Idiopathic cardiac ossification with Chiari mesh in the right atrium: a case report and literature review.

Background: Idiopathic cardiac osseous metaplasia in the right atrium of a 9-year-old boy, accompanied by right atrial Chiari network and right pulmonary artery embolism. This case is rare and can easily be misdiagnosed. Case Description: We encountered a case of a 9-year-old boy with a 3.5 cm diameter neoplasm in the right atrium. Preoperative imaging diagnosis could not determine the nature of the tumor, and the initial clinical suspicion of cardiac myxoma. After admission, a cardiotomy to remove foreign bodies and a pulmonary artery thrombectomy were performed. Conclusions: Idiopathic cardiac osseous metaplasia is relatively rare, and it is even rarer to be accompanied by a Chiari network in the right atrium. Due to the location and characteristics of the lesion in this case, it is easy to be misdiagnosed as atrial myxoma in clinical practice. Whether it is idiopathic osseous metaplasia or myxoma, it needs to be performed surgical treatment and pathological examination can easily rule out the diagnosis of myxoma. However, as idiopathic cardiac metaplasia is difficult to encounter in clinical work and there are few reports in the literature, clinicians and pathologists need to consult more relevant literature. Learn to understand and master the disease through multi-party consultation.

How Right is the Right Ventricle in Predicting Cardiac Mortality in Cardiac Failure: A 6-year Prospective Cohort Study.

Aim: Two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE) may overcome many limitations of the conventional 2D echocardiography (2DE) in assessing right ventricular (RV) function. We sought to determine whether characteristics of the right atrium and right ventricle as measured by 2D-STE and 3DE are associated with cardiac mortality in patients with ischemic heart failure, over a 6-year follow-up. Materials and Methods: The inclusion criteria were ischemic cardiomyopathy with left ventricular ejection fraction of <40% diagnosed using standard 2DE, 2D-STE, and 3DE examination. Patients were followed for 6 years, and cardiac mortality was recorded. Results: The study sample comprised a total of 54 participants. During the period of follow-up, 24% (13/54) died. The 2DE models showed that being older, having a higher body mass index (BMI), having higher systolic pulmonary artery pressure (SPAP), and a lower RV global longitudinal strain were associated with cardiac mortality in our cohort after 6-year follow-up. Finally, the 3DE models showed that in addition to being older, having higher BMI, having a higher SPAP baseline, lower baseline 3DE RV stroke volume, and larger 3DE RV end-diastolic volume and 3DE RV end-systolic volume were associated with cardiac mortality over 6-year follow-up. Conclusion: This study provides evidence that RV dysfunction as seen on 2D-STE and 3DE could be associated with increased risk of cardiac-related mortality in patients with heart failure over 6 years.

Potential Diagnostic and Prognostic Values of Left Atrial Strain in Valvular Heart Disease.

There has been increasing evidence supporting the importance of left atrial (LA) functional analysis and measurement in various physiologic and pathologic cardiovascular conditions due to its high diagnostic and prognostic values. Assessment of LA strain (LAS) has emerged as an early marker of subclinical LA dysfunction. Using speckle-tracking echocardiography, LAS can be measured in all phases of LA function (reservoir, conduit, and booster pump). In valvular heart disease (VHD), surgical and nonsurgical interventions should be performed before irreversible left ventricular (LV) and/or LA myocardial dysfunction. The current guidelines recommended using LV strain as a parameter for early detection and timely intervention. Currently, many published data have shown the diagnostic and prognostic values of LAS in VHD, which is encouraging to integrate LAS during echo assessment. In this review, we aim to collect the current data about the clinical utility of LAS changes in risk stratification, predicting outcome, and guiding the time of intervention in VHD. The review summarized these data according to the type of valve pathologies.

Contractile effects of stimulation of D1-dopamine receptors in the isolated human atrium.

