Costello syndrome is an extremely rare genetic disorder with growth delay after birth and typically results in short stature during childhood. It is one of the RASopathy of Ras/MAPK pathway syndromes. It affects the t...Costello syndrome is an extremely rare genetic disorder with growth delay after birth and typically results in short stature during childhood. It is one of the RASopathy of Ras/MAPK pathway syndromes. It affects the transforming protein p<sup>21</sup>, an enzyme that in humans is encoded by the HRAS gene. H-Ras is a small G protein and once bound to Guanosine triphosphate, it will activate a Raf kinase like C-Raf, the next step in the MAPK/ERK pathway (mitogen-actvated protein kinase/extracellular signal-regulated kinase) i.e., MEK (mitogen-actvated ERK kinase), a protein that phosphorylate ERK which can directly and indirectly activate many transcription factors. This pathway is also known as Ras-Raf, MEK-ERK pathway, which is a chain of proteins on the cell that communicate a signal from a receptor on the surface of the cell to the DNA in the nucleus of the cell. Activation of ERK 1/2 is involved in signal transduction pathways associated with cardiac hypertrophy. The developmental syndromes caused by germline mutations in genes that alter the RAS components of the MAP/ERK signal transduction pathway are called “RASopathies”. Cardiovascular abnormalities are important features of Costello syndrome and other RASopathies such as Noonan syndrome. Background of this case report described the congenital valvular pulmonic stenosis and ventriculomegaly associated with Costello syndrome by transthoracic echocardiographic imaging in a 9-year-old male boy.展开更多
Atrial myxomas are the most common primary cardiac tumors. More than 90% are solitary. A large myxoma occupying in the left atrium producing mitral stenosis and regurgitation was demonstrated by 2D echocardiographic i...Atrial myxomas are the most common primary cardiac tumors. More than 90% are solitary. A large myxoma occupying in the left atrium producing mitral stenosis and regurgitation was demonstrated by 2D echocardiographic images in this case. It remained asymptomatic for a long period with a survival up to the age of 75 years in an elderly female.展开更多
Aim: To present the heterotopic ossification of left-sided heart valves due to rheumatic inflammation and biomineralization. Introduction: Calcification in the region of mitral-aortic continuity is significant at its ...Aim: To present the heterotopic ossification of left-sided heart valves due to rheumatic inflammation and biomineralization. Introduction: Calcification in the region of mitral-aortic continuity is significant at its origin and etiopathogenesis. The etiology of valvular calcification may be divided into 3 groups, namely, inflammation, degeneration and metabolic disturbances. Calcification of cardiac valve leaflets is most often due to rheumatic etiology in tropical nations. Case Report: A 52-year-old male developed sudden onset of light-headedness and palpitations due to atrial fibrillation. Transthoracic 2D echocardiography revealed calcification of anterior mitral leaflet and aortic valve which resembles a bone-like structure and the patient was advised double valve replacement. Conclusion: It was known that the cellular mechanisms play an important role in its genesis and therapeutic strategies are targeted to reverse this process by understanding its biological mediators.展开更多
Aim: To analyse the increasing burden of coronary artery disease (CAD) in tropical and subtropical belts of the Equator since it remains blurred and carries a grim prognosis. Introduction: Endomyocardial fibrosis [EMF...Aim: To analyse the increasing burden of coronary artery disease (CAD) in tropical and subtropical belts of the Equator since it remains blurred and carries a grim prognosis. Introduction: Endomyocardial fibrosis [EMF] is a tropical febrile disorder, confined to peculiar and limited geographical areas. Plaque buildup in endocardium and coronary arteries, causing ischemic injury and arrhythmic episodes, is a vanishing mystery in its pathogenesis and emphasizing alternative routes for understanding and treatment of this enigmatic disease. Case Report: 15 cases in various age groups were reported with potential complications of coronary artery disease and arrhythmias, associated with endocardial lesions, the characteristic feature of endomyocardial fibrosis. Conclusion: The narrowing of coronary arteries as a result of thickening of the walls, spasm, inflammation, plaques and its rupture produce ischemic episodes which can occur slowly or suddenly in a devastating pattern with arrhythmogenic potentials. The important steps to prevent and decrease the risk of CAD is to reduce the chance of getting this disorder by epidemiological measures with an advice of blood thinning medications such as small daily dose aspirin, antibiotics in susceptible individuals and revascularization in established myocardial infarction.展开更多
Aim: To report a case of “end-stage” constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In “End-stage” constrictive pericarditis, the etiology rem...Aim: To report a case of “end-stage” constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In “End-stage” constrictive pericarditis, the etiology remains unknown in majority of cases and inflammation plays a central role in its development. It has been readily confused with cirrhosis of liver in which there may be ascites, but venous pressure is normal, the neck veins are not engorged and cardiac enlargement is frequent in other causes of heart failure. Case Report: A 67 years old male presented with sudden onset of tachycardia. Clinical examination revealed right-sided heart failure, “Egg-shell” calcification in Chest X-ray and echocardiographic features of pericardial constriction such as septal bounce and dynamic respiratory changes in mitral inflow velocity. The patient was advised medical measures. Conclusion: When clinical signs of right heart failure become unresponsive to increased doses of diuretics, constrictive pericarditis is more likely the underlying disease since severe, right-sided failure develops in very advanced, the “end-stage” of the disease.展开更多
