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1.
Orv Hetil ; 161(5): 169-176, 2020 02.
Artigo em Húngaro | MEDLINE | ID: mdl-31984773

RESUMO

Introduction: Hypereosinophilic syndrome (HES) and immunoglobulin light-chain amyloidosis (ALA) are two, rare haematological disorders associated with cardiac alterations. Aim: The goal of the present study was a comparative assessment of left ventricular (LV) deformational parameters in HES and ALA patients using three-dimensional speckle-tracking echocardiography (3DSTE). Method: In the present study, results of 10 HES patients (mean age: 60.9 ± 14.7 years) and 19 ALA patients (mean age: 63.4 ± 7.8 years, 13 males) were analysed. The control group contained 13 age- and gender-matched healthy adults (mean age: 59.2 ± 4.3 years, 5 males). All patients underwent a complete two-dimensional Doppler echocardiography followed by 3DSTE. Results: All basal segmental LV strains were significantly reduced in ALA patients as compared to the control group. Global and mean segmental LV longitudinal strain (LS) values of ALA patients proved to be significantly decreased as compared to those of the healthy control group. During comparison of HES patients and healthy controls, significant difference could be detected in global LV-LS, while segmental basal LV-LS was also significantly reduced in HES patients. Basal LV radial and 3D strains showed significant differences when parameters of HES and ALA patient groups were compared. Conclusion: 3DSTE is a feasible tool for the detailed assessment of LV deformation in HES and ALA patients. Significant LV deformational abnormalities could be detected in both groups. In the case of ALA, these abnormalities are more prominent. Orv Hetil. 2020; 161(5): 169-176.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Ventrículos do Coração/diagnóstico por imagem , Síndrome Hipereosinofílica , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Cardiomiopatias/imunologia , Cardiomiopatias/fisiopatologia , Estudos de Casos e Controles , Ecocardiografia Doppler , Feminino , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/imunologia , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologia , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/imunologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
2.
Curr Opin Anaesthesiol ; 33(1): 83-91, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31789893

RESUMO

PURPOSE OF REVIEW: Transesophageal echocardiography (TEE) has made its way into the cardiac surgery realm and spurred the development of many interventions. In the domain of minimally invasive cardiac surgery (MICS), TEE has become central to reducing cardiovascular complications. RECENT FINDINGS: Real-time three-dimensional TEE is a key contributor to the safe and precise deployment of the PASCAL mitral valve repair system, which is showing great potential in ongoing studies. The current data on outcomes of transcatheter aortic valve replacement show that preprocedural three-dimensional TEE and multidetector computed tomography (CT) perform similarly in aortic root assessment. Three-dimensional color Doppler TEE has been suggested to be more appropriate in quantifying residual mitral regurgitation and evaluating the success of surgical or percutaneous closure. A three-dimensional TEE-derived aortomitral angle may be valuable in predicting and detecting dynamic left ventricular outflow tract obstruction, thereby enhancing the safety of transcatheter mitral valve replacement. SUMMARY: Advanced imaging modalities are essential for the sustained growth of MICS, particularly with the evolution of novel transcatheter systems. These techniques rely on exceptional imaging quality at all stages of the perioperative period to modify surgical-risk and improve patient outcomes. TEE has the additional benefit of providing real-time information on intrathoracic structures to guide intraoperative management.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Insuficiência da Valva Mitral , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Insuficiência da Valva Mitral/cirurgia
3.
Int J Cardiovasc Imaging ; 36(1): 33-43, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31432289

