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Vaccination is considered the most effective intervention to fight against the Covid 19 pandemic and vaccination is not without any risk. Adenoviral vector covid 19 vaccine may have prothrombogenic event which leads to serious complication but myopericarditis is a rarely reported and no incidence rate in Asian population .We report a case of a young Asian male developed myopericarditis with pleuritis after his first AstraZeneca vaccination. In summary, fever followed by general body soreness noticed one week post vaccination. Myopericarditis was suspected from elevated cardiac enzyme and cardiac echo showed myocardial dyskinesia with pericardial effusion with Cardiac MRI and inflammation scan favor cardiac inflammation. In addition bilateral moderate amount pleural effusion with exudate nature was found as well. Thorough investigation has excluded possible autoimmune aetiology and negative cultures results. All abnormal findings resolved after a short period of standard treatment for myopericarditis. We acknowledge vaccination is the key factor to significantly reduce the burden of the covid 19 pandemic. However fear for post vaccination severe complications may held back the coverage rate. It is crucial to have more data allow us to understand nature course of the event. Therefore, it is important to maintain a high index of suspicions for cardiac symptoms following covid 19 vaccination.

Cardiac masses can manifest as a variety of signs and symptoms in adults. In this report, we report a case that highlights the value of advanced imaging of a newly symptomatic and previously undiagnosed cardiac neoplasm. In addition to the standard transthoracic and transesophageal echocardiography, cardiac catheterization may be employed to further understand the vascularity of such cardiac pathology prior to surgical intervention.

Design Retrospective analyses of congenital scoliosis patients at 2 tertiary care pediatric hospitals. Objective This study objectives were (1) to report the rates of anomalies of 10 organ systems in congenital scoliosis patients and (2) to determine whether the presence of a single organ system anomaly increases the rate of nonspinal organ system defects. Summary of background data Intraspinal, cardiac, renal, and gastrointestinal anomalies have been reported to occur at higher rates in congenital scoliosis than the normal population. It is unknown whether the presence of 1 organ system defect increases the risk of nonspinal organ system anomalies. Methods All patients diagnosed, evaluated in the outpatient setting, with congenital scoliosis who were below 18 years of age at time of presentation with available cardiac echo, renal ultrasound, or magnetic resonance imaging were included in this study. Results There were 305 patients (161 females, 53%) whose mean age was 7+3 years. In total, 84% of patients were observed to have at least 1 organ defect. Overall, 22% of patients had 1 organ defect, 19% had 2, 18% had 3, and 18% had ≥4 organ defects. There was an average of 2.2 anomalies per patient (range=0 to 8). Intraspinal anomalies were documented in 43% of patients; syrinx occurred most frequently. Urogenital anomalies were documented in 39% of patients; solitary kidney was most prevalent. Cardiac anomalies were documented in 54% of patients; ventricular septal defect was most common. In 12% of patients, the triad of spinal, urogenital, and cardiac defects was observed. Multiple organ systems were found to have significant associations (P Conclusions Cardiac anomalies were the most common defect (54%), and occurred at a rate >2 times higher than previously reported. The high rate of intraspinal, cardiac, and urogenital defects makes magnetic resonance imaging, echocardiography, and renal ultrasound a critical part of evaluation for all congenital scoliosis patients. Level of evidence Level II.

Introduction. Myocardial lymphoma is one of the rarest lesion localizations among all the lymphoproliferative diseases. Regardless of the current lack of generally accepted specific recommendations for the treatment of primary and secondary myocardial lymphomas the chemotherapy is carried out in accordance with clinical guidelines for the treatment of lymphoproliferative diseases, which in some cases results in a successful outcome. Materials and methods . The article presents a clinical example of the diagnostic procedure and treatment of a 65-year-old female with the following diagnosis: non-Hodgkin’s lymphoma st. II BE gr. II with the involvement of myocardium, cervical and mediastinal lymph nodes, and the right palatine tonsil. The patient received six courses of R-CEOP chemotherapy. Results and discussion . An echo-positive structure 28mm by 20 mm in size attached to the interatrial septum was found inside the right atrium following the second course of chemotherapy. Ejection fraction: 61%. Effect: regression exceeding 50%. Four months following the completion of treatment the ejection fraction was 63%, regression – exceeding 80%, thus implying a partial response. Conclusion. The diagnosis of lymphoma with a lesion in the myocardium has been positively verified by histology and IHC. Currently less invasive techniques are normally preferred, transesophageal cardiac echo guided biopsy being one. Similar to any other lymphoproliferative disease, myocardial lymphoma is a chemosensitive tumour that responds well to treatment. In each individual case, the treatment strategy must be patient-specific and take into account the somatic status of the patient, the tumour size and the degree of its spread, the tumour morphological type, and whether it would be possible to arrange adequate specialized support needed.

Preprocessing plays a vital role in image for reducing noise and other unwanted data. There is a need for preprocessing in many fields, including medical imaging. Many of the medical images are contaminated with noise. In this paper, works related to denoising for brain magnetic resonance imaging (MRI) and cardiac echo have been studied and implemented. Numerous types of traditional filters were compared for this purpose using mean square error (MSE), peak signal-to-noise ratio (PSNR), and structural similarity index (SSIM).

The glomerulonephritis (GN) of granulomatosis polyangiitis is described as "pauci immune" because the glomeruli show little or no evidence of immune complex deposition by immunofluorescence or electron microscopy. Here we describe a severe crescentic GN in which the patient was myeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA) positive, and on renal biopsy the glomeruli were pauci immune (there were only a few electron-dense deposits). However, by immunofluorescence the glomeruli showed "full-house" staining (the glomeruli stained positive for C1q, C3, IgG, IgA, and IgM). The latter staining pattern would be consistent with that seen in patients with lupus-like GN or with severe crescentic GN as a result of bacterial infection. So, should this patient receive high-dose immunosuppressive therapy and steroid therapy to treat presumed autoimmune GN, or should the patient receive intensive antibiotic therapy to treat a presumed underlying severe infection? This dilemma was soon resolved because the patient's blood culture returned positive for Streptococcus mutans and cardiac echo showed evidence of bacterial endocarditis. This report provides further detail regarding the patient's clinical issues.

