1
|
Nishino S, Nishimura M, Asada Y, Yamashita A, Shibata Y. Progressive worsening of aortic regurgitation due to detachment of the aortic valve commissure with multimodality imaging to elucidate pathogenesis: a case report. Eur Heart J Case Rep 2024; 8:ytae178. [PMID: 38651082 PMCID: PMC11033951 DOI: 10.1093/ehjcr/ytae178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 03/26/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
Background Aortic regurgitation (AR) associated with detachment of the aortic valve commissure is extremely rare. We present a case of progressively worsening severe chronic AR due to detachment of the aortic valve commissure during hospitalization that was confirmed with multimodality imaging. Case summary A 50-year-old male with Marfan syndrome visited our hospital to receive treatment for cholelithiasis. Pre-operative examination revealed severe AR and aortic root aneurysm. Because the patient was asymptomatic, it was decided that cholecystectomy should be performed first. However, the patient's heart failure worsened acutely when his blood pressure increased just before induction of anaesthesia. The patient required intubation and management of heart failure. Five days later, the patient underwent cholecystectomy. He was treated for heart failure and underwent open heart surgery on the 35th hospital day. Intraoperative transoesophageal echocardiography revealed that his AR was caused by both enlargement of the aortic root and localized dissection of the aortic valve commissure, which was supported by intraoperative findings and histopathological evaluation. Aortic regurgitation was exacerbated by a new localized dissection, resulting in acute worsening of heart failure. Discussion Aortic valve commissure detachment can easily lead to sudden onset of severe AR, deteriorating haemodynamics, and acute pulmonary oedema. Since delayed medical treatment leads to poor clinical outcomes, prompt and accurate diagnosis and appropriately timed surgical intervention are essential. This very rare case of severe AR worsening due to spontaneous aortic valve commissure dissection was evaluated with multiple modalities during hospitalization. Understanding this clinical condition will help cardiologists provide better medical care.
Collapse
Affiliation(s)
- Shun Nishino
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center, 1173 Arita, Miyazaki 880-2102, Japan
| | - Masanori Nishimura
- Department of Cardiothoracic Surgery, Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan
| | - Yujiro Asada
- Department of Pathology, Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan
| | - Atsushi Yamashita
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center, 1173 Arita, Miyazaki 880-2102, Japan
| |
Collapse
|
2
|
Amin A, Augustine M, Shafique MA, Mustafa MS, Mian ZR, Jaimes DCC, Gaudani A, Shaukat B, Kumar S, Aulakh SS, Jami E, Sharifa M, Ahuja K, Maslamani ANJ, Bhudia S. Left Atrial Septal Pouch (LASP) and cryptogenic stroke risk: An updated systematic review and meta-analysis of observational studies. Curr Probl Cardiol 2024; 49:102400. [PMID: 38232917 DOI: 10.1016/j.cpcardiol.2024.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND The left atrial septal pouch (LASP) is a small anatomical septal recess in the heart that has been linked with cardioembolic events. A systematic appraisal of the existing literature is necessary to establish a better understanding of the risk as studies continue to indicate a correlation between LASPs and cryptogenic strokes. OBJECTIVES To determine the level of association between the presence of LASP and the risk of developing cryptogenic stroke. METHODS We searched PubMed, EMBASE and Scopus for studies comparing the prevalence of LASP in patients with cryptogenic stroke against non-cryptogenic stroke control groups from inception till December, 2023. The Newcastle Ottawa scale was used for quality assessment and Comprehensive Meta-Analysis Version 3.3 was used for data analysis with odds ratio (OR) as the effect measure. RESULTS Our review included a total of 10 retrospective, observational studies published between 2010 to 2022. A total of 683 cases of cryptogenic strokes were identified, out of which 33.1 % (n = 271) were associated with a LASP. Among the non-cryptogenic stroke controls (n = 2641), LASP was present in 20.6 % cases (n = 476). The aggregate OR for cryptogenic stroke was 1.618 times greater than non-cryptogenic stroke (p < 0.001) among LASP cases, CONCLUSION: The presence of a septal pouch in the left atrium is significantly linked to a higher risk of developing cryptogenic strokes. As a potential site of thrombus formation and subsequent dislodgement, further large-scale studies are necessary to establish the guidelines for management and prophylaxis to prevent embolic events.
Collapse
Affiliation(s)
- Aamir Amin
- Department of Cardiothoracic Surgery, Harefield Hospital, London, United Kingdom.
| | | | - Muhammad Ashir Shafique
- Department of Medicine, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, Pakistan 75510.
| | - Muhammad Saqlain Mustafa
- Department of Medicine, Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, Pakistan 75510.
| | | | | | | | | | - Sanjeev Kumar
- Horbachevsky Ternopil National Medical University, Ukraine.
| | | | - Elhama Jami
- Herat University Faculty of Medicine, Afghanistan.
| | | | | | | | - Sunil Bhudia
- Consultant Cardiac Surgeon, Harefield Hospital, London, United Kingdom.
| |
Collapse
|
3
|
Pyra P, Hadeed K, Guitarte Vidaurre A, Vincent R, Dulac Y, Chausseray G, Calvaruso DF, Acar P, Karsenty C. Usefulness of perioperative transoesophageal echocardiography during paediatric cardiac surgery. Arch Cardiovasc Dis 2024; 117:177-185. [PMID: 38272760 DOI: 10.1016/j.acvd.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Paediatric transoesophageal echocardiography probes allow perioperative evaluation during paediatric congenital heart disease surgery. AIM To assess the usefulness of perioperative transoesophageal echocardiography in evaluating the severity of residual lesions, based on the type of congenital heart disease repaired in paediatric patients. METHODS A retrospective analysis was conducted on paediatric patients who underwent open-heart surgery at our tertiary centre over a four-year period. Perioperative transoesophageal echocardiography studies were performed, and residual lesions were classified as mild, moderate or severe. RESULTS Overall, 323 procedures involving 310 patients with a median age of 13.8 (0.07-214.4) months and a median weight of 8.2 (2-96) kg at intervention were enrolled in the study. Twenty-one (6.5%) residual lesions led to immediate reintervention: severe right ventricular outflow tract obstruction (n=12); severe aortic regurgitation (n=3); superior vena cava stenosis (n=2); moderate residual ventricular septal defect (n=2); severe mitral regurgitation (n=1); and severe mitral stenosis (n=1). Three (0.9%) neonates had ventilation difficulties caused by the transoesophageal echocardiography probe having to be removed, but experienced no sequelae. CONCLUSION Perioperative transoesophageal echocardiography is a safe procedure, providing information on severe residual lesions, leading to the immediate revision of several paediatric congenital heart disease cases.