RESUMO

Tricuspid annular (TA) size, assessed by 2D transthoracic echocardiography (TTE), has a well-established prognostic value in patients undergoing mitral valve surgery, with TA dilatation triggering simultaneous tricuspid annuloplasty. While TA dilatation is common in patients with dilated atria secondary to atrial fibrillation, little is known about the mechanisms of TA dilatation in patients with sinus rhythm (SR). This study aimed to identify echocardiographic parameters most closely related to the TA size as a potential tool for identification of patients prone to developing TA enlargement. 120 patients with SR underwent clinically indicated TTE, including 30 patients with normal hearts and 90 patients diagnosed with at least one right heart abnormality, defined as: right ventricular (RV) or right atrial (RA) dilatation, ≥ moderate tricuspid regurgitation (TR) and elevated systolic pulmonary artery pressure (sPAP). RA and RV end-diastolic and end-systolic volumes (EDV, ESV) and function were measured using commercial 3D software (TomTec). 3D RV long and short axes were used as surrogate indices of RV shape. Degrees of TR and sPAP were estimated by 2D TTE. 3D TA sizing was performed at end-diastole using 3D custom software. Linear regression analysis was used to identify variables best correlated with TA size, followed by multivariate analysis to identify independent associations. The highest correlations were found between TA area and: RA ESV (r = 0.73; p < 0.01), RV EDV (r = 0.58; p < 0.01), RV end-diastolic long and short axes (r = 0.53, 0.42; both p < 0.01), TR degree (r = 0.40; p < 0.01) and sPAP (r = 0.32; p < 0.01). Multivariate analysis revealed that RA ESV was the only parameter independently associated with TA area (p < 0.05, r = 0.85). In conclusion, RA volume plays an important role in TA dilatation even in patients with normal SR. Understanding of annular remodeling mechanisms could aid in identifying patients at higher risk for TA dilatation, especially those scheduled for mitral valve surgery.


Assuntos
Ecocardiografia Tridimensional , Hemodinâmica , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Adulto , Idoso , Pressão Arterial , Função do Átrio Direito , Remodelamento Atrial , Chicago , Dilatação Patológica , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Valva Tricúspide/patologia , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/patologia , Insuficiência da Valva Tricúspide/fisiopatologia , Função Ventricular Direita
4.
J Clin Ultrasound ; 48(1): 29-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31566758

RESUMO

PURPOSE: This study aimed to analyze left ventricular (LV) remodeling in patients with LV dilation using three-dimensional (3D) echocardiography, and to compare geometry and systolic function between patients with dilated cardiomyopathy (DCM) and with mitral regurgitation (MR) but similar LV dimension. METHODS: Cross-sectional study of 60 DCM and 60 MR patients with LV end diastolic diameter (LVEDD) > 35 mm/m2 , and of 60 healthy control volunteers. RESULTS: Despite a similar LVEDD, DCM patients showed a significantly higher 3D sphericity index (3D-SI) than MR patients, whereas 3D ejection fraction (3D-EF) was significantly lower (P < .01). There was a linear relationship between 3D-EF and 3D-SI in both DCM and MR patients (r = -0. 745 and r = -0. 642, respectively; both P < .001). Receiver operating characteristic (ROC) curves showed that 3D-SI had could better discriminate between DCM and MR (sensitivity 90%; specificity 73%; AUC 0.852, P < .01) than other variables. The area under the ROC curve of 3D-SI was significantly larger than that of 3D-EF for detecting heart failure in both patients with DCM and MR. CONCLUSIONS: LV geometry appears to be more spherical and associated with worse systolic function in DCM than in MR patients, in spite of similar LV dimensions. Systolic function correlated significantly with 3D-SI, which provided a better description of LV remodeling and could be a stronger indicator of heart failure in patients with LV dilation.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia Tridimensional , Ventrículos do Coração/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Remodelação Ventricular , Adulto , Cardiomiopatia Dilatada/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/etiologia
5.
Kardiologiia ; 59(10S): 22-30, 2019 Sep 11.
Artigo em Russo | MEDLINE | ID: mdl-31876459

