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Lakhdhir S, O'Sullivan ML, Côté E, Allen J. Use of two- and three-dimensional echocardiography for assessment of the left ventricular outflow tract and aortic orifice areas in dogs. J Vet Cardiol 2024; 54:63-77. [PMID: 39033721 DOI: 10.1016/j.jvc.2024.06.001] [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: 12/23/2022] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION/OBJECTIVES In clinical practice, dogs are screened for subaortic stenosis (SAS) using two-dimensional (2DE) and Doppler echocardiography. There is no accepted antemortem diagnostic criterion to distinguish between mild SAS and unaffected, therefore additional means of evaluating the left ventricular outflow tract (LVOT) and aorta may be desirable. This study sought to determine and compare LVOT and aortic orifice areas using 2DE and three-dimensional echocardiography (3DE) in apparently healthy dogs of various breeds and somatotypes. ANIMALS, MATERIALS, AND METHODS Sixty-nine healthy, privately-owned dogs. The LVOT and aortic orifice areas were determined using 2DE aortic valve (AV) diameter-derived area; the continuity equation (CE); and 3DE planimetry of the LVOT, AV, sinus of Valsalva, and sinotubular junction. Orifice areas were indexed to body surface area (BSA). RESULTS Obtaining 3DE images and performing planimetry were feasible in all dogs. The mean indexed area measured using the 2DE AV diameter (2.85 cm2/m2) was significantly lower than that derived from 3DE AV planimetry (3.85 cm2/m2; mean difference, 1.00 cm2/m2; P<0.001). There was poor agreement between the effective area calculated using the CE and the anatomic areas calculated using 2DE AV diameter and 3DE planimetry. The area calculated using the CE was less than all other calculations of area. Interobserver and intraobserver repeatability and reproducibility for 3DE planimetry were excellent. CONCLUSIONS Methods for determining aortic orifice areas in dogs are not interchangeable, and this must be taken into account if these methods are investigated in the evaluation of dogs with SAS in the future.
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Affiliation(s)
- S Lakhdhir
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, 550 University Ave, Charlottetown, PE C1A 4P3, Canada
| | - M L O'Sullivan
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, 550 University Ave, Charlottetown, PE C1A 4P3, Canada.
| | - E Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, 550 University Ave, Charlottetown, PE C1A 4P3, Canada
| | - J Allen
- Department of Cardiology, VCA West Los Angeles Animal Hospital, 1900 S Sepulveda Blvd, Los Angeles, CA 90025, USA
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Calculation of Aortic VAlve and LVOT Areas by a Modified Continuity Equation Using Different Echocardiography Methods: The CAVALIER Study. Diagnostics (Basel) 2022; 12:diagnostics12071656. [PMID: 35885559 PMCID: PMC9321790 DOI: 10.3390/diagnostics12071656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The area of the left ventricular outflow tract (ALVOT) represents a major component of the continuity equation (CE), which is, i.a., crucial to calculate the aortic valve (AV) area (AAV). The ALVOT is typically calculated using 2D echo assessments as the measured anterior–posterior (a/p) extension, assuming a round LVOT base. Anatomically, however, usually an elliptical shape of the LVOT base is present, with the long diameter extending from the medial–lateral axis (m/l), which is not recognized by two-dimensional (2D) echocardiography. Objective: We aimed to compare standard and three-dimensional (3D)-echocardiography-derived ALVOT calculation and its use in a standard CE (CEstd) and a modified CE (CEmod) to calculate the AAV vs. computed tomography (CT) multi-planar reconstruction (MPR) measurements of the anatomical ALVOT, and AAV, respectively. Methods: Patients were selected if 3D transthoracic echocardiography (TTE), 3D transesophageal echocardiography (TEE), and cardiac CT were all performed, and imaging quality was adequate. The ALVOT was assessed using 2D calculation, (a/p only), 3D-volume MPR, and 3D-biplane calculation (a/p and m/l). AAV was measured using both CEstd and CEmod, and 3D-volume MPR. Data were compared to corresponding CT analyses. Results: From 2017 to 2018, 107 consecutive patients with complete and adequate imaging data were included. The calculated ALVOT was smaller when assessed by 2D- compared to both 3D-volume MPR and 3D-biplane calculation. Calculated AAV was correspondingly smaller in CEstd compared to CEmod or 3D-volume MPR. The ALVOT and AAV, using data from 3D echocardiography, highly correlated and were congruent with corresponding measurements in CT. Conclusion: Due to the elliptic shape of the LVOT, use of measurements and calculations based on 2D echocardiography systematically underestimates the ALVOT and dependent areas, such as the AAV. Anatomically correct assessment can be achieved using 3D echocardiography and adapted calculations, such as CEmod.
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Pighi M, Giovannini D, Scarsini R, Piazza N. Diagnostic Work-Up of the Aortic Patient: An Integrated Approach toward the Best Therapeutic Option. J Clin Med 2021; 10:5120. [PMID: 34768640 PMCID: PMC8584438 DOI: 10.3390/jcm10215120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 01/09/2023] Open
Abstract
Aortic stenosis (AS) is the most common valvular heart disease. In the last decade, transcatheter aortic valve implantation (TAVI) has become the standard of care for symptomatic patients at high surgical risk. Recently, indications to TAVI have also been extended to the low surgical risk and intermediate surgical risk populations. Consequently, in this setting, some aspects acquire greater relevance: surgical risk evaluation, clinical assessment, multimodality imaging of the valve, and management of coronary artery disease. Moreover, future issues such as coronary artery re-access and valve-in-valve interventions should be considered in the valve selection process. This review aims to summarize the principal aspects of a multidimensional (multidisciplinary) and comprehensive preprocedural work-up. The Heart Team is at the center of the decision-making process of the management of aortic valve disease and bears responsibility for offering each patient a tailored approach based on an individual evaluation of technical aspects together with the risks and benefits of each modality. Considering the progressive expansion in TAVI indication and technological progress, the role of a work-up and multidisciplinary Heart Team will be even more relevant.
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Affiliation(s)
- Michele Pighi
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada;
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (R.S.)
| | - Davide Giovannini
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (R.S.)
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (R.S.)
