Routine Echocardiographic Screening Research Articles

Frequency Of Left Ventricular Thrombi In Dilated Cardiomyopathy Patients Presenting In Tertiary Care Hospital Of Punjab

Objective: This study has been carried out to determine the frequency of left ventricular thrombi in dilated cardiomyopathy patients presenting in tertiary care hospitals in Punjab. Methods: This descriptive case series was carried out at Arif Memorial Teaching Hospital Lahore. This study involved 150 children of both genders aged between 4-12 years diagnosed with dilated cardiomyopathy. These children underwent echocardiographic screening for left ventricular thrombi (mass filling the ventricular cavity and distinct from normal endocardium). The frequency of left ventricular thrombi was noted and compared across various subgroups of children based on age, gender and BMI. Written informed consent was obtained from parents of every child. Results: The mean age of the children was 8.5±2.4 years. There were 98 (65.3%) boys and 52 (34.7%) girls with a male-to-female ratio of 1.9:1. The mean BMI of these children was 26.9±3.0 Kg/m2 and 29 (19.3%) children were obese. 63 (42.0%) children had left ventricular thrombi. There was no statistically significant difference in the frequency of left ventricular thrombi across various subgroups of children based on age (p-value=0.979), gender (p-value=0.956), and BMI (p-value=0.731). Conclusion: In the present study, a substantial proportion of children with dilated cardiomyopathy had left ventricular thrombi which due to the associated risk of thromboembolism and CVA warrant routine echocardiographic screening of such children so that timely identification and anticipated management may improve the outcome of children with dilated cardiomyopathy in future pediatric practice. Keywords: Dilated cardiomyopathy, Left ventricular thrombus, echocardiography

Anaesthetic management of three Maine Coon cats undergoing hybrid intervention for treatment of cor triatriatum sinister

AbstractThis report describes the anaesthetic management of three Maine Coon cats undergoing hybrid cutting balloon dilatation for treatment of cor triatriatum sinister. In cat 1, cor triatriatum sinister was an incidental finding during routine transthoracic echocardiographic screening. Cats 2 and 3 presented with tachypnoea and underwent preoperative therapy with diuretics and antithrombotics. All cats were premedicated with fentanyl. Anaesthesia was co‐induced with midazolam and either etomidate (cats 1 and 2) or alfaxalone (cat 3). Sevoflurane, a fentanyl continuous‐rate infusion and a dexmedetomidine continuous‐rate infusion were used for maintenance of anaesthesia. Intravenous methadone, epidural morphine and methadone, an intercostal block and a subcutaneous wound splash with local anaesthetics complemented the analgesic protocol. Intraoperative complications included arrhythmias, bleeding, hypotension and hypothermia. Postoperative emergence delirium and haemothorax developed in two and one cat, respectively. All three cats recovered well and were discharged home.

Cardiomyopathy in Cirrhotic Patients and Its Relationship with the Severity of Cirrhosis

Study Objectives: To determine the frequency of cirrhotic cardiomyopathy in patients with liver cirrhosis and to compare it across varying grades of cirrhosis on Child Turcotte Pugh classification. Study Design and Settings: It was a descriptive cross-sectional study carried at Department of Medicine, Lahore General Hospital Lahore over 1 year from Jan 2018 to Dec 2018. Patients and Methods: The present research involved 100 male and female patients aged between 16-70 years having liver cirrhosis diagnosed at least 6 months ago. These patients underwent echocardiographic screening of cardiomyopathy which was diagnosed by the presence of diastolic dysfunction (i.e. increased E/A ratio>1). An informed written consent was obtained from every patient. Results of the Study: There was a male predominance (M:F, 1.6:1) among cirrhotic patients with a mean age of 51.9±9.8 years. The mean BMI was 26.5±3.7 Kg/m2 while the mean duration of cirrhosis was 22.0±10.9 months. Majority (49.0%) of the patients belonged to CTP Class C followed by Class-B (39.0%) and Class-A (12.0%). Cirrhotic cardiomyopathy was observed in 41.0% patients with cirrhosis. There was statistically insignificant difference in the observed frequency of cirrhotic cardiomyopathy among various subgroups of cirrhotic patients depending upon patient’s age (p-value=0.928), gender (p-value=0.997), BMI (p-value=0.983) and duration of disease (p-value=0.782). However, it increased considerably with worsening of disease on CTP Classification; Class-A vs. Class-B vs. Class-C (8.3% vs. 35.9% vs. 53.1%; p-value=0.013). Conclusion: Cirrhotic cardiomyopathy was observed in a substantial proportion of cirrhotic patients and was more frequent in patients with more severe disease which warrants routine echocardiographic screening of cirrhotic patients so that timely recognition and anticipated treatment of this complication may improve the case outcome in future medical practice. Keywords: Cirrhosis, Cardiomyopathy, Child Turcotte Pugh Class

