Atrial Thrombus or Atrial Myxoma? Preliminary Analysis of Echocardiographic Findings of a Case Series.

BACKGROUND: Echocardiography has been proven to be a useful tool for detecting atrial- occupying lesions, ranging from primary or secondary tumors to thrombi. Although the precise diagnosis is important as clinical treatment modalities differ, sometimes differentiating a thrombus from a myxoma is very difficult. CASE REPORT: From January 2019 to December 2022, we retrospectively analyzed the echocardiographic findings of 8 patients who were found to have an interatrial mass. Of the 8 patients, 4 had a right atrial mass, and 4 had a left atrial mass. Based on ultrasonic examination, the initial diagnosis was a thrombus and the second diagnosis was a myxoma for all 8 patients. All masses were finally confirmed to be thrombi. Although an echocardiogram can provide significant information on the nature of atrial masses in many patients, qualitative diagnosis of a small percentage of atrial masses remains difficult. CONCLUSION: An atrial thrombus is occasionally difficult to differentiate from an atrial myxoma in patients without atrial fibrillation, especially when it is not attached to the left atrial appendage. Upon review of the echocardiographic findings of the 8 patients described in our study, it is essential to highlight the fact that a thrombus can mimic a myxoma and thereby create a diagnostic conundrum.

Application of echocardiography in transcatheter aortic valve replacement in patients with severe aortic regurgitation and correlation analysis of postprocedural complications.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is gradually becoming an alternative therapy for patients who cannot adapt to surgical treatment or have contraindications. OBJECTIVES: The purpose of this study was to investigate the value of echocardiography in the evaluation of severe AR patients treated with TAVR and to analyze the correlations with postprocedural complications to improve the evaluation and screening of patients. METHODS: We retrospectively analyzed clinical and echocardiographic data of 70 patients with severe AR. Periaortic valve structures were carefully measured by esophageal echocardiography (TEE) and compared with the multilayer slice computed tomography (MSCT) findings. Real-time three-dimensional esophageal echocardiography (RT-3D TEE) was monitored during the operation, and a 30-day postprocedural follow-up was performed. The relationship between postprocedural complications and patients' clinical data or periaortic valve structures was analyzed by multifactorial analysis to identify relevant predictors of complications. RESULTS: The TEE measurements of periaortic valve structures were in good agreement with the MSCT measurements. Among the patients who underwent successful operations, both left atrial (LA) and left ventricular (LV) diameters were reduced, and the left ventricular ejection fraction (LVEF) was improved 30 days after TAVR compared with the preprocedural period (P < .05). Permanent pacemakers were implanted in 15 patients. The presence of preprocedural right bundle branch block (RBBB) (OR: 2.93; 95% CI: 1.18-12.70; P = .01) was an independent factor for permanent pacemaker implantation after TAVR. CONCLUSIONS: Echocardiography plays an extremely important role in TAVR procedures. The presence of preprocedural RBBB can be an independent predictor of postprocedural pacemaker implantation.

Predictors for new-onset conduction block in patients with pure native aortic regurgitation after transcatheter aortic valve replacement with a new-generation self-expanding valve (VitaFlow Liberty™): a retrospective cohort study.

BACKGROUND: New-generation self-expanding valves can improve the success rate of transcatheter aortic valve replacement (TAVR) for severe pure native aortic regurgitation (PNAR). However, predictors of new-onset conduction block post-TAVR using new-generation self-expanding valves in patients with PNAR remain to be established. Therefore, this study aimed to identify predictors of new-onset conduction block post-TAVR using new-generation self-expanding valves (VitaFlow Liberty™) in patients with PNAR. METHODS: In this retrospective cohort study, patients were categorized into pacemaker and non-pacemaker groups based on their need for new postoperative permanent pacemaker implantation (PPI). Based on the postoperative presence of either new-onset complete left bundle branch block (cLBBB) or high-grade atrioventricular block (AVB), patients were further classified into conduction disorder and non-conduction disorder groups. Laboratory, echocardiographic, computed tomography, preoperative and postoperative electrocardiography, and procedural and clinical data were collected immediately after TAVR and during hospitalization and compared between the groups. Multivariate logistic regression analysis was performed incorporating the significant variables from the univariate analyses. RESULTS: This study examined 68 consecutive patients with severe PNAR who underwent TAVR. In 20 patients, a permanent pacemaker was fitted postoperatively. Multivariate logistic regression analysis revealed an association between the need for postoperative PPI and preoperative complete right bundle branch block (cRBBB) or first-degree AVB, as well as a non-tubular left ventricular outflow tract (LVOT). In addition, valve implantation depth and angle of aortic root were independent predictors of new-onset cLBBB or high-grade AVB developing post-TAVR. The predictive value of valve implantation depth and angle of aortic root was further supported by receiver operating characteristic curve analysis results. CONCLUSIONS: In patients with PNAR undergoing TAVR using self-expanding valves, preoperative cRBBB or first-degree AVB and a non-tubular LVOT were indicators of a higher likelihood of PPI requirement. Moreover, deeper valve implantation depth and greater angle of aortic root may be independent risk factors for new-onset cLBBB or high-grade AVB post-TAVR. Valve implantation depth and angle of aortic root values may be used to predict the possibility of new cLBBB or high-grade AVB post-TAVR.