A 44-year-old man who had been feeling general fatigue was found in an unconscious state on the same day He had no remarkable medical history On arrival at the hospital, his Glasgow Coma Scale was E1V2M3;he had tachycardia and hypertension, was afebrile, and in a severe hypoxic state His PaO2/FiO(2) (P/F) was under 100, even with tracheal intubation with 100% oxygen Chest X-ray and CT revealed a bilateral ground-glass appearance with consolidation Cardiac echo initially showed hyper-dynamic wall motion The main results of a blood analysis suggested an acute inflammatory reaction, rhabdomyolysis, and pancreatitis The microscopic findings of sputum and a rapid test for bacterial and viral infections were all negative As he showed deterioration of P/F, venovenous extracorporeal membrane oxygenation (ECMO) was started He also showed hypotension and therefore underwent vasopressor and steroid administration Due to concerns of pneumonia, he received meropenem and azithromycin in addition to the infusion of gamma-globulin and glycyrrhizin The results of a COVID-19 test, culture of sputum, and collagen disease test were all negative The serum virus neutralization assay as a serological test for Coxsackievirus B4 showed a four-fold increase in titer The multimodal therapy mentioned above resulted in the improvement of his general condition, including acute respiratory distress syndrome (ARDS) In this report, we discuss the benefits of ECMO and immune modulation therapy in the treatment of severe ARDS

A 60-year-old lady with a past history of rheumatic mitral stenosis (MS), percutaneous valvuloplasty and persistent atrial fibrillation represented with heart failure. Cardiac ECHO confirmed severe MS, moderate tricuspid and aortic valve regurgitation and pulmonary hypertension. She underwent mitral and aortic valve replacements, a tricuspid valve repair and left atrial appendage clip. She developed a LV wall rupture and underwent repair of defect. Cardiogenic shock persisted despite IABP counter-pulsation and escalating inotropic support. Central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and 9 days later, a percutaneous Protek Duo right ventricular assist device (RVAD) for RV failure afforded a successful outcome.

NAFLD is common in T2DM patients and has been proposed to be part of the cardiometabolic syndrome. Aim: To determine the relationship between hepatic fibrosis and cardiovascular abnormalities in T2DM. Subjects: 72 T2DM patients with NAFLD and 38 T2DM without NAFLD were studied. Based upon liver elastography and Bonacini and Metavir scores T2DM patients with NAFLD were divided into 3 groups: (I) NAFLD with hepatic fibrosis ≥F2 (n=29); (II) NAFL without fibrosis/inflammation (n=11); (III) NASH (n=32). All subjects had cardiac echo to quantitate ventricular volumes, ejection fraction, and diastolic function. Results: Incidence of cardiovascular complications was higher in patients with hepatic fibrosis: prevalence of arterial hypertension was 40% in T2DM without NAFLD vs. 44 % in NAFL, 69 % in NASH (p Conclusion: Liver fibrosis in T2DM is associated with impaired cardiac function and increased cardiovascular complications. The results demonstrate that hepatic inflammation and fibrosis in T2DM patients with NAFLD is an important risk factor for cardiovascular disease and is associated with cardiac dysfunction. Disclosure O. Lavrynenko: None. O. Zemlianitsyna: None. I. Dunaeva: None. N. Kravchun: None. V. Sinaiko: None. R.A. DeFronzo: None.

To date, cardiac dysfunction after traumatic brain injury (TBI) has not been consistent. In this study, we hypothesized that TBI may play a role in the development of new-onset cardiac dysfunction in healthy experimental rats. Anesthetized healthy male Sprague–Dawley rats were divided into two groups: a sham-operated control group and a TBI group. The brain was injured with 2.4 atm percussion via a fluid percussion injury model. During the 120 min after TBI, we continuously measured brain parameters, including intracranial pressure (ICP) and cerebral perfusion pressure (CPP), and cardiac parameters, such as heart rate (HR), inter-ventricular septum dimension (IVSD), left ventricular internal dimension diastole (LVIDd), end-diastolic volume (EDV), ejection fraction (EF), fractional shortening (FS), and LV mass diastole (LVd mass) by cardiac echo. On days 1, 3, 7, and 14 after TBI, the brain damage volume was evaluated with triphenyltetrazolium chloride; the physiological parameters of the heart, including HR, IVSd, LVIDd, EDV, EF, FS, and LVd mass, were evaluated with cardiac echo; the morphology of cardiomyocytes was examined by hematoxylin and eosin (HE) and Masson trichrome staining; and the biomarkers of cardiac injury troponin I and B-type natriuretic peptide (BNP) were also examined. Compared to sham-operated controls, the TBI groups had higher ICP, lower CPP, and higher brain neuronal apoptosis and infarction contusion volume. The impact of TBI on heart function showed hyperdynamic response trends in IVSd, LVIDd, EDV, EF, FS, and LVd mass within 30 min after TBI; however, EF and FS exhibited eventual decreasing trends. Simultaneously, the values of the biomarkers troponin I and BNP were within normal limits, and HE and Mass trichrome staining revealed no significant differences between the sham-operated control group and the TBI group. Our results suggest that TBI due to 2.4 atm fluid percussion injury in healthy experimental rats may cause significant damage to the brain and affect the heart function as investigated by cardiac echo but not as investigated by HE and Masson trichrome stainings or troponin I and BNP evaluation.

We describe the case of a term baby boy born via vaginal delivery at 39 weeks gestation with oesophageal atresia, tracheaoesophageal fistula, situs inversus abdominalis and azygos continuation. The azygos continuation was diagnosed after cardiac echo and confirmed on cardiac catherisation after an unexpected umbilical line position on thoracoabdominal X-ray. The baby underwent a right-sided thoracotomy on day 1 of life for repair of the oesophageal atresia. A double fistula, of both the proximal and distal segments, of the oesophagus with short segment stenosis was confirmed. The tracheo-oesophageal fistulae were ligated and divided and the oesophageal atresia repaired by primary anastomosis without complications. The azygos vein was not ligated.

Background In the present paper, the authors describe a case of a rare congenital defect - anomalous origin of the right coronary artery from the main pulmonary artery diagnosed in a 5-week-old infant who was deemed eligible for surgical treatment based solely on echocardiography. Such anatomical abnormalities of the coronary arteries are subtle and thus extremely difficult to visualize, especially in patients in whom permanent extensive damage of the cardiac muscle has not yet occurred. For this reason, the diagnosis is usually established when the disease is highly advanced, oftentimes only postmortem. In this paper, the authors present early echocardiographic evaluation, successful surgical treatment and post-operative echocardiographic examination. Case presentation Fetal echocardiographic examinations demonstrated single vascular anomalies. The suspicion was verified after birth. Other congenital defects, including genetic defects, were also investigated. In the 5th week of life, cardiac ECHO showed abnormal origin of the right coronary artery from the trunk of the pulmonary artery. The child was deemed eligible for surgical treatment of the defect. The surgical translocation of the ostium of the right coronary artery to the aorta was done with success, and the child was discharged on the 14th day of hospitalization. Conclusion The present case report demonstrates that careful examination of the child with precise echocardiographic examination makes it possible to establish an early diagnosis of this rare defect. This discrete defect can be treated early, before the symptoms, often connected with irreversible changes in the myocardium, appear.