Echocardiographic Screening of Cardiovascular Status in Pediatric Sickle Cell Disease.

Although elevated right ventricular pressure and left ventricular diastolic dysfunction measured by echocardiogram are independent predictors of death in adults with sickle cell disease (SCD), the utility of routine echocardiographic screening in the pediatric population is controversial. We performed a 3-year retrospective review of children ≥ 10years of age with SCD who underwent an outpatient transthoracic echocardiogram as part of a screening program. Of 172 patients referred for screening, 105 (61%) had a measurable tricuspid regurgitation jet velocity (TRV): median 2.4m/s (IQR 2.3-2.5). Elevated right ventricular (RV) pressure (TRV ≥ 2.5m/s, 25mmHg), documented in 30% (32/105), was significantly associated with chronic transfusion therapy and elevated lactate dehydrogenase. Left ventricle (LV) dilation, documented in 25% (44/172), was significantly associated with lower hemoglobin, and higher reticulocyte count, lactate dehydrogenase level, and bilirubin level. There was no association between elevated right ventricular pressure or left ventricle dilation and indices of biventricular systolic or diastolic function. The one death in the cohort during the study period had normal echocardiographic findings. In conclusion, mild RV pressure elevation and LV dilation in children with SCD is associated with abnormal laboratory markers of disease severity, but not with ventricular dysfunction over the 3-year study period.

Echocardiographic screening in children with very severe obstructive sleep apnea

Objective(i) To determine the prevalence of echocardiographic abnormalities in children with very severe OSA defined by an apnea hypopnea index (AHI) ≥ 30 events/hour. (ii) To test the hypothesis that polysomnographic parameters predict echocardiographic variables in this population. MethodsChildren aged 1–17 years presenting with polysomnography demonstrating an AHI ≥30 and referred for pre-operative echocardiography performed within the 6 months prior to tonsillectomy and adenoidectomy (T&A), over a two-year period (January 1, 2016 to December 31, 2018) were evaluated. The exclusion criteria were the presence of (i) unrepaired congenital cardiac disease, (ii) tracheostomy, (iii) poorly controlled asthma, or (iv) neuromuscular disorder. The prevalence of echocardiographic abnormalities was determined for the study population. The impact of the severity of OSA on echocardiographic parameters was evaluated using Student's t-test. The relationships between polysomnographic variables and biventricular function as well as pulmonary hemodynamics were measured. A penalized regression model was used to identify the contributions of polysomnographic variables to each echocardiographic parameter by mitigating inter-variable relationships. P < .05 was considered significant. ResultsEighty-nine children were screened, of whom 47 were included for analysis. The mean age was 68.8 months [95% confidence interval, 56.0 to 81.6]. Thirty-three (70.2%) were boys. Twenty (42.6%) were obese. All children had normal echocardiograms. The differences in echocardiographic variables between children grouped by the severity of OSA were not statistically significant (P: 0.18-0.98). Polysomnographic variables predicted only 4 out of 13 studied echocardiographic parameters. ConclusionsPre-operative echocardiography did not identify significant abnormalities in children with very severe OSA. Majority of the echocardiographic variables were not predicted by polysomnographic parameters. This study demonstrates the limited benefit associated with routine echocardiographic screening of children with very severe OSA solely based on polysomnographic indices.

