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Matsunaga A, Saito M, Ijiri K, Tsuchiya M, Yasuda A, Kitamura K, Ogata S, Chiba K, Matsukuma S. Cysts of the ligamentum flavum are often linked to ischemic conditions: A morphological study. Pathol Int 2024; 74:475-481. [PMID: 38994749 DOI: 10.1111/pin.13465] [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] [Received: 04/22/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
"Cysts of the ligamentum flavum (cysts-LF)" is the term for non-neoplastic cystic lesion involving LF. The aim of the present study was to elucidate the histopathological characteristics and pathogenesis of "cysts-LF". Herein, we defined cysts-LF as spinal cysts containing degenerative LF components. From archival cases, we investigated 18 symptomatic cysts-LF surgically removed from 18 patients (13 males and five females; median age 68.5 years [range, 42-86 years]). The elastic fibers of LF components in the wall were separated and/or torn, and cyst walls were accompanied by chondroid metaplasia (17 cases), myxoid changes (13 cases), ossification (11 cases), amyloid deposits (14 cases), hemosiderosis (six cases), granular/smudgy calcification (four cases), synovial cell linings (three cases), and severe inflammatory infiltrates (one case). These histologic features of our cysts-LF were shared by previously reported "cysts-LF." Fourteen cysts-LF demonstrated vascular stenosis/occlusion, and eight showed thick hyalinized vessels, suggesting local circulatory insufficiency. Eight cases (44%) exhibited lipomembranous fat necrosis, accompanied by hyalinized vascular changes (p = 0.003). Ischemic conditions were observed in nearly half of the present cysts-LF, and may be one of the main contributing factors for the formation of cysts-LF, via degeneration and cystic changes in the LF.
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Affiliation(s)
- Ayano Matsunaga
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
| | - Mariko Saito
- Department of Laboratory Medicine, National Defense Medical College Hospital, Saitama, Japan
| | - Kaya Ijiri
- Department of Laboratory Medicine, National Defense Medical College Hospital, Saitama, Japan
| | - Motohiro Tsuchiya
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
| | - Akimasa Yasuda
- Department of Orthopedic Surgery, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Kazuya Kitamura
- Department of Orthopedic Surgery, National Defense Medical College, Saitama, Japan
| | - Sho Ogata
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
- Department of Laboratory Medicine, National Defense Medical College Hospital, Saitama, Japan
| | - Kazuhiro Chiba
- Department of Orthopedic Surgery, National Defense Medical College, Saitama, Japan
| | - Susumu Matsukuma
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
- Department of Laboratory Medicine, National Defense Medical College Hospital, Saitama, Japan
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2
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Matusik PS, Mikrut K, Bryll A, Podolec M, Popiela TJ, Matusik PT. Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis. Acta Radiol 2024; 65:588-600. [PMID: 38619912 DOI: 10.1177/02841851241242461] [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: 04/17/2024]
Abstract
The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.
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Affiliation(s)
- Patrycja S Matusik
- Department of Diagnostic Imaging, University Hospital, Kraków, Poland
- Chair of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Mikrut
- Department of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amira Bryll
- Department of Diagnostic Imaging, University Hospital, Kraków, Poland
- Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Podolec
- Department of Coronary Artery Disease and Heart Failure, St John Paul II Hospital, Kraków, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Tadeusz J Popiela
- Department of Diagnostic Imaging, University Hospital, Kraków, Poland
- Chair of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł T Matusik
- Department of Electrocardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
- Department of Electrocardiology, St John Paul II Hospital, Kraków, Poland
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3
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Liu D, Wu T, Wang Y, Dian K, Liu H, He X, Chen J. Persistent right venous valve as a cause of fetal and neonatal pathology from prenatal to postnatal periods: a case report and review. Cardiovasc Diagn Ther 2023; 13:1118-1127. [PMID: 38162111 PMCID: PMC10753248 DOI: 10.21037/cdt-23-288] [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: 07/08/2023] [Accepted: 10/27/2023] [Indexed: 01/03/2024]
Abstract
Background Neonatal cyanosis is a clinical manifestation of hypoxemia and is usually pathological. Persistent right venous valve (PRVV) is a rare cause of cyanosis in newborns and can cause prenatal abnormalities, the clinical significance of which varies depending on the severity of the abnormality. There have been few reports on the intrauterine detection of these abnormalities and their follow-up during infancy. Here, we report a case of PRVV causing supravalvular tricuspid valve (TV) obstruction and secondary right ventricle (RV) hypoplasia. This case is unique in terms of its early prenatal detection, distinct cardiac anomalies, and successful surgery that reversed the symptoms, and the findings offer insights into the diagnosis and management of such rare cardiac conditions. Case Description We report a case of a newborn diagnosed with PRVV at 31 weeks of gestation at our center. There was no underlying family history of congenital heart disease. Prenatal sonography identified an echogenic membrane in the right atrium, suggesting TV obstruction and subsequent RV hypoplasia. After birth, the neonate suffered hypoxia with decreased arterial oxygen saturation (SaO2). Minimally invasive surgery successfully corrected the membrane. Postoperative SaO2 improved immediately. Three months later, follow-up echocardiography revealed normalized TV and RV dimensions. The patient demonstrated steady progress without any complications. We also reviewed previous cases of PRVV before and after birth and summarized the sonographic and clinically relevant features. Conclusions Although PRVV is typically considered as a benign structure, it may lead to significant clinical complications, particularly in fetuses and neonates. The precise identification of its variant forms and related flow patterns is crucial to inform decisions regarding patient management.
