<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
The following case presentation highlights the diagnostic and therapeutic approach to a patient with a rare disease.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
A 47-year-old man was hospitalized with chest pain, shortness of breath, and fatigue. Initial blood test analysis revealed elevated CRP, leukocytosis, and elevated cTn-I. Due to suspected myocarditis, cardiac magnetic resonance (CMR) imaging was performed. CMR ruled out myocarditis. In addition, there were no signs of edema or late gadolinium enhancement (LGE). However, there was evidence of enlarged right ventricular heart chambers. Cine short-axis images and LGE sequences revealed masses in the pulmonary artery, highly suspicious of thrombi. D-dimer was analyzed, showing very high values, and additionally, CTPA confirmed the diagnosis of pulmonary embolism (PE). Venous Doppler ultrasonography demonstrated DVT in the right popliteal vein. Anticoagulation with LMWH was initiated, after which a drug from the NOAC class - Rivaroxaban was given according to a PE protocol. The patient was discharged from the hospital in a hemodynamically stable condition with a recommendation to adhere to the therapy and conduct control after 1 and 3 months of hospitalization.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Thanks to multimodality imaging, we find it easier to get the specific cause of the problem, by establishing it or by ruling it out. However, the most important thing is to have a high clinical suspicion and common sense for faster diagnosis, treatment, and early recovery of the patient.
</sec>
</abstract>

Pulmonary Thromboembolism in a Patient Suspected for Myocarditis - Case Report

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Left atrial (LA) myxoma’s clinical manifestation depends on the size, location, mobility, and architecture of the tumor. The clinical presentation consists of cardiac (67%), embolic (29%), and systemic (34%) symptoms, even sudden cardiac death.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
We present an interesting case and images of a patient with severe mitral valve dysfunction and syncope, who was diagnosed with a giant mass in the left atrium and left ventricle as myxomas. Open heart surgery was performed and the mass was detected and successfully removed. The histopathology confirmed the diagnosis of myxoma of the left atrium.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Myxoma may be challenging to diagnose, but with imaging techniques, such as transthoracic (TTE), transesophageal (TEE) echocardiograms, when a high index of clinical suspicion exists, early diagnosis and therefore curative intervention in the majority of the cases is more likely.
</sec>
</abstract>

Severe Mitral Valve Dysfunction: A Giant Left Atrial Myxoma Was the Guilty

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Patient with hemodialysis (HD) is prone to central venous stenosis (CVS). The presence of CVS contributed to poor dialysis adequacy. Symptomatic CVS is treated with percutaneous transluminal angioplasty (PTA) with or without a stent. This report aimed to understand the characteristics of PTA with or without a stent.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
A 43-year-old woman was admitted to the hospital with a chief complaint of a deteriorating swollen right arm with pain 1 week prior. Patient had been on HD since 2019, had AV shunt access, continuous ambulatory peritoneal dialysis (CAPD), and 4 times balloon angioplasty due to similar complaints. Diagnoses of the patient were AV shunt stenosis, chronic kidney disease Stage 5 on CAPD, heart failure Stage C FC II, hypertension on treatment, anemia related to renal disease, and severe hypoalbuminemia based on anamnesis and extensive examination. PTA with stent was conducted in this patient and showed TIMI Flow III.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
PTA is the primary treatment for symptomatic CVS. A stent implantation is used in cases that failed PTA treatment. PTA with a stent provides immediate symptom alleviation and benefits an angioplasty-resistant lesion by secondary patency.
</sec>
</abstract>

Management of Refractory Central Vein Stenosis in Hemodialysis Patient

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Heart surgery is used to treat serious heart diseases.
</sec>
<sec><title style='display:none'>METHODS</title>
This is a perspective article on heart surgeries, by reviewing the papers on Europe percutaneous mitral commissurotomy (PMC) concerning heart surgeries, as Europe PMC is a trusted academic engine. The author included all papers on the subject, but papers from the last 5 years are the favorite for references, without exclusion from review.
</sec>
<sec><title style='display:none'>RESULTS</title>
There are 192,265 case reports (28.5%), 143,267 clinical trials (21.2%), 303,690 reviews (45%), and 34,323 miscellaneous (5%).
</sec>
<sec><title style='display:none'>CONCLUSIONS</title>
Artificial intelligence is the future of advances in heart surgeries as they are highly distributed in the world.
</sec>
</abstract>