Effect of post-discharge pharmacist-led follow-up on drug treatment in patients with deep venous thrombosis in primary hospitals in China.

Warfarin and rivaroxaban were the two most commonly-used anticoagulant drugs for Deep venous thrombosis (DVT). The aim of this study was to explore the effects of post-discharge pharmacist-led follow-up on drug treatment in patients with DVT in primary hospitals from a pharmacological perspective. A total of 125 patients were recruited from July 2017 to June 2019 and randomized to either a control group or an intervention group. The control group was given routine medication guidance, clinical pharmacists followed up at 3 and 6 months after discharge. The intervention group was based on the control group and was followed up weekly for 6 months after discharge. For patients taking warfarin, the percentage of time in therapeutic range (TTR) and TTR>65% were significantly higher in the intervention group (p<0.05) and they also had less frequent dose changes. For patients taking warfarin or rivaroxaban, vascular ultrasonography showed better improvement rate in the intervention group (p<0.05). Pharmacist-led follow-up showed that the medication adherence (p<0.05) were significantly improved. There were lower risks of total and minor hemorrhage events and thrombosis events in the intervention group (p<0.05). Pharmacist-led follow-up not only reduced the risk of hemorrhage and thrombosis events, but also improved adherence to anticoagulation drugs.

Superconductivity at 40 K in Lithiation-Processed [(Fe,Al)(OH)2][FeSe]1.2 with a Layered Structure.

Exploration of new superconductors has always been one of the research directions in condensed matter physics. We report here a new layered heterostructure of [(Fe,Al)(OH)2][FeSe]1.2, which is synthesized by the hydrothermal ion-exchange technique. The structure is suggested by a combination of X-ray powder diffraction and the electron diffraction (ED). [(Fe,Al)(OH)2][FeSe]1.2 is composed of the alternating stacking of a tetragonal FeSe layer and a hexagonal (Fe,Al)(OH)2 layer. In [(Fe,Al)(OH)2][FeSe]1.2, there exists a mismatch between the FeSe sublayer and the (Fe,Al)(OH)2 sublayer, and the lattice of the layered heterostructure is quasi-commensurate. The as-synthesized [(Fe,Al)(OH)2][FeSe]1.2 is nonsuperconducting due to the Fe vacancies in the FeSe layer. The superconductivity with a Tc of 40 K can be achieved after a lithiation process, which is due to the elimination of the Fe vacancies in the FeSe layer. The Tc is nearly the same as that of (Li,Fe)OHFeSe although the structure of [(Fe,Al)(OH)2][FeSe]1.2 is quite different from that of (Li,Fe)OHFeSe. The new layered heterostructure of [(Fe,Al)(OH)2][FeSe]1.2 contains an iron selenium tetragonal lattice interleaved with a hexagonal metal hydroxide lattice. These results indicate that the superconductivity is very robust for FeSe-based superconductors. It opens a path for exploring superconductivity in iron-base superconductors.

The real cause of right lower abdominal pain: an analysis of ultrasonographic findings.

A pelvic accessory spleen is uncommon and most patients with this condition are asymptomatic. Ureteral calculus is a common disease and can cause acute abdominal pain. We report a 51-year-old male patient who presented at our hospital with acute right lower abdominal pain and gross hematuria. A large mass on the right side of the pelvis was detected on an ultrasound examination, as well as a calculus in the lower segment of the right ureter. Computed tomography angiography showed the presence of a long vascular pedicle with an artery originating from the splenic artery and a vein that joined with the splenic vein. Laparoscopy was carried out and it showed a solid mass covered with omentum on the right lower abdomen. The mass was then removed surgically. Histopathological examination of the resected specimens confirmed splenic tissue. We speculate that the accessory spleen and ureteral calculus caused right lower abdominal pain in our case. However, the ureteral calculus might have played a much more important role in causing acute right lower abdominal pain than the accessory spleen.

Absence of van der Waals Gap in Ternary Thorium Nitride ThNF and ThNCl.

Two kinds of ternary thorium nitride compounds, ThNF and ThNCl, are synthesized. Via the refinement of X-ray diffraction patterns, the accurate crystal structure of the two compounds is solved. Although ThNF and ThNCl share a similar structure with MNX (M = Ti, Zr, Hf; X = Cl, Br) compounds, the interaction between adjacent ThNF and ThNCl layers is not a van der Waals gap. For ThNF, the strong electronegativity of F ions leads to the bonding of Th to the F both in the nearest neighbor layer and the next nearest neighbor layer, which results in the absence of a van der Waals gap between ThNF layers. However, for ThNCl, the reason for the absence of a van der Waals gap could be attributed to the large Th-Cl bond length due to the partially covalent Th-Cl bond as well as the flat ThN layer. It is the absence of van der Waals gap that results in the failure of intercalating cations into ThNF and ThNCl. Our result reveals the reason for unsuccessful intercalation in ThNF and ThNCl, thereby providing a deeper understanding for the interlayer interaction in ternary layer structures in metal nitride halides.