Progression of Right Ventricular Systolic Dysfunction Detected by Myocardial Deformation Imaging in Asymptomatic Preterm Children.

BackgroundTo detect progression of right ventricular (RV) systolic dysfunction (RVSD) in asymptomatic preterm children from infancy to 24-month corrected age, using velocity vector imaging (VVI).MethodsRetrospective study comparing sequential RV longitudinal peak systolic strain (LPSS) from 24 children born at < 33 weeks of gestational age and 10 term infants recruited as controls, obtained at a mean of 4-month (first exam) and 24-month corrected age (second exam).ResultsIn 7/24 (29.2%) of preterm children, RV LPSS of < 16%, defined as RVSD, was detected at the second exam; 5/7 of these children had RV LPSS > 16% at the first exam, and only 2/7 of these children had a history of moderate or severe bronchopulmonary dysplasia.ConclusionIn asymptomatic preterm children, routine echocardiographic screening using VVI could detect RVSD which could progress from 4–24 month corrected age.

(1128) - Utility of the Routine Screening Echocardiogram After Endomyocardial Biopsy for Identification of Hemopericardium or Tricuspid Valve Injury

There is risk of hemopericardium and tricuspid valve injury after endomyocardial biopsy (EMB). Prior studies have shown that procedural complications during EMB are uncommon. The practice of obtaining a routine screening echocardiogram after EMB is varied. The purpose of this study was to determine the utility of the routine screening echocardiogram in identifying complications after EMB. All echocardiograms performed on the same day after an EMB, from January 2010 through August 2015, were reviewed at a single institution where echocardiograms are routinely performed after each EMB. Studies describing significant pericardial effusion (defined as at least “small-moderate”) and/or tricuspid regurgitation (defined as at least “moderate”) were identified. During the study period, 2,200 EMB were performed in 204 heart transplant patients (median age 11.9 yrs, range 0.3-24). Seventy-four percent (1,630/2,200) of the EMB were followed by a routine echocardiogram on the same day. Thirty-four at least “small-moderate” pericardial effusions were noted in 15 patients. Of these, there was one new “moderate” pericardial effusion that required pericardiocentesis and was found to have hemopericardium. Of note, hemodynamic compromise had already been detected in this 5 yo patient, who received a fluid bolus in recovery prior to his echocardiogram. The other 33 effusions had been seen in previous echocardiograms. These effusions were all expectantly managed and none required intervention. Two echocardiograms identified new flail tricuspid valve with at least “moderate” regurgitation in 2 different patients (age 3 and 13yrs). To date, only the younger patient has undergone surgical tricuspid valvuloplasty. Echocardiography following endomyocardial biopsy rarely detects clinically significant complications. These findings argue against the utility of routine post-biopsy echocardiographic screening for identification of hemopericardium or tricuspid valve injury.

Surgical Approach To A Right Ventricular Hydatid Cyst

Hydatid disease (HD) is a parasitic infection caused by larvae of Echinococcus granulosus. HD may affect almost any part of the body. Cardiac involvement in HD is uncommon, constituting only 0.5-2% of all cases of hydatidosis. Here, we present a 29-year-old male patient with a right ventricular hydatid cyst treated surgically. Surgery still remains the treatment of choice in the management of HD. We also believe that routine echocardiographic screening may be useful in endemic regions where the infestation is common.

A study of cardiac complications in HIV infected children

Results Out of 100 HIV infected children, 42% [25 males, 17 females] had cardiac abnormalities of which only 6 [14%] were symptomatic. Majority belonged to WHO clinical stage IV, with 13 [28%] having low CD4 count. The most common cardiac abnormality was left ventricular systolic dysfunction (LVSD) in 19% (p 0.05). Conclusion Though the majority of the children were asymptomatic, investigations revealed 42% with subclinical cardiac abnormalities. They had significant dyslipidemia and anemia as compared to children without cardiac abnormalities. The study thus emphasizes the need for routine echocardiographic screening.

