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Residual pulmonary insufficiency in post-repair Tetralogy of Fallot (rToF) patients often mediates biventricular dysfunction which is associated with long-term adverse clinical outcomes. The objective of this study was to demonstrate the presence of impaired left ventricle (LV) circumferential strain (CS) in pediatric rToF patients as compared to controls using cardiac magnetic resonance imaging (CMRI). Additionally, bivariate analysis between right ventricle (RV) and LV functional measures in rToF patients was performed to further characterize the interventricular interactions thought to mediate LV dysfunction secondary to RV volume overload. The medical records of 12 rToF patients (mean age 13.3 years) and 9 controls (mean age 10.9 years) were analyzed. LV global CS was significantly decreased in rToF patients versus controls ( p = 0.04). This impairment was differentially distributed within the LV, with only the LV anterior and anterior lateral walls significantly decreased versus controls ( p = 0.04, p = 0.03). Bivariate analysis revealed a significant correlation between RV mean CS and LV EF ( r = 0.71, p = 0.01), RV infundibulum CS and LV EF ( r = 0.70, p = 0.01), RV infundibulum CS and LV anterolateral wall CS ( r = 0.59, p = 0.04), and RV infundibulum CS and pulmonary regurgitation fraction ( r = −0.63, p = 0.03). These findings support existing research implicating interventricular interactions in the development of LV dysfunction. Furthermore, the segment specific CS impairment in the LV suggests a possible spatial component to these interactions. The success of this study in identifying regional myocardial strain impairment indicates CMRI based techniques may be useful in localizing otherwise undetectable myocardial dysfunction. [ABSTRACT FROM AUTHOR]

The article focuses on the case of a 3-year-old girl, who was admitted with fever, leg pain, and ambulation failure due to minor leg trauma and was found to have methicillin-resistant staphylococcus aureus (MRSA) in blood culture. It says that posterior septal pseudoaneurysm in communication with the left ventricle was developed. A broad-spectrum intravenous antibiotic coverage was utilized and a surgical repair with ventricular septal patch placement improves the residual aneurysm of the girl.

Objectives: We sought to test the hypothesis that a novel 2-dimensional echocardiographic image analysis system using artificial intelligence-learned pattern recognition can rapidly and reproducibly calculate ejection fraction (EF). Background: Echocardiographic EF by manual tracing is time consuming, and visual assessment is inherently subjective. Methods: We studied 218 patients (72 female), including 165 with abnormal left ventricular (LV) function. Auto EF incorporated a database trained on >10,000 human EF tracings to automatically locate and track the LV endocardium from routine grayscale digital cineloops and calculate EF in 15 s. Auto EF results were independently compared with manually traced biplane Simpson’s rule, visual EF, and magnetic resonance imaging (MRI) in a subset. Results: Auto EF was possible in 200 (92%) of consecutive patients, of which 77% were completely automated and 23% required manual editing. Auto EF correlated well with manual EF (r = 0.98; 6% limits of agreement) and required less time per patient (48 ± 26 s vs. 102 ± 21 s; p < 0.01). Auto EF correlated well with visual EF by expert readers (r = 0.96; p < 0.001), but interobserver variability was greater (3.4 ± 2.9% vs. 9.8 ± 5.7%, respectively; p < 0.001). Visual EF was less accurate by novice readers (r = 0.82; 19% limits of agreement) and improved with trainee-operated Auto EF (r = 0.96; 7% limits of agreement). Auto EF also correlated with MRI EF (n = 21) (r = 0.95; 12% limits of agreement), but underestimated absolute volumes (r = 0.95; bias of −36 ± 27 ml overall). Conclusions: Auto EF can automatically calculate EF similarly to results by manual biplane Simpson’s rule and MRI, with less variability than visual EF, and has clinical potential. [Copyright &y& Elsevier]