1
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Baghi M, Kohansal E, Akbarian M, Adimi S, Bakhshandeh H, Firoozi A, Salehi P, Mehdizadeh K, Hesami H, Yousefi M, Erami S, Dehghani Y, Hosseini Z, Shojaeifard M. Percutaneous versus surgical closure of paravalvular leaks in prosthetic valves: A cross-sectional comparison of clinical outcomes. Health Sci Rep 2024; 7:e70001. [PMID: 39184853 PMCID: PMC11342078 DOI: 10.1002/hsr2.70001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/30/2024] [Accepted: 08/01/2024] [Indexed: 08/27/2024] Open
Abstract
Background and Aims Paravalvular leak (PVL) is a serious complication of prosthetic valve replacement. Both surgical and percutaneous closure techniques are used for PVL closure, but optimal strategies and comparative outcomes are uncertain. This study aimed to compare the efficacy and safety of percutaneous versus surgical PVL closure by analyzing changes in leak severity, functional status, echocardiographic parameters, and clinical outcomes. Methods A total of 72 patients were included in this retrospective cross-sectional single-center study comparing percutaneous (n = 25) and surgical (n = 47) PVL closure from 2015 to 2022. Demographics, medical history, echocardiograms, laboratory data, complications, and mortality data were extracted from the records. Changes in leak severity, NYHA class, echocardiographic parameters, and clinical outcomes were compared between the percutaneous and surgical groups. Results Both percutaneous and surgical PVL closure significantly reduced leak severity and improved NYHA class (both p < 0.01), with no difference between the quantity of changes in each group. The 30-day mortality was 4% after percutaneous and 6.4% after surgical closure (p = 0.65). At 90 days, mortality was 24% percutaneous versus 17% surgical (p = 0.48). The length of stay in the hospital and post-procedural decrease in hemoglobin were considerably lower in the percutaneous group. The rate of complication rates was similar between the groups. Echocardiographic changes were also comparable. Conclusion Percutaneous and surgical PVL closure had similar efficacy in reducing leaks and improving symptoms, with no significant difference in early outcomes. Both options should be considered viable for PVL repair after heart team evaluation.
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Affiliation(s)
- Mohammadsaleh Baghi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
| | - Erfan Kohansal
- Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
| | - Mahsa Akbarian
- Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
| | - Sara Adimi
- Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
| | - Hooman Bakhshandeh
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
| | - Ata Firoozi
- Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
| | - Pegah Salehi
- Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
| | - Kasra Mehdizadeh
- Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
| | - Hamed Hesami
- Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
| | - Mina Yousefi
- Student Research CommitteeShahid Sadoughi University of Medical SciencesYazdIran
| | - Sajjad Erami
- Student Research CommitteeShahid Sadoughi University of Medical SciencesYazdIran
| | - Yeganeh Dehghani
- Student Research CommitteeShahid Sadoughi University of Medical SciencesYazdIran
| | - Zahra Hosseini
- Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
| | - Maryam Shojaeifard
- Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
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2
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Khayata M, Sanchez Nadales A, Xu B. Contemporary applications of multimodality imaging in infective endocarditis. Expert Rev Cardiovasc Ther 2024; 22:27-39. [PMID: 37996246 DOI: 10.1080/14779072.2023.2288152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/22/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Infective endocarditis (IE) is an increasingly important condition with significant morbidity and mortality. With advancements in cardiovascular interventions including prosthetic valve implantation and utilization of intracardiac devices, the prevalence of IE is rising in the modern era. Early detection and management of this condition are critical. AREAS COVERED This review presents a contemporary review of the applications of multi-modality imaging in IE, taking a comparative approach of the various imaging modalities. EXPERT OPINION Transthoracic and transesophageal echocardiography are essential imaging modalities in establishing the diagnosis of IE, as well as evaluating for complications of IE. Other imaging modalities such as cardiac computed tomography and nuclear imaging play an important role as adjuvant imaging modalities for the evaluation of IE, particularly in prosthetic valve IE and cardiovascular implantable device associated IE. It is crucial to understand the strengths, weaknesses, and clinical application of each imaging modality, to improve the diagnosis, management, and outcomes of patients with IE.
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Affiliation(s)
- Mohamed Khayata
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | | | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland, OH, USA
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3
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Abstract
Paravalvular leak (PVL) is a complication that occurs in 5-17% of patients after surgical prosthetic valve implantation. Whereas PVLs can be benign, some PVLs are associated with substantial morbidity and mortality. Percutaneous closure using occluders specifically designed to improve closure and reduce procedural complications has now become the first-line treatment for PVL. In this Review, we first detail the frequency and clinical consequences of PVL closure. The role of cardiac imaging in the assessment and management of PVL, including echocardiographic imaging and adjunctive techniques such as CT, is then discussed, together with important considerations for the percutaneous closure of PVL, such as access site and device selection. Finally, we summarize the clinical evidence for percutaneous closure of PVL, including large national registries from Ireland, Spain and the UK, as well as head-to-head data comparing this procedure with surgical closure.
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Affiliation(s)
- Joel P Giblett
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Department of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Bushra S Rana
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Leonard M Shapiro
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK. .,Department of Cardiovascular Medicine, University of Cambridge, Cambridge, UK.