Collapse
Affiliation(s)
- Pierrick Pyra
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France.
| | - Khaled Hadeed
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Aitor Guitarte Vidaurre
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Rémi Vincent
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Yves Dulac
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Gérald Chausseray
- Department of Paediatric Anaesthesiology, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Davide Felice Calvaruso
- Department of Congenital Cardiac Surgery, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Philippe Acar
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Clément Karsenty
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France; Inserm U1048, Institut des Maladies Métaboliques et Cardiovasculaires (Institute of Metabolic and Cardiovascular Diseases; I2MC), University of Toulouse, 31432 Toulouse, France
| |
Collapse
|
4
|
Longo S, Cheong I, Siri JE, Tamagnone F, Acosta C. Doppler images of intrapulmonary arteries within atelectasis and its impact on right ventricular afterload with transesophageal echocardiography. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71:48-53. [PMID: 37678467 DOI: 10.1016/j.redare.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/07/2023] [Indexed: 09/09/2023]
Abstract
Video-assisted thoracoscopy (VATS) cardiac surgery requires one-lung ventilation (OLV) and transoesophageal ultrasound (TOE) monitoring. Colour and spectral Doppler make it possible to study the pattern of blood flow in the pulmonary vessels within the atelectatic lung. In this case report we describe how TOE can be used to detect blood flow within the atelectatic lung and to assess pulmonary vascular resistance (PVR) and right ventricular (RV) afterload. FINDINGS: Three anaesthetised, mechanically ventilated adults scheduled for cardiac surgery by VATS were scanned with TOE. After left OLV, the transducer was rotated away from the heart to obtain 2D colour Doppler images of blood flow within the consolidated lung parenchyma. We were able to identify the flow pattern of the intrapulmonary branches of the pulmonary artery. PVR was recorded using pulsed cardiac Doppler at baseline, after induction of general anaesthesia, 20 min after OLV and at the end of OLV, and after performing an alveolar recruitment manoeuvre (ARM) that led to complete resolution of the aforementioned consolidation. CONCLUSIONS: TOE is a semi-invasive imaging tool that can be used to diagnose and study PVR-induced atelectasis and to analyse the resulting pulmonary shunt and its possible effect on PVR.
Collapse
Affiliation(s)
- S Longo
- Anestesiología, Hospital Privado Universitario de Córdoba, Argentina; Asociación Argentina de Ultrasonografía Crítica (ASARUC), Argentina.
| | - I Cheong
- Unidad de Cuidados Intensivos, Sanatorio de Los Arcos, Buenos Aires, Argentina; Asociación Argentina de Ultrasonografía Crítica (ASARUC), Argentina
| | - J E Siri
- Anestesiología, Hospital Privado Universitario de Córdoba, Argentina
| | - F Tamagnone
- Asociación Argentina de Ultrasonografía Crítica (ASARUC), Argentina
| | - C Acosta
- Anestesiología, Hospital Privado de la Comunidad de Mar del Plata, Argentina
| |
Collapse
|
5
|
Della Rocca DG, Magnocavallo M, Gianni C, Mohanty S, Al-Ahmad A, Bassiouny M, Denora M, La Fazia VM, Lavalle C, Gallinghouse GJ, Santangeli P, Polselli M, Sarkozy A, Vetta G, Ahmed A, Sanchez JE, Pannone L, Chierchia GB, Tschopp DR, de Asmundis C, Di Biase L, Lakkireddy D, Burkhardt DJ, Horton RP, Natale A. Three-dimensional intracardiac echocardiography for left atrial appendage sizing and percutaneous occlusion guidance. Europace 2023; 26:euae010. [PMID: 38225176 PMCID: PMC10823354 DOI: 10.1093/europace/euae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/10/2024] [Indexed: 01/17/2024] Open
Abstract
AIMS Left atrial appendage (LAA) imaging is critical during percutaneous occlusion procedures. 3D-intracardiac echocardiography (ICE) features direct visualization of LAA from multiple cross-sectional planes at a time. We aimed at reporting procedural success of 3D-ICE-guided LAA occlusion and the correlation between pre-procedural transoesophageal echocardiography (TEE) and intraprocedural 3D-ICE for LAA sizing. METHODS AND RESULTS Among 274 patients undergoing left atrial appendage occlusion (LAAO) with a Watchman FLX, periprocedural ICE guidance was achieved via a commercially available 2D-ICE catheter (220 patients) or a novel (NUVISION™) 3D-ICE one (54 patients). Primary endpoint was a composite of procedural success and LAA sealing at follow-up TEE. Secondary endpoint was a composite of periprocedural device recapture/resizing plus presence of leaks ≥ 3 mm at follow-up TEE. 3D-ICE measurements of maximum landing zone correlated highly with pre-procedural TEE reference values [Pearson's: 0.94; P < 0.001; bias: -0.06 (-2.39, 2.27)]. The agreement between 3D-ICE-based device selection and final device size was 96.3% vs. 79.1% with 2D-ICE (P = 0.005). The incidence of the primary endpoint was 98.1% with 3D-ICE and 97.3% with 2D-ICE (P = 0.99). 2D-ICE patients had a trend towards a higher incidence of periprocedural device recapture/redeployment (31.5% vs. 44.5%; P = 0.09). The secondary endpoint occurred in 31.5% of 3D-ICE patients vs. 45.9% of 2D-ICE ones (P = 0.065). CONCLUSION Intracardiac echocardiography-guided LAAO showed a very high success, with no major adverse events. A very high level of agreement for LAA sizing was found between pre-procedural TEE and periprocedural 3D-ICE. 3D-ICE performed significantly better than 2D-ICE for FLX size selection and may provide better guidance during device deployment.
Collapse
Affiliation(s)
- Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Michele Magnocavallo
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli Isola Tiberina—Gemelli Isola, Rome, Italy
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Marialessia Denora
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Vincenzo Mirco La Fazia
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gerald J Gallinghouse
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Marco Polselli
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli Isola Tiberina—Gemelli Isola, Rome, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Adnan Ahmed
- Kansas City Heart Rhythm Institute, 5100 W 110th St Second Floor, Overland Park, KS, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - David R Tschopp
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute, 5100 W 110th St Second Floor, Overland Park, KS, USA
| | - David J Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
- Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA
- Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
6
|
Perez-Ajami D, Carmona García P, Zarragoikoetxea Jauregui I, Sales Badía G, Argente Navarro P. Left side clot in transit in double-lung transplantation diagnosticated by transesophageal echocardiography: what's next? Rev Esp Anestesiol Reanim (Engl Ed) 2023:S2341-1929(23)00196-8. [PMID: 38065299 DOI: 10.1016/j.redare.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/10/2023] [Indexed: 12/17/2023]
Abstract
A 61-year-old man with no predisposition to thrombosis underwent sequential double lung transplantation without extracorporeal membrane oxygenation (ECMO) support due to terminal stage COPD. After implantation and reperfusion of both lungs, a complete transoesophageal echocardiography study was performed to check the pulmonary venous anastomosis. The study showed a large, heterogeneous, dense, hyperechoic free-floating mass in the left atrium compatible with a clot in transit from the pulmonary circulation. The surgical team were notified of this finding so that they could reopen the anastomosis and remove the clot to prevent a major complication. There were no clinical manifestations when the patient was awakened.
