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Sharifi L, Luzzi C, Vegas A. Perioperative 3D transoesophageal echocardiography. Part 2: clinical applications. BJA Educ 2024; 24:277-287. [PMID: 39099755 PMCID: PMC11293589 DOI: 10.1016/j.bjae.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- L. Sharifi
- Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - C. Luzzi
- Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - A. Vegas
- Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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2
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Prince J, Maidens J, Kieu S, Currie C, Barbosa D, Hitchcock C, Saltman A, Norozi K, Wiesner P, Slamon N, Del Grippo E, Padmanabhan D, Subramanian A, Manjunath C, Chorba J, Venkatraman S. Deep Learning Algorithms to Detect Murmurs Associated With Structural Heart Disease. J Am Heart Assoc 2023; 12:e030377. [PMID: 37830333 PMCID: PMC10757522 DOI: 10.1161/jaha.123.030377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023]
Abstract
Background The success of cardiac auscultation varies widely among medical professionals, which can lead to missed treatments for structural heart disease. Applying machine learning to cardiac auscultation could address this problem, but despite recent interest, few algorithms have been brought to clinical practice. We evaluated a novel suite of Food and Drug Administration-cleared algorithms trained via deep learning on >15 000 heart sound recordings. Methods and Results We validated the algorithms on a data set of 2375 recordings from 615 unique subjects. This data set was collected in real clinical environments using commercially available digital stethoscopes, annotated by board-certified cardiologists, and paired with echocardiograms as the gold standard. To model the algorithm in clinical practice, we compared its performance against 10 clinicians on a subset of the validation database. Our algorithm reliably detected structural murmurs with a sensitivity of 85.6% and specificity of 84.4%. When limiting the analysis to clearly audible murmurs in adults, performance improved to a sensitivity of 97.9% and specificity of 90.6%. The algorithm also reported timing within the cardiac cycle, differentiating between systolic and diastolic murmurs. Despite optimizing acoustics for the clinicians, the algorithm substantially outperformed the clinicians (average clinician accuracy, 77.9%; algorithm accuracy, 84.7%.) Conclusions The algorithms accurately identified murmurs associated with structural heart disease. Our results illustrate a marked contrast between the consistency of the algorithm and the substantial interobserver variability of clinicians. Our results suggest that adopting machine learning algorithms into clinical practice could improve the detection of structural heart disease to facilitate patient care.
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Affiliation(s)
| | | | | | | | | | | | | | - Kambiz Norozi
- Department of Pediatrics, Pediatric CardiologyWestern UniversityLondonONCanada
- Department of Pediatric Cardiology and Intensive Care MedicineHannover Medical SchoolHannoverGermany
- Children Health Research InstituteLondonONCanada
| | | | | | | | - Deepak Padmanabhan
- Sri Jayadeva Institute of Cardiovascular Sciences and ResearchBengaluruIndia
| | - Anand Subramanian
- Sri Jayadeva Institute of Cardiovascular Sciences and ResearchBengaluruIndia
| | | | - John Chorba
- Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
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3
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Hayes DE, Bamira D, Vainrib AF, Freedberg RS, Aizer A, Chinitz LA, Saric M. Left Atrial Appendage Tilt-Up-and-Turn-Left Maneuver: A Novel Three-Dimensional Transesophageal Echocardiography Imaging Maneuver to Characterize the Left Atrial Appendage and to Improve Transcatheter Closure Guidance. CASE (PHILADELPHIA, PA.) 2023; 7:391-395. [PMID: 37970485 PMCID: PMC10635893 DOI: 10.1016/j.case.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
•Precise LAA anatomy must be established for LAA occlusion device selection. •We have developed the TUPLE maneuver, an acronym for “tilt up and turn left”. •The TUPLE maneuver facilitates LAA device selection and intraprocedural guidance.
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Affiliation(s)
- Dena E. Hayes
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Robin S. Freedberg
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Larry A. Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
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4
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Faletra FF, Agricola E, Flachskampf FA, Hahn R, Pepi M, Ajmone Marsan N, Wunderlich N, Elif Sade L, Donal E, Zamorano JL, Cosyns B, Vannan M, Edvardsen T, Berrebi A, Popescu BA, Lancellotti P, Lang R, Bäck M, Bertrand PB, Dweck M, Keenan N, Stankovic I. Three-dimensional transoesophageal echocardiography: how to use and when to use-a clinical consensus statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology. Eur Heart J Cardiovasc Imaging 2023; 24:e119-e197. [PMID: 37259019 DOI: 10.1093/ehjci/jead090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 06/02/2023] Open
Abstract
Three-dimensional transoesophageal echocardiography (3D TOE) has been rapidly developed in the last 15 years. Currently, 3D TOE is particularly useful as an additional imaging modality for the cardiac echocardiographers in the echo-lab, for cardiac interventionalists as a tool to guide complex catheter-based procedures cardiac, for surgeons to plan surgical strategies, and for cardiac anaesthesiologists and/or cardiologists, to assess intra-operative results. The authors of this document believe that acquiring 3D data set should become a 'standard part' of the TOE examination. This document provides (i) a basic understanding of the physic of 3D TOE technology which enables the echocardiographer to obtain new skills necessary to acquire, manipulate, and interpret 3D data sets, (ii) a description of valvular pathologies, and (iii) a description of non-valvular pathologies in which 3D TOE has shown to be a diagnostic tool particularly valuable. This document has a new format: instead of figures randomly positioned through the text, it has been organized in tables which include figures. We believe that this arrangement makes easier the lecture by clinical cardiologists and practising echocardiographers.
