RESUMO
BACKGROUND AND OBJECTIVE: Cardiac computed tomography angiography (CTA) is the preferred modality for preoperative planning in aortic valve stenosis. However, it cannot provide essential functional hemodynamic data, specifically the mean transvalvular pressure gradient (MPG). This study aims to introduce a computational fluid dynamics (CFD) approach for MPG quantification using cardiac CTA, enhancing its diagnostic value. METHODS: Twenty patients underwent echocardiography, cardiac CTA, and invasive catheterization for pressure measurements. Cardiac CTA employed retrospective electrocardiographic gating to capture multi-phase data throughout the cardiac cycle. We segmented the region of interest based on mid-systolic phase cardiac CTA images. Then, we computed the average flow velocity into the aorta as the inlet boundary condition, using variations in end-diastolic and end-systolic left ventricular volume. Finally, we conducted CFD simulations using a steady-state model to obtain pressure distribution within the computational domain, allowing for the derivation of MPG. RESULTS: The mean value of MPG, measured via invasive catheterization (MPGInv), echocardiography (MPGEcho), and cardiac CTA (MPGCT), were 51.3 ± 28.4 mmHg, 44.8 ± 19.5 mmHg, and 55.8 ± 25.6 mmHg, respectively. In comparison to MPGInv, MPGCT exhibited a higher correlation of 0.91, surpassing that of MPGEcho, which was 0.82. Moreover, the limits of agreement for MPGCT ranged from -27.7 to 18.7, outperforming MPGEcho, which ranged from -40.1 to 18.0. CONCLUSIONS: The proposed method based on cardiac CTA enables the evaluation of MPG for aortic valve stenosis patients. In future clinical practice, a single cardiac CTA examination can comprehensively assess both the anatomical and functional hemodynamic aspects of aortic valve disease.
Assuntos
Angiografia por Tomografia Computadorizada , Hemodinâmica , Humanos , Angiografia por Tomografia Computadorizada/métodos , Masculino , Feminino , Idoso , Hemodinâmica/fisiologia , Pessoa de Meia-Idade , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valvopatia Aórtica/diagnóstico por imagem , Valvopatia Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Modelos Cardiovasculares , Ecocardiografia/métodosRESUMO
Lipid deposition has been considered one of the key factors in the occurrence of valvular heart disease (VHD) and a great potential target for the diagnosis of VHD. However, the development of lipid imaging technologies and efficient lipid specific probes is in urgent demand. In this work, we have prepared a lipid droplets (LDs) targeted fluorescence probe CPTM based on a push-pull electronic structure for the imaging of diseased aortic valves. CPTM showed obvious twisted intramolecular charge transfer (TICT) effect and its emission changed from 600 nm in water to 508 nm in oil. CPTM not only exhibited good biocompatibility and high photostability, but also impressive LDs specific imaging performance in human primary valvular interstitial cells and human diseased aortic valves. Moreover, the dynamic changes of intracellular LDs could be monitor in real-time after staining with CPTM. These results were expected to offer new ideals for the designing of novel LDs specific probes for further bioimaging applications.
