Cardiology Commons^™

Myocardial Infarction Caused By An Enclosed Thrombus In A Patent Foramen Ovale, Meriem Boumaaz, Iliyasse Asfalou, Amine Hamami, Maha Raissouni, Zouhair Lakhal, Aatif Benyass

Journal of the Saudi Heart Association

Paradoxical embolism in coronary artery is a rarely diagnosed clinical entity. In the majority of reported cases; the diagnostic of this pathology is « presumptive » based on certain criteria. It can be considered “proven” when the embolus is found lodged in the abnormal communication between the venous and arterial circulation; which is very rare. We herein report a case of myocardial infarction caused by a proven paradoxical coronary embolism through a patent foramen ovale. The authors highlight through this paper the contribution of echocardiography and particularly transesophageal echocardiography, especially if performed soon after presentation, for early diagnosis.

Massive Hemoptysis And Recurrent Infective Endocarditis In Intravenous Drug User: A Case Report, Mutlaq Almutairi, Yasser Ahmed El-Ghoneimy, Abdulaziz Omar Alghamdi, Hashem Abdulkarim Alkhamis, Ziyad Abdulmohsen Altayyar, Khalid Mohsen Houbani

Journal of the Saudi Heart Association

Intravenous drug use (IDU) poses a high risk of serious complications such as infective endocarditis (IE), which carries high morbidity and mortality rates. Mycotic pulmonary artery aneurysms (MPAA) are rarely associated with right-sided IE, especially in the setting of IDU. It is a potentially fatal complication as it can lead to severe hemorrhage if the aneurysm ruptures. We report the case of a young male with a history of current IDU and tricuspid valve replacement post complicated IE 2 years ago. The patient initially presented with massive hemoptysis and fever. Chest computed tomography (CT) showed a lobulated lesion in the …

Cardiac Surgery Services During The Covid-19 Outbreak: Surgeons’ Thoughts, Ahmed Arifi, Abdullah A. Alghamdi

Journal of the Saudi Heart Association

Cardiac surgeons during this pandemic crisis have a responsibility to ensure that essential elective cardiac operations are provided at their centers to the public, at the same time, they have to face administrative as well as the infection prevention guidelines and restrictions to protect themselves and their patients. Here, we describe the patient and procedures characteristics that we recommend to protect our patients and the healthcare workers.

Non-Invasive Cardiac Imaging During The Coronavirus Disease 2019 (Covid-19) Pandemic: A Statement From The Cardiac Imaging Working Group Of The Saudi Heart Association, Yasmin Hanfi, Mirvat Alasnag, Halia Alsherhi, Ahmed Alsaileek, Abdulaziz Alghamdi, Abdullah Al Sehly, Adel Sallam, Ahmed Aljizeeri

Journal of the Saudi Heart Association

COVID-19 pandemic has led to major changes in the delivery of medical care around the globe. Many investigations and elective procedures had to be rescheduled to decrease the risk of spreading the infection. Non-invasive cardiac imaging studies are requested to guide appropriate cardiac care in a variety of urgent, semi-urgent, and elective procedures. This position statement of the Cardiac Imaging Working Group of the Saudi Heart Association provides guidance into the protection of healthcare personnel, assessment of the indications of the imaging studies, and highlights consideration before, during, and after the study.

Saudi Arabian Society Of Echocardiography Recommendations For Echocardiography Service During Corona Virus Disease 2019 (Covid-19) Outbreak, Sami Ghazal, Fatima Qaddoura, Abdulhalim Kinsara Kinsara, Ahmed Omran, Merna Atiyah, Mustafa Al Refae, Faisal Dalak, Saeed Al Ahmari, Abdullah Al Sehly, Noureldin Sahal, Ahmed Onazi, Rima Bader

Journal of the Saudi Heart Association

We are summarizing the recommendations for the use of Echocardiography in patients during COVID-19 pandemic. The patient risk for COVID-19 should be assessed according to the Saudi CDC guidelines. Echocardiography should only be performed of considered appropriate and will likely alter the clinical decision. In COVID-19 suspected/ confirmed patients, echocardiography study should be performed bedside and in infection control approved area with airborne precaution. Limited focused imaging is recommended to minimize contact time. A dedicated machine for COVID-19 suspected/confirmed cases is recommended. Transesophageal echocardiography is considered an aerosol generating procedure; therefore, an alternative modality should be strongly considered. In COVID-19 …

