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1.
Curr Probl Cardiol ; 48(1): 101396, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36126764

RESUMO

In the COVID-19 pandemic, to minimize aerosol-generating procedures, cardiac magnetic resonance imaging (CMR) was utilized at our institution as an alternative to transesophageal echocardiography (TEE) for diagnosing infective endocarditis (IE). This retrospective study evaluated the clinical utility of CMR for detecting IE among 14 patients growing typical microorganisms on blood cultures or meeting modified Duke Criteria. Seven cases were treated for IE. In 2 cases, CMR results were notable for possible leaflet vegetations and were clinically meaningful in guiding antibiotic therapy, obtaining further imaging, and/or pursuing surgical intervention. In 2 cases, vegetations were missed on CMR but detected on TEE. In 3 cases, CMR was non-diagnostic, but patients were treated empirically. There was no difference in antibiotic duration or outcomes over 1 year. CMR demonstrated mixed results in diagnosing valvular vegetations and guiding clinical decision-making. Further prospective controlled trials of CMR Vs TEE are warranted.


Assuntos
COVID-19 , Endocardite Bacteriana , Endocardite , Humanos , COVID-19/complicações , Estudos Retrospectivos , Pandemias , Endocardite/diagnóstico por imagem , Endocardite/terapia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/patologia , Ecocardiografia Transesofagiana/métodos , Imageamento por Ressonância Magnética
2.
Circ Cardiovasc Imaging ; 15(11): e014804, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36378776

RESUMO

Multi-modality imaging plays critical roles during and after procedures associated with atrial fibrillation. Transesophageal echocardiography is an invaluable tool for left atrial appendage occlusion during the procedure and at follow-up. Both cardiac computed tomography and cardiac magnetic resonance contribute to postprocedural evaluation of pulmonary vein isolation ablation. The present review is the second of a 2-part series where we discuss the roles of cardiac imaging in the evaluation and management of patients with atrial fibrillation, focusing on intraprocedural and postprocedural assessment, including the clinical evidence and outcomes data supporting this future applications.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Humanos , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Apêndice Atrial/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Imagem Multimodal , Ecocardiografia Transesofagiana , Ablação por Cateter/efeitos adversos , Resultado do Tratamento
3.
Eur J Med Res ; 27(1): 228, 2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36329503

RESUMO

PURPOSE: The purpose of this study was to observe the morphologic characteristics of patent foramen ovale (PFO) by transesophageal echocardiography (TEE), and to analyze its correlation with right-to-left shunt (RLS) of contrast-transthoracic echocardiography (c-TTE) and contrast-transcranial Doppler ultrasonography (c-TCD). METHODS: 124 patients with PFO were divided into four groups according to the morphological characteristics of PFO. RLS grade of each group PFO with c-TTE and c-TCD in resting and Valsalva manoeuvre was measured. Anatomical structures influencing RLS grade were analyzed statistically through multivariate logistic analyses and predictive models. RESULTS: The 124 cases of PFO were divided into four groups: 55 cases (44.4%) with smooth uniform tubular tunnel (SUT), 21 cases (16.9%) with granule uniform tubular tunnel (GUT), 23 cases (18.5%) of right funnelform, 25 cases (20.2%) of left funnelform. Between group comparisons and multivariate logistic analyses revealed that PFO morphotype and interatrial septum(IAS) mobility were influencing factors of RLS degree. During Valsalva, the probability of c-TCD RLS ≥ 2 for the right funnelform PFO was 13.428 times that of the GUT, one unit increase in IAS mobility increased the probability of c-TCD RLS ≥ 2 by a factor of 2.029, model predicted c-TCD RLS ≥ 2 with 78.1% sensitivity and 94.7% specificity; During Valsalva, the probability of c-TCD RLS ≥ 2 for the SUT PFO was 4.244 times that of the GUT, one unit increase in IAS mobility increased the probability of c-TTE RLS ≥ 2 by a factor of 2.392, model predicted c-TTE RLS ≥ 2 with 80.2% sensitivity and 87.9% specificity. CONCLUSIONS: Studies have shown that the morphological structure of PFO is an influencing factor of RLS, and TEE can observe the specific morphological characteristics of PFO, which can further predict the level of RLS, help predict the occurrence of Cryptogenic stroke (CS). The above provides more evidences and surgical options for Interventional device closure indications.