Objective To determine the prevalence of congenital heart defects (CHDs) in patients with mild or severe congenital anorectal malformations (CARMs), and whether all patients with CARM need pediatric cardiology screening.Study design We included 129 patients with CARM born between 2004 and 2013, and referred to University Medical Center Groningen. Recto-perineal and recto-vestibular fistulas were classified as mild CARMs, all others as severe. Significant patent foramen ovale, secundum atrial septal defect, and small ventricular septum defect were classified as minor CHDs, all others as major.Results Of 129 patients with CARM, 67% had mild CARM, 33% severe CARM, and 17% were additionally diagnosed with CHD. CHDs were distributed equally in patients with mild or severe CARMs. Patients with multiple congenital abnormalities were more frequently diagnosed with CHD (n = 16, 36%) than patients without multiple congenital malformations (n = 5, 9%, P = .001). Patients with CARM diagnosed with CHD using pediatric cardiac echo screening were younger than 3 months of age at diagnosis. Earlier general pediatric examinations missed 7 (50%) children with mild and 4 (50%) with severe CHDs.Conclusions The severity of CARM could predict neither prevalence nor severity of CHD. More than one-half of CHDs were missed during the first physical examination. No new CHDs were found in patients older than 3 months of age at the time CARMs were diagnosed. We recommend screening all patients with CARM younger than 3 months of age for CHD at the time CARM is diagnosed. Preoperative echocardiography should be the rule in children younger than 3 months of age and with multiple congenital anomalies.

Aims Population data suggest that cardiovascular disease (CVD) risk in underweight is greater compared to healthy weight. Study of underweight and catch-up in young children has demonstrated greater future CVD risk. Pulse Wave Velocity (PWV) is a non invasive and easy to measure proxy for arterial stiffening, demonstrated to be a good predictor of CVD. We hypothesise that there will be a change in PWV and other measures of CVD risk with physical recovery. This research important as little is known about long-term physical risk from AN, and in particular how degree of underweight, changes in weight may differentially effect arterial stiffening are important questions. Methods Here we present the rationale, hypotheses and methodologies for two current studies: 1) recruiting new patients admitted to an eating disorder unit and 2) new patients diagnosed with AN and managed in outpatient settings, to measure PWV and other CVD risk factors. For inpatients measures will be recorded weekly for six weeks, for outpatient at baseline and 6 months. Other measures for analysis will include severity of AN, and for outpatient cardiac echo and bone density. Analyses will focus on longitudinal statistical methods to study change in CVD risk in both studies.

Background Streptococcus pasteurianus is a rare cause of neonatal infection, with only 3 cases reported in the USA and 18 cases reported in other countries within the past decade. Neonatal S. pasteurianus infection typically presents as meningitis. This case report describes the first neonatal case of S. pasteurianus endocarditis in the literature, in addition to a neonatal case of S. pasteurianus infection presenting as pneumonitis without meningitis. The S. pasteurianus infections in these two cases are unusual not only because of how rare this particular pathogen is, but also because of the atypical clinical manifestations. Case presentation The first patient is a full-term male infant admitted to NICU at 20 h of life due to respiratory distress. He was empirically started on ampicillin and gentamicin for presumed sepsis. Laboratory analysis of cerebral spinal fluid obtained after initiation of antibiotics was suggestive of partially treated meningitis. Blood cultures came back positive for S. pasteurianus. The neonate was transitioned from ampicillin to cefepime, while gentamicin was continued. Echocardiograph showed a possible tricuspid valve vegetation concerning for endocarditis. Due to the unusual complication of endocarditis, the patient remained on IV cefepime for 28 days rather than the more conventional duration of 14–21 days reported in the literature. The baby clinically improved with no evidence of thrombi or vegetations on repeat cardiac echo. The second patient is a full-term male infant who required intubation at birth for respiratory distress. Chest X-ray findings were concerning for meconium aspiration with pneumonitis. The baby went into septic shock and was empirically started on ampicillin and gentamicin. Blood cultures came back positive for S. pasteurianus, while cerebral spinal fluid and urine cultures were negative. Ampicillin and gentamicin were discontinued after 3 days and the baby was started on cefepime and clindamycin for a total 14-day course. The baby clinically recovered and was discharged from NICU without any sequelae. Conclusions These two cases highlight the importance of recognizing S. pasteurianus as a potential cause of neonatal sepsis and the importance of recognizing endocarditis and pneumonitis as possible clinical manifestations of this infection.

Introduction Niemann-Pick Disease is an autosomal recessive metabolic disorder characterized by deposition of sphingomyelin and cholesterol within the lysosome of reticuloendothelial cells of various organs due to inherited deficiency of an enzyme, acid sphingomyelinase. Niemann-Pick Disease is classified into four types such as A, B, C and D each caused by a different gene mutation. Case We report a case of Niemann Pick Disease type A/B twins. The patients are 3 years old girls, who presented to Sligo University Hospital with repeated episodes of chest infection. On examination they were found to have hepatosplenomegaly, with normal cognition and development, Eye examination was normal, basal blood tests were normal as well as metabolic screen and cardiac Echo, CT chest showed interstitial changes, lysosomal enzyme screen showed marked deficiency of (ASM) Sphingomylinase activity and increased Chitotriosidase activity which is consistent with Nieman pick Type A/B disease. A blood sample has been sent for full gene sequencing of the Nieman Pick A/B gene. Currently they are well and thriving, with no major complications in the mean time Discussion There is no specific treatment for NPD. Orthotopic liver transplantation in an infant with type A disease and cord blood transplantation in several type B NPD patients has been attempted with little or no success. BMT in a small number of type B NPD patients has been successful in reducing the spleen and liver volumes, the sphingomyelin content of the liver, the number of Niemann-Pick cells in the marrow, and radiologically detected infiltration of the lungs. ERT with recombinant human ASM is currently in clinical trials for the treatment of type B patients Conclusion Niemann-Pick disease types A and B is estimated to affect 1 in 250,000 individuals, Chronic visceral ASMD could have a mild course with a relatively good outcome. Other factors such as environmental ones could contribute to the disease severity.

