Unguarded Tricuspid Orifice with Congenitally Corrected Transposition of the Great Arteries and Aortic Atresia- A Highly Unusual Case

Unguarded tricuspid orifice is a very rare anomaly. It is characterised by the absence of one or more of the tricuspid valve leaflets resulting in severe tricuspid regurgitation and right heart failure. It is rarely an isolated anomaly but more often associated with pulmonary atresia and intact ventricular septum. When the ventricles are inverted however, the result of outflow tract obliteration is not pulmonary atresia, but aortic atresia. This anomaly has been described in the literature in only 2 cases so far. We present a case of a neonate with unguarded tricuspid orifice with absence of all tricuspid leaflets, congenitally corrected transposition of the great arteries and aortic atresia. The severe tricuspid regurgitation and right ventricular enlargement would have required a Norwood-like procedure combined with a right ventricular plication. Due to the complexity of this lesion no surgical therapy was attempted in consent with the parents.

Assessment of Subclinical Left Ventricular Systolic and Diastolic Dysfunction in Patients with Type 1 DM with and without Good Metabolic Control

Background: Diabetic patients with normal left ventricular ejection fraction (LVEF)are frequently associated with diastolic dysfunction. However, LVEF is known not to be a sensitive marker for the detection of subclinical LV systolic dysfunction. This study aimed to assess left ventricular systolic and diastolic function in asymptomatic type 1 diabetic patients by conventional, tissue Doppler and two-dimensional speckle tracking echocardiography to assess subclinical left ventricular systolic and diastolic dysfunction. Methods: Case-control study was conducted at 150 patients aged 15-35 y were subdivided into three equal groups: Group A: with type 1 diabetes mellitus (T1DM) with good metabolic control (Hb A1C <7.0), Group B: T1DM with poor metabolic control (Hb A1C>7.0), and Group C: Control group: included 50 normal healthy subjects. Results: Tissue Doppler, diastolic function and strain parameters, AP4C LS, AP2C LS, AP3C LS, and GLS were significantly impaired among the three groups. AP4C LS, AP2C LS, AP3C LS, and GLS were significantly lower in group B than group A and group C and was significantly lower in group A than group C, A velocity was significantly impaired among the three groups. A velocity was significantly higher in group B than group A and group C and was insignificantly impaired in group A than group C. Conclusion: Conventional echocardiography parameters were insignificantly different between the study groups. 2D speckle tracking and tissue Doppler echocardiography showed that subclinical left ventricular systolic function may be affected even before affection of diastolic function. Longer duration and poor glycemic control of diabetes significantly affect GLS.

Association of Epicardial Adipose Tissue Thickness with Left Atrial Size and Atrial Fibrillation

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with detrimental consequences. Epicardial fat is consistently associated with the presence, severity, and recurrence of AF. Aim: The aim of the work was to investigate the association of epicardial adipose tissue thickness with left atrial size in patients with atrial fibrillation. Patients and Methods: This study was conducted on 25 atrial fibrillation (AF) patients and 25 subjects with normal sinus rhythm as a control group matched in body weight. All patients underwent transthoracic echocardiogram. EAT (epicardial adipose tissue) thickness was measured on the right ventricular free wall of the two- dimensional parasternal long-axis view at end systole. Results: The results showed that there was a significant difference between the two groups in waist circumference, EAT (epicardial adipose tissue) thickness, left atrium diameter, LA volume. Receiver operating characteristics (ROC) analysis showed that an EAT thickness of > 0.30 cm maximizes the sensitivity and specificity to predict the development of AF. Conclusion: Increases epicardial adipose tissue is associated with the occurrence of atrial fibrillation.

Hyperuricemia and Smoking Correlation in Egyptian Young Adults with Coronary Artery Disease: Observational Study

Background: Young adults, especially those under 35, are often overlooked; however, previous studies have shown that coronary artery disease (CAD) incidence increases rapidly. Previous studies proved many risk factors for CAD, such as hyperlipidemia, hypertension, diabetes, and smoking. The present study ultimately aimed to figure out the correlation between Hyperuricemia (HUA) and smoking in CAD Patients under the age of 35. Methods: This observational study included 100 young adults (18–35 years of age) suspected of CAD. We used the Gensini Score system to ascertain coronary angiography outcome and CAD; based on the number of affected vessels, localization of the segment, and the stenosis grade. The Gensini score being > 0 indicated the presence of CAD. Results: In young adults under 35, there was a significant correlation between HUA and CAD. The interaction between HUA and smoking had a contrast for CAD that statistically shown the existence of CAD increased in patients who have hyperuricemia and non-smokers compared to smokers. Conclusions: By monitoring various parameters in young adults ≤ 35 years old. This study strengthens the correlation between:1) hyperuricemia and the occurrence of CAD, 2) Smoking and the CAD. Furthermore, there is a clear association between HUA and the occurrence of CAD in non-smokers.

