recommended.

Background: While the number of patients with aortic regurgitation (AR) has been increasing in the aging society, its etiologies remain to be fully elucidated. Methods: We studied consecutive 126 patients with chronic moderate or severe AR who underwent TEE. After the study subjects were divided into 2 groups by the age of 65 years, AR etiology was examined in each group. Results: In the older group (n = 85), cusp bending was the most frequent cause of AR (48.2%), and right coronary cusp (RCC) was the most common (90.2%). In the younger group (n=41), bicuspid valve was the most frequent cause (36.5%), and cusp bending was less frequent (16.5%). Multivariate analysis revealed that age was the only factor associated with cusp bending. Conclusion: Cusp bending of RCC was the most frequent etiology of AR in the elderly. Because AR caused by cusp bending has a possibility to be mended by aortic plasty, it is important to detect it by TEE especially in the older patients.

Introduction: Little is known about reverse cardiac remodeling (CRR) under the low-dose S/V therapy. Methods: In 37 patients (mean age 64.5±17.5 years, five females) 24/26mg S/V BID was started. After one month of observation, the following CRR parameters improved: LVEDD (-∆2,9±2.6mm, p<0.01), LVESD (-∆ 2,4±2.5mm, p<0.01), LVEDV(-∆14.6±33.1ml, p=0.04), LVESV (-∆13.4±30.6ml, p=0.04), LAVI (-∆8.7±37.7ml/m2, p<0.01), and EROA (-∆ 0.09 ± 0,01cm2; p=0.03). In opposite to LVEF global longitudinal strain (GLS) changed from -6.6% to -7.9% (absolute improvement of 16%, p <0.001). Walked distance in 6-MWT ( +∆65.4 ± 75.8 m, p <0.001), and the quality of life (MLHFQ 22 vs 16 scores, p<0.01) improved. Decreasing NT-proBNP (-∆ 1,203,1±3,121,4pg/ml, p=0.03) and troponin T (-∆ 4.7±9.4pg/ml, p=0.004) were observed. Correlation between GLS and LVESV (r = -0,43, p = 0.027) was found. ROC curve analysis showed that GLS cut-off value -8% is a good predictor of clinical improvement (6MWT: AUC 0.69 p=0.04) and CRR (MRvol: AUC:0.74 p=0.01; LAVI: AUC 0.71 p=0.04). Conclusion: One-month, low-dose (24/26 mg BID) S/V therapy initiates CRR. GLS’s ability to evaluate LV function is better than LVEF’s. S/V should be started early as patients with symptomatic HFrEF and less impaired LV systolic function (GLS <-8%) are more likely to develop CRR and clinical improvement.

The following is a case report of an infant born with cri du chat syndrome that has evidence of left ventricular non compaction . Cri du chat syndrome is a rare association of growth retardation, intellectual severe disability, hypertelorism and typical catlike cry, typically combined to congenital heart defect, the occurrence of myocardial non compaction among the associated cardiac anomalies has not been reported so far.

Background: Despite continued efforts, the majority of patients with valvular heart disease (VHD) remain undiagnosed and untreated. This study aimed to assess the adoptability and accuracy of point-of-care handheld echocardiographic assessments (POCE) in the primary care setting. Methods: Eleven previously untrained primary care providers were trained to use the Vscan Extend (GE, WI) POCE to assess VHD, left ventricular function (LVEF), and major extra-cardiac findings. Their assessments were compared to those of 3 blinded expert readers. A total of 180 assessments were evaluated using Kappa statistics (κ) together with their estimated standard error, p-value, and 95% CI bounds. Results: Identical or nearly identical agreement between previously untrained primary providers and expert readers was evident for the diagnosis of tricuspid regurgitation, mitral regurgitation, pericardial effusion, volume status. These agreements were strongest in apical long axis (κ =1, p<0.001) and parasternal long and short axis views (k>=0.82 p<0.001), though agreement remained robust in apical 4-chamber views (k>=0.76). The agreements in LVEF assessment were identical in the apical long axis view (κ =1, p<0.001) and robust in the remaining 3 views (κ>=0.66, p<0.001). The assessments of aortic stenosis (parasternal/long, κ =0.42, and parasternal/short, κ =0.47, both p<0.001) were weak in their agreement. Conclusion: Compared to expert echocardiography readers, the untrained providers’ use of POCE for VHD shows high user adoptability and diagnostic accuracies in the primary care setting.