Introduction: To present a rare occurrence of coronary sinus atrial septal defect (ASD) associated with total anomalous pulmonary venous connection (TAPVC). Case Report: A 16-year-old girl was diagnosed with features ...Introduction: To present a rare occurrence of coronary sinus atrial septal defect (ASD) associated with total anomalous pulmonary venous connection (TAPVC). Case Report: A 16-year-old girl was diagnosed with features of an atrial septal defect (ASD) by transthoracic echocardiography and the absence of PLSVC (persistent left superior vena cava) connection to coronary sinus was confirmed by saline contrast echocardiography (“bubble study”). Discussion: The cause of the dilated coronary sinus was due to total anomalous pulmonary venous connection. Conclusion: Coronary sinus atrial septal defect (ASD) is a rare interatrial shunt that is commonly associated with a persistent left superior vena cava (PLSVC) and occurs in less than 1% of cases of ASDs. It is characterized by the absence of at least a portion of the common wall that separates the coronary sinus and left atrium. Isolated defects are associated with low rate of morbidity and mortality.展开更多
Introduction: To present a rare occurrence of “Swiss-cheese” defects of left ventricle in acute myocardial infarction. Case Report: A 64-year-old male with persistent ST segment elevation in anterior and inferior le...Introduction: To present a rare occurrence of “Swiss-cheese” defects of left ventricle in acute myocardial infarction. Case Report: A 64-year-old male with persistent ST segment elevation in anterior and inferior leads developed sudden deterioration within 2 days after thrombolysis. Echocardiography revealed ventricular septal and LV (left ventricular) free wall ruptures at multiple sites with contractile dysfunction and the patient died suddenly, followed by an episode of ventricular tachycardia. Discussion: Myocardial rupture may complicate in 10% of acute myocardial infarctions and it is the second most common cause of in-hospital mortality next to pump failure. It is responsible for 15% of in-hospital deaths and 50% died within 5 days and 82% died within two weeks of index infarction. Conclusion: Aggressive early diagnosis and surgery may confer a survival rate as high as 75%. The prognosis is grave in patients presented with cardiogenic shock and multiorgan dysfunction;surgery is best avoided and supportive medical therapy may be adequate in such cases.展开更多
Aim: To present the aneurysmal dilatation of left atrium due to rheumatic mitral valve disease and its clinical consequences such as arrhythmic, thromboembolic and compressive manifestations. Introduction: Extreme enl...Aim: To present the aneurysmal dilatation of left atrium due to rheumatic mitral valve disease and its clinical consequences such as arrhythmic, thromboembolic and compressive manifestations. Introduction: Extreme enlargement of left atrium, usually referred to as giant, gigantic or aneurysmal dilatation is an uncommon finding with a reported incidence of 0.3% in rheumatic heart disease. It is an important clinical risk identifier to predict the outcome of cardiovascular disease. Case reports: Aneurysmal left atrium correlating with the length of pure mitral regurgitation jet in a 18-year-old girl, posterior mitral leaflet prolapse with regurgitation jet swirling around the entire interatrial septum in a 37-year-old male, Giant left atrium in mixed mitral valve disease in a 37-year-old female and a thrombosed giant left atrium resembling as “coconut” in a 50-year-old female were reported. Conclusion: Giant left atrium may be misinterpreted as right-sided pleural effusion, pericardial effusion and mediastinal tumor on X-ray chest and so echocardiographic evaluation is mandatory to exclude the aneurysmal left atrium in such conditions.展开更多
Aim: To report a case of solitary, parietal lobe abscess in a boy, aged 16 years in Tetralogy of Fallot. Introduction: Infective endocarditis is a serious and fatal complication in congenital heart disease. Following ...Aim: To report a case of solitary, parietal lobe abscess in a boy, aged 16 years in Tetralogy of Fallot. Introduction: Infective endocarditis is a serious and fatal complication in congenital heart disease. Following bacterial endocarditis, ventricular septal defect (VSD) and Tetralogy of Fallot (TOF) have less morbidity and higher survival rate in children. Neurological complications were recognized in 20% of cases and brain abscess is a serious infection of brain parenchyma as a result of seeding of infective pathogens in the shunted blood from the right side of the heart. Case Report: A 16 year old boy had Tetralogy of Fallot, presented with altered sensorium of sudden onset. Echocardiography revealed a large vegetation, attached to the ventricular septum and a large VSD with overriding of aorta. CT brain revealed a large abscess cavity in the parietal lobe, which was evacuated by aspiration and treated with antibiotics. Conclusion: Any patient presented with altered sensorium in cyanotic congenital heart disease must be evaluated with CT scanning for brain abscess and also check hematocrit to rule out hyperviscosity syndrome. Lumbar puncture has been considered hazardous in patients with brain abscess and usually performed under a strong suspicion of meningitis or ventriculitis in the absence of increased intracranial pressure.展开更多
