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Farjat-Pasos JI, Guedeney P, Horlick E, Abtan J, Nombela-Franco L, Hibbert B, Sondergaard L, Freixa X, Masson JB, Cruz-González I, Estévez-Loureiro R, Faroux L, Shah AH, Abrahamyan L, Mesnier J, Jerónimo A, Abdel-Razek O, Jørgensen TH, Asmar MA, Sitbon S, Abalhassan M, Robichaud M, Houde C, Côté M, Chamorro A, Lanthier S, Verreault S, Montalescot G, Rodés-Cabau J. Determinants of adverse outcomes following patent foramen ovale closure in elderly patients. EUROINTERVENTION 2024; 20:1029-1038. [PMID: 39155753 DOI: 10.4244/eij-d-24-00156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
BACKGROUND Limited data are available on transcatheter patent foramen ovale (PFO) closure outcomes in the elderly. AIMS Through this study, we aimed to determine the incidence and predictors of adverse events (recurrent cerebrovascular events [CVE] and atrial fibrillation [AF]) post-PFO closure in older patients with cryptogenic events. METHODS This multicentre international study included patients over 60 years undergoing PFO closure for cryptogenic thromboembolic events. A dedicated database compiled baseline, procedural, and follow-up data. Competing risk and adjusted outcome predictor analyses were conducted. RESULTS A total of 689 patients were included (median age 65 years, 41.2% female, mean Risk of Paradoxical Embolism [RoPE] score 4.5). The procedural success rate was 99.4%. After a median follow-up of 2 (interquartile range 1-5) years, 66 patients (9.6%) had died. CVE and stroke rates were 1.21 and 0.55 per 100 patient-years, respectively. Diabetes (hazard ratio [HR] 3.89, 95% confidence interval [CI]: 1.67-9.07; p=0.002) and atrial septal aneurysm (ASA; HR 5.25, 95% CI: 1.56-17.62; p=0.007) increased the CVE risk. New-onset AF occurred at a rate of 3.30 per 100 patient-years, with 51.3% within one month post-procedure. Older age (HR 1.05 per year, 95% CI: 1.00-1.09; p=0.023) and the absence of hypertension (HR 2.04, 95% CI: 1.19-3.57; p=0.010) were associated with an increased risk of AF. CONCLUSIONS Older patients undergoing PFO closure had a relatively low rate of CVE and new-onset AF after a median follow-up of 2 years. The presence of diabetes, ASA, and a more advanced age determined an increased risk of adverse clinical events. These factors may be considered in the clinical decision-making process regarding PFO closure in this challenging population.
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Affiliation(s)
- Julio I Farjat-Pasos
- Cardiology Department, Quebec Heart and Lung Institute, Québec, QC, Canada
- Pediatric Cardiology Department, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Eric Horlick
- Cardiology Department, Toronto General Hospital, Toronto, ON, Canada
| | - Jeremie Abtan
- Cardiology Department, Bichat-Claude-Bernard Hospital, Paris, France
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Benjamin Hibbert
- Cardiology Department, Ottawa Heart Institute, Ottawa, ON, Canada
| | - Lars Sondergaard
- Cardiology Department, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Xavier Freixa
- Cardiology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jean-Bernard Masson
- Cardiology Department, University of Montreal Health Centre, Montreal, QC, Canada
| | - Ignacio Cruz-González
- Cardiology Department, University Hospital of Salamanca, IBSAL, CIBER-CV, Salamanca, Spain
| | | | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Reims, France
| | - Ashish H Shah
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lusine Abrahamyan
- Cardiology Department, Toronto General Hospital, Toronto, ON, Canada
| | - Jules Mesnier
- Cardiology Department, Bichat-Claude-Bernard Hospital, Paris, France
| | - Adrián Jerónimo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Omar Abdel-Razek
- Cardiology Department, Ottawa Heart Institute, Ottawa, ON, Canada
| | - Troels Højsgaard Jørgensen
- Cardiology Department, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mike Al Asmar
- Cardiology Department, University of Montreal Health Centre, Montreal, QC, Canada
| | - Samuel Sitbon
- Cardiology Department, Bichat-Claude-Bernard Hospital, Paris, France
| | | | - Mathieu Robichaud
- Cardiology Department, Quebec Heart and Lung Institute, Québec, QC, Canada
| | - Christine Houde
- Pediatric Cardiology Department, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
| | - Mélanie Côté
- Cardiology Department, Quebec Heart and Lung Institute, Québec, QC, Canada
| | - Angel Chamorro
- Neuroscience Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Sylvain Lanthier
- Neurovascular Program and Research Center, Hôpital du Sacré-Coeur-de-Montréal, Montreal, QC, Canada
| | - Steve Verreault
- Neurovascular Department, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Québec, QC, Canada
- Pediatric Cardiology Department, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
- Cardiology Department, Hospital Clinic of Barcelona, Barcelona, Spain
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Zoroufian A, Lotfi-Tokaldany M, Davarpasand T, Jalali A, Moradi M, Damaneh AS. Age-dependent association between aneurysmal and isolated redundant inter-atrial septum with patent foramen ovale. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03217-5. [PMID: 39147917 DOI: 10.1007/s10554-024-03217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Interatrial septum (IAS) could be redundant by abnormal movement with or without aneurysmal bulging. We aimed to determine the prevalence of isolated redundant and aneurysmal IAS motion and their probable relationship with age and presence of patent foramen ovale (PFO) in a large-scale referral center. METHOD A total of 15,288 patients who underwent transthoracic echocardiography (TTE) at Tehran Heart Center were included From March 2019 to March 2021. Contrast echocardiography was conducted on patients with suspected PFO. Data were retrospectively analyzed from our previously established database. The prevalence of aneurysmal and redundant IAS and their relationship with age and PFO presence was evaluated. RESULTS Aneurysmal and isolated redundant IAS were present in 4% and 12.4% of the participants, respectively. The aneurysmal group was older, more frequently female and had higher frequency of PFO. The frequency of PFO among patients with aneurysmal IAS was about 14.4% and 5.3% in isolated redundant IAS patients. In both groups, the prevalence of abnormal IAS motion increased across age groups from the youngest to the oldest, while the prevalence of PFO decreased. CONCLUSION In conclusion, the frequency of PFO among patients with aneurysmal IAS was about 2.5 times more than that among patients with isolated redundant IAS and 24 times more than the normal population. The increasing trend observed across the aging group proposes a potential role for age in the pathophysiology of abnormal IAS. Furthermore, the decreasing prevalence of PFO among patients underlies its clinical significance as an important risk factor.
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Affiliation(s)
- Arezou Zoroufian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Echocardiography, Tehran Heart Center, Tehran, Iran.
| | - Masoumeh Lotfi-Tokaldany
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Davarpasand
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammadhosein Moradi
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abouzar Soleimani Damaneh
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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3
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Ji S, Dong B, Tang Y, Li H, Lai W, Li Y, Chen Y, Peng A, Chen L. Therapeutic value of patent foramen ovale closure for drug-resistant epilepsy: A case series report. Epilepsia Open 2024; 9:1357-1371. [PMID: 38742825 PMCID: PMC11296092 DOI: 10.1002/epi4.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE Closure surgery of patent foramen ovale (PFO) has been found to effectively control cryptogenic stroke and migraine, but it is uncertain whether PFO closure could also alleviate epileptic seizures. This study aims to observe the therapeutic effect of PFO closure on epileptic seizures. METHODS Since July 11th, 2017, in the neurology department of West China Hospital, Sichuan University, Chengdu, we have been regularly monitoring patients with epilepsy who have undergone PFO closure. The patient's clinical information, such as frequency, duration, and severity of seizures, before and after surgery was recorded in detail as well as postoperative safety events. RESULTS Of the 31 epilepsy patients who confirmed PFO observed (27 cases were drug-resistant epilepsy, 87.10%), average age of surgery was 23.74 years, and 12 cases were female (38.71%). After one-year follow-up, 26 patients (83.87%) achieved remission of seizure frequency, and 22 of whom (70.97%) experienced a remission of more than 50%. Additionally, compared to before surgery, 22 cases (70.97%) reported a decrease in the average seizure duration, and 20 cases (64.52%) reported a reduction in seizure severity. In the seizure indicators of frequency, average duration and severity, significant differences were identified between preoperative and postoperative comparisons with all test p values were <0.05. Furthermore, no serious safety events were reported except for one patient who briefly reported chest pain, and all patients expressed effective PFO closure. SIGNIFICANCE The PFO closure has been shown for the first time to result in a significant reduction in the frequency, duration, and severity of seizures. Patients with drug-resistant epilepsy and PFO with a large shunt are ideal candidates for undergoing PFO closure. PLAIN LANGUAGE SUMMARY Since PFO closure was found to have a good therapeutic effect on cryptogenic stroke and migraine, it has become a credible complementary therapy for the treatment of neurological diseases, and drug-resistant epilepsy with PFO is expected to become the next target disease that PFO closure could significantly improve.
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Affiliation(s)
- Shuming Ji
- Department of Clinical Research ManagementWest China Hospital of Sichuan UniversityChengduChina
| | - Bosi Dong
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude HealthSichuan UniversityChengduChina
| | - Yusha Tang
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude HealthSichuan UniversityChengduChina
| | - Hua Li
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude HealthSichuan UniversityChengduChina
| | - Wanlin Lai
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude HealthSichuan UniversityChengduChina
| | - Yajiao Li
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Yucheng Chen
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Anjiao Peng
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude HealthSichuan UniversityChengduChina
| | - Lei Chen
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude HealthSichuan UniversityChengduChina
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Cannata F, Stankowski K, Donia D, Figliozzi S, Fazzari F, Regazzoli D, Reimers B, Bragato RM, Pontone G, Trabattoni D, Colombo A, De Marco F, Mangieri A. Percutaneous suture-based patent foramen ovale closure: A state-of-the-art review. Trends Cardiovasc Med 2024; 34:404-413. [PMID: 37931791 DOI: 10.1016/j.tcm.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/18/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
Percutaneous closure of a patent foramen ovale (PFO), a common variation of interatrial septum anatomy, is a commonly performed procedure in the catheterization laboratory to reduce the risk of recurrent stroke in selected patients and to treat other PFO-related syndromes. In the last twenty years, disc-based devices have represented the armamentarium of the interventional cardiologist; recently, suture-based devices have become an attractive alternative, despite limited data regarding their long-term performance. The present review gives an overview of the current evidence regarding suture-based PFO closure, the device's characteristics, the echocardiographic evaluation of the PFO anatomy, and recommendations for patient selection. A detailed procedural guide is then provided, and potential complications and future developments in the field are discussed.
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Affiliation(s)
- Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy; Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Dario Donia
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Stefano Figliozzi
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Damiano Regazzoli
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Bernhard Reimers
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Renato Maria Bragato
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniela Trabattoni
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Federico De Marco
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Mangieri
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy.
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Cormican DS. Concomitant Percutaneous Atrial Septal Defect Closure With an Amplatzer Septal Occluder and HeartMate 3 Implantation for High-Risk Heart Failure Patients: A Novel Hybrid Strategy. J Cardiothorac Vasc Anesth 2024; 38:1806-1807. [PMID: 37863751 DOI: 10.1053/j.jvca.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Daniel S Cormican
- Division of Cardiothoracic Anesthesiology, Division of Surgical Critical Care, Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA.
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6
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Houska N, Albertz M, Frank B, Ing RJ. 2024 Guidelines for Performing a Comprehensive Pediatric Transthoracic Echocardiogram: Recommendations From the American Society of Echocardiography. J Cardiothorac Vasc Anesth 2024; 38:1627-1629. [PMID: 38834446 DOI: 10.1053/j.jvca.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 06/06/2024]
Affiliation(s)
- Nicholas Houska
- Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Megan Albertz
- Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Benjamin Frank
- Department of Pediatric Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Richard J Ing
- Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO.
