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El-Nashar H, Sabry M, Tseng YT, Francis N, Latif N, Parker KH, Moore JE, Yacoub MH. Multiscale structure and function of the aortic valve apparatus. Physiol Rev 2024; 104:1487-1532. [PMID: 37732828 DOI: 10.1152/physrev.00038.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
Whereas studying the aortic valve in isolation has facilitated the development of life-saving procedures and technologies, the dynamic interplay of the aortic valve and its surrounding structures is vital to preserving their function across the wide range of conditions encountered in an active lifestyle. Our view is that these structures should be viewed as an integrated functional unit, here referred to as the aortic valve apparatus (AVA). The coupling of the aortic valve and root, left ventricular outflow tract, and blood circulation is crucial for AVA's functions: unidirectional flow out of the left ventricle, coronary perfusion, reservoir function, and support of left ventricular function. In this review, we explore the multiscale biological and physical phenomena that underlie the simultaneous fulfillment of these functions. A brief overview of the tools used to investigate the AVA, such as medical imaging modalities, experimental methods, and computational modeling, specifically fluid-structure interaction (FSI) simulations, is included. Some pathologies affecting the AVA are explored, and insights are provided on treatments and interventions that aim to maintain quality of life. The concepts explained in this article support the idea of AVA being an integrated functional unit and help identify unanswered research questions. Incorporating phenomena through the molecular, micro, meso, and whole tissue scales is crucial for understanding the sophisticated normal functions and diseases of the AVA.
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Affiliation(s)
- Hussam El-Nashar
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Malak Sabry
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Yuan-Tsan Tseng
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nadine Francis
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Najma Latif
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - James E Moore
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Magdi H Yacoub
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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La Mura L, Lembo M, Musella F, D’Amato M, D’Andrea A, Izzo R, Esposito G. Aortic Regurgitation in Bicuspid Aortic Valve: The Role of Multimodality Imaging. J Clin Med 2024; 13:3924. [PMID: 38999489 PMCID: PMC11242072 DOI: 10.3390/jcm13133924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
The evaluation of aortic regurgitation (AR) in bicuspid valve (BAV) is still a challenge because of the eccentricity of the jet, which may under/overestimate the regurgitation. The commonly used echocardiography parameters (such as vena contracta, pressure half-time, etc.) may not be useful in this kind of patient. A multimodality approach combining echocardiography, cardiac MRI, cardiac CT, and advanced technologies applied to non-invasive cardiac imaging (e.g., 4D flow and strain imaging) may be useful to better quantify regurgitation and to select patients suitable for valve replacement. This review provides an overview of the most recent insights about cardiovascular imaging tools and their utility in BAV evaluation, focusing on chronic regurgitation. We describe the role of multimodality imaging in both diagnosis and risk assessment of this disease, pointing out the advantages and disadvantages of the imaging techniques, aiming to provide a guide to clinicians and cardiovascular imaging specialists in choosing the best imaging tools to use.
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Affiliation(s)
- Lucia La Mura
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (M.L.); (R.I.); (G.E.)
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (M.L.); (R.I.); (G.E.)
| | - Francesca Musella
- Division of Cardiology, S. Maria delle Grazie Hospital, 80078 Pozzuoli, Italy;
- Division of Cardiology, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Marianna D’Amato
- Servicio de Cardiologìa, Hospital Central de La Defensa Gomez Ulla, 28028 Madrid, Spain;
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy;
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (M.L.); (R.I.); (G.E.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (M.L.); (R.I.); (G.E.)
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Broncano J, Hanneman K, Ghoshhajra B, Rajiah PS. Cardiac Computed Tomography of Native Cardiac Valves. Radiol Clin North Am 2024; 62:399-417. [PMID: 38553177 DOI: 10.1016/j.rcl.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Valvular heart disease (VHD) is a significant clinical problem associated with high morbidity and mortality. Although not being the primary imaging modality in VHD, cardiac computed tomography (CCT) provides relevant information about its morphology, function, severity grading, and adverse cardiac remodeling assessment. Aortic valve calcification quantification is necessary for grading severity in cases of low-flow/low-gradient aortic stenosis. Moreover, CCT details significant information necessary for adequate percutaneous treatment planning. CCT may help to detail the etiology of VHD as well as to depict other less frequent causes of valvular disease, such as infective endocarditis, valvular neoplasms, or other cardiac pseudomasses.
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Affiliation(s)
- Jordi Broncano
- Cardiothoracic Imaging Unit, Radiology Department, Hospital San Juan de Dios, HT Medica, Avenida El Brillante Nº 36, Córdoba 14012, Spain.
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G2N2, Canada
| | - Brian Ghoshhajra
- Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charles River Plaza East, 165 Cambridge Street, Boston, MA 02114, USA
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Broncano J, Rajiah PS, Vargas D, Sánchez-Alegre ML, Ocazionez-Trujillo D, Bhalla S, Williamson E, Fernández-Camacho JC, Luna A. Multimodality Imaging of Infective Endocarditis. Radiographics 2024; 44:e230031. [PMID: 38329903 DOI: 10.1148/rg.230031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Infective endocarditis (IE) is a complex multisystemic disease resulting from infection of the endocardium, the prosthetic valves, or an implantable cardiac electronic device. The clinical presentation of patients with IE varies, ranging from acute and rapidly progressive symptoms to a more chronic disease onset. Because of its severe morbidity and mortality rates, it is necessary for radiologists to maintain a high degree of suspicion in evaluation of patients for IE. Modified Duke criteria are used to classify cases as "definite IE," "possible IE," or "rejected IE." However, these criteria are limited in characterizing definite IE in clinical practice. The use of advanced imaging techniques such as cardiac CT and nuclear imaging has increased the accuracy of these criteria and has allowed possible IE to be reclassified as definite IE in up to 90% of cases. Cardiac CT may be the best choice when there is high clinical suspicion for IE that has not been confirmed with other imaging techniques, in cases of IE and perivalvular involvement, and for preoperative treatment planning or excluding concomitant coronary artery disease. Nuclear imaging may have a complementary role in prosthetic IE. The main imaging findings in IE are classified according to the site of involvement as valvular (eg, abnormal growths [ie, "vegetations"], leaflet perforations, or pseudoaneurysms), perivalvular (eg, pseudoaneurysms, abscesses, fistulas, or prosthetic dehiscence), or extracardiac embolic phenomena. The differential diagnosis of IE includes evaluation for thrombus, pannus, nonbacterial thrombotic endocarditis, Lambl excrescences, papillary fibroelastoma, and caseous necrosis of the mitral valve. The location of the lesion relative to the surface of the valve, the presence of a stalk, and calcification or enhancement at contrast-enhanced imaging may offer useful clues for their differentiation. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Prabhakar Shanta Rajiah
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Maria Luisa Sánchez-Alegre
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Daniel Ocazionez-Trujillo
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Eric Williamson
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - José Carlos Fernández-Camacho
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
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Bahadormanesh N, Tomka B, Abdelkhalek M, Khodaei S, Maftoon N, Keshavarz-Motamed Z. A Doppler-exclusive non-invasive computational diagnostic framework for personalized transcatheter aortic valve replacement. Sci Rep 2023; 13:8033. [PMID: 37198194 PMCID: PMC10192526 DOI: 10.1038/s41598-023-33511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