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4
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Feasibility and accuracy of real-time three-dimensional echocardiography in evaluating the aortic valve in children. Egypt Heart J 2020; 72:2. [PMID: 31912327 PMCID: PMC6946771 DOI: 10.1186/s43044-019-0037-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/19/2019] [Indexed: 11/11/2022] Open
Abstract
Background Aortic valve assessment by 2D transthoracic echocardiography is a relatively complex task owing to the unique anatomical features of the left ventricular outflow tract and its dynamic nature. We aimed to evaluate the accuracy of 3D transthoracic echocardiography [3D TTE] in assessing the aortic valve in children. Results The first group included 11 males and six females, with a mean age of 5.76 ± 6.39 years. All of these patients had aortic valve disease with a bicuspid variant. The second group included seven males and seven females, with a mean age of 4.4 ± 4.05 years. All of these patients had normal aortic valve morphology and had another congenital cardiac anomaly. The aortic valve annulus was assessed using the three modalities; 2D, 3D echocardiography in the vertical and horizontal diameters, and angiography. The aortic valve area was measured by 2D and 3D echocardiography using multiplane reformatted mode. The results of the analysis were then compared. They revealed that 3D echocardiographic measurement of the aortic annulus (horizontal diameter) correlated better with angiography than 2D and 3D (vertical diameter) echocardiographic measurements. There was a significant difference between the aortic valve area measured by 2D echocardiography and that measured by 3D echocardiography among the two groups, 2D echocardiography seems to underestimate the true aortic valve area. Conclusion The study concluded that 3D TTE with multiplane reformatted mode allows a more accurate assessment of the aortic valve when compared to 2D echocardiography and this correlates better with the angiographic findings.
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5
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Galzerano D, Kinsara AJ, Di Michele S, Vriz O, Fadel BM, Musci RL, Galderisi M, Al Sergani H, Colonna P. Three dimensional transesophageal echocardiography: a missing link in infective endocarditis imaging? Int J Cardiovasc Imaging 2020; 36:403-413. [PMID: 31902093 DOI: 10.1007/s10554-019-01747-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
The role of two dimensional (2D) echocardiography (ECHO) for the diagnosis and clinical decision making in infective endocarditis (IE) has been extensively studied and described in the medical literature. Some reports have demonstrated the incremental value of three dimensional (3D) transesophageal (TE) ECHO in the setting of IE. However, a systematic review focusing on the role of 3D imaging is lacking. In this manuscript, we examine the role of 3D TE ECHO in the diagnosis of IE. IE is a challenging disease in which 2D transthoracic (TT) and TE ECHO have complementary roles and are unequivocally the mainstay of diagnostic imaging. Still, 2D imaging has important limitations. Technological advances in 3D imaging allow for the reconstruction of real-time anatomical images of cardiac structure and function. 3D imaging has emerged as a diagnostic technique that overcame some of the limitations of 2D ECHO. Currently, both transthoracic and transesophageal echocardiography transducers are able to generate 3D images. However, 3D TE ECHO provides images of a higher quality in comparison to 3D TT ECHO, and is the best echocardiographic modality able to allow for a detailed anatomical imaging. 3D TE ECHO may represent the key adjunctive echocardiographic technique being able to positively impact on IE-related surgical planning and intervention and to facilitate the interaction between the surgeon and the imaging specialist. Importantly, 3D TE ECHO is not the recommended initial modality of choice for the diagnosis of IE; however, in highly specialized centers, it has become an important complementary technique when advanced surgical planning is required. Furthermore, anatomical imaging has become the link between the different techniques that play a role in IE imaging. In fact, both computed tomography and magnetic resonance allow three dimensional reconstruction. An important future goal should allow for the fusion among various imaging modalities. Our review highlights the role of 3D TE ECHO in IE imaging and emphasize where it offers incremental value.