Dopamine receptors have been claimed not to directly increase contractility in the human heart. Therefore, we performed contraction experiments in isolated electrically driven human atrial preparations (HAP). For comparison, we performed contraction experiments with left atrial preparations of transgenic mice which harbor a cardiac overexpression of human D1-dopamine receptors (D1-TG). In D1-TG, first we noted that dopamine (10 nM-10 µM cumulatively applied) in the presence of propranolol exerted a concentration- and time-dependent positive inotropic effect in D1-TG. In a similar fashion, dopamine increased force of contraction in the presence of 0.4 µM propranolol in HAP and these effects were amplified by pre-treatment with inhibitor of phosphodiesterase III (1 µM) cilostamide. Moreover, contractile effects of dopamine in the presence of propranolol 0.4 µM in HAP were antagonized by odapipam, haloperidol, or raclopride. Ten micromolars of fenoldopam in the presence of cilostamide increased force of contraction in HAP and this effect was antagonized by SCH 23390. We conclude that stimulation of human D1-dopamine receptors can increase force of contraction in the HAP.

Left atrial strain by cardiac MRI feature tracking in mitral stenosis before and after balloon valvuloplasty.

The aim was to investigate LA strain by feature tracking cardiac MRI in mitral stenosis (MS) patients before and after percutaneous balloon mitral valvuloplasty (PBMV). Patients underwent cardiac MRI before and after successful PBMV (n = 18). Mitral valve area, transmitral velocity and gradients, LA volumes and ejection fraction (LAEF) were measured. LA strain feature tracking analysis was used to calculate LA reservoir, conduit, and booster strain. LA strain, LA volumes, LAEF and mitral valve severity indices were compared before and after PBMV. Correlations between LA strain and other cardiac MRI parameters were assessed. After PBMV, mitral valve area increased from 1.18 ± 0.25 cm2 to 2.26 ± 0.27 cm2, p < 0.001. Transmitral peak velocity decreased from 1.7 ± 0.37 m/s to 1.3 ± 0.27 m/s, p < 0.001. Transmitral peak gradient decreased from 12.4 ± 4.8 mmHg to 6.8 ± 2.9 mmHg, p < 0.001, and mean gradient decreased from 6.9 ± 3.8 mmHg to 2.9 ± 1.4 mmHg, p < 0.001. Maximal LA volume decreased from 73.1 ± 14.2 ml/m2 to 62.7 ± 16.3 ml/m2, p = 0.018; corrected p value = 0.054. LAEF increased from 36.3 ± 8.7% to 44.4 ± 9.5%, p = 0.010. Reservoir strain increased from 11.7 ± 3.1% to 14.9 ± 3.6% after PBMV, p = 0.009, and conduit strain from 3.8 ± 2% to 6 ± 2.3%, p = 0.005. Booster strain insignificantly increased after PBMV. Cardiac MRI feature tracking provides information on the 3 LA functional phases. Significant improvement was observed in reservoir and conduit functions after successful PBMV.

Steerable Delivery Sheath for Left Atrial Appendage Closure in Patients With Severely Enlarged Left Atria.

Background: Enlarged left atrium (LA) is frequently identified in patients who undergo left atrial appendage closure (LAAC) and negatively affects the device's final position and intervention results. Steerable delivery sheath (SDS) could represent an option to overcome these difficulties. We aimed to assess the feasibility of SDS-assisted procedures and compare their efficacy to the standard sheath strategy. Methods: This study analyzed patients from our institution's LAAC registry who had severe LA enlargement on CT scan (index LA volume >90 mL/m2) and underwent AMULET device implantation between January 2019 and March 2023. The patients underwent postprocedural CT scan to assess the device's position, residual LAA filling, and peridevice leaks. Results: A total of 195 consecutive patients were screened and 47 (24%) met the inclusion criteria (n = 22 SDS group; n = 25 standard group). There was no difference in baseline clinical, anatomical, or procedural characteristics. The procedural technical success (96%) and complication rates (9% vs 4%; P = .59) were comparable in both groups. Post-LAAC CT scans were obtained in 19 SDS group and 22 standard group patients. We observed significantly lower incidences of residual patent LAA (26% vs 72%; P = .005), peridevice leaks (16% vs 64%; P = .004), and off-axis device position (0% vs 27%; P = .02) in SDS compared to the standard group, suggesting a better LAA sealing. Conclusions: Severe LA enlargement was frequent among LAAC candidates. In this situation, the use of SDS appears feasible and safe, leading to more efficient closures on follow-up imaging without a higher risk of periprocedural complications.

