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Silva Ferreira MV, Soares CSP, Araujo-Filho JDAB, Dantas RN, Torres RVA, Morais TC, Avila LFR, Ishikawa W, Nomura CH, Rajiah PS, Parga Filho J. Mitral Annular Disease at Cardiac MRI: What to Know and Look For. Radiographics 2024; 44:e230156. [PMID: 38870043 DOI: 10.1148/rg.230156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Accurate evaluation of the mitral valve (MV) apparatus is essential for understanding the mechanisms of MV disease across various clinical scenarios. The mitral annulus (MA) is a complex and crucial structure that supports MV function; however, conventional imaging techniques have limitations in fully capturing the entirety of the MA. Moreover, recognizing annular changes might aid in identifying patients who may benefit from advanced cardiac imaging and interventions. Multimodality cardiovascular imaging plays a major role in the diagnosis, prognosis, and management of MV disease. Transthoracic echocardiography is the first-line modality for evaluation of the MA, but it has limitations. Cardiac MRI (CMR) has emerged as a robust imaging modality for assessing annular changes, with distinct advantages over other imaging techniques, including accurate flow and volumetric quantification and assessment of variations in the measurements and shape of the MA during the cardiac cycle. Mitral annular disjunction (MAD) is defined as atrial displacement of the hinge point of the MV annulus away from the ventricular myocardium, a condition that is now more frequently diagnosed and studied owing to recent technical advances in cardiac imaging. However, several unresolved issues regarding MAD, such as the functional significance of pathologic disjunction and how this disjunction advances in the clinical course, require further investigation. The authors review the role of CMR in the assessment of MA disease, with a focus on MAD and its functional implications in MV prolapse and mitral regurgitation. ©RSNA, 2024 Supplemental material is available for this article. See the invited commentary by Stojanovska and Fujikura in this issue.
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Affiliation(s)
- Marcus Vinicius Silva Ferreira
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Clarice Santos Parreira Soares
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Jose de Arimateia Batista Araujo-Filho
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Roberto Nery Dantas
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Roberto Vitor Almeida Torres
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Thamara Carvalho Morais
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Luis Francisco Rodrigues Avila
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Walther Ishikawa
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Cesar Higa Nomura
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Prabhakar Shantha Rajiah
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Jose Parga Filho
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
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2
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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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3
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Khurana S, Gulati A, Rivera Boadla ME, Tan S, Katic L, Sharma A, Vinayak M, Kumar K, Kumar S, Hooda A. Chunky Mitral Annular Calcification: Caseoma or a Tumor? Cureus 2024; 16:e58031. [PMID: 38738040 PMCID: PMC11088215 DOI: 10.7759/cureus.58031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Mitral annular calcification (MAC) is relatively common in clinical practice. Females are more often affected than males. Patients with end-stage renal disease have MAC relatively more commonly than the general population. Patients with MAC often develop conduction system disturbances, including advanced atrioventricular blocks. They are also more likely to develop various arrhythmias, including atrial fibrillation. Caseous mitral annulus calcification is a variant of MAC that often looks like a cardiac tumor on an echocardiogram and needs to be differentiated.
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Affiliation(s)
- Sakshi Khurana
- Radiology, New York Presbyterian-Columbia University Irving Medical Center, New York, USA
| | - Amit Gulati
- Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Samuel Tan
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Luka Katic
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Anupam Sharma
- Hematology and Oncology, Fortis Hospital, Noida, IND
| | - Manish Vinayak
- Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kelash Kumar
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Sachin Kumar
- Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Amit Hooda
- Interventional Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
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4
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Adamo M, Chioncel O, Pagnesi M, Bayes-Genis A, Abdelhamid M, Anker SD, Antohi EL, Badano L, Ben Gal T, Böhm M, Delgado V, Dreyfus J, Faletra FF, Farmakis D, Filippatos G, Grapsa J, Gustafsson F, Hausleiter J, Jaarsma T, Karam N, Lund L, Lurz P, Maisano F, Moura B, Mullens W, Praz F, Sannino A, Savarese G, Tocchetti CG, van Empel VPM, von Bardeleben RS, Yilmaz MB, Zamorano JL, Ponikowski P, Barbato E, Rosano GMC, Metra M. Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur J Heart Fail 2024; 26:18-33. [PMID: 38131233 DOI: 10.1002/ejhf.3106] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/07/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right-sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right-sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right-sided heart failure providing practical suggestions for patient identification and management.
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Affiliation(s)
- Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antoni Bayes-Genis
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site, Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elena-Laura Antohi
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Luigi Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Tuvia Ben Gal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Victoria Delgado
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Francesco F Faletra
- Division of Cardiology, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Dimitrios Farmakis
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Trust, Kings College London, London, UK
| | - Finn Gustafsson
- Department of Cardiology, Heart Centre, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Jörg Hausleiter
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | | | - Nicole Karam
- Heart Valves Unit, Georges Pompidou European Hospital, Université Paris Cité, INSERM, Paris, France
| | - Lars Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Philipp Lurz
- Division of Cardiology, University Medical Center, Mainz, Germany
| | - Francesco Maisano
- Cardiac Surgery and Heart Valve Center, Ospedale San Raffaele, University Vita Salute, Milan, Italy
| | - Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | | | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Anna Sannino
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Carlo Gabriele Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), 'Federico II' University, Naples, Italy
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | | | - Mehmet Birhan Yilmaz
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - José Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Challa AB, Negm AS, Mahayni AA, Wamil M, Williamson E, Guerrero M, Weishaar P, Collins JD. Transcatheter Mitral Valve Replacement: Treatment Planning With Computed Tomography. Semin Roentgenol 2024; 59:67-75. [PMID: 38388098 DOI: 10.1053/j.ro.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Apurva Bhavana Challa
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ahmed S Negm
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN
| | | | - Malgorzata Wamil
- Department of Cardiovascular Medicine, Mayo Clinic Healthcare, London, UK
| | - Eric Williamson
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Paul Weishaar
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN
| | - Jeremy D Collins
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN.
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6
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Grapsa J, Praz F, Sorajja P, Cavalcante JL, Sitges M, Taramasso M, Piazza N, Messika-Zeitoun D, Michelena HI, Hamid N, Dreyfus J, Benfari G, Argulian E, Chieffo A, Tchetche D, Rudski L, Bax JJ, Stephan von Bardeleben R, Patterson T, Redwood S, Bapat VN, Nickenig G, Lurz P, Hausleiter J, Kodali S, Hahn RT, Maisano F, Enriquez-Sarano M. Tricuspid Regurgitation: From Imaging to Clinical Trials to Resolving the Unmet Need for Treatment. JACC Cardiovasc Imaging 2024; 17:79-95. [PMID: 37731368 DOI: 10.1016/j.jcmg.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
Tricuspid regurgitation (TR) is a highly prevalent and heterogeneous valvular disease, independently associated with excess mortality and high morbidity in all clinical contexts. TR is profoundly undertreated by surgery and is often discovered late in patients presenting with right-sided heart failure. To address the issue of undertreatment and poor clinical outcomes without intervention, numerous structural tricuspid interventional devices have been and are in development, a challenging process due to the unique anatomic and physiological characteristics of the tricuspid valve, and warranting well-designed clinical trials. The path from routine practice TR detection to appropriate TR evaluation, to conduction of clinical trials, to enriched therapeutic possibilities for improving TR access to treatment and outcomes in routine practice is complex. Therefore, this paper summarizes the key points and methods crucial to TR detection, quantitation, categorization, risk-scoring, intervention-monitoring, and outcomes evaluation, particularly of right-sided function, and to clinical trial development and conduct, for both interventional and surgical groups.
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Affiliation(s)
- Julia Grapsa
- Cardiology Department, Guys and St Thomas National Health Service Trust, London, United Kingdom.
| | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Joao L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Marta Sitges
- Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Centro de Investigación Biomedica en Red Enfermedades Cardiovasculares, Barcelona, Spain
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Heart Center of Zurich, Zurich, Switzerland
| | - Nicolo Piazza
- Azrieli Heart Center, Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - David Messika-Zeitoun
- Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA
| | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Giovanni Benfari
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA; Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Edgar Argulian
- Cardiology Department, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | | | - Lawrence Rudski
- Azrieli Heart Center, Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Tiffany Patterson
- Cardiology Department, Guys and St Thomas National Health Service Trust, London, United Kingdom
| | - Simon Redwood
- Cardiology Department, Guys and St Thomas National Health Service Trust, London, United Kingdom
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Susheel Kodali
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York City, New York, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York City, New York, USA
| | - Francesco Maisano
- Interventional Cardiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele University Hospital, Milan, Italy
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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7
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Thong EHE, Kong WKF, Poh KK, Wong R, Chai P, Sia CH. Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review. J Cardiovasc Dev Dis 2023; 11:13. [PMID: 38248883 PMCID: PMC10816708 DOI: 10.3390/jcdd11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Cardioembolic strokes account for 20-25% of all ischaemic strokes, with their incidence increasing with age. Cardiac imaging plays a crucial role in identifying cardioembolic causes of stroke, with early and accurate identification affecting treatment, preventing recurrence, and reducing stroke incidence. Echocardiography serves as the mainstay of cardiac evaluation. Transthoracic echocardiography (TTE) is the first line in the basic evaluation of structural heart disorders, valvular disease, vegetations, and intraventricular thrombus. It can be used to measure chamber size and systolic/diastolic function. Trans-oesophageal echocardiography (TOE) yields better results in identifying potential cardioembolic sources of stroke and should be strongly considered, especially if TTE does not yield adequate results. Cardiac computed tomography and cardiac magnetic resonance imaging provide better soft tissue characterisation, high-grade anatomical information, spatial and temporal visualisation, and image reconstruction in multiple planes, especially with contrast. These techniques are useful in cases of inconclusive echocardiograms and can be used to detect and characterise valvular lesions, thrombi, fibrosis, cardiomyopathies, and aortic plaques. Nuclear imaging is not routinely used, but it can be used to assess left-ventricular perfusion, function, and dimensions and may be useful in cases of infective endocarditis. Its use should be considered on a case-by-case basis. The accuracy of each imaging modality depends on the likely source of cardioembolism, and the choice of imaging approach should be tailored to individual patients.
