ABSTRACT
AIM: In patients affected by aortic valve stenosis (AS) it is mandatory to rule out coronary artery disease (CAD). The role of retrospectively ECG-gated 64-slice CT angiography (64-SCTA) was assessed in patients with AS referred for surgical valve replacement. METHODS: Forty-two patients with AS underwent ECG-gated 64-SCTA of thoracic aorta, including the heart and coronary arteries, before surgical valve replacement. Images were evaluated by two independent readers and compared with surgical findings in terms of aortic valve calcification grading, valvular morphology, aortic valve annulus and sino-tubular junction diameters, and valvular area planimetry. Quantitative evaluation of cusps opening was also performed. Finally, the presence of CAD, thoracic aortic aneurysm and left ventricle hypertrophy were assessed. RESULTS: Visualization of the aortic valve without motion artefacts was possible in 38 patients (90.5%). Valvular morphology was correctly assessed in all cases (100%). 64-SCTA correctly determined aortic valve calcification grading and the aortic valve annulus and sinotubular junction diameters in 100% of cases. The aortic valve planimetric area was assessed in 38 cases (90.5%). Ascending aortic aneurysms requiring surgical replacement were detected in 12 patients (28.6%). Significant left ventricle hypertrophy was found in 30 patients (71%). CONCLUSION: Preoperative evaluation of patients undergoing surgical replacement for AS with 64-SCTA is feasible. 64-SCTA can rule out CAD and evaluate the status of the aortic valve and thoracic aorta in the same examination, obtaining relevant information for surgical planning.
Subject(s)
Aortic Valve Stenosis/diagnostic imaging , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Calcinosis/diagnostic imaging , Coronary Angiography/methods , Multidetector Computed Tomography , Aged , Aorta, Thoracic/diagnostic imaging , Aortic Diseases/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve/surgery , Aortic Valve Stenosis/physiopathology , Aortic Valve Stenosis/surgery , Aortography/methods , Calcinosis/physiopathology , Calcinosis/surgery , Cardiac-Gated Imaging Techniques , Coronary Artery Disease/diagnostic imaging , Coronary Vessels/diagnostic imaging , Electrocardiography , Feasibility Studies , Female , Humans , Hypertrophy, Left Ventricular/diagnostic imaging , Male , Middle Aged , Predictive Value of Tests , Radiographic Image Interpretation, Computer-Assisted , Severity of Illness IndexABSTRACT
AIM: Autologous pericardium annuloplasty (APA) is an alternative to prosthetic ring implantation for mitral valve (MV) repair, avoiding the use of foreign material and preserving the mitral annulus' physiological motion. However, data on durability are questionable. Therefore, we analyzed long-term outcomes of treating degenerative mitral regurgitation (MR) with APA. METHODS: Four hundred ninety patients (mean age, 54.3±11.3 years, [15-77 years]; N.=360 men [74.1%]) who had undergone APA and neochordae implantation between July 1988 and December 2006 were retrospectively studied. RESULTS: MR was purely degenerative in 434 (89.3%) patients; endocarditis was present in 44 (9.1%) patients; an anterior, posterior, or bileaflet prolapse was present in 32 (6.6%), 241 (49.6%), and 213 (43.8%) patients, respectively. Clinical follow-up was 100% complete at a median of 6.5 years (5th percentile, 0.9; 95th percentile, 14.9) with an echocardiographic study in 92% of patients. In-hospital mortality was 1% (5 deaths); overall and late cardiac mortality were 7.6% and 3.9% (37 and 19 deaths), respectively. Kaplan-Meier curves for overall survival, late cardiac survival, and freedom from reoperation at 15 years (20 cases) were 86% (95%CI 80-91), 93% (95%CI 88-96), and 93% (95%CI 88-96), respectively. At 15 years, freedom from recurrent MR (28 patients) and endocarditis (6 events) were 86% (95%CI 76-91) and 97% (95%CI 92-99). Dehiscence, significant calcification of APA, and hemolysis never occurred. At reoperations, annular pericardium appeared covered by a smooth layer of tissue. CONCLUSION: APA is feasible, safe, and cost-effective, providing long-term durability, high survival, and a low rate of valve-related complications.
Subject(s)
Heart Valve Prosthesis Implantation , Mitral Valve Annuloplasty/methods , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Pericardium/transplantation , Adolescent , Adult , Aged , Disease-Free Survival , Female , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/mortality , Hospital Mortality , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Mitral Valve/physiopathology , Mitral Valve Annuloplasty/adverse effects , Mitral Valve Annuloplasty/mortality , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/mortality , Mitral Valve Insufficiency/physiopathology , Postoperative Complications/mortality , Postoperative Complications/surgery , Recurrence , Reoperation , Retrospective Studies , Risk Factors , Time Factors , Transplantation, Autologous , Treatment Outcome , Young AdultABSTRACT
Hepatocellular carcinoma (HCC) with extension to the right atrium is an uncommon form of cardiac involvement. We report a case of a 67-year-old man admitted to our Department for the incidental findings of a mass in the right atrium. Physical examination revealed leg edema, distention of external jugular vein and ascites. The anamnestic collection revealed HCC occurred on post-alcoholic liver cirrhosis 3 years earlier. Transthoracic echocardiography revealed a dilated RA containing a mass, with superficial apposition of a thrombotic material. Bi-dimensional echocardiography is the most commonly used noninvasive tool for evaluating intracardiac masses. Although MRI is considered the gold standard, real-time three-dimensional echocardiography has the capability to obtain the entire volume reconstruction of an intracardiac mass, even with an irregular shape. Moreover, it permits an hemodynamic evaluation of the potential obstructive effects visualized from different angles and planes.
