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Kumar V, Katayama M, Peavler R, Alizad A, Belohlavek M, Fatemi M. Real-Time Visualization of an Acoustically Active Injection Catheter With Ultrasound Imaging: Algorithm and In Vivo Validation in a Swine Model. IEEE Trans Biomed Eng 2019; 66:3212-3219. [PMID: 30843791 DOI: 10.1109/tbme.2019.2902338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To independently visualize a catheter and needle during minimally invasive surgery in order to aid in precisely guiding them to their intended location. METHODS Symmetric frequency detection allows for the visualization of the acoustically active catheter tip as a unique color in live imaging. This study extends the algorithm to identify two different crystals by unique colors, validating the algorithm with in vivo pig experiments while simulating the human condition using different attenuation pads. RESULTS The catheter and needle tip were identified with unique colors, differentiable from common Doppler colors, with a frame rate varying between 8 and 10 Hz. Both were visible at graded levels of attenuation induced by interposed polymer pads. Reducing ensemble length increased the frame rate and decreased the signal-to-noise ratio (SNR), though not significantly. At the highest in-path attenuation of 12 dB at 5 MHz, the catheter spot marker was visible whereas the needle was not. The SNR of the catheter signal varied between 12.50 and 18.24 dB and the size of the spot marker varied between 149 and 1015 mm2. The SNR of the needle signal varied between 6.37 and 16.3 dB and the size of the spot marker between 59 and 169 mm2. A reliability index greater than 50% was achieved for all cases except for the needle crystal at the highest attenuation setting. CONCLUSION Modified symmetric frequency detection algorithm can uniquely visualize both catheter and needle in real time with in-path attenuation. SIGNIFICANCE Unambiguous and distinct visualization of separate locations on the catheter facilitates real-time tracking of minimally invasive procedures.
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Kumar V, Liu R, Kinnick RR, Gregory A, Alizad A, Belohlavek M, Fatemi M. Unambiguous Identification and Visualization of an Acoustically Active Catheter by Ultrasound Imaging in Real Time: Theory, Algorithm, and Phantom Experiments. IEEE Trans Biomed Eng 2017; 65:1468-1475. [PMID: 28952929 DOI: 10.1109/tbme.2017.2749245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Ultrasound-guided biopsies and minimally invasive procedures have been used in numerous medical applications, including catheter guidance. The biggest challenge for catheter guidance by ultrasound lies in distinguishing the catheter from neighboring tissue, as well as the ability to differentiate the catheter body from its tip. METHODS In our previous work, we introduced a functional prototype of an acoustically active catheter, in which a miniature piezoelectric crystal allowed accurate localization of the catheter tip by pulsed wave (PW) Doppler imaging and Doppler spectrogram. In this paper, the theory behind the symmetric Doppler shift due to the interaction of ultrasound wave with a vibrating piezoelectric crystal is explained. The theory is validated in an experimental continuous flow phantom setup. A novel algorithm, symmetric frequency detection algorithm, is presented for identification and visualization of the catheter tip in real time along with B-mode and PW Doppler. RESULTS The catheter tip is identified with a distinct color differentiable from common Doppler colors with a frame rate varying from 22 to 50 Hz. The catheter tip can be visualized in a small region of 2.4 mm in the elevational direction. CONCLUSION The algorithm can be implemented in most clinical ultrasound machines with minor additions to the PW Doppler processing algorithm. The algorithm is optimized to be robust for a variety of blood flow velocities and is shown to perform well when the signal from the blood is on par in amplitude with the catheter signal. SIGNIFICANCE Unambiguous and distinct visualization of catheter tip facilitates real-time tracking of the catheter and aids minimally invasive procedures.
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Abstract
Echocardiography provides a useful tool in the diagnosis of many congenital heart diseases, including atrial septal defects, and aids in further delineating treatment options. Although two-dimensional echocardiography has been the standard of care in this regard, technological advancements have made three-dimensional echocardiography possible, and the images obtained in this new imaging modality are able to accurately portray the morphology, location, dimensions, and dynamic changes of defects and many other heart structures during the cardiac cycle.
