MS patients have subclinical LV and RV systolic dysfunction by GLS despite normal ejection fraction and fractional area change. BMV results in marked improvement in LV and RV GLS immediately post-BMV with trend towards normalization at follow-up after 3 months. A mixed aetiology theory involving a myocardial as well as a haemodynamic factor is believed to be the cause for this subclinical biventricular dysfunction and its improvement at short-term follow-up post-BMV.

Case ReportIn January 2013, a 41-year-old man, a heavy smoker who had little medical or surgical history, presented with New York Heart Association functional class III-IV dyspnea, which had worsened progressively over the preceding week and had been associated with subjective fevers, chills, and infrequent episodes of chest pain. On physical examination, the patient had a blood pressure of 96/45 mmHg, a pulse rate of 124 beats/ min, a respiratory rate of 24 breaths/min, and a temperature of 102.5 °F. Cardiac examination revealed the point of maximum impulse to be in the left 5th intercostal space at the mid-clavicular line; auscultation revealed an S 3 gallop at the mitral area, with a grade 4/6 holosystolic murmur best heard over the apex. The electrocardiogram showed sinus tachycardia without evidence of ischemic ST-T changes. The chest radiograph showed a normal cardiac silhouette with signs of pulmonary venous congestion.A 2-dimensional (2D) transthoracic echocardiogram (TTE) showed a membranelike structure extending from the superior LA wall to the base of the posterior mitral leaflet, creating a false lumen that partly occluded the true LA chamber-a picture consistent with LA free-wall dissection. Attached to the lower end of this membrane was a large mass with multiple finger-like projections (Fig. 1). Color-flow Doppler mode revealed a central jet of moderate mitral regurgitation caused by lack of coaptation of the mitral valve leaflets. Additional moderate-to-severe systolic flow was detected-this from the left ventricle into the false lumen, through a perforated posterior mitral leaflet (Fig. 2). Mild pericardial effusion was also noted. These findings were confirmed by a transesophageal echocardiogram (TEE) (Fig. 3). The dissection membrane caused no pulmonary vein obstruction.On the basis of the patient's clinical presentation, we obtained blood cultures and began broad-spectrum antibiotic therapy; however, within one hour of his presentation (and before surgical intervention), the patient died of cardiogenic shock refractory to medical treatment. Three blood cultures grew methicillin-sensitive Staphylococcus aureus.Although no definitive pathologic diagnosis by autopsy was available, the positive blood cultures, together with the 2D TTE and TEE findings in a patient with such a clinical presentation, are highly consistent with the diagnosis of infective endocarditis of the mitral valve. The formation of a large mitral valve vegetation appears to have

Cardiac catheterizations are among the X-ray procedures with the highest patient radiation dose and therefore are of great concern in pediatric settings. This study aimed to evaluate factors that influence variability of X-ray exposure in children with congenital heart diseases during cardiac catheterization. The study included 107 children who underwent either diagnostic (n = 46) or interventional (n = 61) procedures. A custom-made sheet for patient and procedural characteristics was designed. Data were collected, and different correlations were applied to determine factors that influence variability of X-ray exposure. The fluoroscopy time (FT) differed significantly between the diagnostic (8.9 ± 6.3 min) and intervention (12.8 ± 9.98 min) groups (P = 0.032). The mean dose-area product (DAP) differed significantly between the two groups (3.775 ± 2.5 Gy/cm(2) vs. 13.239 ± 15.4 Gy/cm(2); P = 0.003). The highest DAP was during left anterior oblique (LAO) cranial 30° angulation (2.8 Gy/cm(2)/4 s cine). The mean cumulative dose (CD) was 0.053 Gy in diagnostic cases and 0.48 Gy in intervention cases. The effective dose was 5.97 ± 7.05 mSv for therapeutic procedures compared with 3.42 ± 3.64 mSv for diagnostic procedures. The FT correlated significantly with both the DAP (r = 0.718; P < 0.001) and the CD (r = 0.701; P < 0.001). Other correlations were reported. An increasing number of therapeutic catheterization procedures are being performed for children. The justification for these procedures is evident because they avoid complicated surgery. However, the complexity of these procedures results in higher radiation exposures.

Two-dimensional strain at peak stress had an incremental value over DSE visual assessment/ wall-motion score index (WMSI) in reducing false-positive results of DSE. Two-dimensional strain at peak stress had greater accuracy than DSE alone not only in detection of significant CAD but also in detection of number of vessels with significant lesion as well as CAD localization.

BPV is safe and effective to relieve critical PS in infants during the first year of life. The balloon promotes advantageous changes in both, pulmonary annulus and PG across the RVOT. In addition, the Doppler gradient observations during the follow-up support the expectation that BPV is a "curative" therapy.