Introduction the septal perforating arteries of the heart usually branch off from the anterior and inferior interventricular arteries and supply the interventricular septum and the conduction system therein. Aim we present the case of hypertrophic septal perforating branch in a 71-year-old man who experienced dyspnoea in which was initially misinterpreted as interventricular defect. Materials and methods transthoracic echocardiography without and with contrast, coronary angiography and angioTC with 3D reconstructions were performed. Results echocardiography showed dilative cardiopathy with EF 30%, akinesia of IVS, apical and inferior wall. Hypokinesia of the remaining walls. At color-Doppler: severe mitral regurgitation and moderate tricuspidal regurgitation. Coronary angiography showed severe multivessel atherosclerotic coronary artery disease. At the echocardiographic control was reported the presence of turbulent flows at the level of medio-basal segment of posterior IVS. Echo-power-Doppler showed no shunts. For persisting suspect of interventricular defect was performed contrast echocardiography that showed hypoperfusion of IVS after contrast infusion but no clear signs of interventricular shunts. To complete the diagnostic iter was performed finally CT-Scan of coronary arteries that reported a presence of hypertrophic septal perforating branch with long intramyocardial course in the interventricular septum, but was no detected interventricular defect. Conclusions Septal perforating arteries have a large variability in their anatomy. Particular clincal conditions such as chronic coronary syndromes could lead to a reactive hypertrophy. Is important recognise it due to its similarity with interventricular defect or myocardial bridging effect. A better understanding of these arteries will help physicians to enhance cardiac care for their patients.
Background echocardiography is a helpful tool in patients with suspected pulmonary hypertension (PH). Data derived from echocardiographic examination allow to assign a level of probability of PH by using multiple parameters. Nevertheless, the gold standard for the diagnosis of PH remains the right heart catheterization. The evaluation of PH is important in patients undergoing transcatheter tricuspid valve repair, in fact, many trials excluded those with “severe” pulmonary hypertension. Aim the aim of this study was to examine, in the evaluation of PH, the parameters derived from echocardiographic estimation and cardiac catheterization in patients undergoing TriClip implantation. Methods a retrospective analysis of 4 patients underwent to TriClip implantation in our department was performed. Echocardiography and right heart catheterization data were collected. In the assessment of pulmonary hypertension, the analyzed echocardiographic parameters were: enlarged right ventricle in parasternal long-axis view (>30 mm), flattened interventricular septum leading to “D-shaped LV”, dilated inferior vena cava (>21 mm) with diminished inspiratory collapsibility (<50%), RVOT acceleration time of pulmonary ejection <105 msec, reduced right ventricular fractional area change (<35%), decreased tricuspid annular plane systolic excursion (TAPSE <18mm), TAPSE/sPAP ratio <0.55 mm/mmHg, enlarged right atrial area (>18 cm2), increased systolic peak tricuspid regurgitation velocity (peak TRV>2.8 m/s), estimated systolic pulmonary artery pressure (sPAP). Echocardiographic probability of pulmonary hypertension was defined as high: peak TRV >3.4 m/s or a peak TRV between 2.9-3.4 m/s and the presence of other echo PH sign; intermediate: peak TRV between 2.9-3.4 or peak TRV ≤2.8 m/sec with other echo PH signs; low: peak TRV ≤2.8 m/sec. Pulmonary hypertension, in accordance with guidelines, was defined by a mean pulmonary arterial pressure (mPAP)>20 mmHg at rest. Results the echocardiographic probability of pulmonary hypertension was high in three patients: 2 patients had a peak TRV>3.4 m/s, one patient had peak TRV 2.95 with RVOT AT 55, flattened interventricular septum, dilated inferior vena cava with diminished inspiratory collapsibility, right atrium area >18cm2. In one patient the probability was intermediate (peak TRV 2.40 m/s, RA area >18 cm2 and TAPSE/sPAP ratio <0.55 mm/mmHg). Right heart catheterization confirmed the diagnosis of pulmonary hypertension in two patients with high echocardiographic probability. In the other two patients (one with high probability and one with intermediate probability) there was no PH diagnosis at right heart catheterization. Conclusion in only two out of four patients with intermediate-high probability of PH the diagnosis was confirmed by right catheterization. Therefore, invasive evaluation of pulmonary pressures should be performed in patients with severe tricuspid regurgitation undergoing Triclip implantation.
Introduction Brugada syndrome (BrS) is a genetic disorder with a characteristic pattern on the electrocardiogram (ECG) that predisposes to lethal arrhythmias and sudden cardiac death (SCD). Precise diagnosis is therefore mandatory. Aims We evaluated the feasibility and accuracy of a smartwatch in recording multiple ECG leads and detecting ST-segment changes diagnostic for BrS both in basal condition and after ajmaline infusion. Materials and Methods Twelve-leads and smartwatch ECGs were obtained in 32 unselected patients admitted at our institution with type II/III ST-segment elevation suspected for BrS from September 2021 to March 2022. After written informed consent for continuous ECG monitoring during ajmaline test (1 mg/kg, i.v. for 10 min), consecutive ECG strips acquired with both techniques were analyzed before and after drug administration. For each patient smartwatch was tested at three different sites: wrist, abdomen and chest, and intercostal spaces from second to fourth were further studied. The concordance among the results of the smartwatch and standard ECG recordings was assessed using the Cohen κ coefficient and Bland-Altman analysis. Results Subjects were 42±15 y.o. on average; 67% were men (n=25), and diagnosis of BrS was reached in 12 cases (37.5%). Concordance was found between the smartwatch and standard ECG for the identification of the following findings: i) a normal/negative ECG (Cohen κ coefficient, 0.89); ii) ST-segment elevation shift (Cohen κ coefficient, 0.934). In addition, the Bland-Altman analysis demonstrated concordance between the smartwatch and the standard ECG in the assessment of the amplitude of ST-segment elevation shift (bias, −0.003; SD, 0.68; lower limit, −0.52; and upper limit, -0.031). The smartwatch power in diagnosing normal ECG showed a sensitivity of 92% (95% CI, 66%-99%) and a specificity of 100% (95% CI, 64%-100%); for detection of ST-segment elevation and BrS diagnosis, sensitivity was 92% (95% CI, 64%-99%) and specificity was 95% (95% CI, 76%-99%). Conclusions The findings of this study suggest agreement between the multichannel smartwatch acquisition and standard ECG for the identification of Brugada syndrome-associated ST-segment changes.
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