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7
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Yanagi Y, Amano M, Tamai Y, Mizumoto A, Nakagawa S, Moriuchi K, Asano R, Kurashima S, Irie Y, Sakamoto T, Amaki M, Kanzaki H, Ohta Y, Morita Y, Ogo T, Kitai T, Izumi C. Accuracy of Shunt Volume Measured by Three-Dimensional Echocardiography and Cardiac Magnetic Resonance in Patients With an Atrial Septal Defect and a Dilated Right Ventricle. J Am Soc Echocardiogr 2024; 37:797-805. [PMID: 38754748 DOI: 10.1016/j.echo.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The accuracy of right ventricular (RV) quantification by three-dimensional echocardiography (3DE) has been reported mainly in patients with a normal right ventricle (RV). However, there are no data regarding the accuracy of 3DE in patients with a dilated RV, as in shunt diseases. In this study, we evaluated the accuracy of 3DE and that of volumetric (Vol) cardiac magnetic resonance (CMR) for assessment of RV and left ventricular (LV) stroke volume (SV) and the pulmonary (Qp)/systemic (Qs) blood flow ratio in patients with an atrial septal defect (ASD) using the two-dimensional phase contrast (2DPC) method as the gold standard. METHODS We retrospectively investigated 83 patients with ASD who underwent transcatheter closure and clinically indicated CMR and 3DE examinations. The ratio Qp/Qs was calculated using RV and LV SV measured by full-volume volumetric 3DE (Vol-3DE) and CMR (Vol-CMR) and by two-dimensional pulsed Doppler quantification (2D-Dop); the parameters were compared using 2DPC-CMR as the gold standard. RESULTS There was no significant difference in the Qp/Qs value between 2DPC-CMR and Vol-3DE (2.29 ± 0.70 vs 2.21 ± 0.63, P = .79) and 2D-Dop (vs 2.21 ± 0.65, P = 1.00); however, a significant difference was found between 2DPC-CMR and Vol-CMR (P < .001). The Qp/Qs value obtained using Vol-3DE showed the best correlation with 2DPC-CMR (r = 0.93, P < .001). The RV and LV SV values obtained by Vol-3DE showed the best correlation with 2DPC-CMR (RV SV, r = 0.82, P < .001; LV SV, r = 0.73, P < .001), although the absolute values were underestimated. CONCLUSION Qp/Qs was more accurately evaluated by Vol-3DE than by Vol-CMR or 2D-Dop. Three-dimensional echocardiography assessment was feasible and reproducible even in a dilated RV.
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Affiliation(s)
- Yoshiki Yanagi
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masashi Amano
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Yurie Tamai
- Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ayaka Mizumoto
- Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shoko Nakagawa
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenji Moriuchi
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ryotaro Asano
- Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shinichi Kurashima
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuki Irie
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takahiro Sakamoto
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Amaki
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideaki Kanzaki
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasutoshi Ohta
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Ogo
- Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Kitai
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chisato Izumi
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
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8
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Wang W, Zhang H, Li Y, Wang Y, Zhang Q, Ding G, Yin L, Tang J, Peng B. An Automated Heart Shunt Recognition Pipeline Using Deep Neural Networks. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:1424-1439. [PMID: 38388868 PMCID: PMC11300722 DOI: 10.1007/s10278-024-01047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/21/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
Automated recognition of heart shunts using saline contrast transthoracic echocardiography (SC-TTE) has the potential to transform clinical practice, enabling non-experts to assess heart shunt lesions. This study aims to develop a fully automated and scalable analysis pipeline for distinguishing heart shunts, utilizing a deep neural network-based framework. The pipeline consists of three steps: (1) chamber segmentation, (2) ultrasound microbubble localization, and (3) disease classification model establishment. The study's normal control group included 91 patients with intracardiac shunts, 61 patients with extracardiac shunts, and 84 asymptomatic individuals. Participants' SC-TTE images were segmented using the U-Net model to obtain cardiac chambers. The segmentation results were combined with ultrasound microbubble localization to generate multivariate time series data on microbubble counts in each chamber. A classification model was then trained using this data to distinguish between intracardiac and extracardiac shunts. The proposed framework accurately segmented heart chambers (dice coefficient = 0.92 ± 0.1) and localized microbubbles. The disease classification model achieved high accuracy, sensitivity, specificity, F1 score, kappa value, and AUC value for both intracardiac and extracardiac shunts. For intracardiac shunts, accuracy was 0.875 ± 0.008, sensitivity was 0.891 ± 0.002, specificity was 0.865 ± 0.012, F1 score was 0.836 ± 0.011, kappa value was 0.735 ± 0.017, and AUC value was 0.942 ± 0.014. For extracardiac shunts, accuracy was 0.902 ± 0.007, sensitivity was 0.763 ± 0.014, specificity was 0.966 ± 0.008, F1 score was 0.830 ± 0.012, kappa value was 0.762 ± 0.017, and AUC value was 0.916 ± 0.006. The proposed framework utilizing deep neural networks offers a fast, convenient, and accurate method for identifying intracardiac and extracardiac shunts. It aids in shunt recognition and generates valuable quantitative indices, assisting clinicians in diagnosing these conditions.
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Affiliation(s)
- Weidong Wang
- School of Computer Science and Software Engineering, Southwest Petroleum University, Chengdu, Sichuan, China
| | - Hongme Zhang
- Department of Cardiovascular Ultrasound, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
| | - Yizhen Li
- Department of Cardiovascular Ultrasound, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yi Wang
- Department of Cardiovascular Ultrasound, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qingfeng Zhang
- Department of Cardiovascular Ultrasound, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Geqi Ding
- Department of Cardiovascular Ultrasound, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lixue Yin
- Department of Cardiovascular Ultrasound, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jinshan Tang
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, USA
| | - Bo Peng
- School of Computer Science and Software Engineering, Southwest Petroleum University, Chengdu, Sichuan, China.
- Department of Cardiovascular Ultrasound, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
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9
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Zamani-Aliabadi SM, Qanadli SD, Fatehi-Feyzabad SH, Ghasemnezhad M, Ghaemi H, Azarine A, Mohammadzadeh A, Bitarafan-Rajabi A, Mortezaeian H, Rezaei-Kalantari K. Assessment of 4D flow MRI for quantification of left-to-right shunt in pediatric patients with ventricular septal defect: comparison with right heart catheterization. Front Cardiovasc Med 2024; 11:1399110. [PMID: 39105074 PMCID: PMC11298441 DOI: 10.3389/fcvm.2024.1399110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/10/2024] [Indexed: 08/07/2024] Open
Abstract
Objectives The percentage of shunt fraction significantly impacts the management of patients with congenital shunts, influencing strategic choices such as surgical or interventional procedures. This study compared the estimated shunt fraction (the ratio of pulmonary-to-systemic flow, Qp/Qs) for quantifying the left-to-right shunt in children with ventricular septal defect (VSD) using heart catheterization, four-dimensional (4D) flow, and two-dimensional (2D) flow magnetic resonance imaging (MRI). The goal was to establish a non-invasive and reliable measurement ratio between pulmonary and systemic blood flow in these patients. Methods Between July 2022 and June 2023, patients scheduled to undergo invasive right heart catheterization were included in this study. MRI was performed one hour before the catheterization procedure. The correlation of shunt fraction was assessed between all methods after calculating the Qp/Qs ratio from 2D and 4D flow MRI and catheterization. Results A total of 24 patients (aged 3-15 years, eight females) were ultimately included in the study. The Qp/Qs ratios obtained from 4D flow had a robust correlation (correlation coefficient r = 0.962) compared to those obtained during catheterization. Cardiac catheterization recorded the mean shunt fraction at 1.499 ± 0.396, while 4D flow measured it at 1.403 ± 0.344, with no significant difference between the two techniques. Moreover, there was a reasonable correlation (r = 0.894) between 2D flow measurements of Qp/Qs and the results obtained from catheterization, with a mean shunt fraction of 1.326 ± 0.283. Conclusion 4D flow MRI has the potential to be a non-invasive method for accurately measuring the left-to-right shunt in children with VSD.
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Affiliation(s)
| | - Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Seyed Hasan Fatehi-Feyzabad
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ghasemnezhad
- Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Ghaemi
- Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arshid Azarine
- Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, Paris, France
| | - Ali Mohammadzadeh
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Bitarafan-Rajabi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hojjat Mortezaeian
- Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kiara Rezaei-Kalantari
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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10
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Blixenkrone-Møller E, Dannesbo S, Dehn AM, Pihl CA, Sillesen AS, Vøgg ROB, Raja AA, Colan S, Mertens L, Vejlstrup N, Bundgaard H, Iversen K. Interatrial Communications: Prevalence and Subtypes in 12,385 Newborns-a Copenhagen Baby Heart Study. Pediatr Cardiol 2024:10.1007/s00246-024-03571-0. [PMID: 39003423 DOI: 10.1007/s00246-024-03571-0] [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: 04/02/2024] [Accepted: 06/27/2024] [Indexed: 07/15/2024]
Abstract
The prevalence of interatrial communications in newborns, i.e., patent foramen ovale or atrial septal defect, was previously reported to be between 24 and 92%, but the area has been impeded by lack of a universal classification method. A recently published novel echocardiographic diagnostic algorithm for systematic classification of interatrial communications had inter-and intraobserver agreements superior to standard expert assessment. This study aimed to determine the prevalence of subtypes of interatrial communications on transthoracic echocardiography in newborns. Echocardiograms of newborns aged 0-30 days were prospectively collected in the population-based cohort study Copenhagen Baby Heart Study in 2017-2018 and analyzed according to the new diagnostic algorithm, classifying interatrial communications into three subtypes of patent foramen ovale and three subtypes of atrial septal defects. Echocardiograms from 15,801 newborns were analyzed; 3416 (21.6%) were excluded due to suboptimal image quality or severe structural heart disease (n = 3), leaving 12,385 newborns (aged 12 [interquartile range 8; 15] days, 48.2% female) included in the study. An interatrial communication was detected in 9766 (78.9%) newborns. According to the algorithm, 9029 (72.9%) had a patent foramen ovale, while 737 (6.0%) fulfilled criteria for an atrial septal defect, further divided into subtypes. An interatrial communication was seen on echocardiography in almost 80% of newborns aged 0-30 days. Patent foramen ovale was 12 times more frequent than atrial septal defects. The observed prevalence of atrial septal defects was higher than previously reported. Follow up studies could distinguish which interatrial communications require follow-up or intervention. ClinicalTrial.gov, NCT02753348, posted April 27, 2016, [ https://classic.clinicaltrials.gov/ct2/show/NCT02753348 ].
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Affiliation(s)
- Elisabeth Blixenkrone-Møller
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sofie Dannesbo
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anna Maria Dehn
- Department of Cardiothoracic Surgery, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian A Pihl
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - R Ottilia B Vøgg
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Steven Colan
- Department of Cardiology, Boston Children's Hospital, Boston, USA
| | - Luc Mertens
- Department of Cardiology, The Hospital for Sick Children, Toronto, Canada
| | - Niels Vejlstrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Farooqi P, Yaqobi A, Mia Khail B, Niño Medina JA, Obaid Ullah Z, Saeed A, Alamy H, Farooqi SA, Azizi N, Duarte LE, Ghani T, Aminpoor H. Left Atrial Septal Pouch (LASP) and Cryptogenic Stroke: A Narrative Review. Cureus 2024; 16:e64245. [PMID: 39130916 PMCID: PMC11313746 DOI: 10.7759/cureus.64245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Over 20% of ischemic strokes are cardioembolic strokes, necessitating research into thrombus formation locations, particularly the left atrial appendage (LAA). The left atrial septal pouch (LASP), which is linked to thrombus development and stasis, has drawn attention recently as a possible thromboembolic location, especially in atrial fibrillation (AF). The primary aim of this review is to explore LASP's role in cryptogenic strokes and to discuss the methods used to assess LAA anatomy. Imaging modalities such as cardiac computed tomography (CT) and transesophageal echocardiography (TEE) are crucial for diagnosing and characterizing LASP. LASP, found in about one-third of individuals, provides an additional site for thrombus development in the left atrium. The potential clinical implications of LASP-related thromboembolic events include the need for targeted therapeutic strategies, such as anticoagulant medication and, in some cases, consideration of LASP closure to prevent recurrent strokes. Further investigation is required to elucidate LASP's involvement in thromboembolic events and to guide stroke prevention in at-risk patients.
