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Multimodality Imaging of the Neglected Valve: Role of Echocardiography, Cardiac Magnetic Resonance and Cardiac Computed Tomography in Pulmonary Stenosis and Regurgitation. J Imaging 2022; 8:jimaging8100278. [PMID: 36286372 PMCID: PMC9605303 DOI: 10.3390/jimaging8100278] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/25/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
The pulmonary valve (PV) is the least imaged among the heart valves. However, pulmonary regurgitation (PR) and pulmonary stenosis (PS) can occur in a variety of patients ranging from fetuses, newborns (e.g., tetralogy of Fallot) to adults (e.g., endocarditis, carcinoid syndrome, complications of operated tetralogy of Fallot). Due to their complexity, PR and PS are studied using multimodality imaging to assess their mechanism, severity, and hemodynamic consequences. Multimodality imaging is crucial to plan the correct management and to follow up patients with pulmonary valvulopathy. Echocardiography remains the first line methodology to assess patients with PR and PS, but the information obtained with this technique are often integrated with cardiac magnetic resonance (CMR) and computed tomography (CT). This state-of-the-art review aims to provide an updated overview of the usefulness, strengths, and limits of multimodality imaging in patients with PR and PS.
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Mangini F, Bruno E, Biederman RW, Villano RD, Rosato R, Muscogiuri E. Accordion sign in COVID 19 related acute myocarditis, an old sign for a novel context? A cardiac magnetic resonance case series report study. Arch Clin Cases 2022; 9:112-116. [PMID: 36176493 PMCID: PMC9512132 DOI: 10.22551/2022.36.0903.10214] [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] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is related to a higher incidence of myocarditis; we present a case series of seven patients, admitted with COVID-19 related acute myocarditis, evaluated with cardiac magnetic resonance imaging, showing an altered profile of the free wall of the right ventricle, no longer present after six months follow-up. MATERIALS AND METHODS Seven patients have been evaluated for COVID-19 related acute myocarditis, all patients have been evaluated with cardiac magnetic resonance imaging both in the acute setting and after six months follow-up. RESULTS In the acute phase, myocarditis was confirmed in keeping with the current diagnostic criteria. In five out of seven cases, the presence of a crinkling profile of the free wall of the right ventricle was observed; at six months follow up, remission in four out of the five cases and a significant reduction in the remaining case, of the previously described findings, was observed. CONCLUSIONS Crinkling appearance in the profile of the free wall of the right ventricle, detectable with cardiac magnetic resonance imaging, might represent a morphological feature present in the acute setting of COVID-19 related myocarditis; several underlying physiopathological mechanisms are conceivable. Further studies are needed to confirm this correlation, define the underlying mechanisms and the prognostic implication related to it. This is the first report in the literature that has considered such findings to the best of our knowledge.
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Affiliation(s)
- Francesco Mangini
- Cardiac Magnetic Resonance Unit, “Di Summa–Perrino” Hospital, Brindisi, Italy.,Corresponding author: Francesco Mangini, Cardiac Magnetic Resonance Unit, “Di Summa–Perrino” Hospital, Brindisi, Italy.
