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Introdution: Ischemic mitral regurgitation (IMR) remains one of the most complex and unresolved aspects of ischemic heart disease that the impact of percutaneous coronary intervention (PCI) on improvement of intensity of ischemic mitral regurgitation is not well clarified. Patients with coronary artery diseases and ischemic mitral regurgitation have a worse prognosis than the patients with coronary artery disease (CAD) and those without ischemic mitral regurgitation. We sought to investigate the impact of complete revascularization by percutaneous coronary intervention PCI on improvement of IMR in patients with CAD and comparisons of echocardiography indices in patients with and without improvement of ischemic mitral regurgitation. Methods: In this cross sectional retrospective study, echocardiographic reports in pre- percutaneous coronary intervention time and 12 months after PCI of patients with moderate (≥2+) ischemic mitral regurgitation who underwent complete revascularization by percutaneous coronary intervention from Farvardin 1391 to Esfand 1393 were included in the study. Then, echocardiographic data of the patients with improved ischemic mitral regurgitation compared with the patients with non-improved ischemic mitral regurgitation. Results: Comparison of echocardiographic indices before and after percutaneous coronary intervention revealed that after percutaneous coronary intervention (P = 0.002) in 15 patients (16%), improvement in ischemic mitral regurgitation was occurred. Also, left ventricular ejection fraction (P = 0.010), left ventricular end- diastolic (P = 0.003) and end-systolic diameters (P < 0.001), wall motion score index (P = 0.003), left atrial area (P = 0.001) and systolic pulmonary artery pressure (P = 0.046) in pre- percutaneous coronary intervention echocardiography were different between improved and none-improved IMR group. Conclusion: Although, percutaneous coronary intervention can lead to improvement of ischemic mitral regurgitation but most patients did not show improvement of ischemic mitral regurgitation after percutaneous coronary intervention. The structural abnormality of left ventricle and atrium were different between improved and none-improved IMR group

Introduction: We present three cases of ruptured sinus of Valsalva aneurysm concomitant with a cardiac lesion in 2 cases of ventricular septal defect and 1 case of bicuspid aortic valve with mild aortic insufficiency. Case presentation: In 2/3 cases, the site of ruptured sinus of Valsalva aneurysm originated from right coronary cusps and one from non-coronary cusps. Both ruptured sinus of Valsalva aneurysm from right coronary cusps communicated to right ventricle, and one that originated from non-coronary cusps ruptured to right atrium. All cases were diagnosed by transthoracic echocardiography and confirmed by transesophageal echocardiography. Two underwent the surgery, while one did not want to continue treatment. Conclusion: ruptured sinus of Valsalva aneurysm is a rare cardiac anomaly. In the Eastern countries, the most common associated anomalies with ruptured sinus of Valsalva aneurysm are ventricular septal defect and aortic regurgitation. Ruptured sinus of Valsalva aneurysm mainly originates from right coronary cusps and is ruptured into right ventricle. Transthoracic echocardiography and transesophageal echocardiography are employed to confirm the diagnosis. In this cohort, the coexistences of ruptured sinus of Valsalva aneurysm with ventricular septal defect and aortic regurgitation (case 1), ventricular septal defect (case 2), aortic regurgitation and bicuspid aortic valve (case 3) are observed.

Atrial septal defect (ASD) is the defect of interatrial septum, there are four types of ASD: 1. ASD ostium secundum type, 2. ASD ostium primum type, 3. ASD sinus venosus, 4. Unroofing coronary sinus.

Ventricular septal defect (VSD) is one of the most common congenital heart diseases. In fetal life, there may be muscular or perimembranous VSD in septum, most of them are closed until birth or in early life or until puberty.

There is a spectrum of degenerative mitral valve disease from fibroelastic deficiency to Barlow disease [1].

