Orthogonal-biplane imaging (xplane) is a relatively new tool and provides comprehensive information about mitral valve and left atrial appendage evaluation. On the other hand, x plane method is a promising method in diagnosis of semilunar valve pathologies. Below, we report two cases, in which xplane method was used in order to clairify diagnosis. Case 1 : 63 year old male patient with dyspnea admitted to our clinic. Right ventricular dilatation and hypertrophy were assessed. In order to determine the exact reason of right ventricular pressure overload, pulmonary valve was evaluated by xplane and bicuspid pulmonary valve was represented.This patient has been undergone to pulmonary valve percutaneous valvuloplasty. Case 2 48 year-old male patient with historu of cerebrovascular event was admited to our hospital. His initial transthorasic and transoesaphageal echocardiography showed hyperechoic mobile mass on non-coronary cusp. However, after xplane was used to detect aortic valve,it was the prolapsed part of the non-coronary cusp adjacent to  the commissure.

Saphenous venous graft to pulmonary artery fistula is a rare condition.Below we report a casewith saphenous venous graft to left pulmonary artery fistula presenting with coronary ischemia and right heart failure in the literature. 61 year-old male patient was admitted to our emergency department with exertional chest pain. He had previous history of coronary artery bypass graft (CABG) operation.The transthorasic echocardiogram displayed normal left ventricular ejection fraction (55%) .However, right ventricular systolic functional parameters were decreased, tricuspid annular plane systolic excursion (TAPSE)  and tricuspid annular systolic velocity were found as 13mm and 7 cm/sec,respectively. Coronary angiography represented critical stenosis in native coronary arteries.Left internal mammarian arterial graft (LIMA) to LAD remains to be patent. Aorto-CXA saphenous venous graft was also patent. Aorto-RCA and LAD septal sequential saphenous venous graft was patent in RCA course, a fistula from Aorto-RCA and LAD septal sequential venos graft to left pulmonary artery was observed. Coronary computed tomography clearly represented the fistula from venus graft to pulmonary artery. The patient was discussed by Heart Team and re-operation was decided, the patient declined the operation and he was discharged from the hospital under medical therapy. Acquired coronary artery fistulas mostly develop after CABG surgery ; moreover, they may be related to trauma ,neoplasmor infection.They may develop in various areas,there are several data reporting coronary artery fistulas from LIMA or saphenous grafts to pulmonary artery. To the best of our knowledge, this current case was the first case report demonstrating the saphenous venous graft fistulazation without venous aneurysm to pulmonary artery linked to right ventricle failure and coronary ischemia togetherness without any other underlying cause to explain the right heart failure.

Background: Ischemic mitral valve regurgitation is a subgroup of secondary mitral valve insufficiency that develops due to ischemic heart disease. The aim of the study is to evaluate the patients who were operated after acute myocardial infarction for the type of interventions to be performed for the mitral valve in terms of mortality and morbidity. Methods: It is a single-centered, retrospective study. Patients who were admitted to the hospital with the diagnosis of acute myocardial infarction and operated emergently or urgently between January 2017 and December 2020 were evaluated. Patients who were found to have significant IMR (≥ moderate mitral regurgitation) in the early period and who could achieve complete revascularization were included in the study. Patients were divided into two groups whether the mitral valve was intervened or not. Results: The demographical data of the patients that were included in the study is as follows, 73.4% were male and 33% were female. The average age of the patients was 63.2 ± 8.9. Patients were compared in terms of significant (moderate or higher) postoperative residual mitral regurgitation. 62.2% (n=23) of the patients undergone isolated CABG had mild mitral regurgitation. 5 patients with mitral valve annuloplasty (17.9%) had significant residual regurgitation (p<0.001). Conlusion: Mitral valve intervention should not be considered in non-severe mitral valve insufficiencies (without papillary rupture or chorda rupture) after acute MI. Preservation of the dynamic structure of the mitral valve annulus in the acute period makes mitral ring annuloplasty not an appropriate treatment.

Cogan syndrome is an autoimmune disorder characterized with ocular and vestibular symptoms and only minority (less than 15%) of patients suffer from systemic disease which is explained by autoimmuune vasculitis.Cardiovascular involvement of Cogan syndrome is rare and  effects mostly subclavian and carotid arteries, aortic valve or aorta.Mitral valve involvement is rare. Below, we report a case with mitral valve involvement and Cogan syndrome. 39 year old male patient had admitted to our hospital with shortness of breath. He had history of previous aortic valve implantation in 2012. His transthorasic echocardiography demonstrated massively thickened mitral leaflets as well as moderate to severe mitral regurgitation.Transoesaphageal echocardiography revealed moderate to severe mitral regurgitation, severe thickening in both mitral leaflets and and mild restriction in leaflet motions.. Surgery was decided in case progressive dyspnea develops. Cogan syndrome is a vasculitis which effects medium sized arteries and aortic valve. Mitral valve involvement is rare. Differential diagnoses , as well as using certain medical treatments and rheumatic valve disease, were ruled out. This case is one of the rare examples of Cogan syndrome with mitral valve thickening.