Transaortic Video-Assisted Resection of a Recurrent Left Ventricular Myxoma

An asymptomatic 57-year-old woman presented for resection of a fifth cardiac myxoma. To avoid complete redissection of the heart, we proposed a video-assisted transaortic approach for a recurrent left ventricle (LV) myxoma resection. In a hybrid approach, sternotomy and open aortotomy provided the minimally invasive transaortic access to the myxoma. The myxoma was discovered during a routine echocardiographic screening. A 30° 5-mm scope, video-assisted thoracic surgery graspers, and endoshears were used for resection. The video-assisted technique significantly enhanced the intracardiac visualization, and a smaller, second myxoma was discovered after resection of the primary lesion. Both myxoma beds were additionally ablated to prevent recurrence. The total video-assisted operating time was 58 minutes. The transaortic valve approach avoided an atriotomy or ventriculotomy in a fifth redo operation. A transaortic valve approach to LV intracardiac lesions is safe and feasible, and it provides excellent visibility for complex cardiac cases.

071 Concentric hypertrophic remodelling and subendocardial dysfunction in mitochondrial DNA point mutation carriers

BackgroundCardiomyopathy is an independent predictor of morbidity and early mortality in mitochondrial DNA disease, and occurs in 20%–40% of adult patients harbouring the common m.3243A>G mutation, usually with a hypertrophic...

Prevalence and outcome of subclinical rheumatic heart disease in India: The RHEUMATIC (Rheumatic Heart Echo Utilisation and Monitoring Actuarial Trends in Indian Children) study

ObjectiveTo study the prevalence and medium term outcome of subclinical rheumatic heart disease (RHD) in India.DesignCross sectional echocardiographic screening study.SettingSchool children aged 5–15 years living in rural areas of north...

136 Should familial screening be routinely offered to patients with bicuspid aortic valve disease?

Background Bicuspid aortic valve (BAV) disease is one of the most common congenital cardiac abnormalities with prevalence in the general population of up to 2%. There has been growing evidence supporting its familial predisposition with an autosomal dominant pattern of inheritance. It is often associated with ascending aortic dilatation and dissection, occurring at a younger age than in patients with idiopathic aortic aneurysms. BAV disease carries a 6% lifetime risk of aortic dissection, 9 times higher than that of the general population. Thus, the presence of BAV and dilatation of the ascending aorta requires regular monitoring with a view to timely pre-emptive surgery. Current ACC/AHA guidelines state that echocardiographic screening of first degree relatives of patients with BAV is recommended. This, however, to our knowledge, is not routinely done within the UK. Methodology and Results We set out to explore the practicalities of running a routine echocardiographic screening programme for first degree relatives of patients with BAV disease. We identified a total of 47 patients who had undergone aortic valve surgery performed by the same Consultant Cardiothoracic Surgeon in the context of BAV disease in the period May 2007–September 2009. Screening of first degree relatives was offered to these patients. 24 patients (51%) gave us information regarding family members who would like to attend for an echocardiogram. A total of 75 first degree relatives were referred–an approximate average of 3 per patient. Out of these, 52 relatives (70%) actually attended for an appointment. The remainder did not undergo testing with us as they either lived in a different geographic region or expressed a personal preference not to be scanned at this time. The incidence of newly diagnosed bicuspid aortic valve disease in our cohort of first degree relatives was 8% (4 out of 52 relatives). One of these asymptomatic individuals had a significant ascending aortic aneurysm, which required prompt surgery. Among the relatives of the 24 index patients, there were a total of 8 cases (3: 1 ratio) of bicuspid aortic valve disease—either known or newly diagnosed via screening. Conclusions There is a relatively high prevalence and incidence of bicuspid aortic valve disease among first degree relatives of patients with this common congenital cardiac abnormality. Routine echocardiographic screening should be offered to these families. Implementing such a programme is limited by adequate motivation to attend for a screening test if well, and by varying clinical practice in different geographic regions. Patients with bicuspid aortic valve disease should be made aware of its familial pattern of inheritance and screening of their first degree relatives should be actively pursued in order to reduce the potential morbidity and mortality associated with this condition and its related aortopathy.