Assuntos
Valva Aórtica , Corantes Fluorescentes , Humanos , Corantes Fluorescentes/química , Corantes Fluorescentes/síntese química , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Imagem Óptica , Gotículas Lipídicas/química , Cor , Valvopatia Aórtica/diagnóstico por imagem , Lipídeos/química , Lipídeos/análiseRESUMO
BACKGROUND: In congenital aortic valve disease, quantifying aortic regurgitation (AR) varies by the measurement site. Our study aimed to identify the optimal site for AR assessment using 2D and 4D MR flow measurements, with a focus on vortices. METHODS: We retrospectively analysed 31 patients with congenital aortic valve disease, performing 2D and 4D MR flow measurements at the aortic valve, sinotubular junction (STJ), ascending aorta (AAo), and using midpulmonary artery measurements as a reference. We assessed percentage AR and net forward volumes, calculated linear correlations, and plotted Bland-Altman plots. Net forward flow at all aortic sites were correlated with the main pulmonary artery. Differences in AR between 2D and 4D flows were linked to vortices detected by 4D streamlines. RESULTS: The best agreement in % AR between 2D and 4D flows was at the aortic valve (mean difference 4D2D -2.9%, limits of agreement 8.7% to -14.3%; r2 = 0.7). Correlations weakened at STJ and AAo. Vortices in the ascending aorta led to AR overestimation in 2D measurements. Net forward flow at the aortic valve by 4D flow correlated closer with main pulmonary artery than did 2D flow. (Mean difference for 2D and 4D MR flow 7.5 ml and 4.2 ml, respectively). CONCLUSIONS: For congenital aortic valve disease, the most accurate AR quantification occurs at the aortic valve using 2D and 4D MR flow. Notably, vortices in the ascending aorta can result in AR overestimation with 2D MR flow.
Assuntos
Insuficiência da Valva Aórtica , Humanos , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Estudos Retrospectivos , Feminino , Masculino , Adulto , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/anormalidades , Valva Aórtica/fisiopatologia , Imagem Cinética por Ressonância Magnética/métodos , Velocidade do Fluxo Sanguíneo/fisiologia , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Criança , Valvopatia Aórtica/diagnóstico por imagemRESUMO
AIMS: Transcatheter aortic valve replacement (TAVR) revolutionized the therapy of severe aortic stenosis (AS) with rising numbers. Mixed aortic valve disease (MAVD) treated by TAVR is gaining more interest, as those patients represent a more complex cohort as compared with isolated AS. However, concerning long-term outcome for this cohort only, limited data are available. The aim of the study is to assess the prevalence of MAVD in TAVR patients, investigate its association with paravalvular regurgitation (PVR), and analyse its impact on long-term mortality after TAVR. METHODS AND RESULTS: We conducted a registry-based cohort study using the Vienna TAVR registry, enrolling patients who underwent TAVR at Medical University of Vienna between January 2007 and May 2020 with available transthoracic echocardiography before and after TAVR (n = 880). Data analysis included PVR incidence and long-term survival outcomes. A total of 647 (73.52%) out of 880 patients had ≥ mild aortic regurgitation next to severe AS. MAVD was associated with PVR compared with isolated AS with an odds ratio of 2.06, 95% confidence interval (CI): 1.51-2.81 (P = <0.001). More than mild PVR after TAVR (n = 168 out of 880: 19.09%) was related to higher mortality compared with the absence of PVR with a hazard ratio (HR) of 1.33, 95% CI: 1.05- 1.67 (P = 0.016). MAVD patients developing ≥ mild PVR after TAVR were also associated with higher mortality compared with the absence of PVR with an HR of 1.30 and 95% CI: 1.04-1.62 (P = 0.022). CONCLUSION: MAVD is prevalent among TAVR patients and presents unique challenges, with increased PVR risk and worse outcomes compared with isolated AS. Long-term survival for MAVD patients, not limited to those developing PVR post-TAVR, is compromised. Earlier intervention before the occurrence of structural myocardial damage or surgical valve replacement might be a potential workaround to improve outcomes.