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada;
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Vieira MLC, Branco CEDB, Gazola ASL, Vieira PPAC, Benvenuti LA, Demarchi LMMF, Gutierrez PS, Aiello VD, Tarasoutchi F, Sampaio RO. 3D Echocardiography for Rheumatic Heart Disease Analysis: Ready for Prime Time. Front Cardiovasc Med 2021; 8:676938. [PMID: 34355026 PMCID: PMC8329529 DOI: 10.3389/fcvm.2021.676938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Rheumatic heart disease (RHD) remains to be a very important health issue worldwide, mainly in underdeveloped countries. It continues to be a leading cause of morbidity and mortality throughout developing countries. RHD is a delayed non-suppurative immunologically mediated inflammatory response to the throat infection caused by a hemolytic streptococcus from the A group (Streptococcus pyogenes). RHD keeps position 1 as the most common cardiovascular disease in young people aged <25 years considering all the continents. The disease can lead to valvular cardiac lesions as well as to carditis. Rheumatic fever valvular injuries lead most commonly to the fusion and thickening of the edges of the cusps and to the fusion, thickening, and shortening of the chordae and ultimately to calcification of the valves. Valvular commissures can also be deeply compromised, leading to severe stenosis. Atrial and ventricular remodeling is also common following rheumatic infection. Mixed valvular lesions are more common than isolated valvular disorders. Echocardiography is the most relevant imaging technique not only to provide diagnostic information but also to enable prognostic data. Further, it presents a very important role for the correction of complications after surgical repair of rheumatic heart valvulopathies. Three-dimensional (3D) echocardiography provides additional anatomical and morphofunctional information of utmost importance for patients presenting rheumatic valvopathies. Accordingly, three-dimensional echocardiography is ready for routine use in patients with RHD presenting with valvular abnormalities.
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Affiliation(s)
- Marcelo Luiz Campos Vieira
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Flávio Tarasoutchi
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | - Roney Orismar Sampaio
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
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Arain FD, Sohn J. Transesophageal Echocardiographic Assessment of Left Ventricular Outflow Tract Area by 2-Dimensional Diameter, Biplane Planimetry, and 3-Dimensional Planimetry and Its Implications: "Thinking Outside the Circle". A A Pract 2021; 15:e01500. [PMID: 34259649 DOI: 10.1213/xaa.0000000000001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Faisal D Arain
- From the Department of Anesthesiology and Perioperative Medicine, Division of Cardiac Anesthesia, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Evaluation of mechanical prosthetic valves: the role of three dimensional echocardiography in calculating effective orifice area in obese vs non-obese individuals. Int J Cardiovasc Imaging 2020; 37:215-227. [PMID: 32833185 DOI: 10.1007/s10554-020-01978-3] [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: 06/01/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
Calculation of effective orifice area (EOA) is crucial for the evaluation of prosthetic valve (PV) function and there is lack of data on the best method, particularly in obese patients, in whom two-dimensional (2D) transthoracic echocardiography (TTE) is cumbersome. We sought to compare two methods of calculating EOA through Continuity equation; one using standard 2D-TTE and other three-dimensional (3D) stoke volume (SV), in patients with bileaflet mechanical PV stratified by body mass index (BMI). On conventional TTE, SV mas measured using standard 2D derived data and 3D derived SV in 38 aortic and 62 mitral PV patients who were referred for further evaluation for mild/moderate symptoms of dyspnea. Patients were categorized with regard to transprosthetic flow into 'normal-flow' and 'high-flow' groups and several echocardiographic data including 2D and 3D EOA were compared. Rates of obesity (BMI ≥ 30) were similar within high and normal flow groups of mitral and aortic PV patients. Correlation and agreement of 2D and 3D EOA was sought in patients with and without obesity. After identifying patients with possible severe obstruction, ROC analysis was carried out to identify whether 2D and 3D derived EOA could discriminate those with obstruction. There was good correlation and agreement between two methods in patients without obesity in both mitral and aortic PV. In obese individuals, however, there was no correlation between 2D and 3D EOA; in whom echocardiographic criteria showing severe obstruction revealed that 3D EOA measurements were more accurate. ROC analysis supported that 3D EOA performs better to identify patients with obstructive characteristics. In patients with bileaflet PV, measurement of EAO by 3D derived SV yields more accurate results irrespective of BMI.
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Rong LQ, Kaushal M, Mauer E, Pryor KO, Kenfield M, Shore-Lesseron L, Gaudino MFL, Neuburger PJ. Two- or 3-Dimensional Echocardiography-Derived Cardiac Output Cannot Replace the Pulmonary Artery Catheter in Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 34:2691-2697. [PMID: 32693966 DOI: 10.1053/j.jvca.2020.06.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Three-dimensional (3D) transesophageal echocardiography (TEE) has been shown to be more accurate than 2D TEE for the evaluation of the left ventricular outflow tract area. The aim of the present study was to compare the agreement of 3D echocardiography-derived cardiac output (CO) with thermodilution-derived CO (TDCO) before and after cardiopulmonary bypass (CPB). DESIGN This was a prospective observational study of patients who underwent cardiac surgery between 2016 and 2018. SETTING Weill Cornell Medicine, a single large academic medical center. PARTICIPANTS The study comprised 78 patients undergoing elective cardiac surgery. INTERVENTIONS CPB, TEE, pulmonary artery catheter, and elective cardiac surgery. MEASUREMENTS AND MAIN RESULTS Two-dimensional CO, 3D CO-diameter, and 3D CO-area values pre-CPB were strongly correlated with one another both pre-CPB and post-CPB. The 3D CO-diameter and the 3D CO-area were mildly correlated, with TDCO measurements pre-CPB (r = 0.46 and 0.39, respectively) and post-CBP (r = 0.43 and 0.47, respectively). Pre-CPB 3D CO-diameter had the most agreement with TDCO in terms of bias (-0.13 L/min); however, the limits of agreement (LOA) were wide (-2.2- to- 2.45 L/min). Post-CPB, 3D CO-diameter had the most agreement with TDCO in terms of bias (0.41) but with wide LOA (-3.29 to 2.47). All pre-CPB echocardiography-derived CO (2D CO, 3D CO-diameter, 3D CO-area) had more agreement with TDCO than did post-CPB measurements. CONCLUSIONS Three-dimensional CO measurements were only modestly correlated with pulmonary artery catheter-derived CO pre-bypass and post-bypass. Despite low bias, the wide LOA from 2D CO, 3D CO-diameter, and 3D-area compared with TDCO suggested that the 2 methods are not interchangeable.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY.
