Atrioventricular discordance with ventricular-arterial discordance is a rare cardiac anomaly know... more Atrioventricular discordance with ventricular-arterial discordance is a rare cardiac anomaly known as congenitally corrected transposition of the great arteries (CCTGA). This malformation has a prevalence of 0.4–0.6% of all congenital heart disease cases. Complete heart block develops in up to 30% of patients with CCTGA. We present the case of a 62-year-old woman diagnosed with CCTGA who, on echocardiography, had anomalous venous drainage where the inferior vena cava (IVC) bypassed the right atrium and drained into the azygos system. Complementary images with magnetic resonance imaging demonstrated the unique anatomical relationship between the IVC, azygos venous system, and the superior vena cava. (Echocardiography 2012;29:E16-E19)
A 63-year-old lady presented with syncope and atypical chest pain. Conventional two-dimensional (... more A 63-year-old lady presented with syncope and atypical chest pain. Conventional two-dimensional (2D) contrast echocardiogram showed a highly vascular mass compressing the right atrium without direct communication. A real-time three-dimensional echocardiogram (RT3DE) revealed its outer spatial relationship with the surrounding structures and its inner heterogeneity as well. A chest computed tomography revealed a solid cardiac mass (6 x 7 cm(2)) arising from the right atrium and multiple pulmonary nodules. Histopathology of the pericardial fluid confirmed angiosarcoma. To our knowledge, this is the first report of histology-confirmed primary cardiac angiosarcoma, which was completely evaluated by conventional 2D, contrast, and RT3DE.
Left ventricular noncompaction (LVNC) is a cardiomyopathy that occurs due to an arrest of myocard... more Left ventricular noncompaction (LVNC) is a cardiomyopathy that occurs due to an arrest of myocardial maturation during embryogenesis. The diagnostic echocardiographic features in individuals with LVNC include a thick, bilayered myocardium, prominent ventricular trabeculations, and deep intertrabecular recesses. Clinical features associated with LVNC vary in asymptomatic and symptomatic patients, and include the potential for heart failure, conduction defects (eg, left bundle branch block), supraventricular and ventricular arrhythmias, thromboembolic events, and sudden cardiac death. The authors report five cases that emphasize asymptomatic and apparently benign symptoms in patients with LVNC; despite normal physical examination and 12-lead electrocardiogram results, all of these cases unveiled potentially serious clinical consequences. These cases highlight the concern that LVNC patients with mild to moderate left ventricular systolic dysfunction, particularly in the presence of ven...
Atrioventricular discordance with ventricular-arterial discordance is a rare cardiac anomaly know... more Atrioventricular discordance with ventricular-arterial discordance is a rare cardiac anomaly known as congenitally corrected transposition of the great arteries (CCTGA). This malformation has a prevalence of 0.4-0.6% of all congenital heart disease cases. Complete heart block develops in up to 30% of patients with CCTGA. We present the case of a 62-year-old woman diagnosed with CCTGA who, on echocardiography, had anomalous venous drainage where the inferior vena cava (IVC) bypassed the right atrium and drained into the azygos system. Complementary images with magnetic resonance imaging demonstrated the unique anatomical relationship between the IVC, azygos venous system, and the superior vena cava.
European Heart Journal - Cardiovascular Imaging, 2012
Echocardiography is an important imaging modality used to determine the indication of left ventri... more Echocardiography is an important imaging modality used to determine the indication of left ventricular assist device (LVAD) implantation for patients with advanced heart failure (HF) and for serial follow-up to make management decisions in patient care post-implant. Continuous axial-flow LVAD therapy provides effective haemodynamic support for the failing left ventricle, improving both the clinical functional status and quality of life. Echocardiographers must develop a systematic approach to echocardiographic assessment of LVAD implantation and post-LVAD implant cardiac morphology and physiology. This approach must include the evaluation of left and right heart chamber morphology and physiology and the anatomy and physiology of the inflow and outflow cannulas and the rotor pump, and the determination of the degree of tricuspid regurgitation and the presence of interatrial shunts and aortic regurgitation. Collaboration among the echocardiography and HF/transplant teams is essential to obtain this comprehensive evaluation. We outline a systematic approach to evaluating patients with HF who have failed conventional therapy and require LVAD therapy as a bridge to cardiac transplantation or destination therapy.
Viable treatment options for advanced heart failure have not emerged as the number of people affl... more Viable treatment options for advanced heart failure have not emerged as the number of people afflicted with this condition has grown. Although heart transplantation is the only curative strategy for patients with end-stage heart failure, the relative shortage of donors has led to a worldwide plateau of this option over the past 20 years. The result is an unacceptably high mortality rate among patients with advanced heart failure. Interest in developing alternative curative strategies based on chronic circulatory support, with the aim of prolonging and improving quality of life for these patients, has grown. Patients supported with left ventricular assist devices require structured longitudinal care from a team of providers. An integrated approach using basic echocardiography is critical to patient selection, implantation, and continued surveillance and success of patients with left ventricular assist devices.