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Affiliation(s)
- Francesco F Faletra
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Eustachio Agricola
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Frank A Flachskampf
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Rebecca Hahn
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Mauro Pepi
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Nina Ajmone Marsan
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Nina Wunderlich
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Leyla Elif Sade
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Erwan Donal
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Jose-Luis Zamorano
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Bernard Cosyns
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Mani Vannan
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Thor Edvardsen
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Alain Berrebi
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Bogdan A Popescu
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Patrizio Lancellotti
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Roberto Lang
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Magnus Bäck
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Philippe B Bertrand
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Marc Dweck
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Niall Keenan
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Ivan Stankovic
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
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5
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Little SH, Rigolin VH, Garcia-Sayan E, Hahn RT, Hung J, Mackensen GB, Mankad S, Quader N, Saric M. Recommendations for Special Competency in Echocardiographic Guidance of Structural Heart Disease Interventions: From the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:350-365. [PMID: 36841670 DOI: 10.1016/j.echo.2023.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Transcatheter therapies for structural heart disease continue to grow at a rapid pace, and echocardiography is the primary imaging modality used to support such procedures. Transesophageal echocardiographic guidance of structural heart disease procedures must be performed by highly skilled echocardiographers who can provide rapid, accurate, and high-quality image acquisition and interpretation in real time. Training standards are needed to ensure that interventional echocardiographers have the necessary expertise to perform this complex task. This document provides guidance on all critical aspects of training for cardiology and anesthesiology trainees and postgraduate echocardiographers who plan to specialize in interventional echocardiography. Core competencies common to all transcatheter therapies are reviewed in addition to competencies for each specific transcatheter procedure. A core principle is that the length of interventional echocardiography training or achieved procedure volumes are less important than the demonstration of procedure-specific competencies within the milestone domains of knowledge, skill, and communication.
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Affiliation(s)
- Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Vera H Rigolin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rebecca T Hahn
- Columbia University Irving College of Medicine, New York, New York
| | - Judy Hung
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Muhamed Saric
- New York University Langone Health, New York, New York
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6
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Maidman SD, Bamira D, Ro R, Vainrib AF, Saric M. Taking Command of Three-Dimensional Stitching Artifacts: From an Annoyance to an Easy Tool for Navigating Three-Dimensional Transesophageal Echocardiography. J Am Soc Echocardiogr 2023; 36:105-110. [PMID: 36174809 DOI: 10.1016/j.echo.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 01/10/2023]
Abstract
Despite many recent advances in three-dimensional (3D) transesophageal echocardiography (TEE) imagining, the process of orienting 3D TEE images is nonintuitive and uses assumptions based on idealized anatomy. Correlating two-dimensional TEE cross-sectional images to 3D reconstructions remains an additional challenge. In this article, we suggest the repurposing of the stitching artifact generated in 2-beat electrocardiogram-gated 3D TEE as a means of exactly orienting 3D images within a patient's unique anatomy. We demonstrate the application of this strategy to assess a normal mitral valve to localize scallops of mitral valve prolapse and to visualize typical left atrial appendage two-dimensional cuts in a 3D space. By taking command of stitching artifacts, cardiac imagers can successfully navigate the complex structures of the heart for optimal, individualized echocardiographic views.
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Affiliation(s)
- Samuel D Maidman
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Richard Ro
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York.
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7
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Sun F, Sun A, Chen Y, Xiao Y, Zhang X, Qiao W, Tan X, Liang Y, Li D, Yang S, Ren W. Novel TrueVue series of 3D echocardiography: Revealing the pathological morphology of congenital heart disease. Front Physiol 2022; 13:1000007. [PMID: 36148295 PMCID: PMC9485809 DOI: 10.3389/fphys.2022.1000007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Aims: This study explored the advantages and limitations of novel series of three-dimensional (3D) echocardiographic techniques and summarized their application methods for congenital heart diseases (CHDs). Method and result: Two-dimensional (2D), traditional 3D echocardiography, and TrueVue plus light and/or Glass novel 3D technologies were performed on 62 patients with CHD, and a clinical survey was designed to judge whether the novel 3D images were more helpful for understanding the cardiac condition and guide treatment than traditional 3D images. TrueVue increased the visual resolution and simulated the true texture of cardiac tissue, significantly improving the display ability of abnormal anatomical structures in CHDs. TrueVue Glass displayed the blood channel and the internal structure of cardiac cavity more intuitively, indicating a new observation aspect not shown by conventional echocardiography. The clinical survey results showed that the new 3D imaging methods effectively increased the diagnostic confidence of echocardiographers, enabled surgeons to better understand the details of lesions, promoted efficient communication, and improved the confidence of both doctors and patients in treatment. Conclusion: The combined application of TrueVue, TrueVue Light, and TrueVue Glass more closely simulated real anatomical features, showed more comprehensive and subtle blood flow in the lumen, not only increased the visual effect but also provided more useful diagnostic information, improved the accuracy of evaluation and treatment of CHD when compared to traditional imaging techniques, indicating that this combined application has significant clinical value.