| | - Mudit Kaushal
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Elizabeth Mauer
- Department of Health Policy and Research, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Kane O Pryor
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Meaghan Kenfield
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | | | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Medical Center, New York, NY
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8
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Liu S, Churchill J, Hua L, Zeng X, Rhoades V, Namasivayam M, Baliyan V, Ghoshhajra BB, Dong T, Dal-Bianco JP, Passeri JJ, Levine RA, Hung J. Direct Planimetry of Left Ventricular Outflow Tract Area by Simultaneous Biplane Imaging: Challenging the Need for a Circular Assumption of the Left Ventricular Outflow Tract in the Assessment of Aortic Stenosis. J Am Soc Echocardiogr 2020; 33:461-468. [PMID: 32248906 DOI: 10.1016/j.echo.2019.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/20/2019] [Accepted: 12/02/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Evaluation of aortic stenosis (AS) requires calculation of aortic valve area (AVA), which relies on the assumption of a circular-shaped left ventricular outflow tract (LVOT). However, the LVOT is often elliptical, and the circular assumption underestimates the true LVOT area (LVOTA). Biplane imaging using transthoracic echocardiography allows direct planimetry of LVOTA. The aim of this study was to assess the feasibility of obtaining LVOTA using this technique and its impact on the discordance between AVA and gradient criteria in AS grading. METHODS We prospectively studied 134 patients (median age, 80 years; interquartile range, 73-87 years; 39% women) with AS, including 82 (61%) with severe AS and 52 (39%) with mild or moderate AS. LVOTA was traced using direct planimetry (LVOTAbiplane) and compared with LVOTA calculated using the circular assumption (LVOTAcirc). In a subset of patients who underwent cardiac computed tomography, direct planimetry of LVOTA was used as a reference standard. RESULTS LVOTAbiplane was significantly larger than LVOTAcirc (4.20 cm2 [interquartile range, 3.66-4.90 cm2] vs 3.73 cm2 [interquartile range, 3.14-4.15 cm2], P < .001). Among 30 patients who underwent cardiac computed tomography, LVOTAbiplane had better agreement with LVOTA by direct planimetry than LVOTAcirc (mean bias, -0.45 ± 0.63 vs -1.02 ± 0.63 cm2; P < .0001). Of 82 patients with severe AS (AVA ≤ 1 cm2 using LVOTAcirc), 40 (49%) had discordant mean gradient (<40 mm Hg). By using LVOTAbiplane, patients with discordant AVA and mean gradient decreased from 49% to 27% (P = .004), and 29% of patients with severe AS were reclassified with moderate AS, with the highest percentage of reclassification in the group with low-gradient AS with preserved left ventricular ejection fraction. CONCLUSIONS Direct planimetry using biplane imaging avoids the inherent underestimation of LVOTA using the circular assumption. LVOTA obtained by biplane planimetry can lead to better concordance between AVA and mean gradient and classification of AS severity.
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Affiliation(s)
- Shiying Liu
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica Churchill
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lanqi Hua
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xin Zeng
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Valerie Rhoades
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mayooran Namasivayam
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vinit Baliyan
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tony Dong
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jacob P Dal-Bianco
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan J Passeri
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert A Levine
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Judy Hung
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Feasibility and accuracy of real-time three-dimensional echocardiography in evaluating the aortic valve in children. Egypt Heart J 2020; 72:2. [PMID: 31912327 PMCID: PMC6946771 DOI: 10.1186/s43044-019-0037-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/19/2019] [Indexed: 11/11/2022] Open
Abstract
Background Aortic valve assessment by 2D transthoracic echocardiography is a relatively complex task owing to the unique anatomical features of the left ventricular outflow tract and its dynamic nature. We aimed to evaluate the accuracy of 3D transthoracic echocardiography [3D TTE] in assessing the aortic valve in children. Results The first group included 11 males and six females, with a mean age of 5.76 ± 6.39 years. All of these patients had aortic valve disease with a bicuspid variant. The second group included seven males and seven females, with a mean age of 4.4 ± 4.05 years. All of these patients had normal aortic valve morphology and had another congenital cardiac anomaly. The aortic valve annulus was assessed using the three modalities; 2D, 3D echocardiography in the vertical and horizontal diameters, and angiography. The aortic valve area was measured by 2D and 3D echocardiography using multiplane reformatted mode. The results of the analysis were then compared. They revealed that 3D echocardiographic measurement of the aortic annulus (horizontal diameter) correlated better with angiography than 2D and 3D (vertical diameter) echocardiographic measurements. There was a significant difference between the aortic valve area measured by 2D echocardiography and that measured by 3D echocardiography among the two groups, 2D echocardiography seems to underestimate the true aortic valve area. Conclusion The study concluded that 3D TTE with multiplane reformatted mode allows a more accurate assessment of the aortic valve when compared to 2D echocardiography and this correlates better with the angiographic findings.
