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Trifoliate left atrioventricular valve with and without intact septal structures in four dogs: echocardiographic findings and surgical repair. J Vet Cardiol 2022; 41:70-78. [DOI: 10.1016/j.jvc.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
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Mah K, Khoo NS, Tham E, Yaskina M, Maruyama M, Martin BJ, Alvarez S, Alami N, Rebeyka IM, Smallhorn J, Colen T. Tricuspid Regurgitation in Hypoplastic Left Heart Syndrome: Three-Dimensional Echocardiography Provides Additional Information in Describing Jet Location. J Am Soc Echocardiogr 2020; 34:529-536. [PMID: 33373699 DOI: 10.1016/j.echo.2020.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Twenty-five percent of patients with hypoplastic left heart syndrome (HLHS) require tricuspid valve (TV) repair. The location of tricuspid regurgitation (TR) is important in determining the type of repair performed. Studies using three-dimensional echocardiography (3DE) have reported a high incidence of error on two-dimensional echocardiography (2DE) for the identification of TV leaflets. The aim of this study was to compare assessment of TR on 3DE and 2DE in patients with HLHS (jet location, TR grade, and reproducibility). METHODS A retrospective, single-center review was performed. Fifty-six patients with HLHS with available two-dimensional and three-dimensional echocardiograms, and mild or greater TR, were included. TR location, grade, vena contracta area, and TV annular diameter were measured on 2DE and 3DE. Reproducibility was assessed by blinded reviewers. RESULTS Three-dimensional echocardiography identified the primary jet location as central (57%) followed by anteroseptal (36%). There was poor agreement between findings on 3DE and 2DE for jet location (κ = 0.05; 95 CI, -0.08 to 0.19). Interobserver reproducibility for location on 3DE was excellent (κ = 0.8), whereas reproducibility for 2DE was poor (κ = 0.32). The most common jet location pre-Norwood and pre-Glenn was central (70%), whereas pre-Fontan and post-Fontan, jet location was central (45%) and anteroseptal (48%). Vena contracta area on 2DE correlated moderately with vena contracta area on 3DE (r = 0.60, P < .0001). TV annular diameters on 2DE and 3DE for lateral (r = 0.85, P < .0001) and anteroposterior (r = 0.74, P = .001) dimensions were strongly correlated. CONCLUSIONS In children with HLHS, assessment of TR location on 2DE had poor agreement with assessment on 3DE and was poorly reproducible. In contrast, TR jet location on 3DE was highly reproducible. Pre-Glenn, a central TR jet was the most common, while post-Glenn, central and anteroseptal locations were equal, highlighting the importance of preoperative identification of TR jet location in patients with HLHS.
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Affiliation(s)
- Kandice Mah
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Nee Scze Khoo
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Edythe Tham
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Michiko Maruyama
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Billie-Jean Martin
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California
| | - Silvia Alvarez
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Nassiba Alami
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ivan M Rebeyka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey Smallhorn
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy Colen
- Stollery Children's Hospital, Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Jone PN. Applications of three-dimensional transesophageal echocardiography in congenital heart disease. Echocardiography 2020; 37:1665-1672. [PMID: 32594626 DOI: 10.1111/echo.14780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022] Open
Abstract
Three-dimensional echocardiography allows for presurgical planning for congenital heart disease, reduces radiation using fusion imaging in catheter interventions, and provides guidance during catheter interventions and lead placements or extractions. The purpose of this review is to detail applications of three-dimensional transesophageal echocardiography in presurgical planning of congenital heart disease, guidance of catheter interventions such as fusion imaging, and guidance in electrophysiology lead extractions or placements.