Assuntos
Forame Oval Patente , Humanos , Forame Oval Patente/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana , Ecocardiografia , Ecocardiografia Transesofagiana
4.
Transpl Int ; 35: 10753, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36338536

RESUMO

The risk of upper gastrointestinal bleeding (UGIB) after transesophageal echocardiography (TEE) in patients with high grade esophageal varices (EV) that are undergoing Orthotopic Liver transplantation (OLT) is poorly understood. This was a retrospective single-centre cohort study in all patients that underwent OLT at Queen Elizabeth Hospital Birmingham between September 2016 and September 2018. The primary outcome was to determine the incidence of UGIB in patients that have undergone OLT with EV that received TEE. 401 patients were included in the study, of which 320 (80%) received TEE. The incidence of post-operative UGIB in patients that received TEE was 1.6% (5/320) in the entire cohort: 2.7% (4/149) in patients with no evidence of EV and 0.6% (1/171) in patients with EV. UGIB occurred in 1 patient with grade 2 EV and did not occur in patients with grade 1 or 3 EV. The incidence of UGIB in patients that received TEE was not statistically different to patients that did not: 1.6% (5/320) vs. 3.7% (3/81) p = 0.218. In conclusion, in patients that underwent OLT, intra-operative TEE use was associated with low rates of UGIB, even in cohorts with high grade EV. This suggests that TEE is a relatively safe method of haemodynamic monitoring in patients undergoing OLT.


Assuntos
Varizes Esofágicas e Gástricas , Transplante de Fígado , Humanos , Ecocardiografia Transesofagiana/efeitos adversos , Ecocardiografia Transesofagiana/métodos , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Incidência , Estudos Retrospectivos , Estudos de Coortes , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/epidemiologia , Varizes Esofágicas e Gástricas/etiologia
5.
JACC Cardiovasc Interv ; 15(21): 2127-2138, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36357016

RESUMO

BACKGROUND: Peridevice leak (PDL) is a limitation of left atrial appendage occlusion. OBJECTIVES: The aim of this study was to assess the incidence of and outcomes associated with PDL in the Amulet IDE (AMPLATZER™ Amulet™ LAA Occluder Trial) randomized controlled trial. METHODS: Patients with atrial fibrillation at increased stroke risk were randomly assigned to undergo either Amulet (dual occlusive mechanism) or Watchman 2.5 (single occlusive mechanism) device implantation. Transesophageal echocardiography was performed at 45 days and 12 months postprocedure. Clinically significant PDL was defined as ≥3 mm. The primary endpoint was ischemic stroke or systemic embolism, and the secondary endpoint was stroke, systemic embolism, or cardiovascular death. The Kaplan-Meier method was used to estimate 18-month cumulative event rates landmarked at day 45 postprocedure. RESULTS: A total of 1,593 patients underwent successful left atrial appendage occlusion and had an evaluable transesophageal echocardiographic studies at 45 days. The dual-occlusive mechanism device provided superior closure (defined as leak <3 mm) compared with the single-occlusive mechanism device at 45 days (88.9% vs 74.1%; P < 0.01) and 12 months (90.5% vs. 78.3%; P < 0.01). Through 18 months, PDL was associated with a higher, but not statistically significant, risk for the primary endpoint (3.6% vs 1.8%; adjusted HR: 1.98; 95% CI: 0.93-4.19; P = 0.07) and a statistically significantly higher risk for the secondary endpoint (8.1% vs. 4.7%; adjusted HR: 1.66; 95% CI: 1.02-2.69; P = 0.04). CONCLUSIONS: The dual-occlusive mechanism device provided superior closure compared with the single-occlusive mechanism device at both 45 days and 1 year postprocedure. PDL ≥3 mm was associated with a significantly increased 18-month risk for the composite of stroke, systemic embolism, or cardiovascular death. Completeness of closure of the left atrial appendage has important implications for patient outcomes. (AMPLATZER™ Amulet™ LAA Occluder Trial [Amulet IDE]; NCT02879448).


