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1.
Medicine (Baltimore) ; 100(29): e26513, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398006

RESUMO

ABSTRACT: In patients undergoing atrial fibrillation (AF) ablation, an enlarged left atrium (LA) is a predictor of procedural failure as well as AF recurrence on long term. The most used method to assess LA size is echocardiography-measured diameter, but the most accurate remains computed tomography (CT).The aim of our study was to determine whether there is an association between left atrial diameters measured in echocardiography and the left atrial volume determined by CT in patients who underwent AF ablation.The study included 93 patients, of whom 60 (64.5%) were men and 64 (68.8%) had paroxysmal AF, who underwent AF catheter ablation between January 2018 and June 2019. Left atrial diameters in echocardiography were measured from the long axis parasternal view and the LA volume in CT was measured on reconstructed three-dimensional images.The LA in echocardiography had an antero-posterior (AP) diameter of 45.0 ±â€Š6 mm (median 45; Inter Quartile Range [IQR] 41-49, range 25-73 mm), longitudinal diameter of 67.5 ±â€Š9.4 (median 66; IQR 56-88, range 52-100 mm), and transversal diameter of 42 ±â€Š8.9 mm (IQR 30-59, range 23-64.5 mm). The volume in CT was 123 ±â€Š29.4 mL (median 118; IQR 103-160; range 86-194 mL). We found a significant correlation (r = 0.702; P < .05) between the AP diameter and the LA volume. The formula according to which the AP diameter of the LA can predict the volume was: LA volume = AP diam3 + 45 mL.There is a clear association between the left atrial AP diameter measured on echocardiography and the volume measured on CT. The AP diameter might be sufficient to determine the increase in the volume of the atrium and predict cardiovascular outcomes.


Assuntos
Fibrilação Atrial/classificação , Fibrilação Atrial/cirurgia , Função do Átrio Esquerdo/fisiologia , Volume Sanguíneo , Ablação por Cateter/métodos , Adulto , Idoso , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/estatística & dados numéricos , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Am J Case Rep ; 22: e934383, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34400602

RESUMO

Figure Legends Corrected: Figure 1. Intraoperative transesophageal echocardiogram, midesophageal right ventricular infow-outflow view, initial operation September 2018. Figure 2. Intraoperative transesophageal echocardiogram, midesophageal right ventricular inflow-outflow view, second operation January 2019. Figure 3. Intraoperative transesophageal echocardiogram, midesophageal right ventricular inflow-outflow view, third operation March 2019. Reference: Jeffrey W. Cannon, J.W. Awori Hayanga, Thomas B. Drvar, Matthew Ellison, Christopher Cook, Muhammad Salman, Harold Roberts, Vinay Badhwar, Heather K. Hayanga. A 34-Year-Old Male Intravenous Drug User with a Third Episode of Tricuspid Valve Endocarditis Treated with Repeat Valve Surgery. Am J Case Rep. 2021; 22: e927385, 10.12659/AJCR.927385.


Assuntos
Usuários de Drogas , Endocardite Bacteriana , Endocardite , Abuso de Substâncias por Via Intravenosa , Adulto , Ecocardiografia Transesofagiana , Endocardite/cirurgia , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Abuso de Substâncias por Via Intravenosa/complicações , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia
3.
Kardiologiia ; 61(7): 44-54, 2021 Jul 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34397341