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Affiliation(s)
- Palwasha Farooqi
- Internal Medicine, Kabul University of Medical Sciences, Kabul, AFG
| | - Adila Yaqobi
- Pediatric Medicine, Kabul University of Medical Sciences, Kabul, AFG
| | | | - Jose A Niño Medina
- Law and Political Sciences/Health Sciences, University of Carabobo, Valencia, VEN
| | | | - Abed Saeed
- Cardiovascular Medicine, Ali Abad Teaching Hospital, Kabul, AFG
| | - Haroon Alamy
- Internal Medicine, Armed Forces Academy of Medical Sciences, Kabul, AFG
| | - Syed Ahmad Farooqi
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Najim Azizi
- Surgery, Herat Regional Hospital, Herat, AFG
| | | | - Torgot Ghani
- Internal Medicine, Wazir Mohammad Akbar Khan Hospital, Kabul, AFG
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12
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Meng X, Song M, Zhang K, Lu W, Li Y, Zhang C, Zhang Y. Congenital heart disease: types, pathophysiology, diagnosis, and treatment options. MedComm (Beijing) 2024; 5:e631. [PMID: 38974713 PMCID: PMC11224996 DOI: 10.1002/mco2.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 07/09/2024] Open
Abstract
Congenital heart disease (CHD) is a structural abnormality of the heart and/or great vessels and patients with CHD are at an increased risks of various morbidities throughout their lives and reduced long-term survival. Eventually, CHD may result in various complications including heart failure, arrhythmias, stroke, pneumonia, and sudden death. Unfortunately, the exact etiology and pathophysiology of some CHD remain unclear. Although the quality of life and prognosis of patients with CHD have significantly improved following technological advancement, the influence of CHD is lifelong, especially in patients with complicated CHD. Thus, the management of CHD remains a challenge due to its high prevalence. Finally, there are some disagreements on CHD among international guidelines. In this review, we provide an update of the pathophysiology, diagnosis, and treatment in most common type of CHD, including patent foramen ovale, atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, coarctation of the aorta, transposition of the great arteries, congenitally corrected transposition of the great arteries, coronary anomalies, left and right ventricular outflow tract obstruction, tetralogy of Fallot and Ebstein anomaly. In particular, we focus on what is known and what is unknown in these areas, aiming to improve the current understanding of various types of CHD.
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Affiliation(s)
- Xiao Meng
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Ming Song
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Kai Zhang
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Weida Lu
- Shandong Key Laboratory of Cardiovascular Proteomics and Department of Geriatric MedicineQilu Hospital of Shandong UniversityJinanChina
| | - Yunyi Li
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Cheng Zhang
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Yun Zhang
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
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13
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Kamada H, Iriki Y, Yoshimoto I, Ninomiya Y, Ichiki H, Maenosono R, Miyata M, Hamamoto Y, Horizoe Y, Ikeda Y, Ohishi M. Incidence and predictors of persistent iatrogenic atrial septal defect following catheter ablation. J Cardiol 2024:S0914-5087(24)00124-2. [PMID: 38914280 DOI: 10.1016/j.jjcc.2024.06.007] [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: 12/21/2023] [Revised: 05/14/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND The left atrium approach for atrial fibrillation (AF) ablation requires an atrial transseptal puncture that may cause an iatrogenic atrial septal defect (iASD). This study aimed to investigate the incidence and predictors of iASD in catheter ablation, assessed by transthoracic echocardiography (TTE), a relatively non-invasive technique frequently employed in follow-up. METHODS This retrospective study included 639 patients (489 male; 60.2±10.7years) who underwent initial catheter ablation for AF between May 2005 and June 2018. All patients underwent preprocedural transesophageal echocardiography (pre-TEE), preprocedural TTE (pre-TTE), and TTE one day after the procedure (post-TTE). iASD incidence after 6months (6M), preprocedural characteristics, and procedure methods were evaluated. RESULTS Patent foramen ovale (PFO) was diagnosed in 42 patients (6.6%) using pre-TEE and in 11 patients using pre-TTE (26.2% of the patients with PFO in pre-TEE). Among the 597 patients without PFO, 497 underwent 6M-TTE. iASD was observed in 59.6% of patients using post-TTE and 4.6% using 6M-TTE. In the univariate logistic regression analysis, the total diameter of the sheath through the septum (odds ratio 1.15, p<0.001) or two sheaths through a single puncture (odds ratio 4.17, p=0.001) were independent risk factors on iASD incidence in 6M-TTE. iASD was also more likely to occur via cryoballoon ablation using a larger sheath than radiofrequency catheter ablation. CONCLUSIONS iASD was not a rare complication. A larger sheath diameter or two sheaths through a single puncture were associated with the incidence of iASD.
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Affiliation(s)
- Hiroyuki Kamada
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yasuhisa Iriki
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
| | - Issei Yoshimoto
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuichi Ninomiya
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hitoshi Ichiki
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryuichi Maenosono
- Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan
| | - Masaaki Miyata
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuki Hamamoto
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshihisa Horizoe
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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14
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Deng J, Wang E, Liu G, Qin C, Dong Q, Yang W, Wang Y, Abdul Qadir R, Jia F. Feasibility and safety of cryoballoon ablation for atrial fibrillation and closing patent foramen ovale without implantation:A pilot study. Heart Rhythm 2024:S1547-5271(24)02682-1. [PMID: 38871264 DOI: 10.1016/j.hrthm.2024.06.006] [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: 12/05/2023] [Revised: 05/25/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Patent foramen ovale (PFO) affects 20%-34% of adults and is associated with strokes and other disorders. The conventional treatment of PFO-related strokes is a closure procedure. The metal device is associated with some adverse events. OBJECTIVE Our aim was to investigate the efficacy and safety of PFO closure using cryoablation without implantation in patients with atrial fibrillation (AF) who underwent pulmonary vein isolation (PVI). METHODS We divided the 22 patients with both PFO and AF who underwent PVI via cryoablation into 2 groups: standard PVI + atrial septal (AS) cryoablation group (group 1, n = 11) and standard PVI group (group 2, n = 11). The guidewire accesses the left atrium through the PFO without AS puncture during the procedure. Standard PVI via cryoablation was performed. The cryoballoon was retracted to the right atrium and inflated against the AS post-PVI. Patients in group 1 had cryoablation for 120-150 seconds, whereas patients in group 2 received sham ablation. The co-primary end points were the PFO closure rate and a composite of AF recurrence and stroke/transient ischemic attack (TIA) events. RESULTS There were no differences in procedure-related adverse events between the 2 groups. Neither group had an ischemic stroke report at 1-year follow-up. The PFO closure rate at 6 months in group 1 was significantly higher than that in group 2 (7 [63.6%] vs 1 [9.1%]; P = .002). AF recurrence post ablation was comparable in both groups at 3 months (3 [27.3%] vs 1 [9.1%]; P = .269), 6 months (0 vs 0), and 12 months (2 [18.2%%] vs 1 [9.1%]; P = .534) of follow-up. CONCLUSION Cryoablation is a safe and effective approach to close PFO in patients with AF undergoing PVI in a single procedure.
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Affiliation(s)
- Jiang Deng
- Department of Cardiovascular Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - EnRun Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - ChunChang Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Dong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - YanFei Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rana Abdul Qadir
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fengpeng Jia
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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15
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Xu C, Zhang Y, Peng Y, Zhao R, Xie M, Fang L, Lv Q. Live Biplane Transesophageal Echocardiography Improves Detection of Right-to-Left Shunts Through Patent Foramen Ovale. J Am Soc Echocardiogr 2024; 37:643-645. [PMID: 38325762 DOI: 10.1016/j.echo.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Chunyan Xu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yongxing Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuan Peng
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ruohan Zhao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lingyun Fang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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16
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Narimani S, Ayati A, Tayebi A, Jalai A, Amirsardari Z, Sahebjam M, Zoroufian A. Three-dimensional transesophageal echocardiography measurements of ASD sizing parameters in comparison to balloon sizing method in percutaneous ASD closure. Echocardiography 2024; 41:e15822. [PMID: 38853621 DOI: 10.1111/echo.15822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Balloon sizing (BS) has been used for device size selection in percutaneous atrial septal defect (ASD) closure. Due to its limitations, alternative imaging techniques like three-dimensional transesophageal echocardiography (3D-TEE) are valuable for guiding ASD device size selection during ASD closure procedures. The purpose of this study was to compare ASD sizing using measurements obtained from 3D-TEE to those utilizing the standard balloon sizing method. METHODS We identified 53 patients with single secundum type ASD without PFO who underwent percutaneous closure at the Tehran Heart Center between 2019 and 2022. Balloon sizing was performed in all patients with the stop-flow technique, and the choice of device size was determined based on the sizing derived from BS. 3D-TEE imaging was performed before the intervention, and the ASD shape and quality of ASD rims were assessed. RESULTS Among the 53 patients who underwent single ASD device closure, multiple 3D TEE measurements significantly correlated with balloon sizing results. This included defect area, perimeter, and diameter obtained from 3D-TEE images multi-planar reconstruction. ASD perimeter detected by 3D TEE had the best correlation with BS results. When divided by the shape of ASD, there was no significant difference between our 3D-images data and BS in round or oval-shaped ASDs. CONCLUSION The 3D-TEE study is reliable for assessing ASD configurational characteristics in percutaneous device closure candidates. 3D-TEE has the potential to accurately determine the appropriate device size and reduce complications, costs, and procedural duration. Further research is needed to validate these findings and establish the role of 3D-TEE measurements in guiding the best treatment decisions for ASD closure.
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Affiliation(s)
- Sima Narimani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Advanced Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Tayebi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalai
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Amirsardari
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sahebjam
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Advanced Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Zoroufian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Advanced Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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17
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Lanzone AM, Castelluccio EV, Della Pina P, Boldi E, Lussardi G, Frati G, Gaudio C, Biondi-Zoccai G. Comparative diagnostic accuracy of transcranial Doppler and contrast-enhanced transthoracic echocardiography for the diagnosis of patent foramen ovale and atrial septal defect. Panminerva Med 2024; 66:124-130. [PMID: 38563605 DOI: 10.23736/s0031-0808.24.05123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Recognition of right-to-left shunt is crucial in the work-up of patients with suspected patent foramen ovale (PFO) or atrial septal defect (ASD). While transesophageal echocardiography (TEE) remains the gold standard diagnostic tool for the anatomic assessment of PFO/ASD, transcranial Doppler (TCD) and contrast-enhanced transthoracic echocardiogram (CE-TTE) hold the promise of providing minimally invasive yet accurate clinical details. Their comparative accuracy remains however debated. METHODS We conducted a retrospective observational study leveraging our extensive institutional experience with systematic TCD and CE-TTE in patients with suspected PFO/ASD. Several measures of diagnostic test accuracy were computed, with point estimates and 95% confidence intervals, when applicable. RESULTS A total of 1358 patients were included, with age 48±14 years and 772 (58%) women. Tests were performed for diagnostic purposes in 797 (58.6%) and during follow-up in 740 (54.5%). A PFO was eventually diagnosed in 1038 (77.9%) patients, and an ASD in 60 (4.5%). Agreement between TCD and CE-TTE occurred in 1309 (85.2%) cases, with TCD yielding worse findings than CE-TTE in 91 (5.9%) patients, and vice versa in 137 (8.9%), yielding a Cohen kappa of 78.6% (95% CI: 76.3-81.1%) and a highly significant P value at McNemar test (P<0.001). After dichotomization, and using TCD as benchmark, CE-TTE yielded sensitivity 96.9%, specificity 95.1%, area under the curve 92.1%, and P=0.249. Similar findings were obtained when focusing only on diagnostic tests or follow-up ones (Cohen kappa respectively 74.0% [70.2-77.1%], P<0.001 and 80.3% [76.4-84.3%], P<0.001). Notably, Valsalva was necessary to disclose the presence of shunt during TCD in 487 (31.7%) patients and during CE-TTE in 482 (31.4%) cases. Finally, performance of TCD and CE-TTE in a subset of patients eventually undergoing TTE was quite similar. CONCLUSIONS The diagnostic accuracy of CE-TTE appears favorable, and this imaging test may identify patients who may be missed if only TCD is used to screen patients with suspected PFO/ASD. Accordingly, CE-TTE is recommended as an adjunct diagnostic modality for all patients with a high pre-test probability of PFO/ASD and right-to-left shunt.
