Cardiovascular Magnetic Resonance Imaging Findings in Africans with Idiopathic Dilated Cardiomyopathy.

In sub-Saharan Africa, idiopathic dilated cardiomyopathy (IDCM) is a common yet poorly investigated cause of heart failure. Cardiovascular magnetic resonance (CMR) imaging is the gold standard for tissue characterisation and volumetric quantification. In this paper, we present CMR findings obtained from a cohort of patients with IDCM in Southern Africa suspected of having a genetic cause of cardiomyopathy. A total of 78 IDCM study participants were referred for CMR imaging. The participants had a median left ventricular ejection fraction of 24% [interquartile range, (IQR): 18-34]. Late gadolinium enhancement (LGE) was visualised in 43 (55.1%) participants and localised in the midwall in 28 (65.0%) participants. At the time of enrolment into the study, non-survivors had a higher median left ventricular end diastolic wall mass index of 89.4 g/m2 (IQR: 74.5-100.6) vs. 73.6 g/m2 (IQR: 51.9-84.7), p = 0.025 and a higher median right ventricular end-systolic volume index of 86 mL/m2 (IQR:74-105) vs. 41 mL/m2 (IQR: 30-71), p < 0.001. After one year, 14 participants (17.9%) died. The hazard ratio for the risk of death in patients with evidence of LGE from CMR imaging was 0.435 (95% CI: 0.259-0.731; p = 0.002). Midwall enhancement was the most common pattern, visualised in 65% of participants. Prospective, adequately powered, and multi-centre studies across sub-Saharan Africa are required to determine the prognostic significance of CMR imaging parameters such as late gadolinium enhancement, extracellular volume fraction, and strain patterns in an African IDCM cohort.

An unusual case of aorta-right atrial tunnel with windsock aneurysm: imaging, diagnosis and treatment.

The first successfully diagnosed and treated case of aorta-right atrial tunnel was reported by Coto et al. in 1980. The most common cause of aorta-right atrial tunnel is a ruptured aneurysm of the sinus of Valsalva. Sinus of Valsalva aneurysms had been reported as early as 1840 by Thurnam; these were diagnosed at autopsy. With the advances in radiology, many cases of aorta-right atrial tunnel have been reported since then, each with its own subtle variations. We report on a unique case of aorta-right atrial tunnel with a windsock aneurysm in the right atrium. A 55-year-old male presented with abdominal pain and the chest X-ray revealed cardiomegaly. On further investigation with echocardiography and computed tomography angiography, there was an incidental aorta-right atrial tunnel with a windsock aneurysm in the right atrium. He was treated successfully with surgery. A similar case has been reported only once before by Iyisoy et al. in 2014.

Influence of normovolemic anemia on Doppler-derived blood velocity ratios of abdominal splanchnic vessels in clinically normal dogs.

Doppler spectra of the abdominal aorta (AAo), cranial mesenteric artery (CMA), celiac artery (CA), and left renal artery (LRA) were obtained from 11 fasted, clinically healthy, conscious Beagles before and after inducing severe acute normovolemic anemia (mean +/- standard deviation hematocrit 16.0 +/- 0.77%). Peak systolic, end diastolic, and time-averaged mean velocities were measured. The different vessels were compared with each other. Peak systolic velocity ratio and time-averaged mean velocity ratio of splanchnic vessels to corresponding variables of the AAo were computed and compared between and within vessels during physiologic and anemic states. There was no difference between LRA and AAo, CMA or CA regarding time-averaged mean velocity, time-averaged mean velocity ratio, or end diastolic velocity during the physiological state. During the anemic state, LRA mean time-averaged mean velocity (P < or = 0.008) and mean end diastolic velocity (P < or = 0.041) were significantly lower than those of AAo, CMA, and CA. Mean time-averaged mean velocity ratio of the LRA was also significantly (P < or = 0.004) lower than the CMA and CA ratios, and significantly (P = 0.014) lower during anemic state than physiologic state of the same vessel. End diastolic and time-averaged mean velocities of the AAo, CMA, and CA increased proportionally during anemia, but there was a relatively less increase in the same variables of the LRA, suggesting less increase in blood flow. Doppler-ratios allowed a noninvasive comparison between splanchnic and aortic hemodynamics. Velocity ratios might be useful for clinical detection of relative hemodynamic changes between different vessels.