Strain imaging for evaluating response to thrombolytic therapy in pulmonary thromboembolism.

OBJECTIVE: Patients with acute pulmonary thromboembolism (PTE) and right ventricular (RV) dysfunction may benefit from thrombolytic therapy. We sought to determine the usefulness of RV strain imaging in the demonstration of improvement in RV function in response to thrombolytic therapy. METHODS: This study prospectively enrolled 32 consecutive patients who received thrombolytic therapy due to diagnosis of PTE.The diagnosis was verified by 256-slice multi-detector computed tomography. Right ventricular function parameters were assessed via conventional and tissue Doppler imaging echocardiography before and 2-3 days after thrombolytic therapy. RESULTS: Echocardiographic study showed that mean tricuspid annular plane systolic excursion and RV fractional shortening area change increased significantly from 13.32 +/- 3.46 mm to 18.18 +/- 4.77 mm and from 22.95 +/- 9.73% to 36.20 +/- 10.17%, respectively, before compared to after treatment. A significant decrease was observed in systolic pulmonary artery pressure from 61.57 +/- 10.49 mm Hg to 38.78 +/- 14.27 mm Hg. Mid-ventricular peak systolic strain and strain rate of the RV also significantly improved (-6.08 +/- 11.19% to -19.13 +/- 9.51% and -0.72 +/- 0.96 S(-1) to -1.54 +/- 0.66 S(-1), respectively). CONCLUSIONS: Tissue Doppler-derived peak systolic strain of RV mid-ventricular wall may be potentially useful in the serial quantification of improvement in RV function in response to thrombolytic therapy in acute PTE.

Bloody Pericardial Effusion with a Huge Pericardial Mass: A Case Report.

Nowadays, the early diagnosis of tumoral diseases is more possible and accurate with multiple diagnostic imaging modalities such as chest X-ray, echocardiography, computed tomography, and magnetic resonance imaging, especially for cardiac tumors which are usually asymptomatic, even in large sizes. In cardiac masses, the patients' presentations are non- specific and dependent on the tumor size and site as well as its compressive effect on the adjacent structures. On the other hand, the first and last signs could be sudden cardiac death. However, cardiac masses are either benign or malignant and metastatic in their malignant type, and their definite diagnosis is only possible by surgical tumor resection and tissue biopsy. In this paper, we describe an old patient with severe pericardial effusion and an unusual intrapericardial tumor in transthoracic echocardiography, representing a rare case of a giant ectopic thymoma after surgical resection and pathologic assessment.

Transcatheter heart valve in valve implantation with Edwards SAPIEN bioprosthetic valve for different degenerated bioprosthetic valve positions (First Iranian ViV report with mid-term follow up).

Introduction: After early successful experience with transcatheter aortic valve replacement (TAVR), concept of transcatheter implantation of a new valve within a failing bioprosthetic valve emerged. Valve-in-valve (ViV) implantation seems to be a simpler option for high risk surgical patients. Methods: We performed five ViV procedures in different valve positions. We included patients with failing bioprosthetic valves with high surgical risk due to concomitant comorbidities. We performed 2 transapical ViV procedures for failing mitral bioprosthetic valves, 1 transfemoral procedure for failing pulmonary valve and 2 transfemoral ViV implantation for failing tricuspid bioprosthetic valves. Results: The procedures were successfully completed in all 5 cases with initial excellent fluoroscopic and echocardiographic verification. There was no valve embolization or paravalvular leakage in any of the cases. Transcatheter valve function was appropriate with echocardiography. Post procedural clinical adverse events like pleural effusion and transient ischemic attack were managed successfully. In midterm follow up all cases remained in appropriate functional class except from the transcatheter pulmonary valve which became moderately stenotic and regurgitant. Conclusion: As the first Iranian all-comers case series with midterm follow up for ViV implantation, we had no mortality. Interestingly none of our patients had neurologic sequelae after the procedure. Midterm follow up for our patients was acceptable with good functional class and appropriate echocardiographic findings. Due to high surgical risk of the redo procedure after failing of a bioprosthetic valve especially in elderly patients with comorbidities, ViV implantation would be a good alternative to surgery for this high risk group.