Multimodality imaging in assessment of mitral valve tumors: An unusual papillary fibroelastoma?

Mitral valve masses are uncommon. These tumors and tumor-like lesions may have similar morphological and clinical characteristics, but different outcomes. Unlike valvular tumors, caseous calcification of the mitral annulus (CCMA) is a benign degenerative disorder, commonly misdiagnosed, thus differentiating it from other mitral valve masses is important to avoid unnecessary surgery. Multimodality imaging can prove a valuable tool for definitive diagnosis. We present a case of a 72-year-old female patient, with coronary artery disease, referred for angina symptoms. Echocardiography detected a mass in the mitral valve annulus. Cardiac magnetic resonance imaging showed a mobile mass respecting the myocardium suggestion an atypical papillary fibroelastoma and surgery was indicated. However, the definitive diagnosis, after histological examination, was CCMA. The aim of this case report is to illustrate the difficulty in differentiating between mitral valve masses and the repercussion on the subsequent management, emphasizing the pivotal role of multimodality imaging.

Conservative Management of Suicide Left Ventricle After Surgical Aortic Valve Replacement.

Suicide left ventricle (SLV) remains an underdiagnosed cause of haemodynamic compromise following surgical or transcatheter aortic valve replacement (AVR). Risk factors include female sex and a small left ventricular cavity with asymmetric septal hypertrophy. We present the case of a 63-year-old woman, with a medical history of diabetes mellitus, arterial hypertension and dyslipidaemia who was diagnosed with severe aortic stenosis with normal left ventricular ejection fraction and concentric hypertrophy. She underwent surgical AVR using a bioprosthetic valve, but a few hours after surgery, she developed sudden cardiogenic shock. An urgent transthoracic echocardiogram was performed showing marked systolic anterior motion of the mitral valve resulting in severe dynamic left ventricular outflow tract obstruction and intraventricular gradient. The diagnosis of SLV was made. The patient was managed conservatively with volume loading and oral beta-blockers and her haemodynamic state improved gradually. She was then discharged after favourable evolution. Medical management of SLV includes volume loading to expand the ventricular volume and beta-blockers for their negative inotrope effect. When medical therapy fails, surgical myectomy or alcohol septal ablation can be proposed to remove the obstacle. Some authors have proposed these procedures as prophylactic measures to prevent SLV in high-risk patients.

The silent invader: a case of intrapericardial hydatid cyst with exceptional pulmonary artery involvement.

A 70-year-old woman was referred to our cardiology department for the management of dyspnoea. Cardiovascular examination revealed a loud P2, with no sign of right-sided heart failure. Chest X-ray showed a convex left medium cardiac border and a double contour along the right cardiac border. Transthoracic echocardiogram revealed a cystic mass attached to the right ventricle apex. Computed tomography scan showed cyst with fluid density on the apex of the right ventricle; and a honeycomb-like aspect cyst with partial occlusion in the left pulmonary artery. Cardiac magnetic resonance imaging revealed the presence of hydatic intrapericardial cyst that compresses the right ventricular apex; associated with intraluminal left pulmonary artery cyst. Hydatic serology was positive. The patient refused surgery and was discharged on a regimen of Albendazole. She has been followed up closely with a good outcome.

The national moroccan registry of ST-elevation myocardial infarction (MR-MI).

BACKGROUND: MR-MI is the first national Moroccan ST-elevation myocardial infarction (STEMI) registry. Its objectives are to assess patient management modalities and highlight the clinical and therapeutic characteristics of this pathology in all cardiology centres on a national scale. METHODS: Adult patients presenting with STEMI within 5 days of symptoms onset were enrolled over a period of 18 weeks from April to August 2018. 57 cardiology centres distributed in 22 cities in Morocco participated in the study, including 5 university hospitals, representing 70% of Moroccan centres managing STEMI patients. A case report form was sent to the investigators in both electronic and paper forms. Sociodemographic, clinical, management, revascularization, and follow-up data were collected. RESULTS: A total of 809 patients were recruited. The population was mostly male (74.8%) with an average age of 62.6 ± 11.6 years. The most common risk factors were smoking (38.3%) arterial hypertension (30.7%), and diabetes (28%). 30% of patients were admitted within the first 6 h of symptoms onset and early revascularization was performed on 49.6%. Mortality rate was 5.2% in-hospital and 3.2% at the one-month follow-up. CONCLUSION: MR-MI is the first Moroccan STEMI registry on a national scale. Relevant management delays are much longer than other countries, and less than 50% of the patients that present on time benefit from early revascularization. Efforts remain to be done on the optimal diagnosis and treatment of STEMI.