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Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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4
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Fernando RJ, Johnson SD, Patel PA, Gutsche JT, Lauter D, Feinman JW, Guelaff E, Weiss SJ, Richardson KM, Boisen ML, Gelzinis TA, Augoustides JG. Unexpected Mitral Regurgitation During Coronary Artery Bypass Graft Surgery: The Multidisciplinary Management of a Mitral Valve Cleft. J Cardiothorac Vasc Anesth 2018; 32:1480-1486. [DOI: 10.1053/j.jvca.2017.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Indexed: 12/23/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to detail three-dimensional echocardiographic (3DE) innovations in pre-surgical planning of congenital heart disease, guidance of catheter interventions such as fusion imaging, and functional assessment of patients with congenital heart disease. RECENT FINDINGS Innovations in 3DE have helped us delineate the details of atrioventricular valve function and understand the mechanism of atrioventricular valve failure in patients with atrioventricular septal defect and single ventricle post repair. Advancement in holographic display of 3D datasets allows for better manipulation of 3D images in three dimensions and better understanding of anatomic relationships. 3DE with fusion imaging reduces radiation in catheter interventions and provides presentations of 3DE images in the similar fashion as the fluoroscopic images to improve communication between cardiologists. Lastly, 3DE allows for quantitative ventricular volumetric and functional assessment. Recent innovations in 3DE allow for pre-surgical planning for congenital heart disease, reduce radiation using fusion imaging in catheter interventions, and enable accurate assessment of ventricular volume and function without geometric assumptions.
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Simpson J, Lopez L, Acar P, Friedberg MK, Khoo NS, Ko HH, Marek J, Marx G, McGhie JS, Meijboom F, Roberson D, Van den Bosch A, Miller O, Shirali G. Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2016; 30:1-27. [PMID: 27838227 DOI: 10.1016/j.echo.2016.08.022] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good acoustic windows and the non-invasive nature of the technique. The aim of this paper is to provide a review of the optimal application of 3DE in CHD including technical considerations, image orientation, application to different lesions, procedural guidance, and functional assessment.
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Affiliation(s)
- John Simpson
- Evelina London Children's Hospital, London, United Kingdom.
| | - Leo Lopez
- Nicklaus Children's Hospital, Miami, Florida
| | | | | | - Nee S Khoo
- Stollery Children's Hospital & University of Alberta, Edmonton, Alberta, Canada
| | - H Helen Ko
- Mt. Sinai Medical Center, New York, New York
| | - Jan Marek
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Gerald Marx
- Boston Children's Hospital and Harvard School of Medicine, Boston, Massachusetts
| | - Jackie S McGhie
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - David Roberson
- Advocate Children's Hospital, Chicago Medical School, Chicago, Illinois
| | | | - Owen Miller
- Evelina London Children's Hospital, London, United Kingdom
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7
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Simpson J, Lopez L, Acar P, Friedberg M, Khoo N, Ko H, Marek J, Marx G, McGhie J, Meijboom F, Roberson D, Van den Bosch A, Miller O, Shirali G. Three-dimensional echocardiography in congenital heart disease: an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1071-97. [DOI: 10.1093/ehjci/jew172] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/28/2016] [Indexed: 01/02/2023] Open
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8
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Kozak MF, Kozak ACLFBM, Marchi CHD, Sobrinho Junior SH, Croti UA, Moscardini AC. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect. Braz J Cardiovasc Surg 2015; 30:304-10. [PMID: 26313720 PMCID: PMC4541776 DOI: 10.5935/1678-9741.20150036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/25/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Left atrioventricular valve regurgitation is the most concerning residual lesion
after surgical correction of atrioventricular septal defects. Objective To determine factors associated with moderate or severe left atrioventricular
valve regurgitation within 30 days of surgical repair of complete atrioventricular
septal defect. Methods We assessed the results of 53 consecutive patients 3 years-old and younger
presenting with complete atrioventricular septal defect that were operated on at
our practice between 2002 and 2010. The following variables were considered: age,
weight, absence of Down syndrome, grade of preoperative atrioventricular valve
regurgitation, abnormalities on the left atrioventricular valve and the use of
annuloplasty. Median age was 6.7 months; median weight was 5.3 Kg; 86.8% had Down
syndrome. At the time of preoperative evaluation, there were 26 cases with
moderate or severe left atrioventricular valve regurgitation (49.1%).
Abnormalities on the left atrioventricular valve were found in 11.3%; annuloplasty
was performed in 34% of the patients. Results At the time of postoperative evaluation, there were 21 cases with moderate or
severe left atrioventricular valve regurgitation (39.6%). After performing a
multivariate analysis, the only significant factor associated with moderate or
severe left atrioventricular valve regurgitation was the absence of Down syndrome
(P=0.03). Conclusion Absence of Down syndrome was associated with moderate or severe postoperative left
atrioventricular valve regurgitation after surgical repair of complete
atrioventricular septal defect at our practice.
