Double orifice mitral valve in a patient with bicuspid aortic valve and coarctation of the aorta: A rare presentation.

Double orifice mitral valve is a rare condition and may be accompanied by a bicuspid aortic valve (sometimes normal functioning) and coarctation of the aorta. Echocardiography is valuable in detecting the accompanied anomalies. Management depends on the severity of mitral valve function and the severity of associated anomalies.

Effect of kidney transplantation on right ventricular function, assessment by 2- dimensional speckle tracking echocardiography.

BACKGROUND: Advanced chronic kidney disease often results in adverse cardiovascular outcomes and is the leading cause of mortality in patients with end stage renal diseases (ESRD). There is much information about the effect of chronic kidney diseases (CKD) on the left ventricle (LV) chamber, but the right ventricle (RV) as a neglected chamber had not been evaluated precisely, in spite of its importance. OBJECTIVES: The aim of this study was to evaluate the impact of successful kidney transplants on the RV systolic and diastolic function using the advanced method of 2D speckle tracking echocardiography and comparison with the conventional methods. METHOD: The study included 48 patients with CKD who were eligible for kidney transplantation and underwent successful kidney transplantations. Right ventricular indices were evaluated, while RV function was focused by conventional methods and 2D speckle tracking echocardiography before the successful kidney transplant and 1 week, 1 month, and 3 months after the successful kidney transplant. RESULTS: The results of the study showed that RV global longitudinal strain and RV free wall longitudinal strain improved over the time (P = 0.024, P < 0.001 respectively). It also represented that kidney transplantation did not have significant effect on the RV mid cavity diameter, tissue velocity, Myocardial performance index, RV longitudinal diameter, and Tricuspid annular plane systolic excursion indices, but for other indices this effect was significant. On the differences between the mean slope of regression line of the GLS variable in hypertensive subjects (1.0 ± 0.2) and non-hypertensive subjects (0.36 ± 0.32), an independent t-test showed that between the two groups in terms of the improvement of RVGLS, there was a significant statistical difference (P = 0.0067). CONCLUSION: Most of the ESRD patients had subtle RV dysfunction which could be better detected by recent echocardiography methods than conventional methods. Moreover, kidney transplantation led to considerable improvements in RV function in this population.

Two adherent blood cysts in subvalvular apparatus of the mitral valve causing severe left ventricular outflow tract obstruction.

Blood cysts in the heart are often incidentally found during post-mortem examinations in infants, and usually do not cause clinical symptoms. They almost always regress spontaneously, and only a few cases of embolization or valvular dysfunction have been reported previously. We report a 62-year-old man who presented with chest discomfort and dyspnea on exertion for several years, and was found to have a dynamic murmur in left ventricular outflow tract (LVOT) on physical examination. His echocardiogram demonstrated two large blood cysts attached to the subvalvular apparatus of mitral valve, causing significant LVOT obstruction and mild to moderate mitral regurgitation. The cysts were surgically excised and pathology confirmed simple blood cysts. .

The association of serum parathyroid hormone and severity of coronary artery diseases.

INTRODUCTION: The serum level of parathyroid hormone (PTH) has been shown to be a predictor of cardiovascular mortality. Data on the association between PTH level and degree of atherosclerosis severity are lacking. The objective of this study was to determine the relationship of serum PTH level and number of stenotic coronary arteries. PATIENTS AND METHODS: The present article is a descriptive cross-sectional study on 476 patients who had undergone coronary angiography according to documented indications and had coronary lesion more than 50% in at least one main vessel during 2010-2012. The outcome was evaluated by comparison between PTH levels and the number of stenotic coronary arteries. RESULTS: Demographic data of the patients, severity, and number of stenotic vessels were evaluated. Of the 476 patients included, 183 (38.4%) had PTH more than 40 pg/ml. There was a significant association between PTH level and severity and number of coronary lesion: 80% of three-vessel disease patients had PTH more than 40 pg/ml but only 7% of single-vessel disease patients had PTH more than 40 pg/ml (P<0.001). The mean levels of PTH serum in single-vessel, two-vessel, and three-vessel disease were 24.8, 35.8, and 49.8 pg/ml, respectively (P<0.001). Individuals with the higher PTH level had longer history of hypertension and lower left ventricular ejection fraction (P<0.01 and P<0.002, respectively). CONCLUSION: In this relatively small prospective study, serum PTH level is associated with the number of stenotic coronary arteries. There is a correlation between high PTH level with hypertension and low ejection fraction. A prospective study that evaluates the additional value added (by ROC analysis) by PTH to already known cardiac risk factors is recommended.

Cardiac capillary hemangioma in a patient with atypical chest pain and normal ECG.

Cardiac hemangiomas account for less than 2% of primary cardiac tumors. They can present with palpitation, arrhythmia, right ventricular outflow tract obstruction, pseudoangina, and in more extreme cases sudden death. Our case report presents a 41-year-old man with atypical chest pain, who had a normal heart examination, electrocardiogram, and an unremarkable family and medical history. His echocardiography demonstrated a round semimobile mass in the right ventricle. The diagnosis was confirmed by both transesophageal echocardiography and cardiac magnetic resonance imaging. The tumor was surgically excised and sent for pathology, which was reported as capillary hemangioma. .