4
|
Rajiah P, Moore A, Saboo S, Goerne H, Ranganath P, MacNamara J, Joshi P, Abbara S. Multimodality Imaging of Complications of Cardiac Valve Surgeries. Radiographics 2019; 39:932-956. [PMID: 31150303 DOI: 10.1148/rg.2019180177] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Replacement with a prosthetic heart valve (PHV) remains the definitive surgical procedure for management of severe cardiac valve disease. PHV dysfunction is uncommon but can be a life-threatening condition. The broad hemodynamic and pathophysiologic manifestations of PHV dysfunction are stenosis, regurgitation, and a stuck leaflet. Specific structural abnormalities that cause PHV dysfunction include prosthetic valve-patient mismatch, structural failure, valve calcification, dehiscence, paravalvular leak, infective endocarditis, abscess, pseudoaneurysm, abnormal connections, thrombus, hypoattenuating leaflet thickening, and pannus. Multiple imaging modalities are available for evaluating a PHV and its dysfunction. Transthoracic echocardiography is often the first-line imaging modality, with additional modalities such as transesophageal echocardiography, CT, MRI, cine fluoroscopy, and nuclear medicine used for further characterization and establishing a specific cause. The authors review PHVs and the role of imaging modalities in evaluation of PHV dysfunction and illustrate the imaging appearances of different complications. Online supplemental material is available for this article. ©RSNA, 2019.
Collapse
Affiliation(s)
- Prabhakar Rajiah
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Alastair Moore
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Sachin Saboo
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Harold Goerne
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Praveen Ranganath
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - James MacNamara
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Parag Joshi
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Suhny Abbara
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| |
Collapse
|
7
|
Sordelli C, Severino S, Ascione L, Coppolino P, Caso P. Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr 2014; 24:103-113. [PMID: 28465917 PMCID: PMC5353566 DOI: 10.4103/2211-4122.147201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Patients submitted to valve replacement with mechanical or biological prosthesis, may present symptoms related either to valvular malfunction or ventricular dysfunction from other causes. Because a clinical examination is not sufficient to evaluate a prosthetic valve, several diagnostic methods have been proposed to assess the functional status of a prosthetic valve. This review provides an overview of echocardiographic and Doppler techniques useful in evaluation of prosthetic heart valves. Compared to native valves, echocardiographic evaluation of prosthetic valves is certainly more complex, both for the examination and the interpretation. Echocardiography also allows discriminating between intra- and/or peri-prosthetic regurgitation, present in the majority of mechanical valves. Transthoracic echocardiography (TTE) requires different angles of the probe with unconventional views. Transesophageal echocardiography (TEE) is the method of choice in presence of technical difficulties. Three-dimensional (3D)-TEE seems to be superior to 2D-TEE, especially in the assessment of paravalvular leak regurgitation (PVL) that it provides improved localization and analysis of the PVL size and shape.
Collapse
Affiliation(s)
- Chiara Sordelli
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Sergio Severino
- Unit of Cardiology, Vincenzo Monaldi Hospital, Azienda Ospedaliera di Rilievo Nazionale, Ospedali dei Colli, Naples, Italy
| | - Luigi Ascione
- Unit of Cardiology, Vincenzo Monaldi Hospital, Azienda Ospedaliera di Rilievo Nazionale, Ospedali dei Colli, Naples, Italy
| | | | - Pio Caso
- Unit of Cardiology, Vincenzo Monaldi Hospital, Azienda Ospedaliera di Rilievo Nazionale, Ospedali dei Colli, Naples, Italy
| |
Collapse
|
14
|
Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, Khandheria BK, Levine RA, Marx GR, Miller FA, Nakatani S, Quiñones MA, Rakowski H, Rodriguez LL, Swaminathan M, Waggoner AD, Weissman NJ, Zabalgoitia M. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr 2009; 22:975-1014; quiz 1082-4. [PMID: 19733789 DOI: 10.1016/j.echo.2009.07.013] [Citation(s) in RCA: 924] [Impact Index Per Article: 61.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- William A Zoghbi
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Dimitrova NA, Dimitrov GV, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. Effect of electrical stimulus parameters on the development and propagation of action potentials in short excitable fibres. J Am Coll Cardiol 1988; 63:e57-185. [PMID: 2460319 DOI: 10.1016/j.jacc.2014.02.536] [Citation(s) in RCA: 1837] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intracellular action potentials (IAPs) produced by short fibres in response to their electrical stimulation were analysed. IAPs were calculated on the basis of the Hodgkin-Huxley (1952) model by the method described by Joyner et al. (1978). Principal differences were found in processes of activation of short (semilength L less than 5 lambda) and long fibres under near-threshold stimulation. The shorter the fibre, the lower was the threshold value (Ithr). Dependence of the latency on the stimulus strength (Ist) was substantially non-linear and was affected by the fibre length. Both fibre length and stimulus strength influenced the IAP amplitude, the instantaneous propagation velocity (IPV) and the site of the first origin of the IAP (and, consequently, excitability of the short fibre membrane). With L less than or equal to 2 lambda and Ithr less than or equal to Ist less than or equal to 1.1Ithr, IPV could reach either very high values (so that all the fibre membrane fired practically simultaneously) or even negative values. The latter corresponded to the first origin of the propagated IAP, not at the site of stimulation but at the fibre termination or at a midpoint. The characters of all the above dependencies were unchanged irrespective of the manner of approaching threshold (variation of stimulus duration or its strength). Reasons for differences in processes of activation of short and long fibres are discussed in terms of electrical load and latency. Applications of the results to explain an increased jitter, velocity recovery function and velocity-diameter relationship are also discussed.
Collapse
Affiliation(s)
- N A Dimitrova
- CLBA, Centre of Biology, Bulgarian Academy of Sciences, Sofia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|