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Affiliation(s)
- Dan Liu
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
| | - Ting Wu
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
| | - Yu Wang
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
| | - Ke Dian
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hanmin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Chronobiology (Sichuan University), National Health Commission of China, Chengdu, China
- The Joint Laboratory for Lung Development and Related Diseases of West China Second University Hospital, Sichuan University and School of Life Sciences of Fudan University, West China Institute of Women and Children’s Health, West China Second University Hospital of Sichuan University, Chengdu, China
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Xiaolan He
- Ziyang Maternal and Child Health Care Hospital, Ziyang, China
- Ziyang Women and Children Hospital, West China Second University Hospital of Sichuan University, Ziyang, China
| | - Jiao Chen
- Department of Ultrasonic Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
- Department of Ultrasonic Medicine, Tibet Autonomous Region Women’s and Children’s Hospital, Lhasa, China
- Tibet Autonomous Region Women’s and Children’s Hospital, West China Second University Hospital of Sichuan University, Lhasa, China
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4
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Sarin EL, Belani K. Unexpected TEE Findings During Rheumatic Triple-Valve Surgery: Incidental, Yet Impactful. J Cardiothorac Vasc Anesth 2023; 37:2391-2396. [PMID: 37419755 DOI: 10.1053/j.jvca.2023.06.006] [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: 04/24/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 07/09/2023]
Abstract
This E-Challenge highlights an incidental prebypass transesophageal echocardiographic (TEE) finding of a right atrial membrane that impacted cardiac surgical management during triple-valve surgery. Two-dimensional and advanced 3-dimensional (3D) TEE were used in real-time to assist intraoperative decision-making. The findings, clinical course, discussion of the differential diagnosis, final diagnosis, and patient management are detailed here.
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Affiliation(s)
- Eric L Sarin
- Inova Fairfax Hospital, Inova Heart and Vascular Institute, University of Virginia School of Medicine Affiliate, Department of Cardiac Surgery, Falls Church, VA
| | - Kiran Belani
- Northwestern Memorial Hospital, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Department of Anesthesiology, Chicago, IL.
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5
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Mir M, Velez M, Proud KD. A 64-Year-Old Woman With Shock and Right Atrial Thrombus. Chest 2022; 162:e317-e319. [PMID: 36494132 DOI: 10.1016/j.chest.2022.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/06/2021] [Accepted: 01/09/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mahnoor Mir
- University of Texas Health San Antonio, San Antonio, TX.
| | - Maria Velez
- University of Texas Health San Antonio, San Antonio, TX
| | - Kevin D Proud
- University of Texas Health San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX
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6
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Maddali MM, Raju S, Al Aamri I, Al Maskari SN, Al Kindi HN. A New-Onset Mass in the Right-Sided Atrium in a Child After Cardiac Surgery: Unravelling the Diagnosis. J Cardiothorac Vasc Anesth 2022; 36:4217-4219. [PMID: 35965230 DOI: 10.1053/j.jvca.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
| | - Sowmiya Raju
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| | - Is'haq Al Aamri
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| | | | - Hamood Nasar Al Kindi
- Department of Cardiothoracic surgery, National Heart Center, Royal Hospital, Muscat, Oman
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7
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Chan J, Lee B, Lim BL, Lee WF. Man With Fever and Hypotension. Ann Emerg Med 2022; 80:e19-e20. [PMID: 35995523 DOI: 10.1016/j.annemergmed.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jaye Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Berlin Lee
- Emergency Department, Ng Teng Fong General Hospital, Singapore
| | - Beng L Lim
- Emergency Department, Ng Teng Fong General Hospital, Singapore
| | - Wei F Lee
- Emergency Department, Ng Teng Fong General Hospital, Singapore
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8
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Intracardiac Thrombus in Transit Detected by Point-of-Care Ultrasound. Crit Care Nurs Q 2022; 45:285-287. [PMID: 35617094 DOI: 10.1097/cnq.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary embolism (PE) is a condition with a high rate of morbidity and mortality if it is not recognized and treated in a timely fashion. Point-of-care ultrasound (POCUS) is a useful tool that can help clinicians make prompt diagnosis. We present a case where we diagnosed massive PE through visualizing an intracardiac thrombus in transit, and we highlight some important ultrasonographic features.