Journal of the American Society of Echocardiography, 2012
Left ventricular noncompaction (LVNC) is a cardiomyopathy associated with sporadic or familial di... more Left ventricular noncompaction (LVNC) is a cardiomyopathy associated with sporadic or familial disease, the latter having an autosomal dominant mode of transmission. The clinical features associated with LVNC vary from asymptomatic to symptomatic patients, with the potential for heart failure, supraventricular and ventricular arrhythmias, thromboembolic events, and sudden cardiac death. Echocardiography is the diagnostic modality of choice, revealing the pathognomonic features of a thick, bilayered myocardium; prominent ventricular trabeculations; and deep intertrabecular recesses. Widespread use and advances in the technology of echocardiography and cardiac magnetic resonance imaging are increasing awareness of LVNC, and cardiac magnetic resonance imaging is improving the ability to stage the severity of the disease and potential for adverse clinical consequences. Study of LVNC through research in embryology, imaging, and genetics has allowed enormous strides in the understanding of this heterogeneous disease over the past 25 years.
Speckle tracking echocardiography (STE) is an emerging tool to characterize and quantify myocardi... more Speckle tracking echocardiography (STE) is an emerging tool to characterize and quantify myocardial segmental and rotational mechanics. This literature review is aimed at clinical and academic cardiologists to provide: (1) a conceptual framework of STE to initiate understanding of myocardial mechanics; (2) evidence that three-dimensional (3D) STE overcomes the problems of time-consuming data acquisition and postprocessing seen with two-dimensional STE; and (3) illustrative clinical cases with analysis of myocardial mechanics via 3D STE to show the incremental value of strain in clinical decision making.
Physicians participate in the screening, routine medical supervision, and disqualification proces... more Physicians participate in the screening, routine medical supervision, and disqualification process of collegiate student athletes today. Physicians and universities evaluating collegiate student athletes for athletic participation should understand the meticulous medical process necessary to make eligibility/disqualification decisions and the associated liability issues. It is the responsibility of a team physician to take the lead role in the college sports medical evaluation process. The first duty of a team physician and institution is to protect the health and well-being of their collegiate student athletes. The potential liability associated with the evaluation process requires institutions of higher education and physicians to develop sound and reasonable administrative strategies regarding college athletes and their participation in intercollegiate athletics. Reducing this liability risk requires an understanding of the evolving judicial framework and compliance with standard case law and available guidelines. As medical professional standards evolve, so will responsibilities under legal standards.
Atrioventricular discordance with ventricular-arterial discordance is a rare cardiac anomaly know... more Atrioventricular discordance with ventricular-arterial discordance is a rare cardiac anomaly known as congenitally corrected transposition of the great arteries (CCTGA). This malformation has a prevalence of 0.4–0.6% of all congenital heart disease cases. Complete heart block develops in up to 30% of patients with CCTGA. We present the case of a 62-year-old woman diagnosed with CCTGA who, on echocardiography, had anomalous venous drainage where the inferior vena cava (IVC) bypassed the right atrium and drained into the azygos system. Complementary images with magnetic resonance imaging demonstrated the unique anatomical relationship between the IVC, azygos venous system, and the superior vena cava. (Echocardiography 2012;29:E16-E19)
A 63-year-old lady presented with syncope and atypical chest pain. Conventional two-dimensional (... more A 63-year-old lady presented with syncope and atypical chest pain. Conventional two-dimensional (2D) contrast echocardiogram showed a highly vascular mass compressing the right atrium without direct communication. A real-time three-dimensional echocardiogram (RT3DE) revealed its outer spatial relationship with the surrounding structures and its inner heterogeneity as well. A chest computed tomography revealed a solid cardiac mass (6 x 7 cm(2)) arising from the right atrium and multiple pulmonary nodules. Histopathology of the pericardial fluid confirmed angiosarcoma. To our knowledge, this is the first report of histology-confirmed primary cardiac angiosarcoma, which was completely evaluated by conventional 2D, contrast, and RT3DE.
Left ventricular noncompaction (LVNC) is a cardiomyopathy that occurs due to an arrest of myocard... more Left ventricular noncompaction (LVNC) is a cardiomyopathy that occurs due to an arrest of myocardial maturation during embryogenesis. The diagnostic echocardiographic features in individuals with LVNC include a thick, bilayered myocardium, prominent ventricular trabeculations, and deep intertrabecular recesses. Clinical features associated with LVNC vary in asymptomatic and symptomatic patients, and include the potential for heart failure, conduction defects (eg, left bundle branch block), supraventricular and ventricular arrhythmias, thromboembolic events, and sudden cardiac death. The authors report five cases that emphasize asymptomatic and apparently benign symptoms in patients with LVNC; despite normal physical examination and 12-lead electrocardiogram results, all of these cases unveiled potentially serious clinical consequences. These cases highlight the concern that LVNC patients with mild to moderate left ventricular systolic dysfunction, particularly in the presence of ven...