RESUMO

OBJECTIVES: To compare the possibilities and limitations of the two-dimensional (2D) and three-dimensional (3D) multiplane transesophageal echocardiography (TEE) for the diagnosis of the thoracic aorta (TA) atherosclerosis stage, qualitative and quantitative assessment of aortic atheromas and coronary atherosclerosis prediction. Materials and methods. 2D and 3D multiplane TEE of the TA was performed in 180 consecutive CAD patients (104 men, 76 women, mean age 62,4±7,5 years) using Philips IE33 xMatrix system and a X7-2t multiplane probe. Ascending aorta, accessible parts of the arch and descending TA were visualized in 2D mode with standard protocol using Live xPlane mode. 3D study of TA was performed using Live 3D and Full Volume modes. 2D and 3D studies were recorded as video clips series on a system hard drive with subsequent off line processing on a QLab 10.8 (Philips) workstation. Qualitative and quantitative assessment of every atheroma was performed using 2D and 3D modes. The degree of severity and distribution of the TA atheromatosis was evaluated according to the classification of ASE and EACVI (2015): grade 0 - intimal-medial thickness ≤1 mm, 1 - intimal thickness ≤2 mm, 2 - focal or diffuse intimal thickening of 2-3 mm (small atheromas), 3 - atheromas >3-5 mm (no mobile/ulcerated components), 4 - atheromas > 5 mm (no mobile/ulcerated components), 5 - grade 2, 3, or 4 atheromas plus mobile or ulcerated components. After TEE all patients underwent digital coronary angiography. SYNTAX Score was calculated in 122 (67,7%) patients with no coronary stents and bypass grafts. Results. 620 atheromas were analysed: 109 (17,6%) in the ascending part, 8 (1,3%) in the arch and 503 (81,1%) in the descending part. On average 3,4±2,1 atheromas per patient were revealed. Atheromas height in 3D was significantly higher (p<0,001), than in 2D, being 0,38±0,09 cm and 0,26±0,07 cm, respectively.  Averaged atheromas height increase in 3D was 0,12±0,06 cm. In 3D 87,7% of atheromas have shown irregular contours while in 2D only 35,4% of atheromas had rough countors. The mobile component in 6 (66,6%) out of 9 atheromas was revealed only in 3D. In 2D 1-5 stages of TA atheromatosis were revealed in 22 (12,2%), 103 (57,2%), 43 (23,9%), 7 (3,9%) and 4 (2,2%) cases, respectively. In 3D 1-5 stages of TA atheromatosis were revealed in 16 (8,9%), 25 (13,9%), 90 (50%), 38 (21,1%) and 10 (5,5%) cases, respectively. With 3D TEE 130 (72,2%) patients were found to have higher gradation of TA atheromatosis stage. TA atheromatosis was not detected in 1 (0,6%) patient. The direct Spearman's correlation between a stage of TA atheromatosis and SYNTAX Score which has been established for 2D rs =0,32 p<0,001 and 3D rs =0,30, p<0,01, respectively. Conclusion. A comparison between 2D and 3D TEE has shown, that 3D is more precise method of qualitative and quantitative assessment of aortic atheromas and diagnosis of TA atheromatosis stage which allows, ultimately, to change the stage of TA atheromatosis towards a higher gradation. 3D ultrasound stage of TA atheromatosis is a surrogate marker of the severity and prevalence of coronary atherosclerosis.


Assuntos
Doenças da Aorta , Aterosclerose , Ecocardiografia Tridimensional , Idoso , Aorta Torácica , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Expert Rev Cardiovasc Ther ; 17(11): 801-815, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770493

RESUMO

Introduction: Quantification of left ventricular (LV) size and function represents the most frequent indication for an echocardiographic study. New echocardiographic techniques have been developed over the last decades in an attempt to provide a more comprehensive, accurate, and reproducible assessment of LV function.Areas covered: Although two-dimensional echocardiography (2DE) is the recommended imaging modality to evaluate the LV, three-dimensional echocardiography (3DE) has proven to be more accurate, by avoiding geometric assumptions about LV geometry, and to have incremental value for outcome prediction in comparison to conventional 2DE. LV shape (sphericity) and mass are actually measured with 3DE. Myocardial deformation analysis using 3DE can early detect subclinical LV dysfunction, before any detectable change in LV ejection fraction.Expert opinion: 3DE eliminates the errors associated with foreshortening and geometric assumptions inherent to 2DE and 3DE measurements approach very closely those obtained by CMR (the current reference modality), while maintaining the unique clinical advantage of a safe, highly cost/effective, portable imaging technique, available to the cardiologist at bedside to translate immediately the echocardiography findings into the clinical decision-making process.