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9
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Lakhani DA, Balar AB, Kim C. Prominent crista terminalis mimicking a right atrial mass: A case report and brief review of the literature. Radiol Case Rep 2021; 17:434-438. [PMID: 34917223 PMCID: PMC8666457 DOI: 10.1016/j.radcr.2021.11.028] [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: 10/29/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022] Open
Abstract
The crista terminalis is a normal anatomical structure, characterized by a smooth muscular ridge along the superior aspect of the right atrium. It is derived from resorption of the right valve of the sinus venosus and it divides the right atrium into smooth posteromedial and trabeculated anterolateral portions. Crista terminalis is not normally detected in the standard views of transthoracic echocardiogram and non-gated CT of the chest. In rare circumstances, the crista terminalis may be prominent and could lead to misdiagnosis as a malignant process, such as in our case. A comprehensive understanding of the crista terminalis anatomy, and its characteristic appearance on transthoracic echocardiogram, CT and PET/CT will minimize the risk of misdiagnosis and will avoid patient anxiety with more extensive examinations. Here, we present a case of a 78-year-old male with newly diagnosed high-grade invasive urinary bladder urothelial carcinoma. Pre-operative transthoracic echocardiogram reported as 2 cm right atrial mass concerning a metastasis lesion. Subsequent evaluation with MRI cardiac morphology confirmed the diagnosis of benign prominent crista terminalis, a normal anatomical structure.
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10
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Gatti M, D’Angelo T, Muscogiuri G, Dell'aversana S, Andreis A, Carisio A, Darvizeh F, Tore D, Pontone G, Faletti R. Cardiovascular magnetic resonance of cardiac tumors and masses. World J Cardiol 2021; 13:628-649. [PMID: 34909128 PMCID: PMC8641001 DOI: 10.4330/wjc.v13.i11.628] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/19/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiac masses diagnosis and treatment are a true challenge, although they are infrequently encountered in clinical practice. They encompass a broad set of lesions that include neoplastic (primary and secondary), non-neoplastic masses and pseudomasses. The clinical presentation of cardiac tumors is highly variable and depends on several factors such as size, location, relation with other structures and mobility. The presumptive diagnosis is made based on a preliminary non-invasive diagnostic work-up due to technical difficulties and risks associated with biopsy, which is still the diagnostic gold standard. The findings should always be interpreted in the clinical context to avoid misdiagnosis, particularly in specific conditions (e.g., infective endocarditis or thrombi). The modern multi-modality imaging techniques has a key role not only for the initial assessment and differential diagnosis but also for management and surveillance of the cardiac masses. Cardiovascular magnetic resonance (CMR) allows an optimal non-invasive localization of the lesion, providing multiplanar information on its relation to surrounding structures. Moreover, with the additional feature of tissue characterization, CMR can be highly effective to distinguish pseudomasses from masses, as well as benign from malignant lesions, with further differential diagnosis of the latter. Although histopathological assessment is important to make a definitive diagnosis, CMR plays a key role in the diagnosis of suspected cardiac masses with a great impact on patient management. This literature review aims to provide a comprehensive overview of cardiac masses, from clinical and imaging protocol to pathological findings.
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Affiliation(s)
- Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Tommaso D’Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, “G. Martino” University Hospital Messina, Messina 98100, Italy
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan 20149, Italy
| | | | | | - Andrea Carisio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Fatemeh Darvizeh
- School of Medicine, Vita-Salute San Raffaele University, Milan 20121, Italy
| | - Davide Tore
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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11
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Gong AO, Burton KR. Typical chest pain and dyspnoea in a young man with a history of intravenous drug use. Heart 2021; 107:126-127. [PMID: 33443024 DOI: 10.1136/heartjnl-2020-317280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Alexander Oshiro Gong
- Department of Cardiovascular Medicine, LAC USC Medical Center, Los Angeles, California, USA
| | - Kristen R Burton
- Department of Cardiovascular Medicine, LAC USC Medical Center, Los Angeles, California, USA
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12
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Hernandez SD, Jabaay MJ, Marotta DA, Tosto ST, Velayati A. Thoracic Osteomyelitis and Eustachian Valve Endocarditis: A Case Report and Literature Review. Cureus 2021; 13:e13810. [PMID: 33859881 PMCID: PMC8038897 DOI: 10.7759/cureus.13810] [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: 02/08/2021] [Accepted: 03/10/2021] [Indexed: 11/05/2022] Open
Abstract
Infective endocarditis and vertebral osteomyelitis are rare infections, most commonly caused by methicillin-sensitive Staphylococcus aureus (MSSA). The eustachian valve is an embryological remnant of the inferior vena cava that has the potential to harbor a nidus leading to infective endocarditis. Eustachian valve endocarditis has been documented in the literature on less than 50 occasions and has yet to be documented in the presence of concomitant vertebral osteomyelitis. In this case, we present a 43-year-old male presenting with vertebral osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA). Persistent bacteremia prompted the identification of vegetative growth on a eustachian valve remnant. This case helps mend the gap in the literature by documenting the treatment considerations in a patient with eustachian valve endocarditis in the presence of osteomyelitis caused by MRSA.