There are two categories of tricuspid valve involvement: 1. Congenital, like Ebstein disease 2. Acquired

Objectives It is not clear whether the presence and degree of chronic ischemic mitral regurgitation (IMR) in patients with left ventricular (LV) dysfunction are related to LV dysfunction, local LV remodeling or mitral valve deformation. We sought to establish the strongest determinants of IMR severity in patients with LV dysfunction and IMR. Methods We prospectively performed transthoracic echocardiography for 135 patients (mean age = 60.76 ± 9.69 years, 71.9% male) with LV dysfunction (ejection fraction ≤ 50%) and coronary artery disease (70% stenosis in ≥1 coronary artery and no myocardial infarction during the previous 16 days). Global and local LV remodeling and mitral deformity indices were measured. Using the vena contracta, MR severity was graded as no regurgitation; mild; moderate; and severe. Results Mild regurgitation was found in 45 (33.3%) patients, moderate in 71 (52.6%), severe in 6 (4.4%), and no regurgitation in 13 (9.6%). By linear logistic multivariable analysis, the major echocardiographic determinants of MR severity were tenting area (TA), sphericity index (LV systolic length/width), and C-septal (distance between the leaflet coaptation and the septum). TA was best related to coaptation depth and annulus diameter. Mitral annular diameter was best correlated with left atrial surface area (r = 0.630, p

Background: Left ventricular (LV) dyssynchrony is a prevalent feature in heart failure (HF) patients. The current study aimed to evaluate the prevalence of inter and intraventricular dyssynchrony in HF patients with regard to the QRS duration and etiology. Methods: The available data on the tissue Doppler imaging (TDI) of 230 patients with refractory HF were analyzed. The patients were divided into three groups according to the QRS duration: QRS duration < 120 ms; 120-150 ms; and ≥ 150 ms and the patients were re-categorized into two subgroups depending on the underlying etiology: ischemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM). The time-to-peak myocardial sustained systolic velocity (Ts) in six basal and six middle segments of the LV was measured manually using the velocity curves from TDI. LV dyssynchrony was defined as interventricular mechanical delay ≥ 40 ms and tissue Doppler velocity all segments delay ≥ 105 ms; standard deviation (SD) of all segments ≥ 34.4 ms; basal segments delay ≥ 78 ms; SD of basal segments ≥ 34.5 ms; and opposing wall delay ≥ 65 ms. Results: After adjustment for the possible confounders, interventricular dyssynchrony was more prevalent in the patients with QRS duration ≥ 150 ms than in those with QRS duration 120-150 ms and < 120 ms. The patients with DCM also had a higher percentage of interventricular dyssynchrony than those with ICM in the wide QRS groups. Turning to the intraventricular dyssynchrony indices, the patients with QRS duration ≥ 150 ms and 120-150 ms revealed a significantly greater delay between Ts at the basal and all segments than did those with QRS duration < 120 ms, while etiology did not influence the frequency of these indices in each QRS group. Conclusion: The prevalence of both inter and intraventricular dyssynchrony indices was greater in the patients with wide QRS than in those with narrow QRS duration. The underlying etiology may affect the frequency of interventricular but not intraventricular dyssynchrony indices.

A 17-year-old girl presented with dyspnea on exertion (functional class II) since childhood. Physical examination revealed a harsh holosystolic murmur at the left sternal border and apex. Electrocardiography showed normal sinus rhythm and left axis deviation.

A 35-year-old man presented with dyspnea on exertion (functional class II) of recent duration. Physical examination revealed a systolic murmur at the lower left sternal border and the apex.

A 26-year-old obese man presented with a history of multiple episodes of respiratory infections. Physical examination revealed a systolic ejection murmur in the aortic area. Echocardiography showed normal left and right ventricular sizes and functions.

A 24-year-old woman, who had a history of typical chest pain and one episode of ventricular tachycardia as well as a continuous murmur (grade II/VI) in the second right intercostal space, was referred to our clinic. Echocardiography revealed normal left and right ventricular sizes and functions.

A 46-year-old woman referred to our echocardiography laboratory because of recurrent pericardial effusion. She had a holosystolic murmur at the lower left sternal border. Electrocardiography showed right axis deviation.

A 35-year-old man presented with dyspnea on exertion (functional class II–III) of recent duration. Physical examination showed a systolic murmur at the apex and the lower left sternal border.

A 12-year-old girl, who had undergone surgery for an atrioventricular septal defect (AVSD) at infancy, was referred to our echocardiography laboratory. She had dyspnea functional class II symptoms and was underweight. Physical examination revealed a holosystolic murmur at the apex and the left sternal border.

