Atiar M. Rahman

Assessment of Left Atrial Appendage by Live Three‐Dimensional Echocardiography: Early Experience and Comparison with Transesophageal Echocardiography

Background: Live Three‐Dimensional Echocardiography (L3D, Sonos 7500, Philips) has the potential to visualize all cardiac structures including left atrial appendage (LAA). We tested the feasibility of evaluating LAA by L3D and compared the findings to transthoracic echocardiography (2D) and in a subset of patients with transesophageal echocardiography (TEE). Methods: L3D images were obtained in 204 consecutive patients referred for routine 2D or TEE. We performed wide‐angled acquisitions from parasternal and apical views. TomTec system (4D Cardio‐view, RT 1.2) was used to visualize LAA from multiple vantage points. Results: LAA was adequately visualized by L3D in 139 of 204 (68.1%) patients. L3D visualization was dependent on image quality, suboptimal in 100 and diagnostic in 104 patients. Overall, LAA was visualized in 93 (45.5%) patients by 2D compared to 139 (68.1%) by L3D (P < 0.0001). In 100 patients with suboptimal image quality by L3D, LAA visualization was 16% by 2D and 35% by L3D, whereas in 104 patients with diagnostic images, LAA was visualized in 77 (74%) by 2D and in all 104 (100%) patients by L3D (P < 0.0001). In 37 patients referred for transesophageal echocardiography (TEE), live three‐dimensional echocardiography (L3D) visualized left atrial appendage (LAA) in 34 patients with diagnostic image quality. Eight patients with LAA thrombi on TEE had thrombi detected by L3D as well. All patients with LAA thrombus had enlarged LA by both 2D and TEE. Conclusions: L3D is a promising technique in evaluation of LAA with and without thrombi. In patients with good quality transthoracic images L3D may be used as a screening tool in assessment of LAA.

Monomorphic ventricular tachycardia: a late complication of percutaneous alcohol septal ablation for hypertrophic cardiomyopathy.

Percutaneous alcohol septal ablation has emerged as a promising treatment option for patients with symptomatic hypertrophic obstructive cardiomyopathy. Although the procedure involves an alcohol-induced myocardial infarction and results in a substrate potentially conducive to re-entrant tachyarrhythmias, late-occurring ventricular arrhythmias have not been described. We report a case of monomorphic ventricular tachycardia occurring several days after alcohol septal ablation. Patients with hypertrophic cardiomyopathy undergoing alcohol septal ablation should be considered for prophylactic placement of implantable cardioverter defibrillator.

Abciximab Treatment for Obstructive Prosthetic Aortic and Mitral Valve Thrombosis in the Presence of Large Thrombi, Cardiogenic Shock, and Acute Evolving Embolic Stroke

Obstructive thrombosis of left‐sided mechanical prosthetic valves is a life‐threatening complication. Intravenous thrombolytic therapy is contraindicated due to risk of clot embolization and surgical treatment is often required for hemodynamically unstable patients. We report for the first time the successful use of abciximab in the management of a patient in cardiogenic shock with multiple prosthetic valve obstructive thrombosis and evolving embolic stroke. Serial Doppler echocardiography and cinefluoroscopy demonstrated resolution of thrombi, improvements in transvalvular gradients and improvement in leaflet motion. This observation suggests abciximab should be considered as a therapeutic option in the treatment of obstructed prosthetic heart valves. (ECHOCARDIOGRAPHY, Volume 21, January 2004)

Stress-induced right ventricular ischemia in recurrent pulmonary outflow stenosis in repaired tetralogy of fallot

Radionuclide uptake by the right ventricle during myocardial perfusion imaging is minimal compared with the left ventricular myocardium and is not given much importance. However, right ventricular hypertrophy from pressure or volume overload may increase right ventricular radiotracer uptake and demonstrate reversible stress-induced perfusion abnormalities in the presence of normal coronary arteries. We report a case of right ventricular ischemia secondary to right ventricular hypertrophy from recurrent right ventricular outflow tract stenosis in a patient with repaired tetralogy of Fallot. Advances in the management of congenital heart disease have led to more patients surviving to adulthood. These patients subsequently present to cardiologists in adulthood with sequelae or complications arising from previous surgery undertaken during childhood.

Clincal engineering and healthcare delivery performance mesurement: A basic model of clinical engineering department for 250 bed hospital in Bangladesh

In the past few decades, the healthcare technology management performance comes under the clinical engineering for enhancing the healthcare delivery performance of hospital. For this reasons, most of the countries established clinical engineering department in their healthcare delivery organizations such hospitals and clinics. This study explores clinical engineering intermediation to measure the performance of present healthcare delivery and advises to introduce the CED in the healthcare delivery organization. In this paper, we propose a model of CED for 250 bedded hospital in Bangladesh. The study describes the necessity of CE to enhance the present unpleasant healthcare delivery performance in Bangladesh as well as describes the result to introduce CED model in the healthcare delivery organization in Bangladesh. Moreover, the benefit of introduced CE and CED in healthcare delivery organizations in Bangladesh is described. Expected results of this study will enrich the conceptions of the present health care management team on CE and CED for the healthcare delivery performance. We firmly believe that our study will enhance the present unfamiliarity conception of healthcare management team.