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Affiliation(s)
- Feifei Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Aijiao Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yixin Chen
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xintong Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Qiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueying Tan
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanxiao Liang
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dongyu Li
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shu Yang
- Department of Ultrasound, Philips Medical Technology, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Weidong Ren,
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8
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Limitations of Percutaneous Closure of a Complex Secundum Atrial Septal Defect. CASE 2022; 6:233-236. [PMID: 35832827 PMCID: PMC9271411 DOI: 10.1016/j.case.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Percutaneous closure of ASDs can be limited by size or shape of the defect. A 3D evaluation of ASDs is essential for proper sizing and procedural planning. Balloon sizing may help for large or irregularly shaped ASDs.
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9
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Qiu JK, Bamira D, Vainrib AF, Latson LA, Halpern DG, Chun A, Saric M. Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults. CASE 2022; 6:107-113. [PMID: 35602989 PMCID: PMC9120852 DOI: 10.1016/j.case.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
SVASD should be suspected in cases of unexplained RV volume overload. Direct visualization of SVASD with TTE is difficult in adults compared with children. TEE is helpful for diagnosing SVASD and associated pulmonary venous abnormalities. Multimodal imaging techniques offer incremental value in the workup of SVASD.
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10
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Deng B, Chen K, Huang T, Wei Y, Liu Y, Yang L, Qiu Q, Zheng S, Lv H, Wang P, Nie R, Wang J. Assessment of atrial septal defect using 2D or real-time 3D transesophageal echocardiography and outcomes following transcatheter closure. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1309. [PMID: 34532446 PMCID: PMC8422086 DOI: 10.21037/atm-21-3206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022]
Abstract
Background The assessment of interatrial septum (IAS) requires a standardized, systematic approach, including two-dimensional transthoracic echocardiography (2D TTE), 2D transesophageal echocardiography (2D TEE), and three-dimensional (3D) TEE. Although 2D TEE has been widely used for the preoperative assessment of atrial septal defect (ASD), its ability to provide reliable information is often limited due to the structural characteristics of IAS. The introduction of 3D TEE provides a unique "en face" view of IAS, which allows the visualization and accurate measurements of diameters, area, and rims of ASD. Hence, appropriate ASD imaging information is particularly important in successful transcatheter closure. Methods In this retrospective study, 2D TTE/TEE, and 3D TEE were performed before ASD closure, with 2D minimal and maximal diameters, areas, and residual rims being recorded. Adequate 3D TEE imaging data sets were collected and then analyzed. ASD related parameters were compared using different echocardiography. Patients who underwent ASD closure completed a clinical follow-up. Results The mean defect maximal diameter and aperture area by 3D TEE was significantly larger than that of the corresponding 2D TEE (P<0.05). There was no statistical difference in the minimal and maximal diameter or area by TEE for circular-shaped ASDs. For oval ASDs, mean minimal diameter on 2D TEE was larger than that on 3D TEE. The mean maximal diameter measured using 2D TEE was smaller than the 3D TEE measurement (16.0±7.1 vs. 19.8±8.6; P<0.05). For complex-shaped defects, there were statistical differences in minimal and maximal diameter between TEEs. Furthermore, 2D and 3D TEE had a longer superior vena cava (SVC) residual rim than did 2D TTE (P<0.05). The 3D TEE residual rims of the inferior vena cava (IVC) was significantly larger than the corresponding 2D TEE. There was a very strong correlation between the residual rim measurements using 3D and 2D TEE. However, the limits of agreement between 2D and real-time 3D TEE measurements were more apparent in the IVC rim group than in the other groups. Conclusions Our study confirms the value of 3D TEE in assessing ASD shape and size reported by previous studies, and is also the first to accurately and systematically characterize ASD residual rim in complex ASDs.