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Affiliation(s)
- Alberto M Lanzone
- Division of Cardiology and Coronary Care Unit, San Rocco Clinical Institute, Ome, Brescia, Italy
| | - Emanuele V Castelluccio
- Department of Health Promotion, Mother and Child Care, G. D'Alessandro Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy
| | - Paolo Della Pina
- Division of Cardiology and Coronary Care Unit, San Rocco Clinical Institute, Ome, Brescia, Italy
| | - Emiliano Boldi
- Division of Cardiology and Coronary Care Unit, San Rocco Clinical Institute, Ome, Brescia, Italy
| | | | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Carlo Gaudio
- Department of Clinical, Internal Medicine, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy -
- Mediterranea Cardiocentro, Naples, Italy
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18
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Liu Y, Huang Q, Han X, Liang T, Zhang Z, Lu X, Dong B, Yuan J, Wang Y, Hu M, Wang J, Stefanidis A, Su J, Chen J, Li Q, Zhang Y. Atrial Septal Defect Detection in Children Based on Ultrasound Video Using Multiple Instances Learning. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:965-975. [PMID: 38347394 PMCID: PMC11169128 DOI: 10.1007/s10278-024-00987-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 06/13/2024]
Abstract
Thoracic echocardiography (TTE) can provide sufficient cardiac structure information, evaluate hemodynamics and cardiac function, and is an effective method for atrial septal defect (ASD) examination. This paper aims to study a deep learning method based on cardiac ultrasound video to assist in ASD diagnosis. We chose four standard views in pediatric cardiac ultrasound to identify atrial septal defects; the four standard views were as follows: subcostal sagittal view of the atrium septum (subSAS), apical four-chamber view (A4C), the low parasternal four-chamber view (LPS4C), and parasternal short-axis view of large artery (PSAX). We enlist data from 300 children patients as part of a double-blind experiment for five-fold cross-validation to verify the performance of our model. In addition, data from 30 children patients (15 positives and 15 negatives) are collected for clinician testing and compared to our model test results (these 30 samples do not participate in model training). In our model, we present a block random selection, maximal agreement decision, and frame sampling strategy for training and testing respectively, resNet18 and r3D networks are used to extract the frame features and aggregate them to build a rich video-level representation. We validate our model using our private dataset by five cross-validation. For ASD detection, we achieve 89.33 ± 3.13 AUC, 84.95 ± 3.88 accuracy, 85.70 ± 4.91 sensitivity, 81.51 ± 8.15 specificity, and 81.99 ± 5.30 F1 score. The proposed model is a multiple instances learning-based deep learning model for video atrial septal defect detection which effectively improves ASD detection accuracy when compared to the performances of previous networks and clinical doctors.
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Affiliation(s)
- Yiman Liu
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, 200127, People's Republic of China
- Shanghai Key Laboratory of Multidimensional Information Processing, school of communication and electronic engineering, East China Normal University, Shanghai, 200241, People's Republic of China
| | - Qiming Huang
- School of AI and Advanced Computing, Xi'an Jiao tong-Liverpool University, Taicang, 215028, People's Republic of China
| | - Xiaoxiang Han
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, People's Republic of China
| | - Tongtong Liang
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, 201101, People's Republic of China
| | - Zhifang Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xiuli Lu
- Department of Ultrasound, Jiaxing Xiuzhou District Maternal, Child Health Hospital, Jiaxing, Zhejiang, 314031, People's Republic of China
| | - Bin Dong
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, 200127, People's Republic of China
| | - Jiajun Yuan
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, 200127, People's Republic of China
| | - Yan Wang
- Shanghai Key Laboratory of Multidimensional Information Processing, school of communication and electronic engineering, East China Normal University, Shanghai, 200241, People's Republic of China
| | - Menghan Hu
- Shanghai Key Laboratory of Multidimensional Information Processing, school of communication and electronic engineering, East China Normal University, Shanghai, 200241, People's Republic of China
| | - Jinfeng Wang
- School of AI and Advanced Computing, Xi'an Jiao tong-Liverpool University, Taicang, 215028, People's Republic of China
| | - Angelos Stefanidis
- School of AI and Advanced Computing, Xi'an Jiao tong-Liverpool University, Taicang, 215028, People's Republic of China
| | - Jionglong Su
- School of AI and Advanced Computing, Xi'an Jiao tong-Liverpool University, Taicang, 215028, People's Republic of China.
| | - Jiangang Chen
- Shanghai Key Laboratory of Multidimensional Information Processing, school of communication and electronic engineering, East China Normal University, Shanghai, 200241, People's Republic of China.
| | - Qingli Li
- Shanghai Key Laboratory of Multidimensional Information Processing, school of communication and electronic engineering, East China Normal University, Shanghai, 200241, People's Republic of China.
| | - Yuqi Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, 200127, People's Republic of China.
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19
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Sanai R, Hirata T, Yanagihara T, Okamoto M, Ikeda T, Shundo Y, Hamada N, Ebi N, Inoue H, Miura SI, Fujita M. A Rare Case of Platypnea-Orthodeoxia Syndrome in a Patient With Undiagnosed Atrial Septal Defect. Cureus 2024; 16:e61260. [PMID: 38947622 PMCID: PMC11213487 DOI: 10.7759/cureus.61260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 07/02/2024] Open
Abstract
Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnea and oxygen desaturation that worsens in the upright position and improves when lying down. We report the case of a 67-year-old male who presented with a 14-month history of dyspnea in the sitting/standing position. Despite treatment for suspected asthma, his symptoms persisted, and he was referred to our hospital for further evaluation. Physical examination and arterial blood gas analysis confirmed the presence of POS, with a significant decrease in PaO2 and SpO2 when moving from a supine to an upright position. Contrast-enhanced CT showed no obvious embolism nor arteriovenous fistula, and ventilation-perfusion scintigraphy demonstrated ventilation-perfusion mismatch with a right-to-left shunt fraction of 9.4%, without any focal defect. Transthoracic echocardiography with a microbubble test demonstrated a right-to-left shunt that increased in the upright position. Transesophageal echocardiography revealed an atrial septal defect (ASD) with an atrial septal aneurysm and the presence of an inferior vena cava valve, causing a bidirectional shunt. The patient was diagnosed with POS secondary to ASD and was referred for percutaneous closure of the defect. Following the procedure, the shunt resolved, and the patient's orthostatic oxygen desaturation improved. This case highlights the importance of considering POS in patients with positional dyspnea and the value of performing diagnostic tests, such as echocardiography, in different positions to identify the underlying cause. Early recognition and appropriate management of POS can significantly improve patients' quality of life and prevent complications associated with chronic hypoxemia.
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Affiliation(s)
- Rei Sanai
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, JPN
| | - Tetsuo Hirata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, JPN
| | - Toyoshi Yanagihara
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, JPN
| | - Meimi Okamoto
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, JPN
| | - Takato Ikeda
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, JPN
| | - Yuki Shundo
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, JPN
| | - Naoki Hamada
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, JPN
| | - Noriyuki Ebi
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, JPN
| | - Hiroyuki Inoue
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, JPN
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, JPN
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, JPN
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20
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Wong C, Chung JK, Hu K, Chopra A. A 24-Year-Old Woman With Refractory Hypoxemia. Chest 2024; 165:e113-e117. [PMID: 38599755 DOI: 10.1016/j.chest.2023.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/16/2023] [Accepted: 04/25/2023] [Indexed: 04/12/2024] Open
Affiliation(s)
- Christian Wong
- Division of Pulmonary and Critical Care, Department of Medicine, Albany Medical Center, Albany, NY.
| | - Jae K Chung
- Division of Pulmonary and Critical Care, Department of Medicine, Albany Medical Center, Albany, NY
| | - Kurt Hu
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Amit Chopra
- Division of Pulmonary and Critical Care, Department of Medicine, Albany Medical Center, Albany, NY
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21
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Amin A, Augustine M, Shafique MA, Mustafa MS, Mian ZR, Jaimes DCC, Gaudani A, Shaukat B, Kumar S, Aulakh SS, Jami E, Sharifa M, Ahuja K, Maslamani ANJ, Bhudia S. Left Atrial Septal Pouch (LASP) and cryptogenic stroke risk: An updated systematic review and meta-analysis of observational studies. Curr Probl Cardiol 2024; 49:102400. [PMID: 38232917 DOI: 10.1016/j.cpcardiol.2024.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND The left atrial septal pouch (LASP) is a small anatomical septal recess in the heart that has been linked with cardioembolic events. A systematic appraisal of the existing literature is necessary to establish a better understanding of the risk as studies continue to indicate a correlation between LASPs and cryptogenic strokes. OBJECTIVES To determine the level of association between the presence of LASP and the risk of developing cryptogenic stroke. METHODS We searched PubMed, EMBASE and Scopus for studies comparing the prevalence of LASP in patients with cryptogenic stroke against non-cryptogenic stroke control groups from inception till December, 2023. The Newcastle Ottawa scale was used for quality assessment and Comprehensive Meta-Analysis Version 3.3 was used for data analysis with odds ratio (OR) as the effect measure. RESULTS Our review included a total of 10 retrospective, observational studies published between 2010 to 2022. A total of 683 cases of cryptogenic strokes were identified, out of which 33.1 % (n = 271) were associated with a LASP. Among the non-cryptogenic stroke controls (n = 2641), LASP was present in 20.6 % cases (n = 476). The aggregate OR for cryptogenic stroke was 1.618 times greater than non-cryptogenic stroke (p < 0.001) among LASP cases, CONCLUSION: The presence of a septal pouch in the left atrium is significantly linked to a higher risk of developing cryptogenic strokes. As a potential site of thrombus formation and subsequent dislodgement, further large-scale studies are necessary to establish the guidelines for management and prophylaxis to prevent embolic events.
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Affiliation(s)
- Aamir Amin
- Department of Cardiothoracic Surgery, Harefield Hospital, London, United Kingdom.
| | | | - Muhammad Ashir Shafique
- Department of Medicine, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, Pakistan 75510.
| | - Muhammad Saqlain Mustafa
- Department of Medicine, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, Pakistan 75510.
| | | | | | | | | | - Sanjeev Kumar
- Horbachevsky Ternopil National Medical University, Ukraine.
| | | | - Elhama Jami
- Herat University Faculty of Medicine, Afghanistan.
| | | | | | | | - Sunil Bhudia
- Consultant Cardiac Surgeon, Harefield Hospital, London, United Kingdom.
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22
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Toborowsky C, Markovic LE. Large Secundum Atrial Septal Defect Managed Conservatively in an Adult Dog. CASE (PHILADELPHIA, PA.) 2024; 8:226-230. [PMID: 38524968 PMCID: PMC10955082 DOI: 10.1016/j.case.2023.12.022] [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: 03/26/2024]
Abstract
•ASDs can be medically managed in dogs if interventional options are not selected. •3D modeling can be used for canine congenital heart disease. •3D imaging helps with preprocedural planning for ASD.
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Affiliation(s)
- Carl Toborowsky
- University of Georgia, College of Veterinary Medicine, Athens, Georgia
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23
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Nitta M. Posterior perspective of three-dimensional transesophageal echocardiogram in evaluating the superior rim in a patient with ostium secundum atrial septal defect: a case report. J Echocardiogr 2024; 22:48-50. [PMID: 36792864 DOI: 10.1007/s12574-023-00597-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Manabu Nitta
- Department of Cardiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan.
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, 1-1-1-5F Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan.
