Doppler echocardiography in the diagnosis of tri-atrial heart in adults

The authors report a case of isolated and well tolerated cor triatriatum in a 38-year old man without significant history admitted for aetiological diagnosis of atrial fibrillation. Echocardiography displayed the left intra-atrial septum and the openings of the 4 pulmonary veins in the proximal chamber, but there was no evidence of associated anomaly. Colour-coded doppler examination visualized a single systolo-diastolic trans-septal jet. As the maximum velocity of the jet at pulsed doppler velocimetry was 1.1 m/s, the maximum instantaneous gradient could be estimated at 5 mmHg. The mean gradient was estimated at 2.6 mmHg, which showed that the ostium caused little stenosis. All these data were confirmed by cardiac catheterization. Since the malformation was well tolerated, both functionally and haemodynamically, it was decided not to operate.     

Echocardiographic diagnosis of right atrial thromboembolism

In a patient with congestive cardiomyopathy who died suddenly from right ventricular thromboembolism, antemortem two-dimensional echocardiography demonstrated a right atrial mass with acoustic characteristics suggestive of a thromboembolus. These characteristics included an elongated structure that assumed multiple dynamic forms and lack of an intracardiac attachment point. Because of the high likelihood of right ventricular impaction of a cardiac embolus, an aggressive therapeutic approach to such lesions is advised.     

Echocardiographic diagnosis of right atrial tamponade

We report the case of a 27-year-old man who developed isolated right atrial tamponade eight weeks following aortic valve replacement. The diagnosis was made by two-dimensional and contrast echocardiography and was subsequently confirmed by cardiac catheterization and surgery. Right atrial tamponade presents a unique conglomeration of clinical, hemodynamic, and echocardiographic features. Constant awareness of this entity is necessary to make a timely diagnosis.     

Echocardiographic diagnosis of atrial septal aneurysm in an infant with hypoplastic right heart syndrome

Echocardiographic findings are described in a patient with hypoplastic right heart syndrome (pulmonary atresia type with intact ventricular septum and small right ventricular cavity) who had an associated atrial septal aneurysm. An unusual appearance of echoes behind the aorta bulging into the left atrium in diastole on both the M-mode and cross-sectional echo suggested this diagnosis prior to cardiac catheterization. The angiographic findings confirmed the diagnosis of right ventricular hypoplasia, pulmonary atresia and the large atrial septal aneurysm. The infant died after surgery and the atrial septal aneurysm was observed at autopsy. The importance of the diagnosis of the atrial septal aneurysm and its association with restriction of right-to-left atrial shunting prompts this report.     

Echocardiographic diagnosis of a right ventricular metastatic tumor

Clinical and echocardiographic studies were done in a patient with a secondary right ventricular tumor. Stationary cardiac tumors produce differential diagnostic problems not associated with mobile cardiac tumors. In spite of limitations of specificity, positive diagnostic features do exist. This report emphasizes the usefulness as well as technical difficulties in assessing the presence of a secondary right ventricular tumor echocardiographically.     

Echocardiographic diagnosis in carcinoid heart disease

In this case report the typical echocardiographic features of carcinoid heart disease are presented. Newer treatments such as the use of a somatostatin analogue, interferon and hepatic de-arterialisation have improved the prognosis in patients with carcinoid syndrome. Nevertheless this syndrome portends a poor prognosis in patients with cardiac involvement. Cardiac lesions are mainly located in the right side of the heart. Regurgitation and stenosis of the tricuspid and pulmonary valve, leading to right heart failure, are the most common cardiac manifestations of the disease. Elevated levels of serotonin are probably responsible for the development of these cardiac lesions. Despite treatment resulting in significant reductions of urinary levels of 5-HIAA, regression of the cardiac manifestations in carcinoid syndrome has not been observed. Two-dimensional and Doppler echocardiography are the main tools to establish the diagnosis and severity of carcinoid heart disease. Cardiac surgery for carcinoid heart disease might improve symptoms and longevity, but the scarce data report on early mortality of over 35%.     

Echocardiographic diagnosis of anomalous chordae of the left and right ventricles

Seventy-two normal subjects and 486 cardiac patients were investigated by ultrasonic sectorial scanning and one-dimensional echocardiography. An abnormal chorda of the left and/or right ventricle was detected in 19 (3.4%). Echocardiographic symptoms and differential diagnosis of abnormal ventricular chordae are discussed.     

Echocardiographic diagnosis of a case with giant right atrial aneurysm

Right atrial aneurysm (RAA) is a very rare anomaly. Rarer still is its association with atrial septal defect (ASD). We reported a case of a 42-year-old woman with giant RRA and secundum type ASD detected by means of transthoracic echocardiography.     

Echocardiographic right ventricular strain analysis in chronic heart failure.

OBJECTIVE: We sought to compare the additive value of right ventricular (RV) function assessed by longitudinal systolic strain (epsilon% - ROI: 9.2 at 10.8 mm) with cardiopulmonary exercise testing (CPET) or brain natriuretic peptide (BNP) in patients with heart failure (HF). METHOD: We studied 19-patients (age = 56 +/- 8 years) in New York Heart Association HF class III-IV, who underwent standard and tissue Doppler echocardiography, CPET and BNP measurements on the same day. RV function was assessed by systolic strain (epsilon, %, ROI: 9.2-10.8 mm) in the mid-segment. Clinical outcomes were examined at 6 months. RESULTS: epsilon (-19.9+/-6.8%) was correlated with BNP (R = 0.52, P = 0.02), slope VE/VCO(2) (R = -0.65, P = 0.003), peak VO(2) (R = 0.46, P = 0.04) and the maximal workload (Watts) developed during CPET (R = 0.54, P=0.02). During follow-up, 1-patient died, 1-underwent heart transplantation, and 4 were re-hospitalized for worsening HF. Patients with major adverse cardiac events (MACE) had a significantly higher mean BNP concentration (852.8 ng/mL +/- 1114.3 vs. 201.4+ /- 293.8, P = 0.03), higher VE/VCO(2) (41.3 +/- 3.6 vs. 35.0 +/- 4.8 P < 0.001) and lower epsilon (-13.9 +/- 4.9 vs. -22.2+ /- 5.8, P < 0.001) than patients who remained MACE-free. By multivariate analysis, ST was the only predictor of MACE. CONCLUSION: In HF-patients presenting, RV-function assessed by systolic epsilon was reliable, easily measurable and a stronger prognosticator than CPET or BNP.     

Echocardiographic demonstration of pulmonary embolism as it evolves through the right heart chambers

In three patients with pulmonary embolism, two-dimensional echocardiography demonstrated thrombi within the right heart chambers. These thrombi, suspected of embolizing into the pulmonary circulation, showed varied morphology and mobility. Of the two patients undergoing embolectomy, only one survived. The third patient improved with anticoagulation therapy. Two-dimensional echocardiography is useful in evaluating patients suspected of having pulmonary thromboembolism because it may demonstrate evolution of the thrombus.     

Echocardiographic diagnosis of congenital left ventricular - right atrial communication.

2 patients, aged 8 mth and 48 yr, referred for a clinical diagnosis of ventricular septal defect, were studied by ultrasound. In both a fluttering and an anterior bowing of the systolic segment of the tricuspid valve was found, consistent with a left ventricular--right atrial communication. Diagnosis was confirmed by angiography and open-heart surgery, showing in 1 patient a supravalvular defect, and an infravalvular one in the other. The postoperative echocardiograms of the tricuspid valve were normal. Ultrasound appears to be a safe and simple method in detecting this rare cardiac abnormality.