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Background: An impairment of standard echocardiographic parameters of right ventricular (RV) function is a known phenomenon in patients undergoing cardiac surgery, but its significance remains unclear., Aims: This study aimed to assess changes in RV function in patients undergoing cardiac surgery using speckle tracking and 3D echocardiography., Methods: The study population comprised 122 patients referred for cardiac surgery. Transthoracic echocardiographic (TTE) examinations were performed: before the surgery (TTE1), 1 week after surgery (TTE2), and 1 year after surgery (TTE 3). Parameters measured during these examinations included both standard and advanced indices of the RV size and function, as well as a new parameter introduced by our team - RV shortening fraction (RV SF)., Results: TTE1 was performed on average (standard deviation [SD]) 24 (15) hours before surgery, whereas TTE2 and TTE3 were performed on average 7.2 (3) days and 346 (75) days after the surgery, respectively. A postoperative impairment of parameters of RV longitudinal function was observed (P <0.001). However, neither the RV size assessed by both 2D and 3D techniques changed, nor the global RV function measured with the use of fractional area change and ejection fraction. Additionally, during the postoperative period, an increase in the value of an RV SF by 12.9% was observed. After 12 months we observed an improvement in the parameters of the longitudinal RV function., Conclusions: Uncomplicated cardiac surgery causes transient impairment of the longitudinal systolic RV function, with no influence on the global RV function. The preservation of global function results from increased RV SF. After 12 months, an improvement of the longitudinal function can be observed.

Background: The rotation and twist of the left ventricle (LV) have been comprehensively evaluated at rest. However, little is known about rotational mechanics during dobutamine stress echocardiography (DSE)., Aims: We aimed to quantify and compare the basal and apical rotation and twist of the LV at rest as well as at the peak and recovery stages of DSE in patients with and without coronary artery disease (CAD)., Methods: We enrolled 91 patients, including 48 patients with CAD and 43 patients without CAD (mean [SD] age, 62 [9] years and 61 [10] years, respectively). Coronary artery disease was defined as the presence of stenoses of 50% or more in the left main coronary artery and/or stenoses of 70% or more in other epicardial arteries. Rotation was measured by 2‑dimensional speckle‑tracking echocardiography, and twist was calculated as the difference between the basal and apical rotation., Results: Neither rotation nor twist differed between patients with and without CAD at rest, although apical rotation was significantly greater in the CAD group at peak DSE (mean [SD], 5.43° [3.45°] vs 3.71° [3.52°], P = 0.01) and at recovery (mean [SD], 5.05° [3.65°] vs 2.87° [2.73°], P <0.01). On the contrary, the absolute value for basal rotation at recovery was higher in patients without CAD (mean [SD], 3.87° [3.37°] vs 2.63° [2.43°], P = 0.03). In both groups, the rotation and twist did not change significantly during the dobutamine challenge., Conclusions: During DSE, we observed differences in LV rotation between patients with and without CAD, revealing the effect of ischemia on deformation parameters.