Assuntos
Ecocardiografia Tridimensional/métodos , Ventrículos do Coração/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Humanos , Reprodutibilidade dos Testes , Volume Sistólico , Função Ventricular Esquerda
8.
Indian Heart J ; 71(3): 256-262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543199

RESUMO

OBJECTIVES: The aim of the study is to compare two advanced methods of evaluation of left ventricular mechanical dyssynchrony (LVMD), the speckle tracking echocardiography (STE) and the three-dimensional echocardiography (3DE). METHODS: One hundred thirty-six subjects, with or without LV dysfunction and with or without bundle branch block (BBB), were included in this study, designed to investigate agreement between magnitude and spatial pattern of LVMD as assessed by 3DE and STE. The frequency and severity of LVMD and localization of most asynchronous segments were compared. RESULTS: Both 3DE and STE revealed progressive rise in frequency and magnitude of LVMD with increasing disease severity. Dyssynchrony was dependent on left ventricle ejection fraction rather than the QRS duration. The frequency and magnitude of dyssynchrony were maximum in patients having LV dysfunction with left BBB. Compared with STE, 3DE diagnosed LVMD more frequently in patients having LV dysfunction with narrow QRS (17.6% vs 60.3%, respectively; P < 0.001). When the two methods were compared for localization of most asynchronous segments, the results matched only in about 50% cases. CONCLUSIONS: Both 3DE and STE provided consistent results with progressive rise in magnitude of LVMD, correlating with disease severity. 3DE diagnosed more patients as having LVMD in those having LV dysfunction with narrow QRS. The most delayed segment assessed by two methods matched only in about half the cases. Correlation with clinical CRT responsiveness is needed to conclude which method is more accurate in dyssynchrony mapping for targeted lead placement.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Ecocardiografia Tridimensional , Ecocardiografia/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Bloqueio de Ramo/fisiopatologia , Estudos Transversais , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Herz ; 44(7): 574-585, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31555893

RESUMO

Severe mitral regurgitation (MR) is associated with increased morbidity and mortality. Thus, the correct evaluation of the underlying etiology, pathomechanism and severity is crucial for optimal treatment. Echocardiography is the predominant diagnostic modality in the clinical routine as it enables grading of mitral regurgitation, which can frequently be achieved by readily available qualitative parameters. Additionally, echocardiography provides several methods to quantify the hemodynamic significance of MR. The effective regurgitation orifice area (EROA) is the quantitative parameter best correlated with clinical events. American and European imaging guidelines both recommend the use of quantitative parameters even though they disagree on the cut-off values for secondary MR. The evaluation of MR should always include an assessment of the adjacent heart chambers in order to be able to assess the impact of volume overload on size and function of the left ventricle and left atrium. The final interpretation of the quantitative parameters requires knowledge of left ventricular volume and ejection fraction. Newer 3D-echocardiographic approaches to quantify MR are less dependent on mathematical assumptions and have shown convincing results in several studies but still lack sufficient clinical validation. As an alternative to echocardiography, for specific indications cardiac magnetic resonance imaging (MRI) has proven to be a systematic and observer-independent method for quantification of MR.


Assuntos
Ecocardiografia Tridimensional , Insuficiência da Valva Mitral , Ecocardiografia Doppler em Cores , Ventrículos do Coração , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Índice de Gravidade de Doença
10.
J Invasive Cardiol ; 31(9): E274-E276, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31478896

RESUMO

Three-dimensional multiplanar reconstruction was used to diagnose recurrence of mitral regurgitation after MitraClip implantation in a 71-year-old man. Subsequent mitral valve surgery in such a case is high risk, and repeat MitraClip intervention could be feasible but is technically challenging. This imaging series demonstrates that LVAD implantation may be a solution to address MitraClip failure.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Coração Auxiliar , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico
11.
Expert Rev Cardiovasc Ther ; 17(9): 653-662, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31483165

