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Aortic stenosis is associated with aortic plaques in up to 85% of cases because they share risk factors and pathogenic pathways. Intrinsically, complex aortic plaques carry a high risk of stroke, which has also been demonstrated in the context of aortic stenosis, especially in patients who underwent percutaneous or surgical replacement. Transesophageal echocardiography (TEE) is the imaging test of choice to detect plaques in the thoracic aorta and classify them as complex plaques. Furthermore, the 3D modality allows us to better specify its dimensions and anatomical characteristics, such as added thrombi or the presence of ulcers inside. This review aims to evaluate the use of TEE to detect complex aortic plaques in patients with an indication for percutaneous or surgical aortic valve replacement. To highlight the association between aortic stenosis and complex aortic plaques, we attached to the review some TEE studies from our experience.
La estenosis aórtica se asocia con placas aórticas hasta en un 85% de los casos, porque comparten factores de riesgo y vías patogénicas. Intrínsecamente, las placas aórticas complejas conllevan un alto riesgo de accidente cerebrovascular, lo que también se ha demostrado en el contexto de estenosis aórtica, especialmente en pacientes sometidos a reemplazo percutáneo o quirúrgico. La ecocardiografía transesofágica (ETE) es la prueba de imagen de elección para detectar placas en la aorta torácica y clasificarlas como placas complejas. Además, la modalidad 3D nos permite precisar mejor sus dimensiones y características anatómicas como trombos añadidos o la presencia de úlceras en su interior. Esta revisión tiene como objetivo evaluar el uso de ETE para detectar placas aórticas complejas en pacientes con indicación de reemplazo valvular aórtico percutáneo o quirúrgico. Para resaltar la asociación de estenosis aórtica y placas aórticas complejas adjuntamos a la revisión algunos estudios de ETE de nuestra experiencia.
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We present the case of a 56-year-old patient with fever of unknown origin associated with chest and lumbar pain. Multimodality imaging revealed diffuse peri-aortitis in the thoracic aorta without involvement of the aortic valve, contributing substantially to the diagnosis of Ig G4-associated aortitis. Immunosuppressive therapy was started. Follow-up at five months with cardiac magnetic resonance imaging showed a reduction in the inflammatory process in the thoracic aorta.
Presentamos el caso de un paciente de 56 años, con cuadro febril de origen desconocido asociado a dolor torácico y lumbar. La imagen multimodal demostró periaortitis difusa en la aorta torácica sin afectación de la válvula aórtica, lo que contribuyó sustancialmente al diagnóstico de aortitis asociada a Ig4. Se inició tratamiento inmunosupresor. El seguimiento a los 5 meses, la resonancia magnética cardíaca mostró una reducción del proceso inflamatorio en la aorta torácica.
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Quadricuspid aortic valve is a rare congenital cardiac anomaly with an incidence of 0.008% to 0.043%. Its clinical course varies depending on cusp anatomy, function, and associated cardiac malformations. It frequently progresses to aortic valve regurgitation that may require surgical valve replacement. Detection has shifted from incidental discovery during autopsies or cardiac surgeries in the early 20th century to various cardiac imaging methods in recent decades. In addition to contributing to the literature, this report supports the use of transesophageal echocardiography more liberally to detect aortic valve abnormalities. The case presents a 48-year-old female patient with an incidentally discovered quadricuspid aortic valve.
Assuntos
Insuficiência da Valva Aórtica , Valva Aórtica , Ecocardiografia Transesofagiana , Cardiopatias Congênitas , Achados Incidentais , Humanos , Feminino , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Pessoa de Meia-Idade , Ecocardiografia Transesofagiana/métodos , Insuficiência da Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Cardiopatias Congênitas/diagnóstico por imagem , Valor Preditivo dos Testes , Implante de Prótese de Valva Cardíaca , Ecocardiografia Doppler em CoresAssuntos
Próteses Valvulares Cardíacas , Indóis , Valva Mitral , Trombose , Idoso , Feminino , Humanos , Antineoplásicos/efeitos adversos , Ecocardiografia Transesofagiana/métodos , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Indóis/efeitos adversos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Trombose/diagnóstico por imagem , Trombose/etiologiaRESUMO
The American Heart Association sponsored the first iteration of a scientific statement that addressed all aspects of cardiovascular implantable electronic device infection in 2010. Major advances in the prevention, diagnosis, and management of these infections have occurred since then, necessitating a scientific statement update. An 11-member writing group was identified and included recognized experts in cardiology and infectious diseases, with a career focus on cardiovascular infections. The group initially met in October 2022 to develop a scientific statement that was drafted with front-line clinicians in mind and focused on providing updated clinical information to enhance outcomes of patients with cardiovascular implantable electronic device infection. The current scientific statement highlights recent advances in prevention, diagnosis, and management, and how they may be incorporated in the complex care of patients with cardiovascular implantable electronic device infection.