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Affiliation(s)
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ahmed MI, Escañuela MGA, Crosland WA, McMahon WS, Alli OO, Nanda NC. Utility of live/real time three-dimensional transesophageal echocardiography in the assessment and percutaneous intervention of bioprosthetic pulmonary valve stenosis. Echocardiography 2014; 31:531-3. [PMID: 24646027 DOI: 10.1111/echo.12551] [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: 11/28/2022] Open
Abstract
Accurate echocardiographic evaluation of the pulmonary valve is technically difficult because of its close proximity to the left lung, which often limits decision making. Pulmonary valvotomy is the intervention of choice for symptomatic pulmonary valve stenosis, but fluoroscopy lacks appropriate real time anatomic detail. In this report, we present a case where direct imaging of the pulmonary valve with live/real time three-dimensional transesophageal echocardiography (3DTEE) aided in accurate evaluation and was then used to help guide and monitor successful valvuloplasty of a stenotic pulmonary valve bioprosthesis. We demonstrate that even in cases where two-dimensional (2D) evaluation of the pulmonary valve is difficult, the use of live/real time 3DTEE allows for accurate evaluation of bioprosthetic pulmonary valve structure and function, and enhances the precision and monitoring of percutaneous valvuloplasty.
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Affiliation(s)
- Mustafa I Ahmed
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
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5
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Bhaya M, Mutluer FO, Mahan E, Mahan L, Hsiung MC, Yin WH, Wei J, Tsai SK, Zhao GY, Yin WH, Pradhan M, Beniwal R, Joshi D, Nabavizadeh F, Singh A, Nanda NC. Live/Real Time Three-Dimensional Transesophageal Echocardiography in Percutaneous Closure of Atrial Septal Defects. Echocardiography 2013; 30:345-53. [DOI: 10.1111/echo.12106] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Maneesha Bhaya
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Ferit Onur Mutluer
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Edward Mahan
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Luke Mahan
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Ming C. Hsiung
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Wei-Hsian Yin
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Jeng Wei
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Shen-Kou Tsai
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Guang-Yu Zhao
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Wei-Hsian Yin
- Faculty of Medicine; National Yang-Ming University; Taipei; Taiwan
| | - Manish Pradhan
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | | | - Deepak Joshi
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Fatemeh Nabavizadeh
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Amitoj Singh
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Navin C. Nanda
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
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6
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Nabavizadeh F, Nanda NC, Singh A, Mateescu C. Live/Real Time Three-Dimensional Trans Esophageal Echocardiographic Findings in Amplatzer ASD Closure Devices in Adults. Int Cardiovasc Res J 2012; 6:97-100. [PMID: 24757602 PMCID: PMC3987407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 07/26/2012] [Accepted: 08/24/2012] [Indexed: 11/28/2022] Open
Abstract
Six female patients aged from 19 to 73 years, with ostium secundum atrial septal defect underwent closure procedure with Amplatzer septal occluder device. Three-dimensional Echocardiography (3D-TEE) was done during the procedure or one day after the procedure. 3D-TEE provides incremental value over Two- dimensional trans-esophageal echocardiography in measuring Amplatzer septal occluder disc sizes and correlates well with manufacture device size. 3D-TEE will surely prove to increase the technical efficiency and it will become an important tool for the interventionists for periprocedural evaluation of device closures.