The Impact Of Covid-19 Pandemic On The Hospital Management Of Tavi Patients: Tavi Team Thoughts And Recommendation, Mohamed Balgaith, Ahmed Arifi, Dalia Ahmed, A. Mounir Metwally

Journal of the Saudi Heart Association

The COVID-19 Pandemic has put enormous pressure on the healthcare system globally, causing many healthcare organizations all over the world to cancel or stop elective procedures in their cardiac catheterization Labs. This delay in the elective procedures with no doubt has led to a suspension of patient care primarily to those with severe aortic stenosis, which might place them at higher risk for cardiovascular complications like sudden death and heart failure.

Health Care Worker (HCW) faced with the uncertainty of contracting infections while performing procedures in patients with a confirmed diagnosis of COVID-19 or suspected cases. This unprecedented situation is …

Iatrogenic Pulmonary Artery Dissection In Patient With Ostium Secundum Interatrial Septum Defect, Daniela Di Lisi, Giovanni D. Aquaro, Francesca Macaione, Salvatore Novo, Giuseppina Novo

Journal of the Saudi Heart Association

Pulmonary artery dissection is a rare and lethal condition. Few cases are reported in the literature, and most are derived from autopsies. In most cases, pulmonary artery dissection is a complication of chronic pulmonary hypertension leading to pulmonary artery aneurysm but there are other causes. We describe a case of iatrogenic pulmonary artery dissection in an elderly patient with ostium secundum defect. In particular, we describe the role of cardiac magnetic resonance in making this diagnosis and guiding future therapeutic decisions.

Thrombus In Transit Through A Patent Foramen Ovale, An Unusual Cause Of Cardiac Embolism, Carlos Minguito-Carazo, Tomas Benito-Gonzalez, Julio C. Echarte-Morales, Miguel Rodríguez-Santamarta, Mario Castano-Ruiz, Felipe Fernandez-Vazquez

Journal of the Saudi Heart Association

A 78-year-old woman with a history of transient ischemic attack was admitted for sudden aphasia. In order to assess the potential cardioembolic source an echocardiogram was performed, which revealed a large mass consistent with a thrombus in transit through a patent foramen ovale. Because of the high risk of systemic embolism, emergent surgical thrombectomy was performed with the intention to discharge the patient safely without any new embolic events. This case report highlights the importance of echocardiography in the evaluation of cardioembolic stroke and the requirement of an emergent approach in case of impending paradoxical embolism.

Acute Pulmonary Embolism As An Initial Presentation Of Klinefelter Syndrome: A Case Report, Ghizlane El Ouazzani, Chaimae Toutai, Ikbal Alla, Nabila Ismaili, Noha El Ouafi

Journal of the Saudi Heart Association

Venous thromboembolism (VTE) includes deep vein thrombosis and its complications and pulmonary embolism. Cancer, surgery, prolonged immobilization, fractures, paralysis, use of oral contraceptives, and hereditary coagulopathies are classic risk factors for VTE. An increased incidence of VTE has been reported in patients with Klinefelter syndrome (KS), with a reported prevalence of 0.1e0.2% in the general population and up to 3.1% in infertile men. Despite the high rate of thromboembolic disease in patients with KS, the etiology of this phenomenon is not well understood, and most of our current knowledge is limited to small sample studies. We present the case of …

Left Ventricular Aneurysmectomy In A Young Female Of Unknown Etiology With Pseudoaneurysm: A Case Report, Tariq Ashraf, Rashid Aziz, Amin M. Khuwaja, Syed M. Afaque, Musa Karim

