Characterization and normal measurements of the left ventricular outflow tract by ECG-gated cardiac CT: implications for disorders of the outflow tract and aortic valve.

RATIONALE AND OBJECTIVES: Studies suggest that electrocardiographically gated coronary computed tomographic angiography provides a clear definition of the left ventricular outflow tract (LVOT), and normal LVOT morphology may not be round, as assumed when the continuity equation is applied during echocardiography. The aims of this study were to demonstrate the morphology of the LVOT on coronary computed tomographic angiography and to establish normal values for LVOT measurements. MATERIALS AND METHODS: Two independent readers retrospectively measured anterior-posterior (AP) and transverse diameters of the LVOT and performed LVOT planimetry on coronary computed tomographic angiographic studies of 106 consecutive patients with normal aortic valves. RESULTS: Excellent interobserver agreement was observed for all measurements (r = 0.78-0.94). The LVOT was ovoid, with a larger transverse diameter than AP diameter during diastole and systole (P < .001). However, the ratio of AP diameter to transverse diameter was closer to 1.0 during systole (P < .001). Mean indexed LVOT area was minimally larger in systole than in diastole (P = .01-.04) and was larger in men than in women during diastole (P ≤ .001) and systole (P ≤ .01). Mean LVOT area indexed to body surface area was 2.3 ± 0.5 cm(2)/m(2) in women and 2.6 ± 0.7 cm(2)/m(2) in men. LVOT area demonstrated significant correlation with aortic root diameter. CONCLUSIONS: The normal LVOT is ovoid in shape. LVOT is more circular during systole, but the AP diameter remains smaller than the transverse diameter throughout the cardiac cycle. The oval shape of the LVOT has important implications when LVOT area is calculated from LVOT diameters. Normal LVOT area values established in this study should facilitate diagnosis of the fixed component of LVOT obstruction.

Left atrial volume: comparison of 2D and 3D transthoracic echocardiography with ECG-gated CT angiography.

RATIONALE AND OBJECTIVES: Left atrial volume (LAV) measurement by conventional two-dimensional (2D) transthoracic echocardiography (TTE) may be limited by the geometric model, by suboptimal definition of left atrial endocardium, or by chamber foreshortening. Three-dimensional (3D) TTE is posited to eliminate chamber foreshortening, and LAV measurement by 3D TTE should be more reflective of true LAV. The aim of this study was to compare conventional 2D TTE and newer 3D TTE for measurements of LAV to multidetector computed tomographic (MDCT) measurements using automated chamber reconstruction (ACR). MATERIALS AND METHODS: Twenty-two subjects consented to undergo 2D TTE and 3D TTE immediately prior to or following coronary computed tomographic angiography. LAV was calculated from 2D TTE using the area-length method (ALM) and from 3D TTE with the ALM as well as with a 3D model. Electrocardiographically gated coronary computed tomographic angiography was performed in helical mode. LAV was measured using the ALM as well as ACR. RESULTS: LAV was significantly smaller by 2D TTE (80 ± 21 mL) and 3D-TTE (90 ± 24 mL with the ALM, 61 ± 16 mL with the 3D model) compared to MDCT ACR (120 ± 30 mL) (P < .01). Correlation between MDCT ALM and MDCT ACR was excellent (mean Δ = -1.4 ± 14 mL, r = 0.91). Correlation with MDCT ACR was no better for 3D TTE (r = 0.80) than for 2D TTE (r = 0.80). CONCLUSIONS: LAV is underestimated by both 2D TTE and 3D TTE relative to coronary computed tomographic angiography. Excellent agreement between the ALM and ACR with MDCT imaging suggests that the geometric model plays a negligible role in the underestimation of LAV. Underestimation of LAV by echocardiography is likely related to suboptimal definition of left atrial contour.

Left ventricular intracardiac metastatic germ cell tumor presenting with hemorrhagic cerebrovascular event.

We describe an unusual case of a 26-year-old man admitted with respiratory distress and found to have testicular cancer metastatic to the lung and heart. Twelve days after admission, the patient experienced multiple hemorrhagic strokes. Echocardiography demonstrated testicular cancer metastatic to the septal surface of the left ventricle of the heart with presumed embolization to the cerebrovascular region. The patient received chemotherapy and radiation therapy to the areas of tumor mass with subsequent resolution of tumor burden. This is the first reported case of metastasis from embryonal carcinoma of the testis to the left ventricle of the heart.

Echocardiography. The role of this noninvasive test in the geriatric population.

Echocardiography assumes a major role in the diagnosis and evaluation of cardiovascular disease in the older population. Available diagnostic modalities are briefly reviewed and their role in identifying disease entities common in a geriatric population is discussed. The prognostic implications of echocardiographic findings of mitral annular calcification and aortic sclerosis are reviewed, as are the use of echo and Doppler techniques in the assessment of congestive heart failure. Particular emphasis is placed on the evaluation of ischemic heart disease using stress echocardiography, the diagnosis and assessment of degenerative aortic valve disease, and the role of transesophageal echo in the management of atrial fibrillation and stroke.

Rapid Development of a Papillary Fibroelastoma with Associated Thrombus: The Role of Transthoracic and Transesophageal Echocardiography.

Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are frequently utilized in patient's with suspected cerebral vascular ischemia. We describe a patient with suspected cerebral vascular ischemic event whom was found to have a mobile valvular mass by TTE and TEE. The lesion was unusual due to its rapid development over a period 6 months, which was documented on serial echocardiography. The mass was excised surgically and pathology showed a papillary fibroelastoma with extensive thrombus. The differential diagnosis of a cardiac valvular mass and the treatment of cardiac fibroelastomas are reviewed. In this case, both TTE and TEE were valuable in diagnosis and facilitating surgical management of a cardiac fibroelastoma.