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Cardiologia , Infecções Cardiovasculares , Doenças Transmissíveis , Desfibriladores Implantáveis , Endocardite Bacteriana , Estados Unidos , Humanos , American Heart Association , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/terapia , Endocardite Bacteriana/tratamento farmacológico , Desfibriladores Implantáveis/efeitos adversosAssuntos
Comunicação Interatrial , Comunicação Interventricular , Criança , Humanos , Lactente , Ecocardiografia , Ecocardiografia Transesofagiana , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Ventrículos do Coração , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgiaRESUMO
Objective:To explore the effects of the LAmbre device and mitral annulus(MA), as well as left atrium(LA) in patients with non-valvular atrial fibrillation(NVAF) after left atrial appendage closure (LAAC) using real-time-three-dimensional transesophageal echocardiography (3D TEE).Methods:Fity-six consecutive patients who underwent LAAC with the LAmbre device in Zhongshan Hospital of Fudan University from June 2019 to March 2023 were retrospectively enrolled, with no or less than moderate mitral regurgitation (MR). All patients underwent pre-operative and follow-up two-and three-dimensional transesophageal echocardiography (2D TEE, 3D TEE) at 60 days after the operation. The quantitative parameters of MA and LA were obtained by offline analysis using QLab 13.0 (Philips Healthcare, Andover, MA). Importantly, mitral annular measurements were made at seven time points throughout the cardiac cycle: early diastole, mid-diastole, late diastole, mitral valve closure, early systole, mid-systole, and late systole, which facilitates constructing the dynamic model of MA to assess the annular morphology and dynamics.Results:The values of AP diameter (APD), AL-PM diameter (ALPMD), 3D annulus circumference (3DAC), 3D annulus area (3DAA) decreased significantly compared with pre-operative values at all time points of the cardiac cycle (all P<0.05), while non-planar angle (NPA) and AH/CD were not apparently changed (all P>0.05 ). Throughout the cardiac cycle, MA showed regular changes, gradually increased in systole with the saddle shape deepened, and gradually decreased in diastole with the saddle shape shallowed.During systole, there was an increase in the rate of change of AP in MA [pre-operative (3.01±2.64)%, post-operative (3.81±3.51)%, P=0.037] after LAAC, with no significant difference in the rate of change of ALPM, 3DAC, and 3DAA.Meanwhile, we observed an evident reduction in LA minimal volume (LAVmin) [pre-operative (78.36±25.16)ml, post-operative (70.73±22.78)ml, P=0.004] and an obvious increase in LA ejection function [pre-operative (22.88±10.09)%, post-operative (31.41±12.28)%, P<0.05] during follow-up. Conclusions:3D TEE can accurately assess the impact of LAAC on the MA and LA. The LAmbre device can affect the morphology of MA, as well as the structure and function of LA, while the change of the dynamics of MA is not so prominent.
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Resumo Os fibroelastomas são o segundo tumor cardíaco benigno mais comum. São estruturas pequenas, avasculares, com uma dimensão média de 9mm, podendo atingir até 70mm, habitualmente aderentes à superfície das válvulas cardíacas (válvulas aórtica e mitral são as mais comumente afetadas, seguidas das válvulas tricúspide e pulmonar). A etiologia não é clara, sendo a hipótese de formação de microtrombos nas margens de coaptação das válvulas a mais aceite. Na ecocardiografia apresentam aspeto pediculado, móvel, com superfície filamentosa, tipicamente com uma aparência pontilhada nas margens e ecolucente. Do ponto de vista clínico, podem estar associados a fenómenos embólicos, no entanto, na maioria dos casos o diagnóstico é incidental. Apresentamos de seguida quatro casos de diagnóstico incidental de fibroelastomas nas quatro válvulas cardíacas, diagnosticados por ecocardiograma transtorácico (ETT) (Vídeo 1; Figura 1). Vídeo 1 Da esquerda para a direita, de cima para baixo: fibroelastomas no folheto anterior da válvula tricúspide, folheto anterior da válvula mitral, cúspide esquerda da válvula pulmonar e cúspide esquerda da válvula aórtica, cada um correspondendo a um doente diferente. Em: http://abccardiol.org/supplementary-material/2024/12102/2023-0222_IM_video01.mp4 Figura 1 Da esquerda para a direita, de cima para baixo: fibroelastomas no folheto anterior da válvula tricúspide, folheto anterior da válvula mitral, cúspide esquerda da válvula pulmonar e cúspide esquerda da válvula aórtica, cada um correspondendo a um doente diferente.