Transthoracic echocardiography is the primary non-invasive modality for anatomical and functional cardiac assessment. All one-, two-dimensional and Doppler modes use the same phenomenon, i.e. the piezoelectric effect, to visualize mobile cardiac structures and blood flow in cardiac cavities. Novel techniques for myocardial imaging, such as tissue Doppler and acoustic marker tracing, allow for the assessment of regional myocardial contractility of the left and the right ventricle. Cardiac assessment is performed in standard views characterized by an optimal acoustic window. The goal of each cardiac echo is to assess cardiac function and morphology using all available imaging modes. The evaluation of acquired valvular heart diseases should include morphological and functional changes indicative of the type (stenosis, regurgitation, complex defect) and the mechanism (Carpentier's classification of mitral regurgitation) of the defect, as well as its stage (mild, moderate, severe). The assessment of left and right ventricular function should involve the measurement of global and regional parameters. An echocardiographic report should also include information on septal continuity and the presence of additional structures or intracardiac masses. Transthoracic echocardiography is the primary non-invasive modality for anatomical and functional cardiac assessment. All one-, two-dimensional and Doppler modes use the same phenomenon, i.e. the piezoelectric effect, to visualize mobile cardiac structures and blood flow in cardiac cavities. Novel techniques for myocardial imaging, such as tissue Doppler and acoustic marker tracing, allow for the assessment of regional myocardial contractility of the left and the right ventricle. Cardiac assessment is performed in standard views characterized by an optimal acoustic window. The goal of each cardiac echo is to assess cardiac function and morphology using all available imaging modes. The evaluation of acquired valvular heart diseases should include morphological and functional changes indicative of the type (stenosis, regurgitation, complex defect) and the mechanism (Carpentier’s classification of mitral regurgitation) of the defect, as well as its stage (mild, moderate, severe). The assessment of left and right ventricular function should involve the measurement of global and regional parameters. An echocardiographic report should also include information on septal continuity and the presence of additional structures or intracardiac masses.

Cardiovascular diseases remain the leading cause of death, taking an estimated 17.9 million lives each year and representing 31% of all global deaths. The patient records including blood reports, cardiac echo reports, and physician’s notes can be used to perform feature analysis and to accurately classify heart disease patients. In this paper, an incremental deep learning model was developed and trained with stochastic gradient descent using feedforward neural networks. The chi-square test and the dropout regularization have been incorporated into the model to improve the generalization capabilities and the performance of the heart disease patients' classification model. The impact of the learning rate and the depth of neural networks on the performance were explored. The hyperbolic tangent, the rectifier linear unit, the Maxout, and the exponential rectifier linear unit were used as activation functions for the hidden and the output layer neurons. To avoid over-optimistic results, the performance of the proposed model was evaluated using balanced accuracy and the overall predictive value in addition to the accuracy, sensitivity, and specificity. The obtained results are promising, and the proposed model can be applied to a larger dataset and used by physicians to accurately classify heart disease patients.

BACKGROUND Point-of-care ultrasound often includes cardiac ultrasound. It is commonly used to evaluate cardiac function in critically ill patients but lacks the specific quantitative anatomic assessment afforded by standard transthoracic echocardiography (TTE). We developed the Focused Rapid Echocardiographic Examination (FREE), a hybrid between a cardiac ultrasound and TTE that places an emphasis on cardiac function rather than anatomy. We hypothesized that data obtained from FREE correlate well with TTE while providing actionable information for clinical decision making. METHODS FREE examinations evaluating cardiac function (left ventricular ejection fraction), diastolic dysfunction (including early mitral Doppler flow [E] and early mitral tissue Doppler [E']), right ventricular function, cardiac output, preload (left ventricular internal dimension end diastole), stroke volume, stroke volume variation, inferior vena cava diameter, and inferior vena cava collapse were performed. Patients who underwent both a TTE and FREE on the same day were identified as the cohort, and quantitative measurements were compared. Correlation analyses were performed to assess levels of agreement. RESULTS A total of 462 FREE examinations were performed, in which 69 patients had both a FREE and TTE. FREE ejection fraction was strongly correlated with TTE (r = 0.89, 95% confidence interval). Left ventricular outflow tract, left ventricular internal dimension end diastole, E, and lateral E' derived from FREE were also strongly correlated with TTE measurements (r = 0.83, r = 0.94, r = 0.77, and r = 0.88, respectively). In 82% of the patients, right ventricular function for FREE was the same as that reported for TTE; pericardial effusion was detected on both examinations in 94% of the cases. No significant valvular anatomy was missed with the FREE examination. CONCLUSION Functionally rather than anatomically based hybrid ultrasound examinations, like the FREE, facilitate decision making for critically ill patients. The FREE's functional assessment correlates well with TTE measurements and may be of significant clinical value in critically ill patients, especially when used in remote operating environments where resources are limited. LEVEL OF EVIDENCE Diagnostic test, level III.

Background: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation in both paroxysmal and persistent AF. However, this procedure is still challenging and time consuming. Objective: The aim of this study was to present our approach for PVI using a novel circular irrigated multielectrode mapping and ablation catheter (nMARQTM) and to present acute and mid-term results. Methods: The study included 31 consecutive patients with symptomatic AF (4 had persistent and 27 had paroxysmal AF) who underwent PVI using the nMARQTM catheter. Circular ablation was guided by CT image integrated into fast anatomical map and by intra cardiac echo. Isolation of pulmonary veins was identified using the nMARQTM catheter if it was possible to advance it into the veins, otherwise Lasso catheter was used. Patients were followed up to 20 months. Results: PVI was achieved in 119 (98%) out of 121 pulmonary veins identified, and final PVI was obtained in 30 (97%) out of 31 patients. Lasso catheter was needed for PVI confirmation in 16 (52%) patients. Touch up ablation using standard catheter guided by Lasso catheter was needed in 4 (13%) patients. Pericardial tamponade occurred in 1 patient who was treated with pericardiocentesis. No other major complications were detected. During follow-up (mean 15.9 ± 3.6 months, range 9 - 20 months), 4 (13%) patients had recurrence of atrial tachyarrhythmia. Conclusion: PVI using the novel nMARQTM catheter is safe with good acute and mid-term efficacy. Long term follow up trials are needed.