RESUMO

Introduction: Despite current guidelines provide recommendations for the optimal management of degenerative mitral regurgitation (MR), this condition remains often undertreated with delay in surgical referral and dismal effect on outcomes. Areas covered: This review focuses on the role of echocardiography in guiding mitral valve (MV) surgical repair in degenerative MR due to leaflet prolapse. Expert opinion: A stepwise protocol-driven echocardiography shared by referring physician and surgeon may help to guide referral to surgical repair in degenerative MR. This protocol particularly is useful to identify the ideal patho-anatomy for a successful and durable repair especially when early surgery is proposed and to refer the patient to centers of excellence in case of complex anatomy. Nearly 100% repair rate can be achieved when the surgical technique is adapted to the lesions seen in each valve. Three-dimensional echocardiography predicts repair complexity may be useful and should therefore be implemented. However, the current literature is far from comprehensive deriving from small, single-center studies. Therefore, reproducibility and external validation, especially with newly developed quantitative automated software, are still needed.


Assuntos
Ecocardiografia Tridimensional/métodos , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia/métodos , Humanos , Reprodutibilidade dos Testes
12.
Arch Cardiovasc Dis ; 112(10): 585-593, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31540880

RESUMO

BACKGROUND: Atrial remodelling has been poorly investigated in atrial fibrillation (AF), and few studies have focused on biatrial remodelling. AIM: To evaluate right atrial (RA) and left atrial (LA) remodelling in AF using global atrial reservoir strain and three-dimensional (3D) atrial volumes, according to rhythm outcome at mid-term follow-up. METHODS: Two-dimensional and 3D transthoracic echocardiography (TTE) were performed within 24hours after admission (M0) and at 6-month follow-up (M6) in patients admitted for AF. RA and LA variables were assessed: body surface area-indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and minimum 3D volume (Min 3D RA Voli, Min 3D LA Voli); atrial emptying fraction (3D RAEF, 3D LAEF); atrial expansion index (3D RAEI, 3D LAEI); and global RA and LA reservoir strain. RESULTS: Forty-eight consecutive patients were included prospectively. Three groups were identified depending on rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) in 25 (52.1%) patients; AF at M0 and AF at M6 (AF-AF) in 13 (27.1%) patients; and SR at M0 (spontaneous cardioversion before first TTE) and SR at M6 (SR-SR) in 10 (20.8%) patients. Between M0 and M6 in the AF-SR group, we found: significant decreases in Max 3D RA Voli (P=0.020), Min 3D RA Voli (P=0.0008), Max 3D LA Voli (P=0.001) and Min 3D LA Voli (P=0.0021); significant increases in 3D RAEF (P=0.037) and 3D RAEI (P=0.034); no significant differences in 3D LAEF and 3D LAEI; and significant increases in global RA and LA reservoir strain (both P<0.0001). There was no significant difference with regard to these variables in the AF-AF and SR-SR groups. CONCLUSION: 3D volume and strain analyses were useful in the evaluation of RA and LA reverse remodelling in successfully cardioverted patients with AF.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Função do Átrio Esquerdo , Função do Átrio Direito , Remodelamento Atrial , Ecocardiografia Tridimensional , Átrios do Coração/diagnóstico por imagem , Idoso , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Cardioversão Elétrica , Feminino , França , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
13.
Methodist Debakey Cardiovasc J ; 15(2): 149-151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384379

RESUMO

Patients with advanced valvular disease may be at high or prohibitive risk for surgical management. We describe a patient with previous mitral and tricuspid valve repair and recurrent admissions for New York Heart Association Class IV heart failure symptoms due to severe mitral stenosis and severe tricuspid regurgitation. Due to her comorbidities and two previous sternotomies, the patient was at high risk for surgery. We performed a simultaneous transfemoral mitral and tricuspid valve-in-ring implantation. This is the first report of its kind using a Sapien 3 valve (Edwards Lifesciences).


