RESUMEN
The removal of intramyocardial masses has long been thought of as a surgical procedure and is generally reserved for patients with obstructive symptoms when the mass is thought to be benign. Thus, many patients who are incidentally diagnosed with intracardiac masses are either subjected to protracted follow-up with serial imaging awaiting tumor growth before surgical excision is ultimately offered. We report a novel procedure in which a 54-year-old man with an atrial myxoma underwent successful percutaneous resection using electrosurgery followed by removal with a novel endovascular retrieval system. This approach provides an alternative to either surgical excision or watchful waiting in patients with small- to medium-sized intracardiac tumors. (Level of Difficulty: Advanced.).
RESUMEN
BACKGROUND: The present study designed to evaluate feasibility of transesophageal echocardiographic (TEE) imaging of the pulmonary valve (PV) at the transaortic upper esophageal (TAUE) window. We hypothesized that patients with larger aorta would be more likely to have visualization of the PV from this TAUE window. METHODS: 2D TEE images of the PV were prospectively acquired by one operator at the TAUE window looking through the aortic arch. Patients were divided into four groups based on image quality of PV (group 1, not visualized; group 2, barely visualized; group 3, sufficient visualization; group 4, excellent visualization). Clinical, echocardiographic, and radiologic parameters were collected. RESULTS: A total of 212 consecutive patients (54 ± 14 years, 63.7% male) were enrolled. Group distribution was as follows: group 1, n = 60 (28.3%); group 2 n = 39 (18.4%); group 3, n = 27 (12.7%); group 4, n = 86 (40.6%). There were no differences between groups' baseline clinical characteristics. There was a weak although statistically negative correlation between PV image quality and aortic arch dimension (r = -0.17 P = 0.01). There was a stronger positive correlation between PV thickness (r = 0.38 P < 0.001) and PV image quality. Retrospective subgroup analysis of 76 patients with recent chest CT showed similar, but not significant trends as by TEE. CONCLUSION: The use of 2D TEE TAUE results in diagnostic image quality of the PV in the majority of patients and outstanding image quality in a subset of patients. PV image quality is negatively affected by increasing aorta diameter and positively affected by PV thickness.
Asunto(s)
Ecocardiografía Transesofágica/métodos , Válvula Pulmonar/diagnóstico por imagen , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios RetrospectivosAsunto(s)
Disección Aórtica/diagnóstico por imagen , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Atrios Cardíacos/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Anciano de 80 o más Años , Disección Aórtica/etiología , Aorta/diagnóstico por imagen , Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Femenino , Humanos , Complicaciones Posoperatorias/etiologíaAsunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/diagnóstico por imagen , Ecocardiografía Doppler en Color , Ecocardiografía Doppler de Pulso , Ecocardiografía Transesofágica , Hemodinámica , Anciano , Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/fisiopatología , Humanos , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Índice de Severidad de la EnfermedadAsunto(s)
Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/etiología , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/cirugía , Leiomiosarcoma/complicaciones , Leiomiosarcoma/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Válvula Pulmonar/cirugía , Adulto , Ecocardiografía Transesofágica , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/etiología , Humanos , Hipertrofia Ventricular Derecha/diagnóstico por imagen , Hipertrofia Ventricular Derecha/etiología , Válvula Pulmonar/diagnóstico por imagenAsunto(s)
Cardiopatías Congénitas/diagnóstico por imagen , Adulto , Procedimientos Quirúrgicos Cardíacos , Ecocardiografía Transesofágica , Femenino , Cardiopatías Congénitas/cirugía , Defectos del Tabique Interatrial/complicaciones , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/cirugía , Humanos , Válvula Mitral/diagnóstico por imagenAsunto(s)
Estenosis de la Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/diagnóstico por imagen , Ecocardiografía Doppler , Implantación de Prótesis de Válvulas Cardíacas , Pericardio/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Cateterismo Cardíaco , Ecocardiografía Transesofágica , Humanos , Cuidados Intraoperatorios , Modelos Cardiovasculares , Valor Predictivo de las Pruebas , Reproducibilidad de los ResultadosAsunto(s)
Seno Coronario/patología , Defectos del Tabique Interatrial/patología , Anciano , Fibrilación Atrial/complicaciones , Fibrilación Atrial/cirugía , Ecocardiografía Transesofágica , Defectos del Tabique Interatrial/complicaciones , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/cirugía , Humanos , MasculinoRESUMEN
PURPOSE: Chondroblastic osteosarcoma requiring surgical intervention is associated with a high risk of pulmonary tumour embolism. Rapid intraoperative diagnosis with transesophageal echocardiography (TEE) allowed changing the management plan and treatment of a life-threatening pathology. CLINICAL FEATURES: A 32-yr-old female with right pelvic chondrosarcoma presented for right hemipelvectomy. Two hours into the operation during ligation of the iliac blood vessels the patient's hemodynamic condition deteriorated and was followed by cardiac arrest. TEE was performed immediately and revealed massive tumour embolism in the right and left pulmonary arteries. Large tumour emboli were removed from the right and left pulmonary arteries after median sternotomy under cardiopulmonary bypass and moderate hypothermia. The hemipelvectomy was completed on the next day after fluid and inotropic agent resuscitation. An inferior vena cava filter was placed below the renal veins. The patient was discharged from hospital ten days after the surgery. CONCLUSION: This case report illustrates the important role TEE can play in the early diagnosis and subsequent surgical treatment of noncardiac emergencies. Intraoperative TEE can have a significant impact on the decision making process in life threatening emergencies.