Incremental benefit of three-dimensional transthoracic echocardiography in the assessment of left atrial appendage aneurysm leading to severe extrinsic compression of a coronary artery.

Left atrial appendage aneurysm (LAA AN) is a rare disease entity, which can be congenital or acquired in nature. We report an adult patient with LAA AN presenting with anginal chest pain in whom live/real time three-dimensional transthoracic echocardiography (3DTTE) provided incremental value over the two-dimensional (2D) technique in providing a more comprehensive assessment of the lesion. A literature review of the salient features of LAA AN is also provided in a tabular form.

Left Ventricular Aneurysm Repair with Endoaneurysmorrhaphy Technique: An Assessment of Two Different Ventriculotomy Closure Methods.

BACKGROUND: Left ventricular aneurysm is a serious mechanical complication of myocardial infarction and has an incidence of 10-35% after myocardial infarction. Ventricular aneurysm in patients with angina, heart failure, and ventricular arrhythmia should be surgically treated. Endoaneurysmorrhaphy is one of the repair techniques that results in better left ventricular geometry and function. After this surgical procedure the ventriculotomy is repaired either with Teflon felt strips or by direct suture of the epicardium. METHODS: In this study, we described the postoperative early outcomes of two ventriculotomy closing techniques such as Teflon felt versus direct closure after aneurysm repair. This retrospective study included a total of 73 patients (mean age > 70 years) with left ventricular aneurysm, who underwent endoaneurysmorrhaphy repair between 1997 and 2009. All selected patients were divided into two groups according to the ventriculotomy closure technique either by Teflon felt or direct by epicardial closure. The pre-, intra-, and postoperative results of these patients were analyzed accordingly. RESULTS: The postoperative early mortality rate and postoperative bleeding were not significantly different between the Teflon felt and primary closure groups (P = .246 and P = .371 respectively), but postoperative arrhythmias were significantly higher in the Teflon felt repair group (P = .049). CONCLUSION: Endoaneurysmorrhaphy is a better surgical technique in left ventricle aneurysm to restore the internal contour and preserve the surface anatomy of the ventricle. The ventriculotomy closure can be performed with two different approaches, including Teflon felt strips or by direct suture of the epicardium. Based on this study's findings, two repair techniques have similar impact on the early outcomes. However, with overall outcomes with respect to Teflon felt repair, direct closure of the ventriculotomy after endoaneurysmorrhaphy was superior.

Volumetric and functional assessment of a left ventricular aneurysm from a single acquisition by three-dimensional speckle-tracking echocardiography (from the MAGYAR-Path Study).

Three-dimensional speckle-tracking echocardiography (3DSTE) is accepted as a reliable and feasible method in the quantification of left ventricular (LV) volumes, strains and rotational characteristics. This case aimed to demonstrate the diagnostic importance of 3DSTE in volumetric and functional assessment of an LV aneurysm.

Assessment of P-wave dispersion in children with atrial septal aneurysm.

BACKGROUND: This was a prospective controlled study to determine the P-wave duration and P-wave dispersion in patients with atrial septal aneurysm. METHODS: A total of 41 children with atrial septal aneurysm, including 21 boys and 20 girls (mean age 11.85 ± 3.8 years), and 32 controls, including 17 boys and 15 girls (mean age 12.3 ± 2.9 years), were included. P-wave dispersion was calculated from the 12-lead electrocardiogram. Cardiac functions, morphology of the aneurysm, and left atrial diameter were measured using conventional echocardiography. The diagnosis of atrial septal aneurysm was made when the base of the aneurysms with an excursion ratio ≥25% was found on echocardiography. RESULTS: There was no significant difference between the patient and control groups in demographic, clinical findings, and M-mode echocardiographic parameters. The P-wave dispersion in patients with atrial septal aneurysm was significantly longer compared with the control group (64.4 ± 13.4 ms; p < 0.0001). Similarly, the the maximum duration of the P wave in the patient group was significantly longer compared with the control group (106.1 ± 13.3 ms; p < 0.001). The P-wave duration and dispersion were not correlated with age, gender, systolic and diastolic blood pressure, or m-mode echocardiographic parameters. CONCLUSIONS: This study shows that P-wave dispersion is delayed in atrial septal aneurysm patients. Prolonged P-wave dispersion was determined to indicate electrical disturbance, and therefore it has an increased electrocardiographic risk of atrial arrhythmia in children with atrial septal aneurysm.

Sinus of valsalva aneurysms: assessment with cardiovascular MRI.

OBJECTIVE: The aim of this article is to present the role of cardiovascular MRI in the assessment of sinus of Valsalva aneurysms. An imaging protocol is described, along with a systematic approach to interpret MR findings and a synopsis of key findings. CONCLUSION: Radiologists should have a systematic approach to the assessment and evaluation of sinus of Valsalva aneurysms to facilitate optimal patient management.

Comprehensive assessment of left ventricular pseudo-aneurysms with magnetic resonance imaging.