Aim: To report a case of acyanotic Taussig-Bing heart, anatomically consistent with L-transposition and rheumatic Left AV valve regurgitation associated with complete AV block in an adolescent male. Introduction: Taus...Aim: To report a case of acyanotic Taussig-Bing heart, anatomically consistent with L-transposition and rheumatic Left AV valve regurgitation associated with complete AV block in an adolescent male. Introduction: Taussig-Bing heart is one of the conotruncal malformation, characterized by double-outlet right ventricle (DORV) and a subpulmonary VSD. Embryologically, abnormal cardiac looping with malalignment of conotruncal septum result its complexity and great artery relationships. Case Report: A 14-year old acyanotic boy presented with severe left-sided AV valve regurgitation and bradycardia. ECG revealed left sided morphologic right ventricular hypertrophy (RVH) as evidenced by a loss of septal Q waves in left precordial leads suggesting ventricular inversion. X-ray chest revealed a straight upper right cardiac border due to loss of normal relationship of great vessels and cardiomegaly due to both left atrial and morphologic right ventricular enlargements suggesting a left-sided regurgitant lesion. Echocardiography revealed the ventricular inversion, primary origin of both L-transposed great arteries from the left-sided morphologic right ventricle suggesting a “double-outlet morphologic right ventricle” with “double discordance” and a subpulmonary VSD of Taussig-Bing type. The left-sided morphologic tricuspid valve is severely regurgitant due to rheumatic process resulting in heart failure which was improved with anti-failure measures and penicillin prophylaxis. Conclusion: The presence of left-sided regurgitation associated with bradycardia is a suspicion of “double discordance” and “double switch” procedure remains the mainstay of its surgical correction. Left AV valve replacement with intraventricular repair is preferred in this child since the malformation is consistent with Taussing-Bing type of DORV with L-transposition.展开更多
Aim: To present the various echocardiographic spectrum of Ebstein’s mal-formation in adolescence and adults. Introduction: Ebstein’s anomaly has different anatomic and hemodynamic variables with clinical manifestati...Aim: To present the various echocardiographic spectrum of Ebstein’s mal-formation in adolescence and adults. Introduction: Ebstein’s anomaly has different anatomic and hemodynamic variables with clinical manifestations of cyanosis, right-sided heart failure and arrhythmias. The leaflet tethering and dysplasia, together with dilatation of the tricuspid valve ring, constitute the anatomic cause of tricuspid regurgitation observed in this condition. Case Reports: The spectrum of leaflet tethering from mild to extreme with varying degrees of tricuspid regurgitation were documented by echocardiography in a 16-year-old cyanotic male with Ebstein’s anomaly associated with an atrial septal defect and mild low tricuspid regurgitation (TR), 22-year-old acyanotic male with right-sided heart failure due to severe tricuspid regurgitation and an intact atrial septum, 55-year-old asymptomatic female with moderate high tricuspid regurgitation. The extreme form was described as an “atretic” mem-brane in a 28-year-old cyanotic male and as a “blanket” of leaflet tissue in a 30-year-old cyanotic male. Conclusion: Ebstein’s anomaly has to be sus-pected clinically in presence of cyanosis with a WPW (Wolf-Parkinson-White) or atrioventricular (AV) block pattern of ECG and its management is complex and must be individualized. RV (right ventricular) exclusion procedures are preferred in advanced cases.展开更多
Introduction: To report a case of isolated “endocarditic” aortic regurgitation in a 17-year old female with infective vegetations on aortic valve. Case Report: A 17-year old female was admitted with features of hear...Introduction: To report a case of isolated “endocarditic” aortic regurgitation in a 17-year old female with infective vegetations on aortic valve. Case Report: A 17-year old female was admitted with features of heart failure and a febrile illness. Blood cultures were negative and ECG revealed normal. Echocardiography revealed a “kissing-type” of vegetation on the bicuspid aortic valve with severe aortic regurgitation and a dilated left ventricle with moderate dysfunction. Conclusion: The management of aortic insufficiency occurring in infective endocarditis may differ and the presence of intractable pulmonary edema or shock is a clear indication for prompt valve replacement. The traditional diagnostic criteria are insufficient to diagnose infective endocarditis and the modified Duke criteria provide high sensitivity and specificity over 80% for the diagnosis of native valve endocarditis with positive blood cultures.展开更多
Aim: To report a case of longer-lived patent ductus arteriosus with features of pulmonary arterial hypertension up to the age of 65 years in an elderly woman. Introduction: The clinical recognition of patent ductus ar...Aim: To report a case of longer-lived patent ductus arteriosus with features of pulmonary arterial hypertension up to the age of 65 years in an elderly woman. Introduction: The clinical recognition of patent ductus arteriosus with severe pulmonary hypertension is difficult. Only 60% of adults presented with a continuous murmur in a recent series. Asymptomatic patent ductus arteriosus tolerated for many years and may not require closure. Case Report: A 65 years old female presented with dyspnea had signs of pulmonary arterial hypertension with enlarged pulmonary artery and its branches, atrial fibrillation along with a continuous murmur in the left second intercostal space. Echocardiography revealed a 13 mm size patent ductus arteriosus and a bidirectional with predominant left-to-right shunt. Patient was managed conservatively and symptoms got improved with medical therapy. Conclusion: Treatment of patent ductus arteriosus in the setting of pulmonary hypertension is challenging. Early repair can mitigate the development of pulmonary hypertension and reverse vasculopathy in more advanced disease. Maternal aspirin ingestion should be avoided in pregnancy since it causes constriction of fetal ductus.展开更多
Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by...Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by intramural bleeding, resulting in separation of aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. Case Report: A 48-year-old female presented with vague anterior chest discomfort, high blood pressure, systolic-diastolic murmur in the left sternal border with ECG changes of myocardial ischemia. Echocardiography revealed a dilated aortic root with intimal flaps, a leak into the pulmonary artery and regional hypokinesis with contractile dysfunction suggesting a proximal aortic dissection with rupture into the main pulmonary artery. Discussion: The etiology of aortic dissection was mostly hypertension in 80% of cases and aortopathies such as connective tissue disorders, inflammatory and idiopathic. Aortic wall stress is a major trigger of intimal tear and two-dimensional transthoracic echocardiography is an excellent, initial diagnostic gold standard to detect the dissecting flaps, especially in proximal aortic dissection. Conclusion: Blood pressure control is the mainstay of treatment and urgent surgery is indicated in proximal aortic dissection since there is higher chance of rupture with an increase in mortality.展开更多
Aim: To report a case of right ventricular myxoma prolapsing through the tricuspid valve with an attachment of vegetation in a 3-year-old male child. Introduction: Right-sided endocarditis commonly involves the tricus...Aim: To report a case of right ventricular myxoma prolapsing through the tricuspid valve with an attachment of vegetation in a 3-year-old male child. Introduction: Right-sided endocarditis commonly involves the tricuspid valve. Low pressure and low oxygen saturation in the right sided cardiac chambers protect the tricuspid and pulmonary valves from being subjected to excessive strained and damage occurs from injected particulate matter, contaminated venous lines and drug solutions causing endocarditis. RV (right ventricular) myxoma harboured the infection due to trauma as a result of friction movement across the tricuspid valve. Case Report: A 3-year-old male child having the spikes of fever for 2 weeks, presented with tumor “plop” and 3/6 systolic murmur in lower left sternal border and echocardiography revealed a tumor-mimicking vegetation visible as a mass lesion across the tricuspid valve, which is attached to the interventricular septum by a pedicle suggesting a RV myxoma. The vegetation was found to be attached with the tumor and it disappeared with antibiotics and aspirin therapy and the child was advised surgical removal of the tumor. Conclusion: A diagnosis of infective endocarditis can be made in tricuspid valve dysfunction with a floating mass and fever. The cardiac myxoma with an attached vegetation is masquerading as vegetation mass on transthoracic echocardiography in this child.展开更多
<strong>Aim:</strong> To emphasize the role of antibiotics in acute pancreatitis as prophylactic and therapeutic benefits. <strong>Case Report:</strong> A 32-year-old obese male was admitted wi...<strong>Aim:</strong> To emphasize the role of antibiotics in acute pancreatitis as prophylactic and therapeutic benefits. <strong>Case Report:</strong> A 32-year-old obese male was admitted with acute abdomen in the emergency room. He was supported with intravenous fluids and the blood chemistry revealed elevated amylase and lipase levels, raised ESR and a positive ASO titer test. CT abdomen suggested interstitial edematous pancreatitis (IEP) and no fluid collection. Patient was treated with IV cefotaxime and IV metronidazole, his condition remarkably improved with therapy, blood parameters returned normal at the end of 4 weeks, and follow-up CT revealed no abnormal findings and symptom free thereafter. <strong>Conclusion: </strong>Acute pancreatitis is usually a sterile inflammatory process caused by chemical autodigestion of pancreas. The edematous form of acute pancreatitis needs to correct its etiological factor to avoid recurrence. It is observed as an initial manifestation of group A beta hemolytic streptococcal infection in this patient and antibiotics play a role as curative and prophylactic in selected cases.展开更多
Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvemen...Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.展开更多
Infective endocarditis (IE) is the infection of inner endothelial layer of the heart including the heart valves and it may present as rapidly progressive or manifest itself as subacute or chronic disease. The epidemio...Infective endocarditis (IE) is the infection of inner endothelial layer of the heart including the heart valves and it may present as rapidly progressive or manifest itself as subacute or chronic disease. The epidemiology of infective endocarditis has been changed over the past few decades and the incidence of IE in children in United States and Canada is 1 in 1250 pediatric hospital admissions in the early 1980s. At least 70% of infective endocarditis in children occurs with congenital heart disease whereas rheumatic heart disease in southern states of India and the degenerative mitral valve disease (myxomatous, mitral valve prolapse) in the western countries are the most underlying predisposing conditions to infective endocarditis in adolescents. The characteristic lesion of infective endocarditis is “vegetation” and a “large” vegetation >10 mm in size has been reported with an incidence of 15.9% - 62.5% in patients. The significance of vegetation size has been a subject of discussion for many years to predict the embolic episodes. Background of this case study illustrated the varying size and shape of giant vegetation attached to the anterior leaflet of mitral valve in an underlying rheumatic mitral valvulitis and its consequence of valve damage such as chordal rupture, flail leaflet and mitral regurgitation with a description of anatomic features and echocardiographic manifestations in a 10-year-old female child.展开更多
