The aortic paradox: a nationwide analysis of 523 994 individual echocardiograms exploring fatal aortic dissection.

Aims: Increasing aortic dilation increases the risk of aortic dissection. Nevertheless, dissection occurs at dimensions below guideline-directed cut-offs for prophylactic surgery. Currently, there are no large-scale population imaging data assessing aortic dimensions before dissection.

Integrated versus nOn-integrated Peripheral inTravenous catheter. Which Is the most effective systeM for peripheral intravenoUs catheter Management? (The OPTIMUM study): a randomised controlled trial protocol.

Introduction: Peripheral intravenous catheters (PIVCs) are frequently used in hospitals. However, PIVC complications are common, with failures leading to treatment delays, additional procedures, patient pain and discomfort, increased clinician workload and substantially increased healthcare costs. Recent evidence suggests integrated PIVC systems may be more effective than traditional non-integrated PIVC systems in reducing phlebitis, infiltration and costs and increasing functional dwell time.

Transthyretin Cardiac Amyloidosis: A Noninvasive Multimodality Approach to Diagnosis Using Transthoracic Echocardiography, 99m-Tc-Labeled Phosphate Bone Scanning, and Cardiac Magnetic Resonance Imaging.

• Case report highlighting the utility of noninvasive imagining modalities, specifically transthoracic echocardiography in conjunction with nuclear medicine bone scan and cardiac magnetic resonance imaging for the diagnosis of transthyretin cardiac amyloidosis. • Exquisite supporting transthoracic echocardiographic, cardiac magnetic resonance imaging, as well as bone scan images. • Promising demonstration of potential noninvasive use for earlier detection of transthyretin cardiac amyloidosis.

Combined catheter ablation for atrial fibrillation and Watchman® left atrial appendage occlusion procedures: Five-year experience.

Background: Patients with atrial fibrillation (AF) may benefit from undergoing concomitant interventions of left atrial catheter ablation and device occlusion of the left atrial appendage (LAA) as a two-pronged strategy for rhythm control and stroke prevention. We report on the outcome of combined procedures in a single center case series over a 5-year timeframe.

Methods: Ninety-eight patients with non-valvular AF and a mean CHA2DS2-VASc score 2.

Guiding the management of ventricular arrhythmias in patients with left ventricular noncompaction cardiomyopathy: a knowledge gap.

Left ventricular noncompaction (LVNC) is a cardiomyopathy that occurs due to an arrest of myocardial maturation during embryogenesis. The diagnostic echocardiographic features in individuals with LVNC include a thick, bilayered myocardium, prominent ventricular trabeculations, and deep intertrabecular recesses. Clinical features associated with LVNC vary in asymptomatic and symptomatic patients, and include the potential for heart failure, conduction defects (eg, left bundle branch block), supraventricular and ventricular arrhythmias, thromboembolic events, and sudden cardiac death.

Aortopathies: etiologies, genetics, differential diagnosis, prognosis and management.

Aortic root and ascending aortic dilatation are indicators associated with risk of aortic dissection, which varies according to underlying etiologic associations, indexed aortic root size, and rate of progression. Typical aortic involvement is most commonly seen in syndromic cases for which there is increasing evidence that aortic aneurysm represents a spectrum of familial inheritance associated with variable genetic penetrance and phenotypic expression. Aortic root and ascending aortic dimensions should be measured routinely with echocardiography.

Combined Catheter Ablation for Atrial Fibrillation and Watchman Left Atrial Appendage Occlusion Procedures: A Single Centre Experience.

Patients with atrial fibrillation (AF) may be interested in undergoing concomitant interventions of left atrial catheter ablation and device occlusion of the left atrial appendage (LAA). We report on the feasibility and outcome of combined procedures in a single centre case series. Twenty-six patients underwent either first time or redo pulmonary vein isolation (PVI) procedures followed by successful implant of a Watchman device.

The use of computerised simulators for training of transthoracic and transoesophageal echocardiography. The future of echocardiographic training?

Background: Echocardiography is the commonest form of non-invasive cardiac imaging but due to its methodology, it is operator dependent. Numerous advances in technology have resulted in the development of interactive programs and simulators to teach trainees the skills to perform particular procedures, including transthoracic and transoesophageal echocardiography.

Methods: Forty trainee sonographers assessed a computerised mannequin echocardiographic simulator and were taught how to obtain an apical two-chamber (A2C) view and image the superior vena cava (SVC).

Anatomical analysis of the left atrial appendage using segmented, three-dimensional cardiac CT: a comparison of patients with paroxysmal and persistent forms of atrial fibrillation.

Purpose: Successful implantation of percutaneous left atrial appendage (LAA) occlusion devices requires an accurate understanding of LAA anatomy and orifice dimensions. We sought to quantitatively compare LAA anatomy in patients with paroxysmal and persistent patterns of atrial fibrillation (AF).

Methods: Fifty-nine consecutive patients undergoing catheter ablation for AF underwent pre-procedural multislice cardiac computed tomography (CT) scans.

Carotid intima-media thickness measurements are not affected by the ultrasound frequency.

Objective: Carotid intima-media thickness (IMT) is a B-mode ultrasound measure of subclinical atherosclerosis predictive of future cardiovascular risk. Carotid IMT measurements were historically obtained at an ultrasound frequency of 8 MHz or lower, but it is unknown whether measurements obtained at higher frequencies using newer, more advanced ultrasound technology allow for valid comparison to the older general population databases that are commonly used for the interpretation of carotid IMT results.

Methods: Carotid IMT studies were conducted in 35 consecutive patients at standard (8 MHz) and high (14 MHz) frequencies and measurements were performed by two independent expert readers.

Carotid ultrasound identifies high risk subclinical atherosclerosis in adults with low framingham risk scores.

Background: Worldwide, cardiovascular (CV) disease remains the most common cause of morbidity and mortality. Although effective in predicting CV risk in select populations, the Framingham risk score (FRS) fails to identify many young individuals who experience premature CV events. Accordingly, the aim of this study was to determine the prevalence of high-risk carotid intima-media thickness (CIMT) or plaque, a marker of atherosclerosis and predictor of CV events, in young asymptomatic individuals with low and intermediate FRS (<2% annualized event rate) using the carotid ultrasound protocol recommended by the American Society of Echocardiography and the Society of Vascular Medicine.

A rare congenital finding in an elderly lady--scimitar syndrome with dextrocardia in a 79 year old.

We present a case of a 79-year-old African-American woman with scimitar syndrome and associated dextrocardia. This case represents, to our knowledge, the oldest living patient described in the literature with scimitar syndrome.

Atrial fibrillation ablation in cor triatriatum: value of intracardiac echocardiography.

A 72-year old male, referred for percutaneous atrial fibrillation ablation, was found to have cor triatriatum during routine, pre-procedural transesophageal echocardiography. Accessing the superior pulmonary venous atrium and wide area circumferential ablation was guided by intracardiac echocardiography and performed without complications. The patient remains symptom-free, off anti-arrhythmic drug therapy, for 6 months following ablation.