Evaluation of left ventricular rotation in obese subjects by velocity vector imaging.

AIMS: Obesity is a well-known risk factor in the development of cardiovascular disease. We hypothesize that early left ventricular (LV) dysfunction secondary to obesity could be signalled by abnormal LV rotation. METHODS AND RESULTS: This prospective study examined 60 subjects divided into two groups: obese group with body mass index (BMI) >or=30 and control group with BMI <25. The peak rotation, twist, and torsion of the left ventricle were studied in obese and control subjects, using velocity vector imaging. Age and gender were comparable between the two groups. Obese subjects had higher BMI, waist circumference, fasting glucose, triglycerides, systolic and diastolic blood pressure, low-density lipoprotein cholesterol, and lower high-density lipoprotein cholesterol (P < 0.05). In obese subjects, LV mass and LV mass index were increased, and the ratio of mitral early and late diastolic filling velocity was decreased (P < 0.05). In obese subjects, the peak twist and torsion of the left ventricle displayed a lower trend, and the peak rotation of the left ventricle apex decreased significantly (3.81 +/- 2.09 degrees vs. 5.77 +/- 3.27 degrees , P < 0.001). CONCLUSION: Obesity was associated with changes in LV rotation. Velocity vector imaging is a feasible and reproducible echocardiographic technique for the detection of early subclinical LV dysfunction.

Unicuspid aortic valve in children: a systematic review spanning four decades.

BACKGROUND AND AIM OF THE STUDY: To date, the natural history of the unicuspid aortic valve (UAV) has been poorly described in the literature. To study the association between UAV with associated cardiac and extracardiac abnormalities, a systematic review was conducted. METHODS: A computerized search was conducted of the medical literature published between 1st January 1966 and 1st September 2008, using the databases MEDLINE, EMBASE, Web of Science and Cochrane database. RESULTS: Nine articles with 60 pediatric cases (age <15 years) were identified. The mean age at diagnosis was 14 months, the most common presentation of UAV was congestive heart failure due to congenital aortic stenosis, and the most common lesion was isolated aortic stenosis, reported in 19 cases (32%). Associated anomalies included 22 cases (37%) of aortic coarctation, seven (12%) with ventricular septal defect (VSD), three (5%) with patent ductus arteriosus (PDA), and three (5%) with aortic aneurysm. The preoperative diagnosis of UAV was rare, and 33 cases (55%) of pediatric UAV were reported at autopsy or at pathological examination of the surgically excised valves. A total of 26 cases (43%) was treated with either balloon valvoplasty or surgical valvotomy or commissurotomy. CONCLUSION: UAV shares many of the features of bicuspid aortic valve, including valvular dysfunction, aortic dilatation, aortic dissection, and dystrophic calcification. The importance of an early diagnosis of UAV lies in its risk of sudden cardiac death and association with other congenital anomalies, such as PDA, VSD, anomalous coronary arteries, and coarctation of the aorta. Further investigations of UAV are warranted in the pediatric age group with regards to familial incidence, associated aortic histopathological changes, the ideal follow up to monitor complications, and surgical intervention.

Unicuspid aortic valve in adults: a systematic review.

BACKGROUND AND AIM OF THE STUDY: The natural history of the unicuspid aortic valve (UAV) is poorly described in the literature. In order to study the association between UAV with any other cardiac or extra cardiac abnormalities, an evidence-based systematic review was carried out. METHODS: A computerized search was carried out of the medical literature published between 1st January 1966 and 1st September 2008 of the following databases: MEDLINE; EMBASE; Web of Science; and the Cochrane Database. RESULTS: A total of 231 cases of adult UAV was identified in 38 articles. The mean patient age was 42 years, and the most common presenting symptoms reported (in 52 cases) included dyspnea (44%; n=23), angina (21%; n=11), and dizziness or syncope (8%; n=4). The most common lesion in UAV was isolated aortic stenosis (AS) (41%; n=95) and AS with or without aortic regurgitation (28%; n=64). The preoperative diagnosis of UAV is rare, and 139 cases (60%) of UAV were reported at autopsy or by examination of surgically excised valves. Aortic valve replacement was performed in 166 cases (82%). Concomitant aortic surgery was performed in 47 of the UAV cases (23%), either for a dilated or aneurysmal aorta. CONCLUSION: UAV shares many of the features of bicuspid aortic valve, including valvular dysfunction, aortic dilatation, aortic dissection, and dystrophic calcification, although these conditions develop at an earlier age and progress at a faster pace in UAV. Further investigations are warranted regarding the possibility of a familial incidence, associated histopathological changes in the aorta, preoperative diagnostic tools, ideal follow up and surgical intervention.

Eggerthella lenta bacteremia in a Crohn's disease patient after ileocecal resection.

Eggerthella lenta is an anaerobic, nonspore-forming Gram-positive rod and is a common gut commensal. Bacteremia from this organism is rare but when present is always clinically significant. Gastrointestinal disease and malignancy are the most common causes for bacteremia from this organism. Eggerthella species have been isolated in feces from patients with inflammatory bowel disease, but bacteremia has not been reported to the best of our knowledge. Here we report the case of a young African-American female with Crohn's disease who developed Eggerthella lenta bacteremia after ileocaecal resection.

Risk of adverse events after coronary artery bypass graft and subsequent noncardiac surgery.

AIMS: Coronary artery bypass grafts (CABGs) are increasingly performed in elderly patients. Risk factors and outcomes are poorly described for those undergoing noncardiac surgery within 1 year after CABG. Our objectives were to assess the risk and predictors of major adverse events associated with noncardiac surgery within 1 year after CABG. METHODS: In a retrospective review of medical records at Mayo Clinic (Rochester, MN, USA), over a period of 5 years, we identified patients who underwent noncardiac procedures within 1 year post-CABG. All events that occurred within 30 days after noncardiac surgery and deaths within 1 year after noncardiac surgery were considered to be related to CABG. RESULTS: We identified 211 patients; of these, 21 patients had 24 adverse events. Within 1 year, 11 died, and within the first 30 days, three myocardial infarctions, six acute congestive heart failure episodes, three cerebrovascular accidents and one deep vein thrombosis episode had occurred. Predictors of an adverse event included emergency operation (odds ratio: 6.8), ejection fraction less than 45% (p < 0.001) and elevated right ventricular systolic pressure by 40 mmHg or more (p = 0.03). After the noncardiac procedure, patients requiring dialysis (p = 0.02), ventilatory support (p = 0.03) and longer hospital stay (p = 0.03) had greater rates of adverse outcomes. CONCLUSION: Post-CABG, preoperative ejection fraction less than 45%, right ventricular systolic pressure of 40 mmHg or more, as well as emergent noncardiac surgery, were predictors of adverse outcomes after the noncardiac procedure. Longer postoperative hospital stay, dialysis, as well as ventilatory support, were predictors of adverse outcomes after CABG.