Apical hypertrophic cardiomyopathy (apical HCM) is a rare variant of hypertrophic cardiomyopathy with a prevalence of 1% - 2% in Asian population and carries a benign prognosis. It is usually silent in early stages an...Apical hypertrophic cardiomyopathy (apical HCM) is a rare variant of hypertrophic cardiomyopathy with a prevalence of 1% - 2% in Asian population and carries a benign prognosis. It is usually silent in early stages and manifests in adults with a suspicion of typical ECG changes of giant T wave inversion in left precordial leads. Transthoracic echocardiography is the mainstay of non-invasive diagnosis and provides a heterogeneous appearance of its morphological features with a spade-shaped LV (left ventricular) cavity. Background of this case study describes the apical HCM in an asymptomatic male at the age of 54 years old and also predicts the mixed and mid-ventricular forms of left ventricular HCM at this region of Thoothukudi in India.展开更多
Rheumatic involvement of all four heart valves is uncommon and its association with congenital heart disease is very rare. Tetralogy of Fallot is a frequent cyanotic congenital heart disease with a survival beyond mid...Rheumatic involvement of all four heart valves is uncommon and its association with congenital heart disease is very rare. Tetralogy of Fallot is a frequent cyanotic congenital heart disease with a survival beyond middle age. Background of this case report described the rheumatic involvement of all four heart valves (quadrivalvar rheumatic cardiopathy) with stenotic lesions of semilunar valves (aortic and pulmonary valves) and regurgitant lesions of atrioventricular valves (mitral and tricuspid valves) in Tetralogy of Fallot in a 48-year old asymptomatic female, detected by transthoracic two dimensional echocardiography in Thoothukudi region of India.展开更多
文摘Costello syndrome is an extremely rare genetic disorder with growth delay after birth and typically results in short stature during childhood. It is one of the RASopathy of Ras/MAPK pathway syndromes. It affects the transforming protein p<sup>21</sup>, an enzyme that in humans is encoded by the HRAS gene. H-Ras is a small G protein and once bound to Guanosine triphosphate, it will activate a Raf kinase like C-Raf, the next step in the MAPK/ERK pathway (mitogen-actvated protein kinase/extracellular signal-regulated kinase) i.e., MEK (mitogen-actvated ERK kinase), a protein that phosphorylate ERK which can directly and indirectly activate many transcription factors. This pathway is also known as Ras-Raf, MEK-ERK pathway, which is a chain of proteins on the cell that communicate a signal from a receptor on the surface of the cell to the DNA in the nucleus of the cell. Activation of ERK 1/2 is involved in signal transduction pathways associated with cardiac hypertrophy. The developmental syndromes caused by germline mutations in genes that alter the RAS components of the MAP/ERK signal transduction pathway are called “RASopathies”. Cardiovascular abnormalities are important features of Costello syndrome and other RASopathies such as Noonan syndrome. Background of this case report described the congenital valvular pulmonic stenosis and ventriculomegaly associated with Costello syndrome by transthoracic echocardiographic imaging in a 9-year-old male boy.
文摘Atrial myxomas are the most common primary cardiac tumors. More than 90% are solitary. A large myxoma occupying in the left atrium producing mitral stenosis and regurgitation was demonstrated by 2D echocardiographic images in this case. It remained asymptomatic for a long period with a survival up to the age of 75 years in an elderly female.
文摘Aim: To present the heterotopic ossification of left-sided heart valves due to rheumatic inflammation and biomineralization. Introduction: Calcification in the region of mitral-aortic continuity is significant at its origin and etiopathogenesis. The etiology of valvular calcification may be divided into 3 groups, namely, inflammation, degeneration and metabolic disturbances. Calcification of cardiac valve leaflets is most often due to rheumatic etiology in tropical nations. Case Report: A 52-year-old male developed sudden onset of light-headedness and palpitations due to atrial fibrillation. Transthoracic 2D echocardiography revealed calcification of anterior mitral leaflet and aortic valve which resembles a bone-like structure and the patient was advised double valve replacement. Conclusion: It was known that the cellular mechanisms play an important role in its genesis and therapeutic strategies are targeted to reverse this process by understanding its biological mediators.
文摘Aim: To analyse the increasing burden of coronary artery disease (CAD) in tropical and subtropical belts of the Equator since it remains blurred and carries a grim prognosis. Introduction: Endomyocardial fibrosis [EMF] is a tropical febrile disorder, confined to peculiar and limited geographical areas. Plaque buildup in endocardium and coronary arteries, causing ischemic injury and arrhythmic episodes, is a vanishing mystery in its pathogenesis and emphasizing alternative routes for understanding and treatment of this enigmatic disease. Case Report: 15 cases in various age groups were reported with potential complications of coronary artery disease and arrhythmias, associated with endocardial lesions, the characteristic feature of endomyocardial fibrosis. Conclusion: The narrowing of coronary arteries as a result of thickening of the walls, spasm, inflammation, plaques and its rupture produce ischemic episodes which can occur slowly or suddenly in a devastating pattern with arrhythmogenic potentials. The important steps to prevent and decrease the risk of CAD is to reduce the chance of getting this disorder by epidemiological measures with an advice of blood thinning medications such as small daily dose aspirin, antibiotics in susceptible individuals and revascularization in established myocardial infarction.