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Affiliation(s)
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Raymond Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
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8
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Zhu QM, Berry N. Tricuspid Regurgitation: Disease State and Advances in Percutaneous Therapy. Eur Cardiol 2023; 18:e55. [PMID: 37860699 PMCID: PMC10583156 DOI: 10.15420/ecr.2023.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/31/2023] [Indexed: 10/21/2023] Open
Abstract
Tricuspid regurgitation (TR) is a relatively common finding. There has been growing recognition of the morbidity and adverse prognosis of severe TR, which affects 1.6 million people in the US. However, symptomatic TR remains undertreated despite emerging therapeutic modalities. In this review, the pathophysiological and epidemiological features of TR are examined and the diagnosis, natural history, and clinical presentation are discussed. An overview of TR therapy is provided, including medical and surgical treatments, as well as novel percutaneous approaches. The currently available studies on percutaneous therapy demonstrate promise for transcatheter valve repair and replacement with favourable clinical outcomes and short-term durability. However, further study is needed.
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Affiliation(s)
- Qiuyu Martin Zhu
- Kaiser Permanente Mid-Atlantic States Internal Medicine Residency Program Gaithersburg, MD, US
| | - Natalia Berry
- Mid-Atlantic Permanente Medical Group McLean, VA, US
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9
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Meng H, Zhao X, Wang JD, Wan LY, Shi H, OuYang WB, Pan XB. Comparison between multimodality imaging approaches for measurement of the tricuspid annulus in severe tricuspid regurgitation. Int J Cardiol 2023; 383:151-158. [PMID: 37004945 DOI: 10.1016/j.ijcard.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/25/2023] [Accepted: 03/09/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Tricuspid valve (TV) sizing is crucial for surgical or interventional procedures planning. Imaging TV is frequently challenging and often requires multimodal imaging techniques. Computed tomography (CT) is the gold standard for sizing. The authors compared measurements of the tricuspid annulus (TA) acquired using echocardiography and CT. METHODS Thirty-six patients with severe symptomatic tricuspid regurgitation were included in this retrospective analysis. During mid-diastole, the maximal two-dimensional (2D) TA diameter was directly measured in multiple views using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). Three-dimensional (3D) TA size was assessed using cross-sectional long-axis and short-axis diameters, areas, and perimeters measured in the projected plane. The TA diameter was quantified by the perimeter measured on the CT images (CT imaging_indirect) and compared with echocardiography measurements. Tenting height and tenting area were also measured using TTE at mid systole. RESULTS The long-axis dimensions measured using 3DTEE (3DTEE_direct) best correlated with the TA diameter (CT imaging_indirect) (R = 0.851, P = 0.0001) and the least discrepancies (difference 1.2 ± 2.4 mm, P = 0.012). The TA diameters quantified by the perimeters measured using 3DTEE (3DTEE_indirect) were smaller than the CT values (difference 2.5 ± 2.5 mm, P = 0.0001). The maximal dimensions directly measured by 2DTEE (2DTEE_direct) were modestly correlated with the CT values. Overall, the maximal dimensions by TTE_direct were less reliable than those by CT. TA eccentricity index correlated with the maximal tenting height and area. CONCLUSION The patients with severe tricuspid regurgitation had a dilated and circular annulus. The long-axis TA dimensions (3DTEE_direct) were similar to the diameters (CT imaging_indirect).
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Affiliation(s)
- Hong Meng
- Echocardiographic Imaging Center, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Xing Zhao
- Echocardiographic Imaging Center, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Jian-De Wang
- Echocardiographic Imaging Center, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Lin-Yuan Wan
- Echocardiographic Imaging Center, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Hao Shi
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Bin OuYang
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang-Bin Pan
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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10
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Li Y, Lei R, Zhou J, Wu K, Shen J, Zhu Z, Wang J, Zhang H. Innovative use of a self-expanding valve for valve-in-valve transcatheter mitral valve replacement: experience from a four-year single-center study. Front Cardiovasc Med 2023; 10:1137663. [PMID: 37378395 PMCID: PMC10292798 DOI: 10.3389/fcvm.2023.1137663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Background Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) is a minimally invasive option for patients with bioprosthetic mitral valve failure. Since January 2019, our center has been using a new innovative option, J-Valve, to treat patients with bioprosthetic mitral valve failure who were at high risk for open heart surgery. The aim of this study is to explore the effectiveness and safety of J-Valve and report the results from the four-year follow-up period of the innovative application of the transcatheter valve. Methods Patients who underwent the ViV-TMVR procedure between January 2019 and September 2022 in our center were included in the study. J-Valve™ system (JC Medical Inc., Suzhou, China) with three U-shape grippers was used for ViV-TMVR via transapical approach. Data on survival, complications, transthoracic echocardiographic results, New York Heart Association functional class in heart failure, and patient-reported health-related quality of life according to the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) were collected during the four-year follow up. Results Thirty-three patients (mean age 70.1 ± 1.1 years, 13 men) were included and received ViV-TMVR. The surgery success rate was 97%: only one patient was converted to open-heart surgery due to intraoperative valve embolization to the left ventricle. During the first 30 days all-cause mortality was 0%, risk of stroke 2.5% and risk of mild paravalvular leak 15.2%; mitral valve hemodynamics improved (179.7 ± 8.9 at 30 days vs. 269 ± 49 cm/s at baseline, p < 0.0001). Median time from operation to discharge was six days, and there were no readmissions within 30 days from operation. The median and maximum follow-up durations were 28 and 47 months, respectively; during the entire follow-up, all-cause mortality was 6.1%, and the risk of cerebral infarction 6.1%. Cox regression analysis did not identify any variables significantly associated with survival. The New York Heart Association functional class and the KCCQ-12 score improved significantly compared with their preoperative values. Conclusion The use of J-Valve for ViV-TMVR is safe and effective with a high success rate, low mortality and very few associated complications, representing an alternative surgical strategy for the elderly, high-risk patients with bioprosthetic mitral valve failure.
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Affiliation(s)
- Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruobing Lei
- Chevidence Lab of Child & Adolescent Health, Department of Pediatric Research Institute, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jiawei Zhou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kaisheng Wu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinglun Shen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhihui Zhu
- Department of Medicine IV, LMU University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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11
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Segreti A, Celeski M, Monticelli LM, Perillo A, Crispino SP, Di Gioia G, Cammalleri V, Fossati C, Mega S, Papalia R, Pigozzi F, Ussia GP, Grigioni F. Mitral and Tricuspid Valve Disease in Athletes. J Clin Med 2023; 12:jcm12103562. [PMID: 37240669 DOI: 10.3390/jcm12103562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Observing mitral or tricuspid valve disease in an athlete raises many considerations for the clinician. Initially, the etiology must be clarified, with causes differing depending on whether the athlete is young or a master. Notably, vigorous training in competitive athletes leads to a constellation of structural and functional adaptations involving cardiac chambers and atrioventricular valve systems. In addition, a proper evaluation of the athlete with valve disease is necessary to evaluate the eligibility for competitive sports and identify those requiring more follow-up. Indeed, some valve pathologies are associated with an increased risk of severe arrhythmias and potentially sudden cardiac death. Traditional and advanced imaging modalities help clarify clinical doubts, allowing essential information about the athlete's physiology and differentiating between primary valve diseases from those secondary to training-related cardiac adaptations. Remarkably, another application of multimodality imaging is evaluating athletes with valve diseases during exercise to reproduce the sport setting and better characterize the etiology and valve defect mechanism. This review aims to analyze the possible causes of atrioventricular valve diseases in athletes, focusing primarily on imaging applications in diagnosis and risk stratification.
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Affiliation(s)
- Andrea Segreti
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
| | - Mihail Celeski
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Luigi Maria Monticelli
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Alfonso Perillo
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Simone Pasquale Crispino
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Giuseppe Di Gioia
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
- Institute of Sports Medicine, Sport and Health, National Italian Olympic Committee, Largo Piero Gabrielli, 00197 Roma, Italy
| | - Valeria Cammalleri
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
| | - Simona Mega
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
| | - Gian Paolo Ussia
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
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12
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Prandi FR, Lerakis S, Belli M, Illuminato F, Margonato D, Barone L, Muscoli S, Chiocchi M, Laudazi M, Marchei M, Di Luozzo M, Kini A, Romeo F, Barillà F. Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives. J Clin Med 2023; 12:jcm12103384. [PMID: 37240489 DOI: 10.3390/jcm12103384] [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: 03/22/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Severe tricuspid valve (TV) regurgitation (TR) has been associated with adverse long-term outcomes in several natural history studies, but isolated TV surgery presents high mortality and morbidity rates. Transcatheter tricuspid valve interventions (TTVI) therefore represent a promising field and may currently be considered in patients with severe secondary TR that have a prohibitive surgical risk. Tricuspid transcatheter edge-to-edge repair (T-TEER) represents one of the most frequently used TTVI options. Accurate imaging of the tricuspid valve (TV) apparatus is crucial for T-TEER preprocedural planning, in order to select the right candidates, and is also fundamental for intraprocedural guidance and post-procedural follow-up. Although transesophageal echocardiography represents the main imaging modality, we describe the utility and additional value of other imaging modalities such as cardiac CT and MRI, intracardiac echocardiography, fluoroscopy, and fusion imaging to assist T-TEER. Developments in the field of 3D printing, computational models, and artificial intelligence hold great promise in improving the assessment and management of patients with valvular heart disease.