Assuntos
Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Cateterismo Cardíaco/métodos , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/etiologia , Estenose da Valva Mitral/fisiopatologia , Desenho de Prótese , Recuperação de Função Fisiológica , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/fisiopatologia
14.
J Vet Cardiol ; 24: 64-77, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405556

RESUMO

INTRODUCTION: We hypothesized that real-time three-dimensional echocardiography (RT-3DE) was superior to two-dimensional echocardiography for the estimation of left atrial volume (LAV), using electrocardiographic (ECG)-gated multidetector computed tomography angiography (MDCTA) as a volumetric gold standard. The aim was to compare maximum LAV (LAVmax) and minimum LAV (LAVmin) measured by biplane area-length method (ALM), biplane method of disk (MOD) and RT-3DE with 64-slice ECG-gated MDCTA in dogs ANIMALS: The study included twenty dogs, anaesthetized for various diagnostic purposes and without evidence of cardiovascular disease. METHODS: Left atrial volume was estimated by ALM, MOD and RT-3DE following ECG-gated MDCTA. The results were compared with LAV from MDCTA and correlations were performed. The limits of agreement (LoA) between methods were evaluated using Bland-Altman analysis and intraclass correlations. Coefficients of variation were calculated. RESULTS: Area-length method (r = 0.79 and 0.72), MOD (r = 0.81 and 0.70) and RT-3DE (r = 0.94 and 0.82) correlated with MDCTA for LAVmax and LAVmin, respectively (all p < 0.05). Biases for LAVmax (-0.96 mL, 95% LoA: -5.6 to 3.7) and LAVmin (-0.67 mL, 95% LoA: -5.4 - 4.1) were minimal with RT-3DE, reflecting a slight underestimation. Conversely, MOD (LAVmaxbias = 3.19 mL, 95% LoA: -5.7 - 12.1; LAVminbias = 1.96 mL, 95% LoA: -4.6 - 8.5) and ALM (LAVmaxbias = 4.05, 95% LoA: -5.7 - 13.8; LAVminbias = 2.80 mL, 95% LoA: -3.9 - 9.5) suggested LAV overestimation. Intraobserver and interobserver variability were adequate. CONCLUSIONS: Real-time three-dimensional echocardiography is a non-invasive, accurate and feasible method with superior accuracy to two-dimensional methods.


Assuntos
Cães/anatomia & histologia , Átrios do Coração/anatomia & histologia , Animais , Ecocardiografia/veterinária , Ecocardiografia Tridimensional/veterinária , Feminino , Átrios do Coração/diagnóstico por imagem , Masculino , Tomografia Computadorizada Multidetectores/veterinária , Estudos Prospectivos , Valores de Referência
16.
Int J Cardiovasc Imaging ; 35(11): 2029-2036, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31297671

RESUMO

To evaluate the accuracy, reproducibility, and transcatheter heart valve (THV) sizing efficiency of an automated 3-dimensional transesophageal echocardiographic (3D-TEE) post-processing software in the assessments of aortic roots, intra-individually compared with multidetector computed tomography (MDCT). We prospectively studied 67 patients with normal aortic roots. We measured diameters of aortic annulus (AA), sinus of Valsalva (SOV), and sino-tubular junction (STJ) by full-automated and semi-automated methods using 3D-TEE datasets, then compared them to corresponding transthoracic echocardiography and MDCT values. THV sizes were chosen based on echocardiography and MDCT measurements according to recommended criterion. Taking MDCT planimetered diameters as reference, the full-automated (r: 0.4745-0.8792) and semi-automated (r: 0.6647-0.8805) 3D-TEE measurements were linearly correlated (p < 0.0001). The average differences between semi-automated or full-automated measurements and reference were 0.3 mm or 1.3 mm for AA, - 1.9 mm or - 0.5 mm for SOV, and - 0.1 mm or 1.9 mm for STJ, respectively. The intra-class correlation coefficients of semi-automated method were 0.79-0.96 (intra-observer) and 0.75-0.92 (inter-observer). THV sizing by semi-automated measurements using echocardiographic criteria was larger than that by MDCT measurements using MDCT criteria (p < 0.0001) but equivalent (p > 0.05) if both using MDCT standards. The new automated 3D-TEE software allows modeling and quantifying aortic roots with high reproducibility. Measurements by the semi-automated method closely approximate and well correlate with the corresponding MDCT, thus THV sizing by this modeled 3D-TEE measurements should adopt recommended MDCT criteria but not echocardiographic criteria. The full-automated 3D-TEE segmentations are yet immature. (Semi-automated assessMent of Aortic Roots by Three-dimensional transEsophageal echocaRdiography [SMARTER], NCT02724709).