Assuntos
Sistema de Registros , Substituição da Valva Aórtica Transcateter , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Feminino , Masculino , Idoso de 80 Anos ou mais , Idoso , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Ecocardiografia , Taxa de Sobrevida , Estudos Retrospectivos , Áustria/epidemiologia , Índice de Gravidade de Doença , Valvopatia Aórtica/cirurgia , Valvopatia Aórtica/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Estudos de Coortes , Medição de Risco , Fatores de RiscoRESUMO
Resumo: Poster Eletronico apresentado no 12 congresso do DIC. Apresentação do Caso: Paciente do sexo masculino, 82 anos, em seguimento ambulatorial com suspeita diagnóstica de amiloidose, realizou ecocardiograma transtorácico
Assuntos
Valvopatia Aórtica/diagnóstico por imagemRESUMO
Patients with aortic enlargement are recommended to undergo serial imaging and clinical follow-up until they reach surgical thresholds. This study aimed to identify aortic diameter and care of patients with aortic imaging before aortic dissection (AD). In a retrospective cohort of AD patients, we evaluated previous imaging results in addition to ordering providers and indications. Imaging was stratified as >1 or <1 year: 62 patients (53% men) had aortic imaging before AD (most recent test: 82% echo, 11% computed tomography, 6% magnetic resonance imaging). Imaging was ordered most frequently by primary care physicians (35%) and cardiologists (39%). The most frequent imaging indications were arrhythmia (11%), dyspnea (10%), before or after aortic valve surgery (8%), chest pain (6%), and aneurysm surveillance in 13%. Of all patients, 94% had aortic diameters below the surgical threshold before the AD. Imaging was performed <1 year before AD in 47% and aortic size was 4.4 ± 0.8 cm in ascending aorta and 4.0 ± 0.8 cm in sinus. In patients whose most recent imaging was >1 year before AD (1,317 ± 1,017 days), the mean ascending aortic diameter was 4.2 ± 0.4 cm. In conclusion, in a series of patients with aortic imaging before AD, the aortic size was far short of surgical thresholds in 94% of the group. In >50%, imaging was last performed >1 year before dissection.
Assuntos
Aneurisma da Aorta Torácica/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/patologia , Aorta/diagnóstico por imagem , Aorta/patologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/patologia , Valvopatia Aórtica/complicações , Valvopatia Aórtica/diagnóstico por imagem , Arritmias Cardíacas/complicações , Arritmias Cardíacas/diagnóstico por imagem , Cardiologia , Procedimentos Clínicos , Progressão da Doença , Dispneia/complicações , Dispneia/diagnóstico por imagem , Ecocardiografia , Medicina de Família e Comunidade , Feminino , Humanos , Medicina Interna , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos VascularesRESUMO
ABSTRACT: We aimed to compare two-dimension transthoracic echocardiogram (2D-TTE) and three-dimension transthoracic echocardiogram (3D-TTE) measurements of the aortic annular diameter using multi-detector CT (MDCT) as a gold standard.This prospective observational study included 50 consecutive patients who came to the cardiology department, Al-Azhar University Hospital, New Damietta, for MDCT coronary angiography. The study was carried out in the period from July 2016 until February 2017. All patients were subjected to informed consent, clinical history, physical examination, transthoracic echocardiography 2D and 3D, and MDCT.The aortic annular areas measured by MDCT and 3D-TTE were significantly larger than areas by 2D-TTE. A good correlation (râ=â0.82) was observed between the areas obtained by 3D-TTE and MDCT; however, the correlation between the values by 2D-TTE and MDCT was rough (râ=â0.30). Eccentricity Index (EI) values in 28% of the patients were greater than 0.1, that is, the aortic annulus was elliptical.Accuracy of aortic annular diameter measurement by 3D-TTE was superior to that by 2D-TTE. Three-D TTE and MDCT revealed that the shape of the aortic annulus was elliptical in 28% to 30% respectively of study subjects. There is a strong concordance between the minimum and the maximum diameter determine by 3D-TTE and MDCT.