Large Psoas Hematoma Complicating Anti-coagulant Therapy Poses a Diagnostic and Therapeutic Challenge

Spontaneous psoas haematoma in patients on anti-coagulant therapy is a rare phenomenon. It poses a real diagnostic problem and a real therapeutic challenge. We report the case of a 51 year old patient, under anti-vitamin K (acenocoumarone) following a stenosante and tricuspid mitral plasty who presented with right lumbar pain radiating to the lower limb leading to functional impotence. Clinically, he was hemodynamically stable with a hematoma measuring 88x29 mm and extending to 161 mm. The ultrasound scan showed a large collection at the expense of the lumbar psoas muscle and the CT scan showed a swollen appearance of the right psoas muscle in its iliac portion. Management was conservative: discontinuation of anti-vitamin K, bed rest, antibiotic therapy, and monitoring (clinical, biological and radiological). The ultimate outcome was favourable.

Physical Training as a Blood Pressure Reducer and a Remodeler of Cardiac Fibers in Spontaneously Hypertensive Rats (SHR)

Background: Hypertension is the most prevalent of all cardiovascular diseases, reaching target organs such as the heart. Blood pressure control is critical for preventing organ damage induced by hypertension. Objective: To analyze blood pressure, heart rate, left ventricular thickness, the percentage of cardiac fibrosis and the percentage of type III collagen in Spontaneously Hypertensive Rats (SHR) submitted to swimming physical training. Methods: The experimental groups were composed of male Wistar Kyoto (WKY) rats (309-311g), which were divided into: 1) Normotensive Sedentary group (SN) (n = 6); 2) Trained Normotensive group (TN) (n = 6); 3) Sedentary Hypertensive group (SH) (n = 6); 4) Trained Hypertensive group (TH) (n = 6). After the end of the protocol, the animals were initially anesthetized to measure blood pressure. Results: Physical training was responsible for decreasing blood pressure (F = 16,968; p <0.001) and heart rate (F = 10.710; p = 0.004) in the trained groups (normotensive and hypertensive). Moreover, training was responsible for providing an increase in the thickness of the left ventricle (F = 7,254; p = 0.014) and a reduction in the percentage of cardiac fibrosis (F = 16,081; p <0.001). Furthermore, it was observed that the trained group had lower values of type III collagen (F = 13,166; p = 0.002). Conclusions: Physical swimming training triggered a decrease in blood pressure, heart rate, the percentage of fibrosis and the percentage of type III collagen. In addition, there was also a cardiac remodeling due to the increase in left ventricular hypertrophy.

The Correlations between Admission Heart Rate and Corrected QT Interval Prolongations with Coronary Artery Disease in Patients with Acute Coronary Syndrome

Background: Coronary heart disease is a major cause of mortality and this health problem is reaching pandemic in both developed, and developing countries. ACS carries significant morbidity and mortality and the prompt diagnosis, and appropriate treatment is essential. HR was identified as a risk predictor of ACS. Both continuous increase in high baseline heart rate and decrease in low baseline heart rate are associated with higher risk of CVD. Decreased heart rate could also cause dispersion of atrial repolarization which, in turn, initiate cardiovascular events. Aim: The aim of this study was to assess the correlation between heart rate and severity of coronary artery disease in patient with acute coronary syndrome. Patients and Methods: The retrospective study was conducted on 120 patients that fulfilled the inclusion criteria were recruited from Cardiology department in Tanta university hospitals presented with acute coronary syndrome. Results: There was highly significant difference between both groups regarding admission heart rate & QTc interval. Both groups of low AHR< 60 bpm & high AHR >90bpm were significantly associated with severe CAD &.Mainly those patients with higher admission heart rate were more likely to have higher Syntax scores (severe coronary lesion). Also, patients with prolonged QTc had severe coronary artery diseases, higher SS & high probability to suffer adverse cardiac events more than patients without prolonged QTc interval. Conclusion: The current study showed that QTc interval prolongation and admission HR are independent predictors of the severity of coronary artery disease in patients with acute coronary syndrome.

A Novel Method for Measuring Myocardial Performance Index using Non-contact Ballistocardiogram System

Aim: The aim was to validate the Systolic Time Intervals (STI) measured by Ballistocardiography (BCG) with STI derived from simultaneously performed Transthoracic Echocardiogram (TTE) and attempt to create an AI algorithm that automatically calculates Tei Index from BCG tracings. Study design: Cross-sectional study. Place and Duration of Study: Department of Cardiology and Department of Electrophysiology of Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India, between January 2020 and January 2021. Methodology: Two hundred seventy-four patients with clinically indicated TTE were enrolled in the study, average age was 52. Simultaneous recordings on BCG and TTE were done. 150 patients had clinically usable TTE images for accurate calculations. STI was calculated independently by operators experienced in TTE and BCG. Results were compared using Pearson’s R. A proprietary AI algorithm for automatically calculating the MPI, was trained over a subset of patients. Its accuracy in detecting STI was compared to that of TTE and manually calculated STI from BCG. Results: There was a strong positive correlation (r=0.766, P<0.00, 99%CI [0.691,0.824]) between the TTE and BCG derived MPI values. The result was validated over predetermined subgroups of subjects with reduced EF (EF<50) and subjects with normal EF (EF>=50). The AI algorithm had correlation of 0.54(p<0.01) with the MPI calculated by TTE and 0.34(P<0.10) with the manually calculated MPI on the BCG. Conclusion: BCG derived manual and automated MPI correlates well with TTE derived MPI in a variety of EF fraction subgroups. Automated calculation algorithms for MPI derived from BCG remain a work under progress.