RESUMO

Aim    To study the role of blood concentration of growth differentiation factor 15 (GDF-15) as a predictor of left atrial/left atrial appendage (LA/LAA) thrombosis in patients with nonvalvular atrial fibrillation (AF).Material and methods    538 patients with nonvalvular AF were admitted to the Tyumen Cardiology Research Center in 2019-2020 for radiofrequency ablation and elective cardioversion. According to findings of transesophageal echocardiography (EcoCG), 42 (7.8%) of these patients had LA/LAA thrombosis and 79 (14.7%) of them had the effect of spontaneous echo contrast (SEC). This comparative, cross-sectional, cohort study included at the initial stage 158 successively hospitalized patients with nonvalvular AF: group 1 (with LA/LAA thrombosis, n=42) and group 2 (without LA/LAA thrombosis and without SEC, n=116). To eliminate significant differences in age between the groups, an additional inclusion criterium was introduced, age from 45 to 75 years. Finally, 144 patients were included into the study: group 1 (with LA/LAA thrombosis, n=42, mean age 60.9±7.2 years) and group 2 (without LA/LAA thrombosis and without SEC, n=116, mean age 59.5±6.0 years). 93 (91%) patients in group 1 and 40 (95%) patients in group 2 had arterial hypertension (p=0.4168); 53 (52%) and 29 (^(%), respectively, had ischemic heart disease (p=0.0611). The groups did not differ in sex, profile of major cardiovascular diseases, or frequency and range of oral anticoagulant treatment. General clinical evaluation, EchoCG, and laboratory tests, including measurements of blood concentrations of GDF-15 and NT-proBNP, were performed.Results    In the group with LA/LAA thrombosis, 1) persistent AF prevailed whereas paroxysmal AF was more frequently observed in patients without thrombosis; 2) a tendency toward more pronounced chronic heart failure was observed; 3) tendencies toward a high median CHA2DS2­VASc score and toward a greater proportion of patients with scores ≥3 were observed. According to EchoCG findings, group 1 had higher values of sizes and volumes of both atria and the right ventricle, left ventricular (LV) end-systolic volume and size, pulmonary artery systolic blood pressure, and LV myocardial mass index. LV ejection fraction (EF) was in the normal range in both groups but it was significantly lower for patients with LA/LAA thrombosis, 59.1±5.1 and 64.0±7.3, respectively (p=0.00006). Concentrations of GDF-15 (p=0.00025) and NT-proBNP were significantly higher in group 1 than in group 2 (p=0.000001). After determining the threshold values for both biomarkers using the ROC analysis, two independent predictors of LA/LAA thrombosis were obtained by the stepwise multiple regression analysis: GDF-15 >935.0 pg/ml (OR=4.132, 95 % CI 1.305-13.084) and LV EF (OR=0.859, 95 % CI 0.776-0.951). The ROC analysis assessed the model quality as good: AUC=0.776 (p<0.001), sensitivity 78.3 %, specificity 78.3 %.Conclusion    For patients with nonvalvular AF, both increased GDF-15 (>935.0 pg/ml) and LV EF are independent predictors for LA/LAA thrombosis.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Fator 15 de Diferenciação de Crescimento/sangue , Trombose , Idoso , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/patologia , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Estudos de Coortes , Estudos Transversais , Ecocardiografia Transesofagiana , Humanos , Pessoa de Meia-Idade , Trombose/diagnóstico , Trombose/etiologia
4.
Medicine (Baltimore) ; 100(33): e26988, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414978

RESUMO

ABSTRACT: With the declining use of the pulmonary artery catheter (PAC), transesophageal echocardiography (TEE) has become an appealing alternative to obtain pulmonary artery pressure non-invasively using the simplified Bernoulli equation. The validation of this method in the perioperative setting has been scarce with no clear recommendations about which view is the most accurate to estimate right ventricular systolic pressure (RVSP).Therefore, we performed a prospective, observer-blinded, diagnostic test accuracy study to assess the difference in systolic pulmonary artery pressure (sysPAP) measuring both, invasively sysPAP and estimated RVSP with TEE in 3 different views: the mid-esophageal (ME) 4Chamber, the ME right ventricular (RV) inflow-outflow and the ME modified bicaval view.To show a clinically significant difference of at least 10% in RVSP, we included 40 cardiac surgical patients divided into 3 subgroups: Patients with mild to moderate tricuspid regurgitation (TR) and mean PAP <25 mm Hg, patients with mild to moderate TR and mean PAP≥ 25 mm Hg, and patients with severe TR.For the whole cohort, bias of estimated RVSP compared to measured sysPAP was 5.27 mm Hg, precision was 7.96 mm Hg, limits of agreement were -10.66 to 21.19 mm Hg. The best agreement between the 2 methods was found in patients with severe TR and in the ME RV inflow-outflow and the modified bicaval view. Good Doppler signals were available in 35% and 46% in these views, and in 20% in the ME 4 chamber view.The estimation of the sysPAP by TEE cannot be considered reliable in the clinical perioperative setting. Only measurements that provide a full Doppler envelope show sufficient precision to provide accurate estimations.


