Changes in blood flow vortices inside the left ventricle in COVID-19 patients with intraventricular clot despite a normal coronary and myocardial motion.

PURPOSE: Our clinical observations showed clot formations in different regions of the left ventricle of the heart in some COVID-19 patients with normal myocardial motion and coronary artery. The aim of this study was to examine the changes caused by COVID-19 disease on blood flow inside the heart as a possible etiology of intracardiac clot formation. METHODS: In a synergic convergence of mathematics, computer science, and cardio-vascular medicine, we evaluated patients hospitalized due to COVID-19 without cardiac symptoms who underwent two-dimensional echocardiography. Patients with normal myocardial motions on echocardiography, normal coronary findings on noninvasive cardio-vascular diagnostic tests, and normal cardiac biochemical examinations but who presented with a clot in their left ventricle were included. To display the velocity vectors of the blood in the left ventricle, motion and deformation echocardiographic data were imported into MATLAB software. RESULTS: Analysis and output of the MATLAB program indicted anomalous blood flow vortices inside the left ventricular cavity, indicating irregular flow and turbulence of the blood inside the left ventricle in COVID-19 patients. CONCLUSION: Our results suggest that in some COVID-19 patients, cardiac wall motion is not satisfactorily able to circulate the blood fluid in normal directions and that, despite normal myocardium, changes in the directions of blood flow inside the left ventricle might lead to clots in different zones. This phenomenon may be related to changes in blood properties, such as viscosity.

Evaluation of adalimumab effects on left ventricle performance by echocardiography indexes among patients with immunosuppressant refractory ulcerative colitis.

Background and aims: Inflammatory bases lead to a simultaneous flourishing of cardiovascular complications with inflammatory bowel disease (IBD). As a released cytokine, tumor necrosis factor-α (TNF-α) can either disrupt or preserve cardiovascular performance. Due to this controversy, this study aimed to appraise the short-term anti-TNF (adalimumab [ADA]) relics on cardiac function by gauging the echocardiography indexes in patients with immunosuppressant refractory ulcerative colitis (UC). Methods: All cases with a definite diagnosis of UC were included based on providing written informed consent and owning the severe form of active disease (Mayo score ≥7), which did not dampen with immunosuppressant. Patients were excluded in the case of previous cardiac ailments/risk factors and prior related surgical or pharmaceutical intervention. Transthoracic echocardiography (TTE) was carried out before and 3 months after biological regimen allocation and changes in indexes [ejection fraction (EF), left ventricular end-diastolic volume (LVEDV)/left ventricular end-systolic volume (LVESV), and global longitudinal strain (GLS) in standard parasternal short axis from mid-ventricular level, two-, three-, and four-chamber apical long axes] were compared via statistical analyses. Results: The study consisted of 13 (65%) men and 7 (35%) women, with a mean age of 36.54 ± 11.3 years. Participants mainly possessed Montreal class I (45%) and an average of 3.25 years of disease duration. The intervention significantly controlled inflammation [endoscopic Mayo score (P = 0.001), partial Mayo score (P = 0.001), and C-reactive protein (P = 0.001)]. Endoscopic and clinical remission was obtained in 7 (35%) and 9 (45%) patients, respectively; however, no significant discrepancy related to the LVEDV (P = 0.86), LVESV (P-value = 0.25), EF (P-value = 0.06), and GLS in standard parasternal short axis (P = 0.73), long axis [apical 2-chamber (P-value = 0.61), apical 3-chamber (P-value = 0.15), and apical 4-chamber (P-value = 0.19) views] was observed before and after the intervention. Furthermore, no statistically significant correlation between disease activity and cardiac function was found, neither before nor after ADA administration. Conclusion: The present perusal found no deterioration in left ventricular function indexes with ADA intervention among patients with IBD without cardiac ailment. Thus, prescribing the anti-TNF to alleviate the inflammation can be carried out with less concern about cardiac consequences and considering other adverse traces in the target group.

Review of Laser Therapy in Cardiovascular Diseases.

Introduction: In recent years, there has been a rise in laser therapy for the treatment of cardiovascular diseases. Methods: This paper attempted to represent recent advances in laser therapy in cardiovascular tissue repairs. Three standard techniques have been explicitly described here in cardiovascular tissue repairs by laser. Results: One of the advantages of using laser therapy in cardiovascular diseases is its non-invasiveness. It also reduces the treatment process pain and prevents massive surgical incisions and bleeding throughout the operation. Laser therapy can ensure an alternative method to treat the ischemic region of the heart and creating anastomosis of vessels. Conclusion: With professional technologies and endoscopic surgery method development, the role of using lasers has become much more precise and more transparent in cardiovascular diseases.

Effect of bone marrow transplantation on diastolic function indices.