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Affiliation(s)
- Fatemeh Nabavizadeh
- Centre of Cardiology and Cardiovascular Sciences, Med Care Hospital, Dubai, UAE.,Corresponding author: Fatemeh Nabavizadeh, Cardiovascular department, Medcare hospital, Jumeirah 1, PO Box:215565,Dubai,UAE, Tel:+97144079254, Fax: +97144079188, E-mail:
| | - Navin C Nanda
- Echocardiography labratories, University of Alabama at Birmingham, USA
| | - Amitoj Singh
- Echocardiography labratories, University of Alabama at Birmingham, USA
| | - Carmen Mateescu
- Quality Coordinator, Canadian Specialist Hospital, Dubai, UAE
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7
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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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8
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Hage FG, Raslan S, Dean P, Nanda NC. Real Time Three-Dimensional Transthoracic Echocardiography in Congenital Heart Disease. Echocardiography 2011; 29:220-31. [DOI: 10.1111/j.1540-8175.2011.01555.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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Chen JY, Lin KH, Liou YM, Chang KC, Huang SKS. Usefulness of pre-procedure cavotricuspid isthmus imaging by modified transthoracic echocardiography for predicting outcome of isthmus-dependent atrial flutter ablation. J Am Soc Echocardiogr 2011; 24:1148-55. [PMID: 21764555 DOI: 10.1016/j.echo.2011.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Anatomic characteristics of the cavotricuspid isthmus (CTI) have been reported to be related to the outcome of atrial flutter ablation therapy. However, preprocedural evaluation of CTI anatomy using modified transthoracic echocardiography to guide atrial flutter ablation has not been well described. METHODS Transthoracic echocardiography was prospectively performed before atrial flutter ablation in 42 patients with typical CTI-dependent atrial flutter. A modified apical long-axis view was designed to visualize and evaluate anatomic characteristics of the CTI and Eustachian ridge (ER). A prominent ER, extending from the inferior vena cava to the interatrial septum, is defined as an extensive ER. RESULTS Twenty-eight patients had straightforward ablation procedures, and 14 patients had difficult ablation procedures. Two patients with difficult procedures had unsuccessful ablation. Multivariate analysis (using CTI length, the presence of a pouch or recess, ER morphology, and significant tricuspid regurgitation as variables) showed that the presence of extensive ER was the only independent predictor of a difficult ablation procedure. The ablation time in patients with extensive ER (n = 13) was significantly longer than in those patients with nonextensive ER (n = 29) (1,638.4 ± 1,548.3 vs 413.8 ± 195.5 sec, P = .015). The incidence of difficulty in achieving bidirectional isthmus block was also higher in patients with extensive ER (10 of 13 vs four of 29, P < .001). CONCLUSION Preprocedural transthoracic echocardiography using a modified apical long-axis view is useful to characterize the morphology of the CTI and the ER. An extensive ER is a strong predictor for difficult ablation of CTI-dependent atrial flutter.
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Affiliation(s)
- Jan-Yow Chen
- Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
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10
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Shizukuda Y, Bhatti S, Munjal J, Hu YL, Harrelson A. Personalized echocardiography: clinical applications of advanced echocardiography and future directions. Future Cardiol 2010; 6:833-44. [PMID: 21142639 DOI: 10.2217/fca.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Future cardiology practice will be increasingly individualized, and thus to maintain its central role, echocardiography must keep pushing to expand the boundaries of real-time data acquisition from tissue and fluid motion, and yet still provide efficient and timely data analysis that leads to succinct, clear clinical recommendations tailored to each person in our care. In this article, recent efforts to expand echocardiography techniques into an era of increasingly personalized cardiology, including advances in color-coded tissue Doppler, 3D echocardiography and complex exercise stress echocardiography are described. The common metric for success in each of these efforts is the development of robust and institutionally supportable echocardiography protocols for specific cardiology disease populations that currently may be underdiagnosed and/or undertreated. The common result in each case should be the creation of new guidelines that can supplement the current standard protocols advocated by professional echocardiography organizations.
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Affiliation(s)
- Yukitaka Shizukuda
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA.
