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Atici A, Asoglu R, Demirkiran A, Demir AA, Barman HA, Cevik E, Dursun M, Bugra MZ. Impact of Multimodality Imaging on the Diagnosis of Left Ventricular Apical Thrombus in Patients after Anterior Myocardial Infarction. Am J Med Sci 2021; 363:130-139. [PMID: 34848187 DOI: 10.1016/j.amjms.2021.06.028] [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: 07/22/2020] [Revised: 03/12/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presence of the left ventricle (LV) apical thrombus is one of the most critical complications of anterior myocardial infarction (MI). Due to the high risk of systemic embolization, the determination of LV apical thrombus (LVAT) is essential. We aimed to compare the two-dimensional echocardiography (2DE), contrast-2DE and real-time three-dimensional echocardiography (RT-3DE) in the diagnosis of LVAT and determine which imaging modality is superior. METHODS The study was designed as a prospective cohort study, and 161 patients were included. Patients with low ejection fraction (<40%) and LV apical wall motion abnormality (severe hypokinetic, akinetic or dyskinetic) were included. 2DE, contrast-2DE, RT-3DE, and magnetic resonance imaging (MRI) were performed on all patients within one month after anterior MI. RESULTS Transthoracic 2DE detected thrombi in 29 patients, contrast-2DE detected thrombi in 33 patients, RT-3DE detected thrombi in 32 patients, and MRI detected thrombi in 28 patients. While MRI is accepted as the gold standard for non-invasive imaging, the specificity of detecting thrombus with 2DE is 90%, and the sensitivity is 57%, contrast-2DE had 82% sensitivity and 92% specificity for the detection of LVAT. The specificity for detecting thrombus with RT-3DE is 93%, and the sensitivity is 85%. Accuracy was 84%, 90% and 92% with 2DE, contrast-2DE and RT-3DE, respectively. CONCLUSIONS We found that RT-3DE was more sensitive and more specific than 2DE and contrast-2DE in the diagnosis of LVAT. The diagnostic accuracy of RT-3DE was higher than 2DE and contrast-2DE for LVAT.
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Affiliation(s)
- Adem Atici
- Cardiology Department, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Ramazan Asoglu
- Adiyaman Health Education and Research Hospital, Department of Cardiology, Adiyaman, Turkey
| | - Ahmet Demirkiran
- Cardiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Aslan Demir
- Radiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Hasan Ali Barman
- Istanbul University - Cerrahpasa, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
| | - Erdem Cevik
- Cardiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Memduh Dursun
- Radiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
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Domnitskaya TM, Sakhno YF, Sedov VP, Savina NM. [Echocardiographic Diagnostics of Heart Tumors]. ACTA ACUST UNITED AC 2021; 61:85-92. [PMID: 34397346 DOI: 10.18087/cardio.2021.7.n1182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/22/2020] [Accepted: 03/10/2021] [Indexed: 11/18/2022]
Abstract
The article focuses on ultrasound diagnosis of cardiac tumors (CT). In recent time, the frequency of detecting cardiac neoplasm has been growing. Correct diagnosis at an early stage of the process would allow timely treatment. Before the introduction of two-dimensional echocardiography (EchoCG), life-time diagnosis of CT was very rare. This article describes major echocardiographic criteria for most common benign, malignant, and metastatic CTs. The article is illustrated with original echocardiographic images.
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Affiliation(s)
- T M Domnitskaya
- Medical Institute of the Peoples' Friendship University of Russia, Moscow
| | - Yu F Sakhno
- Medical Institute of the Peoples' Friendship University of Russia, Moscow
| | - V P Sedov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - N M Savina
- Central state medical Academy of the President of Russia, Moscow
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Abstract
In the past, cardiac tumors were a just clinical curiosity and the prognosis was poor. Surgical management became possible after the advent of cardiopulmonary bypass, and more recently, preoperative diagnosis was greatly improved by the development of echocardiography, computed tomography, and magnetic resonance imaging. The value of echocardiography for diagnosing cardiac mass lesions has become well established. Numerous advances have occurred in the last 5 decades, and the evolution of echocardiography involves the development of its many modalities. This review is intended to help echocardiologists and forensic pathologists in providing good medical practice when faced with the challenge of investigating unexpected clinical signs, particularly in young people, or unexpected postmortem findings.