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Affiliation(s)
- Marcelo Felipe Kozak
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | | | - Carlos Henrique De Marchi
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Sirio Hassem Sobrinho Junior
- Department of Cardiology, Hospital de Base, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Ulisses Alexandre Croti
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Airton Camacho Moscardini
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
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Kozak MF, Kozak ACLFBM, De Marchi CH, Godoy MFD, Croti UA, Moscardini AC. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of incomplete atrioventricular septal defect. Braz J Cardiovasc Surg 2015; 30:198-204. [PMID: 26107451 PMCID: PMC4462965 DOI: 10.5935/1678-9741.20150026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/06/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Left atrioventricular valve regurgitation is the most concerning residual
lesion after surgical correction of atrioventricular septal defect. Objective To determine factors associated with moderate or greater left
atrioventricular valve regurgitation within 30 days of surgical repair of
incomplete atrioventricular septal defect. Methods We assessed the results of 51 consecutive patients 14 years-old and younger
presenting with incomplete atrioventricular septal defect that were operated
on at our practice between 2002 and 2010. The following variables were
considered: age, weight, absence of Down syndrome, grade of preoperative
left atrioventricular valve regurgitation, abnormalities on the left
atrioventricular valve and the use of annuloplasty. The median age was 4.1
years; the median weight was 13.4 Kg; 37.2% had Down syndrome. At the time
of preoperative evaluation, there were 23 cases with moderate or greater
left atrioventricular valve regurgitation (45.1%). Abnormalities on the left
atrioventricular valve were found in 17.6%; annuloplasty was performed in
21.6%. Results At the time of postoperative evaluation, there were 12 cases with moderate or
greater left atrioventricular valve regurgitation (23.5%). The variation
between pre- and postoperative grades of left atrioventricular valve
regurgitation of patients with atrioventricular valve malformation did not
reach significance (P=0.26), unlike patients without such
abnormalities (P=0.016). During univariate analysis, only
absence of Down syndrome was statistically significant
(P=0.02). However, after a multivariate analysis, none of
the factors reached significance. Conclusion None of the factors studied was determinant of a moderate or greater left
atrioventricular valve regurgitation within the first 30 days of repair of
incomplete atrioventricular septal defect in the sample. Patients without
abnormalities on the left atrioventricular valve benefit more of the
operation.
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Affiliation(s)
- Marcelo Felipe Kozak
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, Brazil
| | | | - Carlos Henrique De Marchi
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, Brazil
| | - Moacyr Fernandes de Godoy
- Department of Cardiology, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, Brazil
| | - Ulisses Alexandre Croti
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, Brazil
| | - Airton Camacho Moscardini
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, Brazil
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10
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Vijarnsorn C, Khoo NS, Tham EB, Colen T, Rebeyka IM, Smallhorn JF. Increased common atrioventricular valve tenting is a risk factor for progression to severe regurgitation in patients with a single ventricle with unbalanced atrioventricular septal defect. J Thorac Cardiovasc Surg 2014; 148:2580-8. [DOI: 10.1016/j.jtcvs.2014.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/26/2014] [Accepted: 08/03/2014] [Indexed: 11/29/2022]
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11
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Khoshhal SQ. Usefulness of the multiplanar reformatting mode of three-dimensional echocardiography in evaluating valvular and structural heart disease: An experience from Saudi Arabia. J Saudi Heart Assoc 2013; 26:23-32. [PMID: 24578597 DOI: 10.1016/j.jsha.2013.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 10/27/2013] [Accepted: 11/05/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The aim of this study is to compare the feasibility and capacity of multiplanar reformatting (MPR) mode of three-dimensional echocardiography (3DE-MPR technique) with two-dimensional echocardiography (2DE) for visualizing morphological details during evaluation of congenital heart disease (CHD). The study also seeks to validate the accuracy of 3DE MPR in determining cardiac valvular lesions and the application of the 3DE-MPR technique in daily clinical practice. METHODS A cross-sectional study was carried out at Madinah Cardiac Centre, Saudi Arabia from May to December 2012. Various forms of CHD were diagnosed in 43 patients by conventional 2DE, and the patients were then examined with the 3DE-MPR technique using dedicated software and a standard protocol. RESULTS Of the 43 patients, 23 (53.5%) were males and 20 (46.5%) females. Their age varied from 30 days to 146 months (mean age, 70.2 months and SD = 42.5 months) and their weight from 4 to 42 kg (mean weight, 20.2 kg and SD = 9.7 kg). The 2DE showed left heart lesions in nine patients (20.9%), right heart lesions in 23 (53.5%), atrial septal defects in five (11.6%) and complex CHD in six patients (14%). The 3DE MPR technique application and analysis was possible in all patients. The study demonstrated the fields where 3DE MPR was of additive value to conventional 2DE for the vena contracta area in valvular regurgitation severity and the planimetry for the valvular stenosis precise estimation, enface views of atrial septal defects with direct visualisation of shape and size of the defect, and segmental analysis of complex CHD using one window. The clinician and surgeon were then able to determine the mechanism and severity of the lesions and thus decide on appropriate treatment and management. CONCLUSION The study demonstrated the usefulness of 3DE-MPR as a complement to conventional 2DE. The technique is a significant technological breakthrough that allows instant visualization of morphological details and precise determination of cardiac valvular lesions, which were less clearly delineated by 2DE alone.