Anomalous pulmonary venous drainage due to malposition of septum primum: two case reports and literature review.

Background: Anomalous pulmonary venous connection with malposition of septum primum (MSP) is a rare pediatric cardiovascular malformation. Although reports in the literature are scarce, accurate pre-operative imaging diagnosis is crucial for selecting the appropriate clinical intervention and determining the prognosis for affected children. Case description: In both case reports, the cardiovascular malformations were incidental findings. In the second case, an enlarged cardiac silhouette was observed on chest x-ray due to pneumonia, which was subsequently confirmed by ultrasound. Combined with computed tomography angiography examination, the diagnosis of MSP-type anomalous pulmonary venous connection was established. Conclusions: Comprehensive imaging examinations are essential in reducing misdiagnosis and achieving an accurate diagnosis of MSP-type anomalous pulmonary venous connection. The typical imaging findings for MSP-type anomalous pulmonary venous connection include absence or hypoplasia of the superior limbic band of the septum secundum, leftward displacement of the septum primum, and partial or total pulmonary vein drainage into the anatomical right atrium.

"Rapid Atrial Swirl Sign": A Better Tool Than the Landmark Technique for Ensuring Correct Depth of Insertion of Central Venous Catheters.

INTRODUCTION: Central venous catheters (CVCs) are widely used in the management and resuscitation of critically ill patients in emergency departments and intensive care units. Correct depth of insertion of the CVC line is important to ensure uninterrupted flow, avoid complications, and monitor central venous pressure. Transthoracic echocardiography, with contrast enhancement, has been proposed as an alternative to chest X-ray in detecting central venous line positioning with high accuracy. Nevertheless, this method is not widely used due to some previous conflicting results and the cumbersomeness of the procedure. MATERIAL AND METHODS: After approval by the Institutional Ethics Committee, this prospective observational study was carried out in patients for whom a central venous line was warranted. The study was conducted in the Intensive Care Unit of a tertiary care hospital among 150 adult patients to compare the "Rapid Atrial Swirl Sign" (RASS) technique by transthoracic echocardiography and the landmark-based technique for ensuring accurate depth of central venous line placement. RESULTS: In this study, we found that the mean depth of insertion of the CVC for the Echocardiography RASS group (E) was 12.84 cm, while for the Landmark technique group (L), it was 12.02 cm. There was a significant difference between these groups, with a p-value of <0.05. We found that the majority of patients (98.63%) in Group E had the catheter tip in Zones 1, 2, and 3, while only 66.6% of patients in Group L had the catheter tip in similar zones. The mean standard deviation for zones on chest X-ray was 1.8 for Group E and 2.26 for Group L, with a significant difference between these groups (p-value <0.05). CONCLUSION: The RASS technique is superior to the landmark technique in ensuring the correct depth of the tip of the CVC. When confirmed by chest X-ray, it was found that most patients had the catheter tip in Zone 1, 2, or 3 using the RASS technique. This confirms that the RASS technique can minimize the requirement of resources and hasten the initiation of patient management in a timely manner, unlike the landmark technique, which requires chest X-ray confirmation before use.

Giant right and left atrium: spectrum of rheumatic triple valve disease (double hit with double impact): a case report and review of the literature.

BACKGROUND: Rheumatic heart disease (RHD) continues to pose a significant burden on global health, particularly in socioeconomically disadvantaged populations. We present the case of a 38-year-old woman with severe multivalvular RHD and giant atria, highlighting the challenges and complexities of managing this condition. CASE PRESENTATION: The patient presented with progressively worsening dyspnoea, signs of right heart failure, and severe valvular abnormalities. Diagnostic evaluations revealed severe mixed mitral valve disease in the form of mitral stenosis and regurgitation, along with involvement of the aortic and tricuspid valves, leading to significant enlargement of both atria. Despite facing socioeconomic constraints and poor adherence to treatment, the patient underwent successful surgical intervention, resulting in remarkable symptomatic improvement. CONCLUSIONS: Through this case, we emphasise the importance of early detection, comprehensive management strategies, and multidisciplinary care in addressing the complexities of RHD. Despite the challenges posed by socioeconomic disparities, positive outcomes can be achieved with timely diagnosis and appropriate intervention. This case underscores the need for targeted efforts to improve access to healthcare resources and reduce the global burden of RHD.