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11
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Lavine SJ, Obeng GB. The relation of left ventricular geometry to left ventricular outflow tract shape and stroke volume index calculations. Echocardiography 2019; 36:905-915. [DOI: 10.1111/echo.14323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Steven J. Lavine
- Quillen College of MedicineEast Tennessee State University Johnson City Tennessee
- Washington University of St. Louis St. Louis Missouri
| | - George B. Obeng
- Quillen College of MedicineEast Tennessee State University Johnson City Tennessee
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12
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Hao GW, Liu Y, Ma GG, Hou JY, Zhu DM, Liu L, Zhang Y, Liu H, Zhuang YM, Luo Z, Tu GW, Yang XM, Chen HY. Reliability of three-dimensional color flow Doppler and two-dimensional pulse wave Doppler transthoracic echocardiography for estimating cardiac output after cardiac surgery. Cardiovasc Ultrasound 2019; 17:5. [PMID: 30944001 PMCID: PMC6448273 DOI: 10.1186/s12947-019-0155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/01/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Three-dimensional color flow Doppler (3DCF) is a new convenient technique for cardiac output (CO) measurement. However, to date, no one has evaluated the accuracy of 3DCF echocardiography for CO measurement after cardiac surgery. Therefore, this single-center, prospective study was designed to evaluate the reliability of three-dimensional color flow and two-dimensional pulse wave Doppler (2D-PWD) transthoracic echocardiography for estimating cardiac output after cardiac surgery. METHODS Post-cardiac surgical patients with a good acoustic window and a low dose or no dose of vasoactive drugs (norepinephrine < 0.05 μg/kg/min) were enrolled for CO estimation. Three different methods (third generation FloTrac/Vigileo™ [FT/V] system as the reference method, 3DCF, and 2D-PWD) were used to estimate CO before and after interventions (baseline, after volume expansion, and after a dobutamine test). RESULTS A total of 20 patients were enrolled in this study, and 59 pairs of CO measurements were collected (one pair was not included because of increasing drainage after the dobutamine test). Pearson's coefficients were 0.260 between the CO-FT/V and CO-PWD measurements and 0.729 between the CO-FT/V and CO-3DCF measurements. Bland-Altman analysis showed the bias between the absolute values of CO-FT/V and CO-PWD measurements was - 0.6 L/min with limits of agreement between - 3.3 L/min and 2.2 L/min, with a percentage error (PE) of 61.3%. The bias between CO-FT/V and CO-3DCF was - 0.14 L/min with limits of agreement between - 1.42 L /min and 1.14 L/min, with a PE of 29.9%. Four-quadrant plot analysis showed the concordance rate between ΔCO-PWD and ΔCO-3FT/V was 93.3%. CONCLUSIONS In a comparison with the FT/V system, 3DCF transthoracic echocardiography could accurately estimate CO in post-cardiac surgical patients, and the two methods could be considered interchangeable. Although 2D-PWD echocardiography was not as accurate as the 3D technique, its ability to track directional changes was reliable.
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Affiliation(s)
- Guang-Wei Hao
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Yang Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Guo-Guang Ma
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Jun-Yi Hou
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Du-Ming Zhu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Lan Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Ying Zhang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Hua Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Ya-Min Zhuang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Xiao-Mei Yang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China.
| | - Hai-Yan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China.
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González-Mansilla A, Martinez-Legazpi P, Prieto A, Gomá E, Haurigot P, Pérez Del Villar C, Cuadrado V, Delgado-Montero A, Prieto R, Mombiela T, Pérez-David E, Rodríguez González E, Benito Y, Yotti R, Pérez-Vallina M, Fernández-Avilés F, Bermejo J. Valve area and the risk of overestimating aortic stenosis. Heart 2019; 105:911-919. [PMID: 30772823 PMCID: PMC6582719 DOI: 10.1136/heartjnl-2018-314482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/15/2019] [Accepted: 01/21/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To obtain reference values of aortic valve area (AVA) in a large population and to infer the risk of overestimating aortic stenosis (AS) when focusing on flow-corrected indices of severity. METHODS We prospectively measured indices of AS in all consecutive echocardiograms performed in a large referral cardiac imaging laboratory for 1 year. We specifically analysed the distribution of AVA, indexed AVA and velocity ratio (Vratio) in patients with and without AS, the latter defined as the coexistence of valvular outflow obstruction (Vmax ≥2.5 m/s) and morphological findings of valve degeneration. RESULTS 16 156 echocardiograms were analysed, 14 669 of which did not show valvular obstruction (peak jet velocity <2.5 m/s). In the latter group, AVA was 2.6±0.7 cm2 in 8190 studies with normal valves and 2.3±0.7 cm2 in 6479 studies with aortic sclerosis (AScl). There was a relatively wide overlap between values of AVA, indexed AVA and velocity ratio between studies of patients with AScl and AS. Values of AVA ≤1.0 cm2 were found in 0.5% of studies with normal valves and 1.8% of studies with AScl. These proportions were 3.1% and 9.3% for AVA ≤1.5 cm2, respectively. Vratio ≤0.25 were found in 0.1% of patients without obstruction. Risk factors for a small AVA in patients without obstruction were AScl, female sex, small body surface area, low ejection fraction and mitral regurgitation. CONCLUSIONS Normal values of continuity-equation derived AVA are smaller than previously considered. AVA values below cutoffs of moderate or severe AS can be found in patients without the disease. Flow-corrected indices may overestimate AS in patients with low gradients, particularly in the presence of well-identified risk factors.
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Affiliation(s)
- Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Pablo Martinez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Andrea Prieto
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Elena Gomá
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Pilar Haurigot
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Candelas Pérez Del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Victor Cuadrado
- Information and Communications Technology Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Antonia Delgado-Montero
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Raquel Prieto
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Esther Pérez-David
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Elena Rodríguez González
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Yolanda Benito
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Manuel Pérez-Vallina
- Information and Communications Technology Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid.,Instituto de Investigación Sanitaria Gregorio Marañón.,CIBERCV
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15
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The mystery of defining aortic valve area: what have we learnt from three-dimensional imaging modalities? J Echocardiogr 2018; 16:130-138. [PMID: 29476387 DOI: 10.1007/s12574-018-0374-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/23/2018] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
Abstract
Aortic valve area is one of the main criteria used by echocardiography to determine the degree of valvular aortic stenosis, and it is calculated using the continuity equation which assumes that the flow volume of blood is equal at two points, the aortic valve area and the left ventricular outflow tract (LVOT). The main fallacy of this equation is the assumption that the LVOT area which is used to calculate the flow volume at the LVOT level is circular, where it is often an ellipse and sometimes irregular. The aim of this review is to explain the physiology of the continuity equation, the different sources of errors, the added benefits of using three-dimensional imaging modalities to measure LVOT area, the latest recommendations related to valvular aortic stenosis, and to introduce future perspectives. A literature review of studies comparing aortic valve area and LVOT area, after using three-dimensional data, has shown underestimation of both measurements when using the continuity equation. This has more impact on patients with discordant echocardiographic measurements when aortic valve area is disproportionate to haemodynamic measurements in assessing the degree of aortic stenosis. Although fusion imaging modalities of LVOT area can help in certain group of patients to address the issue of aortic valve area underestimation, further research on introducing a correction factor to the conventional continuity equation might be more rewarding, saving patients additional tests and potential radiation, with no clear evidence of cost-effectiveness.