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Affiliation(s)
- Domenico Galzerano
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. .,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Abdulhalim J Kinsara
- Ministry of National Guard Health Affair, COM-WR, King Abdullah International Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Sara Di Michele
- Divisione di Cardiologia, Ospedale San Filippo Neri, Rome, Italy
| | - Olga Vriz
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Bahaa M Fadel
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rita Leonarda Musci
- Ecocardiografia Basale e Complessa, Azienda Ospedaliera Universitaria, Policlinico di Bari, Bari, Italy
| | - Maurizio Galderisi
- Department of Cardiology, Cardiac Surgery and Cardiovascular Emergencies, Federico II, University of Naples, Naples, Italy
| | - Hani Al Sergani
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Paolo Colonna
- Ecocardiografia Basale e Complessa, Azienda Ospedaliera Universitaria, Policlinico di Bari, Bari, Italy
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6
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Nicoara A. The Added Power of the Third Dimension. J Cardiothorac Vasc Anesth 2019; 33:3509-3510. [PMID: 31255402 DOI: 10.1053/j.jvca.2019.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Alina Nicoara
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
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7
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Pozo E, Olmos C, de Agustín JA, Jiménez-Ballvé A, Pérez de Isla L, Macaya C. Avances en el diagnóstico por imagen de la endocarditis infecciosa izquierda. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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8
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. Eur Heart J 2017; 39:1224-1245. [DOI: 10.1093/eurheartj/ehx211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/15/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Carlos E Ruiz
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | - Rebecca T Hahn
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
| | | | - Jeffrey S Borer
- State University of New York Downstate Medical Center and College of Medicine, New York, New York
| | | | - Greg Fontana
- Cedars Sinai Medical Center, Los Angeles, California
| | | | - Reda Ibrahim
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Vladimir Jelnin
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | | | | | - Chad Kliger
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Itzhak Kronzon
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Patrick Nataf
- AP-HP Hôpital Bichat Service de Cardiologie, Paris, France
| | | | | | | | | | | | - Paul Sorajja
- Minneapolis Heart Institute and Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | - Zoltan G Turi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | | | | | - Martin B Leon
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
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9
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. J Am Coll Cardiol 2017; 69:2067-2087. [DOI: 10.1016/j.jacc.2017.02.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/09/2017] [Accepted: 02/15/2017] [Indexed: 01/05/2023]
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10
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Olmos C, Vilacosta I, López J, Sarriá C, Ferrera C, San Román JA. Actualización en endocarditis protésica. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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11
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Cruz-Gonzalez I, Rama-Merchan JC, Rodríguez-Collado J, Martín-Moreiras J, Diego-Nieto A, Barreiro-Pérez M, Sánchez PL. Transcatheter closure of paravalvular leaks: state of the art. Neth Heart J 2016; 25:116-124. [PMID: 27878547 PMCID: PMC5260617 DOI: 10.1007/s12471-016-0918-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Paravalvular leak (PVL) is a serious complication after surgical valve replacement or after transcatheter aortic valve replacement. Approximately 1-5% of PVLs can lead to serious clinical consequences, including congestive heart failure and/or haemolytic anaemia. For years, surgical re-intervention has been considered the treatment of choice for symptomatic patients with PVLs. However, surgical re-intervention is associated with a high risk of morbidity and mortality. Transcatheter PVL (TPVL) closure is a less invasive alternative to surgical re-intervention. The safety and feasibility of TPVL closure has been confirmed in several registries and a meta-analysis.In this review, we discuss the clinical implications and diagnosis of PVLs, technical considerations for TPVL, execution of the procedure and assessment of the results.
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Affiliation(s)
- I Cruz-Gonzalez
- Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - J C Rama-Merchan
- Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain. .,Cardiology Department, Hospital of Merida, Badajoz, Spain.
| | - J Rodríguez-Collado
- Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - J Martín-Moreiras
- Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - A Diego-Nieto
- Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - M Barreiro-Pérez
- Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - P L Sánchez
- Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
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12
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Simpson J, Lopez L, Acar P, Friedberg MK, Khoo NS, Ko HH, Marek J, Marx G, McGhie JS, Meijboom F, Roberson D, Van den Bosch A, Miller O, Shirali G. Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2016; 30:1-27. [PMID: 27838227 DOI: 10.1016/j.echo.2016.08.022] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good acoustic windows and the non-invasive nature of the technique. The aim of this paper is to provide a review of the optimal application of 3DE in CHD including technical considerations, image orientation, application to different lesions, procedural guidance, and functional assessment.
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Affiliation(s)
- John Simpson
- Evelina London Children's Hospital, London, United Kingdom.
| | - Leo Lopez
- Nicklaus Children's Hospital, Miami, Florida
| | | | | | - Nee S Khoo
- Stollery Children's Hospital & University of Alberta, Edmonton, Alberta, Canada
| | - H Helen Ko
- Mt. Sinai Medical Center, New York, New York
| | - Jan Marek
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Gerald Marx
- Boston Children's Hospital and Harvard School of Medicine, Boston, Massachusetts
| | - Jackie S McGhie
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - David Roberson
- Advocate Children's Hospital, Chicago Medical School, Chicago, Illinois
| | | | - Owen Miller
- Evelina London Children's Hospital, London, United Kingdom
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13
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Simpson J, Lopez L, Acar P, Friedberg M, Khoo N, Ko H, Marek J, Marx G, McGhie J, Meijboom F, Roberson D, Van den Bosch A, Miller O, Shirali G. Three-dimensional echocardiography in congenital heart disease: an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1071-97. [DOI: 10.1093/ehjci/jew172] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/28/2016] [Indexed: 01/02/2023] Open
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14
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Khalique OK, Hahn RT. Multimodality Imaging in Transcatheter Mitral Interventions. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005071. [DOI: 10.1161/circimaging.116.005071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Omar K. Khalique
- From the Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY
| | - Rebecca T. Hahn
- From the Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY
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15
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Cruz-Gonzalez I, Rama-Merchan JC, Calvert PA, Rodríguez-Collado J, Barreiro-Pérez M, Martín-Moreiras J, Diego-Nieto A, Hildick-Smith D, Sánchez PL. Percutaneous Closure of Paravalvular Leaks: A Systematic Review. J Interv Cardiol 2016; 29:382-92. [PMID: 27242018 DOI: 10.1111/joic.12295] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Paravalvular leak (PVL) is an uncommon yet serious complication associated with the implantation of mechanical or bioprosthetic surgical valves and more recently recognized with transcatheter aortic valves implantation (TAVI). A significant number of patients will present with symptoms of congestive heart failure or haemolytic anaemia due to PVL and need further surgical or percutaneous treatment. Until recently, surgery has been the only available therapy for the treatment of clinically significant PVLs despite the significant morbidity and mortality associated with re-operation. Percutaneous treatment of PVLs has emerged as a safe and less invasive alternative, with low complication rates and high technical and clinical success rates. However, it is a complex procedure, which needs to be performed by an experienced team of interventional cardiologists and echocardiographers. This review discusses the current understanding of PVLs, including the utility of imaging techniques in PVL diagnosis and treatment, and the principles, outcomes and complications of transcatheter therapy of PVLs.