Given the associated risks with transcatheter aortic valve replacement (TAVR), it is crucial to determine how the implant will affect the valve dynamics and cardiac function, and if TAVR will improve or worsen the outcome of the patient. Effective treatment strategies, indeed, rely heavily on the complete understanding of the valve dynamics. We developed an innovative Doppler-exclusive non-invasive computational framework that can function as a diagnostic tool to assess valve dynamics in patients with aortic stenosis in both pre- and post-TAVR status. Clinical Doppler pressure was reduced by TAVR (52.2 ± 20.4 vs. 17.3 ± 13.8 [mmHg], p < 0.001), but it was not always accompanied by improvements in valve dynamics and left ventricle (LV) hemodynamics metrics. TAVR had no effect on LV workload in 4 patients, and LV workload post-TAVR significantly rose in 4 other patients. Despite the group level improvements in maximum LV pressure (166.4 ± 32.2 vs 131.4 ± 16.9 [mmHg], p < 0.05), only 5 of the 12 patients (41%) had a decrease in LV pressure. Moreover, TAVR did not always improve valve dynamics. TAVR did not necessarily result in a decrease (in 9 out of 12 patients investigated in this study) in major principal stress on the aortic valve leaflets which is one of the main contributors in valve degeneration and, consequently, failure of heart valves. Diastolic stresses increased significantly post-TAVR (34%, 109% and 81%, p < 0.001) for each left, right and non-coronary leaflets respectively. Moreover, we quantified the stiffness and material properties of aortic valve leaflets which correspond with the reduced calcified region average stiffness among leaflets (66%, 74% and 62%; p < 0.001; N = 12). Valve dynamics post-intervention should be quantified and monitored to ensure the improvement of patient conditions and prevent any further complications. Improper evaluation of biomechanical valve features pre-intervention as well as post-intervention may result in harmful effects post-TAVR in patients including paravalvular leaks, valve degeneration, failure of TAVR and heart failure.
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Affiliation(s)
- Nikrouz Bahadormanesh
- Department of Mechanical Engineering, McMaster University, JHE-310, Hamilton, ON, L8S 4L7, Canada
| | - Benjamin Tomka
- Department of Mechanical Engineering, McMaster University, JHE-310, Hamilton, ON, L8S 4L7, Canada
| | | | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University, JHE-310, Hamilton, ON, L8S 4L7, Canada
| | - Nima Maftoon
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, JHE-310, Hamilton, ON, L8S 4L7, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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6
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Gogia S, Vahl TP, Thourani VH, Yadav PK, George I, Kodali SK, Hamid N, Ranard L, Chen T, Matsumura M, Maehara A, Treede H, Baldus S, Daniels D, Sheridan BC, Zahr F, Russo MJ, McCabe JM, Chetcuti SJ, Leon MB, Makkar RR, Khalique OK. Cardiac Computed Tomography Angiography Anatomical Characterization of Patients Screened for a Dedicated Transfemoral Transcatheter Valve System for Primary Aortic Regurgitation. STRUCTURAL HEART 2023. [DOI: 10.1016/j.shj.2023.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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7
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Bahadormanesh N, Tomka B, Kadem M, Khodaei S, Keshavarz-Motamed Z. An ultrasound-exclusive non-invasive computational diagnostic framework for personalized cardiology of aortic valve stenosis. Med Image Anal 2023; 87:102795. [PMID: 37060702 DOI: 10.1016/j.media.2023.102795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Aortic stenosis (AS) is an acute and chronic cardiovascular disease and If left untreated, 50% of these patients will die within two years of developing symptoms. AS is characterized as the stiffening of the aortic valve leaflets which restricts their motion and prevents the proper opening under transvalvular pressure. Assessments of the valve dynamics, if available, would provide valuable information about the patient's state of cardiac deterioration as well as heart recovery and can have incredible impacts on patient care, planning interventions and making critical clinical decisions with life-threatening risks. Despite remarkable advancements in medical imaging, there are no clinical tools available to quantify valve dynamics invasively or noninvasively. In this study, we developed a highly innovative ultrasound-based non-invasive computational framework that can function as a diagnostic tool to assess valve dynamics (e.g. transient 3-D distribution of stress and displacement, 3-D deformed shape of leaflets, geometric orifice area and angular positions of leaflets) for patients with AS at no risk to the patients. Such a diagnostic tool considers the local valve dynamics and the global circulatory system to provide a platform for testing the intervention scenarios and evaluating their effects. We used clinical data of 12 patients with AS not only to validate the proposed framework but also to demonstrate its diagnostic abilities by providing novel analyses and interpretations of clinical data in both pre and post intervention states. We used transthoracic echocardiogram (TTE) data for the developments and transesophageal echocardiography (TEE) data for validation.
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Affiliation(s)
| | - Benjamin Tomka
- Department of Mechanical Engineering, McMaster University Hamilton, ON, Canada
| | - Mason Kadem
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University Hamilton, ON, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University Hamilton, ON, Canada; School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada; School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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8
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Voit J, Otto CM, Burke CR. Acute native aortic regurgitation: clinical presentation, diagnosis and management. BRITISH HEART JOURNAL 2022; 108:1651-1660. [PMID: 35641177 DOI: 10.1136/heartjnl-2021-320157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jay Voit
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Christopher R Burke
- Department of Cardiac Surgery, University of Washington, Seattle, Washington, USA
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9
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Carrabba N, Pontone G, Andreini D, Buffa V, Cademartiri F, Carbone I, Clemente A, Guaricci AI, Guglielmo M, Indolfi C, La Grutta L, Ligabue G, Liguori C, Mercuro G, Mushtaq S, Neglia D, Palmisano A, Sciagrà R, Seitun S, Vignale D, Francone M, Esposito A. Appropriateness criteria for the use of cardiac computed tomography, SIC-SIRM part 2: acute chest pain evaluation; stent and coronary artery bypass graft patency evaluation; planning of coronary revascularization and transcatheter valve procedures; cardiomyopathies, electrophysiological applications, cardiac masses, cardio-oncology and pericardial diseases evaluation. J Cardiovasc Med (Hagerstown) 2022; 23:290-303. [PMID: 35486680 DOI: 10.2459/jcm.0000000000001303] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the past 20 years, cardiac computed tomography (CCT) has become a pivotal technique for the noninvasive diagnostic workup of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Randomized clinical trials documented the value of CCT in increasing the cost-effectiveness of the management of patients with acute chest pain presenting in the emergency department, also during the pandemic. Beyond the evaluation of stents and surgical graft patency, the anatomical and functional coronary imaging have the potential to guide treatment decision-making and planning for complex left main and three-vessel coronary disease. Furthermore, there has been an increasing demand to use CCT for preinterventional planning in minimally invasive procedures, such as transcatheter valve implantation and mitral valve repair. Yet, the use of CCT as a roadmap for tailored electrophysiological procedures has gained increasing importance to assure maximum success. In the meantime, innovations and advanced postprocessing tools have generated new potential applications of CCT from the simple coronary anatomy to the complete assessment of structural, functional and pathophysiological biomarkers of cardiac disease. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), represents the second of two consensus documents collecting the expert opinion of cardiologists and radiologists about current appropriate use of CCT.
