Introduction: In this study, two cases that demonstrate the importance of bedside echocardiography and hands-off telemedicine technology for diagnosis and intervention in patients with coronavirus disease 2019 (COVID-19) are discussed. Case Presentation: We report two cases of cardiac emergency associated with COVID-19. Case 1 is a 50-year-old female patient with chronic hypertension and chronic renal failure. Case 2 is a 64-year-old female with atrial fibrillation and recent stroke. Both were admitted to an isolation intensive care unit that was designated specifically to patients with COVID-19. Conclusions: During admission, both patients had sudden deterioration characterized by oxygen desaturation and hypotension necessitating inotropic support. As a result, for both patients, bedside echocardiography was performed by the attending intensivist. Echocardiographic findings showed cardiac tamponade and acute pulmonary embolism, respectively, which were confirmed by a cardiologist through telemedicine technology. Proper emergency management was initiated, and both patients recovered well. Limited bedside transthoracic echocardiography had a front-line impact on the treatment and outcome of the two patients with COVID-19. By implementing telemedicine technology, the lives of two patients were saved, demonstrating the significance of telemedicine in isolation intensive care units in the developing countries during the COVID-19 pandemic.

Background: Transcatheter closure of patent ductus arteriosus (PDA) has gained acceptance over the last two decades, replacing the surgery in more than 90% of the cases, so the safety and efficacy of transcather closure of PDA have been evaluated by studying different experiences from different centers in developing countries. The aim is to report our experience with PDA transcather closure, with focus on the adverse events and complications faced during the procedure.Results: Outcome data on PDA transcatheter closure were collected from two different tertiary centers in a multicenter registry. During the period from June 2017 till January 2021, 308 PDA closure were recorded, using device in 197 (64%) and coils in 111 (36%) patients, most of the patients were in pediatric age group from 6 months to 6 years and only 10 patients (3.2%) were adults. Most patients had isolated PDA of 92%, and 9 (2.9%) patients had residual PDAs either post-surgical or transcatheter closure. Median minimum PDA diameter was 2.8 mm (range 1–7.6 mm; IQR 1.8–3.8 mm). The procedure was successful in 293 patients (95%). Complications occurred in 15/308 patients (5%), and only 6 (2%) of them were major complications, but none was life threating. Frequent complications were device embolization (2%), hemolysis (1%), arrhythmia (1%). Younger age, low body weight and longer procedure time were associated with a high complication rate (p < 0.005). Device-related complications were more common than coil-related complications (2.5% versus 0.5%).Conclusions: Although transcatheter closure of PDA is considered to be effective procedure with low complications rate, however, complications should be anticipated and managed properly.

Background: Accurate measurements of left ventricular (LV) volumes and function are important in the management of patients with various cardiac abnormalities. Two-dimensional (2D) speckle tracking echocardiography (STE) is shown to be accurate in detecting subclinical myocardial dysfunction when most of the conventional echocardiography parameters were normal. Three-dimensional (3D) echocardiography is a new noninvasive imaging technique that has been shown to be accurate in determining cardiac volume and performance. Establishment of normal range values of 3D STE over a different range of ages is crucial before applying this recent technology in clinical applications. This study aimed to assess feasibility of 3D LV STE and establish normal values for the LV systolic function among healthy Egyptian preschool-age pediatric population using 2D and 3D STE. Results: A total of 200 subjects (95%) met the criteria for 2DSTE analysis, 10 were excluded from the 2D analysis and 180 subjects (85%) met the criteria for 3D STE analysis. Regarding the 2D STE GLS, the mean was -22.1345 ± 2.166%, GCS was f -19.02 ± 1.23%, and GRS was 42.25 ± 2.35%. There was a strongly positive significant correlation between age and 2D values of GLS (P = 0.001). The GCS showed a weakly positive nonsignificant correlation with age (P = 0.28), while GRS showed a strongly negative significant correlation with age (P = 0.001). Regarding the 3D STE data, GLS mean was -20.48 ± 1.526%, GCS mean was -13.90 ± 2.05%, while GRS mean was 47.21 ± 2.382%. 3D GLS values had a strongly positive significant correlation with age (P = 0.001). While GCS showed a weakly positive nonsignificant correlation (P = 0.955), GRS showed a strongly negative significant correlation (P = 0.001). Linear correlation analysis of 2D and 3D values of strain showed that GLS had a strongly positive significant correlation (P = 0.001), while GCS showed a weakly positive nonsignificant correlation (P = 0.161) and GRS showed a strongly positive significant correlation (P = 0.001). Conclusions 3D global strain analysis using the 3D STE is feasible in the preschool-age pediatric population. Results were almost concordant with previous observations in most of the values except for GCS, especially 3D values which could be attributed to different vendor system used and different ethnicity. Further studies are required to reinforce these data using the GE vendor machine.

Right pulmonary artery (RPA) to left atrium fistula (LA) is an extremely rare congenital malformation with less than 100 cases of PA-to-LA fistula reported. It causes central cyanosis and may present with heart failure. This is the first case to be closed under 2D and 3D TEE guidance inside cath lab. We present a case of a 12-year-old student who complained of exertional dyspnea and easy fatigability over the past few months. His mother reported mild cyanosis since birth which increased with exertion. On examination, he had central cyanosis with grade II clubbing in both fingers and toes, silent precordium with no audible murmur over his back). ECG showed normal sinus rhythm with no abnormality. CXR showed an abnormal shadow related to right cardiac border with prominent pulmonary artery and otherwise normal pulmonary vasculature. His complete blood count showed erythrocytosis with hemoglobin concentration of 16.4 g/dl and hematocrit value of 69.2%. Transthoracic echocardiography showed dilated left atrium with dilated right pulmonary artery. Patient was diagnosed to have a right pulmonary AV malformation. Invasive cardiac catheterization was done to identify size and number of this pulmonary AV malformation. Right pulmonary angiography showed a right pulmonary artery to left atrium fistula (type I) measuring 11 mm in its narrowest diameter with free shunting of blood. TEE guidance inside our cath lab showed normal pulmonary venous drainage into the left atrium, dilated right pulmonary artery opening into left atrium through an opening 10 mm with systolic flow across of low gradient (15 mmHg). A balloon was advanced across the fistula for sizing. Stretched diameter of fistula measured 13 mm. An Amplatzer ventricular septal occluder 14 was successfully positioned across the fistula. Right pulmonary angiography assured patent right lower pulmonary artery. TEE assured normal pulmonary veins flow into the left atrium. Patient saturation rose from 75% to 95%. Complete cure can be accomplished by transcatheter closure of direct pulmonary artery to left atrium communication. Systematic approach in assessment of patients with rare congenital anomalies can help their management despite of difficult clinical diagnosis. 2D and 3D TEE can guide RPA to LA fistula transcatheter closure as in ASD closure.