In a small number of patients, myocardial infarction, trauma, infection or cardiac surgery are complicated by incomplete wall rupture and pseudo-aneurysm formation. We describe the advances made in the non-invasive assessment of this condition with the introduction of magnetic resonance imaging (MRI) and discuss the value of specific MRI techniques for comprehensive structural and functional cardiac assessment.

Left ventricular aneurysm: comprehensive assessment of morphology, structure and thrombus using cardiovascular magnetic resonance.

AIM: To demonstrate that cardiac magnetic resonance (CMR) techniques provide unique and definitive information on the presence, location, size and nature of left ventricular aneurysm and pseudoaneurysm, the presence of thrombus and the viability of myocardium. METHOD: A retrospective study of 27 patients with a final diagnosis of left ventricular aneurysm or pseudoaneurysm, who underwent CMR at a tertiary referral centre in the period between 2000 and 2003. RESULTS: In 7 cases the correct diagnosis of true aneurysm was confirmed; in 7 cases previously unsuspected thrombus was identified; in 7 cases an unsuspected pseudoaneurysm was identified; and in a further 6 cases a previously unsuspected aneurysm was identified. CONCLUSION: CMR refined the diagnosis in the majority of patients with left ventricular aneurysm, and should be considered in all cases of confirmed or suspected left ventricular aneurysm.

Right atrial tumor arising on an atrial septal aneurysm. Assessment by MR imaging.

An elderly women presenting with transient ischemic events underwent transesophageal echocardiography, which detected an aneurysm of the interatrial septum. A tumor protruding from the right atrial aspect of the aneurysm also was found incidentally. Not only was magnetic resonance (MRI) imaging helpful in better characterizing the aneurysm, but also the use of gadolinium diethylaminetriamine pentaacetic acid permitted differentiation between the tumor and adherent thrombus. To the best of our knowledge, this represents the first report of a tumor arising from an atrial septal aneurysm.

Echocardiographic assessment of aneurysm of the aortic valve caused by infective endocarditis--a case report.

No aneurysm of the aortic valve associated with infective endocarditis has yet been reported. This report describes the clinical echocardiographic and pathologic findings in a patient who developed infective endocarditis resulting in aneurysm of the non-coronary cusp with aortic regurgitation. Surgical treatment was performed because of gradual expansion of the aneurysm and gradual thinning of its wall. Two-dimensional and color Doppler echocardiographies proved useful for the initial diagnosis and serial follow-up of this unusual case and for its successful surgical management.

The role of intraoperative two-dimensional echocardiography in the assessment of thoracic aorta pathology.

The role of intraoperative two-dimensional echocardiography is discussed in 15 consecutive patients with thoracic aorta pathology undergoing cardiac surgery. A 5 MHz mechanical scanner was used before and immediately after cardiopulmonary bypass. In 5 patients intraoperative two-dimensional studies revealed crucial morphologic information which, consequently, had a marked influence on their planned surgical procedure. In 3 patients the findings provided additional information whereas in the remaining patients the intraoperative echocardiographic findings confirmed the preoperative diagnosis. Following surgery the adequacy of cardiac repair was assessed and, in one patient, epicardial echocardiography indicated the necessity for reoperation. The application of intraoperative two-dimensional echocardiography leads to a better understanding of the pathology involved and facilitates a more appropriate decision concerning the surgical procedure.

Assessment of left ventricular aneurysm resectability by two-dimensional echocardiography.

Mortality of surgical resection of a left ventricular (LV) aneurysm is largely determined by size and function of nonaneurysmal or residual myocardium. A residual myocardial index was determined using 2-dimensional echocardiography (2-D echo) in 56 consecutive patients scheduled for LV aneurysmectomy, and these results were correlated with surgical outcome. The index was calculated using 3 apical cross sections: the 2- and 4-chamber views and the long-axis view. These views were recorded at mutual angles of 60 degrees. In each view the end-diastolic length of normally moving endocardium of the 2 opposite walls was expressed as a fraction of the end-diastolic LV long axis. The index was assessed by averaging the 6 ratios obtained. In 41 survivors the index ranged from 40 to 71% (mean +/- standard deviation 53 +/- 7.8) and in 15 nonsurvivors from 29 to 67% (mean 38 +/- 8.5, p less than 0.01). With 1 exception, this echocardiographic index sharply separated survivors from nonsurvivors. The lower limit to survive aneurysmectomy was 40%.

Left ventricular aneurysm and the prediction of left ventricular enlargement studied by two-dimensional echocardiography: quantitative assessment of aneurysm size in relation to clinical course.