Assuntos
Valvopatia Aórtica/diagnóstico por imagem , Pesos e Medidas Corporais/métodos , Ecocardiografia Tridimensional/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Adulto , Aorta/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
BACKGROUND: To determine the normal perivalvular 18F-Fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography (PET) with computed tomography (CT) within one year after aortic prosthetic heart valve (PHV) implantation. METHODS: Patients with uncomplicated aortic PHV implantation were prospectively included and underwent 18F-FDG PET/CT at either 5 (± 1) weeks (group 1), 12 (± 2) weeks (group 2) or 52 (± 8) weeks (group 3) after implantation. 18F-FDG uptake around the PHV was scored qualitatively (none/low/intermediate/high) and quantitatively by measuring the maximum Standardized Uptake Value (SUVmax) and target to background ratio (SUVratio). RESULTS: In total, 37 patients (group 1: n = 12, group 2: n = 12, group 3: n = 13) (mean age 66 ± 8 years) were prospectively included. Perivalvular 18F-FDG uptake was low (8/12 (67%)) and intermediate (4/12 (33%)) in group 1, low (7/12 (58%)) and intermediate (5/12 (42%)) in group 2, and low (8/13 (62%)) and intermediate (5/13 (38%)) in group 3 (P = 0.91). SUVmax was 4.1 ± 0.7, 4.6 ± 0.9 and 3.8 ± 0.7 (mean ± SD, P = 0.08), and SUVratio was 2.0 [1.9 to 2.2], 2.0 [1.8 to 2.6], and 1.9 [1.7 to 2.0] (median [IQR], P = 0.81) for groups 1, 2, and 3, respectively. CONCLUSION: Non-infected aortic PHV have similar low to intermediate perivalvular 18F-FDG uptake with similar SUVmax and SUVratio at 5, 12, and 52 weeks after implantation.
Assuntos
Valvopatia Aórtica/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Implantação de Prótese/métodos , Idoso , Valvopatia Aórtica/diagnóstico , Feminino , Fluordesoxiglucose F18/administração & dosagem , Fluordesoxiglucose F18/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/estatística & dados numéricos , Implantação de Prótese/estatística & dados numéricos , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/uso terapêuticoAssuntos
Aorta/patologia , Valvopatia Aórtica/diagnóstico por imagem , Síndrome de Loeys-Dietz/diagnóstico por imagem , Ultrassonografia Pré-Natal , Aorta/diagnóstico por imagem , Aorta/embriologia , Valvopatia Aórtica/congênito , Valvopatia Aórtica/embriologia , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/embriologia , Dilatação Patológica/genética , Feminino , Humanos , Nascido Vivo , Síndrome de Loeys-Dietz/embriologia , Síndrome de Loeys-Dietz/genética , Ilustração Médica , Gravidez , Adulto JovemAssuntos
Processamento de Imagem Assistida por Computador/normas , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/normas , Infecções Relacionadas à Prótese/diagnóstico , Idoso , Valvopatia Aórtica/diagnóstico por imagem , Valvopatia Aórtica/cirurgia , Feminino , Fluordesoxiglucose F18/administração & dosagem , Fluordesoxiglucose F18/uso terapêutico , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/estatística & dados numéricos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/uso terapêuticoAssuntos
Síndrome Antifosfolipídica , Valvopatia Aórtica , Angiografia Coronária/métodos , Ecocardiografia Transesofagiana/métodos , Endocardite não Infecciosa , Infarto do Miocárdio com Supradesnível do Segmento ST , Tomografia de Coerência Óptica/métodos , Adulto , Angioplastia Coronária com Balão/métodos , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Valvopatia Aórtica/diagnóstico por imagem , Valvopatia Aórtica/etiologia , Valvopatia Aórtica/fisiopatologia , Valvopatia Aórtica/cirurgia , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/etiologia , Endocardite não Infecciosa/diagnóstico por imagem , Endocardite não Infecciosa/etiologia , Endocardite não Infecciosa/fisiopatologia , Endocardite não Infecciosa/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Resultado do TratamentoRESUMO
Aortic valve sclerosis (AVS) is defined as calcified and thickened aortic leaflets without restriction of leaflet motion. We have not found any studies that previously assessed the effect of AVS on myocardial functions with three dimensional-speckle tracking echocardiography (3D-STE). Therefore, we aimed to identify any early changes in left atrial (LA) myocardial dynamics and/or left ventricular (LV) systolic functions in patients with AVS using 3D-STE. Seventy-five patients with AVS and 80 age- and gender-matched controls were enrolled into the study. The baseline clinical characteristics of the study patients were recorded. Conventional 2D echocardiographic and 3D-STE analyses were performed. The LV-global longitudinal strain (LV-GLS) and LV-global circumferential strain (LV-GCS) were significantly decreased in the AVS (+) group than in the control group (p < 0.001 and p = 0.013, respectively). In multivariate logistic regression analysis; LV-GLS (p < 0.001, odds ratio (OR) = 3.16, 95% confidence interval (CI) 1.42-5.63) and Triglyceride (TG) (p = 0.033, OR = 1.29, 95% CI 1.11-1.72) were found to be independent predictors of AVS. ROC analysis was performed to find out the ideal LV-GLS cut-off value for predicting the AVS. A LV-GLS value of > - 18 has 85.8% sensitivity, 67.5% specificity for the prediction of the AVS. Our results support that subjects with AVS may have subclinical LV deformation abnormalities even though they have not LV pressure overload. According to our findings, patients with AVS should be investigated in terms of atherosclerotic risk factors, their dysmetabolic status should be evaluated and closely followed up for their progression to calcific aortic stenosis.