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Affiliation(s)
- Bingqing Deng
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kequan Chen
- Department of Gastroenterology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tucheng Huang
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yulin Wei
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yingmei Liu
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Yang
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiong Qiu
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoxin Zheng
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hanlu Lv
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peiwei Wang
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruqiong Nie
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingfeng Wang
- Cardiovascular Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Morhy SS, Barberato SH, Lianza AC, Soares AM, Leal GN, Rivera IR, Barberato MFA, Guerra V, Ribeiro ZVDS, Pignatelli R, Rochitte CE, Vieira MLC. Position Statement on Indications for Echocardiography in Fetal and Pediatric Cardiology and Congenital Heart Disease of the Adult - 2020. Arq Bras Cardiol 2020; 115:987-1005. [PMID: 33295472 PMCID: PMC8452202 DOI: 10.36660/abc.20201122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Silvio Henrique Barberato
- Cardioeco - Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
- Quanta Diagnóstico e Terapia, Curitiba, PR - Brasil
| | - Alessandro Cavalcanti Lianza
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
- Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brasil
- Hospital do Coração, São Paulo, SP - Brasil
| | - Andressa Mussi Soares
- Hospital Evangélico de Cachoeiro de Itapemirim e Clínica CORImagem, Cachoeiro de Itapemirim, ES - Brasil
| | - Gabriela Nunes Leal
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
- Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brasil
- Hospital do Coração, São Paulo, SP - Brasil
- Hospital e Maternidade São Luiz Itaim, São Paulo, SP - Brasil
| | | | | | - Vitor Guerra
- The Hospital for Sick Children, Toronto - Canadá
| | | | - Ricardo Pignatelli
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas - EUA
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor, FMUSP), São Paulo, SP - Brasil
| | - Marcelo Luiz Campos Vieira
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor, FMUSP), São Paulo, SP - Brasil
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12
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Imaging for Patient's Selection and Guidance of LAA and ASD Percutaneous and Surgical Closure. JACC Cardiovasc Imaging 2020; 14:3-21. [PMID: 32682721 DOI: 10.1016/j.jcmg.2019.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 12/30/2022]
Abstract
This review comprises 2 main subjects: the percutaneous and surgical closure of the left atrial appendage (LAA) and atrial septal defect (ASD). The aim of the authors was to provide a detailed description of: 1) anatomy of LAA, normal interatrial septum, and the various types of ASD as revealed by noninvasive imaging techniques; 2) preprocedure planning of secundum ASD and LAA percutaneous closure; 3) key steps of the procedural guidance emphasizing the role of 2-dimensional/3-dimensional transesophageal echocardiography; and 4) surgical closure of LAA and ASD.
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13
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Taha F, Elshedoudy S. Role of 3D transesophageal echocardiography in transcatheter closure of atrial septal aneurysms. Echocardiography 2019; 36:1884-1894. [PMID: 31541598 DOI: 10.1111/echo.14482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Three dimensional transesophageal echocardiography (3DTEE) is superior to two dimensional transesophageal echocardiography (2DTEE) as it provides all atrial septal information from a single view. AIM To evaluate 3DTEE role in analysis of atrial septal aneurysm (ASA) and in device closure guiding. METHODS Three dimensional transesophageal echocardiography were recorded with Vivid*E9,GE system over 14 months. ASAs were classified into 4 types (A: with PFO, B: with one ASD, C: with 2 ASDs, and D: with multiple fenestrations). Each aneurysm was assessed according to its type, shape, dimensions, orientation, aneurysmal tissue, and the surrounding rims. All patients passed to transcatheter aneurysm closure. RESULTS A total of 26 patients with ASAs were assessed (7 imperforated aneurysms excluded). The remaining 19 patients' age was 12.84 ± 5.82years. Four patients had type A aneurysms, 6 had type B, 4 had type C, and 5 had type D. 3DTEE demonstrated oval aneurysms in 17 patients. The orientation was oblique in 8 patients, vertical in 7, and horizontal in 4. The ASAs dimensions were 23.5 ± 5.1, 23.2 ± 5.1, and 22.0 ± 4.0 mm for oblique, vertical, and horizontal axes. Percutaneous closure succeeded in 18 patients. Balloon sizing was used in 4 patients. Devices used were: In type A:PFO devices, in type B:ASO devices, in type C:two patients required two ASO devices in each patient and two patients required one cribriform device, and in type D:Cribriform devices used for three patients, PFO for one and ASO for one. LA, LUPV, and RUPV approaches were used. Aspirin was received for 6 months. CONCLUSION Three dimensional transesophageal echocardiography helps to select aneurysms suitable for transcatheter closure, select the suitable devices, and guide the transcatheter procedure.
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Affiliation(s)
- Fatma Taha
- Pediatric Cardiology and Congenital Heart Diseases Unit, Cardiology Department, Tanta University, Tanta, Egypt
| | - Sahar Elshedoudy
- Pediatric Cardiology and Congenital Heart Diseases Unit, Cardiology Department, Tanta University, Tanta, Egypt
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Altszuler D, Vainrib AF, Bamira DG, Benenstein RJ, Aizer A, Chinitz LA, Saric M. Left Atrial Occlusion Device Implantation: the Role of the Echocardiographer. Curr Cardiol Rep 2019; 21:66. [PMID: 31183616 DOI: 10.1007/s11886-019-1151-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Atrial fibrillation is the most common arrhythmia worldwide and is a major risk factor for embolic stroke. For patients with atrial fibrillation who are unable to tolerate systemic anticoagulation, left atrial appendage (LAA) occlusion has been shown to mitigate stroke risk. In this article, we describe the vital role of the echocardiographer in intraprocedural guidance of percutaneous LAA occlusion procedures as well as in the pre- and post-procedure assessment of these patients. RECENT FINDINGS A few percutaneously delivered devices for LAA exclusion from the systemic circulation are available in contemporary practice. These devices employ an either exclusive endocardial LAA occlusion approach, such as the Watchman (Boston Scientific, Maple Grove, MN) and Amulet (St. Jude Medical, Minneapolis, MN), or both an endocardial and pericardial (epicardial) approach such as the Lariat procedure (SentreHEART, Palo Alto, CA). Two- and three-dimension transesophageal echocardiography is critical for patient selection, procedure planning, procedural guidance, and ensuring satisfactory immediate as well as long-term LAA occlusion/exclusion efficacy. This review will provide an overview of the role of the echocardiographer in all aspects of LAA occlusion/exclusion procedures for the most commonly used commercially available devices in current practice.