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16
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Baumgartner H, Hung J, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, Lancellotti P, LeFevre M, Miller F, Otto CM. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2018; 18:254-275. [PMID: 28363204 DOI: 10.1093/ehjci/jew335] [Citation(s) in RCA: 432] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 02/07/2023] Open
Abstract
Echocardiography is the key tool for the diagnosis and evaluation of aortic stenosis. Because clinical decision-making is based on the echocardiographic assessment of its severity, it is essential that standards are adopted to maintain accuracy and consistency across echocardiographic laboratories. Detailed recommendations for the echocardiographic assessment of valve stenosis were published by the European Association of Echocardiography and the American Society of Echocardiography in 2009. In the meantime, numerous new studies on aortic stenosis have been published with particular new insights into the difficult subgroup of low gradient aortic stenosis making an update of recommendations necessary. The document focuses in particular on the optimization of left ventricular outflow tract assessment, low flow, low gradient aortic stenosis with preserved ejection fraction, a new classification of aortic stenosis by gradient, flow and ejection fraction, and a grading algorithm for an integrated and stepwise approach of artic stenosis assessment in clinical practice.
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Affiliation(s)
- Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Javier Bermejo
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
| | | | - Thor Edvardsen
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Oslo and University of Oslo, Oslo, Norway
| | | | - Patrizio Lancellotti
- Universtiy of Liège Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liège, Belgium and Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | | | | | - Catherine M Otto
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
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17
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Extent of size, shape and systolic variability of the left ventricular outflow tract in aortic stenosis determined by phase-contrast MRI. Magn Reson Imaging 2018; 45:58-65. [DOI: 10.1016/j.mri.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/20/2017] [Accepted: 09/01/2017] [Indexed: 11/21/2022]
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18
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Barletta G, Venditti F, Stefano P, Del Bene R, Di Mario C. Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis. Echocardiography 2017; 35:329-336. [DOI: 10.1111/echo.13778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Giuseppe Barletta
- Cardiology Diagnostics, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Francesco Venditti
- Cardiology Diagnostics, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Pierluigi Stefano
- Cardiac Surgery, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Riccarda Del Bene
- Cardiology Diagnostics, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Division; Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
- National Institute for Health Research (NIHR) Biomedical Research Unit; Royal Brompton & Harefield NHS Foundation Trust; London UK
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19
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Hahn RT, Pibarot P. Accurate Measurement of Left Ventricular Outflow Tract Diameter: Comment on the Updated Recommendations for the Echocardiographic Assessment of Aortic Valve Stenosis. J Am Soc Echocardiogr 2017; 30:1038-1041. [DOI: 10.1016/j.echo.2017.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 11/26/2022]
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20
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Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2017; 30:372-392. [DOI: 10.1016/j.echo.2017.02.009] [Citation(s) in RCA: 524] [Impact Index Per Article: 74.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Deeprasertkul P, Ahmad M. Evolving new concepts in the assessment of aortic stenosis. Echocardiography 2017; 34:731-745. [PMID: 28345156 DOI: 10.1111/echo.13501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Echocardiography has been pivotal in evaluating aortic stenosis (AS) over the past several decades. Recent experience has shown a wide spectrum in the clinical presentation of AS. A better understanding of the underlying hemodynamic principles has resulted in emergence of new subtypes of AS. New treatment modalities have also been introduced, requiring precise evaluation of aortic valve (AV) pathology for implementation of these therapies. This review will discuss new concepts and indices in the use of echocardiography in patients with AS. Specifically, we will address the hemodynamic characteristics, clinical presentation, and management of normal-flow, high-gradient; paradoxical low-flow, low-gradient; and classical low-flow, low-gradient aortic stenoses.
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Affiliation(s)
| | - Masood Ahmad
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
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22
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Abudiab MM, Pandit A, Chaliki HP. Role of Transesophageal Echocardiography in the Diagnosis of Paradoxical Low Flow, Low Gradient Severe Aortic Stenosis. Korean Circ J 2017; 47:82-88. [PMID: 28154595 PMCID: PMC5287191 DOI: 10.4070/kcj.2016.0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/08/2016] [Accepted: 06/21/2016] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Prior studies indicate that up to 35% of cases of severe aortic stenosis (AS) have paradoxical low flow, low gradient despite preserved left ventricular ejection fraction (LVEF). However, error in left ventricular outflow tract (LVOT) diameter may lead to misclassification. Herein, we determined whether measurement of LVOT diameter by transesophageal echocardiography (TEE) results in reclassification of cases to non-severe AS. Subjects and Methods Patients with severe AS with aortic valve area (AVA) <1 cm2 by transthoracic echocardiography (TTE) within 6 months were studied. Paradoxical low flow, low gradient was defined as mean Doppler gradient (MG) <40 mm Hg and stroke volume index (SVI) ≤35 mL/m2. Preserved LVEF was defined as ≥0.50. Results Among 108 patients, 12 (15%) had paradoxical low flow, low gradient severe AS despite preserved LVEF based on TTE measurement. When LVOT diameter by TEE in 2D was used, only 5 (6.3%) patients had low flow, low gradient severe AS (p<0.001). Coefficients of variability for intraobserver and interobserver measurement of LVOT were <10%. However, the limits of agreement between TTE and TEE measurement of LVOT ranged from 0.43 cm (95% confidence interval [CI]: 0.36 to 0.5) to -0.31 cm (95% CI: -0.38 to -0.23). Conclusion TEE measured LVOT diameter may result in reclassification to moderate AS in some patients due to low prevalence of true paradoxical low flow, low gradient (PLFLG) severe AS.