Assuntos
Valva Aórtica/diagnóstico por imagem , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Doenças das Valvas Cardíacas/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Interpretação de Imagem Assistida por Computador , Desenho de Prótese , Seio Aórtico/diagnóstico por imagem , Adolescente , Adulto , Idoso , Algoritmos , Valva Aórtica/cirurgia , Automação , Feminino , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
17.
J Cardiothorac Surg ; 14(1): 131, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272454

RESUMO

BACKGROUND: Radiofrequency catheter ablation is approved effective therapy for premature ventricular contraction. However, the rare but serious complication such as pseudoaneurysm should be given more attention. It is life-threatening due to the high risk of rupture. Only few cases have been reported in the literature. We herein report a huge acute left ventricular pseudoaneurysm after catheter ablation therapy. CASE PRESENTATION: A 69-year-old man underwent radiofrequency catheter ablation for premature ventricular contraction at a local hospital. The patient developed shock the second day after ablation. A chest computed tomography (CT) scan showed pericardial effusion. Pericardiocentesis was performed, and the puncture fluid was a bloody pericardial effusion. The transthoracic echocardiogram revealed an 9- × 4-cm giant pseudoaneurysm with a cystic structure in the left ventricular inferior wall near the mitral annulus along the left atrium. The pseudoaneurysm was connected to the left ventricular cavity through a 8-mm neck, and the lumen was filled with systolic and diastolic blood flow. The patient underwent three-dimensional transesophageal echocardiography. The pseudoaneurysm and the tract was clearly visible. Emergency surgery was performed to resect the pseudoaneurysm. A bovine pericardial patch was placed on the neck of the pseudoaneurysm. Echocardiographic examination confirmed the absence of cardiac lesions after the operation. CONCLUSIONS: It is rare to see such a large pseudoaneurysm after radiofrequency catheter ablation. Clinicians should be allert to the potential risks to patients in the process of an effective treatment. Echocardiography plays an important role in the prompt diagnosis and prognosis of this disease. Emergency surgery is a better method for treatment of huge pseudoaneurysm.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Ablação por Cateter/efeitos adversos , Complexos Ventriculares Prematuros/cirurgia , Idoso , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino
18.
J Cardiovasc Surg (Torino) ; 60(5): 617-623, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31274274

RESUMO

BACKGROUND: Mitral valve (MV) repair has been recommended for MV diseases. Good repair requires a full understanding of the three-dimensional (3D) structure of the MV, however, currently little is known about the 3D structure of the rheumatic MV. METHODS: A total of 82 cases underwent 3DTEE. Of these, 41 patients with rheumatic valvular disease (RVD) were studied intraoperatively (17 had severe mitral stenosis, 8 had severe mitral regurgitation, 16 had severe mitral stenosis coupled with regurgitation). There were 19 patients with degenerative MV disease (mitral valve prolapse [MVP] with severe regurgitation) and 22 cases with normal MV served as control subjects (CS). RESULTS: Compared with CS, the anteroposterior diameter, anterolateral posteromedial, annulus circumference, and annulus area of both pathological groups, i.e., the RVD and MVP groups, were understandably greater. Though the sphericity index was greater in the RVD group vis-à-vis CS, the MVP group had nearly the same sphericity index as CS. The mitral annulus of patients with RVD tended to be round. Annular unsaddling, defined as annular height to commissural width ratio (an indicator of saddle degree) less than 15%, was significantly more prevalent in the group with degenerative MV disease. Automatic dynamic analysis revealed that the parameters of annular maximum displacement and annulus area fraction (two-dimensional) were considerably decreased in the RVD group. CONCLUSIONS: Annular unsaddling was significantly more prevalent in the degenerative MV disease group. The mitral annulus of patients with RVD tended to be round and stiff.