文摘Aim: To report a case of “end-stage” constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In “End-stage” constrictive pericarditis, the etiology remains unknown in majority of cases and inflammation plays a central role in its development. It has been readily confused with cirrhosis of liver in which there may be ascites, but venous pressure is normal, the neck veins are not engorged and cardiac enlargement is frequent in other causes of heart failure. Case Report: A 67 years old male presented with sudden onset of tachycardia. Clinical examination revealed right-sided heart failure, “Egg-shell” calcification in Chest X-ray and echocardiographic features of pericardial constriction such as septal bounce and dynamic respiratory changes in mitral inflow velocity. The patient was advised medical measures. Conclusion: When clinical signs of right heart failure become unresponsive to increased doses of diuretics, constrictive pericarditis is more likely the underlying disease since severe, right-sided failure develops in very advanced, the “end-stage” of the disease.
文摘Introduction: To present a rare occurrence of coronary sinus atrial septal defect (ASD) associated with total anomalous pulmonary venous connection (TAPVC). Case Report: A 16-year-old girl was diagnosed with features of an atrial septal defect (ASD) by transthoracic echocardiography and the absence of PLSVC (persistent left superior vena cava) connection to coronary sinus was confirmed by saline contrast echocardiography (“bubble study”). Discussion: The cause of the dilated coronary sinus was due to total anomalous pulmonary venous connection. Conclusion: Coronary sinus atrial septal defect (ASD) is a rare interatrial shunt that is commonly associated with a persistent left superior vena cava (PLSVC) and occurs in less than 1% of cases of ASDs. It is characterized by the absence of at least a portion of the common wall that separates the coronary sinus and left atrium. Isolated defects are associated with low rate of morbidity and mortality.
文摘Introduction: To present a rare occurrence of “Swiss-cheese” defects of left ventricle in acute myocardial infarction. Case Report: A 64-year-old male with persistent ST segment elevation in anterior and inferior leads developed sudden deterioration within 2 days after thrombolysis. Echocardiography revealed ventricular septal and LV (left ventricular) free wall ruptures at multiple sites with contractile dysfunction and the patient died suddenly, followed by an episode of ventricular tachycardia. Discussion: Myocardial rupture may complicate in 10% of acute myocardial infarctions and it is the second most common cause of in-hospital mortality next to pump failure. It is responsible for 15% of in-hospital deaths and 50% died within 5 days and 82% died within two weeks of index infarction. Conclusion: Aggressive early diagnosis and surgery may confer a survival rate as high as 75%. The prognosis is grave in patients presented with cardiogenic shock and multiorgan dysfunction;surgery is best avoided and supportive medical therapy may be adequate in such cases.
文摘Aim: To present the aneurysmal dilatation of left atrium due to rheumatic mitral valve disease and its clinical consequences such as arrhythmic, thromboembolic and compressive manifestations. Introduction: Extreme enlargement of left atrium, usually referred to as giant, gigantic or aneurysmal dilatation is an uncommon finding with a reported incidence of 0.3% in rheumatic heart disease. It is an important clinical risk identifier to predict the outcome of cardiovascular disease. Case reports: Aneurysmal left atrium correlating with the length of pure mitral regurgitation jet in a 18-year-old girl, posterior mitral leaflet prolapse with regurgitation jet swirling around the entire interatrial septum in a 37-year-old male, Giant left atrium in mixed mitral valve disease in a 37-year-old female and a thrombosed giant left atrium resembling as “coconut” in a 50-year-old female were reported. Conclusion: Giant left atrium may be misinterpreted as right-sided pleural effusion, pericardial effusion and mediastinal tumor on X-ray chest and so echocardiographic evaluation is mandatory to exclude the aneurysmal left atrium in such conditions.
文摘Aim: To report a case of solitary, parietal lobe abscess in a boy, aged 16 years in Tetralogy of Fallot. Introduction: Infective endocarditis is a serious and fatal complication in congenital heart disease. Following bacterial endocarditis, ventricular septal defect (VSD) and Tetralogy of Fallot (TOF) have less morbidity and higher survival rate in children. Neurological complications were recognized in 20% of cases and brain abscess is a serious infection of brain parenchyma as a result of seeding of infective pathogens in the shunted blood from the right side of the heart. Case Report: A 16 year old boy had Tetralogy of Fallot, presented with altered sensorium of sudden onset. Echocardiography revealed a large vegetation, attached to the ventricular septum and a large VSD with overriding of aorta. CT brain revealed a large abscess cavity in the parietal lobe, which was evacuated by aspiration and treated with antibiotics. Conclusion: Any patient presented with altered sensorium in cyanotic congenital heart disease must be evaluated with CT scanning for brain abscess and also check hematocrit to rule out hyperviscosity syndrome. Lumbar puncture has been considered hazardous in patients with brain abscess and usually performed under a strong suspicion of meningitis or ventriculitis in the absence of increased intracranial pressure.