Collapse
Affiliation(s)
- D Perez-Ajami
- Anesthesiology and Critical Care, Hospital La Fe, Valencia, Spain
| | - P Carmona García
- Cardiothoracic Anesthesiology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | | | - G Sales Badía
- Thoracic Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - P Argente Navarro
- Anesthesiology and Critical Care, Hospital Universitari I Politècnic La Fe, Valencia, Spain.
| |
Collapse
|
7
|
Cemin R, Maggioni AP, Boriani G, Di Pasquale G, Gonzini L, Lucci D, Colivicchi F, Gulizia MM. Is there a reduced confidence towards direct oral anticoagulants compared to vitamin K antagonists in patients scheduled for an elective electrical cardioversion? The results of the BLITZ-AF study. Int J Cardiol 2023; 391:131302. [PMID: 37652271 DOI: 10.1016/j.ijcard.2023.131302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/03/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To study the confidence of cardiologists in performing an electrical cardioversion in patients on oral anticoagulation (OA) with or without transoesophageal echocardiography (TOE). METHODS Data about atrial fibrillation (AF) patients admitted to cardiology wards for elective cardioversion (ECV) were extrapolated from the BLITZ-AF study. Percentage of vitamin K antagonists (VKAs), direct oral anticoagulants (DOAC) and heparin prescription were analysed in relation to the use of TOE before ECV. RESULTS Overall rate of TOE was 33.7% (240/713); it was used before ECV in 124/313 (39.6%) of DOACs patients and in 96/372 (25.8%) of the patients on VKAs, showing a significant reduced resort to TOE in VKAs patients (p = 0.0001). Among non-valvular patients TOE was more frequently performed in males, at younger ages and in patients on heparin when compared to patients treated with OA. TOE was also more frequently performed in tertiary hospitals and in hospitals with cardiology wards and electrophysiology labs, when compared to hospital provided only with cardiology wards. At multivariable analysis there was a significant less recourse to TOE in patients on VKAs (OR 0.47; 95% CI: 0.33-0.67) and higher recourse in the heparin group (OR: 3.85; 95% CI:1.59-9.28) with respect to patients on DOACs; a higher recourse to TOE was observed also in tertiary hospitals (OR 4.25; 95% CI 2.69-6.69) and in hospitals with cardiology wards and electrophysiology (EP) labs (OR 1.87; 95% CI 1.23-2.82). CONCLUSION our study shows the reluctance in cardioverting patients on DOACs respect to VKAs without a previous TOE, despite adequate anticoagulant treatment.
Collapse
Affiliation(s)
- Roberto Cemin
- Department of Cardiology, San Maurizio Regional Hospital of Bolzano, Bolzano, Italy.
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giuseppe Di Pasquale
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy; Direzione Generale Cura della Persona, Salute e Welfare, Regione Emilia-Romagna, Italy
| | - Lucio Gonzini
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | - Donata Lucci
- Department of Cardiology, San Maurizio Regional Hospital of Bolzano, Bolzano, Italy; ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, Emergency Department, San Filippo Neri Hospital, ASL, Rome 1, Rome, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Garibaldi-Nesima Hospital, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| |
Collapse
|
8
|
Christa M, Müntze J, Lengenfelder B, Nordbeck P. Contrast-enhanced ultrasound for non-invasive differential diagnosis of unclear left atrial mass. Int J Cardiovasc Imaging 2023; 39:2173-2174. [PMID: 37665488 PMCID: PMC10673719 DOI: 10.1007/s10554-023-02926-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023]
Abstract
Transthoracic and transesophageal echocardiography detected a left atrial mass attached to the intra-atrialseptum. Intravenous contrast agent ruled out atrial thrombus, sugesting a left atrial myxoma. This highlights theimportance of contrast echocardiography for differential diagnosis of left atrial findings.
Collapse
Affiliation(s)
- Martin Christa
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, Haus A3, D - 97080, Würzburg, Germany.
| | - Jonas Müntze
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, Haus A3, D - 97080, Würzburg, Germany
| | - Björn Lengenfelder
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, Haus A3, D - 97080, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, Haus A3, D - 97080, Würzburg, Germany
| |
Collapse
|
9
|
Dittrich S, Kece F, Scheurlen C, van den Bruck JH, Filipovic K, Wörmann J, Erlhöfer S, Pavel F, Schipper JH, Sultan A, Lüker J, Steven D. Implementation and first outcomes of a novel standard operating procedure for preprocedural transoesophageal echocardiography screening in course of atrial arrhythmia ablation. Europace 2023; 25:euad279. [PMID: 37713241 PMCID: PMC10516708 DOI: 10.1093/europace/euad279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS Preprocedural transoesophageal echocardiography (TEE) screening for left atrial (LA) thrombi is the standard of care in many centres performing atrial fibrillation (AF) ablation. However, TEE imposes procedural risks for patients and is often challenging to implement in daily practice, besides causing patient discomfort. At our centre, a novel standard operating procedure (SOP) was implemented, aiming to identify patients that can be exempt from TEE screening. We aimed to assess whether this screening approach may reduce preprocedural TEEs without imposing patients of higher risks for cerebrovascular events (CVEs). METHODS AND RESULTS Data of 1874 consecutive patients treated by catheter ablation of LA arrhythmias between 2018 and 2022 were retrospectively analysed. A cohort of 937 patients, where decision to perform TEE screening was based on a new SOP (considering rhythm at admission, CHA2DS2-VASc score, and sufficient anticoagulation), was compared to a matched cohort receiving TEE before every procedure. Number of performed TEEs and incidences of CVEs were compared. Implementation of the new SOP led to a 67% reduction in TEEs performed (old SOP: 933 vs. new SOP: 305). No significant differences between the groups were detected regarding transitory ischaemic attack (old SOP: 5 vs. new SOP: 3; P = 0.48) and stroke (no events). No solid thrombi were detected during TEE screening. CONCLUSION The number of preprocedural screening TEEs before AF ablation procedures can be safely reduced by applying risk stratification based on rhythm at admission and CHA2DS2-VASc score, if anticoagulation was performed properly.
Collapse
Affiliation(s)
- Sebastian Dittrich
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Fehmi Kece
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Cornelia Scheurlen
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan-Hendrik van den Bruck
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Karlo Filipovic
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jonas Wörmann
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Susanne Erlhöfer
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Friederike Pavel
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan-Hendrik Schipper
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| |
Collapse
|
10
|
Pezel T, Coisne A. What other than simulation for the future of echocardiography training? Arch Cardiovasc Dis 2023; 116:298-299. [PMID: 37268492 DOI: 10.1016/j.acvd.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Théo Pezel
- Service de cardiologie, hôpital universitaire Lariboisière - AP-HP, université Paris-Cité, 75010 Paris, France; Centre de simulation de l'université Paris-Cité, centre Ilumens, université de Paris, 75006 Paris, France; Inserm UMRS 942, cardiovascular MArkers in Stressed COndiTions (MASCOT), 75010 Paris, France; French Commission of Simulation Teaching (commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France.
| | - Augustin Coisne
- French Commission of Simulation Teaching (commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Université de Lille, Inserm, CHU de Lille, institut Pasteur de Lille, U1011- EGID, 59000 Lille, France; Centre de simulation en santé PRESAGE, faculté de médecine, université de Lille, 59045 Lille, France
| |
Collapse
|
11
|
Hanke D, Hamadanchi A, Schulze PC, Franz M. Congenital membranous ostial stenosis of the left atrial appendage as a secondary finding in a patient with ST elevation myocardial infarction: a case report. Eur Heart J Case Rep 2023; 7:ytad251. [PMID: 37288346 PMCID: PMC10243859 DOI: 10.1093/ehjcr/ytad251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/06/2022] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
Background Stenoses of the left atrial appendage (LAA) represent a common complication after incomplete surgical ligation. However, the idiopathic entity is very rare. So far, there is uncertainty about the thromboembolic risk and potential benefit of anticoagulation in these patients. We report on congenital ostial stenosis of the LAA as a secondary finding in a patient with myocardial infarction. Case summary A 56-year-old patient presented with acute heart failure secondary to ST elevation myocardial infarction (STEMI) and eventually progressed to cardiogenic shock. A percutaneous coronary intervention and stent placement in the first diagonal branch and in the left anterior descending artery was performed in two sessions. There was a new onset of typical atrial flutter and paroxysmal atrial fibrillation with haemodynamically relevant tachycardia. Before synchronized electrical cardioversion, we performed transoesophageal echocardiography. Left atrial thrombi were ruled out. Surprisingly, we found membranous ostial stenosis of the LAA, resulting in a bidirectional flow pattern. After 28 days of treatment in the intensive care unit the patient had full clinical recovery. Discussion Given the very rare cases of congenital LAA ostial stenosis, there is uncertainty about the thrombogenicity and the potential benefit of anticoagulation or even a percutaneous closure of the LAA. We discuss possible similarities regarding the thromboembolic risk of patients with an idiopathic narrowing of the LAA to patients with incomplete surgical ligation and patients with a device leak after percutaneous LAA closure. Congenital ostial LAA stenosis represents a clinically relevant condition and may be considered as a potential hazard for thromboembolism.