Artificial Intelligence Enhances Heart Surgeries

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Health problems with cardiovascular system disorders including congestive heart failure (CHF) still rank highly. CHF is one of the heart diseases that continue to increase in incidence and prevalence every year, including in Indonesia. Lack of health education about how home care is a factor increases the incidence of rehospitalization in CHF patients. Here, researchers have provided knowledge to patients about how things to avoid, foods to avoid, recommended foods, and diet to do.
</sec>
<sec><title style='display:none'>OBJECTIVE</title>
This study aimed to analyze effectiveness of health management education for CHF patients in Surabaya.
</sec>
<sec><title style='display:none'>METHODS</title>
The research method used is quantitative analytics with a pre-experimental design with an approach (one group pre-post-test design). The population in this study was all CHF patients admitted to hospitals in Surabaya as many as 150 respondents. Sampling using accidental sampling technique. Data were analyzed using and Wilcoxon test.
</sec>
<sec><title style='display:none'>RESULTS</title>
Wilcoxon test results obtained knowledge (p = 0.000), diet (p = 0.001), and physical activity (p = 0.001) which means there is an influence on providing health management education for CHF patients.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Health management education effectiveness for CHF patients in Surabaya. Health-care providers can add health education programs for patients with CHF or other diseases, as a form of nursing service implementation.
</sec>
</abstract>

Effectiveness of Health Management Education for Congestive Heart Failure Patients in Surabaya

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Acute myocardial infarction (MI) is a rare occurrence in patients under 40 years of age without positive family history for coronary artery disease (CAD). Genetic conditions as inherited thrombophilia can lead to a hypercoagulable state, resulting in thromboembolic events and arterial thrombosis.
</sec>
<sec><title style='display:none'>CASE SUMMARY</title>
We present a case of a 35-year-old male patient who presented to the emergency room with an inferior MI after a strenuous cycling exercise. An urgent coronary angiography showed thrombotic formations in the right coronary artery without atherosclerotic plaques. Plain old balloon angioplasty and thrombus aspiration were performed, which was followed by GP IIb/IIIa inhibitor infusion and unfractionated heparin for 24 h. From past medical history, the patient had COVID-19 like symptoms 20 days before the event and had his first dose of anti-COVID vaccine 2 weeks prior. After additional testing, molecular genetic analysis results revealed the patient to be heterozygous for factor V Leiden (FVL) and homozygous for methylenetetrahydrofolate reductase C677T gene mutation. The patient was discharged on direct oral anticoagulant and antiplatelet therapy. After 1-year follow-up, he had no symptoms or recurrent cardiovascular events.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Inherited thrombophilia is а significant risk factor for CAD and performing genetic testing in younger patients with a cardiovascular event and plays an important role for adequate treatment and prophylaxis from recurrent complications. The use of oral anticoagulation for prophylaxis is shown to be effective in these patients. However, further studies are needed to prove their exact role and duration of treatment.
</sec>
</abstract>

A Curious Case of Acute STEMI in a Young Patient; Things are Not Always What They Seem

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
With an overall incidence of congenital cardiac disease, tetralogy of fallot (ToF) is the most clinical of cyanotic heart disease. The anomalies seen in patients with ToF are due to an inappropriate anterior and cephalad displacement of the interventricular septum’s infundibular (outflow tract) component. Ventricular septal defect, right ventricular hypertrophy, overriding aorta, and pulmonary stenosis are the four defects that result from this condition. The physiology of healthy women will undergo several changes affecting body system, including the cardiovascular system. Pregnancy and delivery have a high risk for most ill women, including those with uncorrected ToF, due to extensive physiological adaption and alterations. For patients with ToF, it continues to be a significant contributor to maternal morbidity (62.5%), mortality (10%), and neonatal adverse outcomes.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
A 18-year-old female in her first pregnancy at 28 weeks was referred to Saiful Anwar Hospital with uncorrected ToF since she was 2 years old. She suggested repairing ToF at National Cardiovascular Center Harapan Kita Jakarta but her parents still refused. She married at 18 years old and she was pregnant unplanned before. Then, she was referred to RSSA for further management.
</sec>
<sec><title style='display:none'>CONCLUSSION</title>
Pregnancy has been related with higher risks of morbidity and mortality for women with congenital cardiac disease. ToF is the most prevalent cyanosis congenital heart disease. These are poorly tolerated and produce serious complications, including maternal and neonatal mortality. Prenatal counseling is crucial to identify risk factors for the patients and to reassure many patients who are at low risk.
</sec>
</abstract>