E487K point mutation of aldehyde dehydrogenase (ALDH) 2 (ALDH2*2) in East Asians intrinsically lowers ALDH2 activity. ALDH2*2 is associated with diabetic cardiomyopathy. Diabetic patients exhibit heart failure of preserved ejection fraction (HFpEF) i.e. while the systolic heart function is preserved in them, they may exhibit diastolic dysfunction, implying a jeopardized myocardial health. Currently, it is challenging to detect cardiac functional deterioration in diabetic mice. Stress echocardiography (echo) in the clinical set-up is a procedure used to measure cardiac reserve and impaired cardiac function in coronary artery diseases. Therefore, we hypothesized that high-fat diet fed type-2 diabetic ALDH2*2 mutant mice exhibit HFpEF which can be measured by cardiac echo stress test methodology. We induced type-2 diabetes in 12-week-old male C57BL/6 and ALDH2*2 mice through a high-fat diet. At the end of 4 months of DM induction, we measured the cardiac function in diabetic and control mice of C57BL/6 and ALDH2*2 genotypes by conscious echo. Subsequently, we imposed exercise stress by allowing the mice to run on the treadmill until exhaustion. Post-stress, we measured their cardiac function again. Only after treadmill running, but not at rest, we found a significant decrease in % fractional shortening and % ejection fraction in ALDH2*2 mice with diabetes compared to C57BL/6 diabetic mice as well as non-diabetic (control) ALDH2*2 mice. The diabetic ALDH2*2 mice also exhibited poor maximal running speed and distance. Our data suggest that high-fat fed diabetic ALDH2*2 mice exhibit HFpEF and treadmill exercise stress echo test is able to determine this HFpEF in the diabetic ALDH2*2 mice.

Acute aortic dissection (AD) has a high morbidity and mortality rates, 1% to 2% of patients with aortic dissection die per hour for the first 24-48 hours after their admission in the hospital. Medical imaging plays a big role in the diagnosis of AD and treatment plan. The present case is a fifty-four year old male admitted at Mulago Hospital in Uganda with sudden onset chest pains, became unconscious for few minutes then recovered the consciousness with ability to walk, stand and sit. Clinical diagnosis prior to radiological investigation was acute coronary syndrome. Surprisingly cardiac Echo showed AD with aortic regurgitation. Computed tomography aortogram showed aortic dissection De Bakey type I. The immediate medical management included intravenous morphine and an oral beta blocker, with a target of maintaining the systolic blood pressure

International audience; Background, Motivation and ObjectiveThe emergence of ultrafast imaging allowed new insights into cardiac deformation/motion analysis that enabled new advancements in clinical diagnosis. Several studies showed that a good compromise between the temporal and the spatial resolution can be obtained by transmitting multiple focused beams (MLT) simultaneously. However, the currentimplementation of MLT in 3D cannot be used in dynamic conditions as it was obtained synthetically, by summing the Single Line Transmit (SLT) events before beamforming [Ortega et al., TUFFC, 2016]. The objective of this study is to evaluate for the first time the performance of MLT in 3D ultrasound under dynamic conditions. Statement of Contribution/MethodsThe 3D images were acquired by using four Verasonics research scanners, each of them controlling 8-by-32 elements of a 32-by-32, 3 MHz, Vermon ultrasound transducer. The scan volume was created by stitching 30 triangular sectors (each of angular width = 40°) along the azimuth angular direction. For each triangular sector, 9 transmission events were used for insonifying a full sector by sending simultaneously three focused beams. Thus, the total number of transmissions was 270 corresponding to 27 (elevational) x 30 (azimuthal) focal beams. The Pulse Repetition Frequency (PRF) was set to 2250. Our in vitro model was a tissue mimicking spinning disc having a diameter of 11 cm whose speed could be controlled by a step motor. The disk was placed at approximately 3 cm away from transducer and the image depth was 6.8 cm. Doppler velocities were estimated from the IQ signals using a 2D auto-correlator and a packet length of 7.Results/DiscussionThis study demonstrates the feasibility of Doppler velocity estimation for 3D MLT images. The estimated values presented in the image were in agreement with the expected velocities since the relative mean error was 3.5%. We obtained a three-fold increase in volume rate compared with focus imaging. Analyzing further different MLT/MLA configurations would allow increasing the frequency of volumes and obtaining the optimal compromise between high volume rate and quality color Doppler.

Patent foramen ovale (PFO) is an important underlying source of cryptogenic stroke (CS) associated with hematologic procoagulability. However, the association of genetically identified hyperocagulability and paradoxical embolism has been difficult to establish due to retrospective analysis and the limited numbers of of known genetically identified hypercoagulable conditions. In this study, we explored the utility of conventional coagulation status in PFO related stroke, as the patients may harbor genetically unidentified hyperocoagulable conditions. Method: Eligible pts were prospectively recruited in accordance with IRB, and underwent conventional coagulation testing (PT/PTT) testing within 12 hours of stroke. All patients underwent full cryptogenic workup such as MRI/MRA, mobile cardiac outpatient telemetry (>30 days), cardiac echo, and hypercoagulable testing. Results: We screened 4,831 pts admitted with acute neurologic diseases, and recruited 358 eligible acute ischemic stroke pts. 54 (15.1%) pts had CS and 32 pts had PFO related stroke. While there is no difference between PFO-related CS and PFO-unrelated CS on full hypercaogulable screen (protein S, protein C, FVL, PTGM, ATIII, APLAb, LA, hcy), aPTT was statistically significantly shortened in PFO-related stroke patients (PFO CS vs. non-PFO CS: aPTT 27.2±4.1s vs. 29.9±2.3s). ROC curve indicates early shortened aPTT can predict PFO related stroke (sensitivity 70%, specificity 81.5%, p=0.017) (see Figure). Conclusion: We found real time aPTT to be significantly shortened in patients eventually diagnosed with paradoxical embolism related to PFO. While studies in larger pt cohorts accounting for other potential confounders are underway, this proof-of-concept study demonstrates the importance and utility of early conventional coagulation testing in identifying paradoxical embolism. Pts with shortened aPTT may need additional workup for other underlying hypercoagulable conditions.