Coeliac Disease: A Rare Cause of Myocardial Infarction With Non-Obstructive Coronary Arteries.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) poses a diagnostic dilemma. Identifying the underlying etiology is essential to ensuring appropriate management. Cardiac magnetic resonance (CMR) is a valuable tool that can aid clinicians for that purpose. Coeliac disease (CD) is characterized by hypercoagulability and a thrombotic state and represents an exceptional cause of MINOCA. We report the case of a 28-year-old woman who presented with chest pain. The diagnosis of non-ST-elevation MI was obtained based on ECG abnormalities and elevated troponin levels. Coronary angiography was normal. CMR showed late gadolinium enhancement in the lateral left ventricular wall, confirming the diagnosis of MINOCA. A duodenal biopsy allowed the diagnosis of CD. Anticoagulation and a gluten-free diet proved beneficial, with a good outcome after a five-year follow-up. This case highlights the essential role of CMR in MINOCA investigations and the importance of thorough etiological assessment in young patients with no cardiovascular risk factors.

Catastrophic outcomes of thrombus 'bumper' ball in neglected severe rheumatic mitral stenosis: report of three cases.

Patients with rheumatic mitral stenosis (MS) often present complications such as atrial fibrillation and thrombus formation with significant morbi-mortality. Rarely, a free-floating 'ball thrombus' is found with possible catastrophic outcomes. We describe three cases of documented left atrial 'ping-pong' shaped 'thrombus ball' within MS: a 51 year old presented with acute heart failure with a fatal outcome due to the huge round thrombus closing the tight mitral valve, a 67-year-old and a 68-year-old male who were both urgently rushed to the operating room after accidental finding. The surgery was successful and consisted on mitral valve repair and thrombectomy. Our aim is to show that gigantic unattached thrombus ball within neglected rheumatism MS is a rare life-threatening entity, thus highlighting the importance of early diagnosis of such conditions present in endemic countries. A prompt surgery should be considered to avoid an eventual embolization and sudden death.

Anomalous Left Main Coronary Artery From the Right Sinus of Valsalva.

Anomalous coronary arteries are rare, mostly benign anatomic abnormalities. Anomalous origin of the left main coronary artery from the right sinus of Valsalva (LCA-RSV) is a rare variant that may lead to myocardial ischemia or sudden cardiac death. We present the case of a 49-year-old patient with a history of type 2 diabetes and smoking who presented to the emergency department with acute chest pain and was diagnosed with inferior ST-elevation myocardial infarction (STEMI). A transthoracic echocardiogram demonstrated inferolateral wall motion abnormalities of the left ventricle. The patient underwent cardiac catheterization that showed an anomalous left main coronary artery originating from the right sinus of Valsalva, alongside atherosclerotic triple-vessel disease. He was discharged home on medical management, including dual antiplatelet therapy, beta blockers, and statins, with scheduled follow-up.

Giant circumflex artery with bilobed saccular aneurysm and right atrial fistula mimicking a bi-atrial hydatid cyst: a case report.

Coronary artery fistulas (CAF) are rare anomalies that pose a significant diagnostic and therapeutic challenge. Most of them originate from the right coronary artery and are congenital. They are often associated with coronary aneurysms. We report the case of a 38-year-old Black man who presented with exertion dyspnea. Transthoracic echocardiography found what was thought to be a bi-atrial hydatid cyst, alongside a right atrial shunt. Cardiac magnetic resonance imaging showed a cystic lesion hypointense on T1 and T2 sequences, located next to the left atrium as well as an aneurysmal circumflex artery shunting in the right atrium. Coronary angiography and computed tomography angiography confirmed the bilobed circumflex saccular aneurysm and CAF. The patient underwent a successful surgery, which consisted of closure of the fistula using two patches. He was discharged after an uneventful postoperative course. Our case report illustrates the diagnostic difficulty of CAF and the importance of multimodal imaging.

Myocardial Calcifications: An Exceptional Complication of Sepsis.

Myocardial calcifications (MCs) are a fatal condition that often complicates ischemic heart disease, cardiac surgery, rheumatic fever, or myocarditis. To date, cases where myocardial calcifications result from a septic state have rarely been reported. In this paper, we describe the primary imaging findings and discuss both proven and hypothetical mechanisms of MCs in the context of sepsis.

Numerical simulation of universal morphogenesis of fluid interface deformations driven by radiation pressure.

