Differences and Disparities Among Self-Referred and Physician-Referred Populations Undergoing Coronary Artery Calcium Scanning.

Background: Coronary artery calcium computed tomography (CAC) is an important tool for identifying subclinical atherosclerosis and cardiovascular risk stratification. Despite robust evidence and inclusion in current guidelines, CAC is considered investigational by some US insurance carriers and requires out-of-pocket expenses. CAC can be obtained via self-referral (SR) or physician referral (PR).

Pulmonary Artery Intimal Sarcoma Mimicking Right Ventricular Outflow Tract Thrombus.

A 72-year-old man presented with breathlessness and a systolic murmur. Extensive diagnostic work-up revealed a rare pulmonary artery intimal sarcoma mimicking a right ventricular outflow tract thrombus and impacting a cardiac pacemaker lead. Surgical resection, pathology confirmation, and management strategies are discussed, highlighting the challenges of treating this rare malignancy.

Myocardial work indices in bileaflet mitral valve prolapse patients.

Aims: Mechanisms underlying left ventricular dysfunction and arrhythmogenesis in bileaflet mitral valve prolapse (BMVP) patients are not well defined. Myocardial work index (MWI) is a non-invasive assessment that correlates with myocardial oxygen consumption. We aimed to compare global and regional MWI in BMVP patients with normal controls.

Hypertrophic Cardiomyopathy-Septal Perforator Arteries Doppler Flow Dynamics.

Background: Patients with hypertrophic cardiomyopathy (HCM) have been shown to exhibit abnormal diastolic vessel flow; however, flow pattern profiles and their possible association with different grades of diastolic dysfunction have not been studied. Color Doppler two-dimensional echocardiography permits visualization of the septal perforator arteries, and pulsed-wave Doppler allows recording of diastolic septal artery flow (SAF). Through routine visualization of the septal perforator arteries and acquisition of SAF, we noticed 3 patterns of SAF in patients with HCM.

Challenge in mitral valve intervention: Super-elongated anterior and diminutive posterior mitral valve.

Diminutive posterior mitral valve leaflet with an extremely elongated anterior leaflet is a rare phenomenon. We share such a case discovered in an 82-year-old patient with severe, symptomatic mitral regurgitation. LA, left atrium; LV, left ventricle; MR, mitral regurgitation.

Large Symptomatic Ventricular Fibromas: A Surgical Challenge.

• Cardiac fibromas are benign clinical entities that are rarely diagnosed in adulthood. • Echocardiography is considered the first imaging modality used for evaluation. • Multimodality imaging is critical for diagnosis and perioperative intervention.

Left subclavian artery pseudoaneurysm after blunt chest trauma with left upper extremity ischemia.

We describe a 74-year-old male with delayed onset of acute left upper extremity ischemia after blunt chest trauma with left clavicular fracture, resulting in left subclavian artery injury, including pseudoaneurysm formation, intramural hematoma, thrombosis, and distal embolization to the brachial artery. The patient presented with left upper extremity pain, forearm and hand numbness, and digital cyanosis. The patient was treated with a hybrid approach, consisting of transfemoral percutaneous deployment of a covered stent in the left subclavian artery and concomitant surgical thrombectomy of the left brachial artery, resulting in excellent recovery and resolution of symptoms.

Pulmonary Vein Isolation in a Patient with Superior Vena Cava Atresia: Challenges and Solutions.

Congenital cardiac anomalies pose a significant challenge during cardiac ablation procedures. Pre-procedural multimodality imaging can help to identify these incidental findings, which may assist with procedural planning to achieve successful outcomes. Here, we describe the technical challenges associated with cryoballoon ablation of the pulmonary veins in a patient with persistent left superior vena cava who was found to have right superior vena cava atresia during the case.

Case report: Metastatic melanoma masquerading as apical hypertrophic cardiomyopathy.

Background: Cardiac tumors are usually metastatic. Melanoma is the tumor with the highest rate of cardiac metastasis. Clinicians need to be aware of the metastatic involvement of the left ventricular apex as a differential diagnosis of apical hypertrophic cardiomyopathy.

Five-Chambered Heart With Double-Chambered Left Ventricle Diagnosed by Multimodality Imaging.

• Left ventricular (LV) diverticulum is a rare cardiac anomaly. • Echocardiographic examination of accessary LV chambers is critical to diagnosis. • Multimodality imaging can aid in ruling out additional congenital heart defects.

Embolization of a Vascular Plug after a Year and Successful Treatment Using Two Vascular Plugs Side by Side.

• Vascular plugs used for PVL repair usually embolize late after deployment. • A low threshold for echo studies (namely TEE) is an essential part of clinical follow-up. • Redo percutaneous PVL closure should be considered in those at high surgical risk.

Percutaneous Removal of Epicardial Pacing Wire: Nidus for Infective Endocarditis.

• Retained TEPW is fairly common and in rare cases may cause infective endocarditis. • Obtaining medical records and using multimodality imaging confirmed diagnosis. • The heart team assured full understanding of treatment options to reduce patient risk.

Echocardiographic assessment of radial right ventricular function in heart transplant recipients.

Aims: Right ventricular (RV) allograft dysfunction is present in half of all heart transplant (HT) recipients. Non-invasive assessment of RV function in the setting of rejection is not well described. We outline an echocardiographic technique, short-axis fractional area change (SAXFAC), to evaluate RV function in the HT population and correlate this with the grade of pathologic rejection.

Acquired Lutembacher's Syndrome With a Continuous Murmur.

• Development of rapid noninfective thrombosis of TMVR valve. • Reopening of the transseptal puncture site. • A unique cause of continuous murmur.

Rare and Complex Case Mimics Acute Myocardial Infarction: The Importance of Multimodality Imaging.

We report a rare and complex case of cardiac sarcoidosis in a patient presenting with ventricular tachycardia. Multimodality imaging, along with clinical and histological examination, was essential in establishing the diagnosis of cardiac sarcoidosis. ().

Nonvisualization of the Left Atrial Appendage and Role of Multimodality Imaging.

• LAA has a pathologic association with stroke and a role in AF. • The incidence of congenitally absent or rudimentary LAA is unknown. • Highlight multimodality imaging to identify congenitally absent and diminutive LAA.

Association Between Malignant Mitral Valve Prolapse and Sudden Cardiac Death: A Review.

Importance: Malignant arrhythmic mitral valve prolapse (MVP) phenotype poses a substantial risk of sudden cardiac death (SCD), and an estimated 26 000 individuals in the United States are at risk of SCD per year. Thus, identifying risk-stratification strategies for SCD is imperative.

Observations: Patients with MVP have a heterogenous clinical spectrum, ranging from a benign course to a devastating complication such as SCD.

Familial LEOPARD Syndrome With Hypertrophic Cardiomyopathy.

Multiple lentigines syndrome is an autosomal dominant inherited condition with variable expressivity that is also known as LEOPARD syndrome. LEOPARD stands for lentigines, electrocardiographic conduction defects, ocular hypertelorism, pulmonary valve stenosis, abnormalities of genitalia, retardation of growth, and deafness. LEOPARD syndrome most frequently develops secondary to a missense mutation of protein-tyrosine phosphatase nonreceptor type 11 gene, which encodes tyrosine phosphatase.

Double Jeopardy Cardiomyopathy Requiring Heart Transplant: Hydroxychloroquine and Rheumatoid Arthritis.

• Hydroxychloroquine can cause cardiomyopathies. • High suspicion for iatrogenic cardiomyopathy can lead to early diagnosis and treatment. • Multimodality imaging and histologic assessment are needed for diagnosis.