Successful Pregnancy with Uncorrected Tetralogy of Fallot: An Interdisciplinary Team Approach

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Aortic dissection refers to the disruption of the medial layer of the aorta caused by intramural hemorrhage. This leads to the separation of the layers of the aortic wall, resulting in the establishment of a true lumen and a false lumen, which may or may not be connected. The prevalence of aortic dissection ranges from 0.2% to 0.8%. Additionally, a notable percentage, surpassing 20%, of individuals exhibit a familial inclination towards thoracic aorta dissection.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
A male patient in his middle age, 41 years old, with risk factors of uncontrolled hypertension, obesity, and a familial propensity to aortic dissection, presented to the emergency department exhibiting symptoms of chest pain. It characterized the sensation as having a tearing quality and indicated that it extended towards the abdomen region. The results of the test revealed several notable findings. A blood pressure reading of 235/133, a wider mediastinum and cardiomegaly on the chest X-ray, a slight increase in Hs-Troponin levels, and an electrocardiogram showed sinus rhythm with left ventricular hypertrophy. He underwent a computed tomography scan, which revealed the existence of an aortic dissection that extended from the ascending to the descending aorta without any aortic valve involvement. He was assessed with a Stanford A. DeBakey I aortic dissection, and underwent successful therapy for aortic arch replacement with the elephant trunk procedure, and plans to undertake an endovascular procedure for the descending aorta in the upcoming period.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Aortic dissection is a pathological disorder that may exhibit hereditary inheritance, and the choice of surgical technique is dependent on the specific underlying disease.
</sec>
</abstract>

Inherited Stanford A DeBakey I Aortic Dissection: Unveiling Genetic Predispositions and Surgical Management

<abstract>
<title style='display:none'>Abstract</title>
Acute myocard infarct during pregnancy is a rare event with high mortality and women with cardiac comorbid such as hypercholesterolemia, hypertension, and history of myocardial infarction are one of risk that should be warning. However, the main etiology myocard infarct in pregnancy is spontaneous coronary artery dissection, especially in the third semester. Women with unusual chest pain, ST-elevation in electrocardiogram, and sudden cardiac arrest should treat as soon as possible. Patient with unstable condition revascularization is recommended. However, there are several things that should be monitor during revascularization such as consideration type of stent, how much contrast that will be use, and planning after stent implantation. Thrombolysis should be the last option because of bleeding risk. Therapy during and after pregnancy should be monitor continuously because of their side effect to mother and baby, and delivery in women with acute myocard infarct should be one of main concerns. With this review, we hope that we can raise our awareness in pregnant women with their comorbid and their future pregnancy.
</abstract>

Myocardial Infarction in Pregnancy: What Should We Do?

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Chronic venous disease, or chronic venous insufficiency (CVI), is a condition that occurs when the venous valves, particularly in the lower extremities, fail to function properly due to venous obstruction or reflux. CVI is often referred to as a chronic venous disease, with clinical symptoms frequently presenting as varicose veins and often remaining undiagnosed accurately. CVI can occur due to various causes, including congenital, primary, secondary, and idiopathic factors. Body mass index (BMI) is a calculation used to estimate the amount of fat in the body and categorize an individual’s degree of obesity. Obesity is one of the risk factors that can contribute to the development of CVI, as it can lead to increased volume and pressure in the venous blood vessels due to an elevated BMI.
</sec>
<sec><title style='display:none'>OBJECTIVE</title>
This study was conducted to investigate and understand the relationship between BMI and the severity of CVI in patients at Siloam Lippo Village Hospital Building B.
</sec>
<sec><title style='display:none'>METHODOLOGY</title>
This research employed a cross-sectional study design utilizing unpaired categorical comparative analytic study types. The sample was selected using consecutive sampling, with a target sample size of 115 individuals who were patients with CVI at Siloam Lippo Village Hospital Building B. Data were collected through patient interviews during Duplex ultrasound (USG Duplexs) examinations. Subsequently, the data were analyzed using the Chi-square analysis method.
</sec>
<sec><title style='display:none'>RESULTS</title>
The study revealed a significant association between BMI and the severity of CVI (p &lt; 0.001, odds ratio: 6.556, 95% confidence interval: 2.681–16,028).
</sec>
<sec><title style='display:none'>CONCLUSION</title>
The research findings indicate a significant relationship between BMI and the severity of CVI in patients at Siloam Lippo Village Hospital Building B.
</sec>
</abstract>