Collapse
Affiliation(s)
- David Hanke
- Corresponding author. Tel: +49 3641 9324534,
| | - Ali Hamadanchi
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - P Christian Schulze
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | | |
Collapse
|
12
|
N'cho-Mottoh MPB, Erpelding ML, Roubaud C, Delahaye F, Fraisse T, Dijos M, Ennezat PV, Fluttaz A, Richard B, Beaufort C, Nazeyrollas P, Brasselet C, Pineau O, Tattevin P, Curlier E, Iung B, Forestier E, Selton-Suty C. The impact of transoesophageal echocardiography in elderly patients with infective endocarditis. Arch Cardiovasc Dis 2023; 116:258-264. [PMID: 37147149 DOI: 10.1016/j.acvd.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/25/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Infective endocarditis (IE) increasingly involves older patients. Geriatric status may influence diagnostic and therapeutic decisions. AIM To describe transoesophageal echocardiography (TEE) use in elderly IE patients, and its impact on therapeutic management and mortality. METHODS A multicentre prospective observational study (ELDERL-IE) included 120 patients aged ≥75 years with definite or possible IE: mean age 83.1±5.0; range 75-101 years; 56 females (46.7%). Patients had an initial comprehensive geriatric assessment, and 3-month and 1-year follow-up. Comparisons were made between patients who did or did not undergo TEE. RESULTS Transthoracic echocardiography revealed IE-related abnormalities in 85 patients (70.8%). Only 77 patients (64.2%) had TEE. Patients without TEE were older (85.4±6.0 vs. 81.9±3.9 years; P=0.0011), had more comorbidities (Cumulative Illness Rating Scale-Geriatric score 17.9±7.8 vs. 12.8±6.7; P=0.0005), more often had no history of valvular disease (60.5% vs. 37.7%; P=0.0363), had a trend toward a higher Staphylococcus aureus infection rate (34.9% vs. 22.1%; P=0.13) and less often an abscess (4.7% vs. 22.1%; P=0.0122). Regarding the comprehensive geriatric assessment, patients without TEE had poorer functional, nutritional and cognitive statuses. Surgery was performed in 19 (15.8%) patients, all with TEE, was theoretically indicated but not performed in 15 (19.5%) patients with and 6 (14.0%) without TEE, and was not indicated in 43 (55.8%) patients with and 37 (86.0%) without TEE (P=0.0006). Mortality was significantly higher in patients without TEE. CONCLUSIONS Despite similar IE features, surgical indication was less frequently recognized in patients without TEE, who less often had surgery and had a poorer prognosis. Cardiac lesions might have been underdiagnosed in the absence of TEE, hampering optimal therapeutic management. Advice of geriatricians should help cardiologists to better use TEE in elderly patients with suspected IE.
Collapse
Affiliation(s)
| | - Marie-Line Erpelding
- CHRU of Nancy, Inserm, université de Lorraine, CIC, épidémiologie clinique, 54000 Nancy, France
| | | | | | | | - Marina Dijos
- University Hospital of Bordeaux, 33000 Bordeaux, France
| | | | | | | | | | | | | | | | | | - Elodie Curlier
- University Hospital of Guadeloupe, Les Abymes 97142, France
| | - Bernard Iung
- Bichat-Claude Bernard Hospital, 75018 Paris, France
| | | | | |
Collapse
|
13
|
Suzuki W, Nakano Y, Ando H, Fujimoto M, Sakurai H, Suzuki M, Takahashi H, Mukai K, Amano T. Association between coronary flow and aortic stenosis during transcatheter aortic valve implantation. ESC Heart Fail 2023; 10:2031-2041. [PMID: 37057311 DOI: 10.1002/ehf2.14316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 04/15/2023] Open
Abstract
AIMS In patients with aortic stenosis (AS), the coronary flow reserve decreases even in the absence of epicardial coronary artery stenosis. Systolic coronary flow reversal (SFR) reflecting reduced coronary microcirculation, often seen in patients with severe AS, has a potential negative impact on the pathogenesis of cardiac dysfunction. However, there are limited data on the relationship between the severity of AS and SFR, as well as on the benefits of transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate the relationship between the severity of AS and efficacy of TAVI in improving SFR. METHODS AND RESULTS Consecutive patients with AS who had undergone TAVI using transoesophageal echocardiography (TEE) from November 2020 to February 2022 were prospectively enrolled. Coronary flow in the left anterior descending artery as well as the aortic valve peak velocities, and the mean aortic valve pressure gradients (AVPGs), indicating the severity of AS, were measured using intraprocedural TEE before and after TAVI. The following parameters were measured as coronary flow: systolic and diastolic peak velocity (cm/s) and systolic and diastolic velocity-time integral (VTI) (cm). SFR was defined as the presence of a reversal coronary flow component in systole. The enrolled patients were classified into two groups according to the presence or absence of SFR before TAVI. A total of 25 patients were included: 13 had SFR and 12 who had no SFR, before TAVI. Patients with SFR had significantly higher aortic valve peak velocities (451.1 ± 45.9 vs. 372.1 ± 52.1 cm/s; P < 0.001) and mean AVPGs (49.2 ± 14.5 vs. 30.3 ± 11.6 mmHg; P = 0.002) than those without. The optimal binary cut-off aortic valve peak velocity values and the mean AVPG associated with the presence of SFR before TAVI were >410.0 cm/s (specificity, 75.0%; sensitivity, 92.3%) and >37.4 mmHg (specificity, 83.3%; sensitivity, 92.3%), respectively. After TAVI, SFR immediately disappeared in 11 of 13 patients with SFR (84.6%). Overall, the systolic coronary VTI significantly increased after TAVI (2.0 ± 4.7 vs. 6.4 ± 3.2 cm, P < 0.001), and this increase was greater in patients with SFR than in those without SFR before TAVI (interaction P = 0.035). CONCLUSIONS SFR was found to be associated with the severity of AS and with a greater increase in systolic coronary flow immediately after TAVI.