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24
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Tang Y, Sun H, Plummer C, Vogrin SJ, Li H, Li Y, Chen L. Association between patent foramen ovale and migraine: evidence from a resting-state fMRI study. Brain Imaging Behav 2024:10.1007/s11682-024-00868-9. [PMID: 38381323 DOI: 10.1007/s11682-024-00868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 02/22/2024]
Abstract
A relationship between migraine without aura (MO) and patent foramen ovale (PFO) has been observed, but the neural basis underlying this relationship remains elusive. Utilizing independent component analysis via functional magnetic resonance imaging, we examined functional connectivity (FC) within and across networks in 146 patients with MO (75 patients with and 71 patients without PFO) and 70 healthy controls (35 patients each with and without PFO) to elucidate the individual effects of MO and PFO, as well as their interaction, on brain functional networks. The main effect of PFO manifested exclusively in the FC among the visual, auditory, default mode, dorsal attention and salience networks. Furthermore, the interaction effect between MO and PFO was discerned in brain clusters of the left frontoparietal network and lingual gyrus network, as well as the internetwork FC between the left frontoparietal network and the default mode network (DMN), the occipital pole and medial visual networks, and the dorsal attention and salience networks. Our findings suggest that the presence of a PFO shunt in patients with MO is accompanied by various FC changes within and across networks. These changes elucidate the intricate mechanisms linked to PFO-associated migraines and provide a basis for identifying novel noninvasive biomarkers.
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Affiliation(s)
- Yusha Tang
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan Province, 610041, China
| | - Huaiqiang Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chris Plummer
- Department of Neuroimaging, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Simon J Vogrin
- Department of Neuroimaging, Swinburne University of Technology, Hawthorn, VIC, Australia
- Department of Neurosciences, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Hua Li
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan Province, 610041, China
| | - Yajiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Chen
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan Province, 610041, China.
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25
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Lopez L, Saurers DL, Barker PCA, Cohen MS, Colan SD, Dwyer J, Forsha D, Friedberg MK, Lai WW, Printz BF, Sachdeva R, Soni-Patel NR, Truong DT, Young LT, Altman CA. Guidelines for Performing a Comprehensive Pediatric Transthoracic Echocardiogram: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr 2024; 37:119-170. [PMID: 38309834 DOI: 10.1016/j.echo.2023.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Echocardiography is a fundamental component of pediatric cardiology, and appropriate indications have been established for its use in the setting of suspected, congenital, or acquired heart disease in children. Since the publication of guidelines for pediatric transthoracic echocardiography in 2006 and 2010, advances in knowledge and technology have expanded the scope of practice beyond the use of traditional modalities such as two-dimensional, M-mode, and Doppler echocardiography to evaluate the cardiac segmental structures and their function. Adjunct modalities such as contrast, three-dimensional, and speckle-tracking echocardiography are now used routinely at many pediatric centers. Guidelines and recommendations for the use of traditional and newer adjunct modalities in children are described in detail in this document. In addition, suggested protocols related to standard operations, infection control, sedation, and quality assurance and improvement are included to provide an organizational structure for centers performing pediatric transthoracic echocardiograms.
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Affiliation(s)
- Leo Lopez
- Department of Pediatrics Cardiology, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, California.
| | - Daniel L Saurers
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Piers C A Barker
- Duke Children's Hospital & Health Center, Duke University, Durham, North Carolina
| | - Meryl S Cohen
- Cardiac Center and Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Jeanine Dwyer
- Pediatric Heart Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Daniel Forsha
- Ward Family Heart Center, Children's Mercy Kansas City Hospital, Kansas City, Missouri
| | - Mark K Friedberg
- Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Wyman W Lai
- Division of Pediatric Cardiology, University of California School of Medicine, Irvine, California; Department of Pediatrics, Children's Hospital of Orange County, Orange, California
| | - Beth F Printz
- Rady Children's Hospital San Diego and University of California, San Diego, San Diego, California
| | - Ritu Sachdeva
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Neha R Soni-Patel
- Pediatric & Adult Congenital Heart Center, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Dongngan T Truong
- University of Utah and Division of Pediatric Cardiology, Primary Children's Hospital, Salt Lake City, Utah
| | - Luciana T Young
- Seattle Children's Hospital and Pediatric Cardiology, University of Washington School of Medicine, Seattle, Washington
| | - Carolyn A Altman
- Baylor College of Medicine and Texas Children's Heart Center, Texas Children's Hospital, Houston, Texas
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26
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Cinteza E, Vasile CM, Busnatu S, Armat I, Spinu AD, Vatasescu R, Duica G, Nicolescu A. Can Artificial Intelligence Revolutionize the Diagnosis and Management of the Atrial Septal Defect in Children? Diagnostics (Basel) 2024; 14:132. [PMID: 38248009 PMCID: PMC10814919 DOI: 10.3390/diagnostics14020132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Atrial septal defects (ASDs) present a significant healthcare challenge, demanding accurate and timely diagnosis and precise management to ensure optimal patient outcomes. Artificial intelligence (AI) applications in healthcare are rapidly evolving, offering promise for enhanced medical decision-making and patient care. In the context of cardiology, the integration of AI promises to provide more efficient and accurate diagnosis and personalized treatment strategies for ASD patients. In interventional cardiology, sometimes the lack of precise measurement of the cardiac rims evaluated by transthoracic echocardiography combined with the floppy aspect of the rims can mislead and result in complications. AI software can be created to generate responses for difficult tasks, like which device is the most suitable for different shapes and dimensions to prevent embolization or erosion. This paper reviews the current state of AI in healthcare and its applications in cardiology, emphasizing the specific opportunities and challenges in applying AI to ASD diagnosis and management. By exploring the capabilities and limitations of AI in ASD diagnosis and management. This paper highlights the evolution of medical practice towards a more AI-augmented future, demonstrating the capacity of AI to unlock new possibilities for healthcare professionals and patients alike.
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Affiliation(s)
- Eliza Cinteza
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.)
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, F-33600 Bordeaux, France;
| | - Stefan Busnatu
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Cardiology Department, “Prof. Dr. Bagdasar Arseni” Clinical Hospital, 041915 Bucharest, Romania
| | - Ionel Armat
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Arsenie Dan Spinu
- “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania;
- Department 3, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Vatasescu
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Emergency Clinical Hospital, 014461 Bucharest, Romania
| | - Gabriela Duica
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.)
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Alin Nicolescu
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
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27
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Abdul Jabbar A, Jaradat M, Hasan M, Yoo JW, Jenkins JS, Crittendon I, Lucas VS, Ramee S, Collins T. Systematic review of multiple versus single device closure of Secundum atrial septal defects in adults. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:90-97. [PMID: 37596193 DOI: 10.1016/j.carrev.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Multiple device closure (MDC) strategy has been used in treating of complex Atrial septal defects (ASDs) in adults. The safety profile of MDC compared to conventional single device closure (SDC) is unknown in this population. This report represents the first review examining the outcomes of single versus multiple device ASD closure in adults with ostium secundum defects. METHODS Literature databases and manual search from their inception until June 30th, 2017 followed the Preferred Reporting Items of Systemic Review and Meta-Analysis (PRISMA) guideline. Main outcomes are 1) overall complication incidence, 2) arrhythmia incidence, 3) residual shunt rate. Each outcome profile was pooled by MDC and SDC, respectively and chi-square analysis was applied to examine statistical significance between MDC and SDC strategies (two-sided and p < .050). RESULTS A total of 1806 + studies were initially screened, and 20 studies were finally selected (MDC group, 147 patients; SDC group, 1706 patients). There was no difference in overall complication incidence (χ2 = 1.269; p = .259) and arrhythmia incidence (χ2 = 0.325; p = .568) between MDC and SDC. There was no difference in residual shunt rate between the SDC (4.10 %; 70/1706) and MDC groups (6.80 %; 10/147; χ2 = 2.387; p = .122). CONCLUSIONS The outcomes of percutaneous multiple ASD closure (MDC) seem to be safe and effective as compared to conventional single ASD (SDC) closure in terms of device - related complications and technical success of the procedure. Prospective registry data and randomized trials are needed to determine the long-term outcomes of percutaneous ASD closure using MDC.
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Affiliation(s)
- Ali Abdul Jabbar
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America; The Tampa Bay Heart Institue at HCA Florida Northside Hospital, University of South Florida Morsani College of Medicine, HCA West FL Division GME Program, St. Petersburg, FL, United States of America
| | - Mohammad Jaradat
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, United States of America
| | - Mohanad Hasan
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, United States of America
| | - J Stephen Jenkins
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Ivory Crittendon
- Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Victor S Lucas
- Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Stephen Ramee
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Tyrone Collins
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America; Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America.
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De Cillis E, Acquaviva T, Ursi R, Soldato N, Basile P, Siena P, Carella MC, Baggiano A, Mushtaq S, Fusini L, Rabbat MG, Pontone G, Bottio T, Bortone AS, Ciccone MM, Milano AD, Guaricci AI. A comparison of intracardiac echocardiography and transesophageal echocardiography for guiding device closure of ostium secundum atrial septal defect: A 15-year experience. Echocardiography 2024; 41:e15724. [PMID: 38064288 DOI: 10.1111/echo.15724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/03/2023] [Accepted: 11/19/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND AND AIM Our aim was to evaluate the fluoroscopy time (FT), procedure time (PT) safety and efficacy when using intracardiac echocardiography (ICE) in comparison to transesophageal echocardiography (TEE) guidance for transcatheter closure of Ostium Secundum Atrial Septal Defect (OS-ASD). METHOD Ninety patients (n = 90) diagnosed with OS-ASD underwent transcatheter closure between March 2006 and October 2021. Fifty-seven patients were treated under ICE guidance, while 33 patients were treated under TEE guidance. RESULTS Mean age was 43 ± 15 years and 42 ± 10 years in the ICE and TEE groups, respectively. The majority of patients had a centrally placed defect. Median FT was 8.40 min versus 11.70 min (p < .001) in the ICE group compared to the TEE group, respectively. Median PT was 43 min versus 94 min (p < .001) in the ICE group compared to the TEE group, respectively. Both ICE and TEE provided high quality images. All interventions were completed successfully, except for one patient in the ICE group who experienced a device migration, the development of atrial tachycardia in one patient and atrial fibrillation in two patients in the ICE group which spontaneously cardioverted. There were no other complications. CONCLUSION This study on a consistent cohort of patients with OS-ASD undergoing percutaneous closure suggests that use of ICE is safe and efficacious. Compared to TEE, ICE demonstrated significantly shorter FT and PT, decreasing the entire duration of the procedure and x-ray exposure. No relevant differences were observed in terms of success rate and complications.
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Affiliation(s)
- Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Tommaso Acquaviva
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Raffaella Ursi
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Nicolò Soldato
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Basile
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Paola Siena
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Maria Cristina Carella
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, Illinois, USA
- Division of Cardiology, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Tomaso Bottio
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Marco Matteo Ciccone
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Aldo Domenico Milano
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
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29
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Panjwani B, Singh A, Shah A. CT and MR Imaging for Atrial Septal Defect Repair. Semin Roentgenol 2024; 59:103-111. [PMID: 38388089 DOI: 10.1053/j.ro.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024]
Affiliation(s)
| | | | - Amar Shah
- North Shore University Hospital, Manhasset, NY
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30
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Randhawa S, Mehta JL, Dhar G. Percutaneous Patent Foramen Ovale Closure: Stroke and Beyond. Curr Cardiol Rev 2024; 20:77-86. [PMID: 38485682 DOI: 10.2174/011573403x276984240304044109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/13/2024] [Accepted: 01/20/2024] [Indexed: 07/20/2024] Open
Abstract
Over 750,000 individuals suffer from stroke annually in the United States, with 87% of these strokes being ischemic in nature. Roughly 40% of ischemic strokes occur in individuals 60 years of age or under. A quarter of all ischemic strokes have no identifiable cause despite extensive workup and are deemed cryptogenic in nature. Patent Foramen Ovales (PFO) has been postulated in stroke causation by either paradoxical embolization or platelet activation in the tunnel of the defect. The incidence of PFO is reported to be 15-25% in the general population but rises to 40% in patients with cryptogenic stroke. While the initial trials evaluating PFO closures were non-revealing, subsequent long-term follow-ups, as well as recent trials evaluating PFO closures in cryptogenic stroke patients 60 years of age or under, demonstrated the superiority of percutaneous closure compared to medical therapy alone, leading to FDA approval of PFO closure devices. In this review, we review the diagnosis of PFO, postulated stroke mechanisms, literature supporting PFO closure, patient selection for percutaneous closure, procedural considerations, and associated procedural complications.