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Affiliation(s)
| | | | - Patrick A Calvert
- Queen Elizabeth Hospital, University Hospitals Birmingham and Institute of Translational Medicine, University of Birmingham, United Kingdom
| | | | | | | | | | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
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16
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Three-dimensional compared to two-dimensional transesophageal echocardiography for diagnosis of infective endocarditis. Infection 2016; 44:725-731. [PMID: 27189337 DOI: 10.1007/s15010-016-0908-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/11/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE Transesophageal echocardiography is crucial for the diagnosis of infective endocarditis (IE). Use of three-dimensional transesophageal echocardiography (3D-TEE) could improve the reliability of echocardiographic findings. This study sought to determine the value of 3D-TEE in the diagnosis of IE in comparison to two-dimensional (2D)-TEE and 2D transthoracic echocardiography (2D-TTE). METHODS In this prospective cohort study in a tertiary care university hospital 144 consecutive patients with clinically suspected IE were included. The patients were subjected to clinical, microbiological and echocardiographic evaluation (2D-TTE, 2D-TEE and 3D-TEE) and their clinical history evaluated retrospectively to establish a reference diagnosis of IE in accordance to current guideline recommendations. RESULTS In 48 (33 %) patients the diagnosis of IE was established. 2D-TEE and 3D-TEE showed a sensitivity, specificity, positive and negative predictive value for diagnosis of IE of 94 % and 63, 90 and 95 %, 82 and 86 % and 97 and 83 %, respectively, with similar results in patients with native and prosthetic valves. Vegetations and abscess were detected in 43 and 5 patients with final diagnosis of IE by any of the assessed echocardiographic modalities, with only one case of vegetation detected by 3D-TEE only and not by 2D-TEE. CONCLUSIONS In this cohort of patients with suspected IE, 3D-TEE showed substantial lower sensitivity and negative predictive value for diagnosis of IE when compared to 2D-TEE. 3D-TEE might provide additive diagnostic information with impact on clinical decisions only in individual cases.
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17
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Arribas-Jimenez A, Rama-Merchan JC, Barreiro-Pérez M, Merchan-Gómez S, Iscar-Galán A, Martín-García A, Nieto-Ballestero F, Sánchez-Corral E, Rodriguez-Collado J, Cruz-González I, Sanchez PL. Utility of Real-Time 3-Dimensional Transesophageal Echocardiography in the Assessment of Mitral Paravalvular Leak. Circ J 2016; 80:738-44. [PMID: 26823141 DOI: 10.1253/circj.cj-15-0802] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mitral paravalvular leak (PVL) is a potential complication of surgical valve replacement procedures. Real-time 3D transesophageal echocardiography (RT-3DTEE) has emerged as an efficient tool for providing essential information about the anatomy of mitral PVLs compared with 2DTEE findings. The purpose of this study was to evaluate the utility of RT-3DTEE in the assessment of mitral PVLs. METHODS AND RESULTS The 3D characteristics of PVLs were recorded and compared with 2D findings. We included 34 consecutive patients with clinical suspicion of mitral PVL in the study. Mitral PVLs were detected in 26 patients (76%); 26 PVLs were identified by 2DTEE and 37 by RT-3DTEE. Moderate or severe mitral regurgitation was present in 23 patients (88%). The most common PVL locations were the septal and posterior regions. The median PVL size measured by RT-3DTEE was 7 mm long×4 mm wide. The median vena contracta of defect measured by 2DTEE and RT-3DTEE was 5 mm and 4 mm, respectively. The median effective regurgitant orifice area of defect measured by RT-3DTEE was 0.36 cm(2). The defect types were "oval" (54%), "round" (35%), "crescentic" (8%) and highly irregular (3%). CONCLUSIONS Compared with 2DTEE, RT-3DTEE provided detailed descriptions of the number, location, size and morphology of PVLs, which is essential for planning and guiding the potential corrective techniques. (Circ J 2016; 80: 738-744).
