Development and evaluation of methodologies for teaching focused cardiac ultrasound skills to medical students.

Background: Handheld ultrasound is emerging as an important tool for point-of-care cardiac assessment. Although cardiac ultrasound skills are traditionally introduced during postgraduate training, the optimal time and methodology to initiate training in focused cardiac ultrasound (FCU) are unknown. The objective of this study was to develop and evaluate a novel curriculum for training medical students in the use of FCU.

A post-myectomy heart: 20 years later.

We present the case of a 20-year old male that underwent a surgical ventricular septal myectomy at 8 months of age for symptomatic and drug-refractory obstructive hypertrophic cardiomyopathy (HCM). Though he has remained asymptomatic since the operation, he now demonstrates findings of cardiac arrhythmia and left ventricular dysfunction. His case is of particular interest as it represents a detailed and lengthy follow-up from early childhood to adulthood.

An unusual case of infective endocarditis: extension of a tricuspid valve vegetation into the left atrium through a patent foramen ovale.

Tricuspid valve endocarditis frequently occurs in the setting of intravenous drug use. A case of tricuspid valve endocarditis in a 37-year-old woman with a history of intravenous cocaine use is described. Transthoracic echocardiography showed extension of the tricuspid valve mass through a patent foramen ovale and into the left atrium.

Cardiac MRI and pulmonary MR angiography of sinus venosus defect and partial anomalous pulmonary venous connection in cause of right undiagnosed ventricular enlargement.

Objective: Patients may be referred for cardiology assessment because of an enlarged right ventricle (RV) with no cause apparent on echocardiography. Cardiac MRI can contribute to the management of these patients by detecting sinus venosus defect or partial anomalous pulmonary venous connection (PAPVC). We sought to show how often sinus venosus defect or PAPVC was detected on MRI in patients with an enlarged RV without a previously established definite diagnosis.

A single, comprehensive non-invasive cardiovascular assessment in pulmonary arterial hypertension: combined computed tomography pulmonary and coronary angiography.

Background: Comprehensive assessment of pulmonary arterial hypertension (PAH) should identify structural causes and subsequent cardiopulmonary consequences of PAH. This currently requires the use of several imaging modalities. Computed tomography (CT) is routinely used for pulmonary angiography (CTPA).

Adult presentation with vascular ring due to double aortic arch.

This is a case report on the use of cardiovascular magnetic resonance imaging to diagnose vascular ring due to double aortic arch in an adult presenting with an abnormal chest X-ray. The experience in this case and the literature review identify the benefits of using cardiovascular magnetic resonance imaging to clarify complex aortic arch anatomy.

Aortico-left ventricular tunnel in adulthood: twenty-two year follow up.

Aortico-left ventricular tunnel (ALVT) is a rare congenital cardiac defect that is usually managed by surgical or catheter intervention. This case documents the 22 year follow up of a 44 year old man who has been managed medically through a programme of close clinical and echocardiographic monitoring. This report illustrates that conservative management of Type I ALVT can be undertaken without adverse clinical consequences.

The team approach to pregnancy and congenital heart disease.

The successful pediatric management of congenital heart disease has resulted in increasing numbers of these patients in the reproductive age group and increasing clinical challenges for their physicians. These challenges can be met successfully, with improved results for mother and child, through a concerted comprehensive team approach that relies on a thorough understanding of the patient's underlying cardiac pathology and its anticipated interaction with the pregnancy, and ongoing close evaluation and communication with a team of trained and experienced specialist, including (but not limited to) cardiologist, obstetricians, anesthetists, pediatricians, clinical nurse specialists, and clinical geneticists. Such teams are not always available locally and it will be necessary to refer medium- and high-risk patients to a specialized tertiary care center.