Real-time three-dimensional transthoracic echocardiography in daily practice: initial experience.

AIM OF THE WORK: To evaluate the feasibility and possible additional value of transthoracic real-time three-dimensional echocardiography (RT3D-TTE) for the assessment of cardiac structures as compared to 2D-TTE. METHODS: 320 patients (mean age 45 ± 8.4 years, 75% males) underwent 2D-TTE and RT3D-TTE using 3DQ-Q lab software for offline analysis. Volume quantification and functional assessment was performed in 90 patients for left ventricle and in 20 patients for right ventricle. Assessment of native (112 patients) and prosthetic (30 patients) valves morphology and functions was performed. RT3D-TTE was performed for evaluation of septal defects in 30 patients and intracardiac masses in 52 patients. RESULTS: RT3D-TTE assessment of left ventricle was feasible and reproducible in 86% of patients while for right ventricle, it was (55%). RT3D-TTE could define the surface anatomy of mitral valve optimally (100%), while for aortic and tricuspid was (88% and 81% respectively). Valve area could be planimetered in 100% for the mitral and in 80% for the aortic. RT3D-TTE provided a comprehensive anatomical and functional evaluation of prosthetic valves. RT3D-TTE enface visualization of septal defects allowed optimal assessment of shape, size, area and number of defects and evaluated the outcome post device closure. RT3D-TTE allowed looking inside the intracardiac masses through multiple sectioning, valuable anatomical delineation and volume calculation. CONCLUSION: Our initial experience showed that the use of RT3D-TTE in the assessment of cardiac patients is feasible and allowed detailed anatomical and functional assessment of many cardiac disorders.

Organized intrapericardial haematoma: a rare cause of heart failure after 2 years of trauma.

Intrapericardial organized haematoma secondary to blunt chest trauma is an extremely rare cause of constrictive pericarditis. We report a 30-year-old male who presented with heart failure for 12 months and was found to have an organized intrapericardial haematoma secondary to blunt chest trauma in a road traffic accident 2 years prior. The use of multiple imaging modalities including two-dimensional (transthoracic and transoesophageal) echocardiogram and cardiac magnetic resonance imaging established the diagnosis. Surgical excision of the haematoma and removal of the constricting pericardium relieved his symptoms.

Right atrial metastasis mimicking myxoma in advanced hepatocellular carcinoma.

Hepatocellular carcinoma is the most common primary tumor of the liver accounting for 4.6% of all new human cancers. Cardiac metastasis in hepatocellular carcinoma is an uncommon secondary cardiac malignancy. We described two cases of advanced hepatocellular carcinoma with large masses in the right atrium mimicking atrial myxoma. The RA masses were incidentally detected during two-dimensional echocardiographic examination.

Imaging of ventricular septal tumor in an asymptomatic adolescent using multiple modalities.

Primary cardiac tumors are rare at all ages, and especially so in childhood, where the most prevalent type of benign cardiac masses are rhabdomyomas followed by fibromas, both of which have a predilection for ventricular septum. We report an unusual case of a tumor involving the ventricular septum in an asymptomatic 17-year-old adolescent who has been known to have this tumor for 10 years. The use of multiple imaging included myocardial contrast two-dimensional echocardiography, real time three-dimensional echocardiography (with and without myocardial contrast), and magnetic resonance imaging supported the diagnosis of cardiac rhabdomyoma.

Bicaval obstruction complicating right atrial tuberculoma: the diagnostic value of cardiovascular MR.

Cardiac tuberculosis is rare and usually involves the pericardium. Myocardial tuberculoma is a very rare occurrence and only a few cases were reported. We describe the use of cardiovascular magnetic resonance in the diagnosis of a rare case of cardiac tuberculoma involving the right atrium which was complicated by a bicaval obstruction. The patient made a remarkable improvement with the anti-tuberculous treatment. To our knowledge, this complication has never been reported in relation to cardiac tuberculoma.

Biatrial aspergillosis in a patient with immunocompetency.

A 24-year-old man presented with a 24-hour history of pain and numbness in his left arm. The patient's clinical presentation of peripheral embolism was corroborated by angiography. Echocardiographic study showed masses in both right and left atria. Pathologic specimen from the embolus confirmed the diagnosis of aspergillosis.

Central role of real-time three-dimensional echocardiography in the assessment of intracardiac thrombi.

UNLABELLED: The current study was designed to evaluate the feasibility and clinical utility of real-time 3-dimensional echocardiography (RT3DE) for detection of intracardiac thrombi with comparison to 2-dimensional echocardiography (2DE). The study included 45 consecutive patients with intracardiac thrombi detected by routine 2DE (mean age 45 +/- 8.4 years, 75% males). The relevant features of the thrombus by 2DE and RT3DE (site, shape, and number) were assessed according to a subjective four-point score index for image quality (1 = not visualized, 2 = inadequate, 3 = sufficient and 4 = excellent). Measurements included: maximum diameter and volume. 2DE and RT3DE detected 45 thrombi (34 in the left ventricle, six in the left atrium, four in the left atrial appendage, four in the right atrium, and two in the right ventricle). RT3DE could detect seven additional thrombi in five patients (three in the left atrial appendage and four in the left ventricular apex). Visualization score by 2DE and RT3DE was comparable (Kappa index: 7.2). RT3DE measurements of maximum diameter were well correlated with 2DE (R(2) = 0.88, P < 0.01) and showed better interobserver agreement than 2DE (2.88, -1.92 vs. 5.33, -3.87, respectively). RT3DE was superior to 2DE for assessment of thrombus mobility, differentiation between the thrombus and myocardium, and delineation of the changes in thrombi structure, e.g. calcification, degeneration, or lysis. In addition, volume calculation could be obtained by RT3DE only. IN CONCLUSION: RT3DE is comparable to 2DE for the assessment of the intracardiac thrombi and provided more detailed information beyond the scope of the established 2DE.

Partial anomalous pulmonary venous connection associated with Lutembacher's syndrome.

Lutembacher's syndrome is a rare combination of congenital atrial septal defect and mitral stenosis (almost always rheumatic). The hemodynamic effect of this combination makes the clinical diagnosis difficult due to a wide variation of clinical presentation. Echocardiography and cardiac catheterization are useful tools for proper diagnosis and planning of the therapeutic strategy. We present a 28-year-old female with Lutembacher's syndrome associated with partial anomalous pulmonary venous connection (PAPVC), which was surgically corrected. To our knowledge, this combination has never been reported in the literature.

Multivalvular infective endocarditis in a tetralogy of fallot.

Infective endocarditis (IE) is still a problem in patients with adult congenital heart disease. Tetralogy of Fallot (TOF) is one of the most important manifestations of congenital heart disease, which carries a high risk for the development of IE. We present an 18-year-old male with TOF complicated by an aggressive form of IE involving all cardiac valves.