Abstract Fibroelastomas are the second most common benign cardiac tumor1. They are small avascular structures with a mean size of 9mm, ranging up to 70mm, usually attached to the heart valves' surface (aortic and mitral are the most affected, followed by tricuspid and pulmonary valves). Their etiology is unclear, but the hypothesis of coalescence of microthrombus at the coaptation margins of valves is the most widely accepted theory. On echocardiography, they are pedicled, mobile, with a filamentous surface, and usually have a speckled appearance with echolucencies and a stippled pattern near the edges. Clinically, they may be associated with embolic phenomena; however, in most cases, the diagnosis is incidental. We present a series of four clinical cases with an incidental diagnosis of fibroelastomas across the four cardiac valves as assessed by transthoracic echocardiography (Video 1; Figure 1). Video 1 From left to right and top to bottom: fibroelastomas of the anterior leaflet of the tricuspid valve, anterior leaflet of the mitral valve, left cusp of the pulmonary valve and left cuspid of the aortic valve, each corresponding to a different patient. Link: http://abccardiol.org/supplementary-material/2024/12102/2023-0222_IM_video01.mp4 Figure 1 From left to right and top to bottom: fibroelastomas of the anterior leaflet of the tricuspid valve, anterior leaflet of the mitral valve, left cusp of the pulmonary valve and left cuspid of the aortic valve, each corresponding to a different patient.
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ABSTRACT Candida endocarditis is a very serious manifestation of candida infections, and it has increased in incidence over the past years. Of these, C. parapsilosis has been described as a cause of endocarditis in native valves of intravenous drug users and prosthetic valves. We report the case of a female that developed a cerebrovascular accident secondary to emboli from aortic prosthetic valve C. parapsilosis endocarditis, despite apparently normal echocardiography. She received antifungal therapy without surgical intervention.
RESUMEN La endocarditis por Candida spp. es una manifestación muy grave de las infecciones por este patógeno y su incidencia ha ido aumentando en los últimos años. La Candida parapsilosis se ha descrito como causa de endocarditis en válvulas nativas de usuarios de drogas intravenosas y prótesis valvulares. Presentamos el caso de una mujer que desarrolló un accidente cerebrovascular secundario a émbolos fúngicos procedentes de una prótesis valvular aórtica infectada por C. parapsilosis, a pesar de un ecocardiograma sin vegetaciones. La paciente recibió tratamiento antifúngico sin necesidad de intervención quirúrgica.
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BACKGROUND: 18F-sodium fluoride positron emission tomography/computed tomography (18F-NaF PET/CT) has been proven to be useful in identification of microcalcifications, which are stimulated by inflammation. Blood speckle imaging (BSI) is a new imaging technology used for tracking the flow of blood cells using transesophageal echocardiography (TEE). We evaluated the relationship between turbulent flow identified by BSI and inflammatory activity of the aortic valve (AV) as indicated by the 18F-NaF uptake index in moderate aortic stenosis (AS) patients. METHODS: This study enrolled 18 moderate AS patients diagnosed within the past 6 months. BSI within the aortic root was acquired using long-axis view TEE. The duration of laminar flow and the turbulent flow area ratio were calculated by BSI to demonstrate the degree of turbulence. The maximum and mean standardized uptake values (SUVmax, SUVmean) and the total microcalcification burden (TMB) as measured by 18F-NaF PET/CT were used to demonstrate the degree of inflammatory activity in the AV region. RESULTS: The mean SUVmean, SUVmax, and TMB were 1.90 ± 0.79, 2.60 ± 0.98, and 4.20 ± 2.18 mL, respectively. The mean laminar flow period and the turbulent area ratio were 116.1 ± 61.5 msec and 0.48 ± 0.32. The correlation between SUVmax and turbulent flow area ratio showed the most positive and statistically significant correlation, with a Pearson's correlation coefficient (R²) of 0.658 and a p-value of 0.014. CONCLUSIONS: The high degree of trans-aortic turbulence measured by BSI was correlated with severe AV inflammation.
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Primary cardiac sarcoma is a rare type of intracardiac mass. This report describes a patient with atrial flutter who had a new right atrial mass incidentally discovered on transesophageal echocardiography. A thrombus was suspected based on radiographic appearance, but there was minimal change with anticoagulation. The mass was resected and found to be an undifferentiated pleomorphic cardiac sarcoma, an uncommon sub-type within the already rare category of primary cardiac neoplasms. This report highlights the importance of considering primary malignancy and thoroughly correlating radiographic and clinical evidence during the diagnostic workup of patients with intracardiac masses.