Anomalies Unveiled: A Fascinating Case Study of Type I Pulmonary Artery-to-Left Atrium Fistula.

The pulmonary artery-to-left atrium (LA) fistula is one of the rare and unique structural causes of silent cyanosis. This correctable abnormality can be identified by having a high index of clinical suspicion and appropriate investigations using echocardiography and cardiac computed tomography (CT). We report an eight-year-old child who had worsening exertional dyspnea, long-standing central cyanosis, and recurrent infections. A large-sized fistula connecting the right pulmonary artery (RPA) to the LA with all the right- and left-sided pulmonary veins showed normal drainage into the LA, suggesting a type I RPA-to-LA fistula, which was diagnosed on cardiac CT. Percutaneous closure using the occluder device is planned as further management for the patient.

Sex differences in the associations between right heart structure and peak exercise capacity parameters in amateur cyclists.

Introduction: Right heart changes and their association with exercise capacity, including sex differences, are still being investigated. We analysed right heart structure and its relationship with exercise capacity parameters in amateur cyclists. Materials and methods: A cross-sectional study involving 215 consecutive adult amateur cyclists, who underwent resting transthoracic echocardiography and a cardiopulmonary exercise test (CPET) to exhaustion was performed. Results: The median age of participants was 29 years (IQR 24-37), 71% of them were men. The mean training time was 6 h/week, and 90% participated in vigorous or moderate physical activity. Men had larger right ventricular diameters (basal - RVD1, mid-cavity - RVD2 and longitudinal - RVD3) compared to women (40.9 vs. 37.6 mm, p = 0.0005, 28.7 vs. 26.3 mm, p = 0.03, 92.2 vs. 81.9 mm, p < 0.0001). Indexing for body surface area revealed comparable right atrial volume (RAVI) between sexes (24.1 vs. 22.7 mL/m2). Men achieved higher peak exercise capacity parameters [O2 pulse, oxygen consumption (VO2) and workload] in CPET. Multivariate linear regression models revealed a positive association between peak VO2, workload and O2 pulse with RAVI in women but not with RVD1 or RVD3. Conversely, these parameters showed a positive association with RVD3 and RVD1 but not with RAVI in men. Conclusion: Sex differences exist in the relationship between right heart structural parameters and peak exercise capacity descriptors in amateur cyclists. Better exercise capacity during CPET to exhaustion is associated with greater RAVI in women but a greater RVD1 and RVD3 in men. These findings suggest different mechanisms of right heart adaptation to training in men and women.

Left superior vena cava's unconventional path to left atrium drainage: A case report.

Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. We presented PLSVC in a patient with end-stage renal disease (ESRD) requiring hemodialysis. The left internal jugular vein was utilized for central venous access due to difficult central vascular access, resulting in a diagnosis of PLSVC draining in the left atrium. This case underscores the importance of awareness of anatomical variations before central catheter placement.

Case report and literature review: cardiac hematic cyst.

A 49-year-old female patient, asymptomatic, presented to the cardiology office for a right atrial mass, identified incidentally in a non-electrocardiogram (ECG)-gated contrast-enhanced computed tomography, performed for follow-up of pulmonary tuberculosis. Echocardiography, surprisingly, showed an anechogenic ovoid mass in the right atrium measuring 40 × 40 mm2, implanted in the interatrial septum without affecting the tricuspid valve. ECG-gated computed tomography angiography (CTA), confirmed the dimensions of the mass, which presented homogeneous content, calcified areas, and a 12-mm pedicle implanted near the ostium of the coronary sinus. Additionally, contrast uptake and infiltration of adjacent structures were ruled out. In the surgical field, an encapsulated mass with blood content was found, which pathology reported as a hematic endocardial cyst (HEC). These are rare cardiac masses, constituting 1.5% of all primary cardiac tumors. It is usually an incidental finding, and its clinical presentation will depend on its dimensions and the intracardiac hemodynamic impact. A highlighting feature is its anechogenic content on ultrasound, however, multimodality imaging allows for making diagnostic assumptions, discerning between primary cardiac tumors, and provides morphological and hemodynamic information useful for therapeutic decision making. The age of the patient, the large size of the HEC, and its location in the interatrial septum make up a completely atypical presentation of this rare disease, which motivated this report.