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Bhattacharyya S, Khattar RS, Gujral DM, Senior R. Cardiac tumors: the role of cardiovascular imaging. Expert Rev Cardiovasc Ther 2013; 12:37-43. [PMID: 24345096 DOI: 10.1586/14779072.2014.872031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of cardiac tumors with cardiovascular imaging aims to establish aetiology, identify complications of tumor and help define management strategy. 2D echocardiography remains the primary diagnostic modality. Additional use of newer echocardiographic techniques such as 3D, strain and contrast echocardiography better characterise tumor morphology, tissue characteristics and vascularity respectively. Cardiac MRI and computed tomography provide complementary information and are able to identify extra-cardiac infiltration and also provide further tissue characterisation. This review explores the non-invasive diagnostic approach to evaluation of cardiac tumors.
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Anwar AM, Nosir YFM, Zainal-Abidin SK, Ajam A, Chamsi-Pasha H. Real-time three-dimensional transthoracic echocardiography in daily practice: initial experience. Cardiovasc Ultrasound 2012; 10:14. [PMID: 22448671 PMCID: PMC3350441 DOI: 10.1186/1476-7120-10-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 03/26/2012] [Indexed: 11/10/2022] Open
Abstract
AIM OF THE WORK To evaluate the feasibility and possible additional value of transthoracic real-time three-dimensional echocardiography (RT3D-TTE) for the assessment of cardiac structures as compared to 2D-TTE. METHODS 320 patients (mean age 45 ± 8.4 years, 75% males) underwent 2D-TTE and RT3D-TTE using 3DQ-Q lab software for offline analysis. Volume quantification and functional assessment was performed in 90 patients for left ventricle and in 20 patients for right ventricle. Assessment of native (112 patients) and prosthetic (30 patients) valves morphology and functions was performed. RT3D-TTE was performed for evaluation of septal defects in 30 patients and intracardiac masses in 52 patients. RESULTS RT3D-TTE assessment of left ventricle was feasible and reproducible in 86% of patients while for right ventricle, it was (55%). RT3D-TTE could define the surface anatomy of mitral valve optimally (100%), while for aortic and tricuspid was (88% and 81% respectively). Valve area could be planimetered in 100% for the mitral and in 80% for the aortic. RT3D-TTE provided a comprehensive anatomical and functional evaluation of prosthetic valves. RT3D-TTE enface visualization of septal defects allowed optimal assessment of shape, size, area and number of defects and evaluated the outcome post device closure. RT3D-TTE allowed looking inside the intracardiac masses through multiple sectioning, valuable anatomical delineation and volume calculation. CONCLUSION Our initial experience showed that the use of RT3D-TTE in the assessment of cardiac patients is feasible and allowed detailed anatomical and functional assessment of many cardiac disorders.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahd Armed Forces Hospital, P,O, Box: 9862, Jeddah 21159, Saudi-Arabia.
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Khairnar P, Hsiung MC, Mishra S, Nanda NC, Daly DD, Nayyar G, Patel A, Mishra J, Chuang YC, Tsai SK, Yin WH, Wei J. The Ability of Live Three-Dimensional Transesophageal Echocardiography to Evaluate the Attachment Site of Intracardiac Tumors. Echocardiography 2011; 28:1041-5. [DOI: 10.1111/j.1540-8175.2011.01506.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Bai W, Li H, Zhang Q, Rao L. Assessment right atrial thrombus by real-time three dimensional transthoracic echocardiography in patient with dilated cardiomyopathy. Cardiovasc Ultrasound 2011; 9:12. [PMID: 21477357 PMCID: PMC3090317 DOI: 10.1186/1476-7120-9-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 04/10/2011] [Indexed: 02/05/2023] Open
Abstract
We report a case of a 52-year-old patient with dilated cardiomyopathy who presented with worsening heart failure. Two-dimensional transthoracic echocardiography and real-time three dimensional transthoracic echocardiography showed severe dilated cardiac chambers, impaired ejection fraction and a mobile right atrial thrombus 2.6 × 1.0 cm in size, traversing the right atrial cavity during the whole cardiac cycle. After one week therapeutic anticoagulation, echocardiography confirmed no evidence of residual thrombus.