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Fibrilação Atrial , Flutter Atrial , Neoplasias Cardíacas , Sarcoma , Humanos , Ecocardiografia Transesofagiana , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Sarcoma/complicações , Sarcoma/diagnóstico , Sarcoma/cirurgia , Átrios do Coração/diagnóstico por imagemRESUMO
Objective:To evaluate the efficacy and safety of immediate intraoperative transapical beating-heart septal myectomy (TA-BSM) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and explored the clinical value of three-dimensional transesophageal echocardiography (3D-TEE) during the procedure of TA-BSM.Methods:One hundred and thirty-seven HOCM patients who underwent TA-BSM surgery in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2022 to March 2023 were selected.During the operation, 3D-TEE was used to locate the position of the myocardial circumcision system and navigate the range of myocardial circumcision. The interventricular septal thickness( IVST) and peak pressure gradient of the left ventricular outflow tract (LVOT-PG) were measured, and the degree of mitral systolic anterior motion (SAM) and mitral regurgitation (MR) were evaluated in HOCM patients before and after the operation. The range of the incisal margin was measured, and the number of resection knives and the weight of the removed myocardium were recorded.Results:TA-BSM under 3D-TEE navigation was successfully performed in 137 HOCM patients. The number of resection was 7(5, 9), and the weight of the removed myocardium was 5.6(3.4, 8.9)g. During the operation, there were no adverse events such as death, aortic valve injury, and iatrogenic interventricular septal perforation. Compared with those before the operation, the wall thickness of basal and middle segments of the anterior and posterior interventricular septum decreased significantly (all P<0.001), and LVOT-PG decreased significantly ( P<0.001). After TA-BSM, the number of patients with SAM≥3 decreased from 94 cases (68.6%) to 2 cases (1.5%), and the number of patients with MR≥3+ decreased from 86 cases (62.8%) to 9 cases (6.6%)(all P<0.001). For the patients with different degrees of ventricular septal hypertrophy (mild, moderate, and severe), the postoperative IVST and LVOT-PG were significantly lower than the preoperative values, and the degree of MR and SAM signs was relieved considerably. The length of the incisal margin, the weight of excised myocardium, and the number of resection in the group with extensive septal hypertrophy in all three regions were significantly higher than those in the group with localized interventricular septal hypertrophy in single or two areas (all P<0.05). Conclusions:3D-TEE can guide and monitor the process of TA-BSM myocardial resection in real-time. By accurately evaluating the IVST and the range and hemodynamic characteristics of HOCM patients, it can effectively relieve LVOTO and significantly reduce MR to ensure the safety and effectiveness of TA-BSM in HOCM patients with different degrees and ranges of hypertrophy.
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Objective:To evaluate the efficacy of high-flow nasal cannula (HFNC) oxygen therapy in optimizing painless transesophageal echocardiography in elderly patients.Methods:Sixty American Society of Anesthesiologists Physical Status classification Ⅱ patients, regardless of gender, aged 60-75 yr, with body mass index of 18.5-23.9 kg/m 2, were randomized into 2 groups ( n=30 each) by a random number table method: group HFNC and conventional ventilation group (group C). Pure oxygen 10 L/min was inhaled for 3 min preoxygenation using the HFNC device in group HFNC. Group C inhaled pure oxygen at 6 L/min for 3 min preoxygenation via a nasal cannula. Sufentanil 0.1 μg/kg and remazolam 0.25-0.30 mg/kg were intravenously injected in turn. Group HFNC was connected to a high-flow humidification oxygen therapy device and inhaled pure oxygen at 60 L/min (37℃, FiO 2 100%). The flow rate of pure oxygen was maintained at 6 L/min (FiO 2 100 %) in group C. The patients were placed in left lateral decubitus position, esophageal ultrasound was performed after the eyelash reflex disappeared, and remazolam 0.1 mg/kg was intravenously injected intermittently when bucking and body movement were induced by operation stimulation. The occurrence of hypoxia-related adverse events, mandibular intervention and ventilation-related adverse events was observed during examination. The operation time, time of emergence from anesthesia and consumption of remazolam were recorded. Results:Compared with group C, the incidence of severe hypoxia and rate of mandibular intervention were significantly decreased (7%/0 and 53%/17%, P<0.05), the lowest intraoperative SpO 2 was increased ( P<0.05), and no significant change was found in the operation time, time of emergence from anesthesia and consumption of remazolam in group HFNC ( P>0.05). No ventilation-related adverse events occurred in both groups. Conclusions:HFNC can markedly optimize the ventilation management of elderly patients undergoing painless transesophageal echocardiography.