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Affiliation(s)
- Saad Q Khoshhal
- College of Medicine, Taibah University, Al Madinah Al Munawwarah
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12
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Khoshhal S. Feasibility and effectiveness of three-dimensional echocardiography in diagnosing congenital heart diseases. Pediatr Cardiol 2013; 34:1525-31. [PMID: 23677391 DOI: 10.1007/s00246-013-0718-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 04/27/2013] [Indexed: 11/29/2022]
Abstract
Three-dimensional echocardiography (3DE), a novel approach employed in detecting congenital heart disease (CHD), has gained popularity since it was made commercially available in 2002. This modality is now accepted as an important diagnostic tool for diagnosing CHD. Advancement in transducer technologies and digital data processing allows the use of 3DE in daily clinical practice. In this review, modes of 3DE data acquisition and storage methods in the echocardiogram's machine's hard disk (data processing) are examined. Analysis of the acquired data (cropping or slicing the data set) and methods of illustrating the cropped data set for cardiologists and pediatric cardiovascular surgeons are also discussed. Published literature was searched in PubMed using the keywords "three-dimensional echocardiography", "congenital heart disease", "cropping", and "echoangiogram". This search produced 100 articles, which were further short-listed to 30 articles. Based on this algorithm, the final selected 30 articles were extensively examined in the current review. The clinical applications of real-time transthoracic 3DE, as well as novel transesophageal 3DE and color flow 3DE data set analyses (echoangiogram) in the routine practice of CHD assessment, are also reviewed. Finally, the limitations 3DE, together with the potential future developments required to improve various techniques of 3DE to make it more readily applicable, are examined.
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Affiliation(s)
- Saad Khoshhal
- College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia,
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Partial Zone of Apposition Closure in Atrioventricular Septal Defect: Are Papillary Muscles the Clue. Ann Thorac Surg 2013; 96:637-43. [DOI: 10.1016/j.athoracsur.2013.03.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/21/2013] [Accepted: 03/27/2013] [Indexed: 11/22/2022]
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Takahashi K, Mackie AS, Thompson R, Al-Naami G, Inage A, Rebeyka IM, Ross DB, Khoo NS, Colen T, Smallhorn JF. Quantitative Real-Time Three-Dimensional Echocardiography Provides New Insight into the Mechanisms of Mitral Valve Regurgitation Post-Repair of Atrioventricular Septal Defect. J Am Soc Echocardiogr 2012; 25:1231-44. [DOI: 10.1016/j.echo.2012.08.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Indexed: 11/29/2022]
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Evaluation of Atrioventricular Septal Defects by Three-Dimensional Echocardiography: Benefits of Navigating the Third Dimension. J Am Soc Echocardiogr 2012; 25:932-44. [DOI: 10.1016/j.echo.2012.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Indexed: 02/07/2023]
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Koestenberger M. Transthoracic echocardiography in children and young adults with congenital heart disease. ISRN PEDIATRICS 2012; 2012:753481. [PMID: 22778987 PMCID: PMC3384910 DOI: 10.5402/2012/753481] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 04/19/2012] [Indexed: 11/23/2022]
Abstract