Journal of the Saudi Heart Association

A left ventricular pseudoaneurysm is formed when there is free wall rupture of the myocardial wall with discontinuity and roof covered by pericardium mural thrombus or fibrous tissue without any myocardium. A left ventricular pseudoaneurysm is a rare and life-threatening event. We report a young 22-year-old female with unknown etiology of a pseudoaneurysm, who was previously managed as a psychiatric case and for musculoskeletal pain. On subsequent investigation and confirmation with cardiac magnetic resonance imaging, aneurysmectomy was done. This is a rare case in a young 22-year-old woman with a ventricular pseudoaneurysm of unknown etiology. Considering the high risk for …

Perioperative Management Of Wilms’ Tumor With Intracardiac Extension: Report Of Two Cases With Review Of Literature, Hayan Altwaeel, Mohamed S. Kabbani, Ahmad Al Shammari, Mohammed Al- Namshan, Abdullah A. Alghamdi

Journal of the Saudi Heart Association

Wilms’ tumor (WT) is one of the solid tumor that affects children. It involves the kidney and may extend to the lungs and liver. WT conquers the adjacent blood vessels such as renal veins and inferior vena cava (IVC); its extension to IVC and right-sided heart chambers is unusual. Furthermore, when the tumor extends to heart chambers, its surgical management becomes challenging and demands multidisciplinary medical and surgical specialties including pediatric cardiac surgery. In this report, we discuss the surgical management and perioperative treatment of two unusual cases of WT with IVC and intracardiac extension.

Mitral Valve Replacement In Dilated Cardiomyopathy: A Valid Option?, Mohamed H. Mashali, Nashwa Badawi, Mohammed O. Galal

Journal of the Saudi Heart Association

Background: Dilated cardiomyopathy (DCM) is characterized by left ventricular dilation and dysfunction. The association with significant mitral regurgitation worsens the prognosis. Case report: A 2-year-old girl presented withDCMand severe mitral regurgitation. She had a history of viral myocarditis at the age of 4 months, necessitating recurrent hospital admissions for management of intractable heart failure, pneumonia, and failure to thrive. The decision was taken to proceed for mitral valve surgery, which ended with mitral valve replacement. Over 3 years of follow-up after surgery, there was significant improvement in her weight gain and she improved clinically. There were still recurrent admissions, but …

Cardiac Amyloidosis—An Underdiagnosed Cause Of Heart Failure In The Elderly, Tahir Nazir, Mahmud Nuffati

Journal of the Saudi Heart Association

Amyloidosis is a rare, generally multisystem disease that can also involve the heart. Infiltration of the myocardium with amyloid proteins is an important and underappreciated cause of heart failure with preserved ejection fraction in the elderly. We present the case of an 84-year-old man with chest tightness, dyspnoea, and ascites. He had a history of dyslipidaemia and ischaemic heart disease. Initial investigations showed severe diastolic dysfunction and elevated pulmonary artery systolic pressure on echocardiogram along with elevated serum natriuretic peptides. Further evaluation by a magnetic resonance imaging scan of the heart and endomyocardial biopsy confirmed the diagnosis of senile systemic …

Treatment Of Severe Mitral Regurgitation That Mimics A Para-Ring Mitral Regurgitation After Failed Annuloplasty Ring With Mitraclip: A Case Report, Hesham Abdo Naeim, Waleed Saeed, Abeer Mahmood, Lamiaa Khedr, Ramy Elrowiny, Reda Abuelatta

Journal of the Saudi Heart Association

Background: Progressive remodelling of the left ventricle with lateral and apical displacement of one or both papillary muscles can lead to recurrence of severe mitral regurgitation (MR) in the presence of the mitral valve (MV) ring. The MitraClip (Abbott, USA) is the only option in cases with annuloplasty rings too large for implantation of a Sapien prosthesis in high surgical-risk patients. We present a case where the MR jet was directed toward a para-ring hole, and the MitraClip system was used successfully to treat this severe MR. Case summary: An 80-year-old woman underwent coronary artery bypass surgery plus MV repair …

Impact Of Stent Of Ductus Arteriosus And Modified Blalock–Taussig Shunt On Pulmonary Arteries Growth And Second-Stage Surgery In Infants With Ductus-Dependent Pulmonary Circulation, Bana A. Nasser, Mesned Abdulrahman, Abdullah A.L Qwaee, Ali Alakfash, Tageldein Mohamad, Mohamed S. Kabbani