Assuntos
Ecocardiografia Transesofagiana/métodos , Hipertensão Arterial Pulmonar/classificação , Pesos e Medidas/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Ecocardiografia Transesofagiana/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Pesos e Medidas/instrumentação
5.
Kyobu Geka ; 74(9): 692-696, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34446624

RESUMO

A 73-year-old woman with Valsalva aneurysm and mitral regurgitation was introduced to our department. We performed combined operation including aortic root partial repair and mitral valve repair. After wenning from cardiopulmonary bypass, intraoperative aortic dissection was confirmed by transesophageal echocardiography from the ascending aorta to the descending aorta, entry was near to proximal anastomosis line of the ascending aorta. To avoid heart failure, the ascending aorta wrapping by prothesis graft was performed to protect from urgent rupture postoperative at first stage. According to contrast computed tomography (CT) findings, location of entry was correspond with aortic clamping. We performed partial aortic replacement including innominate artery reconstruction for her at fourth day postoperative for treating aortic dissection at second stage. Postoperative course was uneventful.


Assuntos
Aneurisma Dissecante , Insuficiência da Valva Mitral , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta/diagnóstico por imagem , Aorta/cirurgia , Tronco Braquiocefálico , Ecocardiografia Transesofagiana , Feminino , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia
6.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(4): 355-360, 2021 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-34363356

RESUMO

At present, the standard left atrial appendage occlusion procedure mainly involves two-dimensional imaging methods such as X-ray fluoroscopy and transesophageal echocardiography to guide the operation, which will lead to underestimation of the three dimensional structure of the left atrial appendage and the surrounding tissue, thus adversely affects the surgery. To solve this problem, a surgery assist system for left atrial appendage occlusion based on preoperative cardiac CT images is developed. The proposed system realizes the left atrial appendage parameter measurement based on cardiac CT image, and realizes the calculation of optimal delivery sheath trajectory and three-dimensional simulation of the delivery sheath movement on the basis of a novel delivery sheath trajectory model. The system is expected to provide precise guidance for left atrial appendage occlusion, improve the success rate and safety of the operation, and at the same time help reduce the difficulty of learning the operation, and facilitate the promotion of left atrial appendage occlusion.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Cateterismo Cardíaco , Ecocardiografia Transesofagiana , Humanos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Curr Cardiol Rep ; 23(10): 138, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34410510

RESUMO

PURPOSE OF THE REVIEW: Percutaneous closure of sinus venosus atrial septal defects (ASD) using covered stent implantation is a new and promising minimally invasive technique. New imaging tools are used to ensure preoperative anatomical characterization and preoperative guidance, which are key procedural success factors. Here we will describe and analyze these recent developments. RECENT FINDINGS: Sinus venosus ASDs present a wide variety of anatomical features which must be described and analyzed using various imaging tools, including 3D technology. Percutaneous closure is challenging, but can hasten clinical recovery compared to the gold-standard conventional open-heart surgery. The feasibility of percutaneous closure relies on precise preoperative anatomical study and on real-time guidance using a multimodal fusion imaging process. Three-dimensional modeling of sinus venosus ASD is essential to understand the large anatomical panel encountered in this pathology. Multimodal fusion imaging guidance is very useful for performing sinus venosus ASD percutaneous closure in selected patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Comunicação Interatrial , Cateterismo Cardíaco , Ecocardiografia Transesofagiana , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Humanos , Imagem Multimodal , Stents , Resultado do Tratamento
8.
Echocardiography ; 38(8): 1414-1421, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34212409