Atrioventricular discordance with ventricular-arterial discordance is a rare cardiac anomaly know... more Atrioventricular discordance with ventricular-arterial discordance is a rare cardiac anomaly known as congenitally corrected transposition of the great arteries (CCTGA). This malformation has a prevalence of 0.4-0.6% of all congenital heart disease cases. Complete heart block develops in up to 30% of patients with CCTGA. We present the case of a 62-year-old woman diagnosed with CCTGA who, on echocardiography, had anomalous venous drainage where the inferior vena cava (IVC) bypassed the right atrium and drained into the azygos system. Complementary images with magnetic resonance imaging demonstrated the unique anatomical relationship between the IVC, azygos venous system, and the superior vena cava.
European Heart Journal - Cardiovascular Imaging, 2012
Echocardiography is an important imaging modality used to determine the indication of left ventri... more Echocardiography is an important imaging modality used to determine the indication of left ventricular assist device (LVAD) implantation for patients with advanced heart failure (HF) and for serial follow-up to make management decisions in patient care post-implant. Continuous axial-flow LVAD therapy provides effective haemodynamic support for the failing left ventricle, improving both the clinical functional status and quality of life. Echocardiographers must develop a systematic approach to echocardiographic assessment of LVAD implantation and post-LVAD implant cardiac morphology and physiology. This approach must include the evaluation of left and right heart chamber morphology and physiology and the anatomy and physiology of the inflow and outflow cannulas and the rotor pump, and the determination of the degree of tricuspid regurgitation and the presence of interatrial shunts and aortic regurgitation. Collaboration among the echocardiography and HF/transplant teams is essential to obtain this comprehensive evaluation. We outline a systematic approach to evaluating patients with HF who have failed conventional therapy and require LVAD therapy as a bridge to cardiac transplantation or destination therapy.
Viable treatment options for advanced heart failure have not emerged as the number of people affl... more Viable treatment options for advanced heart failure have not emerged as the number of people afflicted with this condition has grown. Although heart transplantation is the only curative strategy for patients with end-stage heart failure, the relative shortage of donors has led to a worldwide plateau of this option over the past 20 years. The result is an unacceptably high mortality rate among patients with advanced heart failure. Interest in developing alternative curative strategies based on chronic circulatory support, with the aim of prolonging and improving quality of life for these patients, has grown. Patients supported with left ventricular assist devices require structured longitudinal care from a team of providers. An integrated approach using basic echocardiography is critical to patient selection, implantation, and continued surveillance and success of patients with left ventricular assist devices.
Journal of the American Society of Echocardiography, 2012
Left ventricular noncompaction (LVNC) is a cardiomyopathy associated with sporadic or familial di... more Left ventricular noncompaction (LVNC) is a cardiomyopathy associated with sporadic or familial disease, the latter having an autosomal dominant mode of transmission. The clinical features associated with LVNC vary from asymptomatic to symptomatic patients, with the potential for heart failure, supraventricular and ventricular arrhythmias, thromboembolic events, and sudden cardiac death. Echocardiography is the diagnostic modality of choice, revealing the pathognomonic features of a thick, bilayered myocardium; prominent ventricular trabeculations; and deep intertrabecular recesses. Widespread use and advances in the technology of echocardiography and cardiac magnetic resonance imaging are increasing awareness of LVNC, and cardiac magnetic resonance imaging is improving the ability to stage the severity of the disease and potential for adverse clinical consequences. Study of LVNC through research in embryology, imaging, and genetics has allowed enormous strides in the understanding of this heterogeneous disease over the past 25 years.
Speckle tracking echocardiography (STE) is an emerging tool to characterize and quantify myocardi... more Speckle tracking echocardiography (STE) is an emerging tool to characterize and quantify myocardial segmental and rotational mechanics. This literature review is aimed at clinical and academic cardiologists to provide: (1) a conceptual framework of STE to initiate understanding of myocardial mechanics; (2) evidence that three-dimensional (3D) STE overcomes the problems of time-consuming data acquisition and postprocessing seen with two-dimensional STE; and (3) illustrative clinical cases with analysis of myocardial mechanics via 3D STE to show the incremental value of strain in clinical decision making.
Physicians participate in the screening, routine medical supervision, and disqualification proces... more Physicians participate in the screening, routine medical supervision, and disqualification process of collegiate student athletes today. Physicians and universities evaluating collegiate student athletes for athletic participation should understand the meticulous medical process necessary to make eligibility/disqualification decisions and the associated liability issues. It is the responsibility of a team physician to take the lead role in the college sports medical evaluation process. The first duty of a team physician and institution is to protect the health and well-being of their collegiate student athletes. The potential liability associated with the evaluation process requires institutions of higher education and physicians to develop sound and reasonable administrative strategies regarding college athletes and their participation in intercollegiate athletics. Reducing this liability risk requires an understanding of the evolving judicial framework and compliance with standard case law and available guidelines. As medical professional standards evolve, so will responsibilities under legal standards.
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