A persistent left superior vena cava (PLSVC) is seen rare but it is the most common thoracic venous anomaly .We report a 30-year-old male presented by repeated attacks of exertional chest pain over the past 2 months that were precipitated by moderate exertion and last for few minutes and relieved by rest. Echocardiography showed an evidence of subaortic flow turbulence with a visible subaortic membrane and mild aortic regurgitation . The Aortic valve was trileaflet with normal leaflets thickness and excursion . Contrast echocardiography using agitated saline injection in the left antecubital vein showed an opacification of the coronary sinus before the right ventricular outflow tract. Non-invasive transthoracic echocardiography study by agitated saline contrast can be easily performed to confirm the related venous anomaly. Computed tomography (CT) of the chest with contrast confirmed the persistence of both right and left SVCs and then, The patient was reassured with symptomatic therapy and he was requested a regular follow up in outpatient clinic. Thus, most adult patients with PLSVC and subaortic membrane should be reassured by symptomatic management.

A 60-year-old female was referred to our clinic for evaluation of her rapidly progressive dyspnea, she had no previuos history of heart disease. A murmur was noted on her examination and transthoracic echocardiography was so difficult to be performed due to poor acoustic windows so she was referred to do a transesophageal echocardiography that showed an ostium primum atrial septal defect (ASD) with left to right shunt and a quadrileaflet mitral valve with severe regurgitation. Later on, she underwent surgery with Ostium Primum ASD closure by a patch and double cleft repair by suture after right heart catheterization.

Atrioventricular septal defects (AVSD) entails a wide range of morphological anomalies including the interatrial and interventricular communications and the atrioventricular (AV) valve(s). However, “En face ”visualization of these anomalies could not be done using standard two-dimensional echocardiography. Therefore, we report a case that highlights the role of three-dimensional echocardiography in imaging AVSDs.

Ortner's syndrome is a really rare complication that manifest by hoarseness of voice. It is usually due to left recurrent laryngeal nerve compression. Cardiac causes of Ortner's syndrome are rarely encountered and it is usually due to left atrial enlargement as a complication of valvular lesions affecting mitral valve but other rare causes include ascending aortic aneurysm or pulmonary artery aneurysm. Hereby, we present the 3rd case in the literature to report Ortner's syndrome due to pulmonary artery aneurysm in a 38-year old female patient with previous history of bilharziasis.

Timely use of Sacubitril/Valsartan has the potential to significantly improve cardiac function and dramatically reduce secondary mitral regurgitation (MR) severity even in patients presenting with acute decompensated heart failure (HF), not only in compensated chronic HF patients. The outstanding impact of echocardiography is obvious in monitoring improvement of cardiac function and MR severity in patients with heart failure with reduced ejection fraction (HFrEF). We report a relevant case of an elderly patient who presented with acute decompensated HF with severe bi-ventricular dysfunction and severe MR. He was previously on optimal medical therapy (OMT), however still symptomatic. Coronary angiogram (CAG) depicted three vessel coronary artery disease (CAD). Patient advised to undergo coronary artery bypass graft surgery (CABG) with mitral valve repair, then followed by implantation of a cardiac resynchronization therapy defibrillator device (CRT-D) if no LV function improvement observed after revascularization. Patient’s ECG showed a QRSd ≥ 125 ms, hence a good candidate for CRT. Two weeks after starting Sacubitril/Valsartan the LV EF improved from 15% to 40%. Severe MR reduced to grade II and there was dramatic improvement of patient’s symptoms from NYHA class IV to NYHA class I. NT-proBNP reduced from 9,000 pg/ml to 800 pg/ml. Following an elective percutaneous coronary intervention (PCI), LV EF further improved to 50%. The patient was symptoms-free with preserved LV EF on follow up for 18 months later. This case report documents the swift echocardiographic and symptom improvement in an elderly patient with decompensated end-stage HF when Sacubitril/Valsartan started during the acute setting

Tetralogy of Fallot (TOF) is the most common etiology of congenital cyanotic heart disease, and Blalock-Taussig shunt (BTS) operation is considered the first-step management to maintain pulmonary blood flow in TOF patients. Complete repair of TOF is the standard surgical treatment that should be performed in infancy or early childhood for improved long-term survival. However, the prognosis of TOF patients treated by only palliative operation remains uncertain. We report a man with TOF underwent classic BTS operation at 2 years of age. Despite no medication, he had a long asymptomatic life. At 53 years of age, he started to complain of dizziness and recurrent attacks of syncope due to complete heart block (CHB) and inserted a permanent pacemaker. 2D and 3D Echocardiography showed uncorrected TOF with an overriding aorta, two ventricular septal defects (VSDs) were seen; a large inlet type VSD and another small muscular one with marked right ventricular hypertrophy with marked infundibular stenosis. Cardiac Computed Tomography (Cardiac CT) showed TOF with noted severely stenotic right ventricular outflow tract and pulmonary flow was maintained through a patent classical BTS between left subclavian artery (SCA) and the left pulmonary artery (LPA). Due to his stable condition, he was discharged on close up follow-up visits.