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Affiliation(s)
- Wenjuan Bai
- Echo Lab, Division of Cardiology Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
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Singh B, Kuruba M, Singh P, Hernandez CM, Waseemuddin M, Nanda NC. Live/Real time three-dimensional transthoracic echocardiographic assessment of inferior vena cava and hepatic vein thrombosis in sickle cell disease. Echocardiography 2010; 27:594-6. [PMID: 20608958 DOI: 10.1111/j.1540-8175.2010.01201.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We describe the value of live/real time three-dimensional transthoracic echocardiography (3DTTE) over two-dimensional transthoracic echocardiography (2DTTE) in the assessment of inferior vena cava (IVC) and hepatic vein (HV) obstruction in a patient with sickle cell disease. 3DTTE provided additional information when compared to 2DTTE by (1) identifying the obstructing lesion as a likely thrombus, (2) by providing assessment of anatomical severity of IVC lumen obstruction since the thrombus could be visualized en face also, and (3) identifying an area of increased mobility of a portion of the thrombus suggesting greater risk of embolization. (Echocardiography 2010;27:594-596).
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Affiliation(s)
- Balwinder Singh
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
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Anwar AM, Nosir YFM, Ajam A, Chamsi-Pasha H. Central role of real-time three-dimensional echocardiography in the assessment of intracardiac thrombi. Int J Cardiovasc Imaging 2010; 26:519-26. [DOI: 10.1007/s10554-010-9593-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 01/18/2010] [Indexed: 11/28/2022]
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10
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Hernandez CM, Singh P, Hage FG, Nanda NC, Hsiung MC, Wei J, Chang CY, Lee KC, Sue SH, Yin WH, Aly NAAR, Deshmukh O, Biswas M, Gupta I, Sanam K, Sen U. Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Pericardial Disease. Echocardiography 2009; 26:1250-63. [DOI: 10.1111/j.1540-8175.2009.01093.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Misra S, Sinha PK, Koshy T, Sandhyamani S, Parija C, Gopal K. Accurate localization and echocardiographic-pathologic correlation of tricuspid valve angiolipoma by intraoperative transesophageal echocardiography. Echocardiography 2009; 26:1228-31. [PMID: 19725840 DOI: 10.1111/j.1540-8175.2009.00997.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Angiolipoma (angiolipohamartoma) of the tricuspid valve (TV) is a rare tumor which may be occasionally misdiagnosed as right atrial (RA) myxoma. Transesophageal echocardiography (TEE) provides accurate information regarding the size, shape, mobility as well as site of attachment of RA tumors and is a superior modality as compared to transthoracic echocardiography (TTE). Correct diagnosis of RA tumors has therapeutic significance and guides management of patients, as myxomas are generally more aggressively managed than lipomas. We describe a rare case of a pedunculated angiolipoma of the TV which was misdiagnosed as RA myxoma on TTE and discuss the echocardiographic-pathologic correlates of the tumor as well as its accurate localization by TEE.
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Affiliation(s)
- Satyajeet Misra
- Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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Anwar AM, Nosir YFM, Chamsi-Pasha H. Real-time three-dimensional echocardiographic assessment of inferior vena caval thrombosis. Eur Heart J Cardiovasc Imaging 2009; 10:872-5. [PMID: 19515705 DOI: 10.1093/ejechocard/jep077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Inferior vena cava thrombosis (IVCT) represents a subset of deep venous thrombosis. Because of the variety of its clinical presentations, the exact incidence is elusive. We present two cases of IVCT that was incidentally discovered during a routine two-dimensional echocardiography. Real-time three-dimensional echocardiography (RT3DE) assessment of IVCT added more valuable information that may help in its management. To the best of our knowledge, this is the first case report using RT3DE in the assessment of IVCT.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahd Armed Forces Hospital, PO Box 9862, Jeddah 21159, Kingdom of Saudi Arabia
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Le Tourneau T, Pouwels S, Gal B, Vincentelli A, Polge AS, Fayad G, Maréchaux S, Ennezat PV, Jegou B, Deklunder G. Assessment of Papillary Fibroelastomas with Live Three-Dimensional Transthoracic Echocardiography. Echocardiography 2008; 25:489-95. [DOI: 10.1111/j.1540-8175.2008.00631.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Badano LP, Dall'Armellina E, Monaghan MJ, Pepi M, Baldassi M, Cinello M, Fioretti PM. Real-time three-dimensional echocardiography: technological gadget or clinical tool? J Cardiovasc Med (Hagerstown) 2007; 8:144-62. [PMID: 17312431 DOI: 10.2459/jcm.0b013e3280116b50] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The complex anatomy of cardiac structures requires three-dimensional spatial orientation of images for a better understanding of structure and function, thereby improving image interpretation. Real-time three-dimensional echocardiography is a recently developed technique based on the design of an ultrasound transducer with a matrix array that rapidly acquires image data in a pyramidal volume. The simultaneous display of multiple tomographic images allows three-dimensional perspective and the anatomically correct examination of any structure within the volumetric image. As a consequence, it is less operator-dependent and hence more reproducible. Dedicated software systems and technologies are based on high-performance computers designed for graphic handling of three-dimensional images by providing possibilities beyond those obtainable with echocardiography. This methodology allows simultaneous display of multiple superimposed planes in an interactive manner as well as a quantitative assessment of cardiac volumes and ventricular mass in a three-dimensional format without a pre-established assumption of cardiac chamber geometry. In addition, myocardial contraction and/or perfusion abnormalities are clearly identified. Finally, real-time three-dimensional colour Doppler flow mapping enables complete visualisation of the regurgitant jet and new ways of assessing regurgitant lesion severity. Thus, this technique expands the abilities of non-invasive cardiology and may open new doors for the evaluation of cardiac diseases. In this article, current and future clinical applications of real-time three-dimensional echocardiography are reviewed.