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Affiliation(s)
- David Altszuler
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Daniel G Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Ricardo J Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA.
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15
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Abstract
Transcatheter procedures offer less invasive approaches allowing rapid recovery and earlier hospital discharge. A number of international guidelines have defined the role of echocardiography spanning diagnosis, detailed anatomical assessment, device sizing and selection, peri-procedure guidance and post device surveillance. This review discusses the role of echocardiography in transcatheter atrial septal defect (ASD) closure. It describes a systematic approach to assessment including the crucial role of three dimensional echo and provides the reader with key information required during device sizing and procedure guidance.
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Affiliation(s)
- Bushra S Rana
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
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16
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Vainrib AF, Harb SC, Jaber W, Benenstein RJ, Aizer A, Chinitz LA, Saric M. Left Atrial Appendage Occlusion/Exclusion: Procedural Image Guidance with Transesophageal Echocardiography. J Am Soc Echocardiogr 2018; 31:454-474. [DOI: 10.1016/j.echo.2017.09.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Indexed: 11/15/2022]
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17
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Vainrib AF, Bamira DG, Saric M. Percutaneous Left Atrial Appendage Closure Devices. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Vegas A. Three-dimensional transesophageal echocardiography: Principles and clinical applications. Ann Card Anaesth 2017; 19:S35-S43. [PMID: 27762247 PMCID: PMC5100241 DOI: 10.4103/0971-9784.192622] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A basic understanding of evolving 3D technology enables the echocardiographer to master the new skills necessary to acquire, manipulate, and interpret 3D datasets. Single button activation of specific 3D imaging modes for both TEE and transthoracic echocardiography (TTE) matrix array probes include (a) live, (b) zoom, (c) full volume (FV), and (d) color Doppler FV. Evaluation of regional LV wall motion by RT 3D TEE is based on a change in LV chamber subvolume over time from altered segmental myocardial contractility. Unlike standard 2D TEE, there is no direct measurement of myocardial thickening or displacement of individual segments.
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Affiliation(s)
- Annette Vegas
- Senior Consultant, Department of Anaesthesia, Toronto General Hospital, Toronto, Ontario, Canada
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19
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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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20
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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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21
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Corti R, Biaggi P, Gaemperli O, Bühler I, Felix C, Bettex D, Kretschmar O, Falk V, Grünenfelder J. Integrated x-ray and echocardiography imaging for structural heart interventions. EUROINTERVENTION 2016; 9:863-9. [PMID: 24280159 DOI: 10.4244/eijv9i7a140] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Treatment of structural heart disease (SHD) represents a growing need and, with increasing device availability, an increasing number of SHD can be and will be treated percutaneously. However, interventional treatment of SHD is challenging. Long procedure times and steep learning curves are recognised obstacles. The main difficulties arise, however, from the inability to visualise simultaneously the anatomy and the devices using a single imaging technology. In fact, the majority of percutaneous interventions in SHD are guided by fluoroscopy. On the other hand, a multitude of imaging technologies are presently available to guide the interventionalist. Of these technologies, transoesophageal echocardiography (TEE), and particularly 3-D TEE, is rapidly becoming the imaging modality of choice for many of these procedures because it provides critical insights into soft tissue anatomy. However, adequate visualisation and appreciation of the relationships between the cardiac structures and the devices using various imaging modalities remain a challenge. Hence, the interaction between the operator and imager is a crucial factor in attaining procedural success. Innovative technology that fuses live 3-D TEE with live x-ray in an intuitive way could have an important added value. This new imaging technology seeks to improve the communication between the echocardiographer and the interventionalist, to increase the confidence and anatomical awareness, to assist in guidance, and to increase procedural efficiency.
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Affiliation(s)
- Roberto Corti
- HeartClinic Hirslanden, Klinik Hirslanden, Zurich, Switzerland
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22
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Kuroda M, Kumakura M, Sato T, Saito S. The Usefulness of Three-Dimensional Transesophageal Echocardiography for a Primum Atrial Septal Defect. Anesth Analg 2015; 121:1151-4. [DOI: 10.1213/ane.0000000000000958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Aizer A, Young W, Saric M, Holmes D, Fowler S, Chinitz L. Three-dimensional transesophageal echocardiography to facilitate transseptal puncture and left atrial appendage occlusion via upper extremity venous access. Circ Arrhythm Electrophysiol 2015; 8:988-90. [PMID: 26286309 DOI: 10.1161/circep.115.002780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anthony Aizer
- From the Section of Electrophysiology, Division of Cardiology, New York University, Langone Medical Center.