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Affiliation(s)
- Francesca Romana Prandi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stamatios Lerakis
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federica Illuminato
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Davide Margonato
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Saverio Muscoli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Mario Laudazi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Massimo Marchei
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marco Di Luozzo
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Annapoorna Kini
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Francesco Romeo
- Department of Departmental Faculty of Medicine, Unicamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
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13
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Otgonbaatar C, Ryu JK, Shin J, Woo JY, Seo JW, Shim H, Hwang DH. Improvement in Image Quality and Visibility of Coronary Arteries, Stents, and Valve Structures on CT Angiography by Deep Learning Reconstruction. Korean J Radiol 2022; 23:1044-1054. [PMID: 36196766 PMCID: PMC9614292 DOI: 10.3348/kjr.2022.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study aimed to investigate whether a deep learning reconstruction (DLR) method improves the image quality, stent evaluation, and visibility of the valve apparatus in coronary computed tomography angiography (CCTA) when compared with filtered back projection (FBP) and hybrid iterative reconstruction (IR) methods. MATERIALS AND METHODS CCTA images of 51 patients (mean age ± standard deviation [SD], 63.9 ± 9.8 years, 36 male) who underwent examination at a single institution were reconstructed using DLR, FBP, and hybrid IR methods and reviewed. CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and stent evaluation, including 10%-90% edge rise slope (ERS) and 10%-90% edge rise distance (ERD), were measured. Quantitative data are summarized as the mean ± SD. The subjective visual scores (1 for worst -5 for best) of the images were obtained for the following: overall image quality, image noise, and appearance of stent, vessel, and aortic and tricuspid valve apparatus (annulus, leaflets, papillary muscles, and chordae tendineae). These parameters were compared between the DLR, FBP, and hybrid IR methods. RESULTS DLR provided higher Hounsfield unit (HU) values in the aorta and similar attenuation in the fat and muscle compared with FBP and hybrid IR. The image noise in HU was significantly lower in DLR (12.6 ± 2.2) than in hybrid IR (24.2 ± 3.0) and FBP (54.2 ± 9.5) (p < 0.001). The SNR and CNR were significantly higher in the DLR group than in the FBP and hybrid IR groups (p < 0.001). In the coronary stent, the mean value of ERS was significantly higher in DLR (1260.4 ± 242.5 HU/mm) than that of FBP (801.9 ± 170.7 HU/mm) and hybrid IR (641.9 ± 112.0 HU/mm). The mean value of ERD was measured as 0.8 ± 0.1 mm for DLR while it was 1.1 ± 0.2 mm for FBP and 1.1 ± 0.2 mm for hybrid IR. The subjective visual scores were higher in the DLR than in the images reconstructed with FBP and hybrid IR. CONCLUSION DLR reconstruction provided better images than FBP and hybrid IR reconstruction.
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Affiliation(s)
| | - Jae-Kyun Ryu
- Medical Imaging AI Research Center, Canon Medical Systems Korea, Seoul, Korea
| | - Jaemin Shin
- Department of Radiology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Ji Young Woo
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung Wook Seo
- Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hackjoon Shim
- Medical Imaging AI Research Center, Canon Medical Systems Korea, Seoul, Korea.,ConnectAI Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyun Hwang
- Department of Radiology, Inje University Seoul Paik Hospital, Seoul, Korea.,Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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14
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Oliveira I, Cruz I, Neto A, Bragança B, Abreu G, Azevedo J, Andrade A. Mitral Valve Perforated Aneurysm: An Issue of Inflammation or Pressure Gradients? Arq Bras Cardiol 2022; 119:S0066-782X2022005017203. [PMID: 36228278 PMCID: PMC9750205 DOI: 10.36660/abc.20211031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/09/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Inês Oliveira
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - Isabel Cruz
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - Ana Neto
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - Bruno Bragança
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - Glória Abreu
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - João Azevedo
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - Aurora Andrade
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
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15
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Pugliese L, Ricci F, Luciano A, De Stasio V, Presicce M, Spiritigliozzi L, Di Tosto F, Di Donna C, D'Errico F, Benelli L, Pasqualetto M, Grimaldi F, Mecchia D, Sbordone P, Cesareni M, Cerimele C, Cerocchi M, Laudazi M, Leomanni P, Rellini C, Dell'Olio V, Patanè A, Romeo F, Barillà F, Garaci F, Floris R, Chiocchi M. Role of computed tomography in transcatheter replacement of 'other valves': a comprehensive review of preprocedural imaging. J Cardiovasc Med (Hagerstown) 2022; 23:575-588. [PMID: 35994705 DOI: 10.2459/jcm.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transcatheter procedures for heart valve repair or replacement represent a valid alternative for treating patients who are inoperable or at a high risk for open-heart surgery. The transcatheter approach has become predominant over surgical intervention for aortic valve disease, but it is also increasingly utilized for diseases of the 'other valves', that is the mitral and, to a lesser extent, tricuspid and pulmonary valve. Preprocedural imaging is essential for planning the transcatheter intervention and computed tomography has become the main imaging modality by providing information that can guide the type of treatment and choice of device as well as predict outcome and prevent complications. In particular, preprocedural computed tomography is useful for providing anatomic details and simulating the effects of device implantation using 3D models. Transcatheter mitral valve replacement is indicated for the treatment of mitral regurgitation, either primary or secondary, and computed tomography is crucial for the success of the procedure. It allows evaluating the mitral valve apparatus, the surrounding structures and the left heart chambers, identifying the best access route and the landing zone and myocardial shelf, and predicting obstruction of the left ventricular outflow tract, which is the most frequent postprocedural complication. Tricuspid valve regurgitation with or without stenosis and pulmonary valve stenosis and regurgitation can also be treated using a transcatheter approach. Computer tomography provides information on the tricuspid and pulmonary valve apparatus, the structures that are spatially related to it and may be affected by the procedure, the right heart chambers and the right ventricular outflow tract.
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Affiliation(s)
- Luca Pugliese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesca Ricci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Alessandra Luciano
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Matteo Presicce
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Luigi Spiritigliozzi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Federica Di Tosto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesca D'Errico
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Leonardo Benelli
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Monia Pasqualetto
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Grimaldi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Daniele Mecchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Paolo Sbordone
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Matteo Cesareni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Cecilia Cerimele
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Martina Cerocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Mario Laudazi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Paola Leomanni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Carlotta Rellini
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Vito Dell'Olio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Alberto Patanè
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Romeo
- Department of System Medicine, University of Rome Tor Vergata and Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Rome, Italy
| | - Francesco Barillà
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Francesco Garaci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Roberto Floris
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging
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16
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Transcatheter Mitral Valve Replacement in High-Surgical Risk Patients: A Single-Center Experience and Outcome. J Interv Cardiol 2022; 2022:6587036. [PMID: 35847236 PMCID: PMC9242753 DOI: 10.1155/2022/6587036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background Re-operative mitral valve (MV) replacement is a high-risk procedure, therefore, transcatheter MV replacement (TMVR) is a promising therapeutic option. Aim In this study, we aimed to evaluate the feasibility and safety of TMVR in patients with high surgical risk with degenerated mitral bioprostheses (TMViV), failed surgical rings (TMViR), and mitral annular calcification (TMViMAC). Methods This is a retrospective cohort study that enrolled patients with high surgical risk who underwent TMVR from February 2017 to September 2020. The TMVR procedure was performed using Edwards SAPIEN-3 valves through the transseptal approach. Results Sixty-four patients aged 62.7 ± 16.1 years with an STS score of 9.2 ± 3.7% underwent TMVR [35 (55%) TMViV, 16 (25%) TMViR, and 13 (20%) TMViMAC]. Mitral stenosis was more frequent in TMViV, mitral regurgitation was more frequent in TMViR, and combined mitral stenosis and regurgitation were more frequent in TMViMAC (P < 0.05). The MV gradient was 14.3 ± 5.3 mmHg and the MV area was 1.5±0.6 cm2. The 29 mm valve was frequently used in TMViV and TMViMAC, while the 23 mm valve was frequently used in TMViR (P=0.003∗). The procedural and fluoroscopy times were 58.7 ± 8.9 and 41.1 ± 8.2 minutes, respectively. Technical success was reported in 62 (98.4%) patients; 1 TMViR patient experienced valve embolization and salvage surgery, and 1 TMViMAC patient experienced slight valve malposition. At 3 months, 2 (3.1%) patients showed valve thrombosis (treated with anticoagulation), and 1 (1.6%) patient developed a paravalvular leak (underwent surgical MV replacement). At 6 months, 3 (4.7%) patients showed valve degeneration (underwent surgical MV replacement). Throughout follow-up, no patient exhibited mortality. Conclusions TMVR is a feasible and safe approach in patients with high surgical risk. TMViV and TMViR are reasonable as the first treatment approaches, and TMViMAC seems encouraging.
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17
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Romeo JD, Bashline MJ, Fowler JA, Kliner DE, Toma C, Smith AJC, Sultan I, Sanon S. Current Status of Transcatheter Tricuspid Valve Therapies. Heart Int 2022; 16:49-58. [PMID: 36275351 PMCID: PMC9524678 DOI: 10.17925/hi.2022.16.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2024] Open
Abstract
Tricuspid regurgitation is a complex disease that carries a poor prognosis, and surgical repair is associated with high mortality. In light of the success of other transcatheter-based valve interventions, transcatheter tricuspid therapy has recently seen exponential use both clinically and in innovation. Given the rapid development of many tricuspid systems and multiple on-going clinical trials, the aim of this review is to highlight the current state of transcatheter tricuspid therapeutics and to provide an up-to-date view of their clinical use, outcomes and future directions.
