Asunto(s)
Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/etiología , Filtros de Vena Cava/efectos adversos , Anciano , Taponamiento Cardíaco/cirugía , Remoción de Dispositivos , Diagnóstico Diferencial , Ecocardiografía , Femenino , Humanos , Tomografía Computarizada por Rayos XAsunto(s)
Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/patología , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Síndrome de la Vena Cava Superior/etiología , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia con Aguja , Ecocardiografía/métodos , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Imagen por Resonancia Magnética/métodos , Masculino , Radiografía Torácica/métodos , Medición de Riesgo , Síndrome de la Vena Cava Superior/patología , Pared Torácica/diagnóstico por imagen , Pared Torácica/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Vacuum-assisted thrombectomy (VAT) is a mechanical suction device that can be deployed to aspirate thrombi in the heart and vascular system. Successful percutaneous aspiration of iliocaval, right heart, and pulmonary arterial thrombi have been reported, in addition to the debulking of intravascular and intracardiac masses and vegetations. VAT is indicated for patients who are poor surgical candidates and/or have a contraindication to thrombolysis. This review discusses the mechanism, current results, potential clinical indications, and limitations of VAT for iliocaval and intracardiac mass removal.
Asunto(s)
Trombosis Coronaria/cirugía , Cardiopatías/cirugía , Embolia Pulmonar/cirugía , Trombectomía/métodos , Trombosis/cirugía , Vacio , Trombosis de la Vena/cirugía , Atrios Cardíacos , Humanos , Venas CavasAsunto(s)
Bioprótesis , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Imagenología Tridimensional , Insuficiencia de la Válvula Mitral/cirugía , Falla de Prótesis , Tomografía Computarizada por Rayos X/métodos , Progresión de la Enfermedad , Disnea/diagnóstico , Disnea/etiología , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Reoperación/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Currently, there is no accepted protocol for left atrial appendage (LAA) imaging with intracardiac echocardiography (ICE). OBJECTIVE: This study aimed to assess the utility of ICE to reliably visualize the entire cavity of the LAA and propose a specific procedural protocol to achieve the above objective. METHODS: We created a three-dimensional reconstruction of the LAA, using two-dimensional ICE sections obtained from three different location (the right atrium [RA], right ventricle inflow [RVI], and right ventricular outflow [RVOT]). We then compared the three-dimensional LAA reconstruction by ICE with one obtained by cardiac computed tomography angiography (CCTA) for morphological and volume differences. RESULTS: Three-dimensional reconstruction with ICE could reliably reproduce the LAA as visualized with CCTA but only when ICE sampling was performed from at least two catheter positions. There was no statistically significant difference between LAA volumes obtained with ICE and CCTA (P = 0.33). The contribution of each anatomical location to the total volume was 17% ± 16.6%, 74% ± 13.3%, and 33% ± 26% for RA, RVI, and RVOT, respectively. CONCLUSION: In comparison with CCTA, the LAA can be reliably visualized in its entity by ICE, but only if multiple imaging positions (RA, RV inflow, and RVOT) are used.
Asunto(s)
Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Ablación por Catéter , Ecocardiografía/métodos , Anciano , Apéndice Atrial/cirugía , Fibrilación Atrial/diagnóstico por imagen , Femenino , Atrios Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Reproducibilidad de los ResultadosAsunto(s)
Cateterismo Cardíaco/métodos , Endocarditis Bacteriana/microbiología , Infecciones Estafilocócicas/complicaciones , Abuso de Sustancias por Vía Intravenosa/complicaciones , Insuficiencia de la Válvula Tricúspide/cirugía , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Catéteres Cardíacos , Ecocardiografía/métodos , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/cirugía , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Infecciones Estafilocócicas/diagnóstico , Abuso de Sustancias por Vía Intravenosa/diagnóstico , Resultado del Tratamiento , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/microbiologíaRESUMEN
The VARC (Valve Academic Research Consortium) for transcatheter aortic valve replacement set the standard for selecting appropriate clinical endpoints reflecting safety and effectiveness of transcatheter devices, and defining single and composite clinical endpoints for clinical trials. No such standardization exists for circumferentially sutured surgical valve paravalvular leak (PVL) closure. This document seeks to provide core principles, appropriate clinical endpoints, and endpoint definitions to be used in clinical trials of PVL closure devices. The PVL Academic Research Consortium met to review evidence and make recommendations for assessment of disease severity, data collection, and updated endpoint definitions. A 5-class grading scheme to evaluate PVL was developed in concordance with VARC recommendations. Unresolved issues in the field are outlined. The current PVL Academic Research Consortium provides recommendations for assessment of disease severity, data collection, and endpoint definitions. Future research in the field is warranted.