Assuntos
Apêndice Atrial , Fibrilação Atrial , Embolia , Dispositivo para Oclusão Septal , Acidente Vascular Cerebral , Humanos , Apêndice Atrial/diagnóstico por imagem , Resultado do Tratamento , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Ecocardiografia Transesofagiana/efeitos adversos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Embolia/etiologia , Cateterismo Cardíaco , Dispositivo para Oclusão Septal/efeitos adversos
8.
JACC Cardiovasc Interv ; 15(21): 2158-2170, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36357020

RESUMO

BACKGROUND: Incomplete left atrial appendage (LAA) closure is an evolving topic of clinical significance and thromboembolic potential, with recent long-term studies suggesting lower cutoffs for relevant leak size. OBJECTIVES: The aim of this prospective observational study was to assess 3 different closure techniques for persistent peridevice leaks after incomplete LAA closure and compare their efficacy and safety outcomes. METHODS: We studied 160 patients (mean age 72 ± 9 years; 71% men) who underwent 1 of the 3 available modalities (detachable embolization coils, vascular plugs or septal occluders, and radiofrequency ablation) for residual central or eccentric leak closure. Both acute postprocedural success (closure or <1-mm leak at the end of the procedure) and closure at 1-year follow-up transesophageal echocardiography imaging were evaluated. RESULTS: Of 160 patients, 0.6%, 41.3%, and 58.1% had mild (1-2 mm), moderate (3-5 mm), and severe (≥5 mm) leaks, respectively. Baseline LAA closure type was 72.5% Watchman FLX, 16.3% Lariat, 5.6% surgical ligation, 1.9% AtriClip, and 1.9% Amulet. Successful closure (0- or <1-mm leak) was seen in 100% of patients in all cohorts following intervention, with overall complete closure (0-1 mm) or mild or minimal leaks (1-2 mm) on 1-year follow-up transesophageal echocardiography seen in 100% of the atrial septal occluder or vascular plug cohort, 85.9% of the coil cohort, and 83.3% of the radiofrequency ablation cohort (P < 0.001). Two patients (1.3%) experienced cardiac tamponade, and there were no deaths or other complications. CONCLUSIONS: Peridevice leaks can safely and effectively be closed using 3 different modalities depending on size and location.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Dispositivo para Oclusão Septal , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Fibrilação Atrial/complicações , Resultado do Tratamento , Ecocardiografia Transesofagiana , Cateterismo Cardíaco/efeitos adversos
10.
G Ital Cardiol (Rome) ; 23(11): 872-875, 2022 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-36300390

RESUMO

Caseous calcification of the mitral annulus is an uncommon variant of mitral annular calcification. It appears as a round echodense mass containing central areas of echolucencies resembling liquefaction and with no flow in the central zone on color Doppler. In most cases it involves the posterior mitral annulus region, particularly in female subjects. The pathogenesis remains unclear: hypercholesterolemia and the dissolution of lipid-rich macrophages may be implicated in liquefaction necrosis. Transthoracic and transesophageal echocardiography represents the most reliable technique for diagnosis, whereas cardiac magnetic resonance imaging is the choice in doubtful cases. We report the case of an 82-year-old female patient describing different aspects of this particular clinical condition.


Assuntos
Calcinose , Doenças das Valvas Cardíacas , Feminino , Humanos , Idoso de 80 Anos ou mais , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Calcinose/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Ecocardiografia Transesofagiana , Lipídeos
12.
Circ Cardiovasc Imaging ; 15(10): e014386, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36256725

RESUMO

Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased risk of heart failure, stroke, and death. In current medical practice, multimodality imaging is routinely used in the management of AF. Twenty-one years ago, the ACUTE trial (Assessment of Cardioversion Using Transesophageal Echocardiography) results were published, and the management of AF changed forever by incorporating transesophageal echocardiography guided cardioversion of patients in AF for the first time. Current applications of multimodality imaging in AF in 2022 include the use of transesophageal echocardiography and computed tomography before cardioversion to exclude left atrial thrombus and in left atrial appendage occlusion device implantation. Transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance are clinically used for AF ablation planning. The decision to use a particular imaging modality in AF is based on patient's characteristics, guideline recommendation, institutional preferences, expertise, and cost. In this first of 2-part review series, we discuss the preprocedural role of echocardiography, computed tomography, and cardiac magnetic resonance in the AF, with regard to their clinical applications, relevant outcomes data and unmet needs, and highlights future directions in this rapidly evolving field.