文摘Aim: To report a case of acyanotic Taussig-Bing heart, anatomically consistent with L-transposition and rheumatic Left AV valve regurgitation associated with complete AV block in an adolescent male. Introduction: Taussig-Bing heart is one of the conotruncal malformation, characterized by double-outlet right ventricle (DORV) and a subpulmonary VSD. Embryologically, abnormal cardiac looping with malalignment of conotruncal septum result its complexity and great artery relationships. Case Report: A 14-year old acyanotic boy presented with severe left-sided AV valve regurgitation and bradycardia. ECG revealed left sided morphologic right ventricular hypertrophy (RVH) as evidenced by a loss of septal Q waves in left precordial leads suggesting ventricular inversion. X-ray chest revealed a straight upper right cardiac border due to loss of normal relationship of great vessels and cardiomegaly due to both left atrial and morphologic right ventricular enlargements suggesting a left-sided regurgitant lesion. Echocardiography revealed the ventricular inversion, primary origin of both L-transposed great arteries from the left-sided morphologic right ventricle suggesting a “double-outlet morphologic right ventricle” with “double discordance” and a subpulmonary VSD of Taussig-Bing type. The left-sided morphologic tricuspid valve is severely regurgitant due to rheumatic process resulting in heart failure which was improved with anti-failure measures and penicillin prophylaxis. Conclusion: The presence of left-sided regurgitation associated with bradycardia is a suspicion of “double discordance” and “double switch” procedure remains the mainstay of its surgical correction. Left AV valve replacement with intraventricular repair is preferred in this child since the malformation is consistent with Taussing-Bing type of DORV with L-transposition.
文摘Aim: To present the various echocardiographic spectrum of Ebstein’s mal-formation in adolescence and adults. Introduction: Ebstein’s anomaly has different anatomic and hemodynamic variables with clinical manifestations of cyanosis, right-sided heart failure and arrhythmias. The leaflet tethering and dysplasia, together with dilatation of the tricuspid valve ring, constitute the anatomic cause of tricuspid regurgitation observed in this condition. Case Reports: The spectrum of leaflet tethering from mild to extreme with varying degrees of tricuspid regurgitation were documented by echocardiography in a 16-year-old cyanotic male with Ebstein’s anomaly associated with an atrial septal defect and mild low tricuspid regurgitation (TR), 22-year-old acyanotic male with right-sided heart failure due to severe tricuspid regurgitation and an intact atrial septum, 55-year-old asymptomatic female with moderate high tricuspid regurgitation. The extreme form was described as an “atretic” mem-brane in a 28-year-old cyanotic male and as a “blanket” of leaflet tissue in a 30-year-old cyanotic male. Conclusion: Ebstein’s anomaly has to be sus-pected clinically in presence of cyanosis with a WPW (Wolf-Parkinson-White) or atrioventricular (AV) block pattern of ECG and its management is complex and must be individualized. RV (right ventricular) exclusion procedures are preferred in advanced cases.
文摘Introduction: To report a case of isolated “endocarditic” aortic regurgitation in a 17-year old female with infective vegetations on aortic valve. Case Report: A 17-year old female was admitted with features of heart failure and a febrile illness. Blood cultures were negative and ECG revealed normal. Echocardiography revealed a “kissing-type” of vegetation on the bicuspid aortic valve with severe aortic regurgitation and a dilated left ventricle with moderate dysfunction. Conclusion: The management of aortic insufficiency occurring in infective endocarditis may differ and the presence of intractable pulmonary edema or shock is a clear indication for prompt valve replacement. The traditional diagnostic criteria are insufficient to diagnose infective endocarditis and the modified Duke criteria provide high sensitivity and specificity over 80% for the diagnosis of native valve endocarditis with positive blood cultures.
文摘Aim: To report a case of longer-lived patent ductus arteriosus with features of pulmonary arterial hypertension up to the age of 65 years in an elderly woman. Introduction: The clinical recognition of patent ductus arteriosus with severe pulmonary hypertension is difficult. Only 60% of adults presented with a continuous murmur in a recent series. Asymptomatic patent ductus arteriosus tolerated for many years and may not require closure. Case Report: A 65 years old female presented with dyspnea had signs of pulmonary arterial hypertension with enlarged pulmonary artery and its branches, atrial fibrillation along with a continuous murmur in the left second intercostal space. Echocardiography revealed a 13 mm size patent ductus arteriosus and a bidirectional with predominant left-to-right shunt. Patient was managed conservatively and symptoms got improved with medical therapy. Conclusion: Treatment of patent ductus arteriosus in the setting of pulmonary hypertension is challenging. Early repair can mitigate the development of pulmonary hypertension and reverse vasculopathy in more advanced disease. Maternal aspirin ingestion should be avoided in pregnancy since it causes constriction of fetal ductus.
文摘Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by intramural bleeding, resulting in separation of aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. Case Report: A 48-year-old female presented with vague anterior chest discomfort, high blood pressure, systolic-diastolic murmur in the left sternal border with ECG changes of myocardial ischemia. Echocardiography revealed a dilated aortic root with intimal flaps, a leak into the pulmonary artery and regional hypokinesis with contractile dysfunction suggesting a proximal aortic dissection with rupture into the main pulmonary artery. Discussion: The etiology of aortic dissection was mostly hypertension in 80% of cases and aortopathies such as connective tissue disorders, inflammatory and idiopathic. Aortic wall stress is a major trigger of intimal tear and two-dimensional transthoracic echocardiography is an excellent, initial diagnostic gold standard to detect the dissecting flaps, especially in proximal aortic dissection. Conclusion: Blood pressure control is the mainstay of treatment and urgent surgery is indicated in proximal aortic dissection since there is higher chance of rupture with an increase in mortality.