Asunto(s)
Válvula Aórtica/cirugía , Ensayos Clínicos como Asunto/métodos , Prótesis Valvulares Cardíacas/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Dispositivos de Cierre Vascular/normas , Válvula Aórtica/patología , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/cirugía , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/normas , Ensayos Clínicos como Asunto/normas , Ecocardiografía/métodos , Determinación de Punto Final , Prótesis Valvulares Cardíacas/normas , Humanos , Evaluación de Resultado en la Atención de Salud , Proyectos de Investigación , Medición de Riesgo , Índice de Severidad de la Enfermedad , SuturasRESUMEN
Congenital abnormalities of the pericardium are a rare group of disorders that include congenital absence of the pericardium, pericardial cysts, and diverticula. These congenital defects result from alterations in the embryologic formation and structure of the pericardium. Although many cases are incidentally found, they can present as symptomatic, life-threatening disease. Owing to their rarity, many cases are inappropriately diagnosed. Alterations in the embryologic formation and structure may result in the formation of these congenital abnormalities. We review the presentation, diagnosis, and management of congenital absence of the pericardium, pericardial cysts, and diverticula. A summary of multimodality imaging features is provided.
Asunto(s)
Divertículo/diagnóstico por imagen , Cardiopatías Congénitas/diagnóstico por imagen , Quiste Mediastínico/diagnóstico por imagen , Pericardio/anomalías , Angiografía Coronaria , Divertículo/embriología , Divertículo/fisiopatología , Divertículo/terapia , Ecocardiografía , Cardiopatías Congénitas/embriología , Cardiopatías Congénitas/fisiopatología , Cardiopatías Congénitas/terapia , Humanos , Imagen por Resonancia Magnética , Imagen por Resonancia Cinemagnética , Quiste Mediastínico/embriología , Quiste Mediastínico/fisiopatología , Quiste Mediastínico/terapia , Pericardio/diagnóstico por imagen , Pericardio/embriología , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE OF REVIEW: With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions. RECENT FINDINGS: Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures. This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.
Asunto(s)
Ecocardiografía/métodos , Endosonografía , Cardiopatías/diagnóstico por imagen , Corazón/diagnóstico por imagen , Apéndice Atrial/cirugía , Cateterismo Cardíaco , Ecocardiografía/efectos adversos , Ecocardiografía/economía , Ecocardiografía Transesofágica , Fenómenos Electrofisiológicos , Endosonografía/efectos adversos , Endosonografía/economía , Cardiopatías/terapia , Defectos del Tabique Interatrial/cirugía , Humanos , Curva de Aprendizaje , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
The VARC (Valve Academic Research Consortium) for transcatheter aortic valve replacement set the standard for selecting appropriate clinical endpoints reflecting safety and effectiveness of transcatheter devices, and defining single and composite clinical endpoints for clinical trials. No such standardization exists for circumferentially sutured surgical valve paravalvular leak (PVL) closure. This document seeks to provide core principles, appropriate clinical endpoints, and endpoint definitions to be used in clinical trials of PVL closure devices. The PVL Academic Research Consortium met to review evidence and make recommendations for assessment of disease severity, data collection, and updated endpoint definitions. A 5-class grading scheme to evaluate PVL was developed in concordance with VARC recommendations. Unresolved issues in the field are outlined. The current PVL Academic Research Consortium provides recommendations for assessment of disease severity, data collection, and endpoint definitions. Future research in the field is warranted.
Asunto(s)
Válvula Aórtica , Prótesis Valvulares Cardíacas/efectos adversos , Evaluación de Resultado en la Atención de Salud/métodos , Reemplazo de la Válvula Aórtica Transcatéter , Ensayos Clínicos como Asunto , Ecocardiografía , Humanos , Proyectos de Investigación , Medición de RiesgoRESUMEN
Acute pericarditis is an acute inflammatory disease of the pericardium, which may occur in many different disease states (both infectious and non-infectious). Usually the diagnosis is based on symptoms (chest pain, shortness of breath), electrocardiographic changes (ST elevation), physical examination (pericardial friction rub) and elevation of cardiac biomarkers. It may occur in isolation or be associated with an underlying inflammatory disorder. In routine clinical practice, acute pericarditis can be associated with myocarditis due to their overlapping etiologies.