RESUMO

BACKGROUND: Assessment of the left atrium and atrial appendage (LAA) for thrombus by transesophageal echocardiography (TEE) may be suboptimal due to difficult imaging windows and ultrasound artifacts. The present study analyzed the benefit of using ultrasound enhancing agents (UEAs) with TEE to improve diagnostic accuracy and image quality. METHODS: A systematic review of studies published through December 2020 was performed, and included investigations comparing the number of cases deemed indeterminate for visualization of LAA thrombi on TEE pre- versus post-UEAs prior to cardioversion for atrial fibrillation or flutter (AF). Study results were pooled where the number of indeterminate cases by conventional TEE were re-classified as thrombus present, indeterminate, or thrombus excluded following administration of UEAs. RESULTS: Three studies with a total of 399 patients were identified. Of these, 83 (26%) participants met the inclusion criteria. The mean age of the study population from the three studies was 66 ± 12 years, 29% were female, and prevalence of congestive heart failure or neurologic events was 22% and 5%, respectively. Use of UEAs with TEE re-classified 66% (55/83) of cases initially deemed to be indeterminate for LAA thrombus on conventional TEE. Thrombus was present in 13% (11/83) and excluded in 53% (44/83) of cases; 34% (28/83) of cases remained indeterminate on TEE post-UEAs. There were no complications reported with the administration of UEAs. CONCLUSION: Adjunctive use of UEAs with TEE can facilitate the diagnosis or exclusion of LAA thrombus, and improve the procedural confidence and cost-efficiency of cardioversion for AF.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Trombose , Idoso , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Ecocardiografia Transesofagiana , Cardioversão Elétrica , Feminino , Humanos , Pessoa de Meia-Idade , Trombose/diagnóstico por imagem
9.
Echocardiography ; 38(8): 1282-1289, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34255390

RESUMO

OBJECTIVE: To compare the agreement of the 2016 ASE/EACVI guidelines for grading diastolic dysfunction (DD) with the most commonly used intraoperative transesophageal echocardiography (TEE)-based diastolic function grading algorithm in cardiac surgical patients, and to describe the contribution of the echocardiographic variables used in the algorithms to any observed differences. DESIGN: Retrospective data analysis. SETTING: University tertiary medical center. PARTICIPANTS: Hundred and one patients undergoing coronary artery bypass grafting (CABG) at a single institution from June 2017 to February 2019. INTERVENTIONS: Preoperative transthoracic echocardiography (TTE) diastolic function grade determined by the 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines was compared to intraoperative diastolic function grade obtained by TEE. MEASUREMENTS AND MAIN RESULTS: Incidence of DD on preoperative TTE was only 19.8%, while 62.3% of patients were graded as having DD on the intraoperative TEE exam. There was grade agreement between TTE and TEE in only 47/101 patients (46.5%). The McNemar test showed poor agreement between the two algorithms (OR for disagreement = 15.33, CI = 4.77-49.30; p < 0.0001). Despite the low incidence of DD on preoperative TTE, mean lateral e' values were significantly lower on TTE compared to TEE (7.7 cm/s vs 9.5 cm/s; p = < 0.0001). CONCLUSIONS: There is strong disagreement between TTE and TEE-based DD grading algorithms. Due to the different echocardiographic variables used in each and the unique clinical settings in which they are applied, they produce fundamentally different results.


Assuntos
Ecocardiografia Transesofagiana , Ecocardiografia , Ponte de Artéria Coronária , Diástole , Humanos , Estudos Retrospectivos
10.
J Card Surg ; 36(10): 3917-3920, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34260108

RESUMO

The safety of transesophageal echocardiography (TEE) probes has been documented in pediatric patients (neonates, infants, and small children even < 2.5 kg). The overall safety profile of TEE probe is quite favorable with a reported incidence of complications of 1%-3%. However, insertion of the TEE probe can induce vagal and sympathetic reflexes such as hypertension or hypotension, nonsustained ventricular and supraventricular tachyarrhythmias, or bradyarrhythmias (third degree heart block), and even angina and myocardial infarction. We hereby document a repeated intraoperative ventricular fibrillation precipitated by TEE probe in a 2-year-old, 10 kg pediatric patient diagnosed with ostium secundum-atrial septal defect, supravalvular pulmonary stenosis, and severe right ventricular dysfunction. The international review board approval or waiver and clinical trial registrations are not applicable for this case report publication.


