Tag Archives: echocardiography

Comparative Study Between Echocardiography and Autopsy Results of Congenital Heart Defects

Imre Ágnes1, Egyed-Zs Imre2, Togănel Rodica2, Cotoi Ovidiu1, Pasc Ana Sorina3, Cucerea Manuela4

1 Morphopathology Departament of County Emergency Clinic Hospital of Tîrgu Mureş
2 University of Medicine and Pharmacy of Tîrgu Mureș
3 Pediatric Cardiology Department of the Emergency Clinic Hospital of Tîrgu Mureş
4 Neonatology Departament of County Emergency Clinic Hospital of Tîrgu Mureş

Background: Congenital heart disease is currently the world’s leading birth defect, with incidence estimated at 8 per 1000 live births. Confidence in the images obtained using echocardiography has continued to increase, with many patients referred for corrective or palliative surgery on the basis of echocardiographic imaging alone. This review outlines the manner in which echocardiography is used to plan and guide congenital heart surgery or intervention, along with some of the advantages and disadvantages of which to be aware.
Aim: To assess the degree of harmonization of echocardiography with postmortem diagnosis in congenital heart disease.
Material and method: We examined the morphology of congenital heart diseases by autopsy in the Morphopathology Department of the County Hospital of Tîrgu Mureş in 2008 and 2009. We analyzed the components of the congenital heart disease and we compared the echocardiographic results with the autopsy results also.
Results: In 2008 and 2009 621 necropsies were carried out, from which 49, meaning 7.89% were diagnosed with simple or complex cardiac malformations; the male-female ration was 1:0.9. We found a few differences between the echocardiography and autopsy results on the following malformations: total anomalous pulmonary venous connection, double outlet ventricle, univentricular heart.
Conclusions: Echocardiography is accepted as the first-line imaging modality for diagnosing most types of congenital heart defects but in some difficult cases surgeons must always keep in mind the possibility of the presence of other heart malformation too.

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Atrial Fibrillation, the First Manifestation of Atrial Myxoma

Opriș Mihaela¹, Maier Anca², Dinesch M², Bilca V³, Moldovan Eugenia4, Mitre Adriana¹, Sîrbu Voichița¹

1 Medical Clinic V, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Clinic of Cardiology, Emergency County Hospital, Tîrgu Mureș, Romania
3 Clinic of Cardiovascular Surgery, Emergency County Hospital, Tîrgu Mureș, Romania
4 Department of Pathology, Emergency County Hospital, Tîrgu Mureș, Romania

Introduction: Atrial myxomas are the most common primary heart tumors. Although quite rare, left atrial myxomas account for 80% of all cardiac tumors. Diagnosis is often difficult due to the wide array of presenting symptoms. This case report discusses an unusual presentation of left atrial myxoma in an elderly patient.
Case presentation: A 73-year old woman with a history of hypertension, dyslipidemia and hyperthyroidism treatment presented to the emergency department with a new onset episode of palpitations. The electrocardiogram revealed atrial fibrillation. Rate control was achieved with beta-blockers and sinus rhythm transition was achieved shortly after admission. Transthoracic echocardiography revealed a heterogeneous mass in the left atria with a villous surface, occupying more than 50% of the left atrial cavity. Surgery was recommended because of the embolic potential of such a mass and tumor excision was performed. Microscopic pathology showed typical histological features of cardiac myxoma with no atypia or malignancy, and the patient was discharged in sinus rhythm 7 days after surgery.
Discussion and conclusions: Left atrial myxoma presenting in the seventh decade of life is rare. Elderly patients often present with non- specific symptoms that are often overlooked in the absence of a supporting cardiac history, which makes an early diagnosis challenging. We conclude that the majority of myxomas mimic many cardiovascular diseases and were detected in symptomatic patients, so a high index of clinical suspicion is important for its early and correct diagnosis. Two-dimensional echocardiography provides substantial advantages in detecting intracardiac tumors.

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Assessment of Ventricular Dissynchrony in Right Ventricular Single Chamber Pacing using Echocardiografic Parameters

Mitre Adriana, Vita I, Dobreanu D

Clinic of Cardiology, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0008

Background: Right ventricular apical pacing has been used since the early years of pace-makers, despite the fact that it determined nonphysiological ventricular depolarization. As medical technologies developed, septal lead implantation became feasible, in order to outrun the above mentioned inconveniences. The question whether the apical or septal lead position is better still gives rise to a lot of controversies. Different echocardiographic parameters are currently used to assess the impact of specific sites of stimulation on ventricular function. The aim of the study was to determine which of the followed synchronicity parameters varied significantly during apical stimulation, compared to septal stimulation in patients requiring single chamber pacing.
Material and method: Fifty-nine patients admitted between January 1st – December 31st 2012 either for battery replacement or for first implant of a single chamber pace-maker were included in this prospective study. Thirty-eight of them had the lead placed in the apex of the right ventricle and 21 on the interventricular septum. All were subjected to echocardiografic examination after device implantation. Measurements included complete chamber and valvular assessment, apart from the synchronicity evaluation, that comprised interventricular mechanical delay (IVMD), septal to posterior wall delay (SPWMD) and electro systolic delays (ESD), in order to assess the presence and compare the relevance of interventricular and intraventricular dissyncrony. All the investigations were in accordance with the Declaration of Helsinki.
Results: Although preejection times were significantly different, there were no statistically significant differences (p = 0.06) between the values of IVMD in the two groups, as well as regarding the longitudinal intraventricular dyssynchrony expressed by ESD. Significant differences appeared though, between the values of SPWMD, reflecting the fact that radial intraventricular dissyncrony is present in apical stimulation.
Conclusions: During apical right ventricular pacing, radial intraventricular dissyncrony appears, while in the case of septal pacing this parameter is close to normal. Surprisingly, although right ventricular pacing determines interventricular and longitudinal intraventricular dissincrony, we found no significant differences in this respect, between apical and septal pacing.

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