A foreign body such as a needle in the heart can be life-threatening. While such occurrences may be accidental, there are reports of cases involving domestic violence or psychiatric patients. Once a needle enters the body, it can migrate through the thorax towards the heart. The clinical outcome varies from an asymptomatic situation to tamponade or shock, depending on how severely the cardiac structures are affected. Here, we report the case of a 34-year-old male with an 8-cmlong needle-like object lodged in his left ventricle.

Primary undifferentiated cardiac sarcomas are rare. We reported herein a case of 56-year-old male farmer with a primary pericardial undifferentiated sarcoma, which invaded the right atrium and superior vena cava.

A 62-year-old woman with mitral regurgitation (MR) underwent cardiac magnetic resonance (CMR) and dobutamine stress CMR imaging, a widely used method to analyze left ventricular function and MR volumes. During dobutamine provocation at escalating doses, the left ventricular end-diastolic diameter (LVEDD) decreased, with a corresponding decrease in MR. At peak dobutamine dose, the LVEDD further decreased, with near complete relief of MR. Upon cessation of dobutamine provocation, the MR returned to predobutamine level. This case thereby demonstrates that MR may be reversible under certain conditions.

A 73-year-old woman presented in right heart failure. Computed tomography of the chest revealed a 3 x 5 cm anterior mediastinal mass. Contrast-enhanced 2D transthoracic echocardiography, cardiac magnetic resonance imaging (MRI), positron emission tomography (PET) and MRI-PET fusion demonstrated invasion of the pericardium and right heart by the tumor. Mediastinal biopsy revealed high-grade diffuse large B-cell lymphoma, which responded to chemotherapy. The role of each modality in this case was discussed in the manuscript. In conclusion, the integration of multiple imaging modalities is extremely useful in the characterization, localization, diagnosis and treatment of an unusual cardiac mass.

Isolated left ventricular apical hypoplasia was fi rst recognized in 2004, and since then, only a few cases have been identifi ed. We report this case of a 21-year-old Filipino female presenting with unstable tachyarrhythmia and heart failure, with characteristic features of isolated left ventricular apical hypoplasia on echocardiography and cardiac magnetic resonance imaging. To our knowledge, this is the fi rst reported adult case in Asia.

Double-chambered right ventricle (DCRV) is a rare form of right ventricular outfl ow tract (RVOT) obstruction consisting of a muscle bundle that divides the right ventricle into a sinus (inlet) and infundibulum (outlet). The hemodynamic obstruction of the RVOT is usually an acquired phenomenon, however the substrate for the anomalous muscle bundle is likely congenital. Most cases are diagnosed in early childhood, and few cases are discovered in adulthood. This poses a unique diagnostic challenge for physicians, as it is commonly mistaken for other common acquired disease states. We describe the course of a young adult with DCRV during pregnancy.

Presence of hepatic portal venous gas is secondary to bowel necrosis, mechanical distension, or intraabdominal sepsis. Gastrointestinal involvement in Kawasaki disease is uncommon and secondary to possible mesenteric small vessel vasculitis, bowel ischemia, and associated myenteric plexus dysfunction. We describe a case of Kawasaki disease presenting with abdominal pain and intussusceptions with demonstrable “aquarium sign” on echocardiography. This manifested as continuous passage of bubble-like echoes, 1–2 mm in diameter, fl owing from the portal vein, intrahepatic portal radicles, and inferior vena cava, toward the right1–2sided cardiac chambers, akin to passage of bubbles in an aquarium.

A unicuspid aortic valve (UAV) is a rare congenital defect that may manifest clinically as severe aortic stenosis or regurgitation in the third to fi fth decade of life. This report describes two cases of UAV stenosis in adult patients diagnosed by transesophageal echocardiography (TEE). The utility of three-dimensional TEE in confi rming valve morphology and its relevance to transcatheter valve replacement are discussed.

A 21-year-old female presented with right1-2sided hemiparesis and headache of fi ve months duration. Computed tomography and magnetic resonance imaging of the brain were suggestive of a lobulated cystic mass in the left parietal paraventricular region. Two-dimensional and live three-dimensional transthoracic echocardiogram followed later by chest computed tomography performed as a part of preoperative workup showed a left ventricular apical hydatid cyst. The patient underwent transmitral total pericystectomy followed by complete excision of the cyst in the brain. Histopathological examination of the surgical specimens confi rmed that they were hydatid cysts.