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1.
J Comput Assist Tomogr ; 44(2): 284-288, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32195808

RESUMO

PURPOSE: The aim of this study was to identify possible predictors for findings of left atrial appendage (LAA) filling defects in patients with atrial fibrillation (AF) on cardiac computed tomography (CT). MATERIALS AND METHODS: We retrospectively evaluated findings of LAA filling defects on the early phase of cardiac CT of 63 patients with history of AF and compared those images with those of 63 control subjects. We investigated potential predictors for LAA filling defects. RESULTS: Filling defects of the LAA correlated significantly with patient history of persistent AF (P = 0.045; odds ratio [OR], 3.17), chicken wing morphology (P = 0.013; OR, 4.12), and with LAA volume (P = 0.0032; OR, 1.19) of 12.53 cm or greater (sensitivity, 87.3%; specificity, 69.8%). CONCLUSIONS: We observed persistent AF, the chicken wing type of LAA morphology, and LAA volume as independent predictors of LAA filling defects on cardiac CT. These findings might improve cardiac CT scanning protocol.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/fisiopatologia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade
3.
Zhonghua Nei Ke Za Zhi ; 58(12): 883-888, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31775450

RESUMO

Objective: To study the correlation between left atrial sphericity (LASP) and thromboembolic events (TE) in patients with atrial fibrillation (AF). Methods: This study was conducted in patients with AF underwent radiofrequency ablation in the Department of Cardiology of First Affiliated Hospital of Zhengzhou University from January 2011 to October 2018. The AF patients with TE (study group, n=157) and the AF patients without TE (control group, n=157) were matched for age and gender. The differences of LASP and other related indexes between the two groups were compared, and the correlation between LASP and TE was analyzed by conditional logistic regression. The receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of LASP for TE. Results: (1) The LASP in the study group was significantly higher than that in the control group [ (87.5±7.1) % vs. (82.8±6.1) %, P=0.001]. (2) Conditional logistic regression analyses showed that LASP (OR=1.10, 95%CI 1.05-1.16, P=0.001), left atrial volume index (OR=1.01, 95%CI 1.00-1.02, P=0.016) and CHA(2)D-VASc score (OR=1.77, 95%CI 1.30-2.41, P=0.001) were independently and positively correlated with TE. (3) The ROC curve analysis showed that the area under the curve (AUC) of left atrial sphericity (AUC=0.712, 95%CI 0.656-0.768, P=0.001) was larger than the AUC of either left atrial volume index (AUC=0.650, 95%CI 0.589-0.710, P=0.001) or CHA(2)D-VASc score (AUC=0.612, 95%CI 0.550-0.674, P=0.001). (4) CHA(2)D-VASc-LASP(2) score was positively correlated with TE (OR=1.95, 95%CI 1.55-2.42, P=0.001). Conclusion: LASP is independently and positively correlated with TE in patients with AF.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Angiografia Coronária/métodos , Ablação por Radiofrequência , Acidente Vascular Cerebral/etiologia , Tromboembolia/etiologia , Apêndice Atrial/fisiopatologia , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Átrios do Coração , Humanos , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Tromboembolia/sangue , Tromboembolia/diagnóstico
4.
Turk J Pediatr ; 61(1): 117-119, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559732

RESUMO

Yakut K, Varan B, Erdogan I. Asymptomatic giant congenital left atrial aneurysm. Turk J Pediatr 2019; 61: 117-119. Congenital aneurysm of the left atrial appendage can be caused by congenital dysplasia of the pectinate muscles and may be accompanied by a congenital absence of the pericardium. Symptoms generally manifest after two decades and the most common symptom is atrial arrhythmia in the form of atrial fibrillation / flutter. A four year-old patient with no symptoms underwent an echocardiographic examination for the investigation of a heart murmur. Echocardiographic examination revealed a large cystic lesion occupying the left hemithorax and compressing the left ventricle. The patient was referred to our center. The lesion caused displacement of the heart rightward behind the sternum which made the examination difficult. We aimed to present this rare case of giant left atrial appendage aneurysm in the light of current literature.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Aneurisma Cardíaco/congênito , Aneurisma Cardíaco/diagnóstico por imagem , Doenças Assintomáticas , Pré-Escolar , Sopros Cardíacos , Humanos , Angiografia por Ressonância Magnética , Masculino , Radiografia
5.
Turk J Pediatr ; 61(1): 142-146, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559738

