RESUMO
BACKGROUND: Transthoracic echocardiography (TTE) has been traditionally considered inadequate for the diagnosis of acute type A aortic syndrome (AAAS). In the last decade, high-resolution probes and harmonic imaging have been implemented in new echocardiographic systems. However, studies assessing the diagnostic accuracy of TTE for the identification of AAAS in large populations using modern ultrasound technology are lacking. METHODS: The diagnostic value of harmonic imaging TTE was assessed in 270 consecutive patients with suspected AAAS in whom TTE was the initial diagnostic test. RESULTS: Acute type A aortic syndrome was diagnosed in 67 patients and excluded in 203 patients (disease prevalence 25%). Sixty-two patients had a classic acute type A aortic dissection, and 5, an acute type A intramural hematoma. Image quality achieved was considered optimal in 244 patients (90%). In the whole study population, TTE had sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of AAAS of 87%, 91%, 75%, and 95%, respectively. When evaluating only patients with optimal image quality, these values increased to 97%, 100%, 100%, and 99%, respectively. Forty-seven patients with clear-cut evidence of AAAS were transferred immediately to the operative room, where transesophageal echocardiography confirmed the diagnosis obtained by TTE in all patients. CONCLUSIONS: Transthoracic echocardiography is a useful imaging modality for the diagnosis of classic acute type A aortic dissection. It cannot be used as the sole screening technique for detecting AAAS, but in the light of the predictive values observed, patients with optimal image quality and clear-cut diagnosis of AAAS should proceed to the operative room, whereas in patients with negative or indeterminate studies, other imaging techniques are needed to refine the diagnosis.
Assuntos
Aneurisma Aórtico/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Idoso , Ecocardiografia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , SíndromeRESUMO
The dimensions of the entire aorta at different anatomic levels were measured by transthoracic 2-dimensional echocardiography in 162 consecutive patients with isolated bicuspid aortic valves (BAVs) without significant aortic valve dysfunction. Aortic dilation involved the aortic root and the ascending aorta but was not present in the descending and abdominal aorta. A significant increase in the dimensions of the aortic arch was found in patients with BAVs aged >40 years. Ascending aortic diameter and the extension of aortic dilation were significantly correlated with age, but no correlation was found between aortic dimensions and aortic valve morphology.
Assuntos
Aorta/patologia , Estenose da Valva Aórtica/patologia , Valva Aórtica/anormalidades , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Aorta/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Criança , Pré-Escolar , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/patologia , Ecocardiografia , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Pessoa de Meia-IdadeRESUMO
Patients with a left atrial thrombus are considered as being at high risk for thromboembolic events. Although embolization may be asymptomatic, embolic events related to large thrombi are usually clinically manifest and tend to be associated with a worse prognosis. We describe the very unusual case of a patient with atrial fibrillation in whom two-dimensional echocardiography revealed a large, pedunculated, highly mobile left atrial thrombus attached by a thin stalk to the interatrial septum. Because of the high risk of embolism the patient was submitted to urgent surgery. At surgery, only the stalk was found. No mass was visualized at intraoperative transesophageal echocardiography. The patient had an uneventful postoperative course without signs of embolism. Computed tomography of the brain did not reveal any cerebral infarction.
Assuntos
Embolia/etiologia , Cardiopatias/patologia , Trombose/patologia , Idoso , Fibrilação Atrial/complicações , Ecocardiografia , Feminino , Átrios do Coração , Humanos , PrognósticoAssuntos
Neoplasias Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valva Pulmonar , Idoso , Ecocardiografia Transesofagiana , Feminino , Neoplasias Cardíacas/patologia , Doenças das Valvas Cardíacas/patologia , Humanos , Valva Pulmonar/diagnóstico por imagemRESUMO
During the past three decades, interventional cardiology and cardiac surgery have found solutions even for the most complex congenital heart malformations with an overall low operative mortality. A careful clinical and instrumental follow-up of postoperative congenital heart disease patients is fundamental not only to prevent complications and/or to treat eventual residua and sequelae, but also to modify future surgical strategies on the basis of long-term results. To be able to give a correct prognostic meaning to the data collected during the follow-up, the cardiologist should have an excellent knowledge of the native defect, the surgical technique and the post-surgical anatomy and physiology. Major cardiological concerns during a follow-up after corrective surgery are: arrhythmias; heart failure; cyanosis and erythrocytosis; and infective endocarditis. Psychosocial needs, such as employment, contraception, pregnancy and physical exercise, are very important to enable a 'normal' life, complying with the postoperative hemodynamic situation of the patients.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas/cirurgia , Atividade Motora , Cuidados Pós-Operatórios , Sobreviventes , Adolescente , Serviços de Saúde do Adolescente , Adulto , Atitude Frente a Saúde , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Continuidade da Assistência ao Paciente , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/etiologia , Humanos , Itália , Assistência de Longa Duração , Prognóstico , Medição de Risco , Síndrome , Resultado do TratamentoRESUMO
The association of a bicuspid aortic valve (BAV) with abnormalities of the proximal thoracic aorta, including dilatation, aneurysm and dissection, has been previously described, leading to the hypothesis of a common underlying developmental defect involving the aortic valve and the aortic wall. Consequently, any patient with BAV should receive a careful assessment not only of the valve function, but also of the aortic root and the ascending aorta. Dilatation of the proximal thoracic aorta is a common finding in patients with BAV and is believed to be related to aortic rupture and dissection. Because progressive dilatation can occur, careful long-term surveillance of the aortic dimensions is required. Prophylactic surgical repair of the dilated aorta should be recommended more aggressively for patients with BAV than for those with a tricuspid aortic valve. However, the optimal timing of aortic surgery in BAV patients remains uncertain because of the limited data available on the natural history of asymptomatic aortic dilatation.
Assuntos
Aorta Torácica/anormalidades , Doenças da Aorta/congênito , Valva Aórtica/anormalidades , Cardiopatias Congênitas/epidemiologia , Doenças das Valvas Cardíacas/congênito , Doenças da Aorta/epidemiologia , Doenças da Aorta/fisiopatologia , Doenças da Aorta/cirurgia , Criança , Dilatação Patológica , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/cirurgia , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , PrevalênciaRESUMO
We report a case of delayed detachment of the right coronary cusp, occurring 12 days after a motorcycle crash. Echocardiographic findings mimicked a type I De Bakey aortic dissection. A brief discussion of cause, evolution, diagnosis, and treatment is included.