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Hudaverdi M, Hamilton-Craig C, Platts D, Chan J, Burstow DJ. Echocardiography for the clinician: a practical update. Intern Med J 2010; 40:476-85. [PMID: 20059600 DOI: 10.1111/j.1445-5994.2010.02167.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: 01/06/2023]
Abstract
Echocardiography is the mainstay of cardiovascular diagnostics, and is the most performed test for the evaluation of cardiac function. Critical and costly management decisions are based on quantification of left ventricular volumes and ejection fraction. Recent advances in echocardiography, such as microsphere contrast echocardiography for left ventricular opacification and perfusion imaging, three-dimensional transthoracic and trans-oesophageal imaging, strain and tissue Doppler imaging, all contribute to improving accuracy and reproducibility of these important measurements. Such techniques are now routinely available on standard echocardiography equipment in Australian centres for daily use. Hand-carried ultrasound devices have been developed, which are portable, are affordable and offer increased availability of echocardiography to the wider community. Clinicians should be actively encouraged to adopt these technologies to improve the diagnostic quality and reproducability of echocardiography for our patients. This article provides an overview of important recent advances in echocardiographic imaging with an emphasis on their role in clinical practice today.
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Affiliation(s)
- M Hudaverdi
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia
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12
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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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13
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Dod HS, Reddy VK, Bhardwaj R, Gudausky T, Warden BE, Beto RJ, Nanda NC, Jain AC. Embolization of Atrial Septal Occluder Device into the Pulmonary Artery: A Rare Complication and Usefulness of Live/Real Time Three-Dimensional Transthoracic Echocardiography. Echocardiography 2009; 26:739-41. [DOI: 10.1111/j.1540-8175.2009.00967.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Silvestry FE, Kerber RE, Brook MM, Carroll JD, Eberman KM, Goldstein SA, Herrmann HC, Homma S, Mehran R, Packer DL, Parisi AF, Pulerwitz T, Seward JB, Tsang TSM, Wood MA. Echocardiography-guided interventions. J Am Soc Echocardiogr 2009; 22:213-31; quiz 316-7. [PMID: 19258174 DOI: 10.1016/j.echo.2008.12.013] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A major advantage of echocardiography over other advanced imaging modalities (magnetic resonance imaging, computed tomographic angiography) is that echocardiography is mobile and real time. Echocardiograms can be recorded at the bedside, in the cardiac catheterization laboratory, in the cardiovascular intensive care unit, in the emergency room-indeed, any place that can accommodate a wheeled cart. This tremendous advantage allows for the performance of imaging immediately before, during, and after various procedures involving interventions. The purpose of this report is to review the use of echocardiography to guide interventions. We provide information on the selection of patients for interventions, monitoring during the performance of interventions, and assessing the effects of interventions after their completion. In this document, we address the use of echocardiography in commonly performed procedures: transatrial septal catheterization, pericardiocentesis, myocardial biopsy, percutaneous transvenous balloon valvuloplasty, catheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO), alcohol septal ablation for hypertrophic cardiomyopathy, and cardiac electrophysiology. A concluding section addresses interventions that are presently investigational but are likely to enter the realm of practice in the very near future: complex mitral valve repairs, left atrial appendage (LAA) occlusion devices, 3-dimensional (3D) echocardiographic guidance, and percutaneous aortic valve replacement. The use of echocardiography to select and guide cardiac resynchronization therapy has recently been addressed in a separate document published by the American Society of Echocardiography and is not further discussed in this document. The use of imaging techniques to guide even well-established procedures enhances the efficiency and safety of these procedures.
