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Introduction: Cardiac tumors are extremely rare tumors. The most common cardiac tumors are myxomas located in the atria, they usually have a stalk and are attached to the interatrial septum. Tumors located in the appendage of the left atrium are extremely rare and they are most often myxomas.1,2 Case report: 85-year-old patient was admitted to the cardiac intensive care unit due to pulmonary edema caused by acute coronary syndrome. Coronary angiography revealed multivessel coronary disease with left main affection and significant coronary disease of all three coronary arteries. The initial cardiac ultrasound verifies degenerative valves disease with a reduced left ventricle ejection fraction. Considering the findings of the coronary angiography and cardiac ultrasound, it was decided to present the patient to the heart team. A control ultrasound shows at the beginning of the left atrial appendage an isoechoic oval formation measuring 1.3 cm x 1.2 cm, which seems to be fixed to the myocardium and without visible flotation (Figure 1). An MSCT of the heart verifies a 45x15x13mm oval tumor formation, which is attached to the lateral part of the atrium wall by its base, and protrudes into the lumen of the left atrium. The radiological characteristics of the solid mass corresponded to a myxoma (Figure 2). The patient refused any interventional treatment. Hospitalization was complicated by the development of a stroke and the patient died. The autopsy was not performed due to the clear cause of death and at the request of the patient’s family so the PHD finding of this tumor mass is missing. Conclusion: Serial performance of cardiac ultrasound is extremely important when monitoring patients in the cardiac intensive care unit. Atypical projections in standard cardiac ultrasounds can be of significant importance and can provide us with additional diagnostic value. A detailed approach to performing an ultrasound of the heart enables a correct diagnosis and the overall treatment of the patient. [ABSTRACT FROM AUTHOR]

Key Clinical Message A high index of suspicion is needed to diagnose a chronic right ventricular lead perforation. They should be suspected in patients who develop breathlessness and have a sudden change in pacing parameters. Contrast‐enhanced CT provides high diagnostic accuracy. They can often be extracted percutaneously and rarely require surgical intervention.

Key Clinical Message: A high index of suspicion is needed to diagnose a chronic right ventricular lead perforation. They should be suspected in patients who develop breathlessness and have a sudden change in pacing parameters. Contrast‐enhanced CT provides high diagnostic accuracy. They can often be extracted percutaneously and rarely require surgical intervention. A high index of suspicion is needed to diagnose a chronic right ventricular lead perforation. They should be suspected in patients who develop breathlessness and have a sudden change in pacing parameters. Contrast‐enhanced CT provides high diagnostic accuracy. They can often be extracted percutaneously and rarely require surgical intervention. [ABSTRACT FROM AUTHOR]

Failure rate for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) is up to 12%. The use of segmentation tools, advanced image registration software, and high-fidelity images from computerized tomography (CT) and cardiac magnetic resonance (CMR) of the coronary sinus (CS) can guide LV lead implantation. We evaluated the feasibility of advanced image registration onto live fluoroscopic images to allow successful LV lead placement. Twelve patients (11 male, 59 ± 16.8 years) undergoing CRT had three-dimensional (3D) whole-heart imaging (six CT, six CMR). Eight patients had at least one previously failed LV lead implant. Using segmentation software, anatomical models of the cardiac chambers, CS, and its branches were overlaid onto the live fluoroscopy using a prototype version of the Philips EP Navigator software to guide lead implantation. We achieved high-fidelity segmentations of cardiac chambers, coronary vein anatomy, and accurate registration between the 3D anatomical models and the live fluoroscopy in all 12 patients confirmed by balloon occlusion angiography. The CS was cannulated successfully in every patient and in 11, an LV lead was implanted successfully. (One patient had no acceptable lead values due to extensive myocardial scar.) Using overlaid 3D segmentations of the CS and cardiac chambers, it is feasible to guide CRT implantation in real time by fusing advanced imaging and fluoroscopy. This enabled successful CRT in a group of patients with previously failed implants. This technology has the potential to facilitate CRT and improve implant success. (PACE 2011; 34:226-234) [ABSTRACT FROM AUTHOR]

Objectives: Dobutamine stress echocardiography (DSE) and contrast-enhanced electron beam tomography (EBCT) both have the potential to noninvasively detect coronary artery disease (CAD). We compared the accuracy of both methods to detect significant CAD in a direct comparison. Methods: 79 patients (32 women, 47 men, mean age 62 years) who were admitted for coronary angiography due to suspected CAD were studied. By EBCT coronary calcification (CAC) as well as angiography (CTA) was assessed. Presence of significant CAD was assumed if the calcium score exceeded 400 or the contrast-enhanced images displayed significant lumen reduction. DSE was performed using a standard protocol (5–40 μg/kg/min dobutamine plus 0.25–1.0 mg atropine if necessary). DSE and EBCT were independently evaluated concerning the presence of signficant CAD. Results were compared to invasive, quantitative coronary angiography. Results: 6 patients (8%) in DSE and 2 patients (3%) in EBCT were unevaluable for various reasons and therefore excluded from further analysis. In the remaining 71 patients, 33 patients (46%) showed significant CAD. DSE demonstrated a sensitivity of 70% (23/33) and a specificity of 84% (32/38). EBCT showed a sensitivity of 91% (30/33) and a specificity of 74% (28/38). By combining DSE and EBCT sensitivity increased to 97% with a specificity of 63%. Conclusions: In a blinded comparison, DSE demonstrated lower sensitivity but higher specificity than EBCT for the detection of significant CAD. Sensitivity was improved by combining both modalities. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Microvascular dysfunction is responsible for chest pain in various kinds of patients, including those with obstructive coronary artery disease and persistent symptoms despite revascularization, or those with myocardial disease without coronary stenosis. Its diagnosis can be performed with an advanced imaging technique such as positron emission tomography, which represents the gold standard for diagnosing microvascular abnormalities. In recent years, cardiovascular magnetic resonance and cardiac computed tomography have demonstrated to be emerging modalities for microcirculation assessment. The identification of microvascular disease represents a fundamental step in the characterization of patients with chest pain and no epicardial coronary disease: its identification is important to manage medical strategies and improve prognosis. The present overview summarizes the main techniques and current evidence of these advanced imaging strategies in assessing microvascular dysfunction and, if present, their relationship with invasive evaluation. [ABSTRACT FROM AUTHOR]