| | - Wilson Young
- From the Section of Electrophysiology, Division of Cardiology, New York University, Langone Medical Center
| | - Muhamed Saric
- From the Section of Electrophysiology, Division of Cardiology, New York University, Langone Medical Center
| | - Douglas Holmes
- From the Section of Electrophysiology, Division of Cardiology, New York University, Langone Medical Center
| | - Steven Fowler
- From the Section of Electrophysiology, Division of Cardiology, New York University, Langone Medical Center
| | - Larry Chinitz
- From the Section of Electrophysiology, Division of Cardiology, New York University, Langone Medical Center
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24
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A Proposed Maneuver to Guide Transseptal Puncture Using Real-Time Three-Dimensional Transesophageal Echocardiography: Pilot Study. Cardiol Res Pract 2015; 2015:174051. [PMID: 26106503 PMCID: PMC4461759 DOI: 10.1155/2015/174051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/17/2015] [Accepted: 05/19/2015] [Indexed: 11/18/2022] Open
Abstract
Aim of Study. To assess the feasibility of a new proposed maneuver “RATLe-90” using real-time three-dimensional transesophageal echocardiography (RT-3DTEE) for anatomically oriented visualization of the interatrial septum (IAS) in guiding the transseptal puncture TSP. Methods. The study included 20 patients (mean age, 60.2 ± 6.7 years; 60% males) who underwent TSP for different indications. RT-3DTEE was used to guide TSP. The proposed maneuver RATLe-90 (Rotate-Anticlockwise-Tilt-Left-90) was applied in all cases to have the anatomically oriented en face view of the IAS from the right atrial (RA) aspect. Having this anatomically oriented view, we guided the TSP catheter towards the proper puncture site according to the planned procedure. Results. Using the RATLe-90 maneuver, the anatomically oriented en face view of the IAS from the RA was obtained in all patients. We were able to guide the puncture catheter to the proper puncture site on the IAS. The 3D images obtained were clearly understood by both echocardiographers and interventionists. The RATLe-90 maneuver acquisition time was 19.9 ± 1.6 seconds. The time-to-tent was 64.8 ± 16.3 seconds. Less TEE probe manipulations were needed while guiding the TSP. Conclusions. Application of RT3D-TEE during TSP using RATLe-90 maneuver is feasible with shorter fluoroscopy time and minimizing TEE probe manipulations.
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25
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Abstract
Most secundum atrial septal defects (ASD) are amenable to device closure. Three- dimensional transesophageal echocardiography (3DTEE) can be used to obtain an en face view of the ASD and important surrounding structures which provides for analysis of the type, size, shape, orientation, number and position of orifices, ASD rims and important surrounding structures in a single live 3D echo view. Also, 3DTEE is ideal for monitoring the position and configuration of devices and delivery hardware using live real -time imaging techniques. In this chapter we will describe and illustrate the methods to obtain and optimize 3DTEE en face views of the ASD during device closure using 3D zoom, live 3D and 3D full volume plus iCrop modalities. The respective 3D TEE modalities, imaging protocols, advantages and limitations will be discussed. Because it is useful, accurate and fairly simple to use, we have adopted 3D TEE for routine clinical use during ASD device closure.
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Affiliation(s)
- David A Roberson
- Advocate Children's Hospital Heart Institute, Oak Lawn, IL, USA,
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26
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Atrial shunts: presentation, investigation, and management, including recent advances in magnetic resonance imaging. Cardiol Young 2014; 24:403-16. [PMID: 24397877 DOI: 10.1017/s1047951113002321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Atrial shunts are a common finding in both paediatric and adult populations. Recent developments in advanced imaging have widened the options for diagnosis and evaluation of such shunts. This paper reviews the various types of interatrial communications, discusses the features of clinical presentation in adults and children, and provides an overview of the clinical assessment including physical examination, electrocardiography, echocardiography, cardiac catheterisation, computed tomography, and magnetic resonance imaging. Focus will be placed on recent developments in magnetic resonance imaging that may improve the non-invasive evaluation of atrial shunts.
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27
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Nyrnes SA, Løvstakken L, Døhlen G, Skogvoll E, Torp H, Skjaerpe T, Norgård G, Samstad S, Graven T, Haugen BO. Blood Flow Imaging in Transesophageal Echocardiography during Atrial Septal Defect Closure: A Comparison with the Current References. Echocardiography 2014; 32:34-41. [DOI: 10.1111/echo.12610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Siri Ann Nyrnes
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Pediatrics; St. Olav's University Hospital; Trondheim Norway
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Gaute Døhlen
- Department of Pediatric Medicine; Section for Pediatric Cardiology; Oslo University Hospital; Oslo Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Anesthesiology and Emergency Medicine; St. Olav's University Hospital; Trondheim Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Terje Skjaerpe
- Department of Cardiology; St. Olav's University Hospital; Trondheim Norway
| | - Gunnar Norgård
- Department of Pediatric Medicine; Section for Pediatric Cardiology; Oslo University Hospital; Oslo Norway
| | - Stein Samstad
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Cardiology; St. Olav's University Hospital; Trondheim Norway
| | - Torbjørn Graven
- Levanger Hospital; Nord-Trøndelag Health Trust; Levanger Norway
| | - Bjørn Olav Haugen
- Department of Cardiology; St. Olav's University Hospital; Trondheim Norway
- MI-Laboratory; Department of Circulation and Medical Imaging; NTNU; Trondheim Norway
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28
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Echocardiographic Follow-up of Grown-ups with Congenital Heart Disease: Update 2013. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9236-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Islas F, Saltijeral A, Pérez de Isla L. [Structural interventions monitoring in the three-dimensional echocardiography era]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:323-4. [PMID: 24268526 DOI: 10.1016/j.acmx.2013.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 04/25/2013] [Accepted: 04/29/2013] [Indexed: 11/16/2022] Open
Affiliation(s)
- Fabián Islas
- Instituto Cardiovascular, Unidad de Imagen Cardiovascular, Hospital Clínico San Carlos, Madrid, España
| | | | - Leopoldo Pérez de Isla
- Instituto Cardiovascular, Unidad de Imagen Cardiovascular, Hospital Clínico San Carlos, Madrid, España.