Assuntos
Valvopatia Aórtica/complicações , Ecocardiografia Tridimensional , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Valvopatia Aórtica/diagnóstico por imagem , Valvopatia Aórtica/patologia , Valvopatia Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/fisiopatologia , Doenças Assintomáticas , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Esclerose , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Longitudinal changes in aortic diameters of young patients with thoracic aortic aneurysm (TAA) have not been completely described, particularly over long periods of follow-up. This retrospective study sought to characterize the rates of proximal aortic dilation in young patients, identify risk factors for TAA progression, and evaluate the predictive utility of early echocardiographic follow-up. Inclusion criteria were: (1) TAA or TAA-predisposing genetic diagnosis, (2) age < 25 years at first echocardiogram, and (3) minimum of 5 years of echocardiographic follow-up. Proximal aortic diameters were measured by echocardiography and Z-scores calculated to index for body surface area. TAA severity was classified as no TAA (Z-score < 2), mild (Z-score 2 to 4), or at least moderate (Z-score > 4). Among 141 included patients, mean age at first echocardiogram was 7.3 ± 3.5 years. Mean follow-up duration was 9.8 ± 3.5 years. Fifty five patients had a genetic syndrome, and 38 of the non-syndromic patients had bicuspid aortic valve (BAV). The rate of aortic dilation was significantly higher at the ascending aorta than other aortic segments. BAV and age > 10 years at first echocardiogram were associated with increased rate of ascending aorta dilation. At the ascending aorta, over 25% of patients had categorical increase in TAA severity between first and last echocardiograms, and such patients demonstrated higher rate of dilation within their first 2 years of follow-up. These longitudinal findings highlight progressive ascending aorta dilation in young patients, which may worsen around adolescence. This may help determine timing of follow-up and target ages for clinical trials.
