Diagnostic accuracy and clarity of steady-state free precession imaging of cardiac valve morphology in congenital heart disease Oscar J Benavidez, Ashwin Prakash, Kimberlee Gauvreau, Tal Geva Archives of Cardiovascular Imaging 2018 6(1):1-6 Purpose: Evaluation of cardiac valve morphology has not been considered an indication for cardiac magnetic resonance imaging (MRI) due to suboptimal imaging quality. Our study aims to evaluate cine of cardiac magnetic resonance-steady-state free precession (CMR-SSFP) imaging quality and diagnostic accuracy in the assessment of cardiac valve morphology for congenital heart disease. Materials and Methods: We retrospectively reviewed consecutive pediatric/congenital cardiac MRI cases. A 5-grade diagnostic clarity score was assigned to the aortic valve annulus and leaflets, tricuspid valve and mitral valve annuli, leaflets, chordae, and papillary muscles by examination of standard cine CMR-SSFP imaging. Among patients with aortic valve imaging, we compared morphologic diagnosis by CMR-SSFP to echocardiography. High-quality diagnostic imaging was defined as a clarity score of 1 or 2. Results: There were a total of 234 cardiac MRI studies evaluated with a total of 1892 valve components. The majority of valve annuli, leaflets, and papillary muscles had high diagnostic clarity score 64%–80% of the time – the tricuspid valve papillary muscles had a high diagnostic clarity score 53% of the time. Among the 39 cases with aortic valve imaging, CMR-SSFP correctly identified the aortic valve morphology including the affected commissure. Conclusions: CMR-SSFP produces high diagnostic quality imaging of cardiac valve morphology in congenital/pediatric cardiac MRI. The valve components with the highest diagnostic clarity score are tricuspid and mitral valve annuli, leaflets and papillary muscles, and aortic valve annuli and leaflets. Aortic valve morphology can be diagnosed with a high degree of reliability.

Evaluation of high left atrial pressure with quality of life in stable heart failure patients with reduced ejection fraction Fariba Bayat, Mohammad Khani, Samira Sadeghzadeh Archives of Cardiovascular Imaging 2018 6(1):7-10 Background: Diastolic function abnormalities contribute to symptoms of heart failure (HF). However, data in this regard are limited. We, therefore, sought the association of sensitive new markers of filling pressure and diastolic function with functional capacity in patients with congested HF. Materials and Methods: This case-series study was conducted from December 2017 to December 2018 in the Department of Heart, Modarres university hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Patients with moderately reduced systolic ejection fraction (EF) (30%–40%) were included in the study. Thirty patients were included in the study and underwent Doppler echocardiography following the exercise tolerance test. All patients had stable systolic HF and were stable on therapy for at least 1 month before testing. The primary endpoint was maximal exercise tolerance defined by the achieved metabolic equivalents (METs). Results: There were 27 (90%) males in the study. Mild diastolic dysfunction presented in 13 (43.3%) patients and moderate/severe diastolic dysfunction in 17 (56.7%) patients. In Pearson analysis, data showed systolic pulmonary arterial pressure (SPAP), left atrial volume index (LAVI), peak early diastolic mitral annulus velocity (E/Ea), left atrial pressure (LAP), and tricuspid annular plane systolic excursion (TAPSE) which were significantly higher in patients with higher age (P < 0.05). Increasing in E/Ea was significantly related to higher SPAP (P < 0.001), lower METs (P < 0.001), higher LAVI (P < 0.001), higher LAP (P < 0.001), higher TAPSE (P < 0.001), and higher S tissue (P = 0.02). LAP and E/Ea were conversely correlating with METs significantly (P < 0.001). Conclusion: In the present study, it was found that the diastolic function and high-LA pressure apart from the left ventricular EF (LVEF) are associated with exercise tolerance in patients with stable functional Class I–III HF and reduced LVEF.

Correlation between mean pulmonary arterial pressure measurement by echocardiography and right ventricular function Shahram Homayounfar, Nakisa Khansary Archives of Cardiovascular Imaging 2018 6(1):11-15 Background: Echocardiography is usually the first imaging modality for the evaluation of the structural and functional disorders of the heart and the great vessels. Color flow and Doppler images can provide hemodynamic and bloodstream assessment. The goal of this study was to investigate the function of the right ventricular (RV) using echocardiography in patients with an increased mean pulmonary artery pressure (PAP) (>25 mmHg). Methods: This cross-sectional study recruited patients with an elevated mean PAP (>25 mmHg) according to echocardiography. The RV function was evaluated in terms of the fractional area change (FAC), pulmonary vascular resistance (PVR), the myocardial performance index (Tei index), and the S-wave velocity. The data were analyzed using SPSS software, version 16, as well as the Chi-square test, the Pearson correlation coefficient, and the t-test. P< 0.05 was considered as statistically significant. Results: The mean FAC and the mean tricuspid annular plane systolic excursion (TAPSE) in the group with a mean PVR value of <2 WU were significantly higher than the mean FAC and the mean TAPSE in the group with a minimum mean PVR value of 2 WU (P = 0.006 andc P = 0.04, respectively). Conclusions: The RV function measured in terms of some basic echocardiographic parameters – namely the FAC, the S-wave velocity, the Tie index, and TAPSE – had a significant correlation with the mean PAP. In addition, the FAC value was more sensitive to an abnormal PVR value owing to the high frequency of the abnormal FAC values in the range of abnormal PVR values.

A floating heart: A case of congenital pericardial agenesis associated with atrial septal defect Anita Sadeghpour, Hoda Mombeini, Kiara Rezaie Kalantari Archives of Cardiovascular Imaging 2018 6(1):16-19 Congenital absence of the pericardium is a rare condition. Diagnosis and management of this condition remain a dilemma for clinicians. Here, we report a case of 15-year-old boy who had complaint of palpitation. Considering the echocardiographic features, pericardial agenesis associated with atrial septal defect (ASD) was suspected and multimodality imaging was performed for subsequent confirmation. Mal-aligned septum leads to failure in ASD device closure; therefore, the defect was repaired surgically by using a Dacron patch. Physicians need to be aware of this disorder and its associated congenital abnormalities, to enable them to make a correct diagnosis and treatment plan.

Germ cell tumour presenting as left atrial mass Anil Ramesh Jawahirani, Dilip Kshirsagar, Deepak Jeswani, Vivek Gupta Archives of Cardiovascular Imaging 2018 6(1):20-22 A 33-year-old male presented with dry cough for 6 months and dyspnea on exertion for 3 months for which he was treated symptomatically by nearby physicians. On two-dimensional echocardiography, it revealed large left atrial mass occupying 2/3rd of the left atrium (LA) extending into the left lower pulmonary vein (PV). Then, his computed tomography of the chest was done, which revealed posterior mediastinal mass invading the left upper and lower lobe of the lung through the left main bronchus. The lesion also invaded the LA through the left PV. Biopsy was suggestive of nonseminomatous germ-cell tumor. This case is presented to demonstrate uncommon cardiac manifestations of secondary spread of testicular malignancy.