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A Case of Epicardial Lipomatous Hypertrophy: A Mimicker of Pericardial Mass

Ket Meng CHIN ; Tai Meng CHEN ; Nor Hanim Mohd AMIN

Cardiovascular Imaging Asia.2024;8(4):81-83. doi:10.22468/cvia.2024.00115

Epicardial lipomatous hypertrophy (ELH) is a rare histologically benign condition characterized by excessive accumulation of epicardial fat. We report a case of a 68-year-old female who experienced reduced effort tolerance for the past year. A transthoracic echocardiogram revealed a suspicious circumferential mass around the heart. Cardiac magnetic resonance (CMR) was subsequently performed and identified a 13- to 15-mm-thick layer of epicardial fat surrounding the myocardium, with a small pericardial effusion at the lateral wall. Cardiac function was preserved, and her symptoms were ultimately attributed to atherosclerotic coronary disease, which was treated accordingly. This case highlights the importance of using complimentary multimodal imaging such as CMR, to differentiate between ELH and others, for accurate diagnosis and further management.

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TricValve in Severe Tricuspid Regurgitation: A Case Series Illustrating The Role of CT Angiography and Treatment Outcome

Hanumantha Reddy MALREDDY ; Jien Sze HO ; Ningyan WONG ; Ignasius Aditya JAPPAR ; Jun Hua CHONG ; Michelle Mei-Yi CHAN ; Foong Koon CHEAH ; Adrian Shoen Choon Seng LOW ; Lohendran BASKARAN ; Felix Yung Jih KENG ; Terrance Siang Jin CHUA ; Swee Yaw TAN ; See Hooi EWE ; Jack Wei Chieh TAN ; Khung Keong YEO

Cardiovascular Imaging Asia.2024;8(4):69-76. doi:10.22468/cvia.2024.00108

Less invasive transcatheter tricuspid therapies are optimal alternative for surgery in high-risk individuals with severe symptomatic tricuspid regurgitation on medical therapy. Various techniques are available with Transcatheter Edge-to-Edge Repair (TEER) having the greatest experience worldwide. When the coaptation gap becomes too large for TEER, caval valve implantation (CAVI) emerge as a better option. We described a series of 4 patients who underwent CAVI with the TricValve system and periprocedural computed tomography angiography imaging for the purpose of TricValve sizing. There were few procedural complications, with significant improvements in New York Heart Association functional class and right ventricular function post-procedure.

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Massive Left Atrial Calcification in Severe Long-Standing Mitral Stenosis Due to Rheumatic Heart Disease: A Case Report

Celly Anantaria ATMADIKOESOEMAH ; Elen ELEN ; Wincent Candra DIWIRYA ; Bagus HERLAMBANG ; Sony Hilal WICAKSONO ; Manoefris KASIM ; Amiliana Mardiani SOESANTO

Cardiovascular Imaging Asia.2024;8(4):77-80. doi:10.22468/cvia.2024.00080

Massive calcification of the left atrium (LA), known as coconut atrium or porcelain atrium, is rare. This study emphasized the importance of assessing the extent of calcification in the LA before surgery. We present a case of a 55-year-old woman with severe, long-standing rheumatic mitral stenosis complicated by massive LA calcification. Mitral valve replacement surgery and thrombus evacuation were performed. Calcified LA complicates management, particularly in determining the surgical incision site, and alters atrial wall hemostatic properties while increasing right ventricular afterload. Available diagnostic modalities allow comprehensive preoperative planning for left atrial calcification. These methods identify specific case concerns and variations to optimize outcomes.

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The Shielded Heart: A Case of Calcified Constrictive Pericarditis

Aditya Doni PRADANA ; Putrika Prastuti Ratna GHARINI ; Ihsanul AMAL ; Saskia Dyah HANDARI

Cardiovascular Imaging Asia.2024;8(4):84-87. doi:10.22468/cvia.2024.00101

Pericardial calcification (PC) is a very rare condition, usually caused by infection, trauma, or chronic inflammation. The clinical consequence of PC presents as constrictive pericarditis, which causes severe diastolic dysfunction. We present a case of a 42-year-old male patient with a history of tuberculosis pericardial effusion about 20 years ago who presented with constrictive pericarditis with signs and symptoms of right heart failure. Non-invasive multimodalities imaging including chest X-ray, echocardiography, and cardiac computed tomography showed a PC on the right-anterior side of the heart causing constrictive pericarditis. The patient successfully underwent a pericardiectomy procedure, and the symptoms improved 3 months after surgery.