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Affiliation(s)
- Jared D Romeo
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael J Bashline
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey A Fowler
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dustin E Kliner
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Catalin Toma
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - AJ Conrad Smith
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Saurabh Sanon
- Division of Cardiology, Department of Medicine, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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18
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Adabifirouzjaei F, Hsiao A, DeMaria AN. Mitral Valve Prolapse-The Role of Cardiac Imaging Modalities. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100024. [PMID: 37273735 PMCID: PMC10236887 DOI: 10.1016/j.shj.2022.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 06/06/2023]
Abstract
Mitral valve prolapse (MVP) is the most common nonischemic mitral regurgitation etiology and mitral abnormality requiring surgery in the Western world. There is an increasing awareness that pathological findings in MVP are not confined to the valve tissue; rather, it is a complex disease, involving the mitral valve apparatus, cardiac hemodynamics, and cardiac structure. Imaging has played a fundamental role in the understanding of the diagnosis, prevalence, and consequences of MVP. The diagnosis of MVP by imaging is based upon demonstrating valve leaflets ascending into the left atrium through the saddle-shaped annulus. Transthoracic and transesophageal echocardiography are the primary modalities in the diagnosis and assessment of MVP patients and must include careful assessment of the leaflets, annulus, chords, and papillary muscles. High-spatial-resolution imaging modalities such as cardiac magnetic resonance images and cardiac computed tomography play a secondary role in this regard and can demonstrate the anatomical relation between the mitral valve annulus and leaflet excursion for appropriate diagnosis. Ongoing development of new methods of cardiac imaging can help us to accurately understand the mechanism, diagnose the disease, develop an appropriate treatment plan, and estimate the risk for sudden death. Recently, several new observations with respect to prolapse have been derived from cardiac imaging including three-dimensional echocardiography and tissue-Doppler imaging. The aim of this article is to present these new imaging-derived insights for the diagnosis, risk assessment, treatment, and follow-up of patients with MVP.
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Affiliation(s)
- Fatemeh Adabifirouzjaei
- Department of Cardiology, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| | - Albert Hsiao
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Anthony N. DeMaria
- Department of Cardiology, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
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19
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The Role of Cardiac Computed Tomography in Heart Failure. Curr Heart Fail Rep 2022; 19:213-222. [PMID: 35588344 DOI: 10.1007/s11897-022-00553-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Cardiac computed tomography (CT) is becoming a more widely applied tool in the diagnosis and management of a variety of cardiovascular conditions, including heart failure. The aim of this narrative review is to examine the role of cardiac CT in patients with heart failure. RECENT FINDINGS Coronary computed tomographic angiography has robust diagnostic accuracy for ruling out coronary artery disease. These data are reflected in updated guidelines from major cardiology organizations. New roles for cardiac CT in myocardial imaging, perfusion scanning, and periprocedural planning, execution, and monitoring are being implemented. Cardiac CT is useful in ruling out coronary artery disease its diagnostic accuracy, accessibility, and safety. It is also intricately linked to invasive cardiac procedures that patients with heart failure routinely undergo.
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20
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Baldasseroni S, Orso F, Herbst A, Bo M, Boccanelli A, Desideri GB, Rozzini R, Terrosu P, Alboni P, Marchionni N, Ungar A. Role of new drug therapies and innovative procedures in older patients with heart failure: from trials to clinical practice. Minerva Med 2022; 113:647-666. [PMID: 35332760 DOI: 10.23736/s0026-4806.22.08082-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Samuele Baldasseroni
- Unit of Geriatric Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy - .,Department of Clinical and Experimental medicine, University of Florence, Florence, Italy - .,Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy -
| | - Francesco Orso
- Unit of Geriatric Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.,Department of Clinical and Experimental medicine, University of Florence, Florence, Italy
| | - Andrea Herbst
- Unit of Geriatric Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.,Department of Clinical and Experimental medicine, University of Florence, Florence, Italy
| | - Mario Bo
- Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy
| | | | | | - Renzo Rozzini
- Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy
| | | | - Paolo Alboni
- Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy
| | - Niccolò Marchionni
- Department of Clinical and Experimental medicine, University of Florence, Florence, Italy.,Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy.,Division of Cardiology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Andrea Ungar
- Unit of Geriatric Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.,Department of Clinical and Experimental medicine, University of Florence, Florence, Italy.,Società Italiana di Cardiologia Geriatrica-SICGE, Florence, Italy
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21
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Patel KP, Vandermolen S, Herrey AS, Cheasty E, Menezes L, Moon JC, Pugliese F, Treibel TA. Cardiac Computed Tomography: Application in Valvular Heart Disease. Front Cardiovasc Med 2022; 9:849540. [PMID: 35402562 PMCID: PMC8987722 DOI: 10.3389/fcvm.2022.849540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
The incidence and prevalence of valvular heart disease (VHD) is increasing and has been described as the next cardiac epidemic. Advances in imaging and therapeutics have revolutionized how we assess and treat patients with VHD. Although echocardiography continues to be the first-line imaging modality to assess the severity and the effects of VHD, advances in cardiac computed tomography (CT) now provide novel insights into VHD. Transcatheter valvular interventions rely heavily on CT guidance for procedural planning, predicting and detecting complications, and monitoring prosthesis. This review focuses on the current role and future prospects of CT in the assessment of aortic and mitral valves for transcatheter interventions, prosthetic valve complications such as thrombosis and endocarditis, and assessment of the myocardium.
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Affiliation(s)
- Kush P. Patel
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Faculty of Population Health Sciences, Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Sebastian Vandermolen
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Anna S. Herrey
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Faculty of Population Health Sciences, Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Emma Cheasty
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Leon Menezes
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Institute of Nuclear Medicine, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - James C. Moon
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Faculty of Population Health Sciences, Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Francesca Pugliese
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Thomas A. Treibel
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Faculty of Population Health Sciences, Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- Institute of Nuclear Medicine, University College London, London, United Kingdom
- *Correspondence: Thomas A. Treibel,
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22
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Nazzari H, Churchill J, Yucel E. Echocardiographic Imaging for Transcatheter Tricuspid Valve Interventions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00946-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: 10/19/2022]
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23
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Burke L, Hassanin M, Ong G, Fam N. A Practical Approach to Combined Transcatheter Mitral and Tricuspid Valve Intervention. Front Cardiovasc Med 2021; 8:706123. [PMID: 34722653 PMCID: PMC8548370 DOI: 10.3389/fcvm.2021.706123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/12/2021] [Indexed: 12/27/2022] Open
Abstract
Concomitant tricuspid regurgitation (TR) is common in patients with mitral regurgitation (MR). While current guidelines recommend repair of both valves at the time of surgery when feasible, high risk patients are often undertreated, leading to significant morbidity and mortality. With advances in transcatheter edge-to-edge repair (TEER) devices and technique, combined TEER for treating significant MR and TR has emerged as a new tool for heart failure management. Recent evidence has shed light on which patients with severe TR should be targeted for transcatheter intervention either in isolation or in combination with a MV TEER procedure and allows for expanded treatment options in patients who otherwise would be limited to medical management. Technological advancements remain ahead of robust clinical data, and thus randomized clinical studies in patients with severe MR and TR will be instrumental in determining the best approach in treating these patients with transcatheter therapies.
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Affiliation(s)
| | | | | | - Neil Fam
- St. Michael's Hospital, Toronto, ON, Canada
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24
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Caravita S, Figliozzi S, Florescu DR, Volpato V, Oliverio G, Tomaselli M, Torlasco C, Muscogiuri G, Cernigliaro F, Parati G, Badano L, Muraru D. Recent advances in multimodality imaging of the tricuspid valve. Expert Rev Med Devices 2021; 18:1069-1081. [PMID: 34617481 DOI: 10.1080/17434440.2021.1990753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The tricuspid valve (TV) and the right heart chambers are complex three-dimensional structures that are difficult to assess using tomographic imaging techniques. The progressive aging of the general population and the advancements in treating left-sided heart diseases by transcatheter procedures have contributed to the tricuspid regurgitation (TR) becoming a major public health problem associated with progression to refractory heart failure and poor outcome. Recent advances in multimodality cardiac imaging allow a better understanding of the pathophysiology of TR that may translate in better management of patients. AREAS COVERED Three-dimensional echocardiography, cardiac magnetic resonance, and computed tomography provide complementary information to i. assess the TV complex; ii. identify the etiology and the mechanisms of TR; iii. evaluate its severity and hemodynamic consequences; iv. explore the remodeling of the right heart chambers; and v. properly plan, guide, and monitor the transcatheter interventions aimed to reduce the severity of TR. EXPERT OPINION We need thorough understanding of both the TV and the right heart chamber geometry and function to understand the pathophysiology of TR. The integrated use of multimodality cardiac imaging is pivotal to assess patients with TR and to identify tailored and timely treatment of TR in properly selected patients.