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30
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Orwat S, Diller GP, Baumgartner H. Imaging of congenital heart disease in adults: choice of modalities. Eur Heart J Cardiovasc Imaging 2013; 15:6-17. [PMID: 23913331 DOI: 10.1093/ehjci/jet124] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Major advances in noninvasive imaging of adult congenital heart disease have been accomplished. These tools play now a key role in comprehensive diagnostic work-up, decision for intervention, evaluation for the suitability of specific therapeutic options, monitoring of interventions and regular follow-up. Besides echocardiography, magnetic resonance (CMR) and computed tomography (CT) have gained particular importance. The choice of imaging modality has thus become a critical issue. This review summarizes strengths and limitations of the different imaging modalities and how they may be used in a complementary fashion. Echocardiography obviously remains the workhorse of imaging routinely used in all patients. However, in complex disease and after surgery echocardiography alone frequently remains insufficient. CMR is particularly useful in this setting and allows reproducible and accurate quantification of ventricular function and comprehensive assessment of cardiac anatomy, aorta, pulmonary arteries and venous return including complex flow measurements. CT is preferred when CMR is contraindicated, when superior spatial resolution is required or when "metallic" artefacts limit CMR imaging. In conclusion, the use of currently available imaging modalities in adult congenital heart disease needs to be complementary. Echocardiography remains the basis tool, CMR and CT should be added considering specific open questions and the ability to answer them, availability and economic issues.
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Affiliation(s)
- Stefan Orwat
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany
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31
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Windram JD, Siu SC, Wald RM, Silversides CK. New Directives in Cardiac Imaging: Imaging the Adult With Congenital Heart Disease. Can J Cardiol 2013; 29:830-40. [DOI: 10.1016/j.cjca.2013.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 11/16/2022] Open
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32
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Rostamian A, Rathod A, Makkar RR, Siegel RJ. Three-Dimensional Echocardiographic Assessment of Patent Foramen Ovale in Platypnea-Orthodeoxia. Echocardiography 2013; 30:E239-42. [DOI: 10.1111/echo.12265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Armand Rostamian
- Heart Institute; Cedars-Sinai Medical Center; Los Angeles; California
| | - Ankit Rathod
- Heart Institute; Cedars-Sinai Medical Center; Los Angeles; California
| | | | - Robert J. Siegel
- Heart Institute; Cedars-Sinai Medical Center; Los Angeles; California
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Kutty S, Delaney JW, Latson LA, Danford DA. Can we talk? Reflections on effective communication between imager and interventionalist in congenital heart disease. J Am Soc Echocardiogr 2013; 26:813-27. [PMID: 23768692 DOI: 10.1016/j.echo.2013.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Indexed: 02/06/2023]
Abstract
The rapid proliferation of catheter-mediated treatments for congenital heart defects has brought with it a critical need for cooperation and communication among the numerous physicians supporting these new and complex procedures. New interdependencies between physicians in specialties including cardiac imaging, interventional cardiology, pediatric cardiology, anesthesia, cardiothoracic surgery, and radiology have become apparent, as centers have strived to develop the best systems to foster success. Best practices for congenital heart disease interventions mandate confident and timely input from an individual with excellent adjunctive imaging skills and a thorough understanding of the devices and procedures being used. The imager and interventionalist must share an understanding of what each offers for the procedure, use a common terminology and spatial orientation system, and convey concise and accurate information about what is needed, what is seen, and what cannot be seen. The goal of this article is to review how the cardiovascular imaging specialists and interventionalists can work together effectively to plan and execute catheter interventions for congenital heart disease.
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Affiliation(s)
- Shelby Kutty
- Division of Pediatric Cardiology, University of Nebraska Medical Center College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska, USA.