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Imaging and Surgical Repair of the Left Pulmonary Venous Anomaly to Coronary Sinus With Small Patent Ductus Arteriosus

Hieu Lan NGUYEN ; Ly Thi Minh NGUYEN ; Tu Ngoc VU ; Luu Tien DOAN ; Thang Duy NGUYEN ; My Thi Ha TRINH

Cardiovascular Imaging Asia.2025;9(2):19-22. doi:10.22468/cvia.2024.00143

A 47-year-old female was admitted with progressive exertional dyspnea and diagnosed with anomalous drainage of the left pulmonary veins into the coronary sinus (CS), combined with an intact interatrial septum and a small patent ductus arteriosus (PDA). Multimodal imaging, including echocardiography, computed tomography, and cardiac catheterization, helps diagnosis, optimal management and monitoring. The patient successfully underwent surgical repair, which involved rerouting the left anomalous pulmonary veins into the left atrium through a surgically created atrial septal defect, while the CS continued to drain into the right atrium and the PDA was closed directly via a transpulmonary approach. The postoperative course was uneventful.

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Post-Cardiac Injury Syndrome in End Stage Renal Disease Hemodialysis Patient After Percutaneous Coronary Intervention for Non-ST Elevated Myocardial Infarction

Taesun KIM ; Kyu Yong KO ; Ji Won HWANG ; Sung Woo CHO ; Sung Eun KIM

Cardiovascular Imaging Asia.2025;9(2):15-18. doi:10.22468/cvia.2024.00136

Post-cardiac injury syndrome (PCIS) is an uncommon complication arising from pericardial and myocardial damage, encompassing post-cardiac surgery, percutaneous intervention (PCI) for acute coronary syndrome, cardiac device implantation, and radiofrequency ablation. The etiology of PCIS is not clearly defined, with approximately 50% of cases remaining idiopathic.Manifestations and symptoms of PCIS vary significantly among patients. Herein, we report a rare case of a 62-year-old male with PCIS that occurred after PCI for non-ST elevation myocardial infarction in an end-stage renal disease (ESRD) hemodialysis (HD) patient. He suddenly developed chest pain, fever, low blood pressure, cold sweating, tachycardia, desaturation and cardiac tamponade with cardiogenic shock after one week of PCI. After emergency pericardiocentesis, he was able to come out of cardiogenic shock. Ultimately, his clinical symptoms improved further with concurrent long-term medical treatment such as non-steroidal anti-inflammatory drugs and colchicine. This case illustrates a rare and unusual case of a relatively subacute onset PCIS in an ESRD patient on HD following emergency PCI. Although pericardial effusion is commonly detected in ESRD patients on HD, cardiologist should not overlook PCIS in dialysis patients, given the potential resemblance to uremic pericarditis or effusion. In addition, imaging modality such as transthoracic echocardiography has significantly important roles in case of urgent situation in order to make differential diagnosis as like this case.

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A Case of Spontaneous Left Main Coronary Artery Spasm of Anomalous Origin of Left Main Coronary Artery

Kyung-Tae JANG ; Jun-Hyok OH ; Hyun-Su KIM ; Hyeon-Gook LEE

Cardiovascular Imaging Asia.2025;9(2):23-25. doi:10.22468/cvia.2025.00038

A 65-year-old male presented with chest pain that occurred after alcohol drinking at the early morning hours and relieved after taking sublingual nitroglycerin. Coronary angiography revealed a malformed left main coronary artery (LMCA) originating from the right sinus of Valsalva with 10%–20% stenosis and 80% vasospasm. Coronary artery spasm (CAS) in the LMCA is extremely rare but can present with catastrophic features. CAS is more frequently observed in atherosclerotic segments of coronary arteries, and multidetector computed tomography is preferred for assessing the degree of atherosclerosis in cases of LMCA spasm. Anomalous origin of coronary arteries (AOCA) is also rare but can lead to severe symptoms. Although surgical intervention is generally recommended for symptomatic patients, while management of asymptomatic cases remains a topic of ongoing research and debated. In this case, there was concern that the patient’s symptoms might be attributable to AOCA or CAS, medical management was selected over surgical intervention, given the presentation consistent with typical angina due to spasm.

