Relationship between New York functional class and duke activity status index with the severity of mitral valve stenosis and echocardiographic parameters: is left atrial strain a better predictor?

Purpose This study aimed to investigate the relationship between symptoms of patients with severe mitral stenosis (MS), evaluated by the New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) score, and echocardiographic parameters. We evaluated patients with severe rheumatic MS diagnosed as mitral valve area (MVA) less than 1.5 cm2. All patients underwent transthoracic echocardiography and the left atrium (LA) reservoir auto-strain (LASr) analysis. In addition, DASI and NYHA scores were determined to evaluate the functional capacity and symptoms of MS patients. We evaluated 60 patients with MS with a mean age of 50.13 ± 10.28 and a median DASI score of 26.95 (26.38). There were 6 (10%) and 28 (46.7%) patients with NYHA class I and II, and 25 (40.0%) and 2 (3.3%) patients with NYHA class III and IV, respectively. NYHA class was positively correlated with LA area (LAA, r = 0.638), LA volume (LAV, r = 0.652), LAV index (LAVI, r = 0.62), E (r = 0.45), A (r = 0.25), and pulmonary artery pressure (PAP, r = 0.34), while negatively correlated with LASr (r = - 0.73) and MVA (r = - 0.417). Furthermore, the DASI score was positively associated with LASr (r = 0.81) and MVA (r = 0.52) while negatively correlated with LAA (r = - 0.62), LAV (r = - 0.65), LAVI (r = - 0.56), E (r = - 0.46), A (r = - 0.3), and PAP (r = - 0.32). Our findings indicate that LAA, LAV, LAVI, E, A, PAP, MVA, and LASr are associated with NYHA and DASI scores in MS patients. Additionally, the LASr had the strongest correlation between all measured parameters in severe MS patients.

Trans-catheter closure of ASD and abnormal connection of left pulmonary vein to vertical vein: A case report.

RATIONALE: Partial anomalous pulmonary venous connection is a rare congenital anomaly in which one or more pulmonary veins are connected to the venous circulation leading to left to right heart shunt. Although correction of anomalous pulmonary venous connection is achieved through surgery, there are rare instances where the abnormal pulmonary vein has dual connection to both left atrium and the major systemic veins. Under these circumstances, catheter-based treatment might become a feasible option. PATIENT CONCERNS: A 22-year-old female presented with exertional dyspnea, holo-systolic murmur in left sternal border, and fixed splitting of S2 in examination. DIAGNOSIS: The patient was diagnosed with secundum type atrial septal defect (ASD) and dual drainage of left upper pulmonary vein. INTERVENTIONS: The patient was candidate for device closure. Under TEE guidance, occluder devices were deployed in the upper part of vertical vein and subsequently in place of ASD. OUTCOMES: Echocardiogram in the next day showed complete occlusion of flow through the vertical vein and ASD. Dual antiplatelet was prescribed on discharge. Follow-up echocardiography after 3 months showed obvious improvement in RV size. Due to suspicion for clot formation, TEE was done and thrombosis with approximate length of extension of 15 mm was detected back to the device. The patient is following for 5 years. Repeated TEE after 2 years did not show any change in the burden of clot. LESSONS: For comprehensive evaluation of patients with ASD, assessment of pulmonic veins is crucial and in the presence of a vertical vein, the dual drainage of pulmonic veins should be considered.

Cardiac MR images of thalassemia major patients with myocardial iron overload: a data note.

OBJECTIVE: Patients with thalassemia major (TM) have the highest mortality rate due to heart failure induced by myocardial iron overload. However, T2* weighted MR imaging is currently a gold standard approach for measuring iron overload. Examining ventricular volumes with magnetic resonance imaging (MR imaging) and measuring myocardial iron overload in TM patients allows for an early prediction of heart failure. This dataset includes cardiac MR images of TM patients and the control group with clinical and echocardiographic data. This dataset may be useful to researchers investigating myocardial iron overload. This dataset can also be used for medical image processing applications, such as ventricle segmentation. DATA DESCRIPTION: This study provides open-source cardiac MR images of 50 subjects and clinical and echocardiographic data. From February 2016 to January 2019, all images and clinical data were obtained from the MRI department of a general hospital in Mashhad, Iran. All the images are 16-bit gray-scale and stored in DICOM format. All patient-specific information is removed from image headers to preserve patient privacy. In addition, all images associated with each subject are compressed and saved in the RAR format.

