The utility of novel STE parameters in echocardiographic assessment of single ventricle after Fontan palliation.

Background and aims of the study A functionally single ventricle (FSV) refers to a group of congenital heart defects that are not amenable for biventricular correction. The Fontan operation is utilized as surgical treatment for most of FSV patients. The evaluation of FSV function is extremely difficult due to its unique pathophysiology. This study aimed to explore the efficacy of speckle tracking echocardiography (STE) parameters measured at rest and during exercise for comprehensive assessment of univentricular heart. METHODS: We enrolled 37 patients with a functionally single ventricle after the Fontan operation, hospitalized in the Department of Congenital Heart Defects between years 2019 and 2021.The echocardiographic stress tests were performed in the Echocardiography Laboratory of the Congenital Heart Defects Department. The study was conducted on a bicycle ergometer in a semi-recumbent position. The parameters obtained by speckle tracking echocardiography (STE): the longitudinal strain of the FSV free wall (Ɛ) and the longitudinal strain of myocardial layers: subendocardial, medial and subepicardial were analyzed. A transmural longitudinal strain gradient (TG) was calculated as the difference between longitudinal deformation of the subendocardial and subepicardial layers. Current results of cardiac magnetic resonance imaging (CMR) and cardio-pulmonary test (CPET) were also incorporated. Demographic data, past interventions, pharmacological treatment and comorbidities were extracted from medical records. RESULTS: Ɛ at rest and during exercise were not related to the parameters of physical capacity obtained on CPET nor to the CMR results. The transmural strain gradient was dependent on physical performance parameter- peak oxygen uptake- and related to the FSV ejection fraction calculated by magnetic resonance imaging. CONCLUSIONS: The transmural strain gradient and FSV free wall strain are readily measurable and suitable for evaluating single ventricle function. The TG is positively correlated with peak oxygen uptake during the cardiopulmonary test and with the ejection fraction derived from cardiac magnetic resonance imaging. The applicability of these findings in patients undergoing the Fontan procedure warrants further exploration.

The First Case of Granulicatella adiacens Identified from a Resected Heart Valve by Next Generation Sequencing (NGS) in Poland.

In this report, we describe the course and successful treatment of a case of complicated infective endocarditis (IE). A patient presented with a high-grade, irregular fever with chills lasting at least 2 months along with dyspnoea, chest pain, fatigue, weight loss, and night sweats during the previous 3 months. As well as cardiac congenital disorders, he was found to have Granulicatella adiacens infective aortic valve endocarditis, presumably transmitted from the oral cavity niche. Validated metagenomic 16S rDNA next generation sequencing was used to perform taxonomic identification, allowing for specific adequate antibiotic therapy instead of empiric therapy. This paper highlights the critical role of rapid taxonomic identification of nutritionally variant streptococci and the benefit of proper IE treatment in avoiding relapses or fatal complications.

What to look for in patient with continuous murmur and history of ventricular septal defect?

During diagnostic process it is very important to conduct scrupulous interview and thorough physical examination. Properly interpreted auscultation phenomena allow for appropriate planning of further imaging studies.

Differences in regional diastolic function between restrictive and normal right ventricular physiology in adult patients late after tetralogy of Fallot repair.

BACKGROUND: Restrictive right ventricular physiology (RRVP) is a common finding in adult patients after tetralogy of Fallot (TOF) repair. Despite many attempts to relate this phenomenon to various factors, its clinical importance and the underlying myocardial pathologies are still enigmatic. AIM: We sought to evaluate the regional diastolic right ventricular (RV) function in patients after TOF repair with and without RRVP. METHODS: A group of 112 consecutive patients with repaired TOF underwent transthoracic echocardiography with tissue Doppler imaging, cardiopulmonary exercise test, cardiac magnetic resonance, and laboratory test. Of them, 83 patients met the inclusion criteria. Regional deformations of the RV and interventricular septum (IVS) in patients with and without RRVP were compared. RESULTS: Tetralogy of Fallot patients demonstrated an inhomogeneous pattern of strain rate (SR) values in the atrial contraction phase (A wave) of the RV free wall compared to healthy volunteers. Patients with RRVP had significantly lower values of A wave curves of IVS segments (velocities and SR) and higher values of RV free wall SR during early filling (E wave) and atrial contraction phases compared to patients without RRVP. In multiple factor analysis RRVP was correlated with lower values of end-diastolic IVS velocities (A wave) and higher values of RV SR A waves. CONCLUSIONS: Tissue Doppler imaging may show diastolic abnormalities in patients with RRVP. This group of patients demonstrated a deterioration in IVS diastolic function as measured by SR A waves. The diastolic function of RV free wall segments was better in patients with RRVP compared to patients without restriction of the RV measured by SR.

What can pulmonary regurgitation indices reflect in patients after tetralogy of Fallot repair?

BACKGROUND: Residual haemodynamic complications remaining after surgical correction of tetralogy of Fallot (ToF) require regular follow-up. AIM: To establish the utility of pulmonary regurgitation (PR) indices in the routine clinical management of adults with repaired ToF. METHODS: 83 consecutive patients with repaired ToF underwent transthoracic echocardiography (TTE), cardiopulmonary exercise test (CPET), cardiac magnetic resonance (CMR), and laboratory test evaluation. They were divided into two subgroups [PR (+) vs. PR (-)] according to the degree of PR fraction (PRF > 20% vs. ≤ 20%) assessed by CMR. RESULTS: Analysis showed that PR vena contracta (PR VC) ≤ 5 mm in TTE study was 83% sensitive and 68% specific in identifying patients with PRF ≤ 20%. Furthermore, PR index (PRi) ≥ 0.73 was 85% sensitive and 43% specific in identifying patients with non-significant PR. In this group of patients, there were significant correlations of TTE parameters describing the degree of PR and right ventricle (RV) size with reference modality CMR. There was no certain influence of PR severity on RV function, physical performance, and renal or hepatic failure indices. CONCLUSIONS: PRi and PR VC are helpful parameters in distinguishing between mild and significant PR and may limit the indication for CMR investigation in a group with non-significant PR. The severity of PR in our study did not seem to have an impact on RV function, physical performance, liver or kidney function indices.