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Affiliation(s)
| | - Maxwell J Jabaay
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Dario A Marotta
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, USA
| | | | - Arash Velayati
- Internal Medicine Residency Program, Southeast Health, Dothan, USA
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13
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Hypertrophied crista terminalis-The great masquerader and savior. Anatol J Cardiol 2021; 23:E11-E12. [PMID: 32235132 PMCID: PMC7163221 DOI: 10.14744/anatoljcardiol.2019.05752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Kemundel Genny SR, Kumar V, Subramaniam G, Balakrishnan KR. Hypoxia due to unusual right to left shunt after arterial switch surgery. Ann Card Anaesth 2021; 24:241-243. [PMID: 33884985 PMCID: PMC8253023 DOI: 10.4103/aca.aca_152_19] [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] [Indexed: 11/05/2022] Open
Abstract
Hypoxia can occur after repair of transposition of great arteries. The most common cause of right to left shunt after arterial switch surgery is related to increased right ventricular pressures and persistent neonatal pulmonary arterial hypertension. We report a case of TGA repair causing right to left shunt with normal right ventricular pressures. Persistence of Eustachian valve with patent foramen ovale (PFO) is the unusual cause of hypoxia and desaturation. The patient was successfully managed by excision of Eustachian valve and closure of PFO.
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Affiliation(s)
- Suresh Rao Kemundel Genny
- Institute of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare Pvt Ltd., New No. 72, Old No.54, Nelson Manickam Road, Aminjikarai, Chennai-29, Postal Code-600 029, India
| | - Vignesh Kumar
- Institute of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare Pvt Ltd., New No. 72, Old No.54, Nelson Manickam Road, Aminjikarai, Chennai-29, Postal Code-600 029, India
| | - Ganapathy Subramaniam
- Institute of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare Pvt Ltd., New No. 72, Old No.54, Nelson Manickam Road, Aminjikarai, Chennai-29, Postal Code-600 029, India
| | - K R Balakrishnan
- Institute of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare Pvt Ltd., New No. 72, Old No.54, Nelson Manickam Road, Aminjikarai, Chennai-29, Postal Code-600 029, India
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15
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Orozco-Vinasco D, Andrade D, Vinasco AO, Muñoz L. New-onset cardiac mass due to left atrial appendage inversion during cardiac surgery. Asian Cardiovasc Thorac Ann 2020; 29:333-335. [PMID: 33100024 DOI: 10.1177/0218492320970061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac mass assessment is challenging in the intraoperative scenario. We present the case of a 22-year-old woman with a new-onset left atrial mass during cardiopulmonary bypass following closure of a ventricular septal defect. We discuss the role of intraoperative echocardiographic examination, the differential diagnosis, and raise awareness of the left atrial appendage as a rare etiology of an acute left atrial mass.
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Affiliation(s)
- David Orozco-Vinasco
- Department of Cardiovascular Anesthesia, Clínica Colsubsidio Calle 100, Bogota Colombia
| | - Dario Andrade
- Department of Cardiac Surgery, Clínica Colsubsidio Calle 100, Bogota, Colombia
| | | | - Luis Muñoz
- Department of Anesthesia, Clínica La Colina, Bogota Colombia
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16
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Montrief T, Alerhand S, Denault A, Scott J. Point-of-care echocardiography for the evaluation of right-to-left cardiopulmonary shunts: a narrative review. Can J Anaesth 2020; 67:1824-1838. [PMID: 32944839 DOI: 10.1007/s12630-020-01813-2] [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] [Received: 02/26/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 12/19/2022] Open
Abstract
Right-to-left pulmonary and cardiac shunts (RLS) are important causes of refractory hypoxia in the critically-ill perioperative patient. Using a point-of-care ultrasound (POCUS) agitated saline bubble study for an early diagnosis allows patients with clinically significant RLSs to receive expedited therapy. This narrative review discusses the principles of agitated saline ultrasonography as well as the role of POCUS in detecting the most common RLS types seen in the intensive care unit, including patent foramen ovale, atrial septal defects, and pulmonary arterio-venous malformations. An illustrated discussion of the procedure, as well as shunt-enhancing maneuvers (Valsalva or lung recruitment maneuver with subsequent rapid release) is provided. With the wide dissemination of bedside ultrasound within the perioperative and critical care arena, POCUS practitioners should be knowledgeable of the potential pitfalls leading to both false-positive and false-negative studies. False-positive studies may be due to congenital abnormalities, mischaracterization of intrapulmonary shunts as intracardiac shunts (and vice versa), or evidence of the Valsalva effect. False negatives are typically due to respiratory-phasic variation, performing an inadequate shunt-enhancing maneuver, inadequate injection of agitated saline, or pathophysiologic states of elevated left atrial pressure. Finally, alternative POCUS methods for determining presence of an RLS in patients with poor echocardiographic windows are discussed, with a focus on pulsed-wave Doppler interrogation of arterial signals.