INTRODUCTION: High-dose chemotherapy and bone marrow transplantation result in direct and indirect changes in cardiac function. the finding suggests a decreased left ventricular diastolic compliance after high-dose cyclophosphamide treatment, but the effects of bone marrow transplantation (BMT) on cardiac diastolic function are less studied. We aimed to evaluate changes before and after the procedure in cardiac diastolic function in patients undergoing BMT. DESIGN AND METHODS: We designed this study to evaluate the effects of BMT on diastolic cardiac function. Patients with lymphoma (Hodgkin's and non-Hodgkin's), multiple myeloma, and solid tumors who were candidates for autologous BMT were selected for the study. The patients underwent a cardiac consultation and echocardiography before their admission for BMT. E-wave velocity and time to relaxation by tissue Doppler echocardiography in the septal, lateral, anterior, inferior, anteroseptal, and posterior wall; and the E-wave velocity of the right ventricle (RV) were measured before and after BMT. RESULT: Thirty patients fulfilled our inclusion criteria and entered the study. The mean diastolic function measures were calculated before and after BMT. E-wave velocity in the septal, lateral, anterior, inferior, anteroseptal and posterior walls after transplantation decreased by 19.2% (p=0.008), 14.5% (p=0.008), 22.19% (p=0.3), 18.9% (p<0.001), 21.9% (p=0.01), and 7.5% (p=0.01), respectively. The time to relaxation decreased by 13.5%, 13.7%, 12.4%, 11.4%, 11.1%, and 13.1%, respectively, after transplantation (p<0.001). E-wave velocity of RV decreased 15.6% after BMT (p=0.02). CONCLUSION: Data regarding alterations in diastolic functioning after BMT are scarce. This study suggests that diastolic function alters after BMT.

Bone marrow transplantation may augment cardiac systolic function in patients with a reduced left ventricular ejection fraction.

INTRODUCTION: Cardiac function is influenced by bone marrow transplantation (BMT). Studies have shown the various cardiotoxic effects of high-dose chemotherapy. In this study, we aimed to determine the effects of BMT on cardiac systolic function using echocardiographic indices. MATERIALS AND METHODS: Patients with lymphoma (Hodgkin's and non-Hodgkin's), multiple myeloma, and solid tumors which were candidates for autologous BMT were selected. The tissue Doppler S wave velocity in left ventricular echocardiographic segments and the Swave velocity in right ventricle, the left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), and ejection fraction (EF) were measured before and after BMT. RESULTS: Nineteen patients studied. The mean systolic function variable measures were calculated before and after BMT. The tissue Doppler S mean decreased in the septal, lateral and anterior walls by 8%, 7.9%, and 4.9% (P = 0.017), respectively. The tissue Doppler S mean increased in the inferior, anteroseptal and posterior walls by 1%, 0.6%, and 6.1%, respectively (not significant). The right ventricle Doppler S mean decreased by 7.5% after BMT (P = 0.03). The LVEDD and LVESD decreased significantly by 4.8% (P = 0.003) and 3.3% (P = 0.015), respectively, following BMT. The ejection fraction increased by about 7% after BMT (P = 0.05). CONCLUSION: The tissue Doppler S increased in all LV walls in patients with an EF less than 47%; surprisingly, tissue Doppler S decreased in all patients with an EF greater than 47%; and the ejection fraction increased by 13.6% and 3.1% in patients with a pre-BMT EF less than 47% and above 47%, respectively.

Endovascular treatment of thoracoabdominal aortic aneurysm: a case report.

INTRODUCTION: Thoracoabdominal aortic aneurysms usually present in elderly patients with serious renal, pulmonary, cerebral, or cardiac comorbidities that pose a great challenge to the attending surgeon. Endovascular techniques for the treatment of thoracoabdominal aneurysms are not yet widely used due to limitations associated with them, such as spinal and visceral ischemia. CASE PRESENTATION: An 87-year-old Caucasian man with a symptomatic Crawford type I thoracoabdominal aortic aneurysm was treated successfully with a long tube stent graft using endovascular techniques and without any complication in follow-up examinations. The stent was placed distal to the left subclavian artery, and proximal to the celiac axis. CONCLUSION: The use of endovascular stents for long segment thoracoabdominal aortic aneurysms needs to undergo clinical investigation to determine whether this procedure decreases morbidity and mortality rates.

Current incidence of peripheral arterial embolism and role of echocardiography.

We reviewed the incidence and outcome of all cases of upper and lower limb embolism surgically treated in our vascular unit, from January 2001 to June 2006, to assess the role of transthoracic and transesophageal echocardiography in defining the source of the embolus. Transthoracic echocardiography was carried out postoperatively, and patients in whom the embolic source was not found underwent transesophageal echocardiography. There were 85 patients (mean age, 69 years) who underwent embolectomy: 58 for lower and 27 for upper limb ischemia. The source or potential source of thrombus was demonstrated in 17 (20%) patients after transthoracic echocardiography. Fifty-three patients had transesophageal echocardiography, the source of embolism was found in 85%, and the subsequent management was changed in 47% of them. Arterial limb emboli are still prevalent in developing countries. Transthoracic echocardiography is a good screening tool for detecting a potential cardiac source of peripheral embolism, with transesophageal echocardiography being reserved for specific indications.