Left ventricular noncompaction in patients with coronary artery disease: Preliminary analysis of echocardiographic findings.

We retrospectively analyzed the echocardiographic findings of eight patients with left ventricular noncompaction (LVNC) and concurrent coronary artery disease. This study was conducted in Yijishan Hospital between January 2012 and May 2017. Of the eight patients, six were diagnosed with coronary arterial atherosclerosis, one patient with coronary pulmonary fistula, and one with coronary myocardial bridge. Regional wall motion abnormalities were detected in all patients. Echocardiography can provide significant information about LVNC in patients with coronary artery disease. However, whether regional wall motion abnormalities are caused by coronary artery disease or noncompaction of the myocardium remains unknown in most patients.

Aortic valve prolapse misdiagnosed as aortic sinus aneurysm in patients with ventricular septal defect. Analysis of the echocardiographic findings.

OBJECTIVES: To retrospectively analyzed the preoperative echocardiographic findings of 9 patients with doubly committed ventricular septal defect (VSD) associated with aortic valve prolapse and to summarize the reasons for misdiagnosis. Methods: This retrospective study was conducted in Yijishan Hospital, Wannan, Anhui, Chinabetween June 2005 and May 2015. Using transthoracic echocardiography (TTE), 92 patients were diagnosed with doubly committed VSD associated with rupture of an aortic sinus aneurysm. The operative findings proved to be in accordance with the echocardiographic findings in 83 patients. Nine patients were confirmed as showing doubly committed VSD associated with perforation of a prolapsed aortic valve. We primarily discussed the 9 patients who were misdiagnosed by TTE. Results: Aneurysm-like protrusions could be detected by 2-dimensional TTE in the right ventricular outflow tract (RVOT) in 9 patients. All of the aneurysm-like protrusions were confirmed by surgery as over-enlarged right coronary leaflets bulging into the RVOT. Conclusion:Occasionally, in patients with doubly committed VSD, aortic valve prolapse can be misdiagnosed as an aortic sinus aneurysm. To reduce the misdiagnosis rate and to provide a more precise preoperative diagnosis, multi-section, and multi-angle observation of these diseases should be performed.

Ultrasonographic features of aggressive primary thyroid diffuse B-cell lymphoma: A report of two cases.

Primary thyroid lymphoma (PTL) is a relatively rare malignant tumor. Aggressive PTL is extremely rare, and there is limited literature regarding the imaging features of PTL with invasion into adjacent structures, including internal jugular vein, muscles, esophagus, trachea and carotid artery. In addition, the ultrasonographic features of the cases presented in the current report differ from those reported in previous studies. In the present study, two cases of PTL, who presented to The First Affiliated Hospital of Wannan Medical College (Wuhu, China) with a short history of a rapidly growing mass in the front of their neck, are reported. Both patients had undergone ultrasound examination, and the subsequent histopathological and immunohistochemical examinations confirmed that the two masses were primary diffuse large B-cell lymphoma. The ultrasonographic findings of these two cases are discussed in the present report.

Coexistence of Primary Sarcomatoid Carcinoma of the Right Ventricle and Absence of Right Pulmonary Artery.

We describe the imaging features of a 48-year-old woman with primary sarcomatoid carcinoma originating from right ventricular outflow tract (RVOT) and isolated absence of right pulmonary artery (RPA). Computed tomography pulmonary angiography (CTPA) demonstrated the absence of RPA. Both transthoracic echocardiography (TTE) and CTPA revealed multiple masses filling and obstructing the RVOT. A palliative operation was performed on the patient, and the postoperative histopathology and immunohistochemical examination confirmed primary sarcomatoid carcinoma originating from the RVOT. The operation also confirmed the absence of RPA.

A Case Report of Double-Chambered Right Ventricle Associated with Subaterial Ventricular Septal Defect and Rupture of Right Coronary Sinus Aneurysm.

Double-chambered right ventricle (DCRV) is a rare congenital heart disease in which the right ventricle (RV) is divided into two chambers by anomalous muscle bundles. Here, we report a case of DCRV associated with subarterial ventricular septal defect (VSD) and rupture of right coronary sinus aneurysm (RCSA); the patient was diagnosed by echocardiography and later confirmed by surgical operation.

Synthesis and photoluminescent properties of nanocrystalline CaMoO4 thin film via chemical solution processing.

Stoichiometric CaMoO4 thin film was successfully fabricated based on chemical solution processing. The thin films were deposited on Si(100) substrates by means of the spin-coating technique. X-ray diffraction reveals that the CaMoO4 thin film prepared are pure and well crystalline thin films. Atom Force Microscope photographs indicate that the film prepared possesses a homogeneous and dense surface morphology. The average grain size of the films was 40-50 nm, and the root-mean-square (RMS) of the surface roughness and the average surface roughness of the film measured were 2.161 nm and 1.726 nm respectively. The photoluminescent properties of calcium molybdate thin film under ultraviolet light excitation were systematically measured from 12 K to room temperature and a green emission band of the films were observed. The results of present work confirm that the chemical solution processing is a promising technology on the fabrication of CaMoO4 thin film.