Transthoracic echocardiography (TTE) is the first-line tool for diagnosis and followup of pediatric and young adult patients with congenital heart disease (CHD). Appropriate use of TTE can reduce the need for more invasive modalities, such as cardiac catheterization and cardiac magnetic resonance imaging. New echocardiographic techniques have emerged more recently: tissue Doppler imaging, tissue tracking (strain and strain rate), vector velocity imaging (VVI), myocardial performance index, myocardial acceleration during isovolumic acceleration (IVA), the ratio of systolic to diastolic duration (S/D ratio), and two dimensional measurements of systolic right ventricular (RV) function (e.g., tricuspid annular plane systolic excursion, TAPSE). These may become valuable indicators of ventricular performance, compliance, and disease progression. In addition, three-dimensional (3D) echocardiography when performed for the assessment of valvular function, device position, and ventricular volumes is being integrated into routine clinical care. In this paper, the potential use and limitations of these new echocardiographic techniques in patients with CHD are discussed. A particular focus is on the echocardiographic assessment of right ventricular (RV) function in conditions associated with increased right ventricular volume (e.g., pulmonary regurgitation after tetralogy of Fallot repair) or pressure (e.g., pulmonary hypertension) in children and young adults.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Auenbruggerplatz 30, 8036 Graz, Austria
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Koestenberger M, Friedberg MK, Ravekes W, Nestaas E, Hansmann G. Non-Invasive Imaging for Congenital Heart Disease: Recent Innovations in Transthoracic Echocardiography. ACTA ACUST UNITED AC 2012; Suppl 8:2. [PMID: 24163784 DOI: 10.4172/2155-9880.s8-002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transthoracic echocardiography (TTE) is an important tool for diagnosis and follow-up of patients with congenital heart disease (CHD). Appropriate use of TTE can reduce the need for more invasive and complex modalities, such as cardiac catheterization and cardiac magnetic resonance imaging. New echocardiographic techniques have emerged for the assessment of ventricular systolic and diastolic function: Tissue Doppler imaging, tissue tracking, strain and strain rate imaging, vector velocity imaging (VVI), myocardial performance index, myocardial acceleration during isovolumic contraction (IVA), the ratio of systolic to diastolic duration (S/D ratio), and other measurements of systolic right ventricular (RV) function like tricuspid annular plane systolic excursion (TAPSE). These modalities may become valuable indicators of ventricular performance, compliance and disease progression, with the caveat of preload-dependency of the variables measured. In addition, three-dimensional (3D) echocardiography for the assessment of cardiac anatomy, valvular function, device position, ventricular volumes and ejection fraction is integrated into routine clinical care. In this review, we discuss the potential use and limitations of these new echocardiographic techniques in patients with CHD. A particular focus is on the echocardiographic assessment of right ventricular (RV) function by means of tissue Doppler imaging, tissue tracking, and three-dimensional imaging, in conditions associated with increased right ventricular volume or pressure load.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
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Abstract
PURPOSE OF REVIEW Despite improvements in surgical techniques, valvular regurgitation results in major morbidity in children with heart disease. Functional anatomy, mechanisms of valve closure and adaptation to changing hemodynamic stress in normal mitral and tricuspid valves are complex and only partially understood. As well, pathology of atrioventricular valve regurgitation is further complicated by congenital valve abnormalities involving leaflet tissue, supporting chordal apparatus and displaced papillary muscles. This review provides a current understanding of the mechanisms that result in atrioventricular valve failure. RECENT FINDINGS Mitral valve leaflets have contractile elements, in addition to atrial muscle modulation of leaflet tension. When placed under mechanical tethering stress, the mitral valve adapts by leaflet expansion, which increases coaptation surface reserve and chordal thickening. Both pediatric and adult studies are increasingly reporting on the importance of subvalvar apparatus function in maintaining valve competency. SUMMARY The maintenance of efficient valve function is accomplished by a complex series of events involving atrial and annular contraction, annular deformation, active leaflet tension, chordal transmission of papillary muscle contractions and ventricular contraction.
