Polyvalvular heart disease syndrome.

An adult case of polyvalvular heart disease syndrome diagnosed in an adult is presented. The characteristic facies and echocardiographic features of this rare autosomal dominant connective tissue disorder are presented.

Cardiac CT angiography in the emergency room: Apical hypertrophic cardiomyopathy presenting as acute coronary syndrome.

A 59-year-old male presented to the emergency room with symptoms of chest tightness and palpitations. Following conversion of atrial fibrillation to sinus rhythm, he had deep symmetrical T-wave changes on his electrocardiogram. Symptoms resolved almost immediately, and his initial troponin was negative. He underwent cardiac CT angiography utilizing an emergency room triage protocol which resulted in a diagnosis of nonobstructive coronary artery disease and apical hypertrophic cardiomyopathy. Following a hospital stay of less than 24 hours, he was discharged to outpatient follow-up on medical management and has remained asymptomatic over 6 months. This case presentation illustrates an example of the diversity of pathology that presents in emergency rooms with symptoms consistent with acute coronary syndrome.

A mathematical algorithm for quantification of CT image noise.

Quantification of computed tomography (CT) noise helps in determination of radiation dosage requirements for adequate image quality. Clinical methods used include calculation of the standard deviation (SD) of a selected region of interest (ROI). In industry, wavelet decomposition has been used for image compression while removing high-frequency noise. We evaluated a cohort of 74 consecutive patients referred for coronary artery calcium scoring and quantitated noise within a 16×16 ROI in the ascending aorta using the traditional SD method and also using a two-dimensional dyadic wavelet decomposition method. Clinically, noise has been shown to be proportional to patient weight and also body mass index (BMI), which is a derived value from height and weight. Noise for both methods was plotted against patient parameters of height, weight, waist circumference and calculated BMI. A regression line was calculated and coefficient of determination (CoD) calculated for each. The CoD was better for height, weight, and waist circumference using the wavelet method as compared to the traditional SD method. The wavelet method of quantification of image noise may be an improved method as compared to the SD method. This method could help further refine an imaging system's determination of radiation dosage requirements to obtain a satisfactory quality image.

Transesophageal echocardiography during pulmonary vein cryoballoon ablation for atrial fibrillation.

We describe our first 20 cases of cryoablation of atrial fibrillation (AF) using transesophageal echocardiography (TEE). Continuous procedural monitoring with TEE by a cardiologist and senior sonographer assists the electrophysiologist in performance of the cryoballoon procedure of AF. Previously using intracardiac echocardiography (ICE) we have found TEE to have better overall procedural imaging, and monitoring for pericardial effusion or thrombus formation. We have found TEE monitoring to be helpful with positioning for interatrial septal (IAS) puncture, catheter tip avoidance of the left atrial appendage (LAA), and guidance of the balloon catheter into each pulmonary vein (PV), with proper positioning within each PV orifice, and documentation of PV occlusion for the cryoballoon procedure. Procedural equipment and the cryoballoon protocol used are presented in detail. The role of TEE imaging during the procedure and in preventing potential dangers is illustrated. It is the goal of this study to demonstrate how the electrophysiology and echocardiography laboratories work together in this cryoablation procedure.

The Convergent Procedure - A Standardised and Anatomic Approach Addresses the Clinical and Economic Unmet Needs of the Persistent Atrial Fibrillation Population.

A standardised treatment management approach is needed to address the escalating worldwide prevalence of atrial fibrillation (AF). The persistent and longstanding persistent AF patient population particularly needs this standardised treatment option to manage their AF. These patients have underlying structural heart disease that result in increased hospitalizations, long-term medical management that increases the cost burden of the healthcare system. Approximately 100 patients have undergone the Convergent Procedure at our center since its introduction 2 years ago, as a treatment option for AF patients. The epicardial and endocardial ablation procedures performed sequentially in a single setting has shown a single procedure success rate of 80%, similar to published success rates at other centers. The epicardial posterior wall isolation silences a majority of known substrates and the endocardial procedure completes the pulmonary vein isolation, creates the cavotricuspid line and provides diagnostic confirmation. The Convergent Procedure should be considered as a first line treatment option for the persistent and longstanding persistent AF patient population who have very limited or no treatment options for the long-term successful management of their AF.

Intracardiac echocardiography in electrophysiology: a review of current applications in practice.

Intracardiac echocardiography (ICE) has emerged as a widespread useful tool in the everyday practice of interventional electrophysiology. Advances in catheter-based ultrasound transducers and imaging technology have made this modality integral to guiding evaluation of anatomy and ablation therapy. Evolution of ablative procedures of the left heart for tachyarrhythmia has highlighted the importance of direct visualization of anatomic landmarks to guide transseptal catheterization and immediately identify complications. The ability to position mapping and ablation catheters according to anatomic landmarks (Fig. 1) has greatly enhanced the safety and efficacy of catheter ablation procedures. ICE has supplanted fluoroscopy as the gold standard for precise imaging of endocardial structures during complex procedures.

Expansion of heart failure device therapy into a rural indigent population in Louisiana: potential economic and health policy implications.

BACKGROUND: Research regarding the use of implantable devices in patients with congestive heart failure (CHF) has shown mortality benefits. The Center for Medicare and Medicaid Services (CMS) approved new criteria for expanding coverage for such therapies. The purpose of this study was to determine the percentages of CHF patients in a rural, indigent heart failure population that would be eligible for implantable defibrillators (ICD) and cardiac resynchronization therapy (CRT) based on the new CMS criteria. METHODS AND RESULTS: The new CMS guidelines were applied to information compiled in a database for 451 CHF disease management patients, at Leonard J. Chabert Medical Center. Results show that, annually, 32% of the newly identified CHF patient population would be eligible for ICD therapy and 7.3% would be eligible for CRT therapy. CONCLUSIONS: Providers of health care to the indigent may lack sufficient resources for the devices and the infrastructure for device implantation and follow-up.

An Unusual Case of Embolic Stroke: A Permanent Ventricular Pacemaker Lead Entirely Within the Arterial System Documented by Transthoracic and Transesophageal Echocardiography.

A pacemaker lead in the left ventricle is a rare complication of implantation. Recognition of this complication is important because thromboembolic events are associated. We report the first case, to our knowledge, of a patient who had a permanent pacemaker implanted via the left subclavian artery to the left ventricle, which is documented by electrocardiography, chest radiography, thoracic echocardiography, and transesophageal echocardiography.