Transesophageal echocardiographic diagnosis of bronchopulmonary vein fistula complicating mitral valve replacement.

A bronchopulmonary vein fistula (BVF) establishes a communication between a pulmonary vein and the alveolar space presumably secondary to alveolar rupture from increase in alveolar pressure. This rare fistula allows air to move continuously from the lungs to a pulmonary vein and into the left side of the heart causing systemic air embolization which is often fatal. We describe an adult patient undergoing a second mitral valve replacement surgery in whom intra-operative transesophageal echocardiography proved crucial in diagnosing BVF by showing persistent and increased streaming of air bubbles into the left heart from the left superior pulmonary vein during each positive pressure ventilation cycle with consequent inability to de-air the heart.

Cardiac device-related invasive aspergilloma assessed by live/real time three-dimensional transthoracic echocardiography.

Cardiac device-related infection caused by Aspergillus species is a rare finding associated with high mortality. Prompt recognition and treatment is imperative, but difficult as blood cultures are often negative and diagnosis requires a high index of suspicion. Live/real time three-dimensional transthoracic echocardiography (3DTTE) provides incremental knowledge in the characterization of valvular vegetations.

The incremental value of three-dimensional transthoracic echocardiography in adult congenital heart disease.

Imaging with echocardiography is useful in diagnosing congenital heart disease (CHD). Two-dimensional (2D) transthoracic echocardiography (TTE) has been the standard cardiac imaging modality, but it forces the reader to mentally create the three-dimensional (3D) cardiac anatomy to understand these complex diseases. 3D TTE, which has relatively recently emerged to address this limitation, is capable of providing clear and dynamic 3D views of these anatomic defects and offers more insight on how to manage them.

Comprehensive and rapid assessment of carotid plaques in acute stroke using a new single sweep method for three-dimensional carotid ultrasound.

We describe a 68-year-old man with acute stroke in whom the newly developed single sweep method for three-dimensional (3D) carotid ultrasound provided a rapid and comprehensive assessment of atherosclerotic plaque burden in the internal carotid artery. The two-dimensional duplex carotid scan diagnosed 50-69% stenosis, and with the three-dimensional method, the markedly hypoechogenic plaque (total volume 1.42 mL) was shown to occupy 77% of the total arterial volume (1.

Alterations in K-ras, APC and p53-multiple genetic pathway in colorectal cancer among Indians.

The incidence of colorectal cancer (CRC) is increasing rapidly in Asian countries during the past few decades, but no comprehensive analysis has been done to find out the exact cause of this disease. In this study, we investigated the frequencies of mutations and expression pattern of K-ras, APC (adenomatosis polyposis coli) and p53 in tumor, adjoining and distant normal mucosa and to correlate these alterations with patients clinicopathological parameters as well as with the survival. Polymerase chain reaction (PCR)-restriction digestion was used to detect mutations in K-ras and PCR-SSCP (Single Strand Conformation Polymorphism) followed by DNA sequencing was used to detect mutations in APC and p53 genes.

Preference for salt contributes to sympathovagal imbalance in the genesis of prehypertension.

Background/objectives: As salt preference is known to cause hypertension (HTN), the present study was conducted to assess the impact of preference for salt on sympathovagal imbalance in prehypertensives by spectral analysis of heart rate variability (HRV).

Subjects/methods: Body mass index (BMI), basal heart rate, blood pressure (BP), rate pressure product and spectral indices of HRV such as total power (TP), normalized low frequency power (LFnu), normalized high frequency power (HFnu), ratio of low frequency power to high frequency power (LF-HF ratio), mean heart rate, square root of the mean squared differences of successive normal to normal (NN) intervals, the number of interval differences of successive NN intervals >50 ms (NN50) and the proportion derived by dividing NN50 by the total number of NN intervals were assessed in 555 subjects divided into four groups: Group 1, normotensives no-salt-preference subjects (n=260); Group 2, normotensives salt-preference subjects (n=185); Group 3, prehypertensives no-salt-preference subjects (n=25); and Group 4, prehypertensives salt-preference subjects (n=89). Sympathovagal balance was analyzed and contribution of individual factor to sympathovagal imbalance was assessed by regression analysis.

Live/Real time three-dimensional transesophageal echocardiography in percutaneous closure of atrial septal defects.

Objectives: This study assessed the ability of live/real time three-dimensional transesophageal echocardiography (3DTEE) in measuring (1) atrial septal defect (ASD) maximum dimension, area, and adjacent rim size, (2) ASD occluder left and right atrial disk size, (3) length of contact between the left atrial (LA) disk and the aorta, and in (4) assessing device related complications such as residual shunt, device embolization, and device encroachment upon adjacent cardiac structures.