Familial Recurrent Atrial Myxoma: Carney's Complex

We report on a family of 4 members, all of whom have had multifocal, recurrent atrial myxomas associated with skin pigmentation, melanotic schwannomas, mucocutaneous myxomas, and tumors of the ovary and pituitary, adrenal, and thyroid glands. Immunochemistry of the myxoma cells is positive for calretinin, confirming their neuroendocrine origin. Genetic studies confirmed mutations in the gene coding protein kinase A, regulatory subunit 1-α (PRKAR1α). This is Carney's complex, characterized by multiple, mucocutaneous myxomas; pigmented lesions over the lips, conjunctiva, and genitalia; adenomas of the breast and thyroid; schwannomas; and endocrinal abnormalities including Cushing syndrome and acromegaly. Members of the family require vigorous screening, including urinary free cortisol, plasma transforming growth factor-β(1) and thyrotropin-releasing hormone, testicular ultrasound, routine echocardiographic screening, searches for cardiac and mucocutaneous myxomas in multiple locations, and genetic studies for the PRKAR1α gene sequence.

1173 Determinants of left atrial dilation in patients with hypertrophic cardiomyopathy

s S209 Eur J Echocardiography Abstracts Supplement, December 2006 performed. Fourteen pts had a follow-up echocardiogram; totally we collected data of 300 echocardiograms. The PE was classified as very mild (mean distance between the pericardial layers 5 and 2 cm). Results: The pts were 228 males, 57 females, 1 transexual (male to female), aged 22 to 66 yrs (mean 40). Among the 286, 122 had AIDS (55 non-Hodgkin lymphoma, 16 Kaposi sarcoma, 10 carcinomas, 41 systemic infections). PE was detected in 31 pts (10.8%) at first examination and in two more pts at follow-up: totally 33 pts (11.5%) had PE, that was very mild in 20, mild in 11, large (requiring pericardial drainage) in 2 pts. PE was more frequent in pts with AIDS than in those without (17.2% vs 7.3%, p<0.05). Among AIDS pts, it was more frequent in those with lymphoma than in those without it (27.2% vs 8.9%, p<0.05). Two pts with myocarditis had mild PE. Conclusions: Pericardial effusion is rare in our HIV+ population, and seldom requires therapeutic interventions. It is more frequent in AIDS pts and, among them, in pts with lymphoma. Routine echocardiographic screening is not recommended in HIV+ pts, unless there is a clinical suspicion of heart disease.

Weight Lifting and Aortic Dissection: More Evidence for a Connection

Background/Aims: In 2003, we reported on a small number of patients in whom acute aortic dissection appeared to be causally related to intense weight lifting. If additional cases could be identified, the phenomenon of weight lifting induced aortic dissection would be further substantiated. We now report a substantially larger number of cases in which aortic dissection is associated with intense physical exertion. Methods: Additional cases of acute aortic dissection occurring at the time of intense physical exertion were accumulated and analyzed. Cases were culled from retrospective review of a large university data base and from reports forwarded to our attention from around the country. We determined type of activity bringing on symptoms, age and sex of the patients, location of the dissection (ascending or descending aorta), aortic size, therapy, and survival. Results: We identified 31 patients in whom acute aortic dissection occurred in the context of severe physical exertion, predominantly weight lifting or similar activities. All patients except one were males. Mean age was 47.3 (range = 19–76). All except four dissections were in the ascending aorta. Only three patients (9.7%) had a family history of aortic disease. Mean aortic diameter on the initial imaging study was 4.63 cm. Twenty-six of the 31 cases were diagnosed ante-mortem and 5 post-mortem. Overall, 10 of the 31 patients (32.2%) died. Of 24 patients reaching surgical therapy, 20 (83.3%) survived. Conclusion: Weight lifting related acute aortic dissection appears to be a real phenomenon, with increasing evidence for the association of extreme exertion with this catastrophic aortic event. Moderate aortic dilatation confers vulnerability to exertion-related aortic dissection. Individuals with known aortic dilatation should be cautioned to refrain from weight lifting or strenuous exertion. Routine echocardiographic screening of individuals engaging in heavy strength training should be considered, in order to prevent this tragic loss of life.

