Unusual association between “congenitally corrected transposition of the great arteries” and “noncompaction” of the right systemic ventriclePatrignani, Anna; D’Aroma, Alessandro; Cicogna, Sabrina
doi: 10.1007/s10554-009-9469-7pmid: 19437130
Congenitally corrected transposition of the great arteries (CCTGA) is a rare and complex congenital anomaly characterized by atrial-ventricular (AV) discordance and ventricular-arterial discordance. Ventricular noncompaction (VNC) is a rare unclassified cardiomyopathy due to the arrest in intrauterine endomyocardial morphogenesis and it is characterized by numerous prominent trabeculations and intratrabecular recesses. We reported the case of a 47-year old female patient. When she was 35-year old an “isolated” CCTGA was diagnosed because of a heart murmur. Since then she attended periodically echocardiograms. She showed us 2 of them where right ventricle apical trabeculation was reported, without any others details. We performed a periodic evaluation in a patient still active, with a 6-month history of mild dyspnea occurring during exertion, no episodes of chest discomfort or palpitation. The ECG showed ectopic atrial rhythm, 83 bpm, normal QRS duration, QS complex in V1–V2 leads. The echocardiogram demonstrated: CCTGA, moderate enlargement and dysfunction of the right systemic ventricle, moderate to severe systemic AV valve regurgitation, severe thinning and dyskinesia of the basal segment of the septum, apical and mid-segments prominent and numerous trabeculations with deep intertrabecular recesses, better showed by Color Doppler, in continuity with the ventricular cavity. This case presents some distinctive features: (1) the association between two rare congenital anomalies; (2) Striking right VNC, involving the apex and mid-segments, rarely described in literature; right VNC has been proposed according to the presence of 3 over 4 criteria proposed by Jenni et al. (Heart 86:666–671, 2001); (3) Severe thinning and dyskinesia of the basal segment of the septum, probably related to coronary artery abnormalities frequently described in CCTGA patients.
Myocardial bridging: light in the tunnelMartín, M.; Romero Tarín, E.; Luyando, Luis; Rondán, Juan; Morales, Carlos
doi: 10.1007/s10554-009-9470-1pmid: 19468862
Myocardial bridging is a congenital anomaly in which a segment of a coronary artery runs intramuscularly. Although traditionally considered as a benign condition, myocardial bridging may be associated with clinically important complications such as myocardial ischemia, acute coronary syndromes and sudden death. We report the case of a highly symptomatic 36 years old patient with a myocardial bridge in left anterior descending coronary artery in which surgical treatment was proposed. Previous to surgery a non invasive coronariography with Cardiac CT was practised in order to define the anatomy.
A preliminary study on the evaluation of relationship between left ventricular torsion and cardiac cycle phase by two-dimensional ultrasound speckle tracking imagingLuo, Xianghong; Cao, Tiesheng; Li, Zhaojun; Duan, Yunyou
doi: 10.1007/s10554-009-9462-1pmid: 19415523
In normal subjects there is a certain corresponding relationship between the peak rotation angle of the apex and the base with respect to the phase of the cardiac cycle. We hypothesized that the myocardial contractile force and the delay of conduction may affect the correspondence of them. Our study aims to use speckle tracking imaging (STI) technique to analyze the relationship between the left ventricular rotation/torsion (LVrot/ LVtor ) characteristics and cardiac cycle phase, to investigate its clinical feasibility. The echocardiographic images of the short-axis view of the left ventricles (LV) at the apical and basal planes were acquired by STI in 32 healthy controls and 48 heart failure patients (New York Heart Association class I or II). LVtor angle, LVrot angle, the peak value and time of LVtor and LVrot were measured offline using frame-to-frame tracking of gray-scale speckle patterns at the standardized time point, respectively. All the acquired data of the two groups were compared and analyzed. In the healthy controls, there was no significant difference among the isovolumetric contraction time, peak time of clockwise rotation at the apical level and the peak time of clockwise rotation at the basal level segments (P > 0.05). There was no significant difference among systolic time, peak time of counterclockwise rotation at the apical level and peak time of counterclockwise rotation at the basal level segments (P > 0.05). There was no significant difference between systolic time and peak time of LVtor (P > 0.05). Compared with normal group, the peak of LVtor and LVrot angle were decreased at both apical and basal planes in heart failure group (P < 0.05). The peak time of LVtor was delayed in heart failure group (P < 0.05). The peak time of clockwise rotation at the apical level segments was longer than control group (P < 0.05) and continued to the ejection period. In the normal subjects, there is no sequence difference of LVrot between the basal and apical planes. They were correspondent to cardiac cycle. There is a temporal sequence difference of LVrot between basal and apical planes during LV contraction in heart failure group and decreased LVtor/rot have been demonstrated to influence left ventricular function. STI has shown great potential in early detecting the conduction variability in ventricular wall.
