Dilatation Of Right Chambers Research Articles

Enormous Enlargement of Right Atrium Occurred Late After Surgical Dilation of Pulmonary Valve Stenosis: Case Report.

Congenital pulmonary valve stenosis is a relatively common congenital defect, often related to abnormal development and fusion of pulmonary valves. Critical pulmonary valve stenosis should be treated, early in life, before dilation of right chambers, and occurrence of arrhythmias. We report one case of enormous enlargement of right atrium revealed by typical atrial flutter which occurred very late, in 48-year-old man, who underwent surgical dilation of pulmonary valve stenosis at eleven years old, but without repairing dilated tricuspid annulus. Despite successfully ablation of atrial flutter in our cathlab, the patient developed atrial fibrillation, because of an enormous enlargement of right atrium and massive tricuspid regurgitation.

724 AN UNUSUAL CASE OF ECHOCARDIOGRAPHY-ESTIMATED PULMONARY HYPERTENSION

Abstract Case Presentation 48-years-old woman was diagnosed with severe pulmonary hypertension at transthoracic echocardiography during cardiological evaluation for bariatric surgery. PAPs was estimated 110 mmHg, mild-moderate tricuspidal insufficiency with no dilatation of right chambers and LVEF preserved (65%). The patient had history of heart murmur since childhood and now presented with type 2 diabetes mellitus on metformin treatment, third grade obesity (BMI 55) and dyslipidemia (LDL col. 120 mg/dL). Diagnostic Workup: The patient was symptomatic dyspnea for mild-moderate exertion (NYHA II-III). Heart-beat was rhythmic with 4/6 ubiquitous systolic sharp murmur. Lung auscultation was normal. Bilateral pretibial edema was noted. The cardiac catheterization showed: A transesophageal echocardiography confirmed post-tricuspidal right intraventricular obstruction due to mid-ventricular fibro-muscular rims and disclosed a small restrictive membranous defect on interventricular septum with minimum left-to-right shunt. A cardiac-MRI confirmed an hypertrophic moderator band with obstruction of the outflow tract. The patients was discharged with a program of sleeve-gastrectomy and after surgical correction of cardiac congenital defects. Conclusion The double-chambered right ventricle (DCRV) is an uncommon congenital anomaly: the right ventricle (RV) is divided into two chambers due to the presence of an abnormally located muscular band or anomalous muscle hypertrophy in the sub-infundibular part of RV outflow tract, with a variable grade of obstruction. This anomaly may be missed by the estimation of high pulmonary pressure through tricuspidal regurgitation. Due to limitations of echocardiography in adult patients additional imaging methods, such as MRI, combined with cardiac catheterization data are required for a definitive diagnosis.

P1700 Recurrent inflammatory myofibroblastic tumor of the right ventricle and pulmonary artery

Abstract Introduction Inflammatory myofibroblastic tumor (IMT), also known as plasma granuloma, is a very rare tumor with varying biological behavior, from completely benign to malignant. IMT can occur in virtually every organ, but cardiac origin is extremely rare. IMT occurs mainly in children and young people. The mainstay of treatment is complete surgical resection of the tumor. We present a case of 28 year old white woman with no contributory medical and family history, who was admitted to hospital because of dyspnea and cough. The transthoracic echocardiography (TTE) showed elevated pulmonary artery systolic pressure up to 61 mm Hg and mild dilation of right chambers. Further assessment by computed tomography showed thrombosis of the main pulmonary artery (PA), narrowing its lumen by 90%, with spread to the lobar and segmental arteries of the left lung - signs of massive pulmonary embolism. During thromboendarterectomy revealed a mass, about 4,1 x 3,1 x 1,8 cm in size, with thrombotic overlays, locating at the right ventricular outflow tract (RVOT) and the pulmonary trunk. Histological examination and Immunohistochemistry studies was consistent with IMT with an intermediate potential of malignancy. A year after the operation, the patient became pregnant. Routine TTE showed low density mobile mass narrowing the pulmonary trunk. The transvalvular blood flow velocity was 2.4 m/s. Cardiac magnetic resonance (CMR) was consistent with echo findings. The pregnancy has been preserved, and after 36 weeks it was decided to perform the birth of a girl by means of a Cesarian section. After 2 months, due to an increase in the size of the tumor and the dyspnea, a reoperation was performed to remove the tumor lining the RVOT and intimately connected with the PA valve, excision of the PA valve. A bioprosthesis was installed. The tumor had an identical morphological picture. Conclusion This case report describes a rare recurrent cardiac inflammatory myofibroblastic tumor involving RVOT and PA. The prognosis after surgical treatment of IMT is usually favorable, but it is known that some tumors recur, and rarely they can even metastasize. The long-term outcome is not well established due to the rarity of these tumors. Abstract P1700 Figure.