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Affiliation(s)
- Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS.,Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome
| | | | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Massa
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, University of Palermo
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, Modena and Raggio Emilia University.,Radiology Department, AOU of Modena, Modena
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare -A.S.L Na1- Centro, Naples
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | | | - Danilo Neglia
- Cardiovascular Department, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Pisa
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence
| | - Sara Seitun
- Radiology Department, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia e le Neuroscienze, Genoa, Italy
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
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10
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Choi E, Mathews LM, Paik J, Corretti MC, Wu KC, Michos ED, Hays AG, Mukherjee M. Multimodality Evaluation of Aortic Insufficiency and Aortitis in Rheumatologic Diseases. Front Cardiovasc Med 2022; 9:874242. [PMID: 35497991 PMCID: PMC9039512 DOI: 10.3389/fcvm.2022.874242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
Aortic insufficiency is commonly observed in rheumatologic diseases such as ankylosing spondylitis, systemic lupus erythematosus, antiphospholipid syndrome, Behçet's disease, granulomatosis with polyangiitis, and Takayasu arteritis. Aortic insufficiency with an underlying rheumatologic disease may be caused by a primary valve pathology (leaflet destruction, prolapse or restriction), annular dilatation due to associated aortitis or a combination of both. Early recognition of characteristic valve and aorta morphology on cardiac imaging has both diagnostic and prognostic importance. Currently, echocardiography remains the primary diagnostic tool for aortic insufficiency. Complementary use of computed tomography, cardiac magnetic resonance imaging and positron emission tomography in these systemic conditions may augment the assessment of underlying mechanism, disease severity and identification of relevant non-valvular/extracardiac pathology. We aim to review common rheumatologic diseases associated with aortic insufficiency and describe their imaging findings that have been reported in the literature.
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Affiliation(s)
- Eunjung Choi
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH, United States
| | - Lena M. Mathews
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Julie Paik
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Mary C. Corretti
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Monica Mukherjee
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11
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Karout L, Salman R, Ershaid F, Sawaya F, Abi-Ghanem AS. Imaging Modalities Employed in the TAVR Procedure With a Focus on CTA: What the Radiologist Needs to Know. Acad Radiol 2022; 29 Suppl 4:S69-S81. [PMID: 34551883 DOI: 10.1016/j.acra.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Aortic stenosis (AS) is one of the most common valvular heart disease. Symptomatic AS is associated with a high mortality rate which prompts fast intervention. The introduction of transcatheter aortic valve replacement (TAVR) has drastically improved the outcome of high surgical risk for mortality patients with severe AS. However, this procedure requires the employment of multimodality imaging in the pre-procedural planning, intra-procedural optimization, and post-procedural follow-up stages. This also requires an accurate understanding of the indications, measurements, strength, and limitations of each imaging modality during the different TAVR stages. CONCLUSION In this review, we aim to outline to radiologists the evidence-based approach and indications of different imaging modalities through the pre, peri, and post TAVR stages.
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12
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Maleszewski JJ, Lai CK, Nair V, Veinot JP. Anatomic considerations and examination of cardiovascular specimens (excluding devices). Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Assaf A, Berry R, Mantha Y, Zughaib M, Saba S. Isolated Ventricular Septal Aneurysm: A Differential Diagnosis for a Right Sinus of Valsalva Aneurysm. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930930. [PMID: 34023848 PMCID: PMC8164883 DOI: 10.12659/ajcr.930930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/15/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND A ventricular septal aneurysm (VSA) is rare and almost always an incidental finding on cardiac imaging. It is rarely an isolated phenomenon and is more commonly associated with other forms of congenital heart disease such a ventricular septal defect (VSD). Differentiating a ventricular septal aneurysm from an aneurysm of the right sinus of Valsalva is crucial as the latter usually has a more aggressive course and may require surgical intervention. Cardiac computed tomography (cardiac CT) or cardiac magnetic resonance imaging (CMR) may help confirm the diagnosis. CASE REPORT We report a case of a 42-year-old obese Japanese man with a past medical history of hyperlipidemia who described occasional effort-related palpitations when climbing stairs over the past few months but no anginal symptoms. Echocardiogram revealed normal left ventricular systolic with a presumed right sinus of Valsalva aneurysm measuring around 1.5 cm. A coronary CTA was obtained to further delineate the aneurysm and revealed normal CT angiographic appearance of a right dominant coronary artery circulation with a small aneurysmal outpouching of the membranous ventricular septum measuring 13×17 mm without any evidence of shunting, along with focal calcification of the medial aspect of the tricuspid annulus. The right sinus of Valsalva appeared normal on coronary CTA. CONCLUSIONS Membranous ventricular septal aneurysm is a rare condition that is almost always an incidental finding on echocardiography and can be mistaken for an aneurysm of the right sinus of Valsalva. Multimodality imaging and high degree of clinical suspicion are needed to accurately diagnose a ventricular septal aneurysm and to achieve favorable outcomes. A VSA usually has a benign course and is rarely a cause of arrythmia, right ventricular outflow obstruction, or valvular insufficiency.