Collapse
Affiliation(s)
- Wataru Suzuki
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Yusuke Nakano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | | | - Hikaru Sakurai
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Mayu Suzuki
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | | | - Kentaro Mukai
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| |
Collapse
|
14
|
Shah N, Demetriades P, Maqableh GM, Khan SQ, Shahid F. Aortic cusp perforation during rotational atherectomy: a case report. Eur Heart J Case Rep 2023; 7:ytad171. [PMID: 37123646 PMCID: PMC10133995 DOI: 10.1093/ehjcr/ytad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/23/2022] [Accepted: 04/03/2023] [Indexed: 05/02/2023]
Abstract
Background Rotational atherectomy has become increasingly utilised over the past decade. Although a relatively safe procedure in appropriately trained physicians' hands, there are a number of recognised complications. Case summary We describe the case of a 64-year-old female who presented with chest pain and was diagnosed with non-ST-segment elevation acute coronary syndrome. A transthoracic echocardiogram (TTE) showed normal biventricular function and no valve disease. Invasive coronary angiogram was performed which revealed a severely calcified ostial right coronary artery (RCA) disease which was felt to be the culprit of the presentation. Balloon dilatation was unsuccessful, therefore, rotational atherectomy with an Amplatz left 0.75 guide and a 1.5 mm rota-burr was utilised and improved calcium burden. This was complicated by ostial dissection, treated with stenting. A TTE following the procedure revealed moderate aortic regurgitation (AR). The patient was discharged as she remained asymptomatic. An outpatient transoesophageal echocardiogram performed eight months later showed evidence of severe eccentric AR. Cardiac magnetic resonance imaging confirmed severe AR with left ventricular dilatation. Repeat angiogram 10 months after index procedure revealed in-stent restenosis, and the patient was accepted by heart multidisciplinary team for aortic valve replacement and grafting of RCA. Discussion As the field of rotational atherectomy continues to expand, we propose that novel complications such as reported in this case may become recognised. Finally, we stress the importance of multi-modality imaging in the investigation and timely planning of interventions in the management of these patients.
Collapse
Affiliation(s)
| | - Polyvios Demetriades
- Department of cardiology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Ghaith M Maqableh
- Department of cardiology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2GW, UK
- Cardiology Department, Faculty of Medicine, Al Balqa Applied University, Amman, Salt 19117, P.O. Box 20, Jordan
| | - Sohail Q Khan
- Department of cardiology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2GW, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | | |
Collapse
|
15
|
Komanek T, Rabis M, Omer S, Peters J, Frey UH. Quantification of left ventricular ejection fraction and cardiac output using a novel semi-automated echocardiographic method: a prospective observational study in coronary artery bypass patients. BMC Anesthesiol 2023; 23:65. [PMID: 36855077 PMCID: PMC9972694 DOI: 10.1186/s12871-023-02025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Echocardiographic quantification of ejection fraction (EF) by manual endocardial tracing requires training, is time-consuming and potentially user-dependent, whereas determination of cardiac output by pulmonary artery catheterization (PAC) is invasive and carries a risk of complications. Recently, a novel software for semi-automated EF and CO assessment (AutoEF) using transthoracic echocardiography (TTE) has been introduced. We hypothesized that AutoEF would provide EF values different from those obtained by the modified Simpson's method in transoesophageal echocardiography (TOE) and that AutoEF CO measurements would not agree with those obtained via VTILVOT in TOE and by thermodilution using PAC. METHODS In 167 patients undergoing coronary artery bypass graft surgery (CABG), TTE cine loops of apical 4- and 2-chamber views were recorded after anaesthesia induction under steady-state conditions. Subsequently, TOE was performed following a standardized protocol, and CO was determined by thermodilution. EF and CO were assessed by TTE AutoEF as well as TOE, using the modified Simpson's method, and Doppler measurements via velocity time integral in the LV outflow tract (VTILVOT). We determined Pearson's correlation coefficients r and carried out Bland-Altman analyses. The primary endpoints were differences in EF and CO. The secondary endpoints were differences in left ventricular volumes at end diastole (LVEDV) and end systole (LVESV). RESULTS AutoEF and the modified Simpson's method in TOE showed moderate EF correlation (r = 0.38, p < 0.01) with a bias of -12.6% (95% limits of agreement (95%LOA): -36.6 - 11.3%). AutoEF CO correlated poorly both with VTILVOT in TOE (r = 0.19, p < 0.01) and thermodilution (r = 0.28, p < 0.01). The CO bias between AutoEF and VTILVOT was 1.33 l min-1 (95%LOA: -1.72 - 4.38 l min-1) and 1.39 l min-1 (95%LOA -1.34 - 4.12 l min-1) between AutoEF and thermodilution, respectively. AutoEF yielded both significantly lower EF (EFAutoEF: 42.0% (IQR 29.0 - 55.0%) vs. EFTOE Simpson: 55.2% (IQR 40.1 - 70.3%), p < 0.01) and CO values than the reference methods (COAutoEF biplane: 2.30 l min-1 (IQR 1.30 - 3.30 l min-1) vs. COVTI LVOT: 3.64 l min-1 (IQR 2.05 - 5.23 l min-1) and COPAC: 3.90 l min-1 (IQR 2.30 - 5.50 l min-1), p < 0.01)). CONCLUSIONS AutoEF correlated moderately with TOE EF determined by the modified Simpson's method but poorly both with VTILVOT and thermodilution CO. A systematic bias was detected overestimating LV volumes and underestimating both EF and CO compared to the reference methods. TRIAL REGISTRATION German Register for Clinical Trials (DRKS-ID DRKS00010666, date of registration: 08/07/2016).
Collapse
Affiliation(s)
- Thomas Komanek
- Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.,Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Marco Rabis
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Saed Omer
- Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.,Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Jürgen Peters
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Ulrich H Frey
- Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany. .,Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany.
| |
Collapse
|
16
|
de Villiers de la Noue V, Théry G, Faroux L, Belkessa N, Rubin S, Mourvillier B, Goury A. Left atrial dissection after a supra-annular mitral valve replacement for endocarditis. J Cardiothorac Surg 2023; 18:75. [PMID: 36793069 DOI: 10.1186/s13019-022-02097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/11/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Left atrial dissection is a rare and a potentially fatal complication of cardiac surgery. Multi-modal imagery is helpful for the diagnosis and to guide the treatment. CASE PRESENTATION We report the case of a 66-year-old female patient who underwent a combined mitral and aortic valve replacement for degenerative valvular disease. She presented an infectious endocarditis revealed by a third-degree atrioventricular bloc and had a redo mitral- and aortic valve replacement. Mitral valve was inserted in supra-annular position due to annular destruction. Post-operative course was marked by a refractory acute heart failure explained by a left atrial wall dissection confirmed by transoesophageal echocardiography and synchronized cardiac CT-scan. Surgical treatment was theoretically indicated but considering the high risk of a third surgery, a palliative care support was collegially decided. CONCLUSIONS Left atrial dissection can occur after a redo surgery and supra-annular mitral valve implantation. Multi-modal imagery including transoesophageal echocardiography and cardiac CT-scan is helpful for the diagnosis.