Journal of the Saudi Heart Association

Introduction: Ducts-dependent pulmonary circulation is spectrum of congenital heart diseases that need urgent intervention to augment pulmonary blood. Systemic to pulmonary shunt is the classical surgical management. Stenting of ductus arteriosus emerged in the last 2 decades as an alternative plausible intervention. Objectives: To evaluate and compare the short and midterm effects of PDA stenting in compared to surgically placed shunt for augmentation of pulmonary blood flow looking to pulmonary artery (PA) branches growth, oxygen saturation and suitability for second stage repair. Methods: We conducted this prospective study in Cardiac Surgical Intensive Care Unit . Cases were divided into “stent …

Preoperative Blood Urea Nitrogen-To-Left Ventricular Ejection Fraction Ratio Is An Independent Predictor Of Long-Term Major Adverse Cardiac Events In Patients Undergoing Coronary Artery Bypass Grafting Surgery, Turan Erdogan, Mustafa Çetin, Goksel Çinier, Savas Ozer, Ahmet S. Yõlmaz, Ozan Karakisi, Tuncay Kõrõs

Journal of the Saudi Heart Association

Background: Long-term mortality rate following coronary artery bypass grafting (CABG) procedure is still considered to be high despite advances in surgical techniques and perioperative management. Identifying high-risk patients by using cost-effective and clinically useful parameters is needed. Methods: Patients who were admitted to our cardiology clinic with the diagnosis of coronary artery disease and underwent CABG between January 2008 and August 2010 were included. Study patients were followed-up for 112.6 ± 17.8 months for major adverse cardiac events (MACE) which were defined as all-cause mortality and new-onset decompensated heart failure (HF). Results: Patients in MACE (þ) group were older ( …

Left And Right Ventricular Speckle Tracking Study Before And After Percutaneous Atrial Septal Defect Closure In Children, Hala M. Agha, Islam S. Mohammed, Hassan A. Hassan, Hassan S. Abu Seif, Ibrahim M. Abu Farag

Journal of the Saudi Heart Association

Objectives: To analyze the acute and short-term deformation changes of both right (RV) and left (LV) ventricular wall before and after transcatheter closure of atrial septal defect (ASD) secundum in children. Outcome measures: To determine the feasibility of tissue Doppler and myocardial deformation imaging for evaluating RV and LV functions in children undergoing transcatheter ASD closure. Patients and methods: A prospective study was performed for 32 children with hemodynamic significant ASD secundum before and 6 months after percutaneous ASD closure in the Pediatric Cardiology Division of Specialized Pediatric Hospital, Cairo University. Speckle tracking echocardiography (STE) of LV and RV global …

N-Terminal Pro-Brain Natriuretic Peptide As A Biomarker For Differentiating Cardiac And Pulmonary Disease In Term Neonates With Respiratory Distress, Azza M. Ahmed, Nagwa Abd El-Ghffar Mohamed, Enas M. Abdelhamid, Randa I. Taha, Maha M.A. Abo-Hashish

Journal of the Saudi Heart Association

Objective: Brain natriuretic peptide (BNP) is synthesized in the cardiac ventricles and released in response to volume or pressure load. The aim of the study was to determine whether plasma level of N-terminal pro BNP (NT-pro BNP) can distinguish between cardiac and pulmonary disease (PD) among neonates with respiratory distress (RD). Patients and methods: The study included 48 term neonates in the first month of life with signs of RD. They were recruited from Neonatal Intensive Care Unit of Al-Galaa Teaching Hospital. Twenty-six healthy neonates were included as a control group. The degree of RD was assessed using SilvermaneAnderson score. …

Systemic Immune-Inflammation Index Predicts Mortality In Infective Endocarditis, Hicaz Z. Agus, Serkan Kahraman, Cagdas Arslan, Ceren Yildirim, Mehmet Erturk, Ali K. Kalkan, Mustafa Yildiz

