An intramural left ventricular fistula caused by left ventriculography

Congenital coronary sinus(CS)fistula is a rare form of cardiac abnormality.The fistula forms an abnormal communication between the cardiac chambers and the coronary arteries.The most common form of fistula arises from the right coronary arteries while the left ventricular and CS fistula is rare.Coronary slow-flow phenomenon(CSFP)is defined as a delayed opacification of distal vessels without any epicardial disease.[1]     

Normal left renal vein mimicking left renal artery aneurysm

On transverse ultrasound scans a small number of patients with a paucity of retroperitoneal fat show an initial false impression of a left renal artery aneurysm due to the confluence of two normal findings. The left renal vein is unusually prominent from the hilum of the left kidney to the area between the superior mesenteric artery and the aorta; and part of the normal aortic wall, adjacent to the left renal vein, is incompletely imaged. Explanations for the prominence in the left renal vein and the partial visualization of the aortic wall are discussed, and various maneuvers that allow for accurate identification of both are described. The use of this analysis should prevent the incorrect diagnosis of a left renal artery aneurysm, which might lead to more invasive diagnostic procedures.     

老年高血压状态下左心室构型与左心房和左心室容积

背景:研究表明,左心房容积可反映左心室充盈压、心房结构重塑及神经激素的活动,左心房容积扩大是预测慢性心力衰竭不良预后的一个强有力的标志。目的:观察老年原发性高血压患者在不同左心室构型情况下左心房容积和左心室容积的变化。方法:采用超声心动图对129例老年原发性高血压患者(高血压组)和125名体检血压正常的老年人(对照组)的左心房容积和左心室容积相关指标进行测量,并依据Ganau标准对左心室几何构型进行分型;同时对老年高血压患者进行动态血压监测,依据血压节律进行分组比较。结果与结论:与对照组比较,高血压组左心房容积、左心房容积指数、左心室收缩末期容积、左心室舒张末期容积均明显增大(P<0.05);同时,在高血压组内,病程和动态血压昼夜节律对左心室几何构型的分布有影响,且左心室构型异常者上述指标较左心室构型正常者增大更明显(P<0.05)。提示,老年原发性高血压患者病程和非杓型血压节律对左心室构型存在重要影响,左心房容积和左心室容积的变化与左心室构型的改变相伴随。     

老年高血压状态下左心室构型与左心房和左心室容积

背景：研究表明,左心房容积可反映左心室充盈压、心房结构重塑及神经激素的活动,左心房容积扩大是预测慢性心力衰竭不良预后的一个强有力的标志。目的：观察老年原发性高血压患者在不同左心室构型情况下左心房容积和左心室容积的变化。方法：采用超声心动图对129例老年原发性高血压患者（高血压组）和125名体检血压正常的老年人（对照组）的左心房容积和左心室容积相关指标进行测量,并依据Ganau标准对左心室几何构型进行分型;同时对老年高血压患者进行动态血压监测,依据血压节律进行分组比较。结果与结论：与对照组比较,高血压组左心房容积、左心房容积指数、左心室收缩末期容积、左心室舒张末期容积均明显增大（P〈0.05）;同时,在高血压组内,病程和动态血压昼夜节律对左心室几何构型的分布有影响,且左心室构型异常者上述指标较左心室构型正常者增大更明显（P〈0.05）。提示,老年原发性高血压患者病程和非杓型血压节律对左心室构型存在重要影响,左心房容积和左心室容积的变化与左心室构型的改变相伴随。     

Echocardiographic evaluation of left superior vena cava to the left atrium

We report two cases of left superior vena cava draining directly to the left atrium in the absence of complex congenital heart disease. This is a rare finding causing a decrease in patient oxygen saturations. The location and diagnosis of this systemic venous anomaly requires diligence on the part of the cardiac sonographer, who should be able to identify the structure during the course of a thorough echocardiographic examination. Both adult and pediatric cardiac sonographers should be alerted to the possible presence of this vessel. Once the vessel has been successfully identified, repair and follow-up are relatively simple with positive patient prognosis.     

Tako-tsubo-like left ventricular dysfunction: transient left ventricular apical ballooning syndrome

Aims/objectives: This review examines the ‘tako‐tsubo‐like’ syndrome or transient left ventricular apical ballooning. The aim of this review is a complete evaluation of epidemiology, clinical and instrumental features, pathophysiological mechanisms, therapy and prognosis of this syndrome. Methods: We have evaluated the data from literature for a comprehensive consideration of multiple aspects of this syndrome. Results/findings: Transient left ventricular apical ballooning typically affects women, and the clinical presentation is comparable to acute coronary syndrome with chest pain or sudden dyspnoea, changes in ECG and elevated cardiac enzymes in the absence of significant coronary stenosis, with complete resolution of wall‐motion abnormalities in a period of days or weeks. This syndrome is triggered by marked psychological or physiological stress. Several pathophysiological mechanisms have been proposed, such as cathecolamine‐mediated cardiotoxicity, abnormalities in coronary microvascular function and multivessel coronary vasospasm. The highest incidence of transient left ventricular apical ballooning is in the Japanese population, but it has been recently identified also in the USA and Europe. Treatment is empirical and supportive. The prognosis is generally favourable, although some deaths have been reported, usually the result of irreversible cardiogenic shock, refractory ventricular arrhythmias, or other catastrophic cardiovascular event. Conclusions/interpretations: We conclude by emphasising the importance of a more deeper knowledge of this syndrome for general physicians and cardiologists and it should be often considered as a possible diagnosis occurring in emergency department and in patients admitted in the Chest Pain Units with a diagnosis of coronary acute syndrome.     

高血压病左房、室构型与心律失常

目的 探讨高血压病患者左房、室构型情况及其与心律失常的关系。方法 95例高血压病患者（EH组）依年龄分为＜60岁和≥60岁两亚组。全组经彩色超声心动图检测左房内径（LAD）,左室重量指数（LVMI）;经动态心电图（Holter）判定心律失常,并将相关指标进行对比分析。结果 EH组中检出左房扩大（LAE）63例（66.3％）,左室肥顾（LVH）45例（47.4%),两者比较有差异（P＜0.05）;其中单纯左房扩大37例,单纯左室肥厚19例,左房扩大并左室肥厚（LEH）26例,与对照组比较P＜0.01。EH组中≥60岁单纯左房扩大、左室肥厚及左房扩大并左室肥厚发生率与＜60岁亚组比较P＜0.05。EH组检出室性心率失常（VA）54例（56.8%）,房性心律失常（AA）71例（74.7％）,两才有显著性差异（P＜0.05）。EH组年龄≥60岁各种房、室性心律失常发生率与＜60岁比较P＜0。05。结论 高血压病除存在LVH外,还存在左房扩大并左室肥厚,其发生率高于左室肥厚。高血压病左房、室构型与心律失常有关,房性心律失常高于室性心律失常;老年高血压病者比中年人更易发生左房、室内型改变及各种心律失常。