Echocardiographic features of interventricular septal dissection in patients with Behçet's disease

Involvement of the heart in Behçet's disease (BD) is rare. We retrospectively analyzed these three patients with interventricular septal (IVS) dissection in BD and discussed the echocardiographic manifestations of IVS dissections. In our patients, the echocardiographic characteristics of IVS dissection were echo‐free space in the IVS basal segment or basal to middle segment, dilatation in the diastole and contraction in systole, and abnormal turbulent blood flow in the heart.     

Successful biventricular cardiac resynchronization therapy in a failing Fontan patient: Implications of ventriculo‐ventricular interdependency in single ventricle physiology

We describe a Fontan patient with severe heart failure who was successfully treated with biventricular cardiac resynchronization therapy (CRT). Our case shows that strain imaging might play a crucial role in guiding placement of pacing leads and in characterizing the electromechanical substrate associated with a favorable CRT response. Furthermore, we demonstrate for the first time that ventriculo‐ventricular interdependency seems an important mechanical concept, which can be utilized to augment cardiac performance in failing Fontan patients with a functional hypoplastic ventricle.     

Low-Velocity Nail-Gun Injuries to the Interventricular Septum: Report of Two Cases,One in a Child

Nail-gun injury to the heart is rare. Nail-gun injury to the interventricular septum is rarer: we could find only 5 reported cases, and none involving a child. We report 2 additional cases, in which nails penetrated the interventricular septum without causing acute pericardial tamponade, heart block, or shunt across the septum. Transesophageal echocardiography provides a dynamic way to evaluate the patient preoperatively, intraoperatively, and postoperatively.In the cases reported here, both the adult with multiple interventricular nails and the child with a single nail underwent foreign-object removal via median sternotomy. The child needed cardiopulmonary bypass for removal of the nail. There were no short-term or long-term sequelae from these interventricular septal injuries.     

Pathomorphological Variants of Midventricular Obstruction of Interventricular Septum during Hypertrophic Cardiomyopathy

Postmortem contrast cardiac ventriculography, coronarography, volume-mass and planimetric cardiometry, as well as echocardiography and pathomorphological data correlation technique were employed for examination of the hearts from patients died from hypertrophy cardiomyopathy (n=100). The following variants of midventricular hypertrophy of the interventricular septum (midventricular obstruction) were established: midleft ventricular, midright ventricular, midproximal, midmaximal. Isolated distal apex hypertrophy and apical hypertrophy were also documented. These variants and forms of cardiac pathology are determined by peculiar changes in geometrical structure of the septum and left ventricle. Multiplanar variability and mobility of interventricular septum combined with peculiar catenary shape promote specific abnormalities of intracardiac hemodynamics determining dissociation between the echocardiographic and pathomorphological diagnostic data and underlying the leading elements of patho- and thanatogenesis of hypertrophic cardiomyopathy.     

Adult definitions for dyssynchrony are inappropriate for pediatric patients

Background: Cardiac resynchronization therapy (CRT) is a promising approach to improve cardiac function in children in heart failure with cardiomyopathy. Cardiac timing measures in pediatrics are typically based on age and heart rate. However, pediatric CRT studies to date have used adult based timing cutoff values. We investigated the applicability of using these adult standards in pediatric patients with normal hearts. Methods: We studied 88 outpatients referred for cardiac evaluation who had a normal cardiac evaluation. Subjects had 12 lead EKG and normal echocardiogram. Patients with known heart disease or abnormal rhythms were excluded. 2D echo and Doppler including color tissue Doppler imaging (TDI, Vivid 7 GE Ultrasound, Norway) were obtained. TDI was performed on three standard apical views (four chamber, two chamber, and long axis). Longitudinal dyssynchrony was determined from (1) Yu index – standard deviation of differences in timing of peak TDI velocity of all 12 basal and mid LV wall segments, adult cutoff >32 ms and (2) opposing wall difference (OWD) in timing of peak TDI velocity of 12 LV wall segments, adult cutoff >65 ms. Radial dyssynchrony was determined from differences in timing of peak radial strain between anterior‐septal and posterior LV segments from speckle tracking of 2D LV views, adult cutoff >130 ms. Results: Median age was 11.5 years; median heart rate was 74.5. Longitudinal dyssynchrony was present in 40% of normals based on Yu index, and in 43% based on OWD. No child had Radial dyssynchrony. Conclusions: This pilot study of children with normal hearts suggests that current adult CRT dyssynchrony cutoff values are inappropriate in the pediatric population. (Echocardiography 2011;28:468‐474)