文摘Aim: To report a case of right ventricular myxoma prolapsing through the tricuspid valve with an attachment of vegetation in a 3-year-old male child. Introduction: Right-sided endocarditis commonly involves the tricuspid valve. Low pressure and low oxygen saturation in the right sided cardiac chambers protect the tricuspid and pulmonary valves from being subjected to excessive strained and damage occurs from injected particulate matter, contaminated venous lines and drug solutions causing endocarditis. RV (right ventricular) myxoma harboured the infection due to trauma as a result of friction movement across the tricuspid valve. Case Report: A 3-year-old male child having the spikes of fever for 2 weeks, presented with tumor “plop” and 3/6 systolic murmur in lower left sternal border and echocardiography revealed a tumor-mimicking vegetation visible as a mass lesion across the tricuspid valve, which is attached to the interventricular septum by a pedicle suggesting a RV myxoma. The vegetation was found to be attached with the tumor and it disappeared with antibiotics and aspirin therapy and the child was advised surgical removal of the tumor. Conclusion: A diagnosis of infective endocarditis can be made in tricuspid valve dysfunction with a floating mass and fever. The cardiac myxoma with an attached vegetation is masquerading as vegetation mass on transthoracic echocardiography in this child.
文摘<strong>Aim:</strong> To emphasize the role of antibiotics in acute pancreatitis as prophylactic and therapeutic benefits. <strong>Case Report:</strong> A 32-year-old obese male was admitted with acute abdomen in the emergency room. He was supported with intravenous fluids and the blood chemistry revealed elevated amylase and lipase levels, raised ESR and a positive ASO titer test. CT abdomen suggested interstitial edematous pancreatitis (IEP) and no fluid collection. Patient was treated with IV cefotaxime and IV metronidazole, his condition remarkably improved with therapy, blood parameters returned normal at the end of 4 weeks, and follow-up CT revealed no abnormal findings and symptom free thereafter. <strong>Conclusion: </strong>Acute pancreatitis is usually a sterile inflammatory process caused by chemical autodigestion of pancreas. The edematous form of acute pancreatitis needs to correct its etiological factor to avoid recurrence. It is observed as an initial manifestation of group A beta hemolytic streptococcal infection in this patient and antibiotics play a role as curative and prophylactic in selected cases.
文摘Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.
文摘Infective endocarditis (IE) is the infection of inner endothelial layer of the heart including the heart valves and it may present as rapidly progressive or manifest itself as subacute or chronic disease. The epidemiology of infective endocarditis has been changed over the past few decades and the incidence of IE in children in United States and Canada is 1 in 1250 pediatric hospital admissions in the early 1980s. At least 70% of infective endocarditis in children occurs with congenital heart disease whereas rheumatic heart disease in southern states of India and the degenerative mitral valve disease (myxomatous, mitral valve prolapse) in the western countries are the most underlying predisposing conditions to infective endocarditis in adolescents. The characteristic lesion of infective endocarditis is “vegetation” and a “large” vegetation >10 mm in size has been reported with an incidence of 15.9% - 62.5% in patients. The significance of vegetation size has been a subject of discussion for many years to predict the embolic episodes. Background of this case study illustrated the varying size and shape of giant vegetation attached to the anterior leaflet of mitral valve in an underlying rheumatic mitral valvulitis and its consequence of valve damage such as chordal rupture, flail leaflet and mitral regurgitation with a description of anatomic features and echocardiographic manifestations in a 10-year-old female child.
文摘Apical hypertrophic cardiomyopathy (apical HCM) is a rare variant of hypertrophic cardiomyopathy with a prevalence of 1% - 2% in Asian population and carries a benign prognosis. It is usually silent in early stages and manifests in adults with a suspicion of typical ECG changes of giant T wave inversion in left precordial leads. Transthoracic echocardiography is the mainstay of non-invasive diagnosis and provides a heterogeneous appearance of its morphological features with a spade-shaped LV (left ventricular) cavity. Background of this case study describes the apical HCM in an asymptomatic male at the age of 54 years old and also predicts the mixed and mid-ventricular forms of left ventricular HCM at this region of Thoothukudi in India.
文摘Rheumatic involvement of all four heart valves is uncommon and its association with congenital heart disease is very rare. Tetralogy of Fallot is a frequent cyanotic congenital heart disease with a survival beyond middle age. Background of this case report described the rheumatic involvement of all four heart valves (quadrivalvar rheumatic cardiopathy) with stenotic lesions of semilunar valves (aortic and pulmonary valves) and regurgitant lesions of atrioventricular valves (mitral and tricuspid valves) in Tetralogy of Fallot in a 48-year old asymptomatic female, detected by transthoracic two dimensional echocardiography in Thoothukudi region of India.