Assuntos
Fibrilação Atrial , Imagem Multimodal , Humanos , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Ecocardiografia Transesofagiana , Cardioversão Elétrica , Ensaios Clínicos como Assunto
13.
Echocardiography ; 39(10): 1348-1358, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36198094

RESUMO

INTRODUCTION: Gram-negative organisms of the AACEK group, formerly known as HACEK, rarely cause endocarditis. CASE SERIES: We present three cases of bacterial endocarditis, involving native and prosthetic valves, caused by AACEK organisms. In two patients, Cardiobacterium hominis was the responsible organism, and in a third, Aggregatibacter aphrophilus was implicated. A dental source of infection was identified in two patients, and in all three patients, the presentation of endocarditis was subacute. DISCUSSION: This case series highlights the indolent nature of infection with the AACEK organisms. It also demonstrates the crucial role of multimodality imaging, especially transesophageal echocardiography, in the diagnosis of AACEk endocarditis of both native and prosthetic valves, and in delineating the extent of abscess in those with prosthetic valve infection.


Assuntos
Endocardite Bacteriana , Endocardite , Humanos , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/diagnóstico por imagem , Ecocardiografia Transesofagiana
14.
Ann Card Anaesth ; 25(4): 441-446, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36254908

RESUMO

Background and Aims: Transcatheter device closure of congenital heart defects (CHD) has recently gained popularity. As limited literature exists regarding the ideal anesthetic technique for these procedures, we studied the perioperative anesthetic management and its effects on hemodynamics and complication rate in patients undergoing device closure. Methods: In this prospective observational study, all patients of 1 month to 50 years of age with acyanotic congenital heart diseases undergoing device closure were included. The anesthesia technique, i.e., general anesthesia with endotracheal tube (GETA)/supraglottic airway device (SGD) or conscious sedation with face mask (S-FM), and intravenous induction agent used was noted. Intraoperatively vital parameters, use of transesophageal echocardiography (TEE), and perioperative complications if any, were noted. Descriptive statistical analysis was done using a statistical package for the social sciences (SPSS) version 15. Results: GETA was used in the atrial septal defect (ASD) (62.8%), patent ductus arteriosus (PDA) (66.7%), ventricular septal defect (VSD) (65%) patients, SGD in ASD (6.3%), PDA (16.7%), and VSD (13.3%) patients. S-FM in ASD (31.3%), PDA (16.7%) and VSD (21.7%) patients. Etomidate was used as an induction agent in 30.61% of the patients and propofol in 69.39% of the patients. The mean arterial pressure (MAP) in the etomidate and propofol groups was statistically insignificant while decreased heart rate was noted in both groups. Complications like SGD dislodgement, supraventricular tachycardia, and device dislodgements were seen. Conclusion: In PDA device closure patients, GETA should be preferred. Patients for VSD device closure should receive general anesthesia as complications are common. In ASD device closure, patients without TEE use can be done under general anesthesia with SGD.


Assuntos
Anestésicos , Permeabilidade do Canal Arterial , Etomidato , Cardiopatias Congênitas , Comunicação Interatrial , Comunicação Interventricular , Propofol , Cateterismo Cardíaco/métodos , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia Transesofagiana/métodos , Cardiopatias Congênitas/cirurgia , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Estudos Prospectivos , Resultado do Tratamento
15.
Ann Card Anaesth ; 25(4): 479-484, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36254914