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Affiliation(s)
- Muaz M. Abudiab
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Anil Pandit
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Hari P. Chaliki
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
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23
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Three-Dimensional Morphology of the Left Ventricular Outflow Tract: Impact on Grading Aortic Stenosis Severity. J Am Soc Echocardiogr 2017; 30:28-35. [DOI: 10.1016/j.echo.2016.10.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Indexed: 01/31/2023]
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Abstract
OBJECTIVES Trans-oesophageal echocardiographic imaging is valuable in the pre- and post-operative evaluation of children and adults with CHD; however, the frequency by which trans-oesophageal echocardiography guides the intra-operative course of patients is unknown. METHODS We retrospectively reviewed 1748 intra-operative trans-oesophageal echocardiograms performed between 1 October, 2005 and 31 December, 2010, and found 99 cases (5.7%) that required return to bypass, based in part upon the intra-operative echocardiographic findings. RESULTS The diagnoses most commonly requiring further repair and subsequent imaging were mitral valve disease (20.9%), tricuspid valve disease (16.0%), atrioventricular canal defects (12.0%), and pulmonary valve disease (14.1%). The vast majority of those requiring immediate return to bypass benefited by avoiding subsequent operations and longer lengths of hospital stay. A total of 14 patients (0.8%) who received routine imaging required further surgical repair within 1 week, usually due to disease that developed over ensuing days. Patients who had second post-operative trans-oesophageal echocardiograms in the operating room rarely required re-operations, confirming the benefit of routine intra-operative imaging. CONCLUSIONS This study represents a large single institutional review of intra-operative trans-oesophageal echocardiography, and confirms its applicability in the surgical repair of patients with CHD. Routine imaging accurately identifies patients requiring further intervention, does not confer additional risk of mortality or prolonged length of hospital stay, and prevents subsequent operations and associated sequelae in a substantial subset of patients. This study demonstrates the utility of echocardiography in intra-operative monitoring of surgical repair and highlights patients who are most likely to require return to bypass, as well as the co-morbidities of such manipulations.
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25
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Charakida M, Pushparajah K, Simpson J. 3D echocardiography in congenital heart disease: a valuable tool for the surgeon. Future Cardiol 2014; 10:497-509. [PMID: 25301313 DOI: 10.2217/fca.14.38] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Real-time 3D echocardiography has been used increasingly in the assessment of patients with congenital heart disease. A number of studies have confirmed that this modality can be used as a complementary method to delineate morphology and spatial relationships of simple and more complex congenital heart lesions during surgical planning. Communication between the echocardiographer and surgeon can be simplified as simulation of surgical views can be achieved, thus minimizing the potential for error related to mental reconstruction. This review summarizes the available evidence for the role of real-time 3D echocardiography in congenital heart disease as an imaging modality to assist surgeons.
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Affiliation(s)
- Marietta Charakida
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, SE1 7EH, UK
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26
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Khan AA, Picard MH. Challenges in the echocardiographic assessment of aortic stenosis. Future Cardiol 2014; 10:541-52. [PMID: 25301316 DOI: 10.2217/fca.14.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Calcific aortic valve stenosis is common in the elderly. While history and examination can establish the diagnosis, determination of its severity typically requires echocardiography to define valve anatomy, measure stenosis severity and assess left ventricular response. The purpose of this review is to describe some of the commonly encountered challenges in the echocardiographic assessment of aortic stenosis. These include errors in the calculation of aortic valve area, assessment of aortic stenosis during atrial fibrillation, determining the presence of aortic stenosis in the setting of low transvalvular pressure gradients and discriminating other forms of obstruction to left ventricular ejection from aortic stenosis. Lastly, a review of how echocardiography is utilized to select patients for transcatheter aortic valve replacement is presented.
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Affiliation(s)
- Asaad A Khan
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
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27
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Jánosi RA, Plicht B, Kahlert P, Eißmann M, Wendt D, Jakob H, Erbel R, Buck T. Quantitative Analysis of Aortic Valve Stenosis and Aortic Root Dimensions by Three-Dimensional Echocardiography in Patients Scheduled for Transcutaneous Aortic Valve Implantation. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014; 7:9296. [PMID: 25506408 PMCID: PMC4260114 DOI: 10.1007/s12410-014-9296-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Accurate assessment of the aortic valve area (AVA) and evaluation of the aortic root are important for clinical decision-making in patients being considered for transcatheter aortic valve implantation (TAVI). Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) provides accurate and reliable quantitative assessment of aortic valve stenosis and the aortic root. We performed two-dimensional transthoracic echocardiography (2D-TTE), real-time 2D transesophageal echocardiography (RT2D-TEE) and RT3D-TEE in 71 consecutive patients referred for TAVI. RT3D-TEE multiplanar reconstruction was used to measure aortic root parameters, including left ventricular outflow tract (LVOT) diameter and area, aortic annulus diameter, aortic annulus area, and AVA. RT3D-TEE methods for planimetry and the LVOT-derived continuity equation for the estimation of AVA showed a good correlation. As iatrogenic coronary ostium occlusion is a potentially life-threatening complication, we evaluated the distances from the aortic annulus to the coronary ostia using RT3D-TEE. Based on our findings, we conclude that the geometry of the aortic root and aortic valve can be reliably and feasibly evaluated using RT3D-TEE, which is important for protecting against potential complications of TAVI, such as underestimation of the size of the aortic annulus that can result in aortic regurgitation and dislocation of the valve, or overestimation can lead to annulus rupture.