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Thanks to the Reviewers of Cardiovascular Imaging Asia

Sang Il CHOI

Cardiovascular Imaging Asia.2025;9(1):1-1. doi:10.22468/cvia.2025.00010

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The Effect of Oral Carbohydrate-Rich Solution Administration for Reducing Discomfort and Adverse Reactions in Patients for Coronary Computed Tomographic Angiography

Sowon JANG ; Sang Il CHOI

Cardiovascular Imaging Asia.2025;9(1):9-14. doi:10.22468/cvia.2025.00017

Objective: This study aimed to evaluate the effect of administration of oral carbohydrate-rich solution (ORS) for reducing discomfort and adverse effects of contrast media in patients who should undergo coronary computed tomographic angiography (CCTA). Materials and Methods: A total 142 patients scheduled for CCTA were randomly divided into two different groups. Patients assigned to group A (n=71) were instructed to maintain fasting at least 6 hours before CCTA. Patients in group B (n=71) were allowed to freely drink ORS up to three cans until 2 hours before CCTA. Subjective discomfort was assessed in both groups by questionnaires consisting of 5 different items that scored from 0 to 10 for each items 2 hours prior to and 30 minutes after CCTA. Acute side effects to contrast media including emetic complication were evaluated in both groups. Results: The ORS was well-tolerated in all patients without causing any unexpected complications. In group B, scores reflecting subjective discomfort were significantly lower than those of group A before (20.8±6.2 vs. 15.1±6.3; p<0.001) and after the CCTA (22.5±6.0 vs. 16.3± 5.0; p<0.001). In addition, emetic symptoms were significantly lower in group B than in group A after the CCTA (p=0.012). Aspiration pneumonia or contrast induced nephropathy were not observed in both groups. Conclusion Our study suggests that preparative ORS intake before CCTA is a safe practice to reduce adverse effects on contrast media and improve patients’ discomfort without causing aspiration pneumonia.

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Machine Learning-Based Computed Tomography-Derived Fractional Flow Reserve Predicts Need for Coronary Revascularisation Prior to Transcatheter Aortic Valve Implantation

Kai Dick David LEUNG ; Pan Pan NG ; Boris Chun Kei CHOW ; Keith Wan Hang CHIU ; Neeraj Ramesh MAHBOOBANI ; Yuet-Wong CHENG ; Eric Chi Yuen WONG ; Alan Ka Chun CHAN ; Augus Shing Fung CHUI ; Michael Kang-Yin LEE ; Jonan Chun Yin LEE

Cardiovascular Imaging Asia.2025;9(1):2-8. doi:10.22468/cvia.2024.00129

Objective: Patients with severe symptomatic aortic stenosis are assessed for coronary artery disease (CAD) prior to transcatheter aortic valve implantation (TAVI) with treatment implications. Invasive coronary angiography (ICA) is the recommended modality but is associated with peri-procedural complications. Integrating machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) into existing TAVI-planning CT protocol may aid exclusion of significant CAD and thus avoiding ICA in selected patients. Materials and Methods: A single-center, retrospective study was conducted, 41 TAVI candidates with both TAVI-planning CT and ICA performed were analyzed. CT datasets were evaluated by a ML-based CT-FFR software. Beta-blocker and nitroglycerin were not administered in these patients. The primary outcome was to identify significant CAD. The diagnostic performance of CT-FFR was compared against ICA. Results: On per-patient level, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 89%, 94%, 80%, 97% and 93%, respectively. On per-vessel level, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 75%, 94%, 67%, 96% and 92%, respectively. The area under the receiver operative characteristics curve per individual coronary vessels yielded overall 0.90 (95% confidence interval 85%–95%). ICA may be avoided in up to 80% of patients if CT-FFR results were negative. Conclusion ML-based CT-FFR can provide accurate screening capabilities for significant CAD thus avoiding ICA. Its integration to existing TAVI-planning CT is feasible with the potential of improving the safety and efficiency of pre-TAVI CAD assessment.

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