Petr Kuchynka

A congenital diverticulum of the left ventricular apex manifested by stroke and recurrent ventricular tachycardia

Ventricular outpouchings include acquired abnormalities (aneurysms and pseudoaneurysms) and congenital ventricular diverticula (CVD). CVD represent rare cardiac pathologies. Although CVD is often associated with other cardiac and extracardiac congenital anomalies, it can also be incidentally observed in otherwise healthy subjects. CVD may lead to significant morbidity and even have lethal consequences. We describe a case of arrhythmogenic left ventricle (LV) apical CVD revealed by cardiac magnetic resonance imaging (CMRI) after being initially overlooked by echocardiography. The paper includes the review of the literature also. This clinical case highlights the possible association of this pathology with recurrent ventricular tachycardia and stroke, and illustrates the importance of multimodal imaging approach in differential diagnosis.

Cardiac involvement in lymphoma mimicking hypertrophic cardiomyopathy

12nd Department of Medicine – Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic 2Department of Radiology, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic 3Institute of Nuclear Medicine, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic

The predictive value of cardiac morphology for long-term outcome of patients undergoing catheter ablation for atrial fibrillation

OBJECTIVEnCatheter ablation (CA) is an established therapy for selected patients with atrial fibrillation (AF), but predictors of CA ablation outcome are still not fully elucidated. The aim of the study was to identify structural and morphological parameters from computed tomography (CT) as predictors of successful CA of AF in a single center prospective cohort.nnnMETHODSnAn analysis of CT scans dedicated to LA evaluation was performed in 99 patients (63u202f±u202f8 years old, 70% males, 59% paroxysmal AF) scheduled for CA of AF. Survival free of atrial fibrillation/flutter/tachycardia at 1- and 3-years was assessed.nnnRESULTSnIn overall study population, both 1- and 3-year responders had smaller distance to the first division in left superior pulmonary vein (16.3u202f±u202f5.42u202fmm vs. 19.1u202f±u202f7.0u202fmm and 14.9u202f±u202f3.6u202fmm vs. 18.7u202f±u202f7.0u202fmm; pu202f<u202f0.05). One-year responders had larger ostium area of left inferior pulmonary vein (median 236u202fmm2 [IQRu202f=u202f97] vs. 222u202fmm2 [IQRu202f=u202f71]; pu202f=u202f0.03) and less acute angle between the interatrial septum and the right superior pulmonary vein (102u202f±u202f20° vs. 95u202f±u202f10°; pu202f=u202f0.03). Three-years responders had smaller ostium area of the right superior pulmonary vein (248u202f±u202f94u202fmm2 vs. 364u202f±u202f282u202fmm2; pu202f=u202f0.02). Multivariate Cox regression analysis identified different predictors in paroxysmal and non-paroxysmal AF. For patients with paroxysmal AF, the predictors were angle to right superior pulmonary vein and left superior/inferior pulmonary veins carina thickness with hazard ratios of 0.965 (95%CI 0.939 to 0.992, pu202f=u202f0.010) and 0.747 (95%CI 0.591 to 0.944, pu202f=u202f0.015). In patients with persistent AF, the predictors were gender and NYHA stage with hazard ratios of 4.9 (95%CI 1.758 to 13.579, pu202f=u202f0.002) and 0.365 (95%CI 0.148 to 0.899, pu202f=u202f0.028) respectively.nnnCONCLUSIONSnThe anatomy of LA, especially morphology of pulmonary veins, seems to be one of the predictors of clinical outcome after CA for paroxysmal AF. In non-paroxysmal AF LA anatomy is less relevant in prediction of clinical outcome.

The predictive value of computed tomography in the detection of reflux esophagitis in patients undergoing upper endoscopy

BACKGROUNDnReflux esophagitis (RE) may mimic symptoms requiring cross-sectional imaging.nnnMETHODSnFrom 565 patients who had CT and esophagogastroduodenoscopy within four days apart, CT scans of 72 patients with RE confirmed by esophagogastroduodenoscopy and 108 matched patients without RE were evaluated for distal esophageal wall characteristics.nnnRESULTSnIn RE patients the distal esophageal wall thickness was greater (5.2±2.0mm) compared to patients without RE (3.5±1.2mm, p<0.0001) with AUC of 0.78 and 56% sensitivity, 88% specificity for a 5.0mm cut-off.nnnCONCLUSIONSnThere is a moderate association between distal esophageal wall thickness on CT and RE diagnosed by esophagogastroduodenoscopy as the reference standard.