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Urmeneta Ulloa J, Molina Borao I, Aured Guallar C, Lapuente González P, Moreno Esteban E, Calvo Cebollero I. Three-Dimensional Echocardiography in the Evaluation of the Dehiscence of Mitral Valve Annuloplasty Ring. Circulation 2015; 132:e388-90. [PMID: 26700011 DOI: 10.1161/circulationaha.115.016064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vilacosta I, Olmos C, de Agustín A, López J, Islas F, Sarriá C, Ferrera C, Ortiz-Bautista C, Sánchez-Enrique C, Vivas D, San Román A. The diagnostic ability of echocardiography for infective endocarditis and its associated complications. Expert Rev Cardiovasc Ther 2015; 13:1225-36. [PMID: 26471429 DOI: 10.1586/14779072.2015.1096780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Echocardiography, transthoracic and transoesophageal, plays a key role in the diagnosis and prognosis assessment of patients with infective endocarditis. It constitutes a major Duke criterion and is pivotal in treatment guiding. Seven echocardiographic findings are major criteria in the diagnosis of infective endocarditis (IE) (vegetation, abscess, pseudoaneurysm, fistulae, new dehiscence of a prosthetic valve, perforation and valve aneurysm). Echocardiography must be performed as soon as endocarditis is suspected. Transoesophageal echocardiography should be done in most cases of left-sided endocarditis to better define the anatomic lesions and to rule out local complications. Transoesophageal echocardiography is not necessary in isolated right-sided native valve IE with good quality transthoracic examination and unequivocal echocardiographic findings. Echocardiography is a very useful tool to assess the prognosis of patients with IE at any time during the course of the disease. Echocardiographic predictors of poor outcome include presence of periannular complications, prosthetic dysfunction, low left ventricular ejection fraction, pulmonary hypertension and very large vegetations.
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Affiliation(s)
- Isidre Vilacosta
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Olmos
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto de Agustín
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier López
- b 2 Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fabián Islas
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Sarriá
- c 3 Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Carlos Ferrera
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Ortiz-Bautista
- b 2 Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - David Vivas
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto San Román
- b 2 Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Abstract
Echocardiography is the imaging modality of choice for the assessment of patients with valvular heart disease. Echocardiographic advancements may have particular impact on the assessment and management of patients with valvular heart disease. This review will summarize the current literature on advancements, such as three-dimensional echocardiography, strain imaging, intracardiac echocardiography, and fusion imaging, in this patient population.
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Affiliation(s)
- Rebecca Hahn
- Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA
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21
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Konoske R, Whitener G, Nicoara A. Intraoperative Evaluation of Paravalvular Regurgitation by Transesophageal Echocardiography. Anesth Analg 2015. [DOI: 10.1213/ane.0000000000000787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Magunia H, Rosenberger P. [Application fields of intraoperative transesophageal 3D echocardiography]. Anaesthesist 2015; 63:662-72, 674-7. [PMID: 24994014 DOI: 10.1007/s00101-014-2346-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Intraoperative transesophageal echocardiography (TEE) is an established diagnostic tool and has to be regarded as the standard of care for intraoperative monitoring and cardiac surgical decision-making. Furthermore, intraoperative TEE is also used for monitoring and assessment of hemodynamic changes and the detection of previously unknown pathologies. In the past few years 3D-TEE has extended the spectrum of 2D-TEE by allowing pathomorphological features to be more easily and intuitively linked to the anatomy of the heart and the great vessels. Thus, a comprehensive 2D-TEE examination is favorably complemented by focused 3D-TEE. Especially during mitral valve surgery, 3D-TEE has proven its superiority in the diagnosis of the underlying pathology as demonstrated by a large number of studies in this field. This review presents the available data about the role of intraoperative 3D-TEE echocardiography and introduces practical fields of application.
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Affiliation(s)
- H Magunia
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Eberhard-Karls-Universität, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland,
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23
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Alli OO, Hsiung MC, Guvenc T, Neill J, Elguindy M, Ahmed MI, Gaba S, Nanda NC. Incremental Value of Three-Dimensional Transesophageal Echocardiography over the Two-Dimensional Technique in Percutaneous Closure of Aortic Paraprosthetic Regurgitation. Echocardiography 2014; 31:1154-8. [DOI: 10.1111/echo.12758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Oluseun O. Alli
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Ming C. Hsiung
- Division of Cardiology; Cheng Hsin General Hospital; Taipei Taiwan
| | - Tolga Guvenc
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - John Neill
- Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama
| | - Mostafa Elguindy
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Mustafa I. Ahmed
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Saurabh Gaba
- 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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24
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Tanis W, Teske AJ, van Herwerden LA, Chamuleau S, Meijboom F, Budde RP, Cramer MJ. The Additional Value of Three-Dimensional Transesophageal Echocardiography in Complex Aortic Prosthetic Heart Valve Endocarditis. Echocardiography 2014; 32:114-25. [DOI: 10.1111/echo.12602] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Wilco Tanis
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Cardiology; Haga Teaching Hospital; The Hague The Netherlands
| | - Arco J. Teske
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Lex A. van Herwerden
- Department of Cardiothoracic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Steven Chamuleau
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Folkert Meijboom
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Ricardo P.J. Budde
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Maarten-Jan Cramer
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
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25
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Dabir D, Arroyo-Ucar E, Ucar EA, Nagel E. [Imaging following valve replacement]. Radiologe 2013; 53:896-907. [PMID: 24036904 DOI: 10.1007/s00117-012-2470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patients who undergo heart valve replacement require lifelong cardiac follow-up care. Although the primary pathology of the patient is treated by valve replacement, the risk of postoperative complications and structural failure of the implanted device requires regular check-ups where imaging plays an important role. Immediately after surgery reference values regarding prosthetic and cardiac function for further check-ups are obtained. Transthoracic and transesophageal echocardiography are the imaging modalities of choice for standard examination and follow-up due to their availability and low costs. However, when it comes to identification of complications they are often insufficient. Magnetic resonance imaging (MRI) and computed tomography (CT) play an increasingly important role as complementary modalities for the detection and monitoring of complications after valve replacement. The following article gives an overview of the current non-invasive examination methods and the use in the investigation of postoperative complications.