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Affiliation(s)
- Rolf Alexander Jánosi
- />Department of Cardiology, West-German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Björn Plicht
- />Department of Cardiology, Klinikum Westfalen Dortmund, Dortmund, Germany
| | - Philipp Kahlert
- />Department of Cardiology, West-German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Mareike Eißmann
- />Department of Cardiology, West-German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Daniel Wendt
- />Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Heinz Jakob
- />Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Raimund Erbel
- />Department of Cardiology, West-German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Thomas Buck
- />Department of Cardiology, Klinikum Westfalen Dortmund, Dortmund, Germany
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Yoshikawa H, Suzuki M, Hashimoto G, Kusunose Y, Otsuka T, Hara H, Noro M, Nakamura M, Sugi K. Assessment of cyclic changes in the diameter of the aortic annulus using speckle-tracking trans-esophageal echocardiography. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:2084-2090. [PMID: 23953499 DOI: 10.1016/j.ultrasmedbio.2013.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 06/16/2013] [Accepted: 06/21/2013] [Indexed: 06/02/2023]
Abstract
It is uncertain whether dynamic variation in the diameter of the aortic annulus occurs during the cardiac cycle in humans. The purpose of this study was to analyze cyclic changes of the aortic annulus using speckle-tracking trans-esophageal echocardiography. The subjects were 40 patients with aortic stenosis and 40 controls. Absolute and relative changes in the diameter of the aortic annulus and the times at which the maximum and minimum diameters occurred during the cardiac cycle were determined using speckle-tracking trans-esophageal echocardiography. The maximum and minimum diameters were 22.9 ± 2.7 and 20.0 ± 2.9 mm, respectively, in controls. The change in diameter of the aortic annulus was 2.9 ± 0.7 mm, and the relative change was 12.9 ± 3.5%. The maximum aortic annulus diameter was reached at the onset of aortic valve opening, and the minimum diameter occurred in the rapid filling phase. The change in diameter of the aortic annulus was significantly smaller (2.2 ± 0.6 mm vs. 2.9 ± 0.7 mm, p < 0.0001), and the time to reach the maximum diameter was significantly longer (98.5 ± 17.5 ms vs. 83.4 ± 18.2 ms, p = 0.0004), in the aortic stenosis group than in the control group. The study found that dynamic changes of the aortic annulus occur in the cardiac cycle and can be measured using speckle-tracking trans-esophageal echocardiography. We also found that aortic stenosis has an effect on the extent and timing of these changes. This suggests that accurate assessment of aortic annulus diameter requires consideration of the timing of the cardiac cycle.
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Affiliation(s)
- Hisao Yoshikawa
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
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Jainandunsing JS, Mahmood F, Matyal R, Shakil O, Hess PE, Lee J, Panzica PJ, Khabbaz KR. Impact of Three-Dimensional Echocardiography on Classification of the Severity of Aortic Stenosis. Ann Thorac Surg 2013; 96:1343-1348. [DOI: 10.1016/j.athoracsur.2013.05.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 05/03/2013] [Accepted: 05/10/2013] [Indexed: 11/26/2022]
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30
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Ruddox V, Mathisen M, Bækkevar M, Aune E, Edvardsen T, Otterstad JE. Is 3D echocardiography superior to 2D echocardiography in general practice? Int J Cardiol 2013; 168:1306-15. [DOI: 10.1016/j.ijcard.2012.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 09/11/2012] [Accepted: 12/01/2012] [Indexed: 02/07/2023]
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31
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Echocardiography in the era of multimodality cardiovascular imaging. BIOMED RESEARCH INTERNATIONAL 2013; 2013:310483. [PMID: 23878804 PMCID: PMC3708397 DOI: 10.1155/2013/310483] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/11/2013] [Indexed: 12/17/2022]
Abstract
Echocardiography remains the most frequently performed cardiac imaging investigation and is an invaluable tool for detailed and accurate evaluation of cardiac structure and function. Echocardiography, nuclear cardiology, cardiac magnetic resonance imaging, and cardiovascular-computed tomography comprise the subspeciality of cardiovascular imaging, and these techniques are often used together for a multimodality, comprehensive assessment of a number of cardiac diseases. This paper provides the general cardiologist and physician with an overview of state-of-the-art modern echocardiography, summarising established indications as well as highlighting advances in stress echocardiography, three-dimensional echocardiography, deformation imaging, and contrast echocardiography. Strengths and limitations of echocardiography are discussed as well as the growing role of real-time three-dimensional echocardiography in the guidance of structural heart interventions in the cardiac catheter laboratory.
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González-Cánovas C, Muñoz-Esparza C, Oliva MJ, González-Carrillo J, López-Cuenca Á, Saura D, García-Navarro M, Espinosa MD, Caro C, Caballero L, Valdés M, de la Morena G. Estenosis aórtica grave con bajo gradiente y fracción de eyección normal: ¿una cuestión de mala clasificación? Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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González-Cánovas C, Muñoz-Esparza C, Oliva MJ, González-Carrillo J, López-Cuenca Á, Saura D, García-Navarro M, Espinosa MD, Caro C, Caballero L, Valdés M, de la Morena G. Severe aortic valve stenosis with low-gradient and preserved ejection fraction: a misclassification issue? ACTA ACUST UNITED AC 2012; 66:255-60. [PMID: 24775614 DOI: 10.1016/j.rec.2012.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Low-gradient severe aortic stenosis with preserved ejection fraction is a controversial entity. Misclassification of valvulopathy severity could explain the inconsistencies reported in the prognosis of these patients. Planimetry of the aortic area using three-dimensional transesophageal echocardiography could clear up these doubts. The objectives were to assess the agreement between measurements of the valvular aortic area by continuity equation in transthoracic echocardiography and that obtained through planimetry with three-dimensional transesophageal echocardiography in low-gradient severe aortic stenosis patients. METHODS Cross-sectional descriptive study of consecutive patients referred due to severe aortic stenosis. Patients underwent transthoracic echocardiography and three-dimensional transesophageal echocardiography. Paradoxical low-gradient severe aortic stenosis was defined by the presence in the transthoracic echocardiography of aortic valve area<1 cm(2), mean ventricular gradient<40 mmHg, and ejection fraction ≥ 50%. Concordance between the two techniques was evaluated. RESULTS Of 212 consecutive severe aortic stenosis patients evaluated, 63 cases (29.7%) fulfilled the paradoxical low-gradient inclusion criteria. We obtained three-dimensional aortic valve planimetry in 61 (96.8%) of those patients. In 52 patients (85.2%), aortic valve area by transesophageal echocardiography was <1 cm(2). The intraclass correlation coefficient between the two methods was 0.505 (95% confidence interval, 0.290-0.671; P<.001). CONCLUSIONS Paradoxical low-gradient severe aortic stenosis is an actual entity, confirmed in 85% of cases evaluated by three-dimensional transesophageal echocardiography.