Editorial: Thromboembolic Complications After Fontan Procedures—The Role Of Prophylactic Anticoagulation

Editorial: Thromboembolic Complications After Fontan Procedures—The Role Of Prophylactic Anticoagulation

Associated Malformations in Infants With Cleft Lip and Palate: A Prospective, Population-based Study

Infants with cleft lip and palate may often have other associated congenital defects although the reported incidence and the types of associated malformations vary between different studies. The purpose of this investigation was to assess the prevalence of associated malformations in a geographically defined population. The prevalence of associated malformations in infants with clefts were collected prospectively between 1975 to 1992 on all infants born in greater Stockholm, Sweden. The patient records were also compared with data from the National Malformation Registry and other hospital records if any. Of the 616 cleft infants (367 boys, 249 girls) born during this period, 21% had associated malformations that either required follow-up or treatment. Associated malformations were more frequent in infants who had both cleft lip and palate (28%) than in infants with isolated cleft palate (22%) or infants with isolated cleft lip (8%). Malformations of the upper or lower limbs or the vertebral column were the most common other anomalies and accounted for 33% of all associated defects. Twenty-four percent of associated malformations were in the cardiovascular system and congenital heart disease was the most common isolated associated malformation. Fifteen percent of all associated malformations were multiple and they were frequently associated with mental retardation or chromosomal anomalies. Twenty-two percent of infants with associated malformations were born preterm, compared with an expected 5% incidence of preterm delivery in Sweden. A more extensive cleft seems to be associated with a higher risk for associated malformations. Although many associated congenital defects can be detected at a physical examination, the high prevalence of congenital heart disease (16 times that of general population) may justify a routine echocardiographic screening.

Urokinase Therapy in Neonates with Catheter Related Central Venous Thrombosis

The results of fibrinolytic therapy with urokinase were evaluated in 26 neonates with catheter related central venous thrombosis. Complete thrombolysis could be achieved in 13 patients (50%), partial thrombolysis in 3 patients (12%). No effect was seen in 10 patients (38%). Therapy success was influenced by age, size and location of the thrombus. Coincidence of infection occurred in 16 patients (62%). Mild hemorrhagic complications were seen in 2 patients (8%), no other significant side effects were observed. Nine patients with residual thrombosis were treated with oral anticoagulants following urokinase resulting in resolution of the thrombus in 6 patients within 3 months (67%). The incidence of asymptomatic recurrent thrombosis was high (28%). Urokinase might be an effective and safe treatment for central venous thrombosis in neonates. Prophylactic antibiotic therapy during the infusion of urokinase and long-term treatment with oral anticoagulants after thrombosis are advisable. Early detection of thrombosis might enhance the success rate of fibrinolytic therapy. Therefore, we strongly recommend routine echocardiographic screening of central venous catheters.

Antenatal diagnosis of congenital heart disease and fetal arrhythmia by ultrasound: prospective study.

Fetal echocardiographic and Doppler ultrasonographic prospective studies were performed in utero on 299 babies delivered at Hirata Municipal Hospital, Shimane, Japan, from May 1984 to June 1986. Two or three ultrasonographic examinations were performed on each fetus from 20 weeks of gestation to term. Three congenital heart anomalies and 12 fetal arrhythmias were diagnosed antenatally, but 3 heart anomalies (2 small ventricular septal defects and 1 moderate pulmonary stenosis) were not detected in utero. Routine echocardiographic screening appears to be a useful diagnostic tool to detect congenital heart anomalies and fetal arrhythmia antenatally.