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Affiliation(s)
- Andrew Assaf
- Department of Cardiology, Ascension Providence Hospital, Southfield, MI, U.S.A
| | - Ryan Berry
- School of Medicine, Michigan State University, Lansing, MI, U.S.A
| | - Yogamaya Mantha
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, Dallas, TX, U.S.A
| | - Marcel Zughaib
- Department of Cardiology, Ascension Providence Hospital, Southfield, MI, U.S.A
| | - Souheil Saba
- Department of Cardiology, Ascension Providence Hospital, Southfield, MI, U.S.A
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14
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Saeedan MB, Wang TKM, Cremer P, Wahadat AR, Budde RPJ, Unai S, Pettersson GB, Bolen MA. Role of Cardiac CT in Infective Endocarditis: Current Evidence, Opportunities, and Challenges. Radiol Cardiothorac Imaging 2021; 3:e200378. [PMID: 33778655 PMCID: PMC7977690 DOI: 10.1148/ryct.2021200378] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/13/2020] [Accepted: 10/05/2020] [Indexed: 11/11/2022]
Abstract
Infective endocarditis (IE) can present with variable clinical and imaging findings and is associated with high morbidity and mortality. Substantial improvement of CT technology, most notably improved temporal and spatial resolution, has resulted in increased use of this modality in the evaluation of IE. The aim of this article is to review the potential role of cardiac CT in evaluating IE. Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Mnahi Bin Saeedan
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Tom Kai Ming Wang
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Paul Cremer
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Ali R. Wahadat
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Ricardo P. J. Budde
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Shinya Unai
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Gosta B. Pettersson
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
| | - Michael A. Bolen
- From the Section of Cardiovascular Imaging, Imaging Institute (M.B.S., T.K.M.W., P.C., M.A.B.), Section of Cardiovascular Imaging, Heart and Vascular Institute (T.K.M.W., P.C., M.A.B.), and Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute (S.U., G.B.P.), Cleveland Clinic, 9500 Euclid Ave, J1-4, Cleveland, OH 44915; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W., R.P.J.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.R.W.); and Department of Cardiology, Haga Hospital, The Hague, the Netherlands (A.R.W.)
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15
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Aortic valve surgery: management and outcomes in the paediatric population. Eur J Pediatr 2021; 180:3129-3139. [PMID: 33970315 PMCID: PMC8429384 DOI: 10.1007/s00431-021-04092-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/18/2021] [Accepted: 04/25/2021] [Indexed: 11/02/2022]
Abstract
Congenital anomalies of the aortic valve frequently necessitate intervention in childhood. The most common aortic valve pathologies present in childhood are aortic stenosis and insufficiency. Presentation of aortic valve disease depends on severity and presence of concomitant syndromes and valvular disorders. Treatment options are largely categorised as medical, percutaneous repair or surgical repair and replacement. Surgical techniques have been refined over the last few years making this the mainstay of treatment in paediatric cases. Whilst repair is considered in most instances before replacement, there are substantial limitations which are reflected in the frequency of reintervention and restenosis rate. Replacements are typically undertaken with tissue or mechanical prosthesis. The current gold-standard aortic valve replacement surgery is called the Ross procedure-where replacement is undertaken with a competent pulmonic valve and a simultaneous pulmonary homograft.Conclusion: In this review, we aim to outline the various surgical options and discuss efficacy and complications of various interventions. What is Known: • Congenital aortic valve defects repair options medically and surgically What is New: • Comparisons between surgical options for aortic valve repair including efficacy, risks and long-term outcomes.
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16
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Bucher AM, Albrecht MH, Scholtz JE, Herrmann E, Kaup M, Gruber-Rouh T, Jacobi V, Vogl TJ, Beeres M. High-pitch Dual-source CT Angiography before TAVI - the Value of ECG Gating. Curr Med Imaging 2020; 15:373-379. [PMID: 31989906 DOI: 10.2174/1573405614666180528102949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/30/2018] [Accepted: 05/10/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate image quality, and radiation dose between ECG-gated singlesource and dual-source CT Angiography (CTA) protocols for planning of Trans-catheter Aortic Valve Implantation (TAVI) with a reference non ECG-gated single-source protocol. METHODS A total of 120 patients were included in four groups: Non ECG-gated single-source (SS), ECG-gated single-source (SSECG), ECG-gated dual-source high-pitch (DSECG), or non-ECG-gated dual-source high-pitch mode (DS). Qualitative image quality of the aortic annulus, aortic valve, and coronary ostia as well as presence of motion or stair-step artefacts of the thoracic aorta were independently assessed by two readers. Quantitative image quality was assessed to calculate contrast to noise ratio. RESULTS Subjective and objective scoring of motion artefacts was significantly reduced in SSECG, DSECG and DS (p= 0.010). The imaging length was comparable between groups. Aortic annulus, aortic valve, and coronary ostia were reliably evaluable in all patients with SSECG, DSECG and DS protocols. CONCLUSION High-pitch, dual-source CT angiography of the whole aorta with or without ECG gating is a dose-efficient and time-saving examination strategy before TAVI. However acquisition timing within the cardiac cycle needs to be taken into account.
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Affiliation(s)
- Andreas Michael Bucher
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Moritz Hans Albrecht
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jan Erik Scholtz
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eva Herrmann
- Department of Biostatistics, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Moritz Kaup
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Volkmar Jacobi
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas Josef Vogl
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Martin Beeres
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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17
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Saffarzadeh M, Gaewsky JP, Tan J, Lahm R, Upadhya B, Jao GT, Weaver AA. Cardiothoracic Morphology Measures in Heart Failure Patients to Inform Device Designs. Cardiovasc Eng Technol 2019; 10:543-552. [PMID: 31637595 DOI: 10.1007/s13239-019-00436-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 10/05/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Approximately 5.7 million people in the US are affected by congestive heart failure. This study aimed to quantitatively evaluate cardiothoracic morphology and variability within a cohort of heart failure patients for the purpose of optimally engineering cardiac devices for a variety of heart failure patients. METHODS Co-registered cardiac-gated and non-gated chest computed tomography (CT) scans were analyzed from 20 heart failure patients (12 males; 8 females) who were primarily older adults (79.5 ± 8.8 years). Twelve cardiothoracic measurements were collected and compared to study sex and left ventricular (LV) ejection fraction (EF) type differences in cardiothoracic morphology. RESULTS Four measures were significantly greater in males compared to females: LV long-axis length, LV end diastolic diameter (LVEDD) at 50% length of the LV long-axis, the minimal distance between the sternum and heart, and the angle between the LV long-axis and coronal plane. Four measures were significantly greater in patients with reduced EF compared to preserved LV: LV long-axis length, LVEDD at 50% length of the LV long-axis, left ventricular volume normalized by body surface area, and the angle between the mitral valve plane and LV long-axis. CONCLUSIONS These cardiothoracic morphology measurements are important to consider in the design of cardiac devices for heart failure management (e.g. cardiac pacemakers, ventricular assist devices, and implantable defibrillators), since morphology differs by sex and ejection fraction.