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Affiliation(s)
- Nee S Khoo
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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19
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Simpson JM, Miller O. Three-dimensional echocardiography in congenital heart disease. Arch Cardiovasc Dis 2011; 104:45-56. [DOI: 10.1016/j.acvd.2010.11.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 11/15/2010] [Accepted: 11/16/2010] [Indexed: 01/17/2023]
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Dragulescu A, Mertens LL. Developments in echocardiographic techniques for the evaluation of ventricular function in children. Arch Cardiovasc Dis 2010; 103:603-14. [PMID: 21147445 DOI: 10.1016/j.acvd.2010.09.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 11/15/2022]
Abstract
Echocardiography is a very important tool for the diagnosis and follow-up of children with congenital and acquired heart disease. One of the challenges that remains in paediatric heart disease is the assessment of systolic and diastolic function in children, as this is influenced by growth, morphology and loading conditions. New echocardiographic techniques, such as tissue Doppler, deformation imaging and three-dimensional echocardiography, have great potential application in this field. They may provide new insights into the influence of growth, morphology and loading on cardiac mechanics, and could become useful clinical tools. In this review, we discuss the potential use and limitations of these new echocardiographic techniques in paediatric and congenital heart disease.
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Affiliation(s)
- Andreea Dragulescu
- Department of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8 Canada
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Tandon R, Takkar S, Kumbhkarni S, Kumar N, Aslam N, Mohan B, Wander GS. A rare case of double orifice mitral valve with perimembranous ventricular septal defect: Application of three-dimensional echocardiography for clinical decision making. Ann Pediatr Cardiol 2010; 3:87-9. [PMID: 20814484 PMCID: PMC2921527 DOI: 10.4103/0974-2069.64362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Double orifice mitral valve (DOMV) is an uncommon anomaly of surgical importance characterized by a mitral valve with a single fibrous annulus with two orifices opening into the left ventricle (LV). Subvalvular structures, especially the tensor apparatus, invariably show various degrees of abnormality. Associated congenital heart defects are common, though DOMV can occur as an isolated anomaly. Two-dimensional echocardiography is useful for diagnosis but combining it with real-time three-dimensional echocardiography helps in a more detailed evaluation of mitral valve and subvalvular structures as is shown in this case description.
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Affiliation(s)
- Rohit Tandon
- Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Tagore Nagar, Civil Lines, Ludhiana, India
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Takahashi K, Mackie AS, Rebeyka IM, Ross DB, Robertson M, Dyck JD, Inage A, Smallhorn JF. Two-Dimensional Versus Transthoracic Real-Time Three-Dimensional Echocardiography in the Evaluation of the Mechanisms and Sites of Atrioventricular Valve Regurgitation in a Congenital Heart Disease Population. J Am Soc Echocardiogr 2010; 23:726-34. [DOI: 10.1016/j.echo.2010.04.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Indexed: 11/24/2022]
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Xue H, Sun K, Yu J, Chen B, Chen G, Hong W, Yao L, Wu L. Three-dimensional echocardiographic virtual endoscopy for the diagnosis of congenital heart disease in children. Int J Cardiovasc Imaging 2010; 26:851-9. [PMID: 20535561 PMCID: PMC2991166 DOI: 10.1007/s10554-010-9649-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 05/27/2010] [Indexed: 10/30/2022]
Abstract
Virtual endoscopy (VE) is a new post-processing method that uses volumetric data sets to simulate the tracks of a "conventional" flexible endoscope. However, almost all studies of this method have involved virtual visualizations of the cardiovascular structures applied to computed tomography (CT) and magnetic resonance (MR) datasets. This paper introduces a novel visualization method called the "three-dimensional echocardiographic intracardiac endoscopic simulation system (3DE IESS)", which uses 3D echocardiographic images in a virtual reality (VR) environment to diagnose congenital heart disease. The aim of this study was to analyze the feasibility of VE in the evaluation of congenital heart disease in children and its accuracy compared with 2DE. Three experienced pediatric cardiologists blinded to the patients' diagnoses separately reviewed 40 two-dimensional echocardiographic (2DE) datasets and 40 corresponding VE datasets and judged whether abnormal intracardiac anatomy was present in terms of a five-point scale (1 = definitely absent; 2 = probably absent; 3 = cannot be determined; 4 = probably present; and 5 = definitely present). Compared with clinical diagnosis, the diagnostic accuracy of VE was 98.7% for ASD, 92.4% for VSD, 92.6% for TOF, and 94% for DORV, respectively. Diagnostic accuracy of VE was significantly higher than that of 2DE for TOF and DORV except for ASD and VSD. The receiver operating characteristic (ROC) curve for VE was closer to the optimal performance point than was the ROC curve for 2DE. The area under the ROC curve was 0.96 for VE and 0.93 for 2DE. Kappa values (range, 0.73-0.79) for VE and 2DE indicated substantial agreement. 3D echocardiographic VE can enhance our understanding of intracardiac structures and facilitate the evaluation of congenital heart disease.
