Value of 3D-Transesophageal Echocardiography in Percutaneous Closure of the Left Atrial Appendage / 中山大学学报(医学科学版)

Objective]To evaluate the value of three-dimensional transesophageal echocardiography(3D-TEE)in the applica?tion of percutaneous left atrial appendage occlusionin patients with atrial fibrillation.[Methods]7 patients with atrial fibrillation in Da?lian area(female 4,male 3,mean age 71.5 ± 3.3 years)were enrolled in the study.The maximum and minimum diameter and the max?imum depth ofleft atrial appendage were measured by 3D-TEE,and export morphology and leaf number were viewed.WATCHMAN occlude size was selectedby 3D-TEE. The process of operation was monitored by 3D-TEE. 3D-TEE was also performed in 3 months after the transcatheter closure.[Results]7 patients were performed the transcatheter closure therapy successfully. Preoperative 3D-TEE showed left atrial appendage export:5 cases were oval,and 2 cases were nearly circular. The leaf number was 1.6 ± 0.8. The maximum diameter of the left atrial appendage export was(23.1 ± 1.7)mm,(19.2 ± 2.1)mm minimum diameter,maximum depth of(27.6 ± 3.3)mm. The maximum diameter had good correlation with the size of occluder(r=0.944,P=0.001). 3D-TEE was used for guidance in the transcatheter therapy and succeeded. There were 1 case with little shunt after the transcatheter closure. 3 months af?ter the treatment ,position and shape of the occluderswere all in good.[Conclusion]3D-TEE has the great value in the percutaneous closure of left atrial appendage.

Infective endocarditis and caseous calcification of the mitral annulus: The odd couple / La endocarditis infecciosa y la calcificación caseosa del anillo mitral: la extraña pareja

Caseous calcification of the mitral annulus is an infrequent echocardiographic finding. The differential diagnosis includes other entities like tumors, abscess or thrombus. Both cardiac CT and cardiac MRI may be useful for its definitive diagnosis.

La calcificación caseosa del anillo mitral es un hallazgo ecocardiográfico poco frecuente. Debe hacerse el diagnóstico diferencial con otras entidades tales como tumores, abscesos o trombos. Para su diagnóstico definitivo además del ecocardiograma tanto el TC cardiaco como la Cardio RM pueden ser de utilidad.

Automated Quantification of Mitral Regurgitation by Three Dimensional Real Time Full Volume Color Doppler Transthoracic Echocardiography: A Validation with Cardiac Magnetic Resonance Imaging and Comparison with Two Dimensional Quantitative Methods

BACKGROUND: Accurate assessment of mitral regurgitation (MR) severity is crucial for clinical decision-making and optimizing patient outcomes. Recent advances in real-time three dimensional (3D) echocardiography provide the option of real-time full volume color Doppler echocardiography (FVCD) measurements. This makes it practical to quantify MR by subtracting aortic stroke volume from the volume of mitral inflow in an automated manner. METHODS: Thirty-two patients with more than a moderate degree of MR assessed by transthoracic echocardiography (TTE) were consecutively enrolled during this study. MR volume was measured by 1) two dimensional (2D) Doppler TTE, using the proximal isovelocity surface area (PISA) and the volumetric quantification methods (VM). Then, 2) real time 3D-FVCD was subsequently obtained, and dedicated software was used to quantify the MR volume. MR volume was also measured using 3) phase contrast cardiac magnetic resonance imaging (PC-CMR). In each patient, all these measurements were obtained within the same day. Automated MR quantification was feasible in 30 of 32 patients. RESULTS: The mean regurgitant volume quantified by 2D-PISA, 2D-VM, 3D-FVCD, and PC-CMR was 72.1 +/- 27.7, 79.9 +/- 36.9, 69.9 +/- 31.5, and 64.2 +/- 30.7 mL, respectively (p = 0.304). There was an excellent correlation between the MR volume measured by PC-CMR and 3D-FVCD (r = 0.85, 95% CI 0.70-0.93, p < 0.001). Compared with PC-CMR, Bland-Altman analysis for 3D-FVCD showed a good agreement (2 standard deviations: 34.3 mL) than did 2D-PISA or 2D-VM (60.0 and 62.8 mL, respectively). CONCLUSION: Automated quantification of MR with 3D-FVCD is feasible and accurate. It is a promising tool for the real-time 3D echocardiographic assessment of patients with MR.