Annotating large collections of medical images is essential for building robust image analysis pipelines for different applications, such as disease detection. This process involves expert input, which is costly and time consuming. Semiautomatic labeling and expert sourcing can speed up the process of building such collections. In this work we report innovations in both of these areas. Firstly, we have developed an algorithm inspired by active learning and self training that significantly reduces the number of annotated training images needed to achieve a given level of accuracy on a classifier. This is an iterative process of labeling, training a classifier, and testing that requires a small set of labeled images at the start, complemented with human labeling of difficult test cases at each iteration. Secondly, we have built a platform for large scale management and indexing of data and users, as well as for creating and assigning tasks such as labeling and contouring for big data medical imaging studies. This is a web-based platform and provides the tooling for both researchers and annotators, all within a simple dynamic user interface. Our annotation platform also streamlines the process of iteratively training and labeling in algorithms such as active learning/self training described here. In this paper, we demonstrate that the combination of the platform and the proposed algorithm significantly reduces the workload involved in building a large collection of labeled cardiac echo images.

Left atrial appendage occlusion using the Amulet device can be accomplished with fluoroscopic and intra-cardiac echo (ICE) imaging for guidance, obviating the need for general anesthesia and trans-esophageal echo. The ICE device can be placed directly into the left atrium, parallel to the occluder delivery system, using a single transseptal puncture, rather than via double transseptal puncture. The ideal methods for left atrial appendage imaging and procedure guidance have yet to be defined. The utility of CT evaluation is increasingly recognized. The emergence of three-dimensional ICE is likely to further our progress along the path of simplifying the LAAO procedure.

Cost effective cardio protective intervention in haploidentical hematopoietic stem cell transplantation in children - A study from a tertiary care center in India Haploidentical hematopoietic stem cell transplantation with post transplant cyclophosphamide (PTCy) is increasingly being offered to children with life threatening blood disorders with no matched family or unrelated donors. High dose cyclophophamide is an alkylating agent known to cause severe cardiac toxicity. Hepatic metabolism of cyclophosphamide results in the production of phosphoramide which is toxic to the myocardium and acrolein which is a bladder irritant. The metabolites deplete antioxidants and augment the inflammatory damage to the cardiac myocytes. N-acetylcysteine (NAC) helps replenish the oxidant pool in the body and provides cardio protective and overall superior outcomes. We present retrospective data on 103 children between the ages of nine months to eighteen years who underwent haploidentical transplantation with PTCy between May 2015 and May 2019. All children received 50 mg/kg of cyclophosphamide on day 3 and day 4 after infusion of stem cells with Mesna starting with the first dose of cyclophosphamide as a continuous infusion till 24 hours after the second cyclophosphamide dose. All children had a cardiac ECHO performed by a pediatric cardiologist before conditioning and on day 5 after completion of Mesna. The first 30 children (Group 1) did not receive continuous infusion of NAC and the subsequent 83 children (Group 2) were treated with NAC at a dose of 10 mg/kg/ hour from the start of cyclophosphamide. Disease free survival, graft rejection and cardio toxicity were recorded. The follow up period ranged from 3 months to 4 years. In Group 1 the disease free survival was 46%, graft rejection rate was 13.5% and adverse cardiac events occurred in 10%. In Group 2 the disease fee survival was 67.5%, graft rejection rate was 3.6% and there were no adverse cardiac events. In conclusion, the introduction of N-acetylcysteine provides a simple and yet cost effective way to eliminate cardiac toxicity even in infants and small children. This is the first interventional study to help safe delivery of a chemotherapeutic agent at a cost of 25 USD for a 10 kg child. We would recommend the use of NAC in all patients undergoing PTCy based transplantation. Disclosures No relevant conflicts of interest to declare.

The use of ultrasound has moved to centre stage in the management of haemodynamically unstable patient. The ability to apply rapidly, the mobility of devices, and bedside delivery are amongst the advantages in using it. In particular, the widespread application of echocardiography has greatly changed the way in which shocked patients are diagnosed and treated. Most importantly is the ability for the clinician to rapidly identify the type of underlying shock, identify pathophysiology that requires immediate treatment and then to clearly outline the need for further imaging or other diagnostic tests. The great majority of patients fall into either one of the following four shock categories, or not infrequently, experience a combination of these. The physician dealing with critically ill patients may have only attained skills in basic echocardiography such as with performing RACE (Rapid Assessment by Cardiac Echo) which is generally adequate in many patients. However an increasing number of clinicians now have advanced skills using a combination of Doppler techniques in addition to newer techniques such as strain or 3 D. These skills add to the diagnostic repertoire. The chart below is a guide to the evaluation in determining the type of shock in a deteriorating patient.

Patient initials or identifier number AN ### Relevant clinical history and physical exam Case was 56 years old, male. In 6/1/2014, pre-operative cardiac echo for bladder cancer revealed LV dysfunction (EF38%) and asynergy at inferior and posterior wall. In 7/1/2014, CAG showed chronic total

Pulmonary vein isolation and atrial substrate modification using catheter ablation have been developed as a standard treatment for atrial fibrillation (AF). However, the standard end-point for these procedures is still not well established. This study aimed to investigate the characteristics among positive and negative AF vulnerability patients with normal structural heart, in order to define the endpoint of the atrial substrate modification. Fifty supraventricular tachycardia patients with normal heart structure referred for electrophysiological study and catheter ablation were enrolled. After eliminating the underling arrhythmias, the basic cycle length, effective refractory period of the right atrium, and the P wave indices in 12-lead electrocardiograms were measured. The AF vulnerability test was performed by atrial burst decremental pacing with a pacing cycle length decreasing from 290 ms to 200 ms. The AF vulnerability test was considered as positive when the duration of the induced AF or atrial tachyarrhythmias (ATs) was longer than 10 seconds. The parameters of atrial substrates were compared between patients with positive and negative values of the AF vulnerability test. ATs or AF were induced in 24 (48%) patients. Among these patients, 12 (24%) induced ATs or AF were found to be sustained (duration more than 10 seconds). However, only two of these patients could reproduce the positive result after 10 minutes of the first induced protocol. Comparing the patient baseline characteristics, P wave characteristics and cardiac echo parameters, there were no significant differences between the positive and negative AF vulnerability groups. In conclusion, AF and ATs could be induced in patients with a structurally normal heart. The traditional clinical indices of atrial substrates were not significantly different between the positive and negative AF vulnerability patients. Protocols other than atrial burst decremental pacing should be investigated to evaluate the endpoint of the atrial substrate modification.