Assuntos
Ecocardiografia Transesofagiana , Comunicação Interatrial , Criança , Pré-Escolar , Ventrículos do Coração , Humanos , Lactente , Recém-Nascido , Fibrilação Ventricular
11.
Can J Anaesth ; 68(10): 1527-1535, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34319575

RESUMO

PURPOSE: Echocardiography is a difficult tool to master. Competency requires the supervised interpretation of hundreds of exams. Perceptual learning modules (PLMs) are novel learning tools that aim to speed up this learning process by enabling learners to go online and interpret numerous clinical images, followed systematically by expert feedback. We developed and tested a PLM aimed at improving novices' ability to quickly visually estimate left ventricular ejection fraction (LVEF) on transesophageal echocardiography images, a critical skill in acute care. We hypothesized that using the PLM would improve the accuracy and the speed of learners' estimations. METHODS: Learners without echocardiography experience were randomly assigned to a group that used the 96-case PLM (n = 26) or a control group (n = 26) that did not. Both groups took a pre-test and an immediate post-test that measured the accuracy of their visual estimations during a first session. At six months, participants also completed a delayed post-test. RESULTS: In the immediate post-test, the PLM group showed significantly better accuracy than the control group (median absolute estimation error 6.1 vs 9.0; difference 95% CI, 1.0 to 4.6; P < 0.001). Nevertheless, at six months, estimation errors were similar in both groups (median absolute estimation error 10.0 vs 10.0; difference 95% CI, -1.3 to 2.1; P = 0.27). CONCLUSIONS: Participation in a short online PLM significantly improved novices' short-term ability to accurately estimate LVEF visually, compared with controls. The effect was not sustained at six months. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT03245567); registered 7 August 2017.


Assuntos
Ecocardiografia Transesofagiana , Função Ventricular Esquerda , Competência Clínica , Ecocardiografia , Humanos , Volume Sistólico
13.
A A Pract ; 15(7): e01497, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34283815

RESUMO

Magnetic gastroesophageal reflux devices are becoming a common treatment option for reflux refractory to medical therapy. These devices are inserted laparoscopically with successful outcomes; however, patients may still complain of dysphagia after implantation. Echocardiographers may be hesitant to perform transesophageal echocardiography (TEE) in these patients as esophageal surgery and dysphagia represent relative contraindications to performing TEE. However, we present 2 cases where intraoperative TEE was performed in patients with reflux devices without complication or image degradation. The described cases, in addition to a review of the perioperative management of these devices, support the use of TEE in this patient population.


Assuntos
Ecocardiografia Transesofagiana , Refluxo Gastroesofágico , Refluxo Gastroesofágico/diagnóstico por imagem , Humanos , Fenômenos Magnéticos
14.
BMC Infect Dis ; 21(1): 689, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271874

RESUMO

BACKGROUND: Infective endocarditis (IE) is diagnosed in 7-8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. METHODS: In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3-10%, high-risk 10-30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3-10%), or "wait & see" (IE < 3%). RESULTS: We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to "wait & see" strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. CONCLUSION: In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.


Assuntos
Algoritmos , Ecocardiografia , Endocardite Bacteriana/diagnóstico , Sepse/diagnóstico , Infecções Estreptocócicas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Ecocardiografia/métodos , Ecocardiografia Transesofagiana/métodos , Endocardite Bacteriana/sangue , Endocardite Bacteriana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Sistema de Registros , Sepse/epidemiologia , Sepse/microbiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/epidemiologia , Streptococcus/fisiologia
15.
Curr Cardiol Rep ; 23(9): 122, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34269898