Collapse
|
17
|
Damlin A, Eriksson MJ, Maret E. Can transthoracic echocardiography be used to a greater extent in the diagnostics of infective endocarditis to avoid unnecessary transoesophageal examinations without jeopardising accuracy? Cardiovasc Ultrasound 2023; 21:3. [PMID: 36717895 PMCID: PMC9887897 DOI: 10.1186/s12947-023-00301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a serious condition that requires prompt diagnosis and treatment. Transthoracic echocardiography (TTE) is usually the initial imaging modality, however transoesophageal echocardiography (TOE) is sometimes necessary because of its higher sensitivity for IE. Yet, TOE may imply an increased risk of complications. This project aims to evaluate whether TTE can be used to a greater extent in the diagnostics of IE to avoid unnecessary TOE examinations without jeopardizing diagnostic accuracy. METHODS Data from all TOE examinations performed on patients hospitalized with clinical suspicion of IE between 2019-05-01 and 2020-04-30 at a university hospital in Stockholm, Sweden, were obtained and analysed. Variables included for analysis were age, sex, blood culture results, aetiology, results from TOE, number of TOEs during the inclusion period, results from positron emission tomography/computed tomography (PET/CT), new regurgitation, cardiac murmur, previous IE, prosthetic valve, predisposing factors, i.e. cardiac comorbidities, injection drug use, fever, vascular phenomena, and immunological phenomena. To assess associations between predisposing factors or aetiology of IE and TOE findings, chi square tests and logistic regression models were used. For continuous variables, linear regression was used for comparisons of means and quantile regression was used for comparisons of medians. P < 0.05 was considered significant. RESULTS In total 195 TOE examinations (Table 1) from 160 patients were included, of which 61 (31%) were positive for IE. In total, 36 examinations had negative TTE prior to TOE of which 32 (86%) also had negative TOE. Of the 5 (14%) negative TTE prior to TOE that had positive TOE, all had cardiovascular implantable electronic device (CIED) and/or prosthetic valves. CONCLUSIONS The existing recommendations for TOE in patients with clinical suspicion of IE are probably broad enough not to miss patients with IE, but there might be an unnecessarily large number of patients being referred for TOE with negative results. Negative TTE examination with good image quality and no CIED or prosthetic valves, may be sufficient without jeopardizing the IE diagnosis.
Collapse
Affiliation(s)
- Anna Damlin
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Division of Clinical Physiology, Karolinska Institutet, (L1:00), Stockholm, 171 76 Sweden ,grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, Solna, A8:01, Eugeniavägen 3, Stockholm, SE-171 76 Sweden
| | - Maria J. Eriksson
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Division of Clinical Physiology, Karolinska Institutet, (L1:00), Stockholm, 171 76 Sweden ,grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, Solna, A8:01, Eugeniavägen 3, Stockholm, SE-171 76 Sweden
| | - Eva Maret
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Division of Clinical Physiology, Karolinska Institutet, (L1:00), Stockholm, 171 76 Sweden ,grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, Solna, A8:01, Eugeniavägen 3, Stockholm, SE-171 76 Sweden
| |
Collapse
|
18
|
Acar P, Hadeed K, Vignaud P, Pyra P, Guitarte A, Dulac Y, Djeddai C, Fourcade J, Lavie-Badie Y, Combes N, Ratsimandresy M, Calvaruso D, Karsenty C. Such a long wait: Three-dimensional paediatric transoesophageal echocardiography finally arises. Arch Cardiovasc Dis 2023; 116:1-2. [PMID: 36529646 DOI: 10.1016/j.acvd.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Philippe Acar
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France.
| | - Khaled Hadeed
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France
| | - Paul Vignaud
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France
| | - Pierrick Pyra
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France
| | - Aitor Guitarte
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France
| | - Yves Dulac
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France
| | - Camélia Djeddai
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France
| | - Julien Fourcade
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Cardiac Imaging Centre, Toulouse University Hospital, Toulouse, France
| | - Nicolas Combes
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France; Department of Cardiology, Clinique Pasteur, 31076 Toulouse, France; Department of Paediatric and Adult Congenital Heart Disease, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, 92350 Le Plessis-Robinson, France
| | | | - Davide Calvaruso
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France
| | - Clément Karsenty
- Department of Paediatric Cardiology, Toulouse University Hospital, 31059 Toulouse, France; Institut Des Maladies Métaboliques Et Cardiovasculaires, University of Toulouse, INSERM U1048, I2MC, BP84225, 31432 Toulouse, France
| |
Collapse
|
19
|
Zendjebil S, Garot P. [Contribution of CT-scan fusion imaging for interventional cardiology]. Ann Cardiol Angeiol (Paris) 2022; 71:417-423. [PMID: 36280514 DOI: 10.1016/j.ancard.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Fusion imaging is developing fast, allowing improvements in interventional cardiology procedures workup and guidance. Computed-tomography (CT) scan and fluoroscopy fusion guidance used in procedures such as left appendage occlusion or perivalvular leak closure permit prediction and simulation of the appropriatedevice, as well as implantation guidance. In the era of tailored medicine, CT/fluoroscopy fusion imaging guidance is an interesting tool for individualizing and adapting the devices implanted to each patient, as well as improving the outcomes and safety of each procedure.
Collapse
Affiliation(s)
- S Zendjebil
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - P Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France.
| |
Collapse
|
20
|
ÖZBİÇER S, YÜKSEL G, Deniz URGUN Ö. Triglyceride glucose index is independently associated with aortic intima-media thickness in patients without known atherosclerotic cardiovascular disease or diabetes. Diab Vasc Dis Res 2022; 19:14791641221136203. [PMID: 36270638 PMCID: PMC9597021 DOI: 10.1177/14791641221136203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The triglyceride-glucose (TyG) index is a reliable marker of insulin resistance. We aimed to investigate the relationship between the TyG index and aortic intima-media thickness (IMT) in individuals without diabetes mellitus and atherosclerotic cardiovascular disease undergoing transoesophageal echocardiography due to suspected structural heart disease.Methods: One hundred twenty-two patients enrolled in the study between January 2021 and June 2021. Patients were divided into two groups according to their median IMT; patients with an IMT equal to or less than 1.42 mm were low IMT group, and higher than 1.42 mm were high IMT group. Triglyceride-glucose index were higher in the high IMT group (8.69 ± 0.59 vs. 8.37 ± 0.53, p = .003).Results: Triglyceride-glucose index was correlated with IMT (r = 0.259, p = .005) and in binary logistic regression analysis age and TyG was independently associated with having high IMT (β = 0.076, exp(B)=1.079 95%CI = 1.041-1.118, p < .001 and β = 0.847, exp(B)= 2.334 95%CI= 1.048-5.199, p = .038, respectively).Conclusion: We found an independent relationship between TyG and IMT of the thoracic aorta, an early marker of subclinical atherosclerosis in patients without known atherosclerotic cardiovascular disease or diabetes. Therefore, the TyG index can identify high-risk subjects in the general population.
Collapse
Affiliation(s)
- Süleyman ÖZBİÇER
- Department of Cardiology, University of Health Sciences Adana
City Training and Research Hospital, Adana, Turkey
- Süleyman ÖZBİÇER, Department of Cardiology,
University of Health Sciences Adana City Training and Research Hospital, Mithat
Özsan Bulvarı Kışla Mah. 4522 Sok. No:1, 01230, Yüreğir/ADANA, Adana, Turkey.