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Affiliation(s)
- Haihong Xue
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Scohy TV, Cate FJT, Lecomte PV, McGhie J, Jong PLD, Hofland J, Bogers AJ. Usefulness of Intraoperative Real‐Time 3D Transesophageal Echocardiography in Cardiac Surgery. J Card Surg 2008; 23:784-6. [DOI: 10.1111/j.1540-8191.2008.00666.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Thierry V. Scohy
- Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Folkert J. Ten Cate
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Jackie McGhie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter L. de Jong
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Hofland
- Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ad J.J.C. Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Padala M, Vasilyev NV, Owen JW, Jimenez JH, Dasi LP, del Nido PJ, Yoganathan AP. Cleft closure and undersizing annuloplasty improve mitral repair in atrioventricular canal defects. J Thorac Cardiovasc Surg 2008; 136:1243-9. [PMID: 19026810 DOI: 10.1016/j.jtcvs.2008.05.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 04/08/2008] [Accepted: 05/16/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Reoperation rates to correct left atrioventricular valve regurgitation after primary repair of atrioventricular canal defects remain relatively high. The causes of valvular regurgitation are likely multifactorial, and simple cleft closure is often insufficient to prevent recurrence. METHODS To elucidate the mechanisms leading to regurgitation, we conducted hemodynamic studies using isolated native mitral valves. Anatomy of these valves was altered to mimic atrioventricular canal type valves and studied under pediatric hemodynamic conditions. The impact of subvalvular geometry, cleft closure, annular dilatation, and annular undersizing on regurgitation were investigated. RESULTS Papillary muscle position did not have a significant effect on regurgitation. Cleft closure had a significant impact on valvular competence, with reduction in regurgitation volume with increased cleft closure. Regurgitation volume decreased from 12.5 +/- 2.4 mL/beat for an open cleft to 4.9 +/- 1.9 mL/beat for a partially closed cleft and to 1.4 +/- 1.6 mL/beat when the cleft was completely closed. Annular dilatation had a significant impact on regurgitation even after cleft closure. A 40% increase in annular size increased regurgitation by 59% for a partially closed cleft and by 84% for a fully closed cleft. Reducing the annular size by 20% from the physiologic level decreased the regurgitation volume by 12% for a fully open cleft and by 58% for the partially closed cleft case. CONCLUSIONS Annular dilatation after primary repair has a potentially significant role in the recurrence of atrioventricular valve regurgitation. Reducing the annular size and restricting dilatation as an adjunct to cleft closure is a promising surgical approach in such valve anatomies.
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Affiliation(s)
- Muralidhar Padala
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0535, USA
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Anwar AM, McGhie JS, Meijboom FJ, ten Cate FJ. Double orifice mitral valve by real-time three-dimensional echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 9:731-2. [DOI: 10.1093/ejechocard/jen149] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Cardiac imaging has had significant influence on the science and practice of pediatric cardiology. Especially the development and improvements made in non-invasive imaging techniques, like echocardiography and cardiac magnetic resonance imaging (MRI), have been extremely important. Technical advancements in the field of medical imaging are quickly being made. This review will focus on some of the important evolutions in pediatric cardiac imaging. Techniques such as intracardiac echocardiography, 3D echocardiography, and tissue Doppler imaging are relatively new echocardiographic techniques, which further optimize the anatomical and functional aspects of congenital heart disease. Also, the current standing of cardiac MRI and cardiac computerized tomography will be discussed. Finally, the recent European efforts to organize training and accreditation in pediatric echocardiography are highlighted.
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Affiliation(s)
- Luc Mertens
- Pediatric Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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