A retrospective study was performed to elucidate the process of left ventricular aneurysm formation and its influence on left ventricular enlargement based on serial two-dimensional echocardiographic observations from 150 consecutive patients with first acute anterior myocardial infarction. Echocardiograms were available and interpretable through the entire period of observation in 68 patients. Because of early death in 13 patients, echocardiograms of 55 patients, 22 with and 33 without aneurysm, were analyzed from 1 to 28 days after infarction. Patients with aneurysms were separated into two groups with large (group 1, 11 patients) and small aneurysms (group 2, 11 patients) on the basis of ratios of aneurysm to overall left ventricular circumferential length [Lcf-LV(RAO)] and area [Area-LV(RAO)], i.e., Lcf(An/LV)-RAO and Area(An/LV)-RAO, respectively, in the right anterior oblique equivalent view at the time of aneurysm formation, with reference to Forrester's subset. Group 1 consisted of patients with Lcf(An/LV)-RAO of 0.4 or greater or Area(An/LV)RAO of 0.3 or greater while group 2 included patients with Lcf(An/LV)-RAO less than 0.4 or Area(An/LV)-RAO less than 0.3. In the test for time trend in these groups with a one-way analysis of variance, Lcf-LV in RAO equivalent and apical four-chamber views and Area-LV in apical four-chamber view effectively separated group 1 from groups 2 and 3 (without aneurysm) with significance (p less than .005, p less than .01, and p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Noninvasive assessment of patients with ischemic heart disease.

The diagnosis of acute myocardial infarction can be strengthened in selected patients by the use of pyrophosphate scanning. Such scans may provide useful information about the relative size of myocardial infarction. Radionuclide angiography and two-dimensional echocardiography are useful for determining the extent of myocardial dysfunction following infarction. Two-dimensional echocardiography is especially suitable for use in the acute care setting and can provide excellent anatomic images to help diagnose the mechanical complications of infarction, such as mural thrombus formation and ventricular septal rupture. Therefore, many investigators believe that two-dimensional echocardiography is indicated for evaluating every myocardial infarction patient. The predischarge assessment of the postinfarction patient is critical for planning a rational rehabilitation program. Uncomplicated patients should have low level treadmill exercise tests to detect unsuspected problems which indicate a poor prognosis, such as angina pectoris. Continuous ambulatory electrocardiograms recordings are useful for excluding prognostically important, but asymptomatic, dysrhythmias. Two-dimensional echocardiography and radionuclide angiography also are helpful for assessing the extent of myocardial dysfunction and defining left ventricular aneurysms and mural thrombi.

[201Thalium scintimetry of the heart as a new method for functional assessment in coronary heart disease (author's transl)]. / Die 201-Thallium-Szintimetrie des Herzens als neues Verfahren zur funktionellen Differenzierung der koronaren Herzkrankheit

201Tl scintimetry of the heart was used for a statistical comparison between normal people (10 individuals) and those with acute anterior wall infarcts (5 patients), anterior wall hypokinesia (5 patients) and dyskinesia (8 patients). Numerical results were obtained by a computer and depended on the relative 201tl storage in the left ventricular myocardium (64 mm2 area) related to mediastinal background uptake. It was found that maximal myocardial uptake, compared with mediastinal activity (about 290%) did not differ between normals and patients with coronary heart disease. Aneurysms of the anterior ventricular wall showed a reduction (with the ventricle perpendicular to the collimator) of 45.8%; in hypokinesia and acute myocardial infarcts, it was 64.2% and 64.6% respectively (normal 82.6%). 201Tl uptake in aneurysms (42.4%) approached background activity (36%) if a projection parallel to the collimator was used. 201Tl scintimetry provides a means of defining functional ability of the myocardium (depdending on myocardial perfusion and mass). Aneurysms and hypokinetic portions of the myocardium can be differentiated statistically from normal 201Tl uptake.

131Cs myocardial scintigraphy. Application to assessment of anterior myocardial infarction.

Earlier studies have indicated that caesium-131 is a good myocardial scanning agent for the demonstration of anterior infarcts. One hundred and ten patients with documented anterior myocardial infarction were studied by 131Cs myocardial scintigraphy. An anterior area of decreased uptake of caesium was noted in all but 3 subjects whose necrotic zone was likely to be of small dimensions. In 20 cases, the scintigram showed a definite, sometimes very large, cold area whereas the electrocardiogram failed to display any diagnostic feature of myocardial necrosis. In most of the latter instances, the electrocardiographic diagnosis was obscured by the presence of intraventricular conduction disturbances. In order to visualize the intracardiac cavities, the 131Cs investigation was usually completed by a 113mIn scintigram, which allowed recognition of a parietal aneurysm in 12 of the 18 patients with extensive anterior lesions. In each case, an index of necrosis was computed from planimetric measurements of the infarcted area as compared to the total left ventricular surfact in both the anteroposterior and left anterior oblique projections. This index was shown to correlate with the incidence of major complications developing after the acute episode of coronary occlusion. The sensitivity, specificity, and accuracy of the method are briefly discussed. It is felt that myocardial scintigraphy represents a sound approach to the semiquantitative assessment of anterior myocardial infarction; the clinical usefulness of the technique seems sufficiently demonstrated to prompt further research in this field.