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Affiliation(s)
- Sandeep Randhawa
- Division of Cardiology, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jawahar L Mehta
- Division of Cardiology, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Gaurav Dhar
- Division of Cardiology, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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31
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English CW, Rogers JH, Smith TW. Intracardiac Echocardiographic Guidance for Structural Heart Procedures: Current Utility as Compared to Transesophageal Echocardiography. Interv Cardiol Clin 2024; 13:39-49. [PMID: 37980066 DOI: 10.1016/j.iccl.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Over the past decade, engineering advances in intracardiac echocardiography (ICE) have improved the ability of an imager or interventionalist to guide not only interatrial septal procedures but now commonly left atrial appendage, tricuspid, and mitral procedures. When transesophageal echocardiography (TEE) is not possible because of anatomic limitations, ICE has proved a useful tool to safely complete structural interventions. ICE will play a growing, key role in structural interventions where anatomic factors strongly favor an intracardiac perspective or augment TEE when imaging is suboptimal.
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Affiliation(s)
- Carter W English
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California - Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California - Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA
| | - Thomas W Smith
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California - Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA.
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32
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Ghanem R, Tabrizi NS, Shapeton AD, Musuku SR. Iatrogenic Left Atrial Puncture Treated with a Septal Occluder Device. J Cardiothorac Vasc Anesth 2024; 38:239-242. [PMID: 37926652 DOI: 10.1053/j.jvca.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/21/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Rami Ghanem
- Department of Anesthesiology, Albany Medical College, Albany, NY.
| | | | - Alexander D Shapeton
- Department of Anesthesia, Critical Care and Pain Medicine, Veterans Affairs Boston Healthcare System, Boston, MA; Tufts University School of Medicine, Boston, MA
| | - Sridhar R Musuku
- Department of Anesthesiology, Albany Medical College, Albany, NY
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Thong EHE, Kong WKF, Poh KK, Wong R, Chai P, Sia CH. Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review. J Cardiovasc Dev Dis 2023; 11:13. [PMID: 38248883 PMCID: PMC10816708 DOI: 10.3390/jcdd11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Cardioembolic strokes account for 20-25% of all ischaemic strokes, with their incidence increasing with age. Cardiac imaging plays a crucial role in identifying cardioembolic causes of stroke, with early and accurate identification affecting treatment, preventing recurrence, and reducing stroke incidence. Echocardiography serves as the mainstay of cardiac evaluation. Transthoracic echocardiography (TTE) is the first line in the basic evaluation of structural heart disorders, valvular disease, vegetations, and intraventricular thrombus. It can be used to measure chamber size and systolic/diastolic function. Trans-oesophageal echocardiography (TOE) yields better results in identifying potential cardioembolic sources of stroke and should be strongly considered, especially if TTE does not yield adequate results. Cardiac computed tomography and cardiac magnetic resonance imaging provide better soft tissue characterisation, high-grade anatomical information, spatial and temporal visualisation, and image reconstruction in multiple planes, especially with contrast. These techniques are useful in cases of inconclusive echocardiograms and can be used to detect and characterise valvular lesions, thrombi, fibrosis, cardiomyopathies, and aortic plaques. Nuclear imaging is not routinely used, but it can be used to assess left-ventricular perfusion, function, and dimensions and may be useful in cases of infective endocarditis. Its use should be considered on a case-by-case basis. The accuracy of each imaging modality depends on the likely source of cardioembolism, and the choice of imaging approach should be tailored to individual patients.
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Affiliation(s)
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Raymond Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
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Scagliola R, Caponi D, Scaglione M. Atrial septal pouches and ridges: Morphological features and potential implications in clinical practice. Trends Cardiovasc Med 2023:S1050-1738(23)00115-9. [PMID: 38158028 DOI: 10.1016/j.tcm.2023.12.007] [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: 10/16/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Incomplete or irregular fusion of the interatrial septum may result in several anatomic variants, including atrial septal pouches and ridges, whose knowledge and recognition are still poorly widespread in clinical practice. An educational review focused on the definition, clinical significance and diagnostic work-up of these anatomic findings was performed using PubMed, MEDLINE, Embase and Cochrane Central databases up to June 2023. Atrial septal pouches and ridges have been associated with an increased difficulty of catheter-based interventions requiring a transseptal approach, due to procedural challenges for transseptal puncture and the restricted motion of guidewires and catheters through the transseptal access. Additionally, left atrial septal pouch may serve as a thrombogenic nidus and a source of systemic embolism, mostly in the presence of factors leading to higher left atrial pressure and/or atrial blood stasis, which increase the risk of thrombus formation and embolic events, rather than for the only presence of left atrial septal pouch itself. Further investigations are needed in order to better elucidate the implications of such anatomic findings in daily clinical practice, and to provide the most appropriate decision-making strategies.
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Affiliation(s)
- Riccardo Scagliola
- Division of Cardiology, Cardinal G. Massaia Hospital, C.so Dante Alighieri n. 202 - 14100, Asti, Italy.
| | - Domenico Caponi
- Division of Cardiology, Cardinal G. Massaia Hospital, C.so Dante Alighieri n. 202 - 14100, Asti, Italy
| | - Marco Scaglione
- Division of Cardiology, Cardinal G. Massaia Hospital, C.so Dante Alighieri n. 202 - 14100, Asti, Italy
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Jin P, Jiao P, Feng J, Shi L, Ma L. The predictive value of abnormal electrocardiogram for patent foramen ovale: A retrospective study. Clin Cardiol 2023; 46:1504-1510. [PMID: 37667505 PMCID: PMC10716327 DOI: 10.1002/clc.24133] [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: 06/20/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS The objective of this study was to identify the characteristics of electrocardiogram (ECG) in adult patients with patent foramen ovale (PFO) and to analyze the predictive value of the characteristics of ECG for PFO in adult patients. METHODS Retrospectively, 267 patients who had undergone ECG, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) with agitated saline contrast echocardiography in our hospital, were recruited continuously from January 2021 to March 2023. Electrocardiographs were analyzed to investigate the presence of right bundle branch block (RBBB) and crochetage R wave. RESULTS The ratio of crochetage R wave in inferior leads in patients with PFO was 45.3% and 21.2% without PFO. There were 17 (6.4%) patients with coexistence of crochetage R wave and RBBB, including 13 (6.5%) patients with PFO and four (6.1%) patients without PFO. The accuracies of TTE, crochetage R wave, and RBBB were 0.637, 0.535, and 0.314, respectively. A combination of crochetage R wave and RBBB demonstrated a sensitivity of 0.507 and a specificity of 0.758. When TTE, crochetage R wave, and RBBB were combined, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 0.712, 0.801, 0.439, 0.813, and 0.420, respectively. Logistic regression analysis revealed a correlation between PFO and the presence of crochetage R wave (odds ratio [OR]: 3.073, 95% confidence interval [CI]: 1.601-5.899, p < 0.001), and also a combination between crochetage R wave and RBBB (OR: 3.220, 95% CI: 1.720-6.028, p < 0.001). CONCLUSIONS Crochetage R wave in ECG was associated with PFO. Crochetage R wave, especially combined with RBBB and TTE, may be helpful in the early detection of patients with PFO.
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Affiliation(s)
- Peng Jin
- Department of Cardiovascular Medicinethe 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyLanzhouChina
| | - Piqi Jiao
- Department of Cardiovascular Medicinethe 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyLanzhouChina
| | - Juan Feng
- Department of Cardiovascular Medicinethe 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyLanzhouChina
| | - Liang Shi
- Department of Cardiovascular Medicinethe 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyLanzhouChina
| | - Ling Ma
- Department of Cardiovascular Medicinethe 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyLanzhouChina
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Chaturvedi A, Moroni F, Axline M, Tomdio A, Mojadidi MK, Gertz Z. Comparative evaluation of intracardiac, transesophageal, and transthoracic echocardiography in the assessment of patent foramen ovale: A retrospective single-center study. Catheter Cardiovasc Interv 2023; 102:1348-1356. [PMID: 37681474 DOI: 10.1002/ccd.30825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Certain patent foramen ovale (PFO) characteristics, such as a large right-to-left shunt (RLS) or atrial septal aneurysm, identify patients who may receive the highest clinical benefit from percutaneous PFO closure. This study aimed to compare intracardiac echocardiography (ICE) with standard echocardiographic imaging in the evaluation of high-risk PFO characteristics and RLS severity in patients with PFO-associated stroke. METHODS We conducted a retrospective review of all patients aged ≥18 years who underwent percutaneous PFO closure for PFO-associated stroke and received all three ultrasound-based cardiac imaging modalities and had interpretable results (N = 51). We then compared RLS severity, high-risk PFO characteristics, and the proportion of patients with a higher likelihood of PFO-associated stroke by ICE versus transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE). RESULTS The final cohort had a mean (±SE) age of 48.4 (±1.8) years and was predominantly female (58.8%). ICE was more likely to identify a large RLS versus TTE/TEE combined (66.7% vs. 45.1%; p = 0.03). The use of ICE resulted in significantly more patients being reclassified as having a higher likelihood of PFO-associated stroke (TTE vs. TEE vs. ICE: 10.4% vs. 14.6% vs. 25%; p = 0.03). A high-quality bubble study was found to be the single most important factor associated with identifying a larger RLS across all modalities (ρ [p]; TTE: 0.49 [<0.001], TEE: 0.60 [<0.001], ICE: 0.32 [0.02]). The presence of a hypermobile septum was associated with significantly greater RLS on ICE (ρ [p]: 0.3 [0.03]), especially with poor quality bubble studies (ρ [p]: 0.49 [0.02]). CONCLUSION In this observational study of patients with PFO-associated stroke, ICE detected a large RLS more frequently than TTE and TEE; and reclassified some patients as having a higher likelihood of PFO-associated stroke.
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Affiliation(s)
- Abhishek Chaturvedi
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Francesco Moroni
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael Axline
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anna Tomdio
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mohammad K Mojadidi
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary Gertz
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Kirkpatrick JN, Swaminathan M, Adedipe A, Garcia-Sayan E, Hung J, Kelly N, Kort S, Nagueh S, Poh KK, Sarwal A, Strachan GM, Topilsky Y, West C, Wiener DH. American Society of Echocardiography COVID-19 Statement Update: Lessons Learned and Preparation for Future Pandemics. J Am Soc Echocardiogr 2023; 36:1127-1139. [PMID: 37925190 DOI: 10.1016/j.echo.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The COVID-19 pandemic has evolved since the publication of the initial American Society of Echocardiography (ASE) statements providing guidance to echocardiography laboratories. In light of new developments, the ASE convened a diverse, expert writing group to address the current state of the COVID-19 pandemic and to apply lessons learned to echocardiography laboratory operations in future pandemics. This statement addresses important areas specifically impacted by the current and future pandemics: (1) indications for echocardiography, (2) application of echocardiographic services in a pandemic, (3) infection/transmission mitigation strategies, (4) role of cardiac point-of-care ultrasound/critical care echocardiography, and (5) training in echocardiography.
