RESUMO
We present two cases in whom live/real time three-dimensional transesophageal echocardiography (3DTEE) provided incremental value in the assessment of atherosclerotic disease in the aorta. In one patient, it identified additional atherosclerotic ulcers as well as thrombi within them which were missed by two-dimensional (2D) TEE. In both cases, the size of the large mobile atherosclerotic plaque was underestimated by 2DTEE as compared with 3DTEE. Furthermore, 3DTEE provided volume quantification of the thrombi and ulcers which is not possible by 2DTEE. The echocardiographic findings of atherosclerotic plaques were confirmed by computed tomography in one patient and by surgery in the other.
Assuntos
Doenças da Aorta/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Trombose/diagnóstico por imagem , Úlcera/diagnóstico por imagem , Idoso , Sistemas Computacionais , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: Recent studies have shown that epicardial adipose tissue (EAT) thickness is increased in patients with hypertension. In this study, we aimed to investigate the relation of EAT thickness with resistant hypertension (RHT). PARTICIPANTS AND METHODS: Study participants (n=150) were classified into three groups according to their office and ambulatory blood pressure measurements: RHT (n=50), controlled hypertension (CHT, n=50), and normotension (NT, n=50). All patients underwent a transthoracic echocardiographic examination to measure EAT thickness. RESULTS: Clinical and biochemical characteristics of the groups were similar, except the CRP level, which was significantly increased in hypertensive patients compared with patients with NT (P<0.001). EAT thickness differed significantly between groups (P<0.001). The highest values were obtained in the RHT group (4.64±1.24 cm), followed by the CHT (3.3±0.82 cm) and NT (2.6±0.76 cm) groups. Multivariate analysis indicated age, physical activity level, and EAT thickness as independent predictors of RHT. The optimal cut-off value of EAT thickness for detection of RHT was found to be 3.42 cm, with a sensitivity and specificity of 82 and 77%, respectively (AUC=0.87, 95% confidence interval 0.81-0.92, P<0.000). CONCLUSION: EAT can be effective on blood pressure by several mechanisms. In this study, for the first time in the literature, the association of EAT with RHT is reported.
Assuntos
Tecido Adiposo/patologia , Hipertensão/patologia , Pericárdio/patologia , Tecido Adiposo/fisiopatologia , Idoso , Pressão Sanguínea , Determinação da Pressão Arterial , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pericárdio/fisiopatologiaRESUMO
We describe the use of a nonstandard left infraclavicular approach in making the diagnosis of an infected valved conduit with two-dimensional transthoracic echocardiography. The patient was an adult with tetralogy of Fallot and pulmonary atresia who had undergone multiple surgical repair procedures. The initial diagnosis of infective endocarditis was made by transesophageal echocardiography. Both techniques demonstrated a single, large vegetation in the conduit. Live/real time three-dimensional transthoracic echocardiography, on the other hand, provided further information by demonstrating several additional vegetations in the conduit and more comprehensively assessed their size by enabling measurement of their azimuthal dimensions and volumes. The patient was treated with antibiotics with complete resolution of the vegetations.
Assuntos
Ecocardiografia Tridimensional , Endocardite Bacteriana/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Próteses e Implantes/microbiologia , Artéria Pulmonar/diagnóstico por imagem , Adulto , Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos , Endocardite Bacteriana/tratamento farmacológico , Ventrículos do Coração/microbiologia , Humanos , Masculino , Artéria Pulmonar/microbiologiaRESUMO
Currently, tricuspid valve infective endocarditis (TVIE) is encountered in daily clinical practice more frequently due to the increasing prevalence of illicit intravenous drug use and the implantation of intracardiac devices. In this study, we compared findings from intra-operative live/real time three-dimensional transesophageal echocardiograms (3DTEE) and two-dimensional transesophageal echocardiograms (2DTEE) of 10 patients who underwent surgery for native tricuspid valve (TV) endocarditis. Unlike 2DTEE, 3DTEE allowed en face visualization of the 3 TV leaflets from both, atrial and ventricular aspects, in 9 of the 10 cases. In the remaining patient, in whom 3DTEE could not identify all 3 leaflets en face, the TV was found essentially destroyed at surgery. Using 3DTEE, the number of vegetations was accurately reported when compared with the surgical record. Furthermore, the orientation of each vegetation was the same as noted in the surgical findings. 2DTEE missed the identification of vegetations in 5 patients. The attachment site of vegetations to the TV were also not characterized by 2DTEE in 5 patients. In all 10 cases, 3DTEE characterized the vegetations more accurately with larger dimensions, including those in the azimuthal axis, and volumes. In addition, a perivalvular abscess that lead to surgical intervention was identified by 3DTEE, however, missed by 2DTEE. In conclusion, 3DTEE allows en face visualization of the TV apparatus permitting accurate description of the number and dimensions of vegetations identified by our surgical standard, which ultimately informs patients' prognosis and dictates the timing and planning for surgical intervention. Its use should be in conjunction with 2DTEE when evaluating TVIE.