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Affiliation(s)
- D Dabir
- Department of Cardiovascular Imaging, The Ranyne Institute, St. Thomas Hospital, King's College London , SE1 7EH, London, UK
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26
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Intraoperative evaluation of transmitral pressure gradients after edge-to-edge mitral valve repair. PLoS One 2013; 8:e73617. [PMID: 24023891 PMCID: PMC3759443 DOI: 10.1371/journal.pone.0073617] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/23/2013] [Indexed: 12/11/2022] Open
Abstract
Objective Edge-to-edge repair of the mitral valve (MV) has been described as a viable option used for the surgical management of mitral regurgitation (MR). Based on the significant changes in MV geometry associated with this technique, we hypothesized that edge-to-edge MV repairs are associated with higher intraoperative transmitral pressure gradients (TMPG) compared to conventional methods. Methods Patient records and intraoperative transesophageal echocardiography (TEE) examinations of 552 consecutive patients undergoing MV repair at a single institution over a three year period were assessed. After separation from cardiopulmonary bypass (CPB), peak and mean TMPG were recorded for each patient and subsequently analyzed. Results 84 patients (15%) underwent edge-to-edge MV repair. Peak and mean TMPG were significantly higher compared to gradients in patients undergoing conventional repairs: 10.7±0.5 mmHg vs 7.1±0.2 mmHg; P<0.0001 and 4.3±0.2 mmHg vs 2.8±0.1 mmHg; P<0.0001. Only patients with mean TMPG ≥7 mmHg (n = 9) required prompt reoperation for iatrogenic mitral stenosis (MS). No differences in peak and mean TMPG were observed among edge-to-edge repairs performed in isolation, compared to those performed in combination with annuloplasty: 11.0±0.7 mmHg vs 10.3±0.6 mmHg and 4.4±0.3 mmHg vs 4.3±0.3 mmHg. There were no differences in TMPG between various types of annuloplasty techniques used in combination with the edge-to-edge repairs. Conclusions Edge-to-edge MV repairs are associated with higher intraoperative peak and mean TMPG after separation from CPB compared to conventional repair techniques. Unless gradients are severely elevated, these findings are not necessarily suggestive of iatrogenic MS. Thus, in the immediate postoperative period mildly elevated TMPG can be expected and tolerated after edge-to-edge mitral repairs.
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27
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Abstract
Infectious endocarditis remains both a diagnostic and a treatment challenge. A positive outcome depends on a rapid diagnosis, accurate risk stratification, and a thorough follow-up. Imaging plays a key role in each of these steps and echocardiography remains the cornerstone of the methods in use. The technique of both transthoracic echocardiography and transoesophageal echocardiography has been markedly improved across the last decades and most recently three-dimensional real-time echocardiography has been introduced in the management of endocarditis patients. Echocardiography depicts structural changes and abnormalities in the heart, but it does not uncover the underlying pathophysiological processes at the cellular or molecular level. This problem is addressed with introduction of new molecular imaging methods as (18)F-fluorodesoxyglucose ((18)F-FDG) PET-CT and single photon emission computed tomography fused with conventional CT (SPECT/CT). Of these methods, (18)F-FDG PET-CT carries the best promise for a future role in endocarditis. But there are distinct limitations with both SPECT/CT and (18)F-FDG PET-CT which should not be neglected. MRI and spiral CT are methods primarily used in the search for extra cardial infectious foci. A flowchart for the use of imaging in both left-sided and right-sided endocarditis is suggested.
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Affiliation(s)
- Niels Eske Bruun
- Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, Hellerup 2900, Denmark
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28
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29
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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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30
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Zaragoza-Macias E, Zaragosa-Macias E, Chen MA, Gill EA. Real time three-dimensional echocardiography evaluation of intracardiac masses. Echocardiography 2012; 29:207-19. [PMID: 22283202 DOI: 10.1111/j.1540-8175.2011.01627.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The evaluation of cardiac masses is often a challenge for cardiac imaging techniques. The traditional standby has been two-dimensional echocardiography (2DE). Real time three-dimensional echocardiography (RT3DE) offers incremental value for the evaluation of intracardiac masses by providing more accurate assessment of the size and shape of the mass as well as in some cases, composition of the mass. RT3DE aids with the relationship between the mass and adjacent structures. Therefore, here we discuss the subject of RT3DE evaluation of cardiac masses is reviewed and discussed in detail.