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Affiliation(s)
- Frank E Silvestry
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Three-Dimensional Echocardiography. Echocardiography 2009. [DOI: 10.1007/978-1-84882-293-1_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Real Time Transthoracic Three-Dimensional Echocardiography: How Should it be Applied in the Clinical Setting? J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60113-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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17
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Three-dimensional echocardiography for management of structural heart disease. CURRENT CARDIOVASCULAR RISK REPORTS 2008. [DOI: 10.1007/s12170-008-0066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bandarupalli N, Faulkner M, Nanda NC, Pothineni KR. Erroneous Diagnosis of Significant Obstruction by Doppler in a Patient with Discrete Subaortic Membrane: Correct Diagnosis by 3D-Transthoracic Echocardiography. Echocardiography 2008; 25:1004-6. [DOI: 10.1111/j.1540-8175.2008.00720.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Karakus G, Kodali V, Inamdar V, Nanda NC, Suwanjutah T, Pothineni KR. Comparative Assessment of Left Atrial Appendage by Transesophageal and Combined Two- and Three-Dimensional Transthoracic Echocardiography‡. Echocardiography 2008; 25:918-24. [DOI: 10.1111/j.1540-8175.2008.00758.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Hage FG, Karakus G, Luke, Jr. WD, Suwanjutah T, Nanda NC, Aqel RA. Effect of Alcohol-Induced Septal Ablation on Left Atrial Volume and Ejection Fraction Assessed by Real Time Three-Dimensional Transthoracic Echocardiography in Patients with Hypertrophic Cardiomyopathy. Echocardiography 2008; 25:784-9. [DOI: 10.1111/j.1540-8175.2008.00735.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Panwar SR, Perrien JL, Nanda NC, Anurag S, Rajdev S. Real Time/Three-Dimensional Transthoracic Echocardiographic Visualization of the Valve of Foramen Ovale. Echocardiography 2007; 24:1105-7. [DOI: 10.1111/j.1540-8175.2007.00546.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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Burri MV, Mahan EF, Nanda NC, Singh A, Pothineni KR, Yelamanchili P, Panwar SR. Superior Vena Cava, Right Pulmonary Artery or Both: Real Time Two- and Three-Dimensional Transthoracic Contrast Echocardiographic Identification of the Echo-Free Space Posterior to the Ascending Aorta. Echocardiography 2007; 24:875-82. [PMID: 17767540 DOI: 10.1111/j.1540-8175.2007.00512.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe the usefulness of contrast echocardiography and live/real time three-dimensional transthoracic echocardiography in characterizing the normal structures imaged posterior to the proximal ascending aorta as superior vena cava, right pulmonary artery, or both.
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Affiliation(s)
- Manjula V Burri
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA
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Singh A, Mehmood F, Romp RL, Nanda NC, Mallavarapu RK. Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Aortopulmonary Window. Echocardiography 2007; 25:96-9. [DOI: 10.1111/j.1540-8175.2007.00558.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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Rajdev S, Singh A, Nanda NC, Baysan O, Hsiung MC. Comparison of Two- and Three-Dimensional Transthoracic Echocardiography in the Assessment of Trabeculations and Trabecular Mass in Left Ventricular Noncompaction. Echocardiography 2007; 24:760-7. [PMID: 17651107 DOI: 10.1111/j.1540-8175.2007.00504.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Twenty-one patients (mean age 47.5 years, 9 females) with left ventricular noncompaction (LVNC) diagnosed by both two-dimensional transthoracic echocardiography (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE) were included in the study. Left ventricular (LV) mass was calculated with epicardial and endocardial border tracings first including the LV trabeculations and then excluding them. LV trabecular mass was then derived as the difference between the two measurements. This was done by 2DTTE using the modified biplane Simpson's method and by live/real time 3DTTE using the Tom Tec imaging system. The number of trabeculations arising from each segment of LV walls as well as the segmental distribution of trabeculations were also assessed by both 2DTTE and 3DTTE. The calculated LV trabecular mass by 3DTTE (mean 11.8 +/- 5.5 g) was significantly greater than 2DTTE (mean 7.3 +/- 4.3 g, P = 0.005). The total number of trabeculations assessed by 3DTTE (mean 11.2 +/- 3.3) was also significantly greater than 2DTTE (mean 3.76 +/- 1.2, P < 0.0001). The values for inter- and intraobserver variability were lower for 3DTTE than 2DTTE. In conclusion, both LV trabecular mass as well as the total number of trabeculations in patients with LVNC were significantly underestimated by 2DTTE as compared to 3DTTE.
