A thrombosed LV aneurysm simulating an Intra-myocardial dissection hematoma (IDH) is a rarely reported condition. We describe a rare case of a 52-year-old man suffering from a thrombosed LV aneurysm, who was initially diagnosed as an IDH by conventional echocardiography. Finally, the patient was diagnosed with thrombosed LV aneurysm through multimodal imaging. We discuss the diagnostic process and surgery of the thrombosed LV aneurysm.

Background: Atrial cardiopathy is a proposed mechanism of embolic stroke of undetermined source (ESUS). Left atrial (LA) strain may identify early atrial cardiopathy prior to structural changes. We aim to study the associations between LA strain, ESUS, and atrial fibrillation (AF) detection in ESUS. Methods: The study population included patients with ESUS and non-cardioembolic (NCE) stroke presenting to statewide stroke center between January 2016 and June 2017 who underwent transthoracic echocardiography. Speckle tracking echocardiography (STE) was used to measure the 3 phases of LA strain (reservoir, conduit, and contractile). Binary logistic regression analysis was performed to determine the associations between LA strain and stroke subtype (ESUS vs. NCE) as well as follow-up detection of AF in ESUS patients. Results: We identified 656 patients, 307 with ESUS and 349 with NCE. In binary logistic regression, the lowest tertiles of LA reservoir (adjusted OR 1.944, 95% CI 1.266-2.986, p = 0.002), contractile (aOR 1.568, 95% CI 1.035-2.374, p = 0.034), and conduit strain (aOR 2.288, 95% CI 1.448-3.613, p = 0.001) were more likely to be significantly associated with ESUS compared to NCE stroke. Among all ESUS patients, the lowest tertiles of LA reservoir strain (OR 2.534, 95% CI 1.029-6.236, p = 0.043), contractile strain (OR 2.828, 95% CI 1.158-6.903, p = 0.022), and conduit strain (OR 2.614, 95% CI 1.003-6.815, p = 0.049) were significantly associated with subsequent detection of AF. Conclusion: Reduced LA strain is associated with ESUS occurrence and AF detection in ESUS patients. Therefore, quantification of LA strain in ESUS patients may improve risk stratification and guide secondary prevention strategies.

A giant ascending aortic aneurysm associated with a ruptured sinus of Valsalva is rare. A 53-year-old male patient successfully underwent Bentall procedure after multimodality imaging which enable the correct diagnosis to be established and intraoperative transesophageal echocardiography provides additional information on the surgical planning.

We report a rare case of right ventricular angioleiomyoma in a 35-years old man diagnosed by multimodality imaging, including echocardiography, cardiac magnetic resonance imaging (CMR), Positron emissions tomography (PET) and Computer tomography angiography (CTA). The imaging results were finally confirmed by surgery. We present the clinical value of multimodality imaging in diagnosing cardiac angioleiomyoma.

We report a rare case of multiple giant coronary artery aneurysms combined with anomalous aortic origin of left coronary artery in a 30-years old man precisely diagnosed by multimodality imaging, including echocardiography, coronary computed tomographic angiography (CCTA), cardiac magnetic resonance imaging (CMR) and selective coronary angiography. The imaging results were finally confirmed by surgery. We present the clinical value of multimodality imaging in diagnosing coronary artery aneurysm and anomalous origin.

Objective: This study was conducted to evaluate pre- and intraoperative risk factors for 30-day mortality in patients with acute type A aortic dissection (ATAAD). Methods: Three hundred thirteen patients with ATAAD who underwent emergency surgery (264 men and 49 women; mean age, 48±10 years) were enrolled in our study. Preoperative and operative risk factors for death were presented. Multivariable analysis was performed to identify the influence of varying factors on 30-day mortality. Results: Overall, 32 patients (10.2%) died within 30 days. Compared with the surviving group, the deceased patients were more likely to have tachycardia, elevated serum potassium levels, moderate to severe pericardial effusion, suprasternal branch involvement, myocardial ischemia, and lower-extremity ischemia. Regarding factors related to surgery, the duration of surgery and cardiopulmonary bypass and concomitant procedures of coronary artery bypass graft（CABG） were greater in patients who died. In multivariate analysis, independent risk factors were longer duration of surgery (odds ratio [OR]: 4.5, p=0.001) and cardiopulmonary bypass (OR: 5.3, p=0.001), moderate to severe pericardial effusion (OR: 3.3, p=0.017), suprasternal branch involvement (OR: 4.9，p=0.002), and lower-extremity ischemia (OR: 7.6, p＜0.001). Conclusions: Lower-extremity ischemia and suprasternal branch involvement have the poorest outcomes. Moderate to severe pericardial effusion could influence the outcome. Shorter duration of surgery is associated with better outcomes. Key Words: acute type A aortic dissection, surgery, mortality, risk factors