3D electroanatomical mapping is less sensitive to atrial remodeling in estimation of true left atrial volume than echocardiography

BackgroundLeft atrial (LA) enlargement has been identified as a predictor of worse clinical outcome after catheter ablation for atrial fibrillation (AF). We investigated the correspondence of LA size parameters assessed by echocardiography, CT and 3D electroanatomical mapping in patients with AF treated by catheter ablation.MethodsWe analyzed echocardiographic LA volume measurements by disc summation method (LAVDISC), computed tomography (LAVCT) and 3D electroanatomical mapping (LAVCARTO) in 100 pts. (71% males; aged 63u2009±u20098xa0years; paroxysmal AF in 55% of patients).ResultsMean LAVDISC was 83u2009±u200925xa0ml (median: 115; IQR: 98–140xa0ml), mean LAVCT was 120u2009±u200934xa0ml (median: 115; IQR: 98–140xa0ml) and mean LAVCARTO was 123u2009±u200936xa0ml (median: 118; IQR: 99–132xa0ml). Pearson’s correlation coefficient between LAVDISC a LAVCT was 0.6 (pxa0<u20090.0001) and between LAVCARTO and LAVCT was 0.79 (pu2009<u20090.0001). There was a significant difference between the two correlation coefficients (pxa0<u20090.004). The absolute difference between LAVCARTO and LAVCT (3.5 (95% CI -42 – 43) ml) was significantly lower (pxa0<u20090.0001) as compared to LAVDISC and LAVCT (−u200939 (95% CI -102 – 24) ml). In opposite to LAVDISC, the bias between LAV obtained by CT and CARTO did not differentiate according to presence of spherical remodeling (1.7u2009±u200928 vs. vs. 5.1u2009±u200931xa0ml). Only presence of sinus rhythm was significant and independent covariate of the difference between CARTO and CT-derived LAVs by multivariate regression analysis.ConclusionsEven though LA volumes evaluated by 3D-electroanatomical mapping have quite good accuracy, the precision is low. For volumes estimated by echocardiography, both precision and accuracy are low.

Giant torturous left circumflex artery draining to the right atrium

Coronary artery anomalies represent a diverse group of congenital disorders characterized by abnormalities of coronary arteries anatomy. We describe an extremely rare case of giant torturous left circumflex artery draining to the right atrium manifesting by palpitations and atrial fibrillation.

An unrecognized combined congenital heart defect – Bicuspid aortic valve and ventricular septal defect as a cause of acute heart failure in adulthood

Bikuspidalni aortalni chlopeň je nejcastějsi vrozenou srdecni vadou (VSV) v dospělosti s incidenci mezi 0,5-2 %.Může být asociovana i s dalsimi vrozenými srdecnimi vadami, nejcastěji patologiemi aortalniho oblouku, ale i s defekty komoroveho septa, jejichž incidence v dětskem věku je uvaděna mezi 25-40 %, v dospělosti pak tvoři až 20 % vsech vrozených srdecnich vad. Bikuspidalni aortalni chlopeň je nejcastějsi přicinou aortalni stenozy ci insuficience v mladsim věku. V naproste větsině připadů jsou tyto vady diagnostikovany v dětskem věku a v připadě hemodynamicke významnosti chirurgicky korigovany. Nicmeně i v dospělem věku se lze s dosud nepoznanou kombinovanou vrozenou srdecni vadou setkat. V nasi kasuistice popisujeme připad 51leteho muže s nově zjistěnou kombinovanou vrozenou srdecni vadou - bikuspidalni aortalni chlopni se zavažnou aortalni regurgitaci, hemodynamicky významným defektem septa komor a významnou trikuspidalni regurgitaci.

A rare case of regressively changed lipomatous hypertrophy of the interatrial septum presenting with anemia and recurrent fever

Lipomatous hypertrophy of the interatrial septum (LHIS) is characterized by excessive accumulation of adipose tissue within some segments of the interatrial septum. Only one published case so far describes fever as a presenting feature of LHIS. On the other hand, systemic symptoms including anemia and fever are well-known clinical presentations of cardiac myxomas. We report an unusual case of a 79-year-old woman who was thoroughly but unsuccessfully investigated for recurrent fever and anemia in several specialized departments over the course of 4 years. Computed tomography scan showed a pathological mass localized in the interatrial septum and spreading to ascending aorta. Histological analysis of the biopsy samples from surgery revealed the unexpected diagnosis of regressively changed LHIS. We discuss the clinical and pathologic features of this lesion suggesting that its regressive changes may be associated with inflammation and can cause systemic symptoms such as fever and anemia.