Evaluation of Time in Therapeutic Range of Patients with Non-Valvular Atrial Fibrillation on Oral Anticoagulation with Vitamin K Antagonist in Delta Region

Background: Non-valvular atrial fibrillation (AF) is the most common cardiac arrhythmia with a prevalence as high as 1.5±2.0% in the general population. This arrhythmia remains one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity in the world. The aim of study was to evaluation of the patients in delta region who have non-valvular AF and on oral anticoagulation with Vitamin K antagonist as regard the time they spend within therapeutic range. Patients and Methods: A total of 100 patients were included in this study for evaluation of the patients in delta region who have non-valvular AF and on oral anticoagulation with Vitamin K antagonist as regard the time they spend within therapeutic range. Results: Our study showed that only 35% achieved the recommended TTR (percent time in therapeutic range) above 60% from studied risk factors, none showed statistical significance. Conclusions: The quality of anticoagulant control was lower that reported in European countries with a significant proportion of patients had TTR below 60%.

Effect of Calamari Oil on Lipid Profile of Streptozotocin Induced Diabetic Rats

Aim: The aim of this study was to assess the effect of Calamari Oil on lipid profile levels in diabetes streptozotocin induced diabetic Rats. Study design: An experimental study. Place and duration of study: Animal House, Department of Applied and Environmental Biology, Rivers State University, Port Harcourt and University of Port Harcourt Rivers State, Nigeria, between February 2020 and August 2020. Methodology: Thirty Six (36) albino rats were purchased and allowed to acclimatize for two (2) weeks in the laboratory at the animal farm house of the Department of Animal and Environmental Biology, Rivers State University. They were fed the normal rat feed (Chow feed) and water was allowed ad libitum. The rats were weighed and randomly grouped into six (6) groups with six rats in each group. Group 1 (Negative control) was placed on normal diet while groups 2 to 6 were placed on a high fat diet (HFD) prior to the induction with Streptozotocin to achieve diabetes and the animals were treated according to their groupings for four weeks by means of oral gavage. The dose of Calamari Oil administered to the rats was extrapolated from human doses. The high fat diet was prepared by mixing the animal feed (Chow diet) with margarine in a ratio of 3:1. After each period of treatments, blood samples were collected from the rats at the end of the treatments via cardiac puncture by anaesthetizing the rats with chloroform after a six (6) hour fast. Fasting blood glucose was determined using the Glucose Oxidase method, lipid profile was analysed spectrophotometrically and Atherogenic coefficient (AC) and Castelli ratio index-1 level (CRI-1) were calculated. The GC–MS analysis of bioactive compounds from Calamari Oil was done using Agilent Technologies GC systems with GC-7890A/MS-5975C model. Data generated were analysed using SPSS version 22.0 of windows statistical package. Results were considered statistically significant at 95% confidence interval (p < 0.05). Results: The results showed that after week 1 - 4 of exposure, the mean TG (Triglyceride) value of the Negative control group (NC), Positive control (PC) group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 130.89 ± 2.52, 174.94 ± 3.11, 166.64 ± 1.95, 160.61 ± 0.60, 153.37 ± 2.24 and 141.62 ± 0.99 respectively. Mean TC (Total cholesterol) value of the NC, PC group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 160.93 ± 2.99, 194.96 ± 2.09, 188.18 ± 1.41, 180.63 ± 0.59, 169.96 ± 1.47 and 159.71 ± 1.43 respectively. HDL (High density lipoprotein) value of the NC, PC group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 83.05 ± 2.96, 65.68 ± 1.78, 66.97 ± 1.28, 72.75 ± 0.52, 76.35 ± 0.77 and 78.94 ± 0.86. Mean LDL (Low density lipoprotein) value of the NC, PC group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 51.7 ± 3.21, 94.3 ± 0.48, 88.15 ± 1.08, 75.76 ± 0.62, 62.95 ± 0.94 and 52.46 ± 0.59 respectively. The mean non- HDL cholesterol value of the NC, PC group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 159.93 ± 2.99, 193.96 ± 2.09, 187.18 ± 1.41, 179.63 ± 0.59, 168.96 ± 1.47 and 158.71 ± 1.42 respectively. Also, mean cholesterol ratio value of the NC, PC groups, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mg/dl were 1.94 ± 0.07, 2.97 ± 0.06, 2.81 ± 0.04, 2.48 ± 0.02, 2.22 ± 0.01 and 2.02 ± 0.01respectively. Conclusion: Type 2 diabetes is associated with dyslipidemia and as such the treatment with the Calamari Oil in the treated groups had positive effect on lipid profile markers with TG, TC, LDL, AC, CRI-1 decreasing and HDL increasing with increase in duration of time.