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Affiliation(s)
- Tim Montrief
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - André Denault
- Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
| | - Jeffrey Scott
- Division of Cardiothoracic and Transplant Critical Care, Jackson Health System, Miami Transplant Institute, Miami, FL, USA
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17
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Shmueli H, Thomas F, Flint N, Setia G, Janjic A, Siegel RJ. Right-Sided Infective Endocarditis 2020: Challenges and Updates in Diagnosis and Treatment. J Am Heart Assoc 2020; 9:e017293. [PMID: 32700630 PMCID: PMC7792231 DOI: 10.1161/jaha.120.017293] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE. Right-sided IE accounts for 5% to 10% of all IE cases, and compared with left-sided IE, it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right-sided IE we provide an up-to-date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.
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Affiliation(s)
- Hezzy Shmueli
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Felix Thomas
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Nir Flint
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA.,Department of Cardiology Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Gayatri Setia
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | | | - Robert J Siegel
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
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18
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Rare Congenital Obstruction of the Inferior Vena Cava Diagnosed by Intraoperative Transesophageal Echocardiography. ACTA ACUST UNITED AC 2020; 4:139-141. [PMID: 32577593 PMCID: PMC7303238 DOI: 10.1016/j.case.2020.01.003] [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] [Indexed: 11/24/2022]
Abstract
Idiopathic IVC obstructions are rare and unlikely to be detected by routine testing. They can be aberrant membranes, stenoses, or malformed Eustachian valves. IVC obstructions may be a cause of congestive hepatopathy. IVC obstructions are more likely detected by complete TEE than standard TTE. Complete and systematic intraoperative TEE is valuable for cardiac surgery.
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19
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Bai J, Cutler TS, Mints G. A Right Atrial Finding in an IV Drug User in His Late 40s. Chest 2020; 157:e203-e205. [DOI: 10.1016/j.chest.2019.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/09/2019] [Accepted: 07/20/2019] [Indexed: 10/24/2022] Open
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20
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Aslaner MA, Yamanoğlu A. A letter to the editor: Evaluation and management of pulmonary hypertension in the emergency department setting. Am J Emerg Med 2020; 38:1023-1024. [PMID: 32201067 DOI: 10.1016/j.ajem.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Mehmet Ali Aslaner
- Department of Emergency Medicine, Gazi University School of Medicine, Ankara, Turkey.
| | - Adnan Yamanoğlu
- Department of Emergency Medicine, İzmir Katip Çelebi University Atatürk Education and Research Hospital, İzmir, Turkey
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21
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André C. Endovascular closure of patent foramen ovale: a critical appraisal of published trials. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:731-740. [PMID: 31664349 DOI: 10.1590/0004-282x20190120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/26/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The treatment of cryptogenic stroke patients with a patent foramen ovale (PFO) is controversial. A critical review of these studies is presented. METHODS A description of all trials comparing medical and endovascular treatment with closing devices is given. Additional pertinent studies are discussed to help construct a rational basis for treatment decisions. RESULTS Initial negative trials evaluating PFO closure were followed by positive studies published in 2017 and 2018. All trials evaluated young patients (up to 60 years). Methodological problems are present in all trials including their open label construction. Most positive trials developed strategies to increase the percentage of patients with interatrial septal aneurysms or hypermobility and large right-to-left shunts. Even in these positive trials, large numbers of patients need to be treated to avoid one stroke. Atrial fibrillation occurred in 2-6% and other adverse effects related to the procedure and to the devices occurred in a substantial number of patients. Incomplete occlusion of the PFO is also frequent. Anticoagulant treatment has not been adequately studied as a therapeutic option. CONCLUSION Young patients with cryptogenic strokes seem to benefit from endovascular closure of a PFO in the presence of a large right-to-left shunt or an associated atrial septum aneurysm. For most other patients, a highly-individualized decision must be made, taking into account the low risk of recurrence in patients with a cryptogenic stroke attributable to a PFO, the high numbers needed to treat and the risks related to the procedure.