Malignant lymphoma with diffuse cardiac involvement and pulmonary stenosis.

Lymphoma is one of the most common tumors with the risk of cardiac metastasis. The pattern of cardiac involvement is usually as focal masses. As early diagnosis of lymphoma plays a crucial role in its response to treatment and patient survival longevity, we report a rare case of cardiac lymphoma with diffuse cardiac involvement and acquired pulmonary stenosis. The patient was referred to our center for further evaluation because of dyspnea and systolic ejection murmur. In pericardial biopsy, T cell lymphoblastic lymphoma was reported. After a full course of chemotherapy and one-year follow up, symptoms had improved and echocardiography was normal except for small pericardial effusion. .

Water Pipe Tobacco Smoking and Risk of Coronary Artery Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Waterpipe smoking has become a vitally important public health issue in the world with a false assumption that it has a less harmful effect. OBJECTIVE: The aim of this study was to systematically review the association between waterpipe tobacco smoking and the risk of coronary artery disease (CAD). METHODS: Up to September 25, 2018, we electronically searched the PubMed, Embase, and ISI Web of Science with no time restriction. We included observational studies and excluded conference abstracts, editorials, case reports, case series, and reviews. With the fixed model effect, we conducted a meta-analysis to evaluate the association between waterpipe smoking and coronary artery disease. Heterogeneity among studies was assessed by the I2 square test. Publication bias was assessed by Egger test. P<0.05 was set as significant level. RESULTS: Among 248 paper records identified through a database search, 52 full texts were eligible for full text assessment whereas 49 papers were excluded. Additionally, three studies were eligible for meta-analysis, which involved 58,960 adults with 1334 in the water pipe smoker group. Risk of CAD was increased in water pipe smokers compared to individuals who had never smoked water pipe but the result did not reach a statistical significance (OR=1.18, 95% CI: 0.98-1.38, p=0.06). We found that heavy water pipe smoking (40 to 50 sessions of waterpipe smoking/year) was associated with CAD compared to lower smokers defined as less than 40 to 50 water pipe/year (OR=2.001, 95% CI: 1.13-2.87). CONCLUSION: Heavy Water pipe smoking was associated with coronary artery disease based on clinical findings. It seems very crucial to increase public awareness on adverse effects of water pipe smoking and its cessation in clinical setting.

Isolated cardiac hydatid cyst presented as myopericarditis: A case report.

Hydatidosis commonly affect the liver and lungs but in rare cases, it can involve heart tissue. A 42-year-old man from urban areas of Khorasan Razavi province, northeastern Iran, was referred to the cardiac clinic with palpitation, and atypical chest pain in 2018. Large pericardial effusion, reduced left ventricle systolic function was found. A cystic-like lesion was also seen in inter-ventricular septum in echocardiography and high-resolution computed tomography (HRCT). Urgent cardiac surgery was done because of echocardiographic evidence of tamponade. Although the serologic analysis was negative for hydatidosis, surgical excision of cyst and the subsequent histopathological findings revealed a hydatid cyst. In endemic areas, hydatidosis should be considered in differential diagnosis of any cystic-like lesions, even if the serological analysis is negative.

Risk factors of premature coronary artery disease in Iran: A systematic review and meta-analysis.