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Affiliation(s)
- Elisa Zaragoza-Macias
- Department of Medicine, Division of Cardiology, University of Washington, Harborview Medical Center, Seattle, Washington 98104, USA
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31
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Chen SY, Lee KC, Hsiung MC, Yin WH. Live/real time three-dimensional transesophageal echocardiography in the assessment of aortic root patch dehiscence. Echocardiography 2012; 29:E233-6. [PMID: 22672577 DOI: 10.1111/j.1540-8175.2012.01760.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report a 66-year-old man who underwent partial reconstruction of the aortic root and presented with heart failure 2 months after the procedure. We used live/real time three-dimensional transesophageal echocardiography (3DTEE) to detect the exact site of the dehiscence flap and extent of the leakage. This information could be valuable to surgeons.
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Affiliation(s)
- Sheng-Yuan Chen
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
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32
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Joshi D, Bicer EI, Donmez C, Hsiung MC, Nanda NC, Sadat K, Sudhakar S, Ibrahim H, Pandey A, Karia N, Bhagatwala K, Yin WH, Chung YC, Tsai SK, Dumaswala B, Dumaswala K. Incremental Value of Live/Real Time Three-Dimensional Transesophageal Echocardiography over the Two-Dimensional Technique in the Assessment of Aortic Aneurysm and Dissection. Echocardiography 2012; 29:620-30. [DOI: 10.1111/j.1540-8175.2012.01715.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Hage FG, Adegunsoye A, Mundkur M, Nanda NC. The role of echocardiography in the evaluation and management of aortic stenosis in the older adult. Int J Cardiol 2012; 155:39-48. [PMID: 21397347 DOI: 10.1016/j.ijcard.2011.01.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 01/01/2011] [Indexed: 11/25/2022]
Abstract
Aortic stenosis is currently the most predominant valvular pathology in older adults. Signs and symptoms of aortic stenosis in this age-group may be difficult to recognize due to the decreased activity associated with aging and attribution of symptoms to other conditions. Echocardiography can be very helpful in the assessment of valvular structure and real time hemodynamic evaluation as well as in the progression of the disease over time. Unprecedented advances in echocardiography, including real time three-dimensional echocardiography, facilitate a comprehensive assessment of this condition and help in the decision-making process. Recent innovations in the percutaneous treatment of valvular diseases promise a revolution in the treatment of aortic stenosis especially in older adults.
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Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL 35249, USA
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34
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Zhang L, Xie M, Balluz R, Ge S. Real Time Three-Dimensional Echocardiography for Evaluation of Congenital Heart Defects: State of the Art. Echocardiography 2012; 29:232-41. [DOI: 10.1111/j.1540-8175.2011.01589.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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35
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Sudhakar S, Khairnar P, Nanda NC. Live/Real Time Three-Dimensional Transesophageal Echocardiography. Echocardiography 2012. [DOI: 10.1111/j.1540-8175.2011.01525.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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36
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Riegel AK, Busch R, Segal S, Fox JA, Eltzschig HK, Shernan SK. Evaluation of transmitral pressure gradients in the intraoperative echocardiographic diagnosis of mitral stenosis after mitral valve repair. PLoS One 2011; 6:e26559. [PMID: 22087230 PMCID: PMC3210749 DOI: 10.1371/journal.pone.0026559] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 09/28/2011] [Indexed: 12/18/2022] Open
Abstract
Objective Acute mitral stenosis (MS) following mitral valve (MV) repair is a rare but severe complication. We hypothesize that intraoperative echocardiography can be utilized to diagnose iatrogenic MS immediately after MV repair. Methods The medical records of 552 consecutive patients undergoing MV repair at a single institution were reviewed. Post-cardiopulmonary bypass peak and mean transmitral pressure gradients (TMPG), and pressure half time (PHT) were obtained from intraoperative transesophageal echocardiographic (TEE) examinations in each patient. Results Nine patients (9/552 = 1.6%) received a reoperation for primary MS, prior to hospital discharge. Interestingly, all of these patients already showed intraoperative post-CPB mean and peak TMPGs that were significantly higher compared to values for those who did not: 10.7±4.8 mmHg vs 2.9±1.6 mmHg; p<0.0001 and 22.9±7.9 mmHg vs 7.6±3.7 mmHg; p<0.0001, respectively. However, PHT varied considerably (87±37 ms; range: 20–439 ms) within the entire population, and only weakly predicted the requirement for reoperation (113±56 vs. 87±37 ms, p = 0.034). Receiver operating characteristic curves showed strong discriminating ability for mean gradients (AUC = 0.993) and peak gradients (area under the curve, AUC = 0.996), but poor performance for PHT (AUC = 0.640). A value of ≥7 mmHg for mean, and ≥17 mmHg for peak TMPG, best separated patients who required reoperation for MS from those who did not. Conclusions Intraoperative TEE diagnosis of a peak TMPG ≥17 mmHg or mean TMPG ≥7 mmHg immediately following CPB are suggestive of clinically relevant MS after MV repair.
