Cardiac involvement is a well-known complication of systemic lupus erythematosus (SLE), which can involve most cardiac components, including pericardium, conduction system, myocardium, heart valves, and coronary arteries. Libman-Sacks (verrucous) endocarditis is the characteristic cardiac valvular manifestation. Although isolated tricuspid valve involvement is quite rare, we report a patient with SLE who had tricuspid stenosis caused by Libman-Sacks endocarditis. The patient underwent successful commisurotomy and Kay annuloplasty on the tricuspid valve under cardiopulmonary bypass.

We report 3 emblematic cases which show how three-dimensional echocardiography (3DE) can provide unique information useful to address management of structural complications in patients with acute myocardial infarction: (1) detailed assessment of size, location, and morphology of an apical ventricular septal defect (VSD) obtained with transthoracic 3DE was pivotal in referring a patient to percutaneous closure; (2) size and location of a complex inferior VSD with irregular margins advised against percutaneous closure; and (3) Transesophageal 3DE assisted surgeons to choose between reparative or replacement surgery for an acute mitral regurgitation due to complete papillary muscle rupture.

Cardiac myxoma arising from right ventricular outflow tract (RVOT) is extremely rare, but could cause major clinical sequelae and pose considerable diagnostic and therapeutic challenges. Here, we report the intraoperative application of real time three-dimensional transesophageal echocardiography (RT3DTEE) in the assessment of a patient with a RVOT myxoma. RT3DTEE clearly assess the characteristics of the mass, such as the size, shape, attachment points, and composition. With the intraoperative guidance of RT3DTEE, the patient underwent successful removal of the mass.

We report a very rare case of the concomitant occurrence of double-outlet right ventricle, an anomalous muscle bundle in the right ventricular outflow tract, and an accessory tricuspid valve leaflet in a 17-year-old male patient. The patient eventually died from severe decompensated heart failure.

Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that can be congenital or acquired. We report 2 cases of SVA: a large right SVA obstructing the right ventricular outflow tract (RVOT) in a patient presenting with syncope, and a ruptured right SVA into the right atrium in a patient presenting with acute onset chest pain.

Speckle tracking echocardiography–derived myocardial strain has useful clinical applications in adults with pulmonary hypertension (PH) as well as preterm infants with chronic lung disease. It is considered more sensitive compared to conventional indices. This report presents a 3-month-old infant with PH and poor right ventricular function who was treated with pulmonary vasodilator therapy. Impaired myocardial strain improved after inhaled nitric therapy. Strain analysis can help improve understanding of cardiac adaptation in critical clinical situations.

An 84-year-old man with dyspnea was found to have severe mitral regurgitation on echocardiography. Interestingly, the mitral valve opened prior to aortic valve closure with both valves briefly open together; hence the isovolumic relaxation phase is absent.

Right atrial appendage aneurysm (RAAA) is a rare malformation of the heart. Here, we present a case of RAAA in an elderly man, who has remained asymptomatic for over 10 months of follow-up. The aneurysm was initially discovered by echocardiography, and confirmed by further investigations using cardiac magnetic resonance (CMR) imaging and 320-row detector computed tomography (320R-CT).

Various pathological changes in the mitral valve apparatus have been reported to be associated with ruptured chordae tendineae. Myxomatous degeneration is one of the most common etiologies. The incidence of posterior chordal rupture is higher than that of anterior mitral leaflet. However, spontaneous rupture of both anterior and posterior chordae is very rare. Herein, we present a patient with severe mitral regurgitation due to bileaflet chordal rupture, evaluated by two-dimensional and real time three-dimensional transesophageal echocardiography.

Percutaneous transluminal septal myocardial ablation (PTSMA) is an accepted strategy to reduce dynamic left ventricular outflow tract (LVOT) obstruction in HOCM. Periinterventional intramyocardial 2D contrast echocardiography (2D-CE) is the primary imaging technique to identify the interventional target region. The role of intramyocardial 3D-CE in a PTSMA procedure has not been described yet. Real time 3D technique will be able to present an “instantaneous overlook” of the target myocardium in 4 dimensions (3D + time), which may increase speed and safety of the procedure. We present a case with HOCM undergoing PTSMA under additional 3D-CE control of the target area.