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Affiliation(s)
- Sergio Caravita
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy
| | - Stefano Figliozzi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Diana-Ruxandra Florescu
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Valentina Volpato
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Giorgio Oliverio
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Michele Tomaselli
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Franco Cernigliaro
- Department of Radiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luigi Badano
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Denisa Muraru
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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25
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Wild MG, Gloeckler M, Wustmann KB, Erne SA, Grogg H, Huber AT, Windecker S, Praz F, Gräni C. Multimodality Imaging for Evaluation of Bicaval Valved Stent Implantation in Severe Tricuspid Regurgitation. JACC Case Rep 2021; 3:1512-1518. [PMID: 34746850 PMCID: PMC8551505 DOI: 10.1016/j.jaccas.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022]
Abstract
Preprocedural planning and postprocedural evaluation after transcatheter treatment of severe tricuspid regurgitation remain challenging and require further research and standardization. We illustrate the use of multimodality imaging techniques in 3 patients undergoing implantation of a novel custom-made bicaval valved stent for symptomatic treatment of severe tricuspid regurgitation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Mirjam G. Wild
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Gloeckler
- Department of Cardiology, Center for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kerstin B. Wustmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie A. Erne
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hanna Grogg
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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26
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Transcatheter Tricuspid Valve-in-Valve Procedure-An Illustrative Case Report and Review. J Clin Med 2021; 10:jcm10174004. [PMID: 34501452 PMCID: PMC8432540 DOI: 10.3390/jcm10174004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
Severe tricuspid commitment is no longer understood as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated tricuspid valve surgery remains rare and to this day continues to be associated with the highest surgical risk among all valve procedures and high operative mortality rates, especially in reoperations. Therefore, the development of tricuspid transcatheter procedures is as necessary as it was for the other valves a couple of years ago. Recently, multiple percutaneous therapies have been developed for the management of severe tricuspid disease, initially only repair and more recently replacement, thus creating a new branch for the management of patients who have already undergone surgery and who present with dysfunctional bioprostheses. The purpose of this review and report is to demonstrate current and possible future challenges, and to show that the valve-in-valve procedure of the tricuspid valve is feasible and safe, and now can be performed in all its range, in the smallest to the largest sizes of presentation, without incurring the untoward risks of conventional surgery.
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27
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Ho EC, Latib A. Imaging for transcatheter native tricuspid valve intervention: patient selection, procedural planning and interventional guidance. Minerva Cardiol Angiol 2021; 69:707-719. [PMID: 34472772 DOI: 10.23736/s2724-5683.21.05697-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are an increasing number of transcatheter tricuspid valve interventions being performed worldwide using commercially available and investigational devices. Imaging in the pre-procedural and periprocedural period is essential for procedural and clinical success. Echocardiographic-based techniques are particularly important in these procedures, especially for interventional guidance. This review summarizes the current devices in use and how imaging is used for patient selection, procedural planning, and interventional guidance. The most commonly used method of transcatheter tricuspid intervention is edge-to-edge repair using the MitraClip or TriClip devices (Abbott, Santa Clara, CA, USA). Randomized controlled data is pending but observational studies have demonstrated success, especially in the setting of smaller coaptation gaps and adequate transesophageal imaging windows. Direct annuloplasty with the Cardioband (Edwards Lifesciences, Irvine, CA, USA) has also been used in many centers and has demonstrated success when the anatomy and mechanism of tricuspid regurgitation are appropriate for annuloplasty based on imaging evaluation. Lastly, transcatheter valve replacement is becoming more common using several investigational devices and relies heavily on imaging methods to achieve procedural success.
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Affiliation(s)
- Edwin C Ho
- Division of Cardiology, Montefiore Medical Center - Weiler Division, Albert Einstein College of Medicine, New York, NY, USA -
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center - Weiler Division, Albert Einstein College of Medicine, New York, NY, USA
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28
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Matta M, Ayoub C, Abou Hassan OK, Layoun H, Cremer PC, Hussein A, Schoenhagen P, Saliba WI, Rodriguez LL, Griffin BP, Kapadia SR, Harb SC. Anatomic and Functional Determinants of Atrial Functional Mitral Regurgitation. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2021.1943765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
PURPOSE OF REVIEW Severe tricuspid regurgitation is a commonly prevalent valvular heart disease that is an independent adverse prognostic marker. However, the majority of patients with tricuspid regurgitation are managed medically; isolated tricuspid valve surgery is rarely performed, partly owing to high associated in-hospital mortality. Therefore, several transcatheter tricuspid valve interventions (TTVIs) that have been developed over the last few years to address this unmet clinical need. RECENT FINDINGS The early experience with TTVI has shown that most devices can be safely implanted with excellent rates of technical success and acceptable safety outcomes. Most TTVI recipients have significant improvement in tricuspid regurgitation severity, functional class, and quality of life. Recent retrospective data also suggest mortality benefit of TTVI compared with medical management. There are several issues that need to be addressed prior to widespread adoption of TTVI, including more effective tricuspid regurgitation reduction and need for longer term efficacy data. SUMMARY TTVI has emerged as an attractive treatment option for management of high-risk patients with tricuspid regurgitation. In this review, we will discuss the anatomical considerations specific to tricuspid valve, patient selection, preprocedure planning, and summarize the current evidence and future perspectives on TTVI.
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30
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Mangieri A, Laricchia A, Cereda A, Khokhar AA, Regazzoli D, Giannini F, Reimers B, Colombo A. Diagnosis and Management of Failed Surgical Tricuspid Valve Annuloplasty. Curr Cardiol Rep 2021; 23:137. [PMID: 34410511 DOI: 10.1007/s11886-021-01569-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW Annular-based strategies for treating tricuspid valve (TV) regurgitation do not always have satisfactory long-term outcomes. Management of failed TV annuloplasty can be challenging and requires a dedicated heart team approach. This review explores the treatment options available for failed TV annuloplasty. RECENT FINDINGS Recent developments and novel percutaneous treatment options have emerged as promising alternatives for patients with failed TV annuloplasty. Leaflet-based interventions, valve-in-valve procedures, transcatheter tricuspid valves and new-generation trans-caval valves are all feasible options, which can assure good results whilst minimizing risks for the patient. Failure of tricuspid annuloplasty is not uncommon amongst patients treated with either a tricuspid ring or suture-based device. The complex anatomy, physiology and clinical risk profile should be carefully evaluated on an individual patient-by-patient basis in order to select the most appropriate clinical and percutaneous treatment strategy. Different transcatheter tricuspid valve repair or replacement techniques may provide an attractive alternative treatment option for managing this challenging patient cohort.
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Affiliation(s)
- Antonio Mangieri
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Alberto Cereda
- Cardiovascular Department, ASST Santi Paolo e Carlo, Milan, Italy
| | - Arif A Khokhar
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Damiano Regazzoli
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Bernhard Reimers
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio Colombo
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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31
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Hayashi A, Ikenaga H, Nagaura T, Yoshida J, Uno G, Rader F, Makar M, Chakravarty T, Siegel RJ, Kar S, Makkar RR, Shiota T. Left ventricular outflow tract area after percutaneous transseptal transcatheter mitral valve implantation: A three-dimensional transesophageal echocardiography study. Echocardiography 2021; 38:932-942. [PMID: 33983660 DOI: 10.1111/echo.15078] [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: 01/12/2021] [Revised: 04/02/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Left ventricular (LV) outflow tract (LVOT) obstruction increases mortality in patients undergoing transcatheter mitral valve implantation (TMVI) in degenerated bioprostheses, annuloplasty rings, and native mitral valves. We aimed to evaluate the LVOT area after TMVI using 3-dimensional (3D) transesophageal echocardiography (TEE) and to investigate the preprocedural cardiac geometry that affects the LVOT area after TMVI. METHODS We retrospectively reviewed echocardiography data in 43 patients who had TMVI. A change in pressure gradient across LVOT from before to after TMVI (∆PG) and postprocedure 3D LVOT cross-sectional area at the level of the most distal portion of the mitral valve stent that was closest to the LV apex were assessed as evidence of LVOT narrowing. RESULTS Transcatheter mitral valve implantation with the use of balloon-expandable valve system was performed for 24 bioprostheses, 7 annuloplasty rings, and 12 native valves. Compared to patients without increase in LVOT gradient (∆PG <10 mm Hg; n = 33), patients with increase in LVOT gradient (∆PG ≥10 mm Hg; n = 10) had smaller LV end-systolic volume (LVESV), greater LV ejection fraction (LVEF), and smaller aorto-mitral (AM) angle. The LVOT area at the valve stent distal edge showed strong association with ∆PG (r = -.68, P < .0001). Only a small AM angle was associated with a small LVOT area at the valve stent distal edge on multivariable analysis, independent of LVESV and LVEF. CONCLUSION Small LV size, preserved LVEF, and small AM angle were associated with LVOT narrowing. 3D-derived AM angle might be independently associated with LVOT narrowing in patients undergoing transcatheter mitral valve-in-valve, valve-in-ring, and valve-in-native valve implantation, independent of LVESV and LVEF.