A 40-year-old asymptomatic woman was referred to our echocardiography laboratory because of dextrocardia and a systolic ejection murmur at the upper right sternal border. Electrocardiography showed a negative P in leads I and AVL. Chest X-ray revealed that the stomach and the heart were located in their right positions.

A 12-year-old boy with a history of balloon dilation and stenting of the right pulmonary artery branch stenosis was referred to our echocardiography laboratory. Physical examination showed an ejection systolic murmur (grade II/VI) at the first and second left intercostal spaces.

A 20-year-old man with a history of a single ventricle and Fontan operation was referred to our echocardiography laboratory for the evaluation of the extracardiac conduit function.

A 46-year-old woman presented with dyspnea on exertion and frequent episodes of palpitations. Physical examination revealed a systolic–diastolic murmur (grade III/VI) in the aortic area. Echocardiography demonstrated a mild left ventricular dilation with a good systolic function as well as mild concentric left ventricular hypertrophy, normal aortic valve thickness, and no evidence of doming and calcification.

A 12-year-old girl, weighing 45 kg, referred to our center. Physical examination showed a holosystolic murmur at the apex and left sternal border. She was asymptomatic.

A 33-year-old woman presented with dyspnea on exertion (functional class II) since childhood. Physical examination revealed a continuous murmur at the left sternal border.

A young woman presented with a history of atypical chest pain and a systolic murmur (grade III/VI) in the aortic area without ejection clicks. She had normal left and right ventricular sizes and functions and mild concentric left ventricular hypertrophy.

A 46-year-old man presented with recent dyspnea on exertion (functional class II). Physical examination showed a systolic ejection murmur and a holodiastolic murmur at the left sternal border. Transthoracic echocardiography revealed that the aortic valve area was 1.1 cm2 by direct planimetry and 0.9 cm2 by continuity equation.

A middle-aged man presented with a history of dizziness during exercise and atypical chest pain. Physical examination revealed a systolic ejection murmur (grade III/VI) at the apex and at the left sternal border.

A 24-year-old man presented with newly diagnosed hypertension. Physical examination revealed an early diastolic murmur (grade II/VI) on the aortic side. Echocardiography showed mild concentric left ventricular hypertrophy, a bicuspid aortic valve with mild aortic insufficiency, and no aortic stenosis.

An 18-year-old female, who had undergone the device closure of a patent ductus arteriosus (PDA) a few months previously, was referred to us for control echocardiography.

A 44-year-old woman presented with recent dyspnea on exertion (functional class II). Physical examination revealed a systolic murmur at the left sternal border and a fixed S2 splitting.

A 24-year-old man, who had previously undergone device closure for a ventricular septal defect (VSD) in our center, was referred to our echocardiography laboratory for follow-up echocardiography. He was totally asymptomatic.

A young woman with a history of harsh systolic murmur on physical examination was referred to our echocardiography laboratory for an evaluation of the systolic murmur. She had a holosystolic murmur (grade III/VI) at the left sternal border, and there was no clubbing and cyanosis.

A 24-year-old woman was referred to our echocardiography laboratory for the evaluation of the feasibility of the Amplatzer device closure of an atrial septal defect (ASD). Transthoracic echocardiography revealed severe right ventricular dilation and a large ASD (ostium secundum type).

A 26-year-old man presented with atypical chest pain. Physical examination revealed a holosystolic murmur at the left lower sternal border.

A 25-year-old man presented with palpitation and dyspnea on exertion (functional class II) of recent duration. Physical examination revealed a harsh systolic murmur at the fourth and third left sternal borders. The left ventricle was moderately dilated (64 mm), and there was mild left ventricular systolic dysfunction. Also, there was mild tricuspid regurgitation, and the pulmonary arterial systolic pressure was about 40 mmHg.

A middle-aged man with a history of clubbing and cyanosis, easy fatigability, and systolic and faint diastolic murmurs in the second intercostal space was referred to our echocardiography laboratory. Echocardiography revealed normal left ventricular size and function with paradoxical septal motion and severely dilated right ventricle with mild systolic dysfunction.

A 28-year-old man presented with chest pain of 1-year duration. Physical examination revealed a harsh holosystolic murmur at the apex and lower left sternal border.

A 27-year-old woman, who had undergone surgery for an atrioventricular septal defect (AVSD) at childhood, presented with recent dyspnea on exertion (functional class I). She had one child and had a holosystolic murmur at the apex.