Variability of carotid artery measurements on 3-Tesla MRI and its impact on sample size calculation for clinical researchSyed, Mushabbar; Oshinski, John; Kitchen, Charles; Ali, Arshad; Charnigo, Richard; Quyyumi, Arshed
doi: 10.1007/s10554-009-9468-8pmid: 19459065
Carotid MRI measurements are increasingly being employed in research studies for atherosclerosis imaging. The majority of carotid imaging studies use 1.5 T MRI. Our objective was to investigate intra-observer and inter-observer variability in carotid measurements using high resolution 3 T MRI. We performed 3 T carotid MRI on 10 patients (age 56 ± 8 years, 7 male) with atherosclerosis risk factors and ultrasound intima-media thickness ≥0.6 mm. A total of 20 transverse images of both right and left carotid arteries were acquired using T2 weighted black-blood sequence. The lumen and outer wall of the common carotid and internal carotid arteries were manually traced; vessel wall area, vessel wall volume, and average wall thickness measurements were then assessed for intra-observer and inter-observer variability. Pearson and intraclass correlations were used in these assessments, along with Bland-Altman plots. For inter-observer variability, Pearson correlations ranged from 0.936 to 0.996 and intraclass correlations from 0.927 to 0.991. For intra-observer variability, Pearson correlations ranged from 0.934 to 0.954 and intraclass correlations from 0.831 to 0.948. Calculations showed that inter-observer variability and other sources of error would inflate sample size requirements for a clinical trial by no more than 7.9%, indicating that 3 T MRI is nearly optimal in this respect. In patients with subclinical atherosclerosis, 3 T carotid MRI measurements are highly reproducible and have important implications for clinical trial design.
Aortic valves stenosis and regurgitation: assessment with dual source computed tomographyLi, Xiaofei; Tang, Lijun; Zhou, Lei; Duan, Yuqing; Yanhui, Sheng; Yang, Rong; Wu, Yanhu; Kong, Xiangqing
doi: 10.1007/s10554-009-9456-zpmid: 19350414
To prospectively evaluate diagnostic accuracy of dual source computed tomography (DSCT) for evaluation of aortic stenosis (AS) and aortic regurgitation (AR) with transthoracic echocardiography (TTE) as reference. We evaluated a total of 79 patients who underwent both DSCT and TTE, 40 with aortic valve disease as assessed by TTE, and 39 matched controls. Maximum aortic valve area (AVA) in systole was planimetrically measured with DSCT, and measurements were compared with TTE, as well as maximum regurgitant orifice area (ROA) in diastole. Dimensions of the aortic root and left ventricular parameters were compared. DSCT correctly identified 30 patients with AS [sensitivity 91%, specificity 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 94%], and 32 patients with AR (sensitivity 94%, specificity 98%, PPV 97%, and NPV 96%). A significant correlation was observed between CT planimetric size of aortic valves area and TTE (r = 0.79; P < 0.01). Bland-Altman plot demonstrates a good intermodality agreement between DSCT and TTE with a slight overestimation of AVA by DSCT (+0.14 cm2). A significant correlation was observed between CT planimetric size of ROA (0.49 cm2 ± 0.40) and TTE classification of mild, moderate and severe AR (r = 0.79; P < 0.01). With receiver operating characterisitic curve analysis, discrimination between degrees of AR with DSCT was not very accurate within cutoff ROAs. A significant correlation was observed between methods in dimensions of aortic annulus (r = 0.87, P < 0.01), sinus of Valsalva (r = 0.91, P < 0.01), and ascending aorta (r = 0.92, P < 0.01), and in end-systolic volume (r = 0.82, P< 0.01), end-diastolic volume (r = 0.87, P < 0.01) and ejection fraction (r = 0.86, P < 0.01). DSCT can provide a simultaneous and accurate evaluation of the AVA, left ventricular ejection fraction and aortic root dimensions in patients with AS or AR, but measurement of ROA is not very accurate to differentiate severity of AR. DSCT can achieve an exhaustive and comprehensive preoperative assessment of patients with AS and AR.