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Affiliation(s)
- Sanjay Rajdev
- Division of Cardiovascular Diseases, The University of Alabama at Birmingham, Birmingham, Alabama 35249, USA
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Burri MV, Nanda NC, Singh A, Panwar SR. Live/Real Time Three-Dimensional Transthoracic Echocardiographic Identification of Quadricuspid Aortic Valve. Echocardiography 2007; 24:653-5. [PMID: 17584206 DOI: 10.1111/j.1540-8175.2007.00456.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe an adult in whom live/real time three-dimensional echocardiography was able to make a definite diagnosis of a quadricuspid aortic valve which was misdiagnosed as bicuspid by live two-dimensional transthoracic echocardiography (2DTTE).
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Affiliation(s)
- Manjula V Burri
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA
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26
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Ren JF, Marchlinski FE. Utility of Intracardiac Echocardiography in Left Heart Ablation for Tachyarrhythmias. Echocardiography 2007; 24:533-40. [PMID: 17456073 DOI: 10.1111/j.1540-8175.2007.00426.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Catheter-based radiofrequency ablation in the left heart can provide effective therapy for tachyarrhythmias. The recent development of the real time intracardiac echocardiography (ICE) with 2D and Doppler color flow imaging can facilitate left heart ablation procedures. This report reviews the use of ICE during radiofrequency catheter ablation procedures for atrial fibrillation (AF) and ventricular tachycardia and is based on our own experience in 955 patients. ICE has a critical role for guiding transseptal catheterization, assisting placement of mapping/ablation catheters and monitoring lesion morphologic changes, especially in the pulmonary vein ostia, Marshall ligament region, thickened interatrial septum, left atrial posterior wall contiguous to esophagus, aortic valve cusps, and the epicardial regions. One of the more powerful utilities of ICE lies in its ability to identify and potentially reduce procedural complications including damage to intracardiac structures, residual atrial septal defect, left atrial thrombus formation, pulmonary vein stenosis, esophageal injury, myocardial air-embolization and pericardial effusion during left heart ablation.
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Affiliation(s)
- Jian-Fang Ren
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania, PA 19104-2692, USA.
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Hung J, Lang R, Flachskampf F, Shernan SK, McCulloch ML, Adams DB, Thomas J, Vannan M, Ryan T. 3D echocardiography: a review of the current status and future directions. J Am Soc Echocardiogr 2007; 20:213-33. [PMID: 17336747 DOI: 10.1016/j.echo.2007.01.010] [Citation(s) in RCA: 193] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Judy Hung
- Massachusetts General Hospital, Boston, MA, USA
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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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Chen FL, Hsiung MC, Hsieh KS, Li YC, Chou MC. Real Time Three-Dimensional Transthoracic Echocardiography for Guiding Amplatzer Septal Occluder Device Deployment in Patients with Atrial Septal Defect. Echocardiography 2006; 23:763-70. [PMID: 16999695 DOI: 10.1111/j.1540-8175.2006.00322.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Transcatheter Amplatzer septal occluder (ASO) device closure of atrial septal defects (ASDs) has traditionally been guided by two-dimensional transesophageal echocardiography (2D-TEE) and intracardiac echocardiography (ICE) modalities. Real time three-dimensional transthoracic echocardiography (RT3D-TTE) provides rotating images to define ASD and adjacent structures with potential as an alternative to 2D-TEE or ICE for guiding the device closure of ASD. Our aim was to assess the feasibility and effectiveness of RT3D-TTE in parasternal four-chamber views to guide ASO device closure of ASD. METHODS AND RESULTS From July 2004 to August 2005, 59 patients underwent transcatheter ASO device closure of ASD. The first 30 patients underwent 2D-TEE guidance under general anesthesia and the remaining 29 patients underwent RT3D-TTE guidance with local anesthesia. All interventions were successfully completed without complications. The clinical characteristics and transcatheter closure variables of RT3D-TTE and 2D-TEE were compared. Echocardiographic visualization of ASD and ASO deployment was found to be adequate when using either methods. Catheterization laboratory time (39.1 +/- 5.4 vs 78.8 +/- 14.1 minutes, P < 0.001) and interventional procedure length (7.6 +/- 4.2 vs 15.3 +/- 2.9 minutes, P < 0.001) were shortened by using RT3D-TTE as compared with 2DE-TEE. There was no difference in the rate of closure following either method, assessed after a 6-month follow-up. The maximal diameter measured by RT3D-TTE and 2D-TEE was correlated well with a balloon-stretched ASD size (y = 0.985x + 0.628, r = 0.924 vs y = 0.93x + 2.08, r = 0.885, respectively). CONCLUSION RT3D-TTE may be a feasible, safe, and effective alternative to the standard practice of using 2D-TEE to guide ASO deployment.