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Affiliation(s)
- Charles André
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Disciplina de Neurologia, Rio de Janeiro RJ, Brasil.,Sinapse Neurologia e Reabilitação, Rio de Janeiro RJ, Brasil
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22
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Sabzi F, Heydari A, Asadmobini A, Heidari MB. Right Atrial Blood Cyst with Stones Suspended from the Coronary Sinus. Sultan Qaboos Univ Med J 2019; 19:e161-e163. [PMID: 31538017 PMCID: PMC6736263 DOI: 10.18295/squmj.2019.19.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/14/2019] [Accepted: 04/18/2019] [Indexed: 11/18/2022] Open
Abstract
Cardiac blood cysts are rare benign neoplasms, usually involving the cardiac valves and are remnants of the Chiari network. They are usually detected in the first six months of life and rarely occur in children or adults. We report a 76-year-old male patient who was referred to the Imam Ali Hospital affiliated with Kermanshah University of Medical Sciences, Kermanshah, Iran, in 2018 with dyspnoea. Transthoracic echocardiography revealed a small patent foramen ovale (PFO) and a circumferential mobile cystic mass in the right atrium, with the impression of a tumour or thrombus. The patient underwent open-heart surgery with cardiopulmonary bypass to repair to PFO and remove the intra-atrial lesion. During surgical examination of the right atrial cavity, a blood cyst containing small stone-like structures on the coronary sinus valve of the right atrium was found. The post-operative course was uneventful and no recurrence of tumour was detected during six months of follow-up. To the best of our knowledge, this is the first reported case of a right atrial blood cyst with a few nodule-like stones in an adult with PFO in Iran and the second case in an adult with PFO worldwide.
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Affiliation(s)
| | | | | | - Mohammad B Heidari
- Department of Surgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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23
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Rajiah P, MacNamara J, Chaturvedi A, Ashwath R, Fulton NL, Goerne H. Bands in the Heart: Multimodality Imaging Review. Radiographics 2019; 39:1238-1263. [DOI: 10.1148/rg.2019180176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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24
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Rajiah P, Fulton NL, Bolen M. Magnetic resonance imaging of the papillary muscles of the left ventricle: normal anatomy, variants, and abnormalities. Insights Imaging 2019; 10:83. [PMID: 31428880 PMCID: PMC6702502 DOI: 10.1186/s13244-019-0761-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023] Open
Abstract
Left ventricular papillary muscles are small myocardial structures that play an important role in the functioning of mitral valve and left ventricle. Typically, there are two groups of papillary muscles, namely the anterolateral and the posteromedial groups. Cardiovascular magnetic resonance (CMR) is a valuable imaging modality in the evaluation of papillary muscles, providing both morphological and functional information. There is a remarkably wide variation in the morphology of papillary muscles. These variations can be asymptomatic or associated with symptoms related to LV outflow tract obstruction, often associated with hypertrophic cardiomyopathy. Abnormalities of the papillary muscles range from congenital disorders to neoplasms. Parachute mitral valve is the most common congenital abnormality of papillary muscles, in which all the chordae insert into a single papillary muscle. Papillary muscles can become dysfunctional, most commonly due to ischemia. Papillary muscle rupture is a major complication of acute myocardial infarction that results in mitral regurgitation and associated with high mortality rates. The most common papillary neoplasm is metastasis, but primary benign and malignant neoplasms can also be seen. In this article, we discuss the role of CMR in the evaluation of papillary muscle anatomy, function, and abnormalities.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | | | - Michael Bolen
- Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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25
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Fathala A. Right ventricular hypertrophy and hpertrabeculation misdiagnosed as a right ventricular mass on echocardiography. Radiol Case Rep 2018; 14:88-90. [PMID: 30377455 PMCID: PMC6202875 DOI: 10.1016/j.radcr.2018.10.001] [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: 08/06/2018] [Revised: 09/20/2018] [Accepted: 10/01/2018] [Indexed: 11/16/2022] Open
Abstract
Isolated right ventricle (RV) hypertrophy, anomalous muscle bundles, heavy trabeculations, a redundant hypertrophic papillary muscle, and variations in the shape and thickness of the moderator band (MB), with or without RV hypertrophy, may be confused with a cardiac mass on echocardiography. Therefore, multiple off-axis echocardiographic images and further cross-sectional imaging with cardiac magnetic resonance or computed tomography coronary angiography (CTCA) must be considered in order to avoid unnecessary surgery. We present a case of 65-year-old man with atypical chest pain was referred to our facility for CTCA to evaluate RV mass that was seen on echocardiography, and to evaluate his coronary arteries before attempting a surgical excision of the mass. The echocardiography showed an RV mass that was causing a minimal inflow obstruction. The CTCA showed nonobstructive coronary artery disease, RV hypertrophy, markedly focal thickening of the MB with multiple thickened trabeculations, and muscle bundles extending from the MB to the free wall of the RV. However, but there was no specific feature to suggest a cardiac tumor.