| | - Elvira Bruno
- Cardiac Magnetic Resonance Unit, “Di Summa–Perrino” Hospital, Brindisi, Italy
| | | | - Roberto Del Villano
- Cardiac Magnetic Resonance Unit, “Di Summa–Perrino” Hospital, Brindisi, Italy
| | - Roberto Rosato
- Cardiac Magnetic Resonance Unit, “Di Summa–Perrino” Hospital, Brindisi, Italy
| | - Eluisa Muscogiuri
- Cardiac Magnetic Resonance Unit, “Di Summa–Perrino” Hospital, Brindisi, Italy
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Orkild BA, Zenger B, Iyer K, Rupp LC, Ibrahim MM, Khashani AG, Perez MD, Foote MD, Bergquist JA, Morris AK, Kim JJ, Steinberg BA, Selzman C, Ratcliffe MB, MacLeod RS, Elhabian S, Morgan AE. All Roads Lead to Rome: Diverse Etiologies of Tricuspid Regurgitation Create a Predictable Constellation of Right Ventricular Shape Changes. Front Physiol 2022; 13:908552. [PMID: 35860653 PMCID: PMC9291517 DOI: 10.3389/fphys.2022.908552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Myriad disorders cause right ventricular (RV) dilation and lead to tricuspid regurgitation (TR). Because the thin-walled, flexible RV is mechanically coupled to the pulmonary circulation and the left ventricular septum, it distorts with any disturbance in the cardiopulmonary system. TR, therefore, can result from pulmonary hypertension, left heart failure, or intrinsic RV dysfunction; but once it occurs, TR initiates a cycle of worsening RV volume overload, potentially progressing to right heart failure. Characteristic three-dimensional RV shape-changes from this process, and changes particular to individual TR causes, have not been defined in detail. Methods: Cardiac MRI was obtained in 6 healthy volunteers, 41 patients with ≥ moderate TR, and 31 control patients with cardiac disease without TR. The mean shape of each group was constructed using a three-dimensional statistical shape model via the particle-based shape modeling approach. Changes in shape were examined across pulmonary hypertension and congestive heart failure subgroups using principal component analysis (PCA). A logistic regression approach based on these PCA modes identified patients with TR using RV shape alone. Results: Mean RV shape in patients with TR exhibited free wall bulging, narrowing of the base, and blunting of the RV apex compared to controls (p < 0.05). Using four primary PCA modes, a logistic regression algorithm identified patients with TR correctly with 82% recall and 87% precision. In patients with pulmonary hypertension without TR, RV shape was narrower and more streamlined than in healthy volunteers. However, in RVs with TR and pulmonary hypertension, overall RV shape continued to demonstrate the free wall bulging characteristic of TR. In the subgroup of patients with congestive heart failure without TR, this intermediate state of RV muscular hypertrophy was not present. Conclusion: The multiple causes of TR examined in this study changed RV shape in similar ways. Logistic regression classification based on these shape changes reliably identified patients with TR regardless of etiology. Furthermore, pulmonary hypertension without TR had unique shape features, described here as the "well compensated" RV. These results suggest shape modeling as a promising tool for defining severity of RV disease and risk of decompensation, particularly in patients with pulmonary hypertension.
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Affiliation(s)
- Benjamin A. Orkild
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Brian Zenger
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Krithika Iyer
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- School of Computing, University of Utah, Salt Lake City, UT, United States
| | - Lindsay C. Rupp
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Majd M Ibrahim
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States
| | - Atefeh G. Khashani
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Maura D. Perez
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Markus D. Foote
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Jake A. Bergquist
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Alan K. Morris
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Jiwon J. Kim
- Weill-Cornell Medical College, Division of Cardiology, New York, NY, United States
| | - Benjamin A. Steinberg
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States
| | - Craig Selzman
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, United States
| | - Mark B. Ratcliffe
- Department of Surgery, The San Francisco VA Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - Rob S. MacLeod
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Shireen Elhabian
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- School of Computing, University of Utah, Salt Lake City, UT, United States
| | - Ashley E. Morgan
- St. Luke’s Medical Center Cardiothoracic and Vascular Surgery, Boise, ID, United States
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Iyer K, Morris A, Zenger B, Karanth K, Khan N, Orkild BA, Korshak O, Elhabian S. Statistical shape modeling of multi-organ anatomies with shared boundaries. Front Bioeng Biotechnol 2022; 10:1078800. [PMID: 36727040 PMCID: PMC9886138 DOI: 10.3389/fbioe.2022.1078800] [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: 10/24/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction: Statistical shape modeling (SSM) is a valuable and powerful tool to generate a detailed representation of complex anatomy that enables quantitative analysis of shapes and their variations. SSM applies mathematics, statistics, and computing to parse the shape into some quantitative representation (such as correspondence points or landmarks) which can be used to study the covariance patterns of the shapes and answer various questions about the anatomical variations across the population. Complex anatomical structures have many diverse parts with varying interactions or intricate architecture. For example, the heart is a four-chambered organ with several shared boundaries between chambers. Subtle shape changes within the shared boundaries of the heart can indicate potential pathologic changes such as right ventricular overload. Early detection and robust quantification could provide insight into ideal treatment techniques and intervention timing. However, existing SSM methods do not explicitly handle shared boundaries which aid in a better understanding of the anatomy of interest. If shared boundaries are not explicitly modeled, it restricts the capability of the shape model to identify the pathological shape changes occurring at the shared boundary. Hence, this paper presents a general and flexible data-driven approach for building statistical shape models of multi-organ anatomies with shared boundaries that explicitly model contact surfaces. Methods: This work focuses on particle-based shape modeling (PSM), a state-of-art SSM approach for building shape models by optimizing the position of correspondence particles. The proposed PSM strategy for handling shared boundaries entails (a) detecting and extracting the shared boundary surface and contour (outline of the surface mesh/isoline) of the meshes of the two organs, (b) followed by a formulation for a correspondence-based optimization algorithm to build a multi-organ anatomy statistical shape model that captures morphological and alignment changes of individual organs and their shared boundary surfaces throughout the population. Results: We demonstrate the shared boundary pipeline using a toy dataset of parameterized shapes and a clinical dataset of the biventricular heart models. The shared boundary model for the cardiac biventricular data achieves consistent parameterization of the shared surface (interventricular septum) and identifies the curvature of the interventricular septum as pathological shape differences.
