We demonstrate the incremental value of live/real time three-dimensional transthoracic echocardiography (3DTTE) over the two-dimensional modality in the identification of all three cusps of the pulmonary valve in patients in whom only two leaflets could be detected by the latter technique. This was because of the ability of 3DTTE to view the cusps enface permitting assessment of relationship to one another and the surrounding cardiac structures. In addition, 3DTTE showed not only the potential errors that can occur in pulmonary valve cusp identification when the two-dimensional modality is used alone but also how some of these errors can be avoided by paying attention to the surrounding structures.
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Overweight and obesity are exponentially growing health concerns, with prevalence fast approaching 2 billion people affected-a number that has tripled over the last few decades. Obesity is a known risk factor for a gamut of diseases including diabetes, hypertension, coronary artery disease, arrhythmias, and heart failure. The relationship of obesity and cardiovascular disease is now extensively studied. Here we discuss this association in detail and elaborate on the underlying mechanisms including metabolic syndrome, hemodynamic compensations, inflammation, hypoxia, and alterations in microbiome. We also evaluate the importance of screening for and treating obesity in the clinical practice, as well as the currently available modalities in management.
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