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Despite a healthy lifestyle, endurance athletes can develop obstructive coronary disease and require appropriate evaluation, medical and interventional therapies. A 58-year-old healthy male presented to the emergency department after a witnessed cardiac arrest while exercising at a gym. He had a

Many patients with severe mitral regurgitation cannot undergo conventional mitral valve surgery due to prohibitive surgical risk and are candidates for transcatheter repair with an edge-to-edge technique. Prior reports suggest efficacy with this approach for mitral regurgitation due to hypertrophic cardiomyopathy with left ventricular outflow obstruction. We present a case report of transcatheter mitral valve repair for posterior leaflet prolapse with concomitant left ventricular outflow tract obstruction due to systolic anterior motion of the mitral valve in the absence of hypertrophic cardiomyopathy.

Introduction: Pulmonary hypertension (PH) is a common and often ominous finding in the echocardiographic evaluation of patients with cardiopulmonary complaints. As with all diagnostic imaging, the report summary may influence future evaluation. Our aim was to explore the relationship between the echocardiographic reports of patients with PH and subsequent referral to a PH clinic. Methods: From the institutional database of a single academic medical center, we randomly selected 500 reports of patients with an estimated RVSP > 40 mm Hg between 2006 and 2014. Demographic and echocardiographic data were recorded prospectively. Referral to the only PH clinic in the region was determined by searching the electronic medical record. We used multivariable logistic regression to identify demographic and echocardiographic characteristics associated with referral. Results: The mean age of the population was 74 years and 54% (269 of 500) were women. The mean RVSP was 53 mm Hg. Pulmonary hypertension was mentioned in only 31% (153 of 500) of the report summaries and only 4.6% (23 of 500) of all patients were referred to the PH clinic. Referral was associated with younger age, indication for the echo, right atrial and right ventricular (RV) pressure, RV dilatation, and mention of PH in the summary. Mention of PH in the summary was the variable most strongly associated with referral (adjusted OR 4.6, 95% CI 1.5-14.2). Over the time period studied, there was no trend in the frequency of mentioning PH in the summary. The sonographer’s coding of PH as a preliminary finding was strongly associated with physician mention of PH in the summary, persisting after adjustment for RV systolic pressure, RV dilatation, and RV systolic function (adjusted OR 11.3, 95% CI 6.2-20.3). Conclusion: In this single institution study, PH was infrequently mentioned in the echo report summary of patients with an RVSP exceeding 40 mm Hg. Referral to the only PH clinic in the region was relatively rare but occurred more often following mention of PH in the summary. Explicitly stating the presence of pulmonary hypertension in the summary of patients with elevated RSVP may facilitate referral for comprehensive evaluation.

Objective: To explore the potential advantages of tissue harmonic imaging (THI) versus fundamental frequency imaging (FFI) when applied to tissue characterization. Methods: A Philips Medical Systems Sonos 5500 echocardiograph equipped with a broadband transducer (S4) and an on-line quantitative analysis software package (Acoustic Densitometry) was used for imaging. The effect of mechanical index (MI), imaging depth, and anisotropy on relative backscatter amplitude was evaluated. Results: This study demonstrated that imaging with tissue harmonics generated relatively greater backscatter values at clinically relevant imaging depths and instrument settings referenced to FFI. This effect was dependent on MI setting. A direct relationship between backscatter amplitude and MI was demonstrated. Additionally, tissue anisotropy had similar effects on integrated backscatter amplitude during both THI and FFI. However, relative backscatter values at each fiber orientation are greater during THI at similar instrument settings when referenced to FFI. Conclusion: Tissue harmonic imaging may offer advantages over FFI for myocardial tissue characterization. (ECHOCARDIOGRAPHY, Volume 20, May 2003)

Background: Technological advances have made it feasible to obtain real-time 3D volume datasets using transthoracic echo; however, despite its widespread availability, only a few echocardiography labs utilize it in daily clinical practice. We hypothesized that an automated system would facilitate

Fibrosarcoma is a rare primary cardiac malignancy. We report the case of a 70-year-old woman who had signs of right ventricular outflow tract obstruction caused by a fibrosarcoma. The pivotal role of multiplanar transesophageal echocardiography in characterizing masses in this location and in guiding transvenous biopsy is discussed.

Two-dimensional strain echocardiography (2DS) has been used to assess ventricular function in several disease states. In previous studies of 2DS, strain analysis was usually performed offline by experienced echocardiographers. The applicability of 2DS in busy clinical labs would be enhanced if 2DS could be reproducibly measured by sonographers at the time of the echo exam. In this study we compared the reproducibility of strain measurements between sonographers at the time of the echo exam with those performed offline by an experienced echocardiographer.Apical left ventricular (LV) B-mode images were acquired in 98 consecutive patients being evaluated for aortic stenosis. 2DS analysis was performed at the time of the exam by a sonographer. The same images were analyzed offline by an experienced echocardiographer. Global longitudinal strain (GLS) results were analyzed for interobserver reproducibility. Additionally, the regional longitudinal strain (RLS) of 20 randomly selected patients was analyzed for intraobserver reproducibility.Acceptable data quality was available in 97.8% of the segments measured at the time of the exam and in 96.9% at the workstation. Interobserver reproducibility of the global peak strain was high (r = 0.855, P0.001). Additionally, applying cutoffs for separating normal from abnormal GLS revealed good agreement between sonographer and experienced echocardiographer [kappa analysis (κ= 0.739, P0.001)]. Overall RLS intraobserver reproducibility was high (raw mean adjusted r = 0.915).The GLS in aortic stenosis patients can be reliably measured at the bedside by a sonographer without additional benefit of offline analysis.