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Affiliation(s)
- Fong L Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Chung Shan Medical University Hospital, No. 110 Section 1 Chien-Kuo North Road, Taichung, Taiwan 402
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Dialetto G, Covino FE, Scognamiglio G, Della Corte A, Manduca S, Iacono C, Calabrò R, Cotrufo M. A rare complication of atrial septal occluders: diagnosis by transthoracic echocardiography. J Am Soc Echocardiogr 2006; 19:836.e5-8. [PMID: 16762768 DOI: 10.1016/j.echo.2006.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Indexed: 10/24/2022]
Abstract
Atrial septal defect transcatheter occlusion techniques have become a reliable alternative to surgical procedures. Possible complications can derive from unfavorable anatomy of the defect and over-dimensioning of the device. We describe the first case ever reported of anterior mitral leaflet perforation caused by an atrial septal occluder. The diagnosis was performed by conventional echocardiography and 3 dimensions helped for a more accurate anatomic definition. Device removal, atrial septal defect closure, and repair of the mitral tear were then successfully performed.
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Affiliation(s)
- Giovanni Dialetto
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Italy
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Chen FL, Hsiung MC, Nanda N, Hsieh KS, Chou MC. Real Time Three-Dimensional Echocardiography in Assessing Ventricular Septal Defects: An Echocardiographic-Surgical Correlative Study. Echocardiography 2006; 23:562-8. [PMID: 16911329 DOI: 10.1111/j.1540-8175.2006.00277.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Two-dimensional echocardiography (2DE) enhanced by combining with color Doppler technology has significant limitations in providing precise quantitative information, geometric assumptions to calculate chamber volume, mass, and ejection fraction. Reconstructed three-dimensional echocardiographic (3DE) systems (from multiple cross-sectional echocardiographic scans) are still cumbersome and time-consuming. Real time 3DE (RT-3DE) with shorter imaging time than with 3D reconstruction techniques can obtain qualitative and quantitative information on heart disorders. Our purpose was to investigate the feasibility and potential value of RT-3DE as a means of accurately and quantitatively estimating the size of VSD to correlate with the surgical findings. MATERIALS AND METHODS 38 patients with VSD were examined with RT-3DE. 3D image database was postprocessed using TomTec echo 3D workstation. The results were compared with the results measured by 2 DE and surgical findings. RT-3DE produced novel views of VSD and improved quantification of the size of the defect. The sizes obtained from 3DE have equivalent correlation with surgical findings as diameter measured by 2DE (r = 0.89 vs r = 0.90). Good agreement between blinded observers was achieved by little interobserver variability. CONCLUSION RT-3DE offers intraoperative visualization of VSD to generate a "virtual sense of depth" without extending examining time. From an LV en face projection, the positions, sizes, and shapes of VSDs can be accurately determined to permit quantitative recording of VSD dynamics. It is a potentially valuable clinical tool to provide precise imaging for surgical and catheter-based closure of difficult perimembranous and singular or multiple muscular VSD.