Assessment of Mitral Valve Complex by Three-Dimensional Echocardiography: Therapeutic Strategy for Functional Mitral Regurgitation

The mitral valve complex is consisted of annulus, leaflets, chordae tendineae, papillary muscle (PMs) and surrounding left ventricle. Functional mitral regurgitation (MR) results from left ventricular remodeling such as dilatation or distortion, which displaces the PMs and then tethers the mitral leaflets, restricting leaflet coaptation. Undersized annuloplasty, which has been widely accepted as a simple and effective procedure for functional MR, sometimes worsens the tethering of posterior leaflet and induces recurrent MR. In order to overcome such problems, several additional procedures to the simple annuloplasty have been produced. Three dimensional echocardiography plays an essential role to understand the geometry of mitral valve complex and contributes greatly to decision making of the surgical strategy in functional MR and its postoperative assessment.

Carcinoid Heart Disease: A Rare Cause of Right Ventricular Dysfunction Evaluation by Transthoracic 2D, Doppler and 3-D Echocardiography

Carcinoid heart disease is a rare cause of heart failure with or without right valvular heart impairments. In this study, we showed a case of carcinoid tumour with hepatic metastases inducing carcinoid heart disease. Neuroendocrine heart involvement happens for severe tricuspid valve insufficiency and plaques on right ventricular (RV) walls produced by a release of serotonin (5-HT). A patient affected by primitive ileal tumour with 5-HT-secernent hepatic metastases inducing tricuspid insufficiency is showed. Transthoracic 2-D echocardiography showed tricuspid valve regurgitation and both right atrium, RV-walls plaques and RV dilation. Continue-wave Doppler showed a characteristic "dagger shaped" spectrum of tricuspid systolic flow. RV function was evaluated with 3-D transthoracic echocardiography. In particular, RV volumes, RV ejection fraction and stroke volume were defined by this technique. 2, 3-D echocardiography and Doppler method are useful techniques to show heart valves' derangements and RV function to non-invasively detect RV impairments in carcinoid heart disease.

Visibilização de artérias coronárias epicárdicas em imagens ecocardiográficas tridimensionais com contraste de microbolha / Visualization of the epicardial coronary arteries in microbubble contrasted tri-dimensional echocardiographic images

Com os avanços tecnológicos das últimas décadas, a ecocardiografia surgiu como uma alternativa de diagnóstico por imagem de relativo baixo custo, que não faz uso de energia ionizante ou radioativa. Recentemente, o advento dos agentes de contraste por microbolhas e dos transdutores matriciais tornou possível a visualização tridimensional da anatomia das artérias coronárias. Neste projeto, é proposta a avaliação de métodos de segmentação capazes de visibilizar as artérias coronárias epicárdicas em Imagens de ecocardiografias tridimensionais com contraste de microbolhas. Esse é o primeiro passo para o desenvolvimento de ferramentas computacionais eficazes e eficientes na assistência não invasiva ao acompanhamento do quadro clínico de pacientes, do diagnóstico ao pós-operatório. Propõe-se, uma metodologia que facilite o acesso às coronárias a partir de imagens de ecocardiografia tridimensionais com aplicação de contraste por microbolhas. Dentre as metodologias estudadas, as técnicas baseadas na teoria Fuzzy Connectedness (FC) foram identificadas como as mais promissoras. Estudou-se, portanto, seis abordagens baseadas nessa teoria, três delas são descritas na literatura (Generalized FC GFC; Relative FC RFC; Dynamic Weighted FC DyWFC) e três proposições originais (Area of Search FC ASFC; Ultrasound-k FC USFC; Guided FC GuFC). Para avaliar a acurácia desses algoritmos, confeccionou-se um conjunto de imagens simuladas, composto por 360 imagens, e selecionou-se um conjunto de imagens de exames reais, composto de 10 imagens reais de pacientes com quadro de Cardiomiopatia Hipertrópica. Para as imagens simuladas, os métodos da literatura alcançaram acurácia de 85,5% para GFC, 89,5% para RFC e 92,0% para DyWFC. Enquanto isso, os métodos propostos alcançaram acurácia de 88,9% para ASFC, 91,7 % para USkFC e 95,2% para GuFC...