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Affiliation(s)
- Mona Saffarzadeh
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, 575 N. Patterson Ave., Suite 120, Winston-Salem, NC, 27101, USA.,Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - James P Gaewsky
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, 575 N. Patterson Ave., Suite 120, Winston-Salem, NC, 27101, USA.,Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Joshua Tan
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Ryan Lahm
- Medtronic, Minneapolis, MN, 55432-5604, USA
| | - Bharathi Upadhya
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Geoffrey T Jao
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Ashley A Weaver
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, 575 N. Patterson Ave., Suite 120, Winston-Salem, NC, 27101, USA. .,Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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18
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Biomechanical assessment of aortic valve stenosis: Advantages and limitations. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2019. [DOI: 10.1016/j.medntd.2019.100009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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19
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Computed Tomography Appearance of Uncorrected Congenital Heart Disease in Adults. J Thorac Imaging 2019; 34:W13-W22. [DOI: 10.1097/rti.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Krieger EV, Stout KK, Grosse-Wortmann L. How to Image Congenital Left Heart Obstruction in Adults. Circ Cardiovasc Imaging 2019; 10:CIRCIMAGING.116.004271. [PMID: 28495822 DOI: 10.1161/circimaging.116.004271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Eric V Krieger
- From the Seattle Adult Congenital Heart Service, University of Washington Medical Center (E.V.K., K.K.S.); Seattle Children's Hospital, Washington (E.V.K., K.K.S.); Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle (E.V.K., K.K.S.); and Labatt Family Heart Centre, Department of Pediatrics, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, ON, Canada (L.G.-W.)
| | - Karen K Stout
- From the Seattle Adult Congenital Heart Service, University of Washington Medical Center (E.V.K., K.K.S.); Seattle Children's Hospital, Washington (E.V.K., K.K.S.); Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle (E.V.K., K.K.S.); and Labatt Family Heart Centre, Department of Pediatrics, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, ON, Canada (L.G.-W.)
| | - Lars Grosse-Wortmann
- From the Seattle Adult Congenital Heart Service, University of Washington Medical Center (E.V.K., K.K.S.); Seattle Children's Hospital, Washington (E.V.K., K.K.S.); Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle (E.V.K., K.K.S.); and Labatt Family Heart Centre, Department of Pediatrics, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, ON, Canada (L.G.-W.).
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21
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Abstract
Valvular heart disease is a common clinical problem. Although echocardiography is the standard technique for the noninvasive evaluation of the valves, cardiac CT has evolved to become a useful tool in the evaluation of the cardiac structures as well. Importantly, CT allows for improved quantification of valvular calcification due to its superior spatial resolution. It may improve the detection of small valvular or perivalvular pathology or the characterization of valvular masses and vegetations. This review describes the assessment of normal and diseased heart valves by cardiac CT and discusses its strengths and weaknesses.
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22
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Functional classification of aortic regurgitation using cardiac computed tomography: comparison with surgical inspection. Int J Cardiovasc Imaging 2018; 34:1295-1303. [PMID: 29564585 DOI: 10.1007/s10554-018-1341-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
In patients with aortic regurgitation (AR), a precise preoperative assessment of aortic valve (AV) pathology is important if AV repair or sparing operation is an alternative option. The aim of this study was to assess the diagnostic accuracy of computed tomography (CT) for evaluating the AR mechanism compared with surgical inspection. 59 patients with AR who underwent AV surgery and preoperative cardiac CT were evaluated. AR mechanism was classified into type 1 (aortic dilatation or cusp perforation), type 2 (prolapsed cusp) and type 3 (cusp retraction). Agreement between CT and surgical inspection was obtained. Correlation between aortic regurgitant orifice (ARO) and imaging parameters were evaluated. On surgical inspection, type 1 AR was noted in 22 patients, type 2 in 16 and type 3 in 21. Agreement regarding the AR mechanism on CT was excellent (intra-class correlation coefficient, 0.81). At the patient level, the Cohen's κ value for CT findings with surgical inspection was of 0.89. At the cusp level, moderate agreement was noted between CT and surgical inspection. In the per-cusp analysis, CT had a sensitivity of 72.6%, specificity of 85.1%, positive predictive value of 73.8% and negative predictive value of 84.3% for the detection of aortic cusp abnormality. The diameter, perimeter and area of aortic annulus had moderate correlation with ARO (r = 0.54-0.66, P < 0.001). CT-derived classification of AR mechanism showed excellent agreement with surgical inspection.
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23
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Lee JC, Branch KR, Hamilton-Craig C, Krieger EV. Evaluation of aortic regurgitation with cardiac magnetic resonance imaging: a systematic review. Heart 2017; 104:103-110. [PMID: 28822982 DOI: 10.1136/heartjnl-2016-310819] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/31/2017] [Indexed: 11/03/2022] Open
Abstract
This review summaries the utility, application and data supporting use of cardiac magnetic resonance imaging (CMR) to evaluate and quantitate aortic regurgitation. We systematically searched Medline and PubMed for original research articles published since 2000 that provided data on the quantitation of aortic regurgitation by CMR and identified 11 articles for review. Direct aortic measurements using phase contrast allow quantitation of volumetric flow across the aortic valve and are highly reproducible and accurate compared with echocardiography. However, this technique requires diligence in prescribing the correct imaging planes in the aorta. Volumetric analytic techniques using differences in ventricular volumes are also highly accurate but less than phase contrast techniques and only accurate when concomitant valvular disease is absent. Comparison of both aortic and ventricular data for internal data verification ensures fidelity of aortic regurgitant data. CMR data can be applied to many types of aortic valve regurgitation including combined aortic stenosis with regurgitation, congenital valve diseases and post-transcatheter valve placement. CMR also predicts those patients who progress to surgery with high overall sensitivity and specificity. Future studies of CMR in patients with aortic regurgitation to quantify the incremental benefit over echocardiography as well as prediction of cardiovascular events are warranted.
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Affiliation(s)
- James C Lee
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kelley R Branch
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Christian Hamilton-Craig
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.,Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia.,Department of Cardiology, Heart & Lung Institute, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Eric V Krieger
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.,Seattle Adult Congenital Heart Service, University of Washington School of Medicine, Seattle, Washington, USA
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Feasibility of a single-beat prospective ECG-gated cardiac CT for comprehensive evaluation of aortic valve disease using a 256-detector row wide-volume CT scanner: an initial experience. Int J Cardiovasc Imaging 2017; 34:293-300. [DOI: 10.1007/s10554-017-1223-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/31/2017] [Indexed: 12/14/2022]
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Radiographic Evaluation of Valvular Heart Disease With Computed Tomography and Magnetic Resonance Correlation. J Thorac Imaging 2017; 31:273-84. [PMID: 27548877 DOI: 10.1097/rti.0000000000000225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Valvular heart disease is a group of complex entities with varying etiologies and clinical presentations. There are a number of imaging tools available to supplement clinical evaluation of suspected valvular heart disease, with echocardiography being the most common and clinically established, and more recent emergence of computed tomography and magnetic resonance imaging as additional supportive techniques. Yet even with these newer and more sophisticated modalities, chest radiography remains one of the earliest and most common diagnostic examinations performed during the triage of patients with suspected cardiac dysfunction. Recognizing the anatomic and pathologic features of cardiac radiography including the heart's adaptation to varying hemodynamic changes can provide clues to the radiologist regarding the underlying etiology. In this article, we will elucidate several principles relating to chamber modifications in response to pressure and volume overload as well as radiographic appearances associated with pulmonary fluid status and cardiac dysfunction. We will also present a pattern approach to optimize analysis of the chest radiograph for valvular heart disease, which will help guide the radiologist down a differential diagnostic pathway and create a more meaningful clinical report.
