3D TEE imaging in a patient with severe tricuspid regurgitation with dextrocardia and tricuspid commissural prolapse.

Although dextrocardia is a rare congenital anomaly, it may be accompanied by numerous pathologies. Tricuspid valve prolapse is an extremely uncommon cause of primary tricuspid valve disease, as is its association with dextrocardia. In this instance, we wished to share our knowledge of tricuspid commissural prolapse together with dextrocardia, which we augmented with 3D images.

The role of three dimensional transesophageal echocardiography in predicting the effect of cardiac resynchronization therapy on mitral regurgitation in patients with low ejection fraction heart failure.

PURPOSE: Cardiac resynchronization therapy (CRT) positively affects the improvement of functional mitral regurgitation (MR) in patients with heart failure with reduced ejection fraction (HFrEF). However, geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to improving mitral regurgitation after CRT have not been clearly defined. Our study aimed to evaluate the geometric parameters of mitral valve apparatus measured with three-dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of MR after CRT. METHODS: In this prospective study, we included thirty patients with moderate or severe MR and HFrEF planned for CRT implantation who had an indication for TEE. Before CRT implantation, effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed. Detailed quantitative measurements of the mitral valve were done from recorded images by 3D TEE. ERO and RV measurements were repeated to evaluate MR at the end of the third month. RESULTS: There were no significant changes in left ventricular EF and left ventricular diameters at third-month follow-up, whereas ERO and RV values were decreased. The posterior leaflet angle was higher in the non-responder group than the responder group (28.93 ± 8.41 vs 41.25 ± 10.90, p = 0.006). The posterior leaflet angle was an independent predictor of decreased RV and ERO. CONCLUSION: Among HFrEF patients with moderate or severe functional MR who underwent CRT implantation had a lower posterior leaflet angle, which was measured by 3D TEE, in the patient group whose MR improved after CRT.

Impact of image integration on clinical and procedural outcomes of radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized controlled trials.

BACKGROUND: The purpose of this meta-analysis was to evaluate the impact of image integration technique on clinical and procedural outcomes in patients undergoing radiofrequency catheter ablation of atrial fibrillation with a three-dimensional electroanatomic mapping system. METHODS: Randomized controlled trials were identified through a systematic literature search of PubMed and CENTRAL databases from inception to April 2020. The primary outcome was arrhythmia recurrence during the follow-up period. The secondary outcomes were the difference in total procedural time and fluoroscopy time. RESULTS: Four studies with a total of 749 patients were included. The pooled result showed no statistically significant difference between the groups with respect to arrhythmia recurrence (RR, 0.75; 95% CI, 0.47-1.21), fluoroscopy time (MD, -6 minutes; 95% CI, -23.4 to 11.3), and total procedural time (MD, 1.1 minutes; 95% CI, -31.8 to 34.1). CONCLUSION: Image integration to guide radiofrequency catheter ablation for patients with atrial fibrillation does not improve clinical and procedural outcomes.

Heart failure due to aorto-right atrial fistula and successful treatment with percutaneous closure.

Aorto-atrial fistula is a rare anomaly of the heart that may be the result of congenital or acquired conditions, such as bacterial endocarditis, paravalvular abscess, aortic dissection, or a complication of cardiac surgery. A 50-year-old female patient presented at the clinic with the complaint of dyspnea and abdominal distention due to ascites. On admission, her functional capacity was New York Heart Association (NYHA) class III. A physical examination revealed a systolic murmur, which was best audible in the right parasternal side, ascites, and hepatomegaly. An aorto-right atrial fistula was detected using transthoracic echocardiography and confirmed with transesophageal echocardiography and aortography. The patient had a history of previous cardiac surgery, anticoagulant use, and heart failure; therefore, percutaneous intervention was preferred to surgery as a result of the high surgical risk. A successful closure of the fistula was performed with an Amplatzer Duct Occluder II device. The patient demonstrated a dramatic response to the treatment, resulting in a decrease in the ascites and halving of her diuretic dose within 1 week. Her functional capacity improved to NYHA class II, and right atrial pressure decreased to 8 mmHg after a month.

Transvenous extraction of a 26-year-old Accufix atrial lead using TightRail rotating dilator sheath.

With the increasing number of implanted pacemakers and implantable cardioverter defibrillators, removal is required more frequently. Presently described is the transvenous extraction of a 26-year-old Accufix atrial lead using a mechanical dilator sheath. A 50-year-old male patient was admitted to the clinic with a pacemaker pocket infection. The atrial lead was an Accufix Bipolar J-Atrial active fixation lead, a model that was recalled in 1994, after reports of 2 deaths and 2 nonfatal injuries related to protrusion of the J retention wire. Both the atrial and ventricular leads were extracted using a mechanical dilator sheath. The Pacemaker Lead Extraction with the Excimer Sheath (PLEXES) Trial reported that of the 57 Accufix leads randomized to a non-laser approach, only 47% were removed successfully, compared with 96% of laser-randomized cases. Since laser sheaths are not available in Turkey, use of a mechanical dilator sheath was required. To our knowledge, this is the oldest Accufix lead extracted with a non-laser sheath. During the extraction of the ventricular lead, the tip of the lead broke off inside the right ventricle and the residual part was left inside the heart. During 3 months of follow-up, no signs of infection or any other undesirable events were encountered.