RESUMO

Ergül Y, Öztürk E, Özgür S. Successful radiofrequency ablation of accessory pathway associated with left atrial appendage aneurysm in a low birthweight premature patient. Turk J Pediatr 2019; 61: 142-146. Tachyarrhythmias are common cardiac arrhythmias in newborns and infants. We present a premature case with a 2.4-kg birth weight, with non-immune hydrops due to supraventricular tachycardia. Despite the combination of amiodarone, esmolol and flecainide, tachyarrhythmia could not be controlled and radiofrequency ablation was applied due to left ventricular dysfunction. After the procedure the rhythm returned to normal sinus and left ventricular functions improved rapidly. The follow-up of the case continues without any problems. In this presentation, successful ablation of the accessory pathway associated with structural heart disease have been covered in the youngest and smallest patient to date.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico por imagem , Ablação por Radiofrequência , Taquicardia Supraventricular/terapia , Ecocardiografia , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Masculino
6.
BMJ Case Rep ; 12(9)2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31492729

RESUMO

Primary cardiac tumours are relatively rare in the paediatric population, with benign tumours accounting for >90% of cases. Cardiac fibromas are rare primary tumours that typically reside in the ventricles. Symptoms are usually the result of blood outflow obstruction or disruption of the cardiac conduction system. They do not typically regress and usually require surgical intervention. In this case, we report a rare finding of a right atrial fibroma in an 18-month-old female who presented with lethargy and vomiting. Chest X-ray revealed an enlarged cardiac silhouette, and follow-up CT showed a 3.7×3.2×3.7 cm hypodense lesion in the right atrium. Cardiac MRI revealed the diagnosis, which was confirmed on pathology.


Assuntos
Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/terapia , Ecocardiografia , Feminino , Fibroma/complicações , Fibroma/cirurgia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Neoplasias Cardíacas/cirurgia , Humanos , Imageamento Tridimensional , Lactente , Imagem por Ressonância Magnética , Derrame Pericárdico/etiologia , Derrame Pericárdico/terapia , Pericardiocentese , Síndrome do Desconforto Respiratório do Adulto/etiologia , Tomografia Computadorizada por Raios X , Vômito/etiologia
9.
Braz J Cardiovasc Surg ; 34(4): 495-498, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454207

RESUMO

Management of symptomatic atrial tachycardia (AT) during pregnancy seems challenging, especially those originating from left atrial appendage (LAA), which easily tend to be incessant and mediate cardiomyopathy. It's contradictory between therapy and pregnancy. In this study, we report a case of a woman who presented with persistent AT, which lead to heart failure, during early pregnancy. She underwent successful catheter ablation using CartoSound and electroanatomic mapping without fluoroscopy. An electrophysiology (EP) study confirmed a focal LAA tachycardia. Soon after, left ventricular function of her heart normalized, and the patient successfully delivered a healthy child.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Eletrocardiografia , Eletrofisiologia , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem
11.
Int Heart J ; 60(4): 849-853, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308325