Journal of the Saudi Heart Association

Objectives: The aim of our study was to evaluate the usefulness of systemic immune-inflammation index (SII) at admission in predicting in-hospital mortality in patients with infective endocarditis. Methods: 133 definite IE patients (≥18 years) according to modified Duke criteria, treated in our tertiary care hospital between December 2009 and May 2019, were retrospectively analysed. Symptoms, comorbidities, predisposing valvular diseases, prosthetic valve, device, history of injectable drug use, blood culture results, echocardiography findings, and complications were collected. We calculated the SII as follows: SII¼platelet count£neutrophil count/lymphocyte count at admission. Results: The median age of the patients was 56 (40e66) years. Prosthetic …

Comparison Between Two Protocols For Deflation Of The Tr Band Following Coronary Procedures Via The Radial Route, Hassan Al Riyami, Adil Al Riyami, Sunil K. Nadar

Journal of the Saudi Heart Association

Aim: Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction. Methods: All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the …

The Use Of Antidepressants In Patients With Heart Failure, Norah Alsumih, Rahaf Alqahtani, Faisal Almutairi, Rakan Faraj, Turki Alsubeai, Ahmed Alghanim, Shmylan Alharbi, Hind Almodaimegh

Journal of the Saudi Heart Association

Background: Heart failure (HF) is a chronic disease affecting patients’ quality of life (QoL) and may cause depression. Recent studies reported that the prevalence of depression in patients with HF is 21.5%. Antidepressants, mainly selective serotonin reuptake inhibitors, are usually prescribed for HF patients diagnosed with depression. Some evidence supports antidepressant’s role in improving symptoms by enhancing the psychological aspect of their QoL. Depression screening and treatment are important in the multidisciplinary management; however, their survival benefits are inconsistent. In our study, we aim to investigate the prevalence of depression and the use of antidepressants in patients with HF as …

Effects Of Cardiopulmonary Bypass Perfusion Temperature On Perioperative Renal Function In Adult Patients Undergoing Cardiac Surgery, Jayavelan Ramkumar, Girish Gopinathan, Karthick Kavin, Ramkumar Shanmugasundaram, George M. Stephen, Annie C. Pragasam, Periyasamy Thangavel

Journal of the Saudi Heart Association

Aims and objective: The primary objective of this investigation was to study the effects of cardiopulmonary bypass (CPB) perfusion temperature on renal function parameters [serum creatinine, creatinine clearance, urine albumin, urine protein, and urine albumin/creatinine ratio (ACR)]. The secondary objective was to detect renal complications of CPB. Materials and methods: This is a prospective longitudinal study of 30 adult patients (17 men, 13 women; mean age, 53.37 ± 16.02 years) who underwent valvular heart surgery [with or without coronary artery bypass grafting (CABG)]. Serum creatinine, creatinine clearance, urine protein, urine albumin, and urine ACR were collected during CPB (at 28 …

Right Ventricular Functions In Subphenotypes Of Sickle Cell Disease, Ilham Youssry, Mohamed F. Shaltout, Antoine F. Abdelmassih, Carolyne Ghobrial, Mohammad Nabih, Ramy Doss, Raghda Fouda, Amal El-Sisi

Journal of the Saudi Heart Association

Objectives: Sickle cardiomyopathy is the most important cause of death in patients with sickle cell disease (SCD). Based on recent evidence, SCD can be divided into two subphenotypes, namely, the viscosity vaso-occlusion (VVO) subphenotype and the hemolysis endothelial dysfunction (HED) subphenotype. The aim of our series is to study right ventricular (RV) functions in both subphenotypes. Methods: Echocardiography including conventional and tissue Doppler imaging as well as speckle tracking echocardiography was performed in 50 patients (23 from the VVO subgroup and 27 from the HED subgroup) based on a serum lactate dehydrogenase (LDH) level below or above 270 U/L, respectively, …

Exercise-Based Cardiac Rehabilitation For Post Coronary Artery Bypass Grafting: Its Effect On Hemodynamics Response And Functional Capacity Using Incremental Shuttle Walking Test: A Retrospective Pilot Analysis, Ahmad Osailan, Walid K. Abdelbasset