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Affiliation(s)
- Ann K. Riegel
- Department of Anesthesiology, University of Colorado Denver, Denver, Colorado, United States of America
| | - Raila Busch
- Department for Cardiology, Angiology, Pneumology and Intensive Care Medicine, University Hospital Greifswald, Greifswald, Germany
| | - Scott Segal
- Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - John A. Fox
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Holger K. Eltzschig
- Department of Anesthesiology, University of Colorado Denver, Denver, Colorado, United States of America
- * E-mail: (SKS); (HKE)
| | - Stanton K. Shernan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (SKS); (HKE)
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Three-dimensional echocardiography in paravalvular aortic regurgitation assessment after transcatheter aortic valve implantation. J Am Soc Echocardiogr 2011; 25:47-55. [PMID: 21962448 DOI: 10.1016/j.echo.2011.08.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) is common, but the evaluation of its severity by two-dimensional (2D) transthoracic echocardiography (TTE) presents several constrains. The aim of this study was to assess the usefulness of a new methodology, using three-dimensional (3D) TTE, for better assessment of paravalvular AR after TAVI. METHODS Two-dimensional and 3D TTE was performed in 72 patients, 5 months after TAVI, using the X5-1 PureWave microbeamforming xMATRIX probe. The position and severity of the paravalvular AR jets were described using 2D and 3D TTE, and a model was designed for paravalvular AR systematic location description. Vena contracta width was measured using 2D transthoracic echocardiographic views, and the planimetry of the vena contracta was assessed after the perfect alignment plane was obtained using the multiplanar 3D transthoracic echocardiographic reconstruction tool. AR volume was calculated as the difference between 3D TTE-derived total left ventricular stroke volume and right ventricular stroke volume estimated using 2D TTE. Diagnostic efficiency for moderate AR was assessed using receiver operating characteristic curve analysis. RESULTS Forty-three patients (57.4%) presented with AR; 10 (13.3%) had central AR, and 33 (44.0%) had paravalvular AR jets. Vena contracta widths were similar between patients with moderate and mild AR (2.1 ± 0.53 vs 1.9 ± 0.16 mm, P = .16), but vena contracta planimetry was larger in patients with moderate AR than in those with mild AR (0.30 ± 0.12 vs 0.09 ± 0.07 cm(2), P = .001). Vena contracta planimetry on 3D TTE was better correlated with AR volume than vena contracta width on 2D TTE (Kendall's τ = 0.82 [P < .001] vs 0.66 [P < .001]). The areas under the receiver operating characteristic curves were 0.96 for vena contracta planimetry and 0.35 for vena contracta width. CONCLUSIONS This study proposes an alternative methodology for paravalvular AR assessment after TAVI. Using vena contracta planimetry on 3D TTE, an accurate methodology for paravalvular AR jet evaluation and moderate AR classification is described.
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Cappelli F, Del Bene MR, Santoro G, Meucci F, Attanà P, Barletta G. The challenge of integrated echocardiographic approach in percutaneous closure of paravalvular leak. Echocardiography 2011; 28:E168-71. [PMID: 21827537 DOI: 10.1111/j.1540-8175.2011.01444.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Paravalvular leak after prosthetic mitral valve surgery may lead to symptomatic mitral regurgitation and hemolytic anemia requiring reoperation. Percutaneous closure of paravalvular leaks is a relatively recent technique still considered a challenging procedure burdened by possible complications, to be offered only to poor redo surgical candidate patients. Multimodality imaging is advocated to plan and guide the procedure, to minimize the risk of complications. We report on a case of dehisced prosthetic mitral valve in which transthoracic real time three-dimensional echocardiography was used to locate the dehiscence area and characterize mitral paraprosthesis leak, whereas intracardiac echocardiography was used to guide and monitor the percutaneous closure procedure.
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39
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Abstract
Prosthetic heart valve (PHV) dysfunction is a rare, but potentially life-threatening, complication. In clinical practice, PHV dysfunction poses a diagnostic dilemma. Echocardiography and fluoroscopy are the imaging techniques of choice and are routinely used in daily practice. However, these techniques sometimes fail to determine the specific cause of PHV dysfunction, which is crucial to the selection of the appropriate treatment strategy. Multidetector-row CT (MDCT) can be of additional value in diagnosing the specific cause of PHV dysfunction and provides valuable complimentary information for surgical planning in case of reoperation. Cardiac magnetic resonance imaging (CMR) has limited value in the evaluation of biological PHV dysfunction. In this Review, we discuss the use of established imaging modalities for the detection of left-sided mechanical and biological PHV dysfunction and discuss the complementary role of MDCT in this context.
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40
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Willens HJ, Hendel RC, Qin JX, Ma C, Keith K, Torres S, Grossman JR, Moscucci M. Effect of Performing Real Time Three-Dimensional Transesophageal Echocardiography in Addition to Two-Dimensional Transesophageal Echocardiography on Operator Diagnostic Confidence. Echocardiography 2011; 28:235-42. [DOI: 10.1111/j.1540-8175.2010.01286.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tsang W, Weinert L, Kronzon I, Lang RM. Ecocardiografía tridimensional en la evaluación de las válvulas protésicas. Rev Esp Cardiol 2011; 64:1-7. [DOI: 10.1016/j.recesp.2010.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 09/19/2010] [Indexed: 11/25/2022]
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