Assuntos
Aorta/patologia , Aneurisma da Aorta Torácica/etiologia , Valvopatia Aórtica/patologia , Dilatação Patológica/patologia , Adolescente , Aorta/diagnóstico por imagem , Valvopatia Aórtica/complicações , Valvopatia Aórtica/diagnóstico por imagem , Criança , Pré-Escolar , Dilatação Patológica/complicações , Progressão da Doença , Ecocardiografia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVES: There is growing interest in the aortic valve (AV) neocuspidalization technique for the treatment of aortic valve disease (AVD). We report our medium-term results with this procedure performed in a paediatric patient population. METHODS: Between July 2016 and May 2020, 22 patients with both congenital and acquired isolated AVD were treated with neocuspidalization. The primary outcome was progression of the preoperatively assessed AVD in the immediate postoperative course and at follow-up. Secondary outcome was freedom from reintervention by material used. Potential predictors of failure were analysed in relation to the primary outcome. RESULTS: The median age at operation was 13.9 (interquartile range, 9.8-16.2) years, and the prevailing AV defect was stenosis in 10 cases (45%) and incompetence in 12 (55%). Pre-treated autologous pericardium was used in 13 patients whereas bovine pericardium in 9. Effective treatment of AV stenosis or regurgitation was achieved and remained stable over a median follow-up of 11.3 (4.7-21) months. Three patients required AV replacement at 4.9, 3.5 and 33 months. At follow-up, an upward trend of both median indexed vena contracta jet widths and aortic peak and mean gradients were recorded, the latter associated with a failure to grow the aortic annulus. Predictor of such outcome turned out to be the use of bovine pericardium. A significant inverse linear correlation between AV peak gradient at follow-up and preoperative aortic annular size (P = 0.008) was also demonstrated. CONCLUSIONS: The Ozaki procedure is safe and effective in paediatric patients with AV disease. The use of heterologous pericardium should probably be minimized. Moreover, preoperative small aortic annuli should probably be promptly treated by means of an associated ring enlargement procedure.
Assuntos
Valvopatia Aórtica/cirurgia , Valva Aórtica/cirurgia , Adolescente , Animais , Valvopatia Aórtica/diagnóstico por imagem , Valvopatia Aórtica/patologia , Bovinos , Criança , Progressão da Doença , Eletrocardiografia , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Pericárdio/transplante , Cuidados Pré-Operatórios , Reoperação , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
Cardiac MRI (CMR) techniques offer non-invasive visualizations of cardiac morphology and function. However, imaging can be time-consuming and complex. Seismocardiography (SCG) measures physical vibrations transmitted through the chest from the beating heart and pulsatile blood flow. SCG signals can be acquired quickly and easily, with inexpensive electronics. This study investigates relationships between CMR metrics of function and SCG signal features. Same-day CMR and SCG data were collected from 28 healthy adults and 6 subjects with aortic valve disease history. Correlation testing and statistical median/decile calculations were performed with data from the healthy cohort. MR-quantified flow and function parameters in the healthy cohort correlated with particular SCG energy levels, such as peak aortic velocity with low-frequency SCG (coefficient 0.43, significance 0.02) and peak flow with high-frequency SCG (coefficient 0.40, significance 0.03). Valve disease-induced flow abnormalities in patients were visualized with MRI, and corresponding abnormalities in SCG signals were identified. This investigation found significant cross-modality correlations in cardiac function metrics and SCG signals features from healthy subjects. Additionally, through comparison to normative ranges from healthy subjects, it observed correspondences between pathological flow and abnormal SCG. This may support development of an easy clinical test used to identify potential aortic flow abnormalities.
Assuntos
Valvopatia Aórtica/diagnóstico por imagem , Valvopatia Aórtica/fisiopatologia , Adulto , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Circulação Coronária , Eletrocardiografia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
Over the last few decades, outcomes with living donor liver transplantation (LDLT) have improved significantly. This has resulted in patients who were denied liver transplantation previously, due to various comorbidities and high risk, now being considered for LDLT. This includes patients with severe valvular heart disease such as aortic stenosis. These patients require aortic valve replacement to help cope with significant perioperative hemodynamic changes. High-risk cardiac procedures like aortic valve replacement are associated with serious perioperative morbidity and mortality in patients with end-stage liver disease. Since the advent of transcatheter aortic valve implantation (TAVI) in 2002, there have been a few case reports of its successful use prior to deceased donor liver transplantation, but there is no literature on this procedure before LDLT. In this article, we report our experience with 2 patients, the first patient with infective endocarditis-induced acute aortic regurgitation and the second patient with bicuspid aortic stenosis who underwent uneventful TAVI followed by successful LDLT. In conclusion, with the increasing expertise and experience in this procedure, an increasing number of potential recipients, previously considered as high-risk transplant candidates, can now be offered liver transplantation by performing pretransplant TAVI.