Journal of the Saudi Heart Association

Background: Coronary artery bypass grafting (CABG) is a common surgical procedure for the restoration of blood flow into stenotic or blocked coronary arteries. Cardiac rehabilitation has been implemented to some extent worldwide for the management of postoperative CABG. However, studies about the effect of exercise training on hemodynamic responses of the heart using the Incremental Shuttle Walking (ISWT) test are limited in Saudi Arabia. Objectives: To investigate the effect of exercise-based cardiac rehabilitation (Phase 3, hospital-based) on some hemodynamic responses including blood pressure, heart rate (HR) and heart rate recovery (HRR), and rate pressure product (RPP) using ISWT on post-CABG …

An Observational Comparison Of Distal Radial And Traditional Radial Approaches For Coronary Angiography, Anupam Bhambhani, Salil Pandey, Aditi N. Nadamani, Kartikey Tyagi

Journal of the Saudi Heart Association

Background: Several studies have recently reported regarding feasibility and safety of distal transradial access (d-TRA) in the anatomical snuff-box (ASB); however, literature comparing it with the conventional TRA at the wrist (w-TRA) is sparse. This study compares the technical efficiency and safety of ASB and wrist approaches for TRA for coronary angiography (CAG) and evaluates the radial artery (RA) anatomy at these sites. Methods: Two hundred consecutive patients undergoing CAG via w-TRA or d-TRA (100 in each group) were investigated. The primary endpoint was comparison of procedural efficiency of the two methods, defined as CAG completion from the intended access …

Occurence Of Left Main Occlusion On Tuesday: Chronobiology Of Acute Myocardial Infarction, Gianluca Rigatelli, Marco Zuin

Journal of the Saudi Heart Association

Objectives: The existence of a “weekend effect” for onset of acute myocardial infarction (AMI) has been suggested in the past, but the relation with the culprit vessel has not been investigated. MI due to left main coronary artery lesion represents a particularly serious life-threatening condition. Our study was aimed to assess the chronobiology of admission to the emergency department for AMI considered to be induced by a left main culprit lesion. Methods: We retrospectively reviewed patients who experienced an AMI due to a left main culprit lesion between January 1, 2008 and January 1, 2018 stratifying them according to the …

A Real-Life Correlation Between Clinical Syntax Score Ii And Carotid Intima-Media Thickness In Patients With Stable Coronary Artery Disease, Mahmoud Abdelnabi, Abdallah Almaghraby, Ozge O. Tok, Tugba K. Oz, Yehia Saleh, Ahmed Morsi, Hiatham Badran

Journal of the Saudi Heart Association

Background: SYNTAX score II (SSII) is an update of the established SYNTAX score (SS) that uses clinical variables such as age, sex, creatinine clearance, left ventricular ejection fraction, chronic obstructive pulmonary disease, and peripheral arterial disease. Furthermore, SSII has been proven to be a more powerful predictive tool than SS in patients with complex coronary artery disease (CAD). Carotid õntima-media thickness (CIMT) is a widely used noninvasive evidence for subclinical or early atherosclerosis, and it was proved to be an independent predictor for cardiovascular events. Most of the previously published articles studied the association between the CIMT with old cardiovascular …

Safety Of Returning Patients Immediately To Their Originating Hospitals After Primary Percutaneous Coronary Intervention, Rahim Gul, Maksymilian P. Opolski, Mufti Akif, Mehboob A. Dar, Yasir Beshir, Haitham Sakr, Hassan Khalaf, Akram Eldesoky, Osama A. Smettei, Tariq I. Soomro, Mohammed Saied, Asim Ganawa, Rami M. Abazid

Journal of the Saudi Heart Association

Introduction: The objective of this study was to evaluate the safety and feasibility of the immediate return of patients with ST-elevation myocardial infarction (STEMI) to their originating hospitals after primary percutaneous coronary intervention (PPCI). Methods: This was a prospective study, conducted between January 2014 and December 2017. All patients with STEMI who were transferred for PPCI and returned back to their referring hospitals (RB group) were included and compared to the onsite STEMI population (OS group). Patient’s demographics, PPCI data, bleeding and adverse cardiovascular events (ACEs) occurring during transfer, hospital stay, and at 1-month follow-up were recorded. Results: A total …

Editorial, Hani Najm

Journal of the Saudi Heart Association

No abstract provided.