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Affiliation(s)
- Ahmed Fathala
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh, Saudi Arabia
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26
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Chan PF, Kofidis T, Tan KB, Yip JWL, Ling LH. Left atrial appendage mass. Echocardiography 2018; 35:2106-2108. [PMID: 30376594 DOI: 10.1111/echo.14168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022] Open
Abstract
Left atrial (LA) masses are known to be associated with peripheral embolization. Accurate identification of etiology is crucial because treatment strategies may differ. We present the case of a young woman, who was initially diagnosed with a LA thrombus and anticoagulated. The diagnosis was revised to a primary cardiac tumor after review of the echocardiographic findings. Surgical excision revealed an atrial myxoma in an unusual location.
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Affiliation(s)
- Po F Chan
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Theodoros Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kong B Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Pathology, National University Health System, Singapore, Singapore
| | - James W-L Yip
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Lieng H Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore, Singapore
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27
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Szirt R, Youssef GS. Acute right to left shunt—Combination of tricuspid valve endocarditis, Chiari network, and ostium secundum atrial septal defect. J Cardiol Cases 2017; 16:151-153. [DOI: 10.1016/j.jccase.2017.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/01/2017] [Accepted: 07/04/2017] [Indexed: 11/26/2022] Open
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28
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Abstract
Echocardiography is a powerful and convenient tool used routinely in the cardiac evaluation of many patients. Improved resolution and visualization of cardiac anatomy has led to the discovery of many normal variant structures that have no known pathologic consequence. Importantly, these findings may masquerade as pathology prompting unnecessary further evaluation at the expense of anxiety, cost, or potential harm. This review provides an updated and comprehensive collection of normal anatomic variants on both transthoracic and transesophageal imaging.
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29
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Malik SB, Chen N, Parker RA, Hsu JY. Transthoracic Echocardiography: Pitfalls and Limitations as Delineated at Cardiac CT and MR Imaging. Radiographics 2017; 37:383-406. [DOI: 10.1148/rg.2017160105] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sachin B. Malik
- From the Department of Diagnostic Imaging, Kaiser Permanente Los Angeles Medical Center, 1505 N Edgemont Ave, Basement, Los Angeles, CA 90027
| | - Natalie Chen
- From the Department of Diagnostic Imaging, Kaiser Permanente Los Angeles Medical Center, 1505 N Edgemont Ave, Basement, Los Angeles, CA 90027
| | - Rex A. Parker
- From the Department of Diagnostic Imaging, Kaiser Permanente Los Angeles Medical Center, 1505 N Edgemont Ave, Basement, Los Angeles, CA 90027
| | - Joe Y. Hsu
- From the Department of Diagnostic Imaging, Kaiser Permanente Los Angeles Medical Center, 1505 N Edgemont Ave, Basement, Los Angeles, CA 90027
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30
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Rainer WG, Bailey DJ, Hollis HW. Giant Cardiac Lipoma: Refined Hypothesis Proposes Invagination from Extracardiac to Intracardiac Sites. Tex Heart Inst J 2016; 43:461-464. [PMID: 27777537 DOI: 10.14503/thij-15-5342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiac lipomas are rare and usually present as benign, encapsulated masses outside the heart; however, they can also be found within the atria. No single theory-including molecular genetic mutation-adequately explains why this occurs. Extensive career experience and broadened knowledge in embryology and cardiac physiology have helped us to develop a hypothesis based on invagination of extracardiac tumors. This report describes a vexing case of a giant right atrial lipoma, from 1985, in which the diagnosis was made incidentally during management of a patient's acute limb ischemia. In addition, we discuss the imaging and treatment of cardiac lipoma.