RESUMO

PURPOSE OF REVIEW: Given the low occurrence of clinically important paravalvular leak (PVL), there are no large registries or trials in this space to investigate management strategies. This review integrates newer evidence, particularly in imaging guidance for these complex procedures, novel techniques and approaches that our group has taken, as well as approaches to more complex PVL plugging reported in case reports. RECENT FINDINGS: Perhaps the largest area of growth in the management of PVL is the use of advanced imaging in both pre-procedure evaluation and intra-procedural guidance with gated cardiac CT, 3D TEE, and fluoroscopy fusion technologies. Outside the USA, a new device, the Occlutech PLD, has become available with early data indicating high success rates. There remains little randomized data to support the efficacy of percutaneous PVL closure. Gated cardiac CT has become key to the pre-procedure evaluation for transcatheter closure as it allows for increased procedural efficiency and more accurate pre-procedure planning, particularly when combined with 3D printing. Intra-procedural TEE-fluoro fusion allows for more rapid crossing of defects by providing a visual target for interventionalists. The advent of purpose-built devices for PVL closure may further increase the efficacy and efficiency of percutaneous closure, but significant barriers remain for approval of these devices in the USA.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Cateterismo Cardíaco , Ecocardiografia Transesofagiana , Fluoroscopia , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Reoperação , Resultado do Tratamento
17.
J Card Surg ; 36(9): 3131-3137, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34212430

RESUMO

AIMS: This study aimed to investigate the safety, feasibility and, availability of perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children. METHODS AND RESULTS: From January 2015 to January 2019, 131 children with restrictive PmVSDs were enrolled in this study and successfully done in 126 patients (96.18%). PmVSDs were occluded via an ultra-minimal trans intercostal incision (≤1 cm), and the entire occlusive process was guided and monitored by TEE. A pericardium hanging technique was employed without sternal incision. PmVSDs were closed through a short delivery sheath assembled using a concentric occluder device. All patients were followed up for a period ranging from18 months to 24 months. Thirteen patients with PmVSD had aneurysm of membranous septum (AMS). Multistream (≥2) PmVSDs with AMS were found in 11 cases. After the operation, mild residual shunt beside the amplatzer occluder in one patient was found and had self-healing result during the 5-month follow-up period. Five patients transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass. One reason was ventricular fibrillation when guidewire passed the PmVSD, another was device dislocation, and others were the guidewire cannot pass through the PmVSD. CONCLUSIONS: PmVSDs closure using a concentric occluder via a left parasternal ultra-minimal trans intercostal incision under TEE guidance is feasible, safe, and effective in children. This approach can be considered as an alternative treatment to open-heart surgery for restrictive PmVSDs.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Comunicação Interventricular , Dispositivo para Oclusão Septal , Cateterismo Cardíaco , Criança , Ecocardiografia Transesofagiana , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Desenho de Prótese , Esternotomia , Resultado do Tratamento
18.
Ann Palliat Med ; 10(8): 9318-9323, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34328003

RESUMO

Paravalvular leaks (PVL) are well-recognized complications after artificial valve replacement and symptomatic periprosthetic leaks are closely associated with increased mobility and mortality. Owing to the difference in types of prosthetic valve and options of suture technique, echocardiography of PVL can be diverse and challenge to diagnose. Herein, we report a patient with continuous low cardiac output syndrome on the second day after surgery after aortic replacement, which was misdiagnosed as coronary-left ventricular fistula by transthoracic echocardiogram (TTE). However, transesophageal echocardiogram (TEE) detected a perpendicular and turbulent jet flow from the outer side of the sewing ring, which was eventually diagnosed as an acute aortic PVL combined with cardiac angiography. The significant PVLs were treated by reoperation previously, while they are recommended for transcatheter closure recently. This patient was received successful percutaneous closure by the Cardi-O-Fix Plug. The cardiac symptom was relieved without additional complications. This report highlights the important role of multi-modality imaging, including the combination of TTE, TEE and cardiac angiography, in the diagnosis and treatment of PVL. Percutaneous closure is an appropriate option for the repair of PVL with long-term symptom relief and reduced mortality compared to reoperation. Therefore, this article describes the diagnosis and treatment of this patient with acute aortic PVL.