Automatic diagnosis for fetal echocardiography plays an important part in diagnostic aid in the discrimination of congenital heart disease (CHD). Instead of traditional methods analyzing 2D cardiac echo video that need to find the standard view for discrimination, in this paper, we proposed a new system for automatic discrimination of CHD applying 4D original echocardiogram, which avoids the challenging work of searching standard views. We extracted the features of 3D static structure and 3D motion via 3D SIFT and 3D Histogram of Optical Flow (HOF) from the original 4D (3D+T) echocardiogram data, respectively. Bag of Words (BoW) method was employed to construct the quantized feature. Both static and motion features were fused to form the final image representation. One-Class SVM classifier was utilized to discriminate CHD due to the lack of CHD data and the significant difference in all the CHD cases. Experiments on the real data demonstrate the improved discrimination accuracy due to the fused feature.

Planning of mitral valve replacement would benefit from pre-procedural 3D models that could allow the clinician to fully understand the patient anatomical and functional condition. However, no single image modality can provide the complete picture alone but 3D echocardiography and magnetic resonance imaging MRI could be combined to leverage the advantages of each modality. The fusion of cardiac echo and MR images is a challenging task that currently requires the use of anatomical landmarks to drive the registration. In mitral valve treatment planning, the papillary muscles represent an ideal landmark set as they can be clearly identified in both image modalities. In this paper, we address the problem of papillary muscles automatic segmentation from MRI by proposing an atlas-based segmentation method. Results show that a good quality segmentation Dice score $$0.60\pm 0.14$$ and $$0.73\pm 0.06$$ for anterior and posterior papillary muscle, respectively can be achieved within the straightforward pipeline provided by this approach, also on images acquired with different scanners. Hence, our atlas-based segmentation method could represent the first key step towards a novel, automated echo and MRI fusion algorithm.

Background Appropriate use criteria (AUC) in echocardiography are essential tools for aligning the indications of echocardiography with the best clinical standards, improving clinical outcome, restraining abuse, and preserving health-care resources. Objectives The aim of this study was to ascertain the AUC for transthoracic echocardiography in a university hospital and create a quality improvement project (QIP). Methods The assessment of 501 inpatients who received transthoracic cardiac echo was conducted according to the 2011 AUC report. Indications were classified as appropriate, uncertain, or inappropriate, and patients not matching any of the abovementioned divisions were grouped in the nonfitting category. Results Of the 501 eligible patients, 374 patients (74.66%) were in the appropriate group, 85 patients (16.96%) in the inappropriate group, 20 patients (3.99%) in the uncertain group, and 22 patients (4.39%) in the nonfitting category. Discussion Interpretation and analysis of the obtained results are presented, along with the results of many comparable studies; moreover, a QIP was set up accordingly. Conclusion AUC are useful to assess local practice, preserve health-care resources, and improve clinical outcome.

A 37-year-old patient with cystic fibrosis underwent double lung transplantation. She developed disseminated Scedosporium apiospermum infection 2 months after surgery. Along with multiple brain abscesses, lung infection, and chorioretinitis, a cardiac echo revealed 2 large intra-atrial mycetomas floating close to the right upper pulmonary vein orifice. The mycetomas were removed through a trans-atrial approach under cardiopulmonary by pass; histology and cultures confirmed the diagnosis. Despite intensive treatment, the patient succumbed from massive brain hemorrhage on the 10th postoperative day.

Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, is associated with increased mortality and cardiovascular morbidity both in nonuremic and (recently) in dialysis patients. The aims of this study are: (i) to assess the prevalence of AF, the risk factors, and predictors of its presence in a cohort of incident hemodialysis (HD) patients in Greece and (ii) to report on current practices in the management of these patients. This is a prospective, cross-sectional, multicenter study of 574 patients on a regular HD program for >6 months. Demographic characteristics, cause of renal disease, cardiovascular risk factors, medication use, dialysis data (Kt/V, dialysis method, type of dialysate), 12-lead electrocardiogram (ECG) (interdialytic day), and cardiac echo data were collected. Pertinent demographic, ECG, and echocardiographic data were entered into univariate and multivariate analyses to evaluate associations with AF. The CHADS2 score (congestive heart failure [HF], hypertension, age ≥ 75, diabetes, previous stroke/transient ischemic attack [TIA]) was estimated and clinical practices in high-risk (CHADS2 score ≥ 2) patients were evaluated. The cohort included 368 men (64.1%) and 206 (35.8%) women (mean age 65.1 ± 14.4 years) with a mean duration on dialysis of 72.1 ± 60.4 months. Hypertension (75.6%) and coronary artery disease (47.2%) were the commonest cardiovascular risk factors for AF. The prevalence of AF was 23.2% and showed an age-dependent increase; in patients

Introduction Catecholamine-induced polymorphic ventricular tachycardia (CPVT) is one of the most severe inherited arrhythmogenic disorders, where patients clinically present with syncope or seizures. Case An 18-year-old white male with a history of mild developmental delay and CPVT, was brought to the ED after an episode of unresponsiveness for several minutes. The EMS documented a rhythm strip showing sinus tachycardia. The patient was awake and alert with no clinical evidence of any focal neurologic deficits, but unable to recall the event. Initial blood works including cardiac enzymes were normal. EKG showed sinus rhythm at 86 bpm, along with bigeminy and couplets of bidirectional QRS morphology with a QT interval of 0.3 seconds. Imaging studies including computed tomography scans of head, magnetic resonance imaging of brain, and 2D cardiac echo were normal. A routine EEG revealed abnormal bursts of spike and aftergoing slow wave complexes, highly suggestive of a potential for seizure activity. A 24-hour video EEG-EKG confirmed abnormal brain activity in the presence of normal sinus rhythm. A recent experimental study showed that knock in models of mice mutated with leaky calcium channels in the heart and brain exhibited seizures independent of arrhythmias. Conclusions Our patient is probably the clinical paradigm of this study. This episode of unresponsiveness, most probably a complex partial seizure, may have been caused by the same mutations known to precipitate CPVT.