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34
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35
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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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36
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García-Fuertes D, Mesa-Rubio D, Ruiz-Ortiz M, Delgado-Ortega M, Tejero-Mateo I, Pan-Álvarez-Ossorio M, Suárez-de-Lezo J, Lafuente M. Monitoring Complex Secundum Atrial Septal Defects Percutaneous Closure with Real Time Three-Dimensional Echocardiography. Echocardiography 2012; 29:729-34. [DOI: 10.1111/j.1540-8175.2012.01679.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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37
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Kuroda M, Hiroki T, Suto T, Miyoshi S, Kadoi Y, Saito S. Two- and Three-Dimensional Transesophageal Echocardiography for Multiple Atrial Septal Defects. Anesth Analg 2012; 114:738-41. [DOI: 10.1213/ane.0b013e318246dfa4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Heyns MD, Schroder JN, Jaquis RD, Mackensen GB. Three-dimensional transesophageal echocardiography enhances multimodal imaging of a successful repair of a case with scimitar syndrome. Circ Cardiovasc Imaging 2012; 5:164-6. [PMID: 22253336 DOI: 10.1161/circimaging.111.969865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- M Daneel Heyns
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
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Burri MV, Gupta D, Kerber RE, Weiss RM. Review of novel clinical applications of advanced, real-time, 3-dimensional echocardiography. Transl Res 2012; 159:149-64. [PMID: 22340764 DOI: 10.1016/j.trsl.2011.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 12/22/2011] [Accepted: 12/22/2011] [Indexed: 11/16/2022]
Abstract
Advances in computer processing speed and memory along with the advent of the microbeam former that can sample an entire crystal of the ultrasound transducer made possible the performance of 3-dimensional echocardiography in real time (RT3DE). The miniaturization of a 3-dimensional transducer permitting its extension to transesophageal mode rapidly expanded its use in a variety of conditions. Recent development of user-friendly automated/semiautomated cropping and display software may make it rather simple, even for the novice to gather useful information from RT3DE. We discuss the background, technique, and cutting-edge research and novel clinical applications of advanced RT3DE, including left ventricular dyssynchrony assessment, 3-D speckle tracking, myocardial contrast echocardiography, complete 4-dimensional (4-D) shape and motion analysis of the left ventricle, 4-D volumetric analysis of the right ventricle, 3-D volume rendering of the mitral valve, and other percutaneous and surgical procedural applications.
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Affiliation(s)
- Manjula V Burri
- Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Dr., Iowa City, IA 52242, USA.
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Urheim S, Andersen K, Aakhus S. Tredimensjonal ultralydundersøkelse i kardiologisk diagnostikk. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:2171-4. [DOI: 10.4045/tidsskr.11.0410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Taniguchi M, Akagi T. Real-time imaging for transcatheter closure of atrial septal defects. Interv Cardiol 2011. [DOI: 10.2217/ica.11.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Siegel RJ, Makkar R, Doumanian A, Gurudevan SV. Transcatheter Aortic Valve Implantation Three-Dimensional Echo Monitoring and Guidance. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9103-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Real-time three-dimensional echocardiography during percutaneous edge-to-edge mitral valve repair. J Cardiovasc Echogr 2011. [DOI: 10.1016/j.jcecho.2011.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Evaluation of Atrial and Ventricular Septal Defects with Real-Time Three-Dimensional Echocardiography: Current Status and Literature Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9102-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW To provide an overview of the various modalities that have emerged in the last years as adjunctive tools to provide detailed imaging of the cardiovascular system in the catheterization laboratory. RECENT FINDINGS Completion angiography after cardiac surgery for congenital heart disease using a dedicated hybrid operating cardiac suite may aid in early diagnosis and therapy of postsurgical abnormalities. The application of three-dimensional rotational digital angiography results in a more precise delineation of the three-dimensional anatomy of vascular structures outside the heart with rapid image processing and reduction of the amount of contrast used and ionizing radiation dose. Combined catheterization/magnetic resonance (MR) hybrid laboratories have the potential to accurately assess changes in the anatomy and physiology pretranscatheter and posttranscatheter interventions. Fully MR-guided transcatheter procedures have become possible in animal models. Real-time three-dimensional transesophageal echocardiography (TEE) has helped to guide transcatheter procedures in septal and valvar structures. Miniaturization of probes has expanded the applications of TEE for smaller neonates. The use of intravascular ultrasound has helped to better understand the mechanisms of vascular diseases and transcatheter treatments. SUMMARY Knowledge and proper application of new imaging modalities during interventions in the catheterization laboratory may improve the outcomes of patients with congenital and acquired structural heart disease.
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Faletra FF, Nucifora G, Ho SY. Imaging the Atrial Septum Using Real-Time Three-Dimensional Transesophageal Echocardiography: Technical Tips, Normal Anatomy, and Its Role in Transseptal Puncture. J Am Soc Echocardiogr 2011; 24:593-9. [DOI: 10.1016/j.echo.2011.01.022] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Indexed: 01/29/2023]
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Roberson DA, Cui W, Patel D, Tsang W, Sugeng L, Weinert L, Bharati S, Lang RM. Three-Dimensional Transesophageal Echocardiography of Atrial Septal Defect: A Qualitative and Quantitative Anatomic Study. J Am Soc Echocardiogr 2011; 24:600-10. [DOI: 10.1016/j.echo.2011.02.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Indexed: 01/14/2023]
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Current world literature. Curr Opin Cardiol 2011; 26:165-73. [PMID: 21307667 DOI: 10.1097/hco.0b013e328344b569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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