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Affiliation(s)
- Luigi P Badano
- Department of Cardiopulmonary Sciences, University Hospital of Udine, Udine, Italy.
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Correale M, Ieva R, Di Biase M. LIVE transthoracic three-dimensional visualization of a tumor mass in the inferior vena cava and heart. J Cardiovasc Med (Hagerstown) 2007; 8:219-20. [PMID: 17312444 DOI: 10.2459/01.jcm.0000260823.06973.1a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Michele Correale
- Department of Cardiology, Ospedali Riuniti OO.RR, Foggia, Italy.
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Abstract
We report a case involving a surgical sponge retained following an aortic valve replacement. The surgical sponge was placed into the left ventricle to protect calcified debris from falling down into the left ventricular cavity. However, the sponge was forgotten and left inside the patient. We identified the retained surgical sponge by transesophageal echocardiography, which was performed because of a difficulty in weaning the patient from the cardiopulmonary bypass.
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Affiliation(s)
- Yildirim Imren
- Department of Cardiovascular Surgery, Gazi University Medical Faculty, Ankara, Turkey.
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Abstract
In contrast to primary cardiac tumors, which are less frequent and mostly benign in nature, the majority of intracardiac tumors are metastatic lesions. Cardiac ultrasound has evolved enormously since its emergence in the 1950s and is presently the modality of choice for imaging space-occupying lesions of the heart; it provides high quality, real-time images that are extremely valuable in the evaluation of cardiac masses. Although transthoracic echocardiography is an excellent initial diagnostic technique to evaluate and diagnose cardiac masses, transesophageal echocardiography provides superior image resolution and better visualization of cardiac masses in patients with suboptimal transthoracic echocardiography studies. Computed tomography and magnetic resonance imaging are additional tools used for cardiac imaging and may provide useful information in addition to that obtained by echocardiography, especially when the images obtained by the latter are suboptimal.
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Affiliation(s)
- Moluk Mirrasouli Ragland
- Department of Medicine, University of North Texas Health Science Campus, 855 Montgomery Road, 4 Floor, Fort Worth, Texas 76107, USA
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Abstract
PURPOSE OF REVIEW Recent advances in the field of three-dimensional (3D) echocardiography have allowed improved visualization of cardiac structures. These advances have also provided valuable insights into cardiac function. The purpose of this review is to describe the recent developments in 3D echocardiography in assessing valvular heart disease. RECENT FINDINGS Application of 3D echocardiography to valvular heart disease has improved with advances made in both the hardware and software components of 3D ultrasound systems. The most significant advancement has been the development of a matrix transducer that is capable of rapid real-time 3D acquisition and rendering. There have been many studies evaluating 3D echocardiographic assessment of mitral valve disease, aortic valve disease, as well as congenital heart disease using both real-time 3D transthoracic echocardiography (TTE) as well as off-line reconstructed 3D images from transesophageal echocardiography (TEE) using post image processing. More recent studies have combined the structural 3D information with color Doppler 3D imaging, providing qualitative functional information. SUMMARY Developments in the field of 3D ultrasound imaging have allowed better qualitative assessment of valvular structures. The addition of color flow Doppler to the 3D imaging has provided improved visualization of regurgitant lesions and holds great promise for improved quantitative assessment of such lesions. The ongoing miniaturization of transducers and improvements in hardware and software components of ultrasound systems will certainly enhance both the ease of image acquisition as well as image quality, which should result in more precise quantitation of valvular dysfunction. However, clinical benefits of 3D echocardiography are yet to be demonstrated in properly conducted clinical trials, which are needed for wider acceptance of this technique.
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Affiliation(s)
- Omid Salehian
- Echocardiography Laboratory, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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