Carfilzomib (CFZ) is a proteasome inhibitor associated with cardiovascular (CV) adverse events (AEs) mainly hypertension (HTN) and cardiac dysfunction. Endothelial dysfunction is a major mediating mechanism in cardiovascular diseases and endothelial function may be adversely affected by proteasome inhibition. However, CFZ effects on endothelial and vascular function and associations with inhibition of proteasome activity have not been explored in humans. We prospectively evaluated CFZ effects on endothelial function and underlying mechanisms as well as baseline vascular function and its response to treatment as potential predictors of CFZ-associated CV toxicity. In this prospective study (NCT03543579), 48 relapsed/refractory myeloma patients (median 1 (1-3) lines of therapy, median age: 67.5, 67% men) received Kd [CFZ 20/56 mg/m2 and dexamethasone] in routine practice. A detailed medical history and evaluation of risk factors for cardiotoxicity [age≥65 years, obesity, smoking, HTN, hypercholesterolemia, diabetes mellitus, previous anthracyclin use, chest or mediastinum radiotherapy and current myocardial disease] were recorded. Before CFZ start and at prespecified timepoints cardiac echo, hemodynamic parameters and vascular function that reflect pivotal mechanisms involved in development of HTN and CV events were non-invasively assessed [aortic blood pressure and arterial wave reflections, aortic stiffness and endothelial function using flow-mediated dilatation of the brachial artery (FMD)] along with 24h ambulatory blood pressure monitoring. Proteasome activity (PrA) was measured in peripheral blood mononuclear cells (PBMC) before and 2 hours post CFZ infusion on days 1 (FMDbaseD1 and FMDpostCFZD1) and 2 (FMDbaseD2 and FMDpostCFZD2) of cycle 1 and at prespecified time points concurrently with vascular function assessment. CV AEs were recorded and rated according to CTCAE v4.03. The prevalence of risk factors for cardiotoxicity was high (median 3 factors, IQR 2-4). After first CFZ dose, FMD decreased acutely at 2 hours (FMDbaseD1: 5.2%, IQR: 3.2-7.4 vs FMDpostCFZD1: 3.6%, IQR: 1.5-4.7, p=0.008), which partially recovered before and after second CFZ infusion (FMDbaseD2: 4.1% and FMDpostCFZD2: 4%, as compared to FMDbaseD1) (Figure1A). However, FMD decrease was more pronounced among patients who subsequently had lower recovery rate of PBMC PrA 24 hours after first CFZ administration (FMDbaseD1: 5.1%, vs FMDpostCFZD1: 3%, p=0.002) while FMD was not decreased significantly in those who had higher recovery rates of PrA (FMDbaseD1: 5.3%, vs FMDpost CFZD1: 4.5%, p=0.197, Figure 1B), suggesting that the ability to recover PrA is implicated in CFZ induced endothelial dysfunction. At the time of analysis, enrolment has completed; 35 patients are still receiving therapy, 13 have discontinued Kd and median follow up is 4.73 months. CV AEs were recorded in 17 (35.4%) patients [HTN(Gr3): 20.8%, Gr3 Left Ventricular dysfunction : 8.3%, Gr3 acute coronary syndrome: 4.2%, Gr3 pulmonary embolism: 2.1%] and generally occurred early (median time to CV event 2.9 months). Kd was discontinued in 2 patients (4.2%) due to cardiotoxicity and in 2 patients (4.2%) CFZ dose was reduced due to cardiotoxicity; no CFZ dose reduction or discontinuation was needed for HTN. Among clinical and hemodynamic parameters assessed at baseline, patients with higher aortic SBP (i.e at higher quartile) had a higher risk of HTN even after adjustment for age, gender and baseline HTN (HR=8, 95%CI 2.4-26, p=0.001 and HR=4.9, 95%CI 1.5-15, p=0.007 respectively). Lower PrA recovery rate was associated with increased risk of developing Gr3 HTN (log-rank test p=0.01). Higher post-CFZ reduction of FMD was associated with HTN in patients not receiving statins but not in those receiving statins (a drug class strongly affecting FMD), indicating that statin treatment may exert protective effects against CFZ-related CV toxicity. In conclusion, CFZ causes acute endothelial dysfunction; however, higher recovery of proteasome activity is associated with ameliorated depression of endothelial function. Given that poor proteasome recovery rate and acute deterioration of endothelial function are both associated with development of HTN, these findings may improve our understanding of CFZ-related CV toxicity and its prevention. The study is ongoing and more data will be presented at the meeting. Disclosures Kastritis: Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Prothena: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Terpos:Amgen Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel grant, steering committee member, Research Funding; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: member of DMC, Research Funding; Genesis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel grant, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: member of steering committee, Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel grant, Research Funding; BMS: Consultancy; Novartis: Consultancy. Dimopoulos:Bristol-Myers Squibb: Honoraria; Amgen: Honoraria; Takeda: Honoraria; Celgene: Honoraria; Janssen: Honoraria.

Introduction In trauma patients with chest injuries, traumatic pericardial effusion is an important scenario to consider because of its close linkage to cardiac injury. Even with advances in imaging, diagnosis remains a challenge and use of which surgical approach is controversial. This study reviews the treatment algorithm, surgical outcomes, and predictors of mortality for traumatic pericardial effusion. Patients and methods Information on demographics, mechanisms of trauma, injury scores, diagnostic tools, surgical procedures, associated injuries, and hospital events were collected retrospectively from a tertiary trauma center. Results Between June 2003 and December 2009, 31 patients (23 males and 8 females) with a median age of 31 (range 16–77), who had undergone surgical drainage of pericardial effusion were enrolled in the study. Blunt trauma accounted for 27 (87.1%) insults, and penetrating injury accounted for 4 (12.9%). Patients were diagnosed by Focused Assessment with Sonography for Trauma (FAST) (8 patients), computerized tomography (7 patients), echocardiography (9 patients), and incidentally during surgery (7 patients). Notably, sixteen (51.7%) patients required surgical repair for traumatic cardiac ruptures, including 6 (19.6%) with pericardial defects who presented initially with hemothorax. The surgical approaches were subxiphoid in 8 patients (25.8%), thoracotomy in 7 (22.6%), and sternotomy in 19 (61.2%), including 3 conversions from thoracotomy. The survival to discharge rate was 77.4% (24/31). Concomitant cardiac repair, associated pericardial defects, and initial surgical approach did not affect survival, but the need for massive transfusion, cardiopulmonary cerebral resuscitation (CPCR), trauma score, and incidental discovery at surgery all had a significant impact on the outcome. Conclusions Precise diagnoses of traumatic pericardial effusions are still challenging and easily omitted even with FAST, repeat cardiac echo and CT. The number of patients with traumatic pericardial effusion requiring surgical repair is high. Standardized therapeutic protocol, different surgical approaches have not impact on survival. Correct identification, prompt drainage, and preparedness for concomitant cardiac repair seem to be the key to better outcomes.