| | - Gülhan YÜKSEL
- Department of Cardiology, University of Health Sciences Adana
City Training and Research Hospital, Adana, Turkey
| | - Örsan Deniz URGUN
- Department of Cardiology, University of Health Sciences Adana
City Training and Research Hospital, Adana, Turkey
| |
Collapse
|
21
|
Wybraniec MT, Mizia‐Szubryt M, Cichoń M, Wrona‐Kolasa K, Kapłon‐Cieślicka A, Gawałko M, Budnik M, Uziębło‐Życzkowska B, Krzesiński P, Starzyk K, Gorczyca‐Głowacka I, Daniłowicz‐Szymanowicz L, Kaufmann D, Wójcik M, Błaszczyk R, Hiczkiewicz J, Łojewska K, Kosmalska K, Fijałkowski M, Szymańska A, Wiktorska A, Haberka M, Kucio M, Michalski B, Kupczyńska K, Tomaszuk‐Kazberuk A, Wilk‐Śledziewska K, Wachnicka‐Truty R, Koziński M, Burchardt P, Mizia‐Stec K. Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation or atrial flutter. ESC Heart Fail 2022; 9:4064-4076. [PMID: 36039813 PMCID: PMC9773653 DOI: 10.1002/ehf2.14105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transoesophageal echocardiography (TOE) in patients with atrial fibrillation or atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes. METHODS AND RESULTS The research is a sub-study of the multicentre, prospective, observational Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TOE prior to direct current cardioversion or catheter ablation. TOE parameters, including presence of LAT, were compared between patients with and without HF and across different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%; P < 0.001). LAT presence increased with more advanced type of systolic dysfunction (HFpEF vs. HFmrEF vs. HFrEF: 7.4% vs. 10.5% vs. 20.3%; P < 0.001). Univariate analysis revealed that HFrEF (odds ratio [OR] 4.13; 95% confidence interval [95% CI]: 3.13-5.46), but not HFmrEF or HFpEF, was associated with the presence of LAT. Multivariable logistic regression indicated that lower left ventricular ejection fraction (OR per 1%: 0.94; 95% CI 0.93-0.95) was an independent predictor of LAT formation. Receiver operator characteristic analysis showed LVEF ≤48% adequately predicted increased risk of LAT presence (area under the curve [AUC] 0.74; P < 0.0001). CONCLUSION The diagnosis of HFrEF, but neither HFmrEF nor HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation.
Collapse
Affiliation(s)
- Maciej T. Wybraniec
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland,Members of the European Reference Network on Heart diseases ‐ ERN GUARD‐HEARTAmsterdamNetherlands
| | - Magdalena Mizia‐Szubryt
- First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Małgorzata Cichoń
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Karolina Wrona‐Kolasa
- First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Agnieszka Kapłon‐Cieślicka
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Chair and Department of CardiologyMedical University of WarsawWarsawPoland
| | - Monika Gawałko
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Chair and Department of CardiologyMedical University of WarsawWarsawPoland,Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands,Institute of Pharmacology, West German Heart and Vascular CentreUniversity of Duisburg‐EssenDuisburgGermany
| | - Monika Budnik
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Chair and Department of CardiologyMedical University of WarsawWarsawPoland
| | | | - Paweł Krzesiński
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology and Internal DiseasesMilitary Institute of MedicineWarsawPoland
| | - Katarzyna Starzyk
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre; Collegium MedicumThe Jan Kochanowski UniversityKielcePoland
| | - Iwona Gorczyca‐Głowacka
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre; Collegium MedicumThe Jan Kochanowski UniversityKielcePoland
| | | | - Damian Kaufmann
- Department of Cardiology and ElectrotherapyMedical University of GdańskGdańskPoland
| | - Maciej Wójcik
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of LublinLublinPoland
| | - Robert Błaszczyk
- Department of CardiologyMedical University of LublinLublinPoland
| | - Jarosław Hiczkiewicz
- Clinical Department of CardiologyNowa Sól Multidisciplinary HospitalNowa SólPoland,University of Zielona GóraZielona GóraPoland
| | - Katarzyna Łojewska
- Clinical Department of CardiologyNowa Sól Multidisciplinary HospitalNowa SólPoland
| | | | - Marcin Fijałkowski
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Department of CardiologyMedical University of GdanskGdańskPoland
| | - Anna Szymańska
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Heart DiseasesPostgraduate Medical SchoolWarsawPoland
| | - Anna Wiktorska
- Department of Heart DiseasesPostgraduate Medical SchoolWarsawPoland
| | - Maciej Haberka
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology, School of Health SciencesMedical University of SilesiaKatowicePoland
| | - Michał Kucio
- Department of Cardiology, School of Health SciencesMedical University of SilesiaKatowicePoland
| | - Błażej Michalski
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of LódżŁódźPoland
| | - Karolina Kupczyńska
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of LódżŁódźPoland
| | - Anna Tomaszuk‐Kazberuk
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of BiałystokBiałystokPoland
| | | | - Renata Wachnicka‐Truty
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology and Internal MedicineMedical University of GdańskGdyniaPoland
| | - Marek Koziński
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology and Internal MedicineMedical University of GdańskGdyniaPoland
| | - Paweł Burchardt
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Biology and Lipid DisordersPoznań University of Medical SciencesPoznańPoland
| | - Katarzyna Mizia‐Stec
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland,Members of the European Reference Network on Heart diseases ‐ ERN GUARD‐HEARTAmsterdamNetherlands
| |
Collapse
|
22
|
Guo Y, Shi Z, Zheng Y, Xie C, Yi J, Chen Z, Shu Y, Zhou D. Short-term results of percutaneous closure of a patent foramen ovale guided by transoesophageal echocardiography in patients with cryptogenic stroke: a retrospective study. J Cardiothorac Surg 2022; 17:96. [PMID: 35505434 PMCID: PMC9066844 DOI: 10.1186/s13019-022-01845-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background A patent foramen ovale (PFO) is a risk factor for cryptogenic stroke (CS), and interventional therapy for PFO can reduce the recurrence rate of CS. However, interventional therapies are primarily guided by X-ray imaging, and data on regular post-surgical follow-up with the transthoracic ultrasound foaming test (UFT) are rare. Thus, this study aimed to assess the short-term (12 months) results of PFO occlusion guided by transoesophageal echocardiography (TEE) and the results of regular UFTs. Methods Clinical records, echocardiographic data, and UFT results of 75 patients who underwent interventional therapy for PFO and CS were retrospectively analysed. The patients were grouped according to their preoperative UFT results: group A (n = 21), small volume of right-to-left shunts; group B (n = 22), moderate volume of right-to-left shunts; and group C (n = 32), large volume of right-to-left shunts. All patients were treated with an Amplatzer occluder under TEE guidance. UFT follow-up was conducted regularly until 12 months after surgery. Results No significant differences in preoperative data, length of hospital stay, or operative time were noted between the groups (p > 0.05). The length of the PFO and diameter of the occluder differed between the groups as follows: group A = group B < group C (p < 0.001). Notably, 1 patient in group C developed recurrent stroke 11 months postoperatively, and 2 patients in group C developed atrial arrhythmia, which improved after 3 months of antiarrhythmic treatment. However, 19 patients still had positive UFT results 12 months postoperatively. Furthermore, the positive UFT rate 12 months postoperatively differed between the groups as follows: group A = group B < group C (p < 0.05). A preoperative large-volume shunt was negatively associated with a negative UFT rate 12 months postoperatively (OR = 0.255, 95% CI: 0.104–0.625). Conclusions In patients with PFO and CS, interventional therapy guided by TEE could lead to satisfactory short-term (12 months) outcomes. Although the positive UFT rate gradually decreased, some patients still had positive UFT results 12 months postoperatively. Preoperatively, a large volume of right-to-left shunts and a longer PFO were the two risk factors for positive UFT results postoperatively. Further studies are required to clarify the relationship between postoperative positive UFT results and stroke recurrence.