We report on numerical simulation of fluid interface deformations induced by either acoustic or optical radiation pressure. This is done by solving simultaneously the scalar wave propagation equation and the two-phase flow equations using the boundary element method. Using dimensional analysis, we show that interface deformation morphogenesis is universal, i.e., depends on the same dimensionless parameters in acoustics and electromagnetics. We numerically investigate a few selected phenomena-in particular the shape of large deformations and the slenderness transition and its hysteresis-and compare with existing and novel experimental observations. Qualitative agreement between the numerical simulations and experiments is found when the mutual interaction between wave propagation and wave-induced deformations is taken into account. Our results demonstrate the leading role of the radiation pressure in morphogenesis of fluid interface deformations and the importance of the propagation-deformation interplay.

Cerebellar stroke complicating coronary catheterization: a case report.

Cerebrovascular events are rare but devastating events that can complicate any coronary intervention. In the vast majority of cases, they involve major cerebral arteries. We report the case of a 56-year-old woman admitted for unstable angina associated with severe left systolic dysfunction. She developed moderate cerebellar stroke while undergoing percutaneous coronary intervention, with a national institutes of health stroke scale score of 5. Immediate systemic thrombolysis was performed, but her neurological status deteriorated. A large hemorrhagic transformation was then diagnosed, and she died despite surgical intervention. Periprocedural strokes are marred with high morbidity and mortality, therefore preventionis key, as many risk factors can be controlled or mitigated. Our patient presented many of these factors; they can be procedure-related (transfemoral approach, anticoagulation) or patient-related (age, diabetes mellitus, uncontrolled hypertension, diffuse atherosclerosis).

Contactless thin-film rheology unveiled by laser-induced nanoscale interface dynamics.

One of the classical limitations for the investigation of the local rheology of small scale soft objects and/or confined fluids is related to the difficulty to control mechanical contact and its consequences. In order to overcome these issues, we implement a new local, active, fast and contactless optical strategy, called optorheology, which is based on both the optical radiation pressure of a laser wave to dynamically deform a fluid interface and interferometry to probe this deformation with nanometric resolution. This optical approach is first validated by measuring the surface tension and the viscosity of transparent Newtonian liquids. We also show how non-equilibrium situations, such as continuous evaporation, can be used to deduce the thickness dependence of the rheology of thin films and the concentration dependence of the viscosity of binary liquid mixtures and suspensions. We further extend the investigation to elasticity and viscoelasticity measurements of polymer solutions. Finally, since liquids may absorb light, we discuss the influence of a weak laser heating and the triggering of interface deformations by thermocapillary tangential stresses that could represent a complementary approach to probe the rheology at small scale.

Convection flows driven by laser heating of a liquid layer.

When a fluid is heated by the absorption of a continuous laser wave, the fluid density decreases in the heated area. This induces a pressure gradient that generates internal motion of the fluid. Due to mass conservation, convection eddies emerge in the sample. To investigate these laser-driven bulk flows at the microscopic scale, we built a setup to perform temperature measurements with a fluorescent-sensitive dye on the one hand, and measured the flow pattern at different beam powers, using a particle image velocimetry technique on the other hand. Temperature measurements were also used in numerical simulations in order to compare predictions to the experimental velocity profiles. The combination of our numerical and experimental approaches allows a detailed description of the convection flows induced by the absorption of light, which reveals a transition between a thin and a thick liquid layer regime. This supports the basis of optothermal approaches for microfluidic applications.

Sedimentation of granular columns in the viscous and weakly inertial regimes.

We investigate the dynamics of granular columns of point particles that interact via long-range hydrodynamic interactions and fall under the action of gravity. We investigate the influence of inertia using the Green's function for the Oseen equation. The initial conditions (density and aspect ratio) are systematically varied. Our results suggest that universal self-similar laws may be sufficient to characterize the temporal and structural evolution of the granular columns. A characteristic time above which an instability is triggered (which may enable the formation of clusters) is also retrieved and discussed.

Stretching and squeezing of sessile dielectric drops by the optical radiation pressure.

We study numerically the deformation of sessile dielectric drops immersed in a second fluid when submitted to the optical radiation pressure of a continuous Gaussian laser wave. Both drop stretching and drop squeezing are investigated at steady state where capillary effects balance the optical radiation pressure. A boundary integral method is implemented to solve the axisymmetric Stokes flow in the two fluids. In the stretching case, we find that the drop shape goes from prolate to near-conical for increasing optical radiation pressure whatever the drop to beam radius ratio and the refractive index contrast between the two fluids. The semiangle of the cone at equilibrium decreases with the drop to beam radius ratio and is weakly influenced by the index contrast. Above a threshold value of the radiation pressure, these "optical cones" become unstable and a disruption is observed. Conversely, when optically squeezed, the drop shifts from an oblate to a concave shape leading to the formation of a stable "optical torus." These findings extend the electrohydrodynamics approach of drop deformation to the much less investigated "optical domain" and reveal the openings offered by laser waves to actively manipulate droplets at the micrometer scale.