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Affiliation(s)
- Krithika Iyer
- University of Utah, School of Computing, Salt Lake City, UT, United States
- University of Utah, Scientific Computing and Imaging Institute, Salt Lake City, UT, United States
| | - Alan Morris
- University of Utah, Scientific Computing and Imaging Institute, Salt Lake City, UT, United States
| | - Brian Zenger
- University of Utah, Scientific Computing and Imaging Institute, Salt Lake City, UT, United States
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Karthik Karanth
- University of Utah, School of Computing, Salt Lake City, UT, United States
- University of Utah, Scientific Computing and Imaging Institute, Salt Lake City, UT, United States
| | - Nawazish Khan
- University of Utah, School of Computing, Salt Lake City, UT, United States
- University of Utah, Scientific Computing and Imaging Institute, Salt Lake City, UT, United States
| | - Benjamin A. Orkild
- University of Utah, Scientific Computing and Imaging Institute, Salt Lake City, UT, United States
- University of Utah, Department of Biomedical Engineering, Salt Lake City, UT, United States
| | - Oleksandre Korshak
- University of Utah, School of Computing, Salt Lake City, UT, United States
- University of Utah, Scientific Computing and Imaging Institute, Salt Lake City, UT, United States
| | - Shireen Elhabian
- University of Utah, School of Computing, Salt Lake City, UT, United States
- University of Utah, Scientific Computing and Imaging Institute, Salt Lake City, UT, United States
- *Correspondence: Shireen Elhabian ,
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Schlossbauer SA, Faletra FF, Paiocchi VL, Leo LA, Franciosi G, Bonanni M, Angelini G, Pavon AG, Ferrari E, Ho SY, Hahn RT. Multimodality Imaging of the Anatomy of Tricuspid Valve. J Cardiovasc Dev Dis 2021; 8:jcdd8090107. [PMID: 34564125 PMCID: PMC8469874 DOI: 10.3390/jcdd8090107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 12/23/2022] Open
Abstract
Even though the tricuspid valve is no longer “forgotten”, it still remains poorly understood. In this review, we focus on some controversial and still unclear aspects of tricuspid anatomy as illustrated by noninvasive imaging techniques. In particular, we discuss the anatomical architecture of the so-called tricuspid annulus with its two components (i.e., the mural and the septal annulus), emphasizing the absence of any fibrous “ring” around the right atrioventricular junction. Then we discussed the extreme variability in number and size of leaflets (from two to six), highlighting the peculiarities of the septal leaflet as part of the septal atrioventricular junction (crux cordis). Finally, we describe the similarities and differences between the tricuspid and mitral valve, suggesting a novel terminology for tricuspid leaflets.
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Affiliation(s)
- Susanne Anna Schlossbauer
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Francesco Fulvio Faletra
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
- Correspondence: ; Tel.: +41-91-805-3179; Fax: +41-91-805-3167
| | - Vera Lucia Paiocchi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Laura Anna Leo
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Giorgio Franciosi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Michela Bonanni
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Gianmarco Angelini
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Anna Giulia Pavon
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Enrico Ferrari
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (S.A.S.); (V.L.P.); (L.A.L.); (G.F.); (M.B.); (G.A.); (A.G.P.); (E.F.)