Asunto(s)
Pericarditis , Pericardio/diagnóstico por imagen , Enfermedad Aguda , Diagnóstico Diferencial , Electrocardiografía/métodos , Humanos , Pericarditis/diagnóstico , Pericarditis/etiología , Pericarditis/fisiopatología , PronósticoAsunto(s)
Aneurisma de la Aorta Torácica/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Imagenología Tridimensional , Imagen Multimodal , Embolia Pulmonar/diagnóstico por imagen , Anciano de 80 o más Años , Disección Aórtica/parasitología , Disección Aórtica/cirugía , Angiografía/métodos , Aneurisma de la Aorta Torácica/patología , Aneurisma de la Aorta Torácica/cirugía , Procedimientos Quirúrgicos Cardiovasculares/métodos , Diagnóstico Diferencial , Ecocardiografía/métodos , Humanos , Masculino , Embolia Pulmonar/patología , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Imagen por Resonancia Cinemagnética/métodos , Marcapaso Artificial , Síndrome del Seno Enfermo/terapia , Vena Cava Superior/anomalías , Anciano , Estimulación Cardíaca Artificial/efectos adversos , Estimulación Cardíaca Artificial/métodos , Ecocardiografía/métodos , Estudios de Seguimiento , Humanos , Masculino , Medición de Riesgo , Síndrome del Seno Enfermo/diagnóstico por imagen , Resultado del Tratamiento , Malformaciones Vasculares/complicaciones , Malformaciones Vasculares/diagnóstico por imagen , Vena Cava Superior/diagnóstico por imagenAsunto(s)
Amiloidosis/diagnóstico por imagen , Fibrilación Atrial/diagnóstico por imagen , Mapeo del Potencial de Superficie Corporal , Cardiomiopatía Restrictiva/diagnóstico por imagen , Imagen Multimodal , Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Diagnóstico Diferencial , Ecocardiografía/métodos , Femenino , Humanos , Imagenología Tridimensional , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas , Imagen por Resonancia Cinemagnética/métodos , Persona de Mediana Edad , Cuidados Preoperatorios/métodosRESUMEN
BACKGROUND: Right heart thrombus in the absence of structural heart disease, atrial fibrillation, or intracardiac catheter is rare. It typically represents a thrombus migrating from the venous system to the lung, known as thrombi-in-transit, and can lead to a life-threatening pulmonary embolism. The optimal therapy for thrombi-in-transit remains controversial. We report our experience using percutaneous removal of right heart thrombus using vacuum aspiration. METHODS: Patients with right atrial mass who were hemodynamically stable and underwent vacuum thombectomy using the AngioVac system (AngioDynamics) at our institution were included in this analysis. Between December 2012 and August 2014, a total of 7 patients (2 men, 5 women) with a mean age of 51.5 years (range, 20-83 years) underwent right atrial thrombectomy. Data during the procedure and follow-up period were collected and analyzed. RESULTS: All patients were hemodynamically stable before the procedure. The procedure was considered successful in 6 patients. All patients survived through hospitalization. No periprocedural bleeding, stroke, or myocardial infarction occurred. One patient developed cardiogenic shock after the procedure that required extracorporeal membrane oxygenation support for <24 hours. There was no recurrent venous thromboembolism at a mean follow-up of 9 months. CONCLUSION: Vacuum-assisted thrombectomy can be a potential treatment option for hemodynamically stable patients with large right-sided intracardiac thrombus who are not surgical candidates.
Asunto(s)
Cateterismo Cardíaco/métodos , Cardiopatías/terapia , Trombectomía/métodos , Trombosis/terapia , Adulto , Anciano , Anciano de 80 o más Años , Ecocardiografía , Femenino , Estudios de Seguimiento , Atrios Cardíacos/diagnóstico por imagen , Cardiopatías/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trombosis/diagnóstico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vacio , Adulto JovenRESUMEN
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
Asunto(s)
Ecocardiografía Transesofágica/normas , Cardiopatías/complicaciones , Guías de Práctica Clínica como Asunto , Tromboembolia/etiología , Diagnóstico Diferencial , Cardiopatías/diagnóstico por imagen , Humanos , Tromboembolia/diagnósticoRESUMEN
Transcatheter therapies in structural heart disease have evolved tremendously over the past 15 years. Since the introduction of the first balloon-expandable valves for stenotic lesions with implantation in the pulmonic position in 2000, treatment for valvular heart disease in the outflow position has become more refined, with newer-generation devices, alternative techniques, and novel access approaches. Recent efforts into the inflow position and regurgitant lesions, with transcatheter repair and replacement technologies, have expanded our potential to treat a broader, more heterogeneous patient population. The evolution of multimodality imaging has paralleled these developments. Three- and 4-dimensional visualization and concomitant use of novel technologies, such as fusion imaging, have supported technical growth, from pre-procedural planning and intraprocedural guidance, to assessment of acute results and follow-up. A multimodality approach has allowed operators to overcome many limitations of each modality and facilitated integration of a multidisciplinary team for treatment of this complex patient population.
Asunto(s)
Enfermedades de las Válvulas Cardíacas/terapia , Insuficiencia de la Válvula Aórtica/terapia , Cateterismo Cardíaco , Diagnóstico por Imagen , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/fisiopatología , Prótesis Valvulares Cardíacas , Humanos , Insuficiencia de la Válvula Mitral/terapia , Insuficiencia de la Válvula Pulmonar/terapia , Insuficiencia de la Válvula Tricúspide/terapiaRESUMEN
Pericardial defects are a rare disorder that can be characterized as acquired or congenital. Congenital defects can be further characterized by location and size of the defect, e.g. left- or right-sided and partial or complete absence of the pericardium. While physical examination and electrocardiogram are not diagnostic, chest radiographs and echocardiography have findings that should alert the clinician to the absence of the pericardium as a possible diagnosis. Despite its limitations with visualizing the normal pericardium in areas of minimal adipose, cardiac magnetic resonance is currently the gold standard for diagnosing the congenital absence of the pericardium. Patients have a similar life expectancy to those without pericardial defects; however in certain cases, herniation and strangulation of cardiac chambers can be life threatening and lead to sudden cardiac death. Treatment is tailored to the patient's symptoms, presentation, and the size and location of the defect.