Assuntos
Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Estudos de Coortes , Endocardite/microbiologia , Endocardite/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Tricúspide/microbiologia , Valva Tricúspide/cirurgiaRESUMO
Aorta to pulmonary artery fistula is an uncommon and potentially fatal condition. This case is of a 48-year-old Caucasian male with congestive heart failure and multiple aortic valve replacement surgeries who presented with an acquired ascending aortic aneurysm to pulmonary artery fistula diagnosed using two-dimensional transthoracic echocardiography via nonstandard imaging windows. Three-dimensional transthoracic echocardiography using live/real time three-dimensional color Doppler was used to assess the size of the opening of the fistula, providing additional value. This patient was surgically managed and is doing well 8 months postoperation.
Assuntos
Aorta/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Tridimensional/métodos , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Aneurisma Aórtico/cirurgia , Fístula Arteriovenosa/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Resultado do TratamentoRESUMO
In this retrospective study, we identified 7 cases where Lambl's excrescences were identified by two-dimensional transesophageal echocardiography (2DTEE) and also had live/real time three-dimensional transesophageal echocardiography (3DTEE) studies available for comparison. We subsequently assessed them for the presence of Lambl's excrescences (LE) and nodules of Arantius (NA) on the aortic valve. After their identification, we qualitatively and quantitatively organized our findings by number, cusp location, measurements, and orientation if applicable. A greater number of LE was found by 3DTEE than 2DTEE (19 vs. 11, respectively). In all 3DTEE studies, their cusp attachment site, their x-, y-, and z-axis measurements, and orientation were clearly visualized and described. Only 3DTEE studies provided confident visualization of the cusp attachment sites. Similarly, a greater number of NA was found by 3DTEE than 2DTEE (21 vs. 5, respectively). The triad of NA was visualized in all 3DTEE studies and each was described using its x-, y-, and z- axis measurements. Only three 2DTEE studies provided reliable identification of the NA. In conclusion, we present further evidence of the incremental value of 3DTEE over 2DTEE in the qualitative and quantitative assessment of cardiac structures including LE and NA on the aortic valve.
Assuntos
Algoritmos , Valva Aórtica/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Ecocardiografia/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Aumento da Imagem/métodos , Idoso , Doença da Válvula Aórtica Bicúspide , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Hypertrophic cardiomyopathy (HCM) is the most common genetically transmitted cardiomyopathy. In patients resistant to medical management, myectomy is the surgical procedure of choice to reduce the symptoms of left ventricular outflow obstruction. Two-dimensional transesophageal echocardiography (2DTEE) has become part of the operative procedure by decreasing the incidence of postoperative complications. However, because of the three-dimensional geometry of left ventricular outflow tract, it is unable to comprehensively assess the location and severity of the obstruction and to provide accurate guidance during myectomy. In this study, 10 patients with HCM underwent live/real time three-dimensional transesophageal echocardiography (3DTEE) intra-operatively to measure the volume of the resected septum. This volume correlated well with the volume of the resected septal muscle directly obtained using a graduating cylinder containing water (r = 0.9, P < 0.000). 3DTEE may be potentially used as an adjunct to guide the surgeon in performing an adequate myectomy with a lower incidence of residual obstruction and complications such as an iatrogenic ventricular septal defect.