The Relationship between Body Mass Index and Severity of Chronic Venous Insufficiency in Patients at Siloam Hospitals Lippo Village Building B

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Myocardial infarction is the leading cause of the occlusion of the coronary artery. Meanwhile, right ventricular myocardial infarction (RVMI) is usually associated with inferior left ventricular infarction in 10–50% of cases. We presented isolated RV infarcts which are rare cases that happen in only 3% of total myocardial infarction.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
We presented a case of a 67-year-old man with sudden chest pain, shortness of breath, and a history of diabetes mellitus. From his 12 lead electrocardiogram, there is no specific ST elevation yet elevation in V3R and V4R and elevated troponin I highly sensitive value. The patient developed junctional bradycardia and early percutaneous coronary intervention backup temporary pacemaker showed total occlusion in the proximal right coronary artery (RCA)
</sec>
<sec><title style='display:none'>CONCLUSION</title>
The RVMI commonly occurs in the dominant RCA that also supplies the sinoatrial node and atrioventricular node. Therefore, due to its location that passed through the RCA, bradycardia to complete heart block may happen. Isolated right ventricular (RV) infarction may happen because either RV marginal as the predominant location is occluded, or non-dominant RCA occluded by thrombus. RV infarction may impair RV contractility causing a decrease in RV stroke volume and this condition leads to hypotension, shock, and severe hemodynamic derangement. Meanwhile, acute proximal RCA occlusions do not result in significant RV necrosis, one of the reasons is collateral flow from the left coronary system further protects from RV dysfunctions in our patient.
</sec>
</abstract>

Isolated Right Ventricular Infarction without Right Ventricular Dysfunction: A Case Report

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Lipomatous hypertrophy of the interatrial septum is a rare benign cardiac condition characterized by fatty tissue infiltration of the septum.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
We presented some interesting images and some possible pitfalls during the cannulation in this circumstance.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Surgical therapy appears to be reserved to patients with SVC obstruction or any rhythm disturbances.
</sec>
</abstract>

Interatrial Septum Hypertrophy: A Pitfall in Bicaval Cannulation

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Clinical echocardiography often reveals mitral annular calcification (MAC), and this condition has been connected to atherosclerosis and cardiovascular risk factors. To this day, our knowledge of the left ventricle’s (LV) physiology is still somewhat restricted. Using 2D speckle tracking echocardiography, we analyzed the connection between MAC and LV mechanical functions (2DSTE).
</sec>
<sec><title style='display:none'>AIM</title>
The purpose of the current investigation is to assess how left ventricular mechanics are impacted by MAC.
</sec>
<sec><title style='display:none'>MATERIALS AND METHODS</title>
Between April 2020 and October 2021, this prospective and cross-sectional study was carried out in Islamic Center of Cardiology Al Azhar University and Cardiology Department of Al Hussien University Hospital. Eighty participants were utilized in the study. When necessary, patients were referred to the Cardiology Clinics at the Medical Schools of Al Azhar University for follow-up care. Sixty MAC patients were studied with 20 healthy controls of similar age and gender. All patients had a 2D echocardiogram. Sixty consecutive patients with a MAC diagnosis and 20 age-and sex-matched controls with normal cardiac evaluations made up the study population. The patients were all given a 2D echocardiogram.
</sec>
<sec><title style='display:none'>RESULTS</title>
The longitudinal strain significantly decreased as the MAC severity rose. The LV’s rotating mechanics varied greatly among MAC organizations. The E/A ratio, the global longitudinal speed (GLS), and the systolic tissue velocity were all shown to have a negative correlation with MAC thickness. Additional variables were found to have statistically significant connections. There were significant correlations between MAC severity and age, LV mass index, and t-LV UR. Age, LV mass index, and linear speed were significantly related to MAC severity.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
The LV ability to contract systolically and diastolically is compromised when MAC is both present and severe. The LV ability to contract systolically and diastolically is likewise impacted by an increase in MAC severity.
</sec>
</abstract>

Speckle Tracking Analysis of Mitral Annular Calcification and Left Ventricular Mechanics

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South East European Journal of Cardiology

The Journal of Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia

 The South East European Journal of Cardiology (SEEJCA) is an open-access, peer-reviewed journal, founded in 2015 and is restarting its’ publication process this year. SEEJCA is...

 The South East European Journal of Cardiology (SEEJCA) is an open-access, peer-reviewed journal, founded in 2015 and is restarting its’...

South East European Journal of Cardiology

The Journal of Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia

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