A 32-year-old man was referred for the evaluation of the cause of a stroke. He had suffered an ischemic cerebral stroke 2 months previously.

A 22-year-old man presented with fever of 1-month duration. He was a known case of dextrocardia and situs inversus from childhood. Physical examination revealed a systolic ejection murmur at the right sternal border and right precordium, cyanosis and clubbing, an ejection systolic murmur at the second right intercostal space, and a holosystolic murmur at the right apex. On transthoracic echocardiography, the left atrium was located on the right side of the right atrium. All the images were obtained from the right precordium, with the patient lying in the right lateral decubitus position.

A 34-year-old woman presenting with dyspnea on exertion (functional class III) was referred to our echocardiography laboratory for a precise evaluation of her severe mitral regurgitation and left ventricular systolic dysfunction prior to surgery.

A 33-year-old male athlete presented with palpitation and dyspnea of recent duration (within the previous 3 months). Electrocardiography was normal. Physical examination revealed a faint continuous murmur at the lower sternal border.

A 40-year-old woman was referred to our echocardiography laboratory for decision-making about a ventricular septal defect (VSD) and rull out of Gerbode defect (VSD between the left ventricle and right atrium). She was asymptomatic and had a holosystolic murmur (grade II/VI) at the lower left sternal border.

A young woman presented with a history of long-standing easy fatigability and recent exacerbation of dyspnea on exertion. Physical examination revealed a harsh systolic murmur (grade IV/VI) at the left sternal border and clubbing.

A middle-aged woman with a history of palpitation and a continuous murmur (grade II/VI) in the second intercostal space was referred to our echocardiography laboratory for further evaluation. Echocardiography revealed a mild left ventricular dilation with a normal systolic function.

A 57-year-old woman was referred to our center for decision-making regarding an atrial septal defect (ASD). Transthoracic echocardiography (TTE) revealed moderate tricuspid regurgitation (TR) with a gradient of about 40 mmHg.

A 15-year-old girl presented with dyspnea on exertion (functional class II) and cyanosis. Physical examination revealed an ejection-type murmur at the pulmonic area. The electrocardiogram showed right-axis deviation and right ventricular hypertrophy.

A 23-year-old man presented with dyspnea on exertion (functional class II). Physical examination revealed a harsh systolic murmur at the lower left sternal border and apex.

A 33-year-old man was referred to our center due to sustained ventricular tachycardia (VT).

A young man presented with a history of frequent episodes of palpitation and exercise intolerance of 3-month duration. Physical examination showed a blood pressure of 130/80 mmHg, regular pulse rate of 85 beats per minute, normal jugular venous pressure, widely split S1 with a loud tricuspid component (sail sound), right-sided third heart sound, and pansystolic murmur, which increased with inspiration and could be best heard at the lower left sternal border. The body surface area was equal to 1.7 m2. The patient was a candidate for the radiofrequency ablation of paroxysmal supraventricular tachycardia. Transthoracic echocardiography showed a normal left ventricular size with mild systolic dysfunction and a left ventricular ejection fraction of about 45 %. The right ventricular systolic function, in terms of the fractional area change (FAC), was normal (FAC = 66 %).

A 33-year-old man presented with a seizure of recent onset. He was a known case of a ventricular septal defect (VSD) from childhood. Physical examination showed a harsh systolic murmur at the lower sternal border and apex.

A 22-year-old woman was referred to our clinic because of multiple abortions. She had dyspnea on exertion (functional class II). Physical examination revealed an early diastolic murmur in the aortic area. The O2 saturation of the patient was 83 % by pulse oximetry in room air. Electrocardiography showed normal sinus rhythm, right axis deviation, and equal R and S in lead V1. Chest X-ray revealed hypovascularity of the lungs and cardiomegaly. Transthoracic echocardiography showed normal left ventricular size and mild systolic dysfunction, normal right ventricular size and function, and mild mitral and tricuspid regurgitation with a tricuspid regurgitation gradient of about 70 mmHg.

A 17-year-old girl presented with dyspnea on exertion (functional class I) of 1-year duration. She was a known case of ventricular septal defect (VSD) since childhood. Physical examination revealed a holosystolic murmur at the apex and the left sternal border.