Materials And Methods: 3DTEE images acquired during percutaneous ASD closure by the Amplatzer Septal Occluder in 15 adult patients were retrospectively analyzed. Offline analysis was done using both the Philips 5500 ultrasound system and Philips QLAB software.

Two- and three-dimensional transthoracic echocardiography in the assessment of aortic arch vasum vasi to pulmonary artery fistula.

We report an elderly patient presenting with a stroke and also hemolytic anemia secondary to mitral and tricuspid valve repair 3 years earlier, in whom two-dimensional transesophageal echocardiography (2DTEE) suspected a fistula into the pulmonary artery (APAF) from the posterior wall of the aortic arch. For further assessment, two-dimensional transthoracic echocardiography (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE) were performed. 2DTTE showed findings similar to 2DTEE.

Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions.

Two-dimensional speckle tracking echocardiography (2D STE) is a novel technique of cardiac imaging for quantifying complex cardiac motion based on frame-to-frame tracking of ultrasonic speckles in gray scale 2D images. Two-dimensional STE is a relatively angle independent technology that can measure global and regional strain, strain rate, displacement, and velocity in longitudinal, radial, and circumferential directions. It can also quantify rotational movements such as rotation, twist, and torsion of the myocardium.

Cardiovascular dysfunctions and sympathovagal imbalance in hypertension and prehypertension: physiological perspectives.

Hypertension (HTN) and prehypertension (pre-HTN) have been identified as independent risk factors for adverse cardiovascular events. Recently, increased psychosocial stress and work stress have contributed to the increased prevalence of HTN and pre-HTN, in addition to the contribution of obesity, diabetes, poor food habits and physical inactivity. Irrespective of the etiology, sympathetic overactivity has been recognized as the main pathophysiologic mechanism in the genesis of HTN and pre-HTN.

Role of live/real time three-dimensional transthoracic echocardiography in pericardial disease.

Despite the high sensitivity of two-dimensional transthoracic echocardiography (2DTTE) in diagnosing pericardial effusion, it has limitations in assessing its size and extent and in evaluating other pericardial pathologies. There are only limited reports so far, but live/real time three-dimensional transthoracic Echocardiography (3DTTE) has shown promise and potential advantages over 2DTTE in certain clinical situations. With its ability to crop and view cardiac structures from any desired angulation it offers incremental value in assessing the anatomy of the pericardium including echo densities within the effusion, fibrinous bands, and loculated effusions.

Is it time to move on from two-dimensional transesophageal to three-dimensional transthoracic echocardiography for assessment of left atrial appendage? Review of existing literature.

Left atrial appendage (LAA) has unique anatomical and physiological properties, which make it a common site for thrombus formation in many cardiovascular and systemic diseases. Assessment of LAA for thrombus thus becomes important in many clinical situations and two-dimensional transesophageal echocardiography (2D TEE), which allows excellent quality images of LAA because of its close proximity to esophagus is routinely used for this purpose. However, it is a semiinvasive procedure, requires more time and involves some degree of patient discomfort.

Live/real time three-dimensional transesophageal echocardiography.

Since the advent of matrix array transducer, three-dimensional transesophageal echocardiography has come to frequent clinical use. It has significantly enhanced the communication between the operators and cardiac imagers in the operating room as well as in the cardiac interventional labs. This article reviews the history, technological aspects, and the protocol for acquisition and processing of the data sets.

Real time three-dimensional echocardiography for the evaluation of cardiomyopathy.

Cardiomyopathy refers to a set of diseases that are characterized by myocardial dysfunction. Classically, two-dimensional echocardiography has been used in the diagnosis of these disorders and to help guide their management. Three-dimensional transthoracic echocardiography is now increasingly being used in the diagnosis, management, and prognostication of intrinsic cardiomyopathies.

Population cytogenetic and molecular evidence for existence of a new species in Anopheles fluviatilis complex (Diptera: Culicidae).

Anopheles fluviatilis James, an important malaria vector in the Oriental region has been established as a complex of at least three cryptic species which vary in their biological characteristics and malaria transmission potential. The sibling species S, T and U of Fluviatilis Complex can be identified by examination of species-specific fixed inversions in the polytene chromosomes and can also be differentiated by an allele-specific PCR assay based on differences in the D3 region of 28S ribosomal DNA (rDNA) of these species. Here we report a new An.