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31
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Papanikolaou J, Tsolaki V, Makris D, Mantzarlis K, Zakynthinos E. Right Atrial Transverse Band Prevents a "Passing-by" Thrombus From Migrating Into Pulmonary Circulation. J Cardiothorac Vasc Anesth 2016; 30:e47-8. [PMID: 27474332 DOI: 10.1053/j.jvca.2016.03.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Indexed: 11/11/2022]
Affiliation(s)
- John Papanikolaou
- Department of Critical Care, School of Medicine University of Thessaly, University Hospital of Larissa Thessaly, Greece
| | - Vasiliki Tsolaki
- Department of Critical Care, School of Medicine University of Thessaly, University Hospital of Larissa Thessaly, Greece
| | - Demosthenes Makris
- Department of Critical Care, School of Medicine University of Thessaly, University Hospital of Larissa Thessaly, Greece
| | - Konstantinos Mantzarlis
- Department of Critical Care, School of Medicine University of Thessaly, University Hospital of Larissa Thessaly, Greece
| | - Epaminondas Zakynthinos
- Department of Critical Care, School of Medicine University of Thessaly, University Hospital of Larissa Thessaly, Greece
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32
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Maybrook RJ, Afzal MR, Parashar S, Deibert B, Chivington M, Walker JY, Dawn B, Parashara D. Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature. Echocardiography 2015; 33:117-32. [DOI: 10.1111/echo.13089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Ryan J. Maybrook
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Muhammad R. Afzal
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Sonya Parashar
- University of Kansas School of Medicine; Kansas City Kansas
| | - Brent Deibert
- University of Kansas School of Medicine; Kansas City Kansas
| | - Mary Chivington
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Jacquelyn Y. Walker
- Division of Cardiology; VA Eastern Kansas Health Care System; Leavenworth Kansas
| | - Buddhadeb Dawn
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Deepak Parashara
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
- Division of Cardiology; Kansas City VA Medical Center; Kansas City Missouri
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33
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Baxi AJ, Tavakoli S, Vargas D, Restrepo CS. Bands, Chords, Tendons, and Membranes in the Heart: An Imaging Overview. Curr Probl Diagn Radiol 2015; 45:380-391. [PMID: 26433812 DOI: 10.1067/j.cpradiol.2015.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/24/2015] [Indexed: 11/22/2022]
Abstract
Crests, bands, chords, and membranes can be seen within the different cardiac chambers, with variable clinical significance. They can be incidental or can have clinical implications by causing hemodynamic disturbance. It is crucial to know the morphology and orientation of normal structures, aberrant or accessory muscles, and abnormal membranes to diagnose the hemodynamic disturbance associated with them. Newer generation computed tomographic scanners and faster magnetic resonance imaging sequences offer high spatial and temporal resolution allowing for acquisition of high resolution images of the cardiac chambers improving identification of small internal structures, such as papillary muscles, muscular bands, chords, and membranes. They also help in identification of other associated complications, malformations, and provide a road map for treatment. In this article, we review cross-sectional cardiac imaging findings of normal anatomical variants and distinctive imaging features of pathologic bands, chords, or membranes, which may produce significant hemodynamic changes and clinical symptomatology.
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Affiliation(s)
- Ameya Jagdish Baxi
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Sina Tavakoli
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Daniel Vargas
- Department of Radiology, University of Colorado Hospital, Denver, CO
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
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34
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Chen S, Chen X, Zheng B. Diagnostic usefulness of quantitative tissue velocity imaging and anatomic M-mode echocardiography for coronary artery diseases: A pilot study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:346-52. [PMID: 25111981 DOI: 10.1002/jcu.22218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 06/09/2014] [Accepted: 07/10/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE To explore the potential clinical usefulness and determine optimal diagnostic criteria of quantitative tissue velocity imaging and anatomic M-mode echocardiography in patients with coronary artery disease (CAD). METHODS We used quantitative tissue velocity imaging for the measurement of systolic myocardial velocity, and anatomic M-mode echocardiography for the measurement of ventricular wall-thickening fraction in 44 subjects with suspected CAD. Subjects were classified as patients if coronary angiography demonstrated a stenosis ≥ 50%, and as controls if it was strictly normal. The diagnostic criteria, sensitivity, and specificity were assessed by receiver-operator curves. RESULTS Controls had greater mean systolic myocardial velocity and ventricular wall-thickening fraction in the basal (6.59 ± 1.25 cm/s and 0.44 ± 0.05) and mid segment (5.23 ± 0.93 cm/s and 0.43 ± 0.04) than patients (5.02 ± 1.17 cm/s and 0.29 ± 0.04, 3.27 ± 1.29 cm/s and 0.29 ± 0.04, respectively, p < 0.001). Mid-segment ventricular wall-thickening fraction offered 95% sensitivity (95% CI 88.7% to 98.4%), and 98.3% specificity (95% CI 90.9% to 1.0) with an optimal cut-off point of 0.349, yielding better results than systolic myocardial velocity, which provided 83% sensitivity (95% CI 74.2% to 89.8%), 90% specificity (95% CI 79.5% to 96.2%), and optimal cut-off point 4.47. The combination of systolic myocardial velocity and ventricular wall-thickening fraction offered 97% sensitivity (95% CI 91.5% to 99.4%) CONCLUSIONS Mid-segment ventricular wall-thickening fraction might be suitable for the evaluation of patients with CAD.
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Affiliation(s)
- Shaoqi Chen
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
| | - Xiaoxia Chen
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
| | - Baoqun Zheng
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
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