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β-Thalassemia major (β-TM) patients are at increased risk for cardiovascular diseases. Determination of subclinical cardiac involvement is essential for preventive measures. Thus, we aimed to evaluate the role of stress echocardiography for identification of subclinical cardiac dysfunction in β-TM patients. In this prospective study, 45 β-TM patients who were referred for cardiac evaluation, were enrolled. Exclusion criteria included non sinus rhythm and overt cardiac disease. Stress echocardiography levels and cardiac magnetic resonance imaging (MRI) results were obtained from β-TM patients. Patients were divided into two groups of normal vs. iron overload from cardiac T2* greater or less than 20 msec, respectively. Resting and peak exercise right ventricular stroke volume (RVSV) and left ventricular SV (LVSV) were significantly lower in iron overload vs. normal β-TM patients, respectively ( p value <0.05). At peak LV global longitudinal strain (GLS) and myocardial performance index (MPI) were significantly decreased and increased compared with resting in iron overload vs. normal β-TM patients, respectively ( p value <0.05). There was a significant relationship between inappropriate hemodynamic response to exercise and lower age ( p value = 0.032). Resting LVSV and RVSV seemed better prognosticators for iron overload than LV ejection fraction (LVEF). Decreased GLS and increased MPI at peak exercise could also predict the presence of cardiac iron overload. These measurements by stress echocardiography could be evaluated when cardiac T2* could not be determined.

The most commonly reported collateral systems in the setting of superior vena cava obstruction are azygos venous system, vertebral venous system, external and internal thoracic venous system based on McLntire and Sykes classification. A 49-year-old female with renal disease complained dyspnea on exertion. Transesophageal echocardiography showed significant mitral annular calcification, large multi-lobulated mass at posterior aspect of RA, and complete obstruction of superior vena cava by thrombus formation. Computed tomography angiography showed a collateral vein to the left atrium (LA) roof. This case report is the first one which shows development of collateral vein from right subclavian to LA., (© 2018 Wiley Periodicals, Inc.)

Blunt trauma to the chest can damage any thoracic organ. Heart valve damage and particularly mitral apparatus occurs relatively rare, and the patients are expected to become acutely symptomatic. However, in patients with multiple traumas, other dominant severe damages tend to draw away the attention of the physicians resulting in neglect of less salient heart injuries. Here, we present a patient with history of blunt chest trauma and incidental finding of posttraumatic severe mitral regurgitation., (© 2018 Wiley Periodicals, Inc.)