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Sritharen Y, Enriquez-Sarano M, Schaff HV, Casaclang-Verzosa G, Miller JD. Pathophysiology of Aortic Valve Stenosis: Is It Both Fibrocalcific and Sex Specific? Physiology (Bethesda) 2017; 32:182-196. [PMID: 28404735 PMCID: PMC6148342 DOI: 10.1152/physiol.00025.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 12/24/2022] Open
Abstract
Our understanding of the fundamental biology and identification of efficacious therapeutic targets in aortic valve stenosis has lagged far behind the fields of atherosclerosis and heart failure. In this review, we highlight the most clinically relevant problems facing men and women with fibrocalcific aortic valve stenosis, discuss the fundamental biology underlying valve calcification and fibrosis, and identify key molecular points of intersection with sex hormone signaling.
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Affiliation(s)
- Yoginee Sritharen
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Grace Casaclang-Verzosa
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Jordan D Miller
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota;
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; and the
- Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota
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The Role of Cardiac CT in the Evaluation of Endocarditis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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MRI evaluation prior to Transcatheter Aortic Valve Implantation (TAVI): When to acquire and how to interpret. Insights Imaging 2016; 7:245-54. [PMID: 26911969 PMCID: PMC4805621 DOI: 10.1007/s13244-016-0470-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/07/2016] [Accepted: 01/26/2016] [Indexed: 12/18/2022] Open
Abstract
Transcatheter Aortic Valve Implantation (TAVI) is increasingly being used in patients with severe aortic stenosis who are not candidates for surgery. ECG-gated CT angiography (CTA) plays an important role in the preoperative planning for these devices. As the number of patients undergoing these procedures increases, a subset of patients is being recognized who have contraindications to iodinated contrast medium, either due to a prior severe allergic type reaction or poor renal function. Another subgroup of patients with low flow and low gradient aortic stenosis is being recognized that are usually assessed for severity of aortic stenosis by stress echocardiography. There are contraindications to stress echocardiography and some of these patients may not be able to undergo this test. Non-contrast MRI can be a useful emerging modality for evaluating these patients. In this article, we discuss the emerging indications of non-contrast MRI in preoperative assessment for TAVI and describe the commonly used MRI sequences. A comparison of the most important measurements obtained for TAVI assessment on CTA and MRI from same subjects is included. Teaching Points • MRI can be used for preoperative assessment of aortic annulus. • MRI is an alternate to CTA when iodinated contrast is contraindicated. • Measurements obtained by non-contrast MRI are similar to contrast enhanced CTA. • MRI can be used to assess severity of aortic stenosis.
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Andreini D, Martuscelli E, Guaricci AI, Carrabba N, Magnoni M, Tedeschi C, Pelliccia A, Pontone G. Clinical recommendations on Cardiac-CT in 2015. J Cardiovasc Med (Hagerstown) 2016; 17:73-84. [DOI: 10.2459/jcm.0000000000000318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Maleszewski J, Lai C, Veinot J. Anatomic Considerations and Examination of Cardiovascular Specimens (Excluding Devices). Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00001-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Carcano C, Kanne JP, Kirsch J. Interventricular membranous septal aneurysm: CT and MR manifestations. Insights Imaging 2015; 7:111-7. [PMID: 26687514 PMCID: PMC4729708 DOI: 10.1007/s13244-015-0456-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/28/2015] [Accepted: 12/01/2015] [Indexed: 12/27/2022] Open
Abstract
Advanced cardiac imaging is a valuable method to investigate cardiac malformations. The detection of the interventricular membranous septum has clinical significance due to thrombogenic and arrythmogenic predisposition, as well as a role in obstructing the pulmonary flow. This review describes six clinical presentations in which advanced cardiac imaging has been the tool for evaluation, with special emphasis in CT angiography and cardiac MRI sequences. Teaching Points • The interventricular membranous septum can predispose patients to thrombogenic and arrythmogenic events. • Subpulmonic stenosis relates to the protrusion of the aneurysm into the right ventricle • During surgery, ventricular pressures of the opened heart become balanced, making the aneurysm less evident.
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Affiliation(s)
- Carolina Carcano
- Department of Radiology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, Fl, 33331, USA. .,Department of Radiology, Mount Sinai Medical center, 4300 Alton Road, Miami Beach, FL, 33141, USA.
| | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53726, USA.
| | - Jacobo Kirsch
- Department of Radiology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, Fl, 33331, USA.
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Hammer MM, Mawad K, Gutierrez FR, Bhalla S. Adult Cardiac Valvular Disease for the General Radiologist: Resident and Fellow Education Feature. Radiographics 2015; 35:1358-9. [DOI: 10.1148/rg.2015150006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cardiac CT angiography beyond the coronary arteries: what radiologists need to know and why they need to know it. AJR Am J Roentgenol 2015; 203:W583-95. [PMID: 25415723 DOI: 10.2214/ajr.13.12400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE With current state-of-the-art CT combining fast scanning times and high spatial resolution, anatomy beyond the coronary arteries is well visualized and may lead to discovery of abnormalities. The purpose of this article is to provide a strategy for radiologists to recognize important extracoronary cardiac CT angiography (CTA) findings. CONCLUSION A systemic approach to cardiac CTA by anatomic location and attention to key CT features are critical to identify and properly characterize important extracoronary cardiac abnormalities.
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Das KM, Momenah TS, Larsson SG, Jadoon S, Aldosary AS, Lee EY. Williams-Beuren syndrome: computed tomography imaging review. Pediatr Cardiol 2014; 35:1309-20. [PMID: 25139247 DOI: 10.1007/s00246-014-0998-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 07/31/2014] [Indexed: 11/24/2022]
Abstract
Williams-Beuren syndrome (WBS) affects young infants and children. The underlying etiopathogenesis of this rare disease is due to the mutation of the elastin gene that is responsible for the elasticity of the arterial wall. As a result of inadequate elastin production, the major systemic arteries become abnormally rigid and can be manifested by an impediment to the blood flow. The most common cardiovascular abnormalities encountered in WBS are supravalvular aortic stenosis, pulmonary arterial stenosis, and mitral valve prolapse. Less frequently observed cardiovascular abnormalities include coarctation of the aorta, ventricular septal defect, patent ductus, subaortic stenosis, and hypertrophic cardiomyopathy. Coronary artery stenosis and severe impediment to the bi-ventricular outflow as a result of supravalvular aortic and pulmonary artery stenosis predispose patients to sudden death. Patients with progressed arterial stenosis and severe stenosis are likely to require intervention to prevent serious complications. Rarely, imaging findings may precede clinical presentation, which allows the radiologist to participate in the patient care. However, to be more prudent, the radiologist must be accustomed to the imaging characteristics of WBS as well as the patient's clinical information, which could raise the suspicion of WBS. We performed a retrospective analysis of all the available images from patients diagnosed with WBS in last 4 years at our institution, and present key imaging findings along with a review of the literature to summarize the clinically relevant features as demonstrated by multidetector computed tomography in WBS. Cross-sectional imaging plays a vital role in the diagnosis of WBS cases with equivocal clinical features. MDCT evaluation of complex cardiovascular abnormalities of WBS including coronary artery disease is feasible with modern MDCT scanners and in the future, this approach could provide accurate information for planning, navigation, and noninvasive assessment of the secondary arterial changes in WBS and thus reducing the dependence upon invasive contrast catherization techniques.