RESUMO

Background: Transesophageal echocardiography (TEE) is a powerful diagnostic tool which has become an integral part in the management of cardiac surgery patients. We developed a one-day 3D TEE workshop specifically designed to meet the needs of perioperative cardiac anaesthesiologists. We hypothesized that participation in the workshop would increase the uptake of 3D TEE in routine perioperative practice. Aims: To examine the impact of one-day 3D TEE workshop on 3D TEE image acquisition and incorporation into routine perioperative practice. Setting: Tertiary care hospital. Design: Prospective observational monocentric study. Subjects and Methods: A convenience sample of 20 cardiac anesthesiologists (with an option to attend the one- day workshop midway through the study) from a single center consented to have their intraoperative TEE images collected during the course of the study reviewed for research purposes. Images acquired 6 months before, immediately after, and 6 months following the workshop and images were examined by a blinded, expert echocardiographer. Results: Data collected for 16 participants (8 workshop attendees, 8 non-attendees) indicate that the TEE workshop increased the number of 3D TEE images, but not x images acquired immediately following the workshop (P=0.006). No difference was observed in number of 3D images at six months' post workshop. Workshop participants obtained more 3D and multi-plane images after the workshop and more 3D images at 6 months compared to those who did not attend the workshop. Conclusion: Our study suggests that a single day hands-on 3D TEE workshop may have had an impact on the implementation of intraoperative 3D TEE in experienced echocardiographers.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ecocardiografia Tridimensional , Ecocardiografia/métodos , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Humanos
16.
Semin Cardiothorac Vasc Anesth ; 26(4): 274-281, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36202226

RESUMO

Transesophageal echocardiography is frequently but not always used to guide anesthetic management during liver transplantation. We performed a systematic review of the literature to identify and summarize any studies reporting on the frequency and characteristics of TEE use for liver transplantation. Studies were identified by searching several relevant terms on PubMed and citation searching of relevant reviews. We identified 5 studies reporting the results of surveys performed between 2003 and 2018. Use of TEE for liver transplantation increased from 11.3% of centers in 2003 to greater than 90% of centers by 2014 and 2018. Only 38%-56% of centers use it routinely with the rest using it only in special circumstances. About a third of centers usually perform a comprehensive exam, with the majority performing a more limited exam based on the needs of the case. Use of TEE for liver transplantation is common but not universal. This review summarizes the current knowledge about the frequency and circumstances of use, but there is an opportunity for further systematic study and discussion.


Assuntos
Ecocardiografia Transesofagiana , Transplante de Fígado , Humanos , Ecocardiografia Transesofagiana/métodos , Transplante de Fígado/métodos , Monitorização Intraoperatória/métodos , Inquéritos e Questionários
17.
J Clin Ultrasound ; 50(8): 1060-1065, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36218208

RESUMO

Infective endocarditis (IE) poses a large diagnostic and therapeutical challenge. An early diagnosis is necessary for a positive outcome. Echocardiography is initial diagnostic method when there is a possibility of IE presence. TTE and TEE are useful in detection, accurate localisation and estimation of vegetation size, and also in detection of paravalvular spreading of infection. In certain situations, there is a need for usage of complementary methods like CCT and nuclear techniques. This article will outline advantages and limitations of certain diagnostic methods in diagnosis of IE.


Assuntos
Ecocardiografia Transesofagiana , Endocardite , Ecocardiografia/métodos , Ecocardiografia Transesofagiana/métodos , Endocardite/diagnóstico por imagem , Humanos
18.
J Clin Ultrasound ; 50(8): 1194-1201, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36218213

RESUMO

Atrial fibrillation (AF) is the most common arrhythmia in the general population. Systemic thromboembolism from left atrial appendage (LAA) thrombosis is a well-known complication of AF, whereas thromboembolic complications from a right atrial (RA) thrombus are infrequent. Nevertheless, the prevalence of RA thrombosis is debated; despite having a low prevalence in echocardiographic studies, the higher prevalence found in autoptic studies rises the hypothesis of an under detection of RA clots, possibly related to the limited evaluation of right atrial appendage (RAA) with non-invasive imaging. Here we present a review of the current literature about RA thrombosis, regarding its diagnosis, differentials, and best treatment options.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Cardiopatias , Trombose , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Humanos , Fatores de Risco , Trombose/complicações , Trombose/diagnóstico por imagem
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