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Sinus venosus atrial septal defects present a wide variety of anatomical features and are frequently associated with partial anomalous pulmonary venous drainage of one or more right pulmonary veins. Surgical correction used to be the standard treatment. In recent times, transcatheter correction of superior sinus venosus atrial septal defects has come into vogue. The transcatheter closure of these defects with covered stents at a tertiary care centre in Oman between 2018 and 2023 is reported.
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Comunicação Interatrial , Veias Pulmonares , Humanos , Comunicação Interatrial/cirurgia , Veias Pulmonares/cirurgia , Veias Pulmonares/anormalidades , Stents , OmãRESUMO
Abstract Background Atrial fibrillation (AF) is the most frequent arrhythmia, and its prevalence increases with age. The management of AF in the elderly is challenging, as it is normally associated with comorbidities and frailty. AF catheter ablation (CA) is a safe and superior alternative to antiarrhythmic drugs (AADs) for the maintenance of sinus rhythm. Objectives To evaluate the rate of complications associated with CA for AF across different age groups. Methods A retrospective analysis of 219 patients who underwent CA for AF between 2016 and 2020 were divided into 3 age groups: less than 60 years, 60 to 70 years, and > 70 years. All the included patients underwent radiofrequency ablation using an electroanatomic mapping system. Categorical variables were evaluated with chi-square and Fisher's test, and continuous variables were evaluated by Kruskal-Wallis and post-hoc Tamhane's T2. P values less than 0.05 were considered significant. Results We found an overall total complication rate of 4.6%. The total complication rate was 3.3% in patients < 60 years of age, 5.7% in patients between 60 and 70 years, and 5.2% in patients > 70 years (p = 0.742). No deaths occurred. Conclusion There was no significant difference in the AF CA-related complications when comparing the patients by age group.
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Introduction: Rheumatic heart disease (RHD), is a common cause of mitral stenosis (MS) in developing nations. As per current recommendation, Percutaneous Transvenous Mitral Commissurotomy (PTMC) is advised as a Class IA (I-Class Of Recommendation, COR; A-Level Of Evidence, LOE) indication in patients with symptomatic severe mitral stenosis. We aim to examine the clinical profile and in-hospital results of PTMC for mitral stenosis. Methods: A cross-sectional retrospective study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center from April 2020 to May 2022. A structured questionnaire was used to collect the data and ethical approval for conducting the study was taken from the Institutional Review Committee (IRC) of Institute of Medicine (IOM). The data was collected in Microsoft Excel (Ver. 2013). For statistical analysis, SPSS 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) Association was measured using a parametric and non-parametric test (depending upon the distribution of data) and p value < 0.05 was considered significant. Results: A total of 104 patients who met the inclusion criteria underwent PTMC during the study period. The mean age group of the patient was 41.7 ± 12.5 years, of which 23 (22.1%) were males and 81 (78.9%) were females. Mean mitral valve area prior to PTMC was 0.98 ± 0.19 mm2 that increased to 1.69 ± 0.19 mm2 after the procedure and it was statistically significant (p=<0.001). The post PTMC MVA varied with PTMC Wilkin's score with less than or equal to 8 having favorable outcomes. Conclusion: Successful PTMC is highly influenced by the patients' increasing age, valve morphology (calcification, thickness, mobility), Left atrial dimensions, Pre PTMC mitral valve area, Degree of Baseline mitral regurgitation. Post procedure development of MR is usually well tolerated but rarely be severe enough requiring surgical valve replacement.
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Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Cateterismo Cardíaco , Resultado do Tratamento , Ecocardiografia TransesofagianaRESUMO
Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased risk of heart failure, stroke, and death. In current medical practice, multimodality imaging is routinely used in the management of AF. Twenty-one years ago, the ACUTE trial (Assessment of Cardioversion Using Transesophageal Echocardiography) results were published, and the management of AF changed forever by incorporating transesophageal echocardiography guided cardioversion of patients in AF for the first time. Current applications of multimodality imaging in AF in 2022 include the use of transesophageal echocardiography and computed tomography before cardioversion to exclude left atrial thrombus and in left atrial appendage occlusion device implantation. Transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance are clinically used for AF ablation planning. The decision to use a particular imaging modality in AF is based on patient's characteristics, guideline recommendation, institutional preferences, expertise, and cost. In this first of 2-part review series, we discuss the preprocedural role of echocardiography, computed tomography, and cardiac magnetic resonance in the AF, with regard to their clinical applications, relevant outcomes data and unmet needs, and highlights future directions in this rapidly evolving field.