BACKGROUND: The aim of this study was to determine the mean age at which coronary artery disease (CAD) hase decreased in recent years in Iran. This systematic review and meta-analysis compares the prevalence of different risk factors of premature CAD (PCAD) in patients vs healthy individuals. METHODS: Medline, Web of Science, Embase and Scientific Information Database were searched for studies about PCAD risk factors in Iran until 28 October 2017. Observational studies of Iranians, comparing risk factors between patients with PCAD and age- and sex-matched healthy subjects, were included. Fixed-effects and random-effects model were used for pooling data. Odds ratio (OR) with 95% CI and mean difference were used for effect size estimation among studies. RESULTS: Twelve studies were eligible for meta-analysis. Diabetes mellitus (OR: 2.4, 95% CI: 1.9-3.03; P = 0.0001, I2  = 25.5%; P = 0.2), family history of CAD (OR: 2.09, 95% CI: 1.22-3.6; P = 0.007, I2  = 86%; P = 0.0001), dyslipidaemia (OR: 2.05, 95% CI: 1.15-3.64; P = 0.01, I2  = 54%; P = 0.08), smoking (OR: 1.65, 95% CI: 1.11-2.46; P = 0.01, I2  = 77.2%; P = 0.000) and hypertension (OR: 1.35, 95% CI: 1.21 to-1.50; P < 0.001, I2  = 31%, P = 0.1) associated with PCAD. Sensitivity analysis demonstrated that patients with PCAD had significantly lower levels of high-density lipoprotein (HDL) cholesterol and significantly higher levels of triglycerides compared to healthy subjects (MD: -2.56, 95% CI: -3.54 to -1.58, P < 0.001, I2  = 42%, P = 0.01 and MD: 21.17, 95% CI: 14.73-27.62, P < 0.001, I2  = 80.12%, P < 0.001, respectively). It should be noted that although high levels of heterogeneity in LDL and HDL values among the studies were observed, when dyslipidaemia was studied as a binary variable, no significant heterogeneity among studies was observed. CONCLUSION: Diabetes mellitus, family history of CAD, dyslipidaemia, smoking, and hypertension were significantly and positively associated with CAD in young adults compared to healthy age- and sex-matched population in Iran.

Primary Pulmonary Valve Leiomyosarcoma in a 35-Year-Old Woman.

Primary cardiac leiomyosarcomas are rare, with a high incidence of local recurrence. Herein, we report the case of a 35-year-old woman who was admitted with right ventricular failure and suspected pulmonary embolism. Upon echocardiography, we detected a mass in the pulmonary trunk that involved the pulmonary valve and led to valvular stenosis. The optimal protocol for treating these tumors is as yet unclear. Complete resection can rarely be achieved. However, palliative surgery is usually undertaken because many patients present with mechanical obstruction, such as significant pulmonary stenosis.

Giant cardiac hydatid cyst with rare adhesions.

We present a 29-year-old woman who was admitted to the emergency department with shortness of breath. Using echocardiography, a giant multi-cystic mass was detected in the right ventricle, attached to the septal leaflet of the tricuspid valve and basal portion of the interventricular septum. Serologic tests (hydatid cyst antibody) confirmed Echinococcus infection. Lung computed tomography with intravenous contrast showed involvement of the pulmonary vasculature. The patient underwent cardiac surgery and the large cardiac cyst and the one in the right pulmonary artery branch were both removed. The tricuspid valve was also replaced by a bioprosthetic one. Albendazole was started preoperatively and was continued for six months after surgery. The patient recovered uneventfully and was followed up for one year. This is a report of a rare case of a very large cardiac hydatid cyst complicated by pulmonary embolism with attachments to both the tricuspid valve and interventricular septum.

Rapid and sustained resolution of serous retinal detachment in Sturge-Weber syndrome after single injection of intravitreal bevacizumab.

PURPOSE: To report the effect of a single intravitreal bevacizumab injection on serous retinal detachment (SRD) in Sturge-Weber syndrome (SWS). DESIGN: Interventional case report. METHODS: A 15-year-old boy with history of SWS was referred with a complaint of sudden visual loss 2 days before, having choroidal hemangioma accompanied with SRD. Visual acuity was 20/160. RESULTS: He was treated with 1.25 mg of bevacizumab injected intravitreally. One week later, the retina was completely attached and visual acuity was 20/20. After 20 months, without repeating the injection, the retina remained attached and vision was stable. CONCLUSIONS: An early single dose of intravitreal bevacizumab is effective in the treatment of serous retinal detachment in SWS with good long-term results.