Collapse
Affiliation(s)
- Yilong Guo
- Medical School of Chinese PLA, Beijing, People's Republic of China.,Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, 570311, People's Republic of China
| | - Zhensu Shi
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, 570311, People's Republic of China
| | - Yin Zheng
- Department of Special Medical Services, Hainan Cancer Hospital, No. 6th Changbin West 4th Street, Haikou, Hainan, 570300, People's Republic of China
| | - Caichan Xie
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, 570311, People's Republic of China
| | - Jiao Yi
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, 570311, People's Republic of China
| | - Zelun Chen
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, 570311, People's Republic of China
| | - Yue Shu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, 570311, People's Republic of China. .,Department of Special Medical Services, Hainan Cancer Hospital, No. 6th Changbin West 4th Street, Haikou, Hainan, 570300, People's Republic of China.
| | - Dexing Zhou
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, 48th of Bai Shui Tang Road, Haikou, Hainan, 570311, People's Republic of China.
| |
Collapse
|
23
|
Shah TR, Beig JR, Choh NA, Rather FA, Yaqoob I, Jan VM. Phase contrast cardiac magnetic resonance imaging versus transoesophageal echocardiography for the evaluation of feasibility for transcatheter closure of atrial septal defects. Egypt Heart J 2022; 74:27. [PMID: 35416569 PMCID: PMC9008100 DOI: 10.1186/s43044-022-00269-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background This prospective study was aimed at comparing phase contrast cardiac magnetic resonance imaging (PC-CMR) with 2D transoesophageal echocardiography (TEE) for determining potential candidature for transcatheter closure in ostium secundum ASD (OS-ASD) patients. We included consecutive adult patients with OS-ASD for the evaluation of feasibility for transcatheter closure using 2D-TEE and PC-CMR over a period of 2 years. Patients who fulfilled the conventional criteria for transcatheter closure, i.e. maximum ASD diameter ≤ 34 mm, adequate rims (≥ 5 mm, except for anterosuperior rim), and normal pulmonary venous drainage on both imaging modalities, were taken for device closure. In patients where there was discrepancy in the measurements of ASD diameter or rim size, making them eligible for device closure on one imaging modality and ineligible on the other hand, provisional device closure was attempted. All patients who underwent transcatheter closure were followed up to 6 months to rule out any complications. Results A total of 58 patients (mean age 35.93 ± 10.59 years) were enrolled in the study. Overall, there was significant positive correlation between 2D-TEE and CMR measurements of maximal ASD diameter and rim size (p < 0.001). However, TEE significantly underestimated maximal ASD diameter and posteroinferior rim size in comparison with CMR (p = 0.013 and p = 0.023, respectively). 46 (79.3%) patients were suitable for transcatheter closure on CMR, while 44 (75.9%) were eligible on TEE. Transcatheter closure was attempted in 48 patients based on imaging findings and was successful in 46 (95.8%) patients. Device closure was unsuccessful in 2 patients with defect size < 34 mm on TEE but > 34 mm on CMR. Among 7 patients with deficient posteroinferior rim on TEE, 5 had sufficient rim on CMR and underwent successful transcatheter closure. CMR detected anomalous pulmonary venous drainage in one patient which was missed on TEE, hence excluding the patient from transcatheter closure. Mean device size was 28.3 ± 7.4 mm and correlated more strongly with the defect dimensions on PC-CMR (r = 0.85, p < 0.001) compared to TEE (r = 0.71, p = 0.02). Conclusions PC-CMR may to be superior to 2D-TEE for the preprocedural planning and feasibility assessment for transcatheter closure in adult patients with ostium secundum ASD.
Collapse
Affiliation(s)
| | - Jahangir Rashid Beig
- Department of Cardiology, Super Speciality Hospital, Government Medical College, Srinagar, Jammu and Kashmir, 190010, India.
| | | | | | - Irfan Yaqoob
- Department of Cardiology, SKIMS, Srinagar, J&K, India
| | | |
Collapse
|
24
|
Falasconi G, Boccellino A, Esposito A, Pepe G, Mapelli P, Agricola E, Margonato A, Slavich M. Clinical implication of multimodality imaging of aortic root intramural hematoma. Int J Cardiovasc Imaging 2021; 38:489-490. [PMID: 34524594 DOI: 10.1007/s10554-021-02410-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 01/16/2023]
Abstract
We present a case of a chronic intramural haematoma of the aortic root discovered in the setting of an acute coronary syndrome. We investigated the nature of the lesion through echocardiography, computed-tomography, magnetic resonance and positron emission tomography. In conclusion, the use of complex multimodality imaging led to the final diagnosis and allowed to define the proper management of the lesion.
Collapse
Affiliation(s)
- Giulio Falasconi
- Clinical Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Antonio Boccellino
- Clinical Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonio Esposito
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gino Pepe
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Mapelli
- Vita-Salute San Raffaele University, Milan, Italy.,Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Vita-Salute San Raffaele University, Milan, Italy.,Echocardiography Laboratory, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Clinical Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Slavich
- Clinical Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| |
Collapse
|
25
|
Ding F, Shrestha NK, Chetrit M, Verma B, Gordon S, Pettersson GB, Unai S, Griffin BP, Xu B. Clinical and Echocardiographic Characteristics of Bartonella Infective Endocarditis: An 8-Year Single-Centre Experience in the United States. Heart Lung Circ 2021; 31:350-357. [PMID: 34456130 DOI: 10.1016/j.hlc.2021.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/20/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infective endocarditis due to Bartonella species is rare. The clinical and echocardiographic characteristics are not well defined. We aimed to investigate the clinical and echocardiographic findings of Bartonella endocarditis in the contemporary era. METHODS The infective endocarditis (IE) registry and echocardiographic database at our institution were retrospectively analysed to evaluate the clinical and echocardiographic features of Bartonella endocarditis. RESULTS Between January 2008 and December 2015, there were 11 patients with Bartonella IE (0.84% among a total of 1,308 cases of definite IE): median age 54 (30-69) years, all male, 9 Caucasian, 10 had a history of cat exposure, 10 had a pre-existing valvulopathy including 6 patients with a prosthetic valve with prosthesis age range between 3 to 5 years and 1 patient with implantable cardioverter defibrillator (ICD). Bartonella henselae was responsible for all the cases. Echocardiographic evidence of IE was found in 6 of 11 patients on transthoracic echocardiography (TTE), and 6 of 8 on transoesophageal echocardiography (TEE). Bartonella IE was associated with significant valvular destruction and dysfunction on echocardiography. Nine (9) patients were managed surgically with excellent outcomes, including two patients who failed initial medical therapy. Two (2) patients who were managed medically had progression of valvular dysfunction. At a median follow-up of 6 months, there were no deaths attributable to IE or other cardiovascular causes. CONCLUSION In a contemporary single-centre cohort in the United States, Bartonella IE remains rare, but should be considered when pathogen could not be identified in patients with suspected IE, especially those with prosthetic valves or bicuspid aortic valve (BAV). The vast majority of patients with Bartonella IE were managed surgically with excellent outcomes.
Collapse
Affiliation(s)
- Feihong Ding
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Chetrit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Beni Verma
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Steven Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
26
|
Hussein L, Rehman MA, Jelic T, Berdnikov A, Teran F, Richards S, Askin N, Jarman R. Transoesophageal echocardiography in cardiac arrest: A systematic review. Resuscitation 2021; 168:167-175. [PMID: 34390824 DOI: 10.1016/j.resuscitation.2021.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
AIMS To identify, appraise and synthesize all available clinical evidence to evaluate the diagnostic role of transoesophageal echocardiography (TEE) during resuscitation of in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) in the