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Affiliation(s)
- Atsushi Hayashi
- Department of Noninvasive Cardiac Laboratory, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Hiroki Ikenaga
- Department of Noninvasive Cardiac Laboratory, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Takafumi Nagaura
- Department of Noninvasive Cardiac Laboratory, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Jun Yoshida
- Department of Noninvasive Cardiac Laboratory, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Goki Uno
- Department of Noninvasive Cardiac Laboratory, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Florian Rader
- Department of Noninvasive Cardiac Laboratory, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Moody Makar
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tarun Chakravarty
- Department of Interventional Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Robert J Siegel
- Department of Noninvasive Cardiac Laboratory, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA, USA
| | - Raj R Makkar
- Department of Interventional Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Takahiro Shiota
- Department of Noninvasive Cardiac Laboratory, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
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Vaiyani D, Kelleman M, Downey LA, Kanaan U, Petit CJ, Bauser-Heaton H. Risk Factors for Adverse Events in Children with Pulmonary Hypertension Undergoing Cardiac Catheterization. Pediatr Cardiol 2021; 42:736-742. [PMID: 33512547 DOI: 10.1007/s00246-020-02535-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/23/2020] [Indexed: 11/25/2022]
Abstract
Pulmonary hypertension (PH) can lead to progressive heart failure with high morbidity and mortality. Cardiac catheterization (CC) is the gold standard for diagnosis and response to vasodilatory medications. The invasive nature of CC and associated anesthesia predispose this patient population to adverse events including death. Catheterization records were queried from 1/1/2011 to 10/31/2016. Patients with PH, defined as pulmonary vascular resistance (PVR) greater than 3 WU m2, pulmonary artery pressure above 20 mmHg, and pulmonary wedge pressure less than or equal to 15 mmHg, who underwent hemodynamic CC were included in this retrospective study. Both patients with and without congenital heart disease were included. There were 198 CC in 191 patients. Adverse events (n = 28, 14.1%) included cardiac arrest, increased respiratory support requiring ICU care, PH crisis, bradycardia/hypotension requiring intervention, and arrhythmias. Odds of an adverse event increased by 22% for every 15-min increase in procedure times (OR 1.22, CI 1.01-1.39, p = 0.002) and were significantly increased for procedures longer than 80 min (OR 3.75, CI 1.56-9.00, p = 0.007) (Fig. 1). Patients with an adverse event had higher mean pulmonary artery pressures while breathing oxygen (43 [35-58] versus 34 [27-44] mmHg, p = 0.017) and oxygen with inhaled nitric oxide (37 [32-56] versus 32 [25-40] mmHg, p = 0.026). Females carried more risk than males (OR 3.88, CI 1.44-10.40, p = 0.007). Younger age, medication regimens, prematurity, and genetic disease did not carry an increased risk. Adverse events are common in pediatric patients with PH undergoing CC. The risk of adverse events correlates with greater procedure times and higher mean pulmonary artery pressure. Minimizing procedure time may improve patient outcomes.
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Affiliation(s)
- Danish Vaiyani
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Laura A Downey
- Division of Cardiac Anesthesia, Emory University, Atlanta, GA, USA
| | - Usama Kanaan
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatrics, Emory University, Atlanta, GA, USA
| | - Christopher J Petit
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatrics, Emory University, Atlanta, GA, USA
| | - Holly Bauser-Heaton
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Division of Pediatrics, Emory University, Atlanta, GA, USA.
- Sibley Heart Center, 2835 Brandywine Rd Suite 300, Atlanta, GA, 30341, USA.
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33
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Papadimitraki ED, Patrianakos A, Pitsis A, Marketou M, Zacharaki A, Parthenakis F. Mitral commissural prolapse. Echocardiography 2021; 38:646-656. [PMID: 33749914 DOI: 10.1111/echo.14984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 11/27/2022] Open
Abstract
Mitral commissural prolapse or flail, either isolated or combined with more extensive degenerative valve disease, imposes several challenges both on its diagnosis and management while being a risk factor for valve reoperation after mitral valve repair. Accurate identification of the prolapsing segment is often not feasible with transthoracic 2D echocardiography, with transesophageal 3D imaging then required for correct diagnosis and surgical planning. Various surgical techniques employed alone or in combination have yielded good results in the repair of commissural prolapse. Herein, we analyze the specific characteristics of commissural disease focusing our attention on 2D and 3D echocardiographic findings and we briefly comment on techniques employed for surgical correction of the disease.
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Affiliation(s)
- Eva D Papadimitraki
- Department of Cardiology, University Hospital of Herakleion, Voutes, Crete, Greece
| | | | - Antonios Pitsis
- Head of Cardiac Surgery, Thessaloniki Heart Institute, St Luke's Hospital, Thessaloniki, Greece
| | - Maria Marketou
- Department of Cardiology, University Hospital of Herakleion, Voutes, Crete, Greece
| | - Angeliki Zacharaki
- Department of Cardiology, University Hospital of Herakleion, Voutes, Crete, Greece
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34
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Fortuni F, Hirasawa K, Bax JJ, Delgado V, Ajmone Marsan N. Multi-Modality Imaging for Interventions in Tricuspid Valve Disease. Front Cardiovasc Med 2021; 8:638487. [PMID: 33634175 PMCID: PMC7900427 DOI: 10.3389/fcvm.2021.638487] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
Abstract
Several studies have demonstrated that severe tricuspid regurgitation (TR) has a significant negative impact on morbidity and mortality. Nowadays, several therapeutic options to treat TR are available and patients at high surgical risk can also be treated with transcatheter procedures. For the management of patients with TR, an accurate assessment of the tricuspid valve and its surrounding structures is therefore of crucial importance and has gained significant interest in the medical community. Different imaging modalities can provide detailed information on the tricuspid valve apparatus, right ventricle, right atrium, and coronary circulation which are fundamental to define the timing and anatomic suitability of surgical and percutaneous procedures. The present review illustrates the role of 2D and 3D echocardiography, cardiac magnetic resonance, and multidetector row computed tomography for the assessment of the tricuspid valve and right heart with a particular focus on the data needed for planning and guiding interventional procedures.
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Affiliation(s)
- Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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35
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Kapadia S, Krishnaswamy A, Layoun H, Griffin BP, Wierup P, Schoenhagen P, Harb SC. Tricuspid annular dimensions in patients with severe mitral regurgitation without severe tricuspid regurgitation. Cardiovasc Diagn Ther 2021; 11:68-80. [PMID: 33708479 DOI: 10.21037/cdt-20-903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Concomitant TV repair during mitral valve (MV) surgery based on tricuspid valve annulus (TVA) dilation, rather than the degree of tricuspid regurgitation (TR), is beneficial and supported by the valve guidelines. We sought to determine TVA geometry and dimensions in controls and assess the changes that occur in patients with severe primary (PMR) and secondary (SMR) mitral regurgitation without TR. Methods We analyzed cardiac computed tomographic angiography (CCTA) of 125 consecutive subjects: 50 controls with normal coronary CCTA and no valvular dysfunction, 50 PMR patients referred for robotic repair, and 25 SMR patients referred for transcatheter therapy. Patients with >2+ TR on echocardiography were excluded. Annular measurements were performed using dedicated software and compared. Correlations and determinants of TVA dimensions were analyzed. Results Patients with SMR were older and had significantly more comorbidities. In controls, the TVA was larger and more planar and eccentric compared to the MV annulus (all P<0.01). Dimensions of both annuli correlated significantly (r≥0.5; P<0.001 for all dimensions) in controls and patients with severe MR. In both PMR and SMR, the TVA enlarged in all dimensions (P<0.01) with a trend towards becoming more circular. On multivariable regression, the MV annular area was the primary determinant of the TVA area (adjusted β=0.430, P<0.001). Conclusions Substantial changes in TVA dimensions are encountered in patients with severe MR even in the absence of severe TR such that TVA and MVA dimensions remain correlated. Close attention to the TVA in patients with severe MR is warranted.
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Affiliation(s)
- Sohum Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Per Wierup
- Department of Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH, USA
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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36
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Transcatheter Interventions for Tricuspid Valve Disease: What to Do and Who to Do It On. Can J Cardiol 2021; 37:953-967. [PMID: 33493660 DOI: 10.1016/j.cjca.2020.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/21/2022] Open
Abstract
Tricuspid valve disease, and particularly the management of severe tricuspid regurgitation (TR), has gained momentum in recent years. Although it is well known that this frequent condition is associated with poor clinical outcomes, these patients have been classically managed medically, leading to end-stage right ventricular heart failure. Moreover, late referral to surgery has contributed to a high rate of periprocedural complications and in-hospital surgical mortality. Thus, the development of a less invasive catheter-based therapy would be of high clinical relevance in this context. Several transcatheter tricuspid valve intervention (TTVI) devices have been developed in recent years. The particular characteristics of the tricuspid valve (large noncalcific annulus, presence of chief surrounding structures such as the conduction system or the right coronary artery) make multimodality imaging (eg, transesophageal echocardiography, computed tomography) key in the preprocedural assessment of TTVI. According to their mechanism of action and therapeutic target, TTVI includes transcatheter repair either with coaptation or annuloplasty systems, caval valve devices, and transcatheter tricuspid valve replacement. The initial TTVI experience showed that most procedures were well tolerated, with high procedural success and low in-hospital and early mortality. Also, most TTVI recipients improved their functional status and recent data suggest improved outcomes compared with medical management. However, the rate of significant residual TR after transcatheter tricuspid valve repair remains high and very scarce data exist on longer term (beyond 6-12 months) outcomes. The present review provides an overview regarding the framework of chronic TR and TTVI therapeutic options, and describes the updated current evidence in this challenging field.
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37
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Fortuni F, Hirasawa K, Marques AI, Pio SM, Chimed S, Lustosa R, Tjahjadi C, Wang X, Bax JJ, Ajmone Marsan N, Delgado V. Computed Tomography-Derived Transesophageal Echocardiographic Views: Step Forward for Procedural Planning of Transcatheter Tricuspid Valve Annuloplasty. Circ Cardiovasc Imaging 2021; 14:e011107. [PMID: 33401920 DOI: 10.1161/circimaging.120.011107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, The Netherlands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.).,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Italy (F.F.)
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, The Netherlands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.)
| | | | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, The Netherlands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.)
| | - Surenjav Chimed
- Department of Cardiology, Leiden University Medical Center, The Netherlands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.)
| | - Rodolfo Lustosa
- Department of Cardiology, Leiden University Medical Center, The Netherlands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.)
| | - Catherina Tjahjadi
- Department of Cardiology, Leiden University Medical Center, The Netherlands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.)
| | - Xu Wang
- Department of Cardiology, Leiden University Medical Center, The Netherlands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.)
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, The Netherlands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.)
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, The Netherlands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.)