Opposite Contractile Effects of Amphetamine-Related Hallucinogenic Drugs in the Isolated Human Atrium.

The present study examined three hallucinogenic amphetamine derivatives, namely, 2,5-dimethoxy-4-iodoamphetamine (DOI) as well as 2,5-dimethoxy-4-methylamphetamine (DOM) and 4-methylmethcathinone (mephedrone). The objective of this study was to test the hypothesis that DOI, DOM, and mephedrone would increase the contractile force in isolated human atrial preparations in a manner similar to amphetamine. To this end, we measured contractile force under isometric conditions in electrically stimulated (1 Hz) human atrial preparations obtained during open surgery. DOI and DOM alone or in the presence of isoprenaline reduced the contractile force concentration-dependently in human atrial preparations. These negative inotropic effects of DOM and DOI were not attenuated by 10 µM atropine. However, mephedrone increased the contractile force in human atrial preparations in a concentration- and time-dependent manner. Furthermore, these effects were attenuated by the subsequent addition of 10 µM propranolol or pretreatment with 10 µM cocaine in the organ bath. Therefore, it can be concluded that amphetamine derivatives may exert opposing effects on cardiac contractile force. The precise mechanism by which DOI and DOM exert their negative inotropic effects remains unknown at present. The cardiac effects of mephedrone are probably due to the release of cardiac noradrenaline.

Beyond Blood Sugar: How Left Atrium Strain Predicts Cardiac Outcomes in Type 2 Diabetes.

Speckle tracking echocardiography is an innovative imaging technique that evaluates myocardial motion, including the function of the left atrium (LA). The assessment of the left atrium's function across its dimensions can have diagnostic and prognostic roles in various cardiovascular conditions. Left atrial strain has been recognized as a valuable predictor of mortality and cardiovascular incidents in the general population across various conditions. For individuals with type 2 diabetes mellitus (T2DM), left atrial dysfunction, as gauged by speckle tracking echocardiography, appears particularly prognostic. Parameters such as peak atrial longitudinal strain (PALS) and left atrial stiffness have been linked with heightened risks of severe cardiovascular events, including atrial fibrillation (AF), heart failure (HF) hospitalizations, or mortality. Consequently, recognizing left atrial dysfunction early is crucial for accurate diagnosis, guiding treatment choices, comprehensive patient management, and prognosis evaluation. Using two-dimensional (2D) speckle tracking echocardiography, results from recent studies report that treatment with empagliflozin significantly enhanced LA function in patients with type 2 diabetes mellitus, improving left atrial strain (LAS) contraction and reservoir values. Furthermore, treatments with glucagon-like peptide-1 (GLP)-1 receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors were shown to improve LA reservoir strain more effectively than insulin alone, suggesting their potential in reducing cardiovascular complications in T2DM patients. This narrative review further addresses ongoing challenges and potential enhancements needed to boost the clinical value of left atrium strain, emphasizing its significance in managing and improving outcomes for diabetic patients.

Left Atrium Reverse Remodeling in Fusion CRT Pacing: Implications in Cardiac Resynchronization Response and Atrial Fibrillation Incidence.

Background: When compared to biventricular pacing, fusion CRT pacing was linked to a decreased incidence of atrial fibrillation (AF). There is a gap in the knowledge regarding exclusive fusion CRT without interference with RV pacing, and all the current data are based on populations of patients with intermittent fusion pacing. Purpose: To assess left atrium remodeling and AF incidence in a real-life population of permanent fusion CRT-P. Methods: Retrospective data were analyzed from a cohort of patients with exclusive fusion CRT-P. Device interrogation, exercise testing, transthoracic echocardiography (TE), and customized medication optimization were all part of the six-monthly individual follow-up. Results: Study population: 73 patients (38 males) with non-ischemic dilated cardiomyopathy aged 63.7 ± 9.3 y.o. Baseline characteristic: QRS 159.8 ± 18.2 ms; EF 27.9 ± 5.1%; mitral regurgitation was severe in 38% of patients, moderate in 47% of patients, and mild in 15% of patients; 43% had type III diastolic dysfunction (DD), 49% had type II DD, 8% had type I DD. Average follow-up was 6.4 years ± 27 months: 93% of patients were responders (including 31% super-responders); EF increased to 40.4 ± 8.5%; mitral regurgitation decreased in 69% of patients; diastolic profile improved in 64% of patients. Paroxysmal and persistent AF incidence was 11%, with only 2% of patients developing permanent AF. Regarding LA volume, statistically significant LA reverse remodeling was observed. Conclusions: Exclusive fusion CRT-P was associated with important LA reverse remodeling and a low incidence of AF.