With the technological advances of recent decades, echocardiography has emerged as a relatively low cost imaging diagnostic alternative, that does not use ionizing or radioactive energy. Lately, the advent of micro bubble-based contrast agents and array transducers turned possible the visualization of three-dimensional coronary arteries anatomy. The present project proposes to evaluate segmentation methods able to deal with the visualization of the epicardial coronary arteries in microbubble-based three-dimensional echocardiography images. This is the first step towards the development of effective and efficient computational tools for diagnosis and prognosis assistance of cardiac pacient. We propose a methodology to facilitate the access to epicardial coronary arteries in tridimensional echocardiographic images. Among the studied approaches, Fuzzy Connectedness based segmentation methods were identified as being the most promising. We studied six approaches based on this theory, three of them are described in the literature (Generalized FC GFC; Relative FC RFC; Dynamic Weighted FC DyWFC) and three original contributions (Area of Search FC ASFC; Ultrasound-k FC USFC; Guided FC GuFC). To evaluate the accuracy of these algorithms, a set composed of 360 simulated images were created. We also selected a set of 10 real images, composed of hypertrophic cardiomyopathy patients. For simulated images set, the methods of literature achieved accuracy of 85.5% for GFC, 89,5% for RFC and 92,0% for DyWFC, meanwhile, the proposed method achieved accuracy of 88.9% for ASFC, 91,7 % for USkFC and 95,2% for GuFC. Using the real images set, the methods converged to good results for clinical purposes. These results demonstrate that the proposed method GuFC has shown a better performance than the others, becoming a candidate to the segmentation step in a computational tool for coronary arteries visualization in the future...

Utilidad de la ecocardiografía tridimensional en tiempo real en la valoración de la estenosis mitral reumática / Usefulness of Real Time 3D echocardiography in assessment of rheumatic mitral stenosis

Hasta el momento, la valoración de la severidad de la estenosis miral reumática ha estado basado en métodos Doppler, muy influenciares por las condiciones hemodinámicas del paciente y en métodos de planimetría valvular obtenida a partir de imágenes bidimensionales. La ecocardiografia 3D en tiempo real ha hecho su aparición en la rutina clínica diaria, proporcionando imágenes de alta calidad en tres dimensiones y requiriendo un muy corto período de tiempo para su adquisición. En el presente trabajo tratamos de realizar una puesta al día de la utilidad de esta técnica en la valoración de la severidad de la estenosis mitral reumática. Estos hallazgos están basados en la experiencia de nuestra Unidad de Imagen Cardiovascular del Hospital Clínico San Carlos de Madrid.

To date, the assessment of rheumatic mitral stenosis has been based on Doppler methods, which have a high dependence on the hemodinamic conditions and on the planimetry obtained from 2D echo images. Real Time 3D echocardiography has been implemented in the daily clinical practice. It provides high quality 3D images and the acquisition time is very short. In the present work, we try to show the "state of the art" of Real Time 3D echocardiography in the assessment of rheumatic mitral stenosis. These findings are based on the experience of our "Unidad de Imagen Cardiovascular" at the Hospital Clínico San Carlos de Madrid. (Arch Cardiol Mex 2005; 75:210-221).