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, The Netherlands (F.F., K.H., S.M.P., S.C., R.L., C.T., X.W., J.J.B., N.A.M., V.D.)
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38
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Ricci F, Aung N, Gallina S, Zemrak F, Fung K, Bisaccia G, Paiva JM, Khanji MY, Mantini C, Palermi S, Lee AM, Piechnik SK, Neubauer S, Petersen SE. Cardiovascular magnetic resonance reference values of mitral and tricuspid annular dimensions: the UK Biobank cohort. J Cardiovasc Magn Reson 2020; 23:5. [PMID: 33407573 PMCID: PMC7788733 DOI: 10.1186/s12968-020-00688-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mitral valve (MV) and tricuspid valve (TV) apparatus geometry are essential to define mechanisms and etiologies of regurgitation and to inform surgical or transcatheter interventions. Given the increasing use of cardiovascular magnetic resonance (CMR) for the evaluation of valvular heart disease, we aimed to establish CMR-derived age- and sex-specific reference values for mitral annular (MA) and tricuspid annular (TA) dimensions and tethering indices derived from truly healthy Caucasian adults. METHODS 5065 consecutive UK Biobank participants underwent CMR using cine balanced steady-state free precession imaging at 1.5 T. Participants with non-Caucasian ethnicity, prevalent cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Absolute and indexed reference ranges for MA and TA diameters and tethering indices were stratified by gender and age (45-54, 55-64, 65-74 years). RESULTS Overall, 721 (14.2%) truly healthy participants aged 45-74 years (54% women) formed the reference cohort. Absolute MA and TA diameters, MV tenting length and MV tenting area, were significantly larger in men. Mean ± standard deviation (SD) end-diastolic and end-systolic MA diameters in the 3-chamber view (anteroposterior diameter) were 2.9 ± 0.4 cm (1.5 ± 0.2 cm/m2) and 3.3 ± 0.4 cm (1.7 ± 0.2 cm/m2) in men, and 2.6 ± 0.4 cm (1.6 ± 0.2 cm/m2) and 3.0 ± 0.4 cm (1.8 ± 0.2 cm/m2) in women, respectively. Mean ± SD end-diastolic and end-systolic TA diameters in the 4-chamber view were 3.2 ± 0.5 cm (1.6 ± 0.3 cm/m2) and 3.2 ± 0.5 cm (1.7 ± 0.3 cm/m2) in men, and 2.9 ± 0.4 cm (1.7 ± 0.2 cm/m2) and 2.8 ± 0.4 cm (1.7 ± 0.3 cm/m2) in women, respectively. With advancing age, end-diastolic TA diameter became larger and posterior MV leaflet angle smaller in both sexes. Reproducibility of measurements was good to excellent with an inter-rater intraclass correlation coefficient (ICC) between 0.92 and 0.98 and an intra-rater ICC between 0.90 and 0.97. CONCLUSIONS We described age- and sex-specific reference ranges of MA and TA dimensions and tethering indices in the largest validated healthy Caucasian population. Reference ranges presented in this study may help to improve the distinction between normal and pathological states, prompting the identification of subjects that may benefit from advanced cardiac imaging for annular sizing and planning of valvular interventions.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Casa Di Cura Villa Serena, 65013, Città Sant'Angelo, Pescara, Italy
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Filip Zemrak
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Jose Miguel Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Stefano Palermi
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Aaron M Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, NIHR BRC Oxford, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, NIHR BRC Oxford, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK.
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Ajam M, Touma R, Chehab O, Shokr M, Abidov A. Unmasking pulmonary hypertension following tricuspid valve replacement. Echocardiography 2020; 38:151-154. [PMID: 33301185 DOI: 10.1111/echo.14945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022] Open
Abstract
In this Viewpoint, we highlight a possible hemodynamic problem arising following tricuspid valve replacement (TVR) in patients with severe chronic tricuspid regurgitation, represented by "unmasking" of pulmonary hypertension (PH) following the surgery. We share an observation that should alert cardiologists to the fact that this increasingly utilized surgery is not risk free, and careful assessment of the right ventricular function and pulmonary circulation preoperatively is extremely important, especially in patients with preexisting risk factors for PH, since TVR may lead to a sudden increase in right ventricular afterload.
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Affiliation(s)
- Mustafa Ajam
- Department of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Rabih Touma
- Section of Cardiology, John D. Dingell VA Medical Center, Detroit, MI, USA.,Division of Cardiology, Wayne State University, Detroit, MI, USA
| | - Omar Chehab
- Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Aiden Abidov
- Section of Cardiology, John D. Dingell VA Medical Center, Detroit, MI, USA.,Division of Cardiology, Wayne State University, Detroit, MI, USA
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40
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Clemente A, Seitun S, Mantini C, Gentile G, Federici D, Barison A, Rossi A, Cuman M, Pizzuto A, Ait-Ali L, Bossone E, Cademartiri F, Chiappino D. Cardiac CT angiography: normal and pathological anatomical features-a narrative review. Cardiovasc Diagn Ther 2020; 10:1918-1945. [PMID: 33381435 DOI: 10.21037/cdt-20-530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The normal and pathological anatomy of the heart and coronary arteries are nowadays widely developed topics and constitute a fundamental part of the cultural background of the radiologist. The introduction of cardiac ECG-gated synchronized CT scanners with an ever-increasing number of detectors and with increasingly high structural characteristics (increase in temporal resolution, increase in contrast resolution with dual-source, dual energy scanners) allows the virtual measurement of anatomical in vivo structures complying with heart rate with submillimetric precision permitting to clearly depict the normal anatomy and follow the pathologic temporal evolution. Accordingly to these considerations, cardiac computed tomography angiography (CCTA) asserts itself as a gold standard method for the anatomical evaluation of the heart and permits to evaluate, verify, measure and characterize structural pathological alterations of both congenital and acquired degenerative diseases. Accordingly, CCTA is increasingly used as a prognostic model capable of modifying the outcome of diseased patients in planning interventions and in the post-surgical/interventional follow-up. The profound knowledge of cardiac anatomy and function through highly detailed CCTA analysis is required to perform an efficient and optimal use in real-world clinical practice.
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Affiliation(s)
- Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Sara Seitun
- IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Science, Institute of Radiology, "G. d'Annunzio" University, Chieti, Italy
| | - Giovanni Gentile
- Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Duccio Federici
- Pediatric Cardiac Surgery, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Andrea Barison
- Cardiology Division, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Pisa, Italy
| | - Andrea Rossi
- Arrhythmology Unit, Department of Invasive Cardiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Pisa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | | | - Dante Chiappino
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
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41
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Reid A, Ben Zekry S, Turaga M, Tarazi S, Bax JJ, Wang DD, Piazza N, Bapat VN, Ihdayhid AR, Cavalcante JL, Blanke P, Leipsic J. Neo-LVOT and Transcatheter Mitral Valve Replacement: Expert Recommendations. JACC Cardiovasc Imaging 2020; 14:854-866. [PMID: 33248959 DOI: 10.1016/j.jcmg.2020.09.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
With the advent of transcatheter mitral valve replacement (TMVR), the concept of the neo-left ventricular outflow tract (LVOT) was introduced and remains an essential component of treatment planning. This paper describes the LVOT anatomy and provides a step-by-step computed tomography methodology to segment and measure the neo-LVOT while discussing the current evidence and outstanding challenges. It also discusses the technical and hemodynamic factors that play a major role in assessing the neo-LVOT. A summary of expert-based recommendations about the overall risk of LVOT obstruction in different scenarios is presented along with the currently available methods to reduce the risk of LVOT obstruction and other post-procedural complications.
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Affiliation(s)
- Anna Reid
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sagit Ben Zekry
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mansi Turaga
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Tarazi
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Vinayak N Bapat
- Department of Medicine, Division of Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Abdul Rahman Ihdayhid
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Philipp Blanke
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Daubert MA, Tailor T, James O, Shaw LJ, Douglas PS, Koweek L. Multimodality cardiac imaging in the 21st century: evolution, advances and future opportunities for innovation. Br J Radiol 2020; 94:20200780. [PMID: 33237824 DOI: 10.1259/bjr.20200780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular imaging has significantly evolved since the turn of the century. Progress in the last two decades has been marked by advances in every modality used to image the heart, including echocardiography, cardiac magnetic resonance, cardiac CT and nuclear cardiology. There has also been a dramatic increase in hybrid and fusion modalities that leverage the unique capabilities of two imaging techniques simultaneously, as well as the incorporation of artificial intelligence and machine learning into the clinical workflow. These advances in non-invasive cardiac imaging have guided patient management and improved clinical outcomes. The technological developments of the past 20 years have also given rise to new imaging subspecialities and increased the demand for dedicated cardiac imagers who are cross-trained in multiple modalities. This state-of-the-art review summarizes the evolution of multimodality cardiac imaging in the 21st century and highlights opportunities for future innovation.