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Affiliation(s)
| | | | | | | | - Judy Hung
- Massachusetts General Hospital, Boston, Massachusetts
| | - Noreen Kelly
- Sanger Heart Institute, Charlotte, North Carolina
| | - Smadar Kort
- Stony Brook University Medical Center, Stony Brook, New York
| | | | - Kian Keong Poh
- Department of Cardiology, National University of Singapore, Singapore
| | - Aarti Sarwal
- Wake Forest Baptist Health Center, Winston-Salem, North Carolina
| | - G Monet Strachan
- Division of Cardiology, University of California, San Francisco, California
| | - Yan Topilsky
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Cathy West
- Royal Brompton Hospital, London, United Kingdom
| | - David H Wiener
- Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Reibel I, Hauguel-Moreau M, Guedeney P, Hage G, Hammoudi N, Duthoit G, Zeitouni M, Lattuca B, Kernéis M, Collet JP, Silvain J, Montalescot G. Comparison of three echo-guidance techniques in percutaneous patent foramen ovale closure for stroke prevention: Conventional transoesophageal, microprobe transoesophageal and intracardiac echocardiography. Arch Cardiovasc Dis 2023; 116:523-528. [PMID: 37838576 DOI: 10.1016/j.acvd.2023.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Recent randomized trials have demonstrated a consistent reduction in recurrent stroke after percutaneous transcatheter patent foramen ovale closure versus medical therapy in patients with recent cryptogenic stroke. AIM To compare the safety and efficacy of intracardiac echocardiography-guided and microprobe transoesophageal echocardiography-guided patent foramen ovale closure under local anaesthesia with transoesophageal echocardiography-guided patent foramen ovale closure under general anaesthesia. METHODS This prospective observational single-centre study included 194 consecutive patients scheduled for patent foramen ovale closure for secondary prevention of stroke from February 2018 to December 2019. Patients were asked to choose between an intracardiac echocardiography-guided, microprobe transoesophageal echocardiography-guided or transoesophageal echocardiography-guided procedure. The primary endpoint was the rate of successful closure at 6 months, defined as correct positioning of the device without severe shunt on 6-month contrast echocardiography. RESULTS Successful closure was high and did not differ between groups: 97.8% (95% confidence interval 88.5-99.9%) in the intracardiac echocardiography-guided group versus 96.9% (95% confidence interval 83.8-99.9%) in the microprobe transoesophageal echocardiography-guided group and 99.1% (95% confidence interval 95.3-99.9%) in the transoesophageal echocardiography-guided group (P=0.63). Adverse events related to patent foramen ovale closure were low and did not differ between groups. CONCLUSION Our preliminary real-world experience suggests good efficacy and safety with intracardiac echocardiography and microprobe transoesophageal echocardiography guidance compared with conventional transoesophageal echocardiography guidance for percutaneous transcatheter patent foramen ovale closure in recurrent stroke prevention.
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Affiliation(s)
- Iphigénie Reibel
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Marie Hauguel-Moreau
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Paul Guedeney
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Georges Hage
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Nadjib Hammoudi
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Guillaume Duthoit
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Michel Zeitouni
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Benoit Lattuca
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Mathieu Kernéis
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Jean-Philippe Collet
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Johanne Silvain
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Gilles Montalescot
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Naseem JA, Riyaz MSU, Joseph SP, Krupa J, Agarwal M, Mathen PG, George OK, George PV, Jose J, Thomson VS. Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center retrospective study. Ann Pediatr Cardiol 2023; 16:393-398. [PMID: 38817268 PMCID: PMC11135894 DOI: 10.4103/apc.apc_163_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 06/01/2024] Open
Abstract
Background In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend ASD device closure in children with defect sizes >20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure. Methods We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing <20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up. Results We identified 40 patients meeting inclusion criteria with a median (interquartile range [IQR]) procedural age of 5 (4-7) years and median (IQR) weight of 14 (12-18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%- I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt. Conclusion In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.
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Affiliation(s)
| | | | | | - Jesu Krupa
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mayank Agarwal
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Oommen K. George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Paul V. George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - John Jose
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Viji Samuel Thomson
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
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40
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Das AS, Gökçal E, Fouks AA, Horn MJ, Regenhardt RW, Viswanathan A, Singhal AB, Schwamm LH, Greenberg SM, Gurol ME. Left ventricular hypertrophy and left atrial size are associated with ischemic strokes among non-vitamin K antagonist oral anticoagulant users. J Neurol 2023; 270:5578-5588. [PMID: 37548681 PMCID: PMC11111216 DOI: 10.1007/s00415-023-11916-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Ischemic strokes (IS) occurring in patients taking non-vitamin K antagonist oral anticoagulants (NOACs) are becoming increasingly more frequent. We aimed to determine the clinical, echocardiographic, and neuroimaging markers associated with developing IS in patients taking NOACs for atrial fibrillation. METHODS From a quaternary care center, clinical/radiologic data were collected from consecutive NOAC users with IS and age-matched controls without IS. Brain MRIs were reviewed for markers of cerebral small vessel disease. Variables with significant differences between groups were entered into a multivariable regression model to determine predictors of IS. Among IS patients, a Cox regression analysis was constructed to determine predictors of IS recurrence during follow-up. RESULTS 112 patients with IS and 94 controls were included in the study. Variables significantly different between groups included apixaban use, dabigatran use, prior cerebrovascular events, hemoglobin A1c (HbA1c), left ventricular hypertrophy, left atrial volume index, and severe white matter hyperintensities. After multivariable adjustment, prior cerebrovascular events (aOR 23.86, 95% CI [6.02-94.48]), HbA1c levels (aOR 2.36, 95% CI [1.39-3.99]), left ventricular hypertrophy (aOR 2.73, 95% CI [1.11-6.71]) and left atrial volume index (aOR 1.05, 95% CI [1.01-1.08]) increased the risk of stroke, whereas apixaban use appeared to decrease the risk (aOR 0.38, 95% CI [0.16-0.92]). Malignancy was associated with IS recurrence (aHR 4.90, 95% CI [1.35-18.42]) after adjustment for age and chronic renal failure. CONCLUSIONS Prior cerebrovascular events, diabetes, left ventricular hypertrophy, and increased left atrial size are risk factors for developing an IS among NOAC users.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Neurocritical Care, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Lowry Medical Office Building, Suite 9A-05, Boston, MA, 02215, USA.
| | - Elif Gökçal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Avia Abramovitz Fouks
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Yale New Haven Health System, Yale School of Medicine, New Haven, CT, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Muroke V, Tuohinen S, Jalanko M, Sinisalo J. Anatomical variability of transverse sinus and its implication on atrial septal defect closure device erosion. Eur Heart J Cardiovasc Imaging 2023; 24:1563-1565. [PMID: 37379417 DOI: 10.1093/ehjci/jead148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- V Muroke
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - S Tuohinen
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - M Jalanko
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - J Sinisalo
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, Haartmaninkatu 4, 00029, Helsinki, Finland
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Jiang Y, Luo F, Bu H. Percutaneous closure of simple congenital heart diseases under echocardiographic guidance. Eur J Med Res 2023; 28:408. [PMID: 37805534 PMCID: PMC10559656 DOI: 10.1186/s40001-023-01398-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
Congenital heart disease (CHD), birth defect with the highest incidence rates worldwide, and is mainly characterized by the abnormal internal structure of the heart or/and the anatomical structure of great vessels. In the past few decades, CHD repair surgery through standard median sternotomy incision combined with cardiopulmonary bypass (CPB) technology has been considered the gold standard for surgical correction of heart and great vessels. With the promotion and clinical application of interventional catheterization technology, transcatheter closure of CHD under radioactive radiation has gradually been recognized and applied. However, its radiation exposure and potential complications related to arteriovenous vessels still face challenges. In recent years, an increasing number of surgeons have explored new surgical procedures, for the safe and effective treatment of CHD, as far as possible to reduce surgical trauma, avoid radiation exposure, and improve the cosmetic effect. Therefore, on the premise of satisfactory exposure or guidance, how to integrate ultrasound and percutaneous interventional technology remained the focus of the exploration. This mini-review highlights and summarizes the signs of progress of ultrasound intervention in the last decade that have proven the effectiveness and operability of a well-established procedure for percutaneous closure of congenital heart diseases under echocardiographic guidance only. We discuss potential diseases that will benefit from this emerging procedure based on this progress. Owing to the crucial advantages played by this strategy in the treatment of CHD, better understanding and promotion of this less exploited field may contribute to the development of therapeutics targeting CHD, improve medical utilization rate, promote the optimization of medical resources, and ultimately achieve precise and efficient medical treatment.
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Affiliation(s)
- Ying Jiang
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Fanyan Luo
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Haisong Bu
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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Mattoso AAA, Sena JP, Hotta VT. The Role of Echocardiography in the Assessment of the Interatrial Septum and Patent Foramen Ovale as an Emboligenic Source. Arq Bras Cardiol 2023; 120:e20220903. [PMID: 37909574 PMCID: PMC10586815 DOI: 10.36660/abc.20220903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 11/03/2023] Open
Abstract
A comunicação do septo atrial (CIA) representa, aproximadamente, de 6%-10% dos defeitos cardíacos congênitos, com incidência de 1 em 1.500 nascidos vivos.1 Forame oval patente (FOP) é mais comum e está presente em mais de 20%-25% dos adultos.2 Síndromes clínicas associadas a CIA e FOP são variáveis, com implicações abrangendo a medicina pediátrica e adulta, neurologia e cirurgia. O interesse adicional na anatomia do septo interatrial (SIA) aumentou substancialmente nas últimas duas décadas, com evolução simultânea dos procedimentos percutâneos envolvendo cardiopatia estrutural do lado esquerdo e procedimentos eletrofisiológicos. Idealmente, essas intervenções baseadas em cateter requerem rota direta para o átrio esquerdo (AE) através do SIA, necessitando completo entendimento de sua anatomia. Atualmente, tecnologias de imagem sofisticadas e não invasivas como ecocardiografia transesofágica bidimensional (ETE 2D) e tridimensional (ETE 3D), ressonância cardíaca (RMC) e tomografia computadorizada (TC) passaram por um extraordinário desenvolvimento tecnológico, fornecendo detalhes anatômicos das estruturas cardíacas visualizadas em formato 2D e 3D e são essenciais para diagnóstico e tratamento de pacientes com doenças cardíacas. A avaliação da anatomia e anormalidades do SIA, portanto, requer abordagem padronizada e sistemática, integrando modalidades diagnósticas e fornecendo avaliação adequada e uniforme para terapias cirúrgicas e transcateter.
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Affiliation(s)
| | - Joberto Pinheiro Sena
- Hospital Santa IzabelSalvadorBABrasilHospital Santa Izabel – Hemodinâmica, Salvador, BA – Brasil
| | - Viviane Tiemi Hotta
- Instituto do CoraçãoHCFMUSPSão PauloSPBrasilInstituto do Coração HC-FMUSP – Unidade Clinica de Miocardiopatias e Doenças da Aorta, São Paulo, SP – Brasil
- Fleury Medicina e SaúdeSão PauloSPBrasilFleury Medicina e Saúde, São Paulo, SP – Brasil
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Dannesbo S, Blixenkrone-Moeller E, Pihl CA, Sillesen AS, Voegg RO, Davidsen AS, Lind LE, Jeppesen DL, Kruse C, Noerager B, Dodd JK, Jorgensen FS, Raja AA, Colan SD, Mertens L, Hjortdal VE, Vejlstrup N, Anderson RH, Bundgaard H, Iversen K. A novel algorithm for classification of interatrial communications within the oval fossa in the newborn. Cardiol Young 2023; 33:1942-1949. [PMID: 36408693 DOI: 10.1017/s1047951122003365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND An interatrial communication is present in most neonates. The majority are considered the "normal" patency of the oval foramen, while a minority are abnormal atrial septal defects. Differentiation between the two with transthoracic echocardiography may be challenging, and no generally accepted method of classification is presently available. We aimed to develop and determine the reliability of a new classification of interatrial communications in newborns. METHODS AND RESULTS An algorithm was developed based on echocardiographic criteria from 495 newborns (median age 11[8;13] days, 51.5% females). The algorithm defines three main categories: patency of the oval foramen, atrial septal defect, and no interatrial communication as well as several subtypes. We found an interatrial communication in 414 (83.6%) newborns. Of these, 386 (93.2%) were categorised as patency of the oval foramen and 28 (6.8%) as atrial septal defects.Echocardiograms from another 50 newborns (median age 11[8;13] days, 36.0% female), reviewed by eight experts in paediatric echocardiography, were used to assess the inter- and intraobserver variation of classification of interatrial communications into patency of the oval foramen and atrial septal defect, with and without the use of the algorithm. Review with the algorithm gave a substantial interobserver agreement (kappa = 0.66), and an almost perfect intraobserver agreement (kappa = 0.82). Without the use of the algorithm, the interobserver agreement between experienced paediatric cardiologists was low (kappa = 0.20). CONCLUSION A new algorithm for echocardiographic classification of interatrial communications in newborns produced almost perfect intraobserver and substantial interobserver agreement. The algorithm may prove useful in both research and clinical practice.