Background: General anaesthesia may have negative impact on patient mortality and morbidity, as well as overall procedure costs, in atrial septal occluder (ASO) implantation., Aim: We sought to evaluate the safety, efficacy, and feasibility of conscious sedation for transcatheter implantation of ASOs., Methods: A total of 122 patients referred for transcatheter implantation of ASO were included. Mean patient age was 51 ± 15 years, and 43 (35%) patients were male. The initial dose of midazolam was 2 mg and fentanyl dose was 25 μg. Additional doses of midazolam and fentanyl were administered, if necessary. Patient responsiveness was assessed every 10 min, and the sedatives doses were titrated in order not to exceed grade 3 sedation in the Ramsey scale., Results: Atrial septal occluders were successfully implanted in the majority of patients (98.4%). In two (1.6%) cases the proce-dure failed because of too small patent foramen ovale (PFO) diameter (n = 1, 0.8%) or device instability (n = 1, 0.8%). The mean duration of procedure was 47.6 ± 28.4 min and was similar for ASD and PFO closure (p = 0.522). The overall mean dose of midazolam was 4.7 ± 2.2 mg (63.9 ± 32.5 μg/kg) and fentanyl was 30.0 ± 11.9 μg (0.43 ± 0.17 μg/kg). Median entrance dose of radiation at the patient plane was 25 (interquartile range: 16-57) mGy, and did not differ between ASD and PFO procedures (p = 0.614). The majority of patients were free of complications (91.0%). The following early complications were observed: transient ischaemic attack (n = 2, 1.6%), supraventricular arrhythmias (n = 4, 3.3%), left atrial thrombus formation (n = 1, 0.8%), symptomatic bradycardia (n = 1, 0.8%), and femoral venous bleeding (n = 5, 4.1%). After mean follow-up of 386 days residual shunt was observed in eight (6.6%) patients., Conclusions: Conscious sedation for transcatheter implantation of ASO is a feasible, safe, and efficient technique, allowing successful PFO and ASD closure in the majority of patients.

We describe a case of a 30 year-old female with implantable cardioverter-defibrillator. One and a half year later the patient suffered from endocarditis und undevent surgery. The factor V Leiden mutation was diagnosed. Diagnosis and treatment of device-related interactive complications is discussed.

Intracardiac tumours are usually found after clinical symptoms lead to a positive imaging study, or as an incidental finding of imaging study, usually echocardiography. Cardiac tumours range from non-neoplastic lesions to high grade malignancies. The majority of primary cardiac tumours are myxomas (in 75% cases) or sarcomas (about 10% cases). In this paper we present cases of 2 patients with right atrial tumour, extending from renal carcinoma, invading renal vein and inferior vena cava into right atrium. Two different therapeutic strategies were undertaken in those patients.

Background and Aim: The study was set out to assess feasibility and diagnostic value of the echocardiographic quantitative analysis of the resting regional systolic function (i.e. strain and strain rate) with use of the speckle tracking (2D strain) for myocardial viability assessment in patients with acute myocardial infarction (MI) treated with primary angioplasty. The reference method was the late enhancement magnetic resonance imaging (LE MRI)., Methods: The study group consisted of 40 patients (29 men, mean age 61 ± 9 years) in whom resting echocardiographic examination was performed 7-10 days after MI with peak systolic longitudinal strain (STS) and systolic longitudinal strain rate (SLSR) measurement by 2D strain technique on external workstation (EchoPac 6.1.0., GE Vingmed Ultrasound). Within 72 h LE MRI was performed in all patients, with visual assessment of late enhancement in all segments of the left ventricle. Viability of a segment was assessed based on two distinct, frequently adopted criteria: LE extent ≤ 50% or ≤ 75% of the wall thickness., Results: Due to suboptimal image quality 70 (10.9%) of the segments were excluded from 2D strain analysis. In the analysis of akinetic and dyskinetic segments, SLS and SLSR measurements with 2D strain technique had good discrimination value for viability defined as LE extent of ≤ 75% by MRI (area under the ROC curve 0.715 and 0.705, respectively; diagnostic accuracy of the criterion SLS ≤ -7.61% was 72.8%; diagnostic accuracy of the criterion SLSR ≤ -0.79/s was 64.9%). However, when the ≤ 50% viability criterion by LE MRI was used, only SLS measurement could be used for viability assessment, with sufficient diagnostic value (area under the ROC curve 0.620; diagnostic accuracy of the criterion SLS ≤ -9.77% was 57%). In the analysis of all segments, including hypokinetic and normokinetic segments, SLS and SLSR measurements did not provide additional information, beyond that of the visual viability analysis., Conclusions: Resting quantitative echocardiographic analysis of myocardial function seems to be a promising tool for myocardial viability assessment. There is a trend towards greater diagnostic value of SLS than SLSR measurements.