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Affiliation(s)
- Melissa A Daubert
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Tina Tailor
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Olga James
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Leslee J Shaw
- Department of Radiology, Cornell Medical Center, New York, New York, USA
| | - Pamela S Douglas
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Lynne Koweek
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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43
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Yu YJ, Chen Y, Lau CP, Liu YX, Wu MZ, Chen YY, Ho LM, Tse HF, Yiu KH. Nonapical Right Ventricular Pacing Is Associated with Less Tricuspid Valve Interference and Long-Term Progress of Tricuspid Regurgitation. J Am Soc Echocardiogr 2020; 33:1375-1383. [DOI: 10.1016/j.echo.2020.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 01/26/2023]
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Mangieri A, Pagnesi M, Regazzoli D, Laricchia A, Ho E, Goldberg Y, Chau M, Gallo F, Fisicaro A, Khokhar A, Colombo A, Giannini F, Latib A. Future Perspectives in Percutaneous Treatment of Tricuspid Regurgitation. Front Cardiovasc Med 2020; 7:581211. [PMID: 33173788 PMCID: PMC7591745 DOI: 10.3389/fcvm.2020.581211] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
Tricuspid regurgitation (TR) has a not negligible prevalence and its severity is correlated with poorer outcomes. However, surgical options are rarely offered to these patients because of their high surgical risk. Given that medical therapy plays a limited role in the management of these patients, there is an increasing clinical need for transcatheter treatment options. Although, transcatheter tricuspid valve interventions (TTVIs) are still at an early stage, emerging data suggests their clinical effectiveness and safety, with preliminary results highlighting the potential benefits of transcatheter treatments over medical therapy. In this review, we highlight the challenges and future directions of current and emerging technologies dedicated to the treatment of TR along with an analysis of the next steps required in future clinical trials and studies dedicated to the treatment of the forgotten valve.
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Affiliation(s)
- Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Damiano Regazzoli
- Unit of Cardiovascular Interventions, Humanitas Research Hospital, Rozzano, Italy
| | - Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Edwin Ho
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
| | - Ythan Goldberg
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
| | - Mei Chau
- Department of Cardiac Surgery, Montefiore Medical Center, New York, NY, United States
| | - Francesco Gallo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Fisicaro
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Arif Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
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45
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Tarasoutchi F, Montera MW, Ramos AIDO, Sampaio RO, Rosa VEE, Accorsi TAD, Santis AD, Fernandes JRC, Pires LJT, Spina GS, Vieira MLC, Lavitola PDL, Ávila WS, Paixão MR, Bignoto T, Togna DJD, Mesquita ET, Esteves WADM, Atik F, Colafranceschi AS, Moises VA, Kiyose AT, Pomerantzeff PMA, Lemos PA, Brito Junior FSD, Weksler C, Brandão CMDA, Poffo R, Simões R, Rassi S, Leães PE, Mourilhe-Rocha R, Pena JLB, Jatene FB, Barbosa MDM, Abizaid A, Ribeiro HB, Bacal F, Rochitte CE, Fonseca JHDAPD, Ghorayeb SKN, Lopes MACQ, Spina SV, Pignatelli RH, Saraiva JFK. Update of the Brazilian Guidelines for Valvular Heart Disease - 2020. Arq Bras Cardiol 2020; 115:720-775. [PMID: 33111877 PMCID: PMC8386977 DOI: 10.36660/abc.20201047] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Roney Orismar Sampaio
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Vitor Emer Egypto Rosa
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Tarso Augusto Duenhas Accorsi
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Antonio de Santis
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - João Ricardo Cordeiro Fernandes
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Lucas José Tachotti Pires
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Guilherme S Spina
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Paulo de Lara Lavitola
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Walkiria Samuel Ávila
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Milena Ribeiro Paixão
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Tiago Bignoto
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | | | - Fernando Atik
- Fundação Universitária de Cardiologia (FUC), São Paulo, SP - Brasil
| | | | | | | | | | - Pedro A Lemos
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | | | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Carlos Manuel de Almeida Brandão
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Robinson Poffo
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Ricardo Simões
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | | | - Ricardo Mourilhe-Rocha
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | - Fabio Biscegli Jatene
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Alexandre Abizaid
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Henrique Barbosa Ribeiro
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Fernando Bacal
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | - José Francisco Kerr Saraiva
- Sociedade Campineira de Educação e Instrução Mantenedora da Pontifícia Universidade Católica de Campinas, Campinas, SP - Brasil
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Aremu OO, Samuels P, Jermy S, Lumngwena EN, Mutithu D, Cupido BJ, Skatulla S, Ntusi NAB. Cardiovascular imaging modalities in the diagnosis and management of rheumatic heart disease. Int J Cardiol 2020; 325:176-185. [PMID: 32980432 DOI: 10.1016/j.ijcard.2020.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
Rheumatic heart disease (RHD) is prevalent in sub-Saharan Africa, where the capacity for diagnosis and evaluation of disease severity and complications is not always optimal. While the medical history and physical examination are important in the assessment of patients suspected to have RHD, cardiovascular imaging techniques are useful for confirmation of the diagnosis. Echocardiography is the workhorse modality for initial evaluation and diagnosis of RHD. Cardiovascular magnetic resonance is complementary and may provide additive information, including tissue characteristics, where echocardiography is inadequate or non-diagnostic. There is emerging evidence on the role of computed tomography, particularly following valve replacement surgery, in the monitoring and management of RHD. This article summarises the techniques used in imaging RHD patients, considers the evidence base for their utility, discusses their limitations and recognises the clinical contexts in which indications and imaging with various modalities are expanding.
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Affiliation(s)
- Olukayode O Aremu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Petronella Samuels
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Stephen Jermy
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Evelyn N Lumngwena
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Centre for the Study of Emerging and Ee-emerging Infections (CREMER), Institute for Medical Research and Medicinal Plant studies (IMPM), Ministry of Scientific Research and Innovation, Cameroon
| | - Daniel Mutithu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Blanche J Cupido
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sebastian Skatulla
- Division of Structural Engineering and Mechanics, Department of Civil Engineering, University of Cape Town, South Africa; Department of Civil Engineering, Centre for Research in Computational and Applied Mechanics (CERECAM), University of Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa.
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47
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Agricola E, Asmarats L, Maisano F, Cavalcante JL, Liu S, Milla F, Meduri C, Rodés-Cabau J, Vannan M, Pibarot P. Imaging for Tricuspid Valve Repair and Replacement. JACC Cardiovasc Imaging 2020; 14:61-111. [PMID: 32828782 DOI: 10.1016/j.jcmg.2020.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 12/16/2022]
Abstract
Primary or secondary tricuspid regurgitation (TR) represents an important health care burden and challenge which has often been neglected or undertreated in the past. The expansion and reinforcement of the indications for tricuspid valve (TV) intervention in the 2017 editions of the guidelines as well as the introduction of transcatheter tricuspid valve intervention (TTVI) has considerably increased the attention of the community on the TV and the volume of TV interventions in the past years. Depending on the anatomic target, TTVI can be categorized as the following: 1) direct or indirect tricuspid restrictive annuloplasty; 2) direct (edge-to-edge repair) or indirect (coaptation device) restoration of leaflet coaptation; 3) heterotopic tricuspid valve implantation; and 4) transcatheter tricuspid valve replacement. Multimodality imaging has crucial role for the following: 1) patient selection for TTVI and procedure planning; 2) guiding and monitoring the procedure; and 3) assessing and following over time the results of the procedure. The key points for pre-procedural imaging are: 1) accurate quantitation of TR severity; 2) proper identification of the mechanism(s) responsible for the TR; and 3) quantitation of RV dysfunction and pulmonary arterial hypertension. This imaging work-up is essential to select the right type of intervention for the right patient and TV. Transesophageal echocardiography and fluoroscopy imaging is also key for guiding the TTVI procedures and fusion between these 2 modalities may further enhance the quality of procedure guiding.
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Affiliation(s)
| | - Lluis Asmarats
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec, Canada
| | | | - João L Cavalcante
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Shizhen Liu
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Federico Milla
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Christopher Meduri
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec, Canada
| | - Mani Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec, Canada.
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48
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Alharbi Y, Otton J, Muller DW, Geelan-Small P, Lovell NH, Al Abed A, Dokos S. Predicting the outcome of transcatheter mitral valve implantation using image-based computational models. J Cardiovasc Comput Tomogr 2020; 14:335-342. [DOI: 10.1016/j.jcct.2019.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/06/2019] [Accepted: 11/27/2019] [Indexed: 11/28/2022]
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49
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Hinzpeter R, Eberhard M, Pozzoli A, von Spiczak J, Manka R, Tanner FC, Taramasso M, Maisano F, Alkadhi H. Dynamic anatomic relationship of the coronary arteries to the valves. Part 1: mitral annulus and circumflex artery. EUROINTERVENTION 2020; 15:919-922. [PMID: 31746756 DOI: 10.4244/eij-d-19-00669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ricarda Hinzpeter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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50
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Hahn RT, Waxman AB, Denti P, Delhaas T. Anatomic Relationship of the Complex Tricuspid Valve, Right Ventricle, and Pulmonary Vasculature: A Review. JAMA Cardiol 2020; 4:478-487. [PMID: 30994879 DOI: 10.1001/jamacardio.2019.0535] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Severe functional or secondary tricuspid regurgitation (TR) is associated with poor long-term outcomes in natural history studies as well as specific disease states. An understanding of the physiologic causes of the TR is lacking precluding a systematic approach to treatment. Observations The complex anatomic relationship between the tricuspid valve apparatus and structure of the right side of the heart lends insight into the functional changes seen with secondary TR. The association of these changes with changes in pulmonary vascular hemodynamics can lead to a cascade of events that result in disease progression. Conclusions and Relevance Appreciating the role of pulmonary vascular hemodynamics on right ventricular and tricuspid valve morphology and function improves our understanding of the pathophysiology of secondary TR. The limitations of current therapeutic approaches for secondary TR have stimulated interest in improving outcomes with this morbid disease. Changes in timing or approach to intervention require a more comprehensive understanding of the pathophysiology.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Division of Cardiology/New York Presbyterian Hospital, New York-Presbyterian/Columbia University Medical Center, New York
| | - Aaron B Waxman
- Brigham and Women's Hospital Heart and Vascular and Lung Center, Harvard Medical School, Boston, Massachusetts
| | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Tammo Delhaas
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center/Maastricht University, Maastricht, the Netherlands
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