Cardiac papillary fibroelastomas: Unveiling a rare right atrial presentation with surgical insights-A case report and review of the literature.

Cardiac papillary fibroelastomas (CPF) are rare, benign tumors with thromboembolic potential. We present a 40-year-old male with a right atrial CPF, referred with acute chest pain. Advanced imaging and surgical excision with tricuspid valve repair were crucial, emphasizing the need for early detection and intervention in symptomatic and asymptomatic cases.

Distinctive Deposition Patterns of Sporadic Transthyretin-Derived Amyloidosis in the Atria: A Forensic Autopsy-Based Study.

Left-to-right differences in the histopathologic patterns of transthyretin-derived amyloid (ATTR) deposition in the atria of older adults have not yet been investigated. Hence, this study evaluated heart specimens from 325 serial autopsy subjects. The amount of ATTR deposits in the seven cardiac regions, including both sides of atria and atrial appendages, was evaluated semiquantitatively. Using digital pathology, we quantitatively evaluated the immunohistochemical deposition burden of ATTR in the myocardium. We identified 20 sporadic ATTR cardiac amyloidosis cases (nine males). All patients had ATTR deposition in the left atrial regions of the myocardium. In the semiquantitative analysis, 14 of the 20 cases showed more severe ATTR deposition on the left atrial regions than on the right side, with statistically significant differences in the pathology grading (p < 0.01 for both the atrium and atrial appendage). Quantitative analysis further supported the difference. Moreover, six had ATTR deposition in the epineurium and/or neural fibers of the atria. Cluster analysis revealed that ATTR deposition in the myocardium was significantly more severe in males than in females. The heterogeneous distribution of amyloid deposits between atria revealed in this study may impair the orderly transmission of the cardiac conduction system and induce arrhythmias, which may be further aggravated by additional neuropathy in the advanced phase. This impairment could be more severe among males. These findings emphasize that atrial evaluation is important for individuals with sporadic ATTR cardiac amyloidosis, particularly for early detection.

Prognostic value of left atrial size and function by cardiac magnetic resonance in non-ischemic cardiomyopathy.

To evaluate left atrial (LA) function and strain parameters by cardiac magnetic resonance imaging (CMR) in patients with non-ischemic cardiomyopathy (NICM) and evaluate the association of these parameters with long-term clinical outcomes. We retrospectively included 92 patients with NICM and 50 subjects with no significant cardiovascular disease (control group). We calculated LA volumes using the Simpson area-length method to derive LA ejection fraction and expansion index. LA reservoir (ƐR), conduit (ƐCD), and contractile strain (ƐCT) were measured using dedicated CMR software (cvi42, Circle Cardiovascular Imaging Inc., version 5.14). An adjusted multivariate regression analysis was performed to determine the association of LA parameters with death and heart failure hospitalization (HFH). NICM patients were older with male preponderance. The mean age for NICM patients was 59.6 ± 15.9 years, 64% males, and 73% whites versus 52.2 ± 12.4 years, 34% male and 64% white for controls. LA strain patterns were significantly lower in NICM patients when compared to controls. During a median follow-up of 58.9 months, 12 patients (13%) died and 33(35.9%) had a HFH. None of the clinical or CMR factors were significantly associated with death. On multivariate analysis, after adjusting for age and significant univariate variables, ƐR was the only variable significantly associated with the HFH (OR 0.98, CI 0.96-1.0). Unadjusted and adjusted Cox proportional hazard models divided by the median ƐR (~ 18%) showed a significant difference in HFH over time (χ2 statistic = 21.1; P value = 0.03). In NICM patients, all LA strain components were reduced. ƐR was found to be significantly associated with HFH.