RESUMO

The diagnostic performance of 320-detector cardiac computed tomography (CCT) for the detection of thrombi in the left atrial appendage (LAA), relative to transesophageal echocardiography (TEE) as the gold standard, has not yet been evaluated. A total of 91 consecutive patients who were scheduled to undergo pulmonary vein isolation and underwent TEE and CCT were enrolled in this study. Delayed scanning on CCT was performed following early scanning, at 60 seconds after the start of the contrast injection. The radiation dose was estimated for both scans. The early scans showed a contrast medium filling defect (FD) in the LAA in 27 patients, whereas the delayed scans showed an FD in the LAA in six patients. Of these, five patients were confirmed to have a thrombus in the LAA by TEE. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100, 74.4, 18.5, 100, and 75.8% for early scanning and 100, 98.8, 83.3, 100, and 98.9% for delayed scanning, respectively. The area under the curve for the detection of a thrombus in the LAA on the delayed scans was significantly larger than that for the detection on the early scans (0.99 versus 0.87, P < 0.001). The estimated median radiation doses for the early and delayed scans were 2.86 and 0.42 mSv, respectively. Addition of delayed scanning to early scanning improved the diagnostic performance for the detection of a thrombus in the LAA and may obviate unnecessary TEE, with minimal additional radiation exposure.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Cardiopatias/diagnóstico , Tomografia Computadorizada Multidetectores/métodos , Trombose/diagnóstico , Idoso , Fibrilação Atrial/complicações , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Trombose/etiologia
12.
Int J Cardiovasc Imaging ; 35(10): 1831-1839, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31321654

RESUMO

Percutaneous left atrial appendage closure (LAAC) has emerged as an alternative of stroke prevention in non-valvular atrial fibrillation (NVAF) patients. Peri-device leakage after LAAC is common. This retrospective, case-control study aimed to identify risk factors related with peri-device leakage after LAAC with Watchman devices. Patients who underwent Watchman devices implantation received trans-esophageal echocardiography (TEE) before, during and 45 days after procedure. Peri-device leakage was defined as a residual flow of any size detected with TEE. Patients with residual flows were compared with sex and age matched controls without leakage after implantation. Basic clinical characteristics, as well as LAA imaging characteristics were collected and compared. From 2014 to 2016, 125 consecutive patients were implanted with Watchman devices in our center. TEE at 45 days after implantation identified 53 patients with peri-device leakages (2.62 ± 1.55 mm), who were compared with 43 sex and age matched controls who also received the Watchman devices implantation and had no peri-device residual flow. The basic clinical characteristics, as well as LAA morphology were comparable between the two groups, while patients with leakages had larger LAA orifice, longer LAA body and larger LAA volume. Multivariate logistic regression analysis showed that LAA orifice size measured with TEE was the only independent risk factor predicting post-procedural leakage. The AUC of the receiver operating characteristic (ROC) curve was 0.70. Using the TEE orifice size cutoff value of 18.7 mm yielded a sensitivity of 0.92 (specificity 0.52), while the cutoff value of 23.1 mm yielded a high specificity of 0.91 (sensitivity 0.24). Minor peri-device leakage ( < 5 mm) is common after LAAC with Watchman devices. LAA orifice diameter measured with TEE is the independent risk factor predicting peri-device leakage after the implantation.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Dispositivo para Oclusão Septal , Idoso , Apêndice Atrial/fisiopatologia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
14.
EuroIntervention ; 15(8): 663-670, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31217149