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Affiliation(s)
- Karuna M Das
- Department of Medical Imaging, King Fahad Medical City, Riyadh, 11525, Kingdom of Saudi Arabia,
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Fused aortic valve without an elliptical-shaped systolic orifice in patients with severe aortic stenosis: cardiac computed tomography is useful for differentiation between bicuspid aortic valve with raphe and tricuspid aortic valve with commissural fusion. Eur Radiol 2014; 25:1208-17. [PMID: 25424562 DOI: 10.1007/s00330-014-3494-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 10/29/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective is to determine cardiac computed tomography (CCT) features capable of differentiating between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in severe aortic stenosis (AS) patients with fused cusp and without elliptical-shaped systolic orifices. METHODS We retrospectively enrolled 53 patients who had severe AS with fused cusps and without an elliptical-shaped systolic orifice on CCT and who had undergone surgery. CCT features were analyzed using: 1) aortic valve findings including cusp size, cusp area, opening shape, midline calcification, fusion length, calcium volume score, and calcium grade; 2) diameters of ascending and descending aorta, and main pulmonary artery; and 3) rheumatic mitral valve findings. The variables were evaluated using univariate and multivariate logistic regression analyses. RESULTS At surgery, 19 patients had BAV and 34 had TAV. CCT features including uneven cusp size, uneven cusp area, round-shaped systolic orifice, longer cusp fusion, and dilatation of ascending aorta were significantly associated with BAV (P < 0.05). In particular, fusion length (OR, 1.76; P = 0.001), uneven cusp area (OR, 10.46; P = 0.012), and midline calcification (OR, 0.08; P = 0.013) were strongly associated with BAV. CONCLUSION CCT provides diagnostic clues that helps differentiate between BAV with raphe and TAV with commissural fusion in patients with severe AS. KEY POINTS • Accurate morphologic assessment of the aortic valve is important for treatment planning. • It is difficult to differentiate BAV from TAV with a fused cusp. • CCT provides diagnostic clues for the differentiation of BAV and TAV.
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Hoey ETD, Ganeshan A. Multi-detector CT angiography of the aortic valve-Part 1: anatomy, technique and systematic approach to interpretation. Quant Imaging Med Surg 2014; 4:265-72. [PMID: 25202662 DOI: 10.3978/j.issn.2223-4292.2014.07.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 12/31/2022]
Abstract
The aortic valve and adjacent structures should be routinely evaluated on all thoracic cross-sectional imaging studies. Echocardiography and magnetic resonance imaging (MRI) are the main imaging techniques used for assessment of the aortic valve and related pathology but multi-detector computed tomography (MDCT) can offer valuable complimentary information in some clinical scenarios. Radiologists should be familiar with the indications, advantages and limitations of MDCT for assessment of the aortic valve. This article reviews aortic valve anatomy and relevant terminology, technical aspects of MDCT image optimisation and describes a suggested approach to interpretation.
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Affiliation(s)
- Edward T D Hoey
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
| | - Arul Ganeshan
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
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Multidetector CT findings of complications of surgical and endovascular treatment of aortic aneurysms. Radiol Clin North Am 2014; 52:961-89. [PMID: 25173654 DOI: 10.1016/j.rcl.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aortic aneurysms remain a significant problem in the population, and there is a concerted effort to identify, define, image, and treat these conditions to ultimately improve outcomes. The rapid development of diagnostic modalities, operative strategies, and endovascular techniques within the realm of this aortic disease has transformed the field and broadened the spectrum of patients that can be treated with minimally invasive techniques. This investigation has a broad spectrum of normal expected findings that must be differentiated from early or late complications in which intervention is required. In this article, normal and abnormal postoperative and post-TEVAR/EVAR MDCT findings are described.
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Aortic root disease in athletes: aortic root dilation, anomalous coronary artery, bicuspid aortic valve, and Marfan's syndrome. Sports Med 2014; 43:721-32. [PMID: 23674060 DOI: 10.1007/s40279-013-0057-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Two professional athletes in the U.S. National Basketball Association required surgery for aortic root dilation in 2012. These cases have attracted attention in sports medicine to the importance of aortic root disease in athletes. In addition to aortic root dilation, other forms of aortic disease include anomalous coronary artery, bicuspid aortic valve, and Marfan's syndrome. In this review, electronic database literature searches were performed using the terms "aortic root" and "athletes." The literature search produced 122 manuscripts. Of these, 22 were on aortic root dilation, 21 on anomalous coronary arteries, 12 on bicuspid aortic valves, and 8 on Marfan's syndrome. Aortic root dilation is a condition involving pathologic dilation of the aortic root, which can lead to life-threatening sequelae. Prevalence of the condition among athletes and higher risk athletes in particular sports needs to be better delineated. Normative parameters for aortic root diameter in the general population are proportionate to anthropomorphic variables, but this has not been validated for athletes at the extremes of anthropomorphic indices. Although echocardiography is the favored screening modality, computed tomography (CT) and cardiac magnetic resonance imaging (MRI) are also used for diagnosis and surgical planning. Medical management has utilized beta-blockers, with more recent use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and statins. Indications for surgery are based on comorbidities, degree of dilation, and rate of progression. Management decisions for aortic root dilation in athletes are nuanced and will benefit from the development of evidence-based guidelines. Anomalous coronary artery is another form of aortic disease with relevance in athletes. Diagnosis has traditionally been through cardiac catheterization, but more recently has included evaluation with echocardiography, multislice CT, and MRI. Athletes with this condition should be restricted from participation in competitive sports, but can be cleared for participation 6 months after surgical repair. Bicuspid aortic valve is another form of aortic root disease with significance in athletes. Although echocardiography has traditionally been used for diagnosis, CT and MRI have proven more sensitive and specific. Management of bicuspid aortic valve consists of surveillance through echocardiography, medical therapy with beta-blockers and ARBs, and surgery. Guidelines for sports participation are based on the presence of aortic stenosis, aortic regurgitation, and aortic root dilation. Marfan's syndrome is a genetic disorder with a number of cardiac manifestations including aortic root dilation, aneurysm, and dissection. Medical management involves beta-blockers and ARBs. Thresholds for surgical management differ from the general population. With regard to sports participation, the most important consideration is early detection. Athletes with the stigmata of Marfan's syndrome or with family history should be tested. Further research should determine whether more aggressive screening is warranted in sports with taller athletes. Athletes with Marfan's syndrome should be restricted from activities involving collision and heavy contact, avoid isometric exercise, and only participate in activities with low intensity, low dynamic, and low static components. In summary, many forms of aortic root disease afflict athletes and need to be appreciated by sports medicine practitioners because of their potential to lead to tragic but preventable deaths in an otherwise healthy population.