Pharmacokinetic study of omacetaxine mepesuccinate administered subcutaneously to patients with advanced solid and hematologic tumors.

Purpose: Omacetaxine mepesuccinate is a first-in-class cephalotaxine demonstrating clinical activity in chronic myeloid leukemia. A subcutaneous (SC) formulation demonstrated efficacy and safety in phase 1/2 trials in patients previously treated with ≥1 tyrosine kinase inhibitor. This study assessed pharmacokinetics and safety of SC omacetaxine in patients with advanced cancers.

Ejection fraction at the first attack of myocardial infarction and postinfarction survival in South Indian population.

Ischemic heart disease is estimated to be the most important cause of mortality by the end of 2020 world wide despite sufficient improvement in health care. It has several modifiable and few non modifiable prognostic variables. Therefore, we analyzed the data of all patients admitted for the first time for acute myocardial infarction (MI) and evaluated the long term modifiable prognostic variables retrospectively.

Prevalence and incrimination of Anopheles fluviatilis species S (Diptera: Culicidae) in a malaria endemic forest area of Chhattisgarh state, central India.

Background: Chhattisgarh state in central India is highly endemic for malaria and contributes about 13% of annually reported malaria cases in the country with predominance of P. falciparum. Entomological investigations were carried out in a tribal forested area of district Bastar located in the southern part of Chhattisgarh state to record the prevalence of sibling species of Anopheles fluviatilis and An.

Role of live/real time three-dimensional transesophageal echocardiography in the percutaneous epicardial closure of the left atrial appendage.

We are reporting the use of three-dimensional transesophageal echocardiography as a supplement to two-dimensional transesophageal echocardiography in the percutaneous suture closure of the left atrial appendage.

Live/Real time three-dimensional transthoracic echocardiographic assessment of the involvement of cardiac valves and chambers in carcinoid disease.

We present an adult with metastatic carcinoid disease affecting the heart, in whom live/real time three-dimensional transthoracic echocardiography (3DTTE) provided incremental value over two-dimensional transthoracic echocardiography (2DTTE). Initial 2DTTE was able to demonstrate severe pulmonic and tricuspid regurgitation, but was unable to visualize the posterior leaflet of the tricuspid valve or the right (right anterior) leaflet of the pulmonic valve. Further analysis with 3DTTE demonstrated thickening, restricted mobility, and noncoaptation of all three leaflets of both the tricuspid and the pulmonary valves.

Live/Real Time Three-Dimensional Trans Esophageal Echocardiographic Findings in Amplatzer ASD Closure Devices in Adults.

Six female patients aged from 19 to 73 years, with ostium secundum atrial septal defect underwent closure procedure with Amplatzer septal occluder device. Three-dimensional Echocardiography (3D-TEE) was done during the procedure or one day after the procedure. 3D-TEE provides incremental value over Two- dimensional trans-esophageal echocardiography in measuring Amplatzer septal occluder disc sizes and correlates well with manufacture device size.

Atrial septal occluder device embolization to an iliac artery: a case highlighting the utility of three-dimensional transesophageal echocardiography during percutaneous closure.

Percutaneous closure of secundum atrial defects has become an accepted treatment in part because it is minimally invasive and relatively low risk. Despite recent advances in implantation technique and device improvements, complications occur. Here, we report a case of device embolization during percutaneous repair of an atrial septal defect (ASD) with multiple fenestrations.

Aortic stiffness assessed by global pulse wave velocity in postmenopausal women: an ultrasonographic study.

Objective: The first goal of our study was to investigate major determinants of aortic stiffness in postmenopausal women using an echocardiographic method to calculate global pulse wave velocity (PWVg) rather than the less accurate carotid-femoral pulse wave velocity (PWVc). The second goal was to relate PWVg to the absolute risk of major cardiovascular (CV) events estimated by CV risk factors.

Patients And Methods: Two hundred forty-four consecutive women who presented to our heart station were screened.

Phase 2 study of subcutaneous omacetaxine mepesuccinate after TKI failure in patients with chronic-phase CML with T315I mutation.

Chronic myeloid leukemia (CML) patients with the BCR-ABL T315I mutation do not benefit from therapy with currently approved tyrosine kinase inhibitors. Omacetaxine mepesuccinate is a protein synthesis inhibitor that has demonstrated activity in cells harboring the T315I mutation. This phase 2 trial assessed the efficacy of omacetaxine in CML patients with T315I and tyrosine kinase inhibitor failure.