Ventriculosternal Shunt for the Treatment of Idiopathic Normal Pressure Hydrocephalus: A Case Report

Background: Conventional corticospinal fluid (CSF) diversion surgery for idiopathic normal pressure hydrocephalus (iNPH) includes ventriculoperitoneal shunt and ventriculoatrial shunt. Ventriculosternal (VS) shunt may be considered if both the abdominal cavity and atrium are not feasible.Methods: A 76-year-old woman was admitted to our hospital with gait disturbance and urinary incontinence for 2 years, and the condition aggravated in the last 1 month. Based on clinical assessment and imaging findings, the patient was diagnosed with iNPH, with surgical indications. She was on peritoneal dialysis for chronic renal failure, and a cardiac Doppler echocardiogram showed enlargement of the left atrium and decreased diastolic function of the left ventricle. Due to these conditions, we chose the sternum as the vessel for CSF absorption and performed VS shunt.Results: No swelling, exudation, and effusion were found in the suprasternal fossa. Gait disturbance and urinary incontinence improved significantly immediately and 1 week after surgery, respectively. No shunt-related complication was reported at 16 months follow-up.Conclusion: This case demonstrated VS shunting as a feasible and alternative for the management of hydrocephalus.

Kawasaki disease: About a case in Senegal

Kawasaki disease is an acute multisystemic vasculitis. We report the case of a 10-month-old boy received for a fever of 38.7° Celsius persisting on usual antipyretics for 10 days and bilateral conjunctivitis. The patient had bilateral serous rhinorrhea, polymorphic rash with diffuse perineal erythema, bilateral angular cheilitis, erythematous throat, plus perioral, periorbital and trunk desquamative lesions. There was microcytic hypochromic anemia at 9.5g/dL, thrombocytosis at 760x103/mm3, hyperleukocytosis at 28.27x103/mm3, positive C-reactive protein at 58 mg/L and an elevated sedimentation rate at 88 mm at the second hour. Aspartate amino transferase acid (AST) was elevated to 30 IU/L and alanine amino transferase acid (ALT) to 45 IU/L. Gamma glutamate transferase (γ-GT) was elevated at 488mg/dl. Cytobacteriological examination of the urine indicated aseptic pyuria. Cardiac Doppler ultrasonography showed low-grade pericarditis without coronary involvement. In the presence of prolonged fever > 5 days: bilateral conjunctivitis, oropharyngeal involvement, polymorphic rash, CRP >30mg/dL, VS >40mm/h, thrombocytosis, elevated transaminases and gamma GT, aseptic pyuria and pericarditis, we retained the diagnosis of Kawasaki disease in its incomplete form. The patient had been treated with acetylsalicylic acid 50mg/kg/24h. The evolution was favorable with stable apyrexia, regression of mucocutaneous lesions and normalization of cardiac ultrasound.

419 Revisiting cardiac Doppler index with single heart beat 4D ultrafast echocardiography

Funding Acknowledgements European Research Council under the European Union’s Seventh Framework Programme (FP/2007-2013) / ERC Grant Agreement n° 311025 and the ANR-10-IDEX-00 Background 4D echocardiography has the strong potential to improve cardiac index quantification by providing reproducible and user independent measurements. Quantification of left ventricle volume and ejection fraction, for instance, have been shown to be more reliable using 4D echocardiography. However, Doppler index evaluation has not yet benefited from it, due to limited volume rates and single location estimation when assessing spectral Doppler. Purpose In this study, we propose to demonstrate the feasibility of performing semi-automatic evaluation of cardiac Doppler indices within a single heartbeat on three human hearts by performing 4D ultrafast echocardiography, a new technique allowing a drastic volume rate increase. Methods A 4D ultrafast echocardiography scanner prototype connected to a matrix probe was developed to image the human heart. The probe was positioned on the apical 4-chamber view of N = 3 volunteers. High volume rate (5200 volume/s) acquisitions were performed three times by two different trained cardiologists. 4D color flow and tissue Doppler imaging were computed from the each single heartbeat acquisition. Spectral Doppler were derived at each voxel of the volumes. Region of interest such as LV outflow tract, mitral inflow or basal inferoseptal locations were automatically detected. Doppler index were derived from Doppler spectra and tissue velocity curves at these locations, and were compared against indices obtained using a clinical procedure based on 2D echocardiography. Results For each acquisition and the three volunteers, major Doppler indices: E, A, E/A, S, e’, a’, e’/a’, s’, E/e’, cardiac output were successfully assessed during a single heartbeat. A high degree of similarity between the indices assessed by 4D ultrafast echocardiography and clinical 2D measurements were found.(p > 0.05 for each index). Conclusions 4D ultrafast echocardiography can quantify the major cardiac Doppler indices in a single heart beat acquisition. It promises to improve patient care by accelerating examination time and to improve results reproducibility by removing most of the operator dependency. It also offers a unique feature by enabling E/e’ index assessment in the same heart beat which could be of a great interest for atrial fibrillation patients. Abstract 419 Figure.

Cardiac Doppler in patients with primary varicose veins of lower extremities

Aim This study examines the characteristics of cardiac Doppler in patients with primary varicose veins of lower extremities. Material and methods We performed retrospective descriptive statistical analysis of cardiac Doppler data of 85 patients with primary varicose veins and compared obtained parameters with normal values. Results Patients with primary varicose veins in comparison with normal controls have significantly lower early diastolic mitral and tricuspid inflow velocities (E wave), significantly higher late diastolic mitral and tricuspid inflow and annular velocities (A and a′ waves), significantly higher systolic mitral and tricuspid annular velocities (s′ wave), and they have normal early diastolic mitral and tricuspid annular velocities (e′ wave). Conclusion Cardiac Doppler in patients with primary varicose veins differs significantly from the actual normal values. Possible mechanism of this finding is compensatory increased atrial ejection fraction due to altered preload in patients with primary varicose veins.