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Comparison of the effectiveness of transcatheter aortic valve implantation in patients with stenotic bicuspid versus tricuspid aortic valves (from the German TAVI Registry). Am J Cardiol 2014; 113:518-21. [PMID: 24342758 DOI: 10.1016/j.amjcard.2013.10.023] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 11/22/2022]
Abstract
Patients with bicuspid aortic valves (BAVs) are considered a relative contraindication to transcatheter aortic valve implantation (TAVI). One of the main reasons is the presumed risk for residual aortic regurgitation (AR). However, case reports and small case series have suggested that TAVI can be successfully performed with acceptable clinical outcomes in high-risk patients with BAV. Within the large German TAVI Registry, we sought to evaluate TAVI in older high-risk patients with BAV. From January 2009 to June 2010, a total of 1,424 patients with severe aortic stenosis undergoing TAVI were prospectively enrolled into the German TAVI Registry. For the present analysis, patients with valve-in-valve procedures were excluded and those with BAV (n = 38, 3%) were compared with those with tricuspid aortic valve (TAV; n = 1357, 97%). Patient characteristics did not markedly differ and procedural success was very high in both groups. There was a higher rate of relevant AR (≥II) after TAVI among patients with BAV (25 vs 15%, p = 0.05), whereas pacemakers were more often implanted in patients with TAV (17% vs 35%, p = 0.02). Thirty-day mortality rate was similar in both cohorts (11% vs 11%). In a Cox proportional regression analysis, BAV was not associated with higher 1-year mortality rate (hazard ratio 0.64, 95% confidence interval 0.29 to 1.41). In selected patients with BAV, TAVI can be performed with a satisfactory clinical result. Although the risk for relevant AR seems to be greater among patients with BAV, 30-day and 1-year mortality rates were not elevated compared with patients with TAV.
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Harvey JJ, Hoey ETD, Ganeshan A. Imaging of the aortic valve with MRI and CT angiography. Clin Radiol 2013; 68:1192-205. [PMID: 24034550 DOI: 10.1016/j.crad.2013.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/20/2013] [Accepted: 07/15/2013] [Indexed: 12/31/2022]
Abstract
The aortic valve may be affected by a wide range of congenital and acquired diseases. Echocardiography is the main non-invasive imaging technique for assessing patho-anatomical alterations of the aortic valve and adjacent structures and in many cases is sufficient to establish a diagnosis and/or guide treatment decisions. Recent technological advances in magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) have enabled these techniques to play a complimentary role in certain clinical scenarios and as such can be useful problem-solving tools. Radiologists should be familiar with the indications, advantages, and limitations of MRI and MDCT in order to advise and direct an appropriate imaging strategy depending upon the clinical scenario. This article reviews the role of MRI and MDCT angiography for assessment of the aortic valve including relevant anatomy, scan acquisition protocols, and post-processing methods. An approach to interpretation and the key imaging features of commonly encountered aortic valvular diseases are discussed.
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Affiliation(s)
- J J Harvey
- Department of Radiology and Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Edgbaston, UK
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Loeser H, Wittersheim M, Puetz K, Friemann J, Buettner R, Fries JW. Potential complications of transcatheter aortic valve implantation (TAVI)—an autopsy perspective. Cardiovasc Pathol 2013; 22:319-23. [DOI: 10.1016/j.carpath.2013.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 01/09/2013] [Accepted: 01/11/2013] [Indexed: 11/28/2022] Open
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Golzio PG, D'Ascenzo F, Perversi J, Gaita F. Analysis of extracted cardiac device leads for bacteria type: clinical impact. Expert Rev Cardiovasc Ther 2013; 11:1237-45. [PMID: 23944962 DOI: 10.1586/17476348.2013.824690] [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] [Indexed: 11/08/2022]
Abstract
The use of cardiac implantable electronic devices (CIED) increased over time, followed by rise of CIED-related complications, mainly infections and malfunctions. A clear diagnosis of CIED infection is of pivotal importance. When infection is confirmed, transvenous lead extraction (TLE) becomes mandatory, with associated risks and mortality. Local lesions at the device pocket often return negative swabs and tissue specimens, but conservative interventions are inconclusive, raising risks of systemic dissemination of infection and difficulties of subsequent TLE any more. When local bacteriological analyses are positive, once again, a contamination effect cannot be excluded. So traditional local swabs and tissue specimens exhibit low sensitivity and specificity for diagnosis of CIED infection. On the contrary, in cases sepsis, blood samples show high specificity, while the sensibility remains low, due to possible negative results in patients on antibiotics. In this scenario, the analysis of extracted device leads seems more appropriate for diagnostic purposes.
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Affiliation(s)
- Pier Giorgio Golzio
- Department of Internal Medicine, Division of Cardiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Corso A. M. Dogliotti, 14, 10126 Torino, Italy
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Bateman MG, Hill AJ, Quill JL, Iaizzo PA. The clinical anatomy and pathology of the human arterial valves: implications for repair or replacement. J Cardiovasc Transl Res 2013; 6:166-75. [PMID: 23325456 DOI: 10.1007/s12265-012-9438-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 12/05/2012] [Indexed: 02/06/2023]
Abstract
A thorough understanding of valvar anatomy is essential for design engineers and clinicians in the development and/or employment of improved technologies or therapies for treating valvar pathologies. There are two arterial valves in the human heart--pulmonary and aortic valves. Both are complex structures whose normal anatomical components can vary greatly between individuals. We discuss the anatomy, pathology, and challenges relating to transcatheter and surgical repair/replacement of the arterial valves in a translational manner. The high prevalence of aortic valvar pathologies in the burgeoning elderly population, coupled with poor clinical outcomes for patients who go untreated, has resulted in prolific spending in the research and development of more effective and less traumatic therapies. The accelerated development of therapies for treating arterial valves has been guided by anatomical information gathered from high-resolution imaging technologies, which have focused attention on the need for complete understanding of arterial valvar clinical anatomies. This article is part of a JCTR special issue on Cardiac Anatomy.
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