Assuntos
Próteses Valvulares Cardíacas , Ecocardiografia Transesofagiana , Humanos , Resultado do Tratamento
19.
Am J Cardiol ; 153: 109-118, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34210503

RESUMO

Multidetector computed tomography (MDCT) can provide valuable information for preprocedural planning of transcatheter mitral valve interventions. However, no data exists on pre-MDCT parameters predicting high transmitral pressure gradient (TMPG) post-MitraClip procedure. We analyzed the preprocedural MDCTs of 156 consecutive patients with mitral regurgitation undergoing MitraClip implantation at our institution. The mean TMPG was assessed by periprocedural transesophageal and pre-discharge transthoracic echocardiography. MDCT-derived mitral annulus area (MAA), anterior-posterior (AP) and medial-lateral (ML) mitral annulus diameters, and mitral valve orifice area (MVOA) were smaller in patients with mean TMPG ≥5 mmHg than those with mean TMPG <5 mmHg after 1-or 2-clip implantation. Small MAA, AP and ML diameters, and MVOA were moderately correlated with high TMPG post-MitraClip, in which MAA and MVOA had the highest degree of correlation after 1-clip (r = -0.46 both), whereas MAA and ML had the strongest degree of correlation after 2-clip (r = -0.39 both) and at discharge (r = -0.38 both). From the receiver-operating-characteristic curve analyses, no significant differences in the area under the curve were observed among these MDCT parameters for low TMPG after MitraClip implantation, except for those between MAA and AP diameter at discharge (p=0.026). For optimal cutoff values, MAA ≥1100 and ≥1300 mm2 had positive predictive values of 89% and 91%, while both MAA ≥750 and ≥900 mm2 had negative predictive values of 100%, for mean TMPG <5 mmHg after 1-and 2-clip implantation, respectively. In conclusion, in patients undergoing the MitraClip procedure, preprocedural MDCT parameters are useful to predict postprocedural mitral stenosis.


Assuntos
Cateterismo Cardíaco , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/epidemiologia , Valva Mitral/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/etiologia , Tomografia Computadorizada Multidetectores , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Medição de Risco
20.
Echocardiography ; 38(8): 1307-1313, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34286878

RESUMO

PURPOSE: Transthoracic echocardiography (TTE) provides noninvasively quantitative assessment of aortic regurgitation (AR) severity, but its diagnostic accuracy depends on image quality. Two-dimensional transesophageal echocardiography (TEE) is a semi-invasive procedure that is excellent in evaluating AR mechanism. However, quantitative assessment may be challenging due to restrictions in probe manipulation. This study aimed to investigate the diagnostic value of three-dimensional TEE to measure the vena contracta area (3DVCA) of AR. METHODS: The subjects comprised 62 patients (age, 65 ± 16 years) whose AR was evaluated using TEE. The 3DVCA and semi-quantitative TEE parameters, such as the ratio of AR jet width to left ventricular outflow tract (jet/LVOT) and the vena contracta width (VCW) of AR jet, were compared using angiography grade and quantitative TTE measurements including regurgitant volume (RVol) and effective regurgitant orifice area (EROA). The diagnostic accuracy was determined using receiver operating characteristic (ROC) analysis, and the reproducibility of 3DVCA was also evaluated. RESULTS: In 3DVCA, less overlap between angiography grades were observed. Correlation with RVol or EROA was better in 3DVCA than in Jet/LVOT or VCW. The area under the ROC curve was .737 for jet/LVOT, .773 for VCW, and .849 for 3DVCA, respectively. The optimal cutoff value of 3DVCA was ≥.31 cm2 for grading severe AR. Inter- and intra-observer reproducibility of 3DVCA were .92 and .97, respectively. CONCLUSIONS: The 3DVCA method using TEE showed high diagnostic accuracy and reproducibility. 3DVCA deserves use in accurately assessing AR severity, especially in patients who present difficulty in quantitative Doppler assessment using TTE.


Assuntos
Insuficiência da Valva Aórtica , Idoso , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
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