RESUMO

AIMS: Device surveillance after left atrial appendage (LAA) closure (LAAC) is important to assess device positioning, peri-device leak (PDL) and device-related thrombus (DRT). There are limited data on the role of cardiac CT angiography (CCTA) after LAAC. We therefore sought to compare CCTA to transoesophageal echocardiography (TEE) in patients who successfully underwent LAAC. METHODS AND RESULTS: We report our consecutive series of non-valvular atrial fibrillation patients who underwent LAAC and had CCTA and TEE post LAAC. Prospective cardiac-gated CCTA was performed with the Toshiba 320-detector or Siemens second-generation 128-slice dual-source scanner, and post-processing was performed with IMPAX 3D reformats. Glomerular filtration rate <30 mL/min/1.73 m² was an exclusion for CCTA. Device positioning, PDL or fabric leak, ratio of left atrial (LA) to LAA linear attenuation coefficient, and DRT were analysed. One hundred and two patients underwent LAAC (79 WATCHMAN, 17 Amulet, 6 ACP). Mean age was 76.4±7.5 years, CHADS2 score 3.0±1.3, and CHADS-VASc score 4.6±1.6. CCTA was performed at a mean of 105.2±54.8 days, and TEE at a mean of 124.9±100.3 days post LAAC. LAA patency was observed in 52/100 (52%), with 45 (86.5%) via PDL and seven (13.5%) through fabric leak. Linear attenuation coefficient <100 HU and LA:LAA ratio <0.25 were seen in occluded devices. PDL was only observed in 35/102 (34.3%) on TEE. Mean device compression was greater with sealed devices (11.3±4.3% versus 8.2±4.0%, p<0.001). There was only one DRT, which was observed on both TEE and CCTA. CONCLUSIONS: CCTA is a suitable alternative to TEE for device surveillance post LAAC. CCTA was more sensitive than TEE for assessing PDL and can delineate the cause of residual LAA contrast patency.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Ecocardiografia Transesofagiana/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Dispositivo para Oclusão Septal , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Procedimentos Endovasculares , Humanos , Estudos Prospectivos
16.
Curr Cardiol Rep ; 21(7): 66, 2019 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-31183616

RESUMO

PURPOSE OF REVIEW: Atrial fibrillation is the most common arrhythmia worldwide and is a major risk factor for embolic stroke. For patients with atrial fibrillation who are unable to tolerate systemic anticoagulation, left atrial appendage (LAA) occlusion has been shown to mitigate stroke risk. In this article, we describe the vital role of the echocardiographer in intraprocedural guidance of percutaneous LAA occlusion procedures as well as in the pre- and post-procedure assessment of these patients. RECENT FINDINGS: A few percutaneously delivered devices for LAA exclusion from the systemic circulation are available in contemporary practice. These devices employ an either exclusive endocardial LAA occlusion approach, such as the Watchman (Boston Scientific, Maple Grove, MN) and Amulet (St. Jude Medical, Minneapolis, MN), or both an endocardial and pericardial (epicardial) approach such as the Lariat procedure (SentreHEART, Palo Alto, CA). Two- and three-dimension transesophageal echocardiography is critical for patient selection, procedure planning, procedural guidance, and ensuring satisfactory immediate as well as long-term LAA occlusion/exclusion efficacy. This review will provide an overview of the role of the echocardiographer in all aspects of LAA occlusion/exclusion procedures for the most commonly used commercially available devices in current practice.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/métodos , Ecocardiografia Transesofagiana/métodos , Cirurgia Assistida por Computador/métodos , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico , Átrios do Coração , Humanos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
17.
Heart Vessels ; 34(12): 1936-1943, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31168655

RESUMO

Left atrial (LA) functional remodeling as well as LA structural remodeling are associated with incident LA appendage (LAA) thrombus formation. This study aimed to elucidate whether combined assessment of LA functional and structural remodeling can predict LAA dysfunction and recurrent cerebrovascular events in patients with acute ischemic stroke. We performed transthoracic and transesophageal echocardiography in 196 patients within 7 days after acute ischemic stroke. Peak systolic LA strain was evaluated using 2D speckle tracking imaging. We defined the ratio of LA peak systolic strain to LA volume index (LAVI) as the LA remodeling index (LARI). All patients were prospectively followed for recurrent cerebrovascular events. We divided patients into four groups according based on the LARI quartile. LAA dysfunction increased with decreasing LARI. In total, 52 recurrent cerebrovascular events were noted during the median follow-up period of 700 days. Patients with recurrent cerebrovascular events had lower LARI than those without recurrent events (0.50 ± 0.45 vs. 1.10 ± 0.95, P < 0.001). Kaplan-Meier analysis showed that patients with lower LARI were more susceptible to recurrent cerebrovascular events than those with higher LARI. Multivariate Cox proportional hazard regression analysis showed that LARI was an independent predictor of recurrent cerebrovascular events after adjustment for confounding factors. Net reclassification index improved with the addition of LARI to basic predictors. LARI is a novel feasible parameter for LAA dysfunction and can predict recurrent cerebrovascular events in patients with acute ischemic stroke.