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London SW36NP, UK;
| | - Rebecca T. Hahn
- Cardiovascular Research Foundation, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA;
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Mangieri A, Laricchia A, Cereda A, Khokhar AA, Regazzoli D, Giannini F, Reimers B, Colombo A. Diagnosis and Management of Failed Surgical Tricuspid Valve Annuloplasty. Curr Cardiol Rep 2021; 23:137. [PMID: 34410511 DOI: 10.1007/s11886-021-01569-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW Annular-based strategies for treating tricuspid valve (TV) regurgitation do not always have satisfactory long-term outcomes. Management of failed TV annuloplasty can be challenging and requires a dedicated heart team approach. This review explores the treatment options available for failed TV annuloplasty. RECENT FINDINGS Recent developments and novel percutaneous treatment options have emerged as promising alternatives for patients with failed TV annuloplasty. Leaflet-based interventions, valve-in-valve procedures, transcatheter tricuspid valves and new-generation trans-caval valves are all feasible options, which can assure good results whilst minimizing risks for the patient. Failure of tricuspid annuloplasty is not uncommon amongst patients treated with either a tricuspid ring or suture-based device. The complex anatomy, physiology and clinical risk profile should be carefully evaluated on an individual patient-by-patient basis in order to select the most appropriate clinical and percutaneous treatment strategy. Different transcatheter tricuspid valve repair or replacement techniques may provide an attractive alternative treatment option for managing this challenging patient cohort.
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Affiliation(s)
- Antonio Mangieri
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Alberto Cereda
- Cardiovascular Department, ASST Santi Paolo e Carlo, Milan, Italy
| | - Arif A Khokhar
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Damiano Regazzoli
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Bernhard Reimers
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio Colombo
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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Sánchez Ramírez CJ, Pérez de Isla L. Tetralogy of Fallot: cardiac imaging evaluation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:966. [PMID: 32953766 PMCID: PMC7475417 DOI: 10.21037/atm.2020.02.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Thanks to advances in pediatric cardiology, most infants with tetralogy of Fallot (TOF) now survive into adulthood. This relatively new population of adult patients may face long-term complications, including pulmonary regurgitation (PR), right ventricular (RV) tract obstruction, residual shunts, RV dysfunction, and arrythmias. They will often need to undergo pulmonary valve (PV) replacement and other invasive re-interventions. However, the optimal timing for these procedures is challenging, largely due to the complexity of evaluating RV volume and function. The options for the follow-up of these patients have rapidly evolved from an angiography-based approach to the surge of advanced imaging techniques, mainly echocardiography, cardiac magnetic resonance (CMR), and computer tomography (CT). In this review, we outline the indications, strengths and limitations of these modalities in the adult TOF population.
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Affiliation(s)
| | - Leopoldo Pérez de Isla
- Department of Cardiac Imaging, Hospital Clínico San Carlos, Professor Martín Lagos, Madrid, Spain
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Imaging Needs in Novel Transcatheter Tricuspid Valve Interventions. JACC Cardiovasc Imaging 2019; 11:736-754. [PMID: 29747849 DOI: 10.1016/j.jcmg.2017.10.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 02/01/2023]
Abstract
The advent of novel transcatheter therapies for severe tricuspid regurgitation (TR) has attracted much attention. Novel 3-dimensional imaging techniques have permitted analysis of the tricuspid valve (TV) anatomy from unparalleled views and better understanding of the underlying pathophysiology of TR. Grading TR and assessment of right ventricular function remain challenging, and although 2-dimensional echocardiography is the mainstay imaging technique to evaluate patients with severe TR the use of 3-dimensional echocardiography and cardiovascular magnetic resonance is increasing. The number of transcatheter interventions for TR is growing, and procedural success relies significantly on the pre-procedural evaluation of the anatomy of the TV, etiology and severity of TR, right ventricular size and function, and importantly, the anatomic relationships of the TV. The role of multimodality imaging in patient selection and procedural planning for transcatheter TV repair is reviewed.