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Affiliation(s)
- Sofie Dannesbo
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Blixenkrone-Moeller
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian A Pihl
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ruth O Voegg
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Agnes S Davidsen
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Louise E Lind
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorthe L Jeppesen
- Department of Pediatrics, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Charlotte Kruse
- Department of Pediatrics, The Juliane Marie Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Betina Noerager
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - James K Dodd
- Department of Pediatrics, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Finn S Jorgensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anna A Raja
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Luc Mertens
- Department of Cardiology, The Hospital for Sick Children, Toronto, Canada
| | - Vibeke E Hjortdal
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiothoracic Surgery, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robert H Anderson
- Faculty of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Henning Bundgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Tang Y, Ji S, Li H, Dong B, Li Y, Zhu C, Chen L. Association of patent foramen ovale with epilepsy: A hospital-based case-control study. Epilepsia Open 2023; 8:1075-1083. [PMID: 37422851 PMCID: PMC10472407 DOI: 10.1002/epi4.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/01/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the proportion of patent foramen ovale (PFO) in people with epilepsy (PWE) compared to controls without epilepsy and to assess whether PWEs with and without PFO exhibit distinctive clinical features. METHODS This is a case-control study conducted in a hospital. Contrast transthoracic echocardiography with a venous microbubble bolus and provocative maneuvers (Valsalva and coughing) were used to identify PFO and its right-to-left shunt (RLS) among 741 PWEs and 800 controls without epilepsy. The risk of having PFO in PWEs was explored using multiple matching methods and logistic regression with adjusted congenital factors that may affect the occurrence of PFO. RESULTS The proportion of PFO in PWEs and controls was 39.00% and 24.25%, respectively. After 1:1 propensity score matching, the risk of suffering PFO in PWEs was 1.71 times (OR, 1.71; 95% CI, 1.24-2.36) higher than that in controls. PWEs also had a higher risk of having a high RLS grade (βepilepsy = 0.390, P < 0.001). Among clinical characteristics of PWEs, migraine, and drug-resistant epilepsy showed significantly different distributions between those without RLS and those with RLS grade I to III. PWEs with PFO had higher risk of suffering from migraine and drug-resistant epilepsy (OR in migraine, 2.54, 95% CI, 1.65-3.95; OR in drug-resistant epilepsy, 1.47, 95% CI, 1.06-2.03). SIGNIFICANCE The proportion of PFO was found to be higher in PWE than in controls without epilepsy, especially in patients with drug-resistant epilepsy, suggesting potential relationship between the two disorders. Large multicentric study will be needed to confirm this finding.
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Affiliation(s)
- Yusha Tang
- Department of NeurologySichuan University West China HospitalChengduChina
| | - Shuming Ji
- Department of Project Design and StatisticsSichuan University West China HospitalChengduChina
| | - Hua Li
- Department of NeurologySichuan University West China HospitalChengduChina
| | - Bosi Dong
- Department of NeurologySichuan University West China HospitalChengduChina
| | - Yajiao Li
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - Chenxing Zhu
- Department of Clinical Research ManagementSichuan University West China HospitalChengduChina
| | - Lei Chen
- Department of NeurologySichuan University West China HospitalChengduChina
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Brandt RR, Stöbe S, Ewers A, Helfen A. [Echocardiography in cardiac arrhythmias]. Herzschrittmacherther Elektrophysiol 2023; 34:256-264. [PMID: 37584761 DOI: 10.1007/s00399-023-00956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023]
Abstract
Echocardiography plays a key role in planning and guidance of electrophysiological procedures. After exclusion of structural heart disease, echocardiography provides insight into the extent of left atrial remodeling by determining left atrial metrics. This "biomarker" is associated with the risk of new-onset atrial fibrillation and predictive of atrial fibrillation recurrence after ablation. Transesophageal echocardiography is necessary to exclude left atrial thrombi and is able to guide a transseptal puncture. In case of a rare but life-threatening cardiac tamponade, an echocardiographic-guided pericardiocentesis ensures quick and effective treatment. Left ventricular ejection fraction and deformation analysis determined by echocardiography are established methods for risk stratification in patients with systolic dysfunction and used to guide pharmacological and device therapy.
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Affiliation(s)
- Roland R Brandt
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Aydan Ewers
- Medizinische Universitätsklinik II - Kardiologie und Angiologie, BG Universitätsklinikum Bergmannsheil Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Deutschland
| | - Andreas Helfen
- Abteilung für Kardiologie, Katholische St. Paulus Gesellschaft, St.-Marien-Hospital Lünen, Altstadtstr. 23, 44534, Lünen, Deutschland
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Song JK. Pearls and Pitfalls in the Transesophageal Echocardiographic Diagnosis of Patent Foramen Ovale. J Am Soc Echocardiogr 2023; 36:895-905.e3. [PMID: 37196905 DOI: 10.1016/j.echo.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
Large randomized controlled trials have shown the benefits of percutaneous closure of patent foramen ovale (PFO) in patients with cryptogenic stroke and PFO. Recent studies have highlighted the clinical significance and prognostic implication of various anatomical features of PFO and the adjacent atrial septum, such as atrial septal aneurysm (ASA), PFO size, large shunt, and hypermobility. Transthoracic echocardiography with contrast study is used for the indirect diagnosis of PFO, as it reveals the passage of the contrast into the left atrium. In contrast, transesophageal echocardiography (TEE) offers a direct demonstration of PFO by measuring its size using the maximum separation distance between the septum primum and septum secundum. Furthermore, TEE enables the acquisition of detailed anatomical features of the adjacent atrial septum including ASA, hypermobility, and PFO tunnel length, which carry significant prognostic implications. Transesophageal echocardiography also facilitates the diagnosis of pulmonary arteriovenous malformation, a relatively rare cause of paradoxical embolism. This review provides evidence for supporting TEE as a useful screening test for patients with cryptogenic stroke to identify suitable candidates for percutaneous device closure of PFO. Additionally, cardiac imaging specialists with proficiency in comprehensive TEE examination should be part of the heart-brain team for proper evaluation of and decision-making in patients with cryptogenic stroke.
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Affiliation(s)
- Jae-Kwan Song
- Professor of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Yu Y, Ding M, Chen JL, Wang T, Chen YH, Yang XM, Chen SY, Wang YP, Li YG. Multimodality imaging in diagnosing lipomatous atrial septal hypertrophy with atrial septal defect: a case report. Front Cardiovasc Med 2023; 10:1245213. [PMID: 37680561 PMCID: PMC10482038 DOI: 10.3389/fcvm.2023.1245213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Background Lipomatous atrial septal hypertrophy (LASH) with atrial septal defect (ASD) is a rare congenital anomaly. Although LASH is a histologically benign cardiac lesion characterized by excessive fat deposition in the interatrial septum that spares the fossa ovale, it has been associated with supraventricular arrhythmias or sick sinus syndrome. Application of multimodal imaging is crucial for accurate diagnosis, appropriate treatment of LASH with ASD, and follow-up. Case summary A 68-year-old female patient presented with recurrent chest tightness and palpitation. Multimodal imaging revealed the characterizations of LASH and ASD. Two-dimensional transesophageal echocardiography showed a "dumbbell"-shaped involvement of the cephalad and caudal regions with sparing of a single secundum ASD. The septum with a brightness feature is an uncommon condition characterized by the deposition of unencapsulated fat cells in the atrial septum. Real-time four-dimensional transesophageal echocardiography reflected the lipomatous hypertrophy of the atrial septum and an oval-shaped ASD. Cardiac computer tomography angiography later confirmed this finding. The patient achieved a good clinical response with an ASD percutaneous occlusion guided by intracardiac echocardiography (ICE). Conclusion This case demonstrates a LASH combined with ASD. Multimodality imaging can provide an accurate diagnosis and may guide the procedure for precise occlusion.
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Affiliation(s)
- Yi Yu
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Ding
- Department of Radiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jin-Lan Chen
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Wang
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Han Chen
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Min Yang
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Su-Yun Chen
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue-Peng Wang
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Zhou J, He J, Duan J, Li X. Case report: Unusual cause of refractory hypoxemia after pacemaker lead extraction. Front Cardiovasc Med 2023; 10:1237595. [PMID: 37645525 PMCID: PMC10461397 DOI: 10.3389/fcvm.2023.1237595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
A 59-year-old woman with a history of a pacemaker implanted for III-degree atrioventricular block was admitted due to pocket infection. The atrial and ventricular leads were removed via the right femoral vein using a needle's eye snare. Hypoxemia was observed immediately after the removal of the lead. It was refractory to oxygen therapy. The pulse oxygen saturation (SpO2) showed 89% in the supine position and 77% in the upright position. However, the CTPA and pulmonary perfusion SPECT/CT imaging did not reveal any signs of pulmonary embolism. Pulmonary function tests and chest CT showed normal results. Transthoracic contrast echocardiography revealed a patent foramen ovale (PFO) and a right-to-left intracardiac shunt, no significant tricuspid regurgitation, without any signs of elevated right heart pressure or pulmonary hypertension. Hypoxemia was considered to be associated with the right-to-left shunt through PFO. The condition was relieved by percutaneous closure of the PFO. Refractory hypoxemia resulting from an intracardiac right-to-left shunt following pacemaker lead extraction is a rare but serious complication. Transthoracic contrast echocardiography helps in diagnosis. If the right-to-left intracardiac shunt through PFO persists irreversibly and the associated hypoxemic symptoms are significant, closure of the PFO is necessary. Transesophageal echocardiography also revealed the presence of a left-to-right shunt through PFO during cardiac systole. The closure of the PFO is also necessary to avoid long-term complications, such as chronic pulmonary hypertension and right heart failure.
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Affiliation(s)
| | | | | | - Xuebin Li
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, China
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Dong B, Lu Y, He S, Li B, Li Y, Lai Q, Li W, Ji S, Chen Y, Dai L, Chen L. Multisite and multitimepoint proteomics reveal that patent foramen ovale closure improves migraine and epilepsy by reducing right-to-left shunt-induced hypoxia. MedComm (Beijing) 2023; 4:e334. [PMID: 37576864 PMCID: PMC10422075 DOI: 10.1002/mco2.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/02/2023] [Accepted: 03/12/2023] [Indexed: 08/15/2023] Open
Abstract
Patent foramen ovale (PFO) is a congenital defect in the partition between two atria, which may cause right-to-left shunt (RLS), leading to neurological chronic diseases with episodic manifestations (NCDEMs), such as migraine and epilepsy. However, whether PFO closure was effective in improving NCDEMs and the mechanism were unclear. Twenty-eight patients with migraine or epilepsy who underwent PFO closure were recruited. Notably, approximately half of patients received 50% or more reduction in seizure or headache attacks. Meanwhile, the postoperative blood oxygen partial pressure and oxygen saturation were elevated after PFO closure. Multisite (peripheral, right, and left atrial) and multitimepoint (before and after surgery) plasma proteomics from patients showed that the levels of free hemoglobin and cell adhesion molecules (CAMs) were significantly increased after PFO closure, which may be related to the relief of the hypoxic state. Furtherly, the omics data from multiple brain regions of mice revealed that a large number of proteins were differentially expressed in the occipital region in response to PFO, including redox molecules and CAMs, suggesting PFO-caused hypoxia may have great impacts on occipital region. Collectively, PFO may cause NCDEMs due to RLS-induced hypoxia, and PFO closure could prevent RLS to improve migraine and epilepsy.
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Affiliation(s)
- Bosi Dong
- Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Ying Lu
- State Key Laboratory of BiotherapyNational Clinical Research Center for Geriatrics and Department of General PracticeWest China HospitalSichuan Universityand Collaborative Innovation Center of BiotherapyChengduSichuanChina
| | - Siyu He
- State Key Laboratory of BiotherapyNational Clinical Research Center for Geriatrics and Department of General PracticeWest China HospitalSichuan Universityand Collaborative Innovation Center of BiotherapyChengduSichuanChina
| | - Baichuan Li
- Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Yajiao Li
- Department of CardiologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Qi Lai
- Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Wanling Li
- Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Shuming Ji
- Department of Clinical Research ManagementWest China HospitalSichuan UniversityChengduSichuanChina
| | - Yucheng Chen
- Department of CardiologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Lunzhi Dai
- State Key Laboratory of BiotherapyNational Clinical Research Center for Geriatrics and Department of General PracticeWest China HospitalSichuan Universityand Collaborative Innovation Center of BiotherapyChengduSichuanChina
| | - Lei Chen
- Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina
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