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Affiliation(s)
| | - Carmen Muñoz-Esparza
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - María J Oliva
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Ángel López-Cuenca
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Daniel Saura
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Miguel García-Navarro
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - María D Espinosa
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - César Caro
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Luis Caballero
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Mariano Valdés
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Gonzalo de la Morena
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
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Anwar AM, Nosir YFM, Galal AN, Al-Barakati M, Chamsi-Pasha H. Incremental Utility of Real Time Three-Dimensional Tranthoracic Echocardiography in the Assessment of Congenitally Malformed Aortic Valve. Echocardiography 2012; 29:978-83. [DOI: 10.1111/j.1540-8175.2012.01711.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lass T, Møller-Madsen MK, Nielsen HHM, Ringgaard S, Hasenkam JM. Dynamic geometry of the left ventricular outflow tract of pigs with induced supravalvular aortic stenosis. Eur J Cardiothorac Surg 2012; 42:e80-5. [DOI: 10.1093/ejcts/ezs397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gaspar T, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, Shiran A. Three-Dimensional Imaging of the Left Ventricular Outflow Tract: Impact on Aortic Valve Area Estimation by the Continuity Equation. J Am Soc Echocardiogr 2012; 25:749-57. [DOI: 10.1016/j.echo.2012.05.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Indexed: 01/05/2023]
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Muraru D, Badano LP, Vannan M, Iliceto S. Assessment of aortic valve complex by three-dimensional echocardiography: a framework for its effective application in clinical practice. ACTA ACUST UNITED AC 2012; 13:541-55. [DOI: 10.1093/ehjci/jes075] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Silva CD, Pedro F, Deister L, Sahlén A, Manouras A, Shahgaldi K. Two-Dimensional Color Doppler Echocardiography for Left Ventricular Stroke Volume Assessment: A Comparison Study with Three-Dimensional Echocardiography. Echocardiography 2012; 29:766-72. [DOI: 10.1111/j.1540-8175.2012.01695.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Badano LP, Boccalini F, Muraru D, Bianco LD, Peluso D, Bellu R, Zoppellaro G, Iliceto S. Current clinical applications of transthoracic three-dimensional echocardiography. J Cardiovasc Ultrasound 2012; 20:1-22. [PMID: 22509433 PMCID: PMC3324722 DOI: 10.4250/jcu.2012.20.1.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 03/15/2012] [Accepted: 03/15/2012] [Indexed: 02/04/2023] Open
Abstract
The advent of three-dimensional echocardiography (3DE) has significantly improved the impact of non-invasive imaging on our understanding and management of cardiac diseases in clinical practice. Transthoracic 3DE enables an easier, more accurate and reproducible interpretation of the complex cardiac anatomy, overcoming the intrinsic limitations of conventional echocardiography. The availability of unprecedented views of cardiac structures from any perspective in the beating heart provides valuable clinical information and new levels of confidence in diagnosing heart disease. One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. Another benefit of 3DE is the realistic en face views of heart valves, enabling a better appreciation of the severity and mechanisms of valve diseases in a unique, noninvasive manner. The purpose of this review is to provide readers with an update on the current clinical applications of transthoracic 3DE, emphasizing the incremental benefits of 3DE over conventional two-dimensional echocardiography.
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Affiliation(s)
- Luigi P Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Rosendal C, Hien MD, Bruckner T, Martin EO, Szabo G, Rauch H. Left Ventricular Outflow Tract: Intraoperative Measurement and Changes Caused by Mitral Valve Surgery. J Am Soc Echocardiogr 2012; 25:166-72. [DOI: 10.1016/j.echo.2011.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Indexed: 11/28/2022]
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Sudhakar S, Khairnar P, Nanda NC. Live/Real Time Three-Dimensional Transesophageal Echocardiography. Echocardiography 2012. [DOI: 10.1111/j.1540-8175.2011.01525.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Urheim S, Andersen K, Aakhus S. Tredimensjonal ultralydundersøkelse i kardiologisk diagnostikk. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:2171-4. [DOI: 10.4045/tidsskr.11.0410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Lang RM, Tsang W, Weinert L, Mor-Avi V, Chandra S. Valvular Heart Disease. J Am Coll Cardiol 2011; 58:1933-44. [DOI: 10.1016/j.jacc.2011.07.035] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 07/14/2011] [Accepted: 07/18/2011] [Indexed: 10/16/2022]
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Clinical Challenges in Accurate Assessment of Severe Aortic Stenosis With a Special Focus on Low-Gradient Aortic Stenosis and Normal Ejection Fraction. Cardiol Rev 2011; 19:239-45. [DOI: 10.1097/crd.0b013e3182213f23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shahgaldi K, Manouras A, Brodin LÅ, Winter R. Direct Measurement of Left Ventricular Outflow Tract Area Using Three-Dimensional Echocardiography in Biplane Mode Improves Accuracy of Stroke Volume Assessment. Echocardiography 2010; 27:1078-85. [DOI: 10.1111/j.1540-8175.2010.01197.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Sagmeister F, Herrmann S, Ritter C, Machann W, Köstler H, Hahn D, Voelker W, Weidemann F, Beer M. [Functional cardiac MRI for assessment of aortic valve disease]. Radiologe 2010; 50:541-7. [PMID: 20521022 DOI: 10.1007/s00117-010-1988-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aortic valve disease shows a rising incidence with the increasing mean age of Western populations. The detection of hemodynamic parameters, which transcends the mere assessment of valve morphology, has an important future potential concerning classification of the severity of disease. MRI allows a non-invasive and a spatially flexible view of the aortic valve and the adjacent anatomic region, left ventricular outflow tract (LVOT) and ascending aorta. Moreover, the technique allows the determination of functional hemodynamic parameters, such as flow velocities and effective orifice areas. The new approach of a serial systolic planimetry velocity-encoded MRI sequence (VENC-MRI) facilitates the sizing of blood-filled cardiac structures with the registration of changes in magnitude during systole. Additionally, the subvalvular VENC-MRI measurements improve the clinically important exact determination of the LVOT area with respect to its specific eccentric configuration and its systolic deformity.
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Affiliation(s)
- F Sagmeister
- Institut für Röntgendiagnostik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland.
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3D transesophageal echocardiography: a review of recent literature 2007–2009. Curr Opin Anaesthesiol 2010; 23:80-8. [DOI: 10.1097/aco.0b013e328334a6b3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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de la Morena G, Saura D, Oliva MJ, Soria F, Gonzalez J, Garcia M, Moreno V, Bonaque JC, Valdes M. Real-time three-dimensional transoesophageal echocardiography in the assessment of aortic valve stenosis. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 11:9-13. [DOI: 10.1093/ejechocard/jep154] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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