Assuntos
Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Cardiopatia Reumática/diagnóstico por imagem , Adulto , Idoso , Tomada de Decisão Clínica , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/cirurgia , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Prospectivos , Desenho de Prótese , Recuperação de Função Fisiológica , Cardiopatia Reumática/fisiopatologia , Cardiopatia Reumática/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento
19.
Anatol J Cardiol ; 22(1): 13-20, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31264652

RESUMO

OBJECTIVE: Left ventricle (LV) geometry and dyssynchrony are associated with LV remodeling after acute myocardial infarction (AMI). The aim of this prospective study was to assess the diagnostic value of new three-dimensional echocardiography (3DE) parameters [sphericity (SI) and systolic dyssynchrony indexes (SDI)] for the prediction of LV remodeling after AMI and to compare them with two-dimensional echocardiography (2DE) parameters. METHODS: 2DE and 3DE were performed in 75 patients with AMI within 3 days from the onset of MI and 6 months later. LV remodeling was defined as a ≥15% increase in the LV end-diastolic volume (EDV) at follow-up. 3D SI was calculated by dividing EDV by the volume of a sphere whose diameter was derived from the major end-diastolic LV long axis. SDI was considered as a standard deviation of the time from cardiac cycle onset to minimum systolic volume in 16 LV segments. RESULTS: LV remodeling was identified in 34 (45%) patients using the 2DE method and in 22 (29%) patients using the 3DE method. Evaluated 3DE parameters, such as EDV [area under the receiver operating characteristic (ROC) curve (AUC) 0.742, sensitivity 71%, specificity 79%], end-systolic volume (AUC 0.729, sensitivity 69%, specificity 78%), SDI (AUC 0.777, sensitivity 73%, specificity 77%), and SI, had significant prognostic value for LV remodeling. According to the AUC, the highest predictive value had 3D SI (AUC 0.957, sensitivity 90%, specificity 91%). CONCLUSION: 3DE parameters, especially 3D SI and SDI, play important roles in the prediction of LV remodeling after AMI and can be used in clinical practice.


Assuntos
Ecocardiografia Tridimensional/normas , Infarto do Miocárdio/diagnóstico por imagem , Disfunção Ventricular Esquerda/prevenção & controle , Remodelação Ventricular , Idoso , Área Sob a Curva , Proteína C-Reativa/análise , Estudos de Coortes , Feminino , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Revascularização Miocárdica , Nefelometria e Turbidimetria , Variações Dependentes do Observador , Intervenção Coronária Percutânea , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Fumar , Terapia Trombolítica , Troponina I/análise , Função Ventricular Esquerda/fisiologia
20.
Int J Cardiovasc Imaging ; 35(12): 2177-2188, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31321655

RESUMO

Longitudinal right ventricular (RV) function is substantial and might be reflected by free wall longitudinal strain (FWLS). Software solutions for FWLS analysis by two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) are available, but data on validation are sparse. In this study, a novel method for FWLS analysis on 3D meshes ("mesh surface", MS-FWLS,) was tested for feasibility and compared to available parameters. 80 patients undergoing left-sided cardiac valve surgery with intraoperative TEE were included retrospectively. 2D-FWLS, 3D-derived (3Dd)-FWLS (assessed in optimized four-chamber views after volume analysis) and MS-FWLS were measured and compared to conventional parameters (3Dd-TAPSE, FAC and RVEF). The mean FWLS values did not differ significantly between methods (- 19.0 ± 6.1%, - 20.0 ± 7.3%, - 19.5 ± 7.3% for 2D-, 3Dd- and MS-FWLS, respectively). No significant differences in the mean FWLS between patients with normal or increased pulmonary artery pressures as well as normal or reduced left ventricular ejection fraction were observed. Agreement was best between 3Dd- and MS-FWLS (r = 0.89, bias = - 1.0%, LOA ± 6.9%). Conventional echocardiographic parameters yielded poorer intermodality agreement. In patients with discrepant results between 2D- and 3Dd-FWLS, 3Dd-FWLS and MS-FWLS yielded similar results (r = 0.82, bias = - 0.3%, LOA ± 8.6%), while 2D-FWLS and MS-FWLS did not. Intra- and interobserver variabilities of strain analyses were low. MS-FWLS might represent a promising method to overcome artefacts associated with 2D analysis. Its prognostic relevance needs to be investigated in prospective studies.


Assuntos
Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Contração Miocárdica , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Disfunção Ventricular Direita/fisiopatologia
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