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Affiliation(s)
- Fong Lin Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
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Singh A, Romp RL, Nanda NC, Rajdev S, Mehmood F, Baysan O, Patel V, Duncan K. Usefulness of Live/Real Time Three-Dimensional Transthoracic Echocardiography in the Assessment of Atrioventricular Septal Defects. Echocardiography 2006; 23:598-608. [PMID: 16911337 DOI: 10.1111/j.1540-8175.2006.00268.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We studied nine patients (five newborns and infants, two children, and two adults) with atrioventricular septal defects (four complete, one intermediate, and four partial) utilizing live/real time three-dimensional transthoracic echocardiography (3DTTE) and a 4-MHz matrix array transducer. In all patients, 3DTTE provided additional morphological and/or functional information as compared to standard two-dimensional transthoracic echocardiography (2DTTE). 3DTTE may be a useful supplement to 2DTTE in the assessment of atrioventricular septal defects.
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Affiliation(s)
- Anurag Singh
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA
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Mehmood F, Miller AP, Nanda NC, Patel V, Singh A, Duncan K, Rajdev S, Enar S, Singh V, Nunez A, McGiffin DC, Kirklin JK, Pacifico AD. Usefulness of Live/Real Time Three-Dimensional Transthoracic Echocardiography in the Characterization of Ventricular Septal Defects in Adults. Echocardiography 2006; 23:421-7. [PMID: 16686630 DOI: 10.1111/j.1540-8175.2006.00239.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In this report, we present 12 patients (range 14-76 years, mean 40 +/- 22.7 years) who underwent surgical repair of a ventricular septal defect (VSD). Location, size, and surrounding anatomy of the VSD were assessed prior to intervention in all patients with live/real time three-dimensional transthoracic echocardiography (3DTTE). In 9 patients, measurements of maximum dimension, circumference, and area by 3DTTE correlated well with the same measurements from intraoperative three-dimensional transesophageal echocardiographic (3DTEE) reconstruction. 3DTTE measurement of maximum dimension of VSDs also agreed well with maximum dimension by surgery in 10 patients. Live/real time 3DTTE accurately defined VSD location, size, and surrounding anatomy in all patients studied by us. VSD characterization by live 3DTTE agreed well with surgery descriptions and 3DTEE measurements.
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Affiliation(s)
- Farhat Mehmood
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Alabama 35249, USA
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Rajdev S, Nanda NC, Patel V, Singh A, Yelamanchili P, Duncan K, Mehmood F. Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Mycotic Pseudoaneurysm Involving the Descending Thoracic Aorta. Echocardiography 2006; 23:340-3. [PMID: 16640716 DOI: 10.1111/j.1540-8175.2006.00235.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe a patient in whom a mycotic aneurysm involving the distal descending thoracic aorta could be definitively diagnosed by live/real time three-dimensional transthoracic echocardiography.
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Affiliation(s)
- Sanjay Rajdev
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA
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Perich Duran RM, Subirana Domènech MT, Malo Concepción P. [Progress in pediatric cardiology and congenital heart defects]. Rev Esp Cardiol 2006; 59 Suppl 1:87-98. [PMID: 16540024 DOI: 10.1157/13084452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present a review of progress reported in the fields of pediatric cardiology and congenital heart disease between July 2004 and July 2005. The review covers diagnosis, medical treatment, interventional cardiology, and surgery. Among advances in diagnosis, we highlight new diagnostic imaging methods such as three-dimensional echocardiography, magnetic resonance imaging, CT angiography, and tissue Doppler imaging. In the area of fetal cardiology, we focus on advances in fetal interventions, such as percutaneous aortic valvuloplasty, percutaneous pulmonary valvuloplasty, and intact or restrictive atrial balloon septostomy. In interventional cardiology, we highlight advances in the application of percutaneous techniques to adult congenital heart disease to help solve problems resulting from previous surgery, and we review new devices for enabling the percutaneous closure of muscular and membranous ventricular septal defects. In cardiac surgery, a number of developments in valved conduits and in aortic translocation in patients with complex transposition of the great arteries are of particular interest.
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Affiliation(s)
- Rosa M Perich Duran
- Unidad de Cardiología Pediátrica, Hospital Sabadell, Corporació Parc Taulí, Sabadell, Barcelona, Spain.
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