Assuntos
Função do Átrio Esquerdo/fisiologia , Remodelamento Atrial , Isquemia Encefálica/fisiopatologia , Átrios do Coração/fisiopatologia , Tromboembolia/complicações , Doença Aguda , Idoso , Apêndice Atrial/diagnóstico por imagem , Isquemia Encefálica/etiologia , Ecocardiografia Transesofagiana , Estudos de Viabilidade , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Prognóstico , Tromboembolia/diagnóstico , Tromboembolia/fisiopatologia , Tomografia Computadorizada por Raios X
18.
J Vet Cardiol ; 23: 15-20, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31174725

RESUMO

Aneurysmal dilation of the atrial appendage (auricle) is rare in humans and dogs. Congenital and acquired etiologies are hypothesized. Although right auricular aneurysm has been described in dogs, this is the first case report of an aneurysm of the left auricle of a dog with an intact pericardium. In humans, because complications of arrhythmia and thromboembolic disease have been reported, surgical resection of left auricular aneurysm is recommended. This report describes the successful surgical resection of a left auricular aneurysm in a dog, including a one-year follow up. Surgical resection can be considered in dogs with auricular aneurysm.


Assuntos
Apêndice Atrial/cirurgia , Doenças do Cão/cirurgia , Aneurisma Cardíaco/veterinária , Animais , Apêndice Atrial/diagnóstico por imagem , Doenças do Cão/diagnóstico por imagem , Cães , Ecocardiografia/veterinária , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/cirurgia , Masculino , Resultado do Tratamento
19.
Int J Cardiovasc Imaging ; 35(9): 1721-1731, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31250161

RESUMO

To compare planned and achieved device position in patients undergoing left atrial appendage occlusion (LAAO). It is unclear how devices used for LAAO position themselves compared to what is planned. All patients undergoing LAAO at our institution had pre- and post-procedural multi detector-row computed tomography (MDCT) at 3 months (N = 52). Using dedicated software, both datasets were fused to superimpose the left atria in all planes. The effective device position was traced on the post-procedural MDCT and then imported in the pre-procedural dataset to allow comparisons. Planned and effective landing zones were compared with respect to size, location and orientation. The device's final position was in a significantly larger landing zone than planned (452 ± 174 vs. 351 ± 112 mm2 for effective and planned landing zones, respectively, paired t-test: p < 0.0001), resulting in significantly less-than-intended area oversizing (41 ± 31 vs. 12 ± 28%, p < 0.0001). In terms of device orientation, there was a difference of 19.7° between the planned and effective landing zones (p < 0.0001). The Amplatzer device had a shallower-than-planned position in 70% of cases, whereas the Watchman device had a deeper-than-planned position in 75% of cases (p = 0.04). Incomplete occlusion was found in 17 patients (33%). In a multivariable model, oversizing at the effective landing zone was the only MDCT independent predictor of incomplete occlusion (OR: 0.96 per 1% increment, 95% CI 0.95-0.98, p = 0.009). MDCT fusion showed that LAAO device position and orientation are different than planned, and this is associated with incomplete occlusion of the LAA.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Cateterismo Cardíaco/instrumentação , Imageamento Tridimensional/métodos , Tomografia Computadorizada Multidetectores/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Terapia Assistida por Computador/instrumentação , Idoso , Idoso de 80 Anos ou mais , Apêndice Atrial/fisiopatologia , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Cateterismo Cardíaco/efeitos adversos , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudo de Prova de Conceito , Estudos Retrospectivos , Software , Resultado do Tratamento
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