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Secchi F, Chessa M, Petrini M, Monti CB, Alì M, Cannaò PM, Di Leo G, Sardanelli F. Pulmonary Insufficiency. J Thorac Imaging 2019; 34:380-386. [DOI: 10.1097/rti.0000000000000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dellegrottaglie S, Ostenfeld E, Sanz J, Scatteia A, Perrone-Filardi P, Bossone E. Imaging the Right Heart-Pulmonary Circulation Unit. Heart Fail Clin 2018; 14:377-391. [DOI: 10.1016/j.hfc.2018.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
OPINION STATEMENT Right ventricular (RV) structure and function is clinically important in a wide range of conditions. While conventional echocardiography (echo) methods are widely used, its limitations in RV assessment due its complex geometry are well recognized. New applications of traditional echo methods as well as emerging echo techniques including 3-dimensional (3D) echo and speckle tracking strain have the potential to overcome limitations of conventional echo, though widespread clinical use remains to be seen. Volumetric methods using cardiac magnetic resonance (CMR) and computed tomography (CT) provide accurate assessment of RV function without geometric assumptions. In addition, tissue characterization imaging for myocardial scar and fat using CMR and CT provides important information regarding the RV beyond structure and function alone and has clinical applications for diagnosis and prognosis in a broad range of pathologies. Limitations also exist for these two advanced modalities including availability and patient suitability for CMR and need for contrast and radiation exposure for CT. The complementary role of each modality for the RV as well as emerging evidence for the use of each imaging method in diagnosis and management of RV pathologies is outlined in this study.
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Magunia H, Schmid E, Hilberath JN, Häberle L, Grasshoff C, Schlensak C, Rosenberger P, Nowak-Machen M. 2D Echocardiographic Evaluation of Right Ventricular Function Correlates With 3D Volumetric Models in Cardiac Surgery Patients. J Cardiothorac Vasc Anesth 2016; 31:595-601. [PMID: 28129939 DOI: 10.1053/j.jvca.2016.11.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The early diagnosis and treatment of right ventricular (RV) dysfunction are of critical importance in cardiac surgery patients and impact clinical outcome. Two-dimensional (2D) transesophageal echocardiography (TEE) can be used to evaluate RV function using surrogate parameters due to complex RV geometry. The aim of this study was to evaluate whether the commonly used visual evaluation of RV function and size using 2D TEE correlated with the calculated three-dimensional (3D) volumetric models of RV function. DESIGN AND SETTING Retrospective study, single center, University Hospital. PARTICIPANTS AND INTERVENTION Seventy complete datasets were studied consisting of 2D 4-chamber view loops (2-3 beats) and the corresponding 4-chamber view 3D full-volume loop of the right ventricle. RV function and RV size of the 2D loops then were assessed retrospectively purely qualitatively individually by 4 clinician echocardiographers certified in perioperative TEE. Corresponding 3D volumetric models calculating RV ejection fraction and RV end-diastolic volumes then were established and compared with the 2D assessments. MEASUREMENTS AND MAIN RESULTS 2D assessment of RV function correlated with 3D volumetric calculations (Spearman's rho -0.5; p<0.0001). No correlation could be established between 2D estimates of RV size and actual 3D volumetric end-diastolic volumes (Spearman's rho 0.15; p = 0.25). CONCLUSION The 2D assessment of right ventricular function based on visual estimation as frequently used in clinical practice appeared to be a reliable method of RV functional evaluation. However, 2D assessment of RV size seemed unreliable and should be used with caution.
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Affiliation(s)
- Harry Magunia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Eckhard Schmid
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Jan N Hilberath
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany; Department of Anesthesiology and Intensive Care Medicine, Herzentrum Lahr, Lahr, Germany
| | - Leo Häberle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Christian Grasshoff
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Martina Nowak-Machen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.
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Kalçık M, Yesin M, Gürsoy MO, Karakoyun S, Cerşit S, Köksal C, İzgi C, Özkan M. An unusual mass of tricuspid valve in an adult patient: blood-filled cyst. Echocardiography 2015; 32:1199-202. [PMID: 25556838 DOI: 10.1111/echo.12878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Blood-filled cysts (BFC) within the heart are common findings at postmortem examinations of fetuses and infants. However, such cysts are very rare entities in adolescents and adults. We report here an adult case of BFC attached to the posterior leaflet of the tricuspid valve, demonstrating the importance of multimodal diagnostic imaging combining both echocardiography and magnetic resonance imaging.
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Affiliation(s)
- Macit Kalçık
- Department of Cardiology, İskilip Atıf Hoca State Hospital, Çorum, Turkey
| | - Mahmut Yesin
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | | | - Süleyman Karakoyun
- Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey
| | - Sinan Cerşit
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Cengiz Köksal
- Department of Cardiovascular Surgery, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Cemil İzgi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Mehmet Özkan
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.,Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey
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