Ganji, Jhansi L.

Introduction- Two dimensional speckle tracking echocardiography is a novel non-invasive method to assess subtle changes in left ventricular (LV) function such as strain and rotational dynamics. Limited data exists for assessing the impact of severity of aortic stenosis (AS) on LV apical rotation Objective- To determine the impact of severity of AS on LV longitudinal strain as well as LV apical rotation in patients with preserved LV ejection fraction and various degrees of AS. Methods- We prospectively measured longitudinal LV strain and apical rotation in 74patients with preserved LV ejection fraction but no (n= 22), mild (MG 10-25 mmHg; n= 20), moderate (MG 25-40 mmHg; n= 18), or severe (MG >40 mmHg; n= 14) AS who were undergoing echocardiographic examination at our institution. Two dimensional speckle tracking method was used to obtain average peak longitudinal strain using apical 4, 2-chamber and long-axis views while apical short axis view was used to obtain the LV apical rotation. Results- Mean age between no vs. mild vs. mod vs. severe AS groups (73±11yrs; 70±13yrs; 77±6yrs; 76±14 yrs) was not different (p=0.26). Presence of hypertension (64%, 65%, 78%, 71%) and coronary artery disease (14%, 6%, 25%, 29%) were also not different between the groups (p = 0.76 and p = 0.23 respectively). Average LV peak global longitudinal strain was not different between groups (-17.5±3%; -17.5±5%;-16.6±4%; -16.6±3% (p=0.82). However LV peak apical rotation was higher with worsening severity of aortic stenosis (14.8±8°; 14.7±9°; 21.3±11°; 23.7±12°) (overall p=0.02) (Figure). Conclusions- 1) LV peak longitudinal strain was not different between patients with no stenosis when compared to patients with various levels of aortic stenosis. 2) However, LV apical rotation increases with worsening levels of AS probably to maintain the LV stroke volume. Further studies are needed to evaluate the role of LV apical rotation in deciding the timing of surgery in patients with severe AS.

Mini‐AbstractWe present a case of a 25‐year‐old man with aortic regurgitation secondary to infective endocarditis. A preoperative transesophageal echocardiography demonstrated an abnormal aortic valve with possible vegetation or torn leaflet with severe aortic regurgitation, markedly dilated left coronary arteries, and a fistulous communication between the circumflex artery and the coronary sinus. The aortic valve was repaired and the coronary sinus arteriovenous fistula was ligated. At 1‐year follow‐up, there was no evidence of recurrent arteriovenous fistula or aortic regurgitation.

Mini‐AbstractWe present a case of a 76‐year‐old woman with new‐onset atrial flutter who underwent transesophageal echocardiography, which demonstrated a large left atrial mass consistent with myxoma and a “shimmering” mobile mass on the aortic side of the right coronary cusp, with fronds consistent with a papillary fibroelastoma. Such concurrent primary cardiac tumors of different histology are a rare occurence.