P879 3D transoesophageal echocardiography to asses a case of a non-ebstein tricuspid valve congenital regurgitation

Abstract Introduction Due to the complexity of congenital heart disease and limitations of transthorathic echocardiogram (TTE), especially in adult patients, it is not unusual to need other image techniques to assess cardiac anatomy and function. The most common primary anomaly of tricuspid valve (TV) is Ebstein anomaly, but there are other much rarer primary anomalies of this valve consisting in prolapse, cord retraction.... without downward displacement of the leaflet, generally causing tricuspid regurgitation (TR) that can be severe and sometimes intervention is needed, preferably reparation. Due to anatomical issues, it is difficult to assess anatomy of TV in TTE, so sometimes 3D-TTE must be performed to clarify the mechanism and to measure orifice, but when transthoracic view is not enough, 3D transoesophageal echocardiogram (TOE) can be useful for this purpose. Case We report the case of a 15-year-old boy that was referred to our clinic because of shortness of breath and a systolic tricuspid murmur. TTE was performed and an image compatible with tricuspid valve prolapse with no apical displacement of any leaflets (Figure, A) causing severe TR (Figure, B) was noticed, as well as severely dilated right chambers, with good ejection fraction of both ventricles. It was not clear the mechanism so 2D TOE was done, showing a prolapse of a leaflet (Figure, C) causing severe TR (Figure, D). The mechanism was finally clarified by 3D TOE (figure E). This was a prolapse of lateral portion of posterior leaflet (asterisk) with restrictive movement of anterior (triangle) and septal (arrow) ones, causing a huge coaptation defect in systole leading to a very severe tricuspid insufficiency with signs of volume overload of right ventricle. There was no atrial septal defect and pulmonary drainage anomalies were ruled out by cardiac magnetic resonance. Patient was referred to surgery due to symptoms and great dilatation of right chambers. Conclusión: Due to anatomical complexity and limitations of echography, cross and multimodality cardiac imaging is usually needed in assessing congenital heart disease. Apart from Ebstein anomaly, other congenital entities of tricuspid valve such as prolapse and/or retraction can lead to severe tricuspid regurgitation. Due to limitations of 2D TTE in assessing tricuspid valve anatomy, 3D TTE has to be performed, but if it is not enough, 3D TOE can be an option to evaluate mechanism and directly see the orifice of regurgitation in congenital disease of tricuspid valve. Abstract P879 Figure

P648 Right heart volume overload after surgical correction of atrial septal defect sinus venosus type with partial anomalous pulmonary veins drainage

Abstract 40 year-old male with history of congenital heart disease. Atrial septal defect (ASD) sinus venosus type associated with partial anomalous pulmonary venous drainage (PAPVD) was diagnosed during childhood and surgically repaired at the age of three. Since then the patient was asymptomatic and he was lost to follow up when reached adulthood. A transthorathic echocardiogram was performed during a hospitalization because of a complicated pneumonia. A severe dilatation of right chambers and main pulmonary artery was observed. The estimated Qp:Qs by this technique was 2.0 but the atrial septum seemed to be intact. Agitated saline was administered in this procedure and no passage of microbubbles was observed. A cardiac MRI was performed because of suspicion of anomalous pulmonary venous drainage. The findings observed in the echocardiogram were confirmed and an uncommon PAPVD was demonstrated by this technique: the superior left pulmonary vein drainaged into a dilated innominated vein. Also, a small pulmonary vein from the right upper lobe emptied into a "venous conduct" (yellow circle) located posterior to the superior cava vein (SCV) that later drainaged into the right atrium under the mouth of the SVC, posterior to the interatrial septum. Surgically correctioin of the PAPVD was performed. Discussion PAPVD is a congenital heart disease characterized by the drainage of one or several pulmonary veins –but not all of them- into the right atrium or systemic veins, which leads to left-to-right shunting. The estimated incidence of this disease ranges between 0.1 and 0.2% of the general population. The right superior pulmonary vein is the most frequently involved and is commonly associated to ASD sinus venosus type. Bilateral anomalous drainage, as occurred in this case, is exceptional. Furhermore, this case highlights the importance of long-term follow-up in patients with congenital heart disease due to the fact that, even when the disease is considered to be cured, long term complications could appear compromising the prognosis of the patient. Abstract P648 Figure. Unusual PAPVD

Embolismo paradojal - tromboembolismo pulmonar e isquemia cerebral por foramen oval permeable: reporte de caso

El 30 a 40% de las enfermedades cerebrovasculares presentan un origen desconocido o criptogénico. Puede estar relacionado con la persistencia de foramen oval (FOP), cuya prevalencia es de 12 a 30%. Reportamos el caso de una paciente mujer de 62 años, que fue intervenida por tumoración de tiroides. En el postoperatorio presentó disnea, hipoxemia, compromiso de conciencia y afasia de expresión. La ecocardiografía transtorácica mostró dilatación de cámaras derechas y la ecocardiografía transesofágica reveló un foramen oval permeable (FOP) con la presencia de ecos compatibles con coágulos que bordeaban dicho orificio: la tomografía cerebral evidenció un infarto cerebral en el hemisferio izquierdo. El hallazgo de coágulos y del FOP en el intraoperatorio confirmó el desarrollo de tromboembolismo pulmonar y embolismo paradojal.

Value of Two Dimensional Echocardiography for Assessment of Disease Severity in Patients With Pulmonary Hypertension

To carry out complex assessment of the right ventricular (RV) function with two-dimensional echocardiography (2D-EchoCG) for detection of most informative markers of the disease severity in patients with pulmonary hypertension (PH). We examined 63 patients with PH (38 with idiopathic PH, 7 with corrected congenital heart defects, 6 with systemic scleroderma, 12 with chronic inoperable thromboembolic PY). Examination included right heart catheterization, 2D-EchoCG, and cardiac magnetic resonance tomography (MRT). 2D-EchoCG revealed dilation of right chambers of the heart, hypertrophy of RV anterior wall, increase of ratio of right to left ventricular end-diastolic dimensions (RV:LV), reduction of LV stroke volume, diminution of amplitude and velocity of tricuspid annular plane systolic excursion, and significant increase of myocardial performance index Tei. MRT data evidenced for lowering of RV ejection fraction. Canonical correlation was found between integral characteristic of 2D-EchoCG and integral hemodynamic characteristic (r=0.77; p=0.007). We also determined threshold values of RV: LV to be used for stratification of risk in patients with PH. In patienns with PH calculation of simple 2D-EchoCG parameters provides information important for determination of disease severity, selection of optimal method of treatment, and monitoring of patients condition.

0301: Pulmonary embolism mimicking acute coronary syndrome: How to make the right diagnosis? A case report and literature review

Clinical and electocardiographic features in Pulmonary Embolism lack of specificity and may mimic an acute coronary syndrom. We report a case of a 55-year-old man hypertensive and with history of active smoking, presenting with epigastric pain and polypnea, the Troponin was positive (12.51 ng/ml, normal values <0,06 ng/ml) and at the ECG we found negative T waves in anterior teritory initially diagnosed as Non-STEMI, the coronary angiography was normal, and the echocardiography found a major dilatation of right chambers (DTDRV / DTDLV >1) and pulmonary hypertention (45 mmHg), thoracic CT angiograpm objectify a massive embolism of the right and left pulmonary arteries, which confirmed the diagnosis of intermediate risk pulmonary embolism and the treatment was adjusted, the patient was discharged under acenocoumarol. We report through this clinical case a misdiagnosed pulmonary embolism treated as Non-STEMI, the clinical and electectrocardiographic features may be confusing between this two emergencies, because of lack of specificity of the symptoms, the hypothesis of pulmonary embolism may be suspected by the echocardiography when aspect of acute Cor pulmonale is present and the confirmation should be obtained by thoracic CT angiogram.

Displasia congénita de la válvula tricúspide (Ebstein like) en un varón de 73 años con insuficiencia tricuspídea severa

Multiple congenital abnormalities in the structure of the tricuspid valve have been described and, the majority of cases could be considered as variations of Ebstein's anomaly. The onset of the symptoms and the diagnosis depend on the severity of the valve dysfunction and the right ventricular function and size. The age at diagnosis ranges from birth to adulthood, but a delayed diagnosis is rare when tricuspid regurgitation is severe. We cite as an example the case of a 73 year-old male classified as class I of the NYHA up to 5 months before, since then he developed progressive ascitis and edema on his legs. The physical examination suggested severe tricuspid regurgitation. We performed a transtoracic and transesophageal ecocardiogram that showed severe dysplasia in the tricuspid leaflets, severe regurgitation because of lack of adequate joining, dilatation of right chambers and right ventricular systolic dysfunction.