Three-dimensional echocardiographic delineation of an acquired aorto-left atrial fistula complicating native aortic valve endocarditis - "advantage of three dimensions".

Aorto-atrial fistulas are rare, but important complications resulting from aortic valve infective endocarditis, aortic valve surgery, or aortic dissection. We hereby report a case of a 20-year male, referred to us with infective endocarditis of the native aortic valve with severe aortic regurgitation and symptoms of heart failure. Detailed evaluation with two-dimensional and three-dimensional transthoracic echocardiography revealed aorto-left atrial fistula secondary to the involvement of the mitral-aortic intervalvular fibrosa (MAIVF) region. The patient underwent successful removal of the vegetations, closure of the defect along with aortic valve replacement, and mitral valve repair.

Pacemaker lead induced inferior vena caval thrombosis leading to portal hypertension.

Inferior vena caval thrombosis is an unusual complication of permanent pacemaker implantation. The clinical presentation due to thrombosis depends on the site of thrombus. We have described here a rare case of pacemaker lead associated thrombosis of inferior vena cava, its diagnostic work up and briefly reviewed the existing literature of this uncommon complication.

1H NMR-derived metabolomics of filtered serum of myocardial ischemia in unstable angina patients.

BACKGROUND: Despite continuing research for development of accurate biomarkers of myocardial ischemia in unstable angina, lack of biochemical biomarkers is alarming. We sought to develop accurate biomarkers using high throughput proton nuclear magnetic resonance ((1)H NMR) spectroscopy and filtered serum (lacking proteins and lipoproteins) based metabolomics for detecting myocardial ischemia in unstable angina patients with utmost precision. METHODS: Study includes 127 filtered serum samples from myocardial ischemia in unstable angina patients (UA; n=65) and healthy controls (HC; n=62). High resolution NMR spectra were obtained to highlight metabolic perturbations of small metabolites. A supervised orthogonal partial least square discriminant analysis was applied to generate a prediction model. Receiver operating characteristic (ROC) curve analysis was performed to reveal the clinical utility of signature biomarkers. RESULTS: Five biomarkers--valine, alanine, glutamine, inosine and adenine--could differentiate 95% of UA from HC with 96% sensitivity and 95% specificity. CONCLUSIONS: (1)H NMR-based filtered serum metabolic profiling appears to be an assuring, least invasive and faster way to screen and identify myocardial ischemia in unstable angina patients.

Bicuspid aortic valve with severe stenosis and ruptured sinus of Valsalva aneurysm to left ventricle.

Bicuspid aortic valve (BAV) is a common congenital cardiac anomaly, and rarely, it is associated with sinus of Valsalva aneurysms (SOVAs). And very infrequently, these SOVAs rupture into left side of heart. We hereby report a case of 12-year-old male with BAV with severe aortic stenosis with a large SOVA that ruptured into the left side of the heart. The anatomy was delineated with multimodality imaging; initially with two-dimensional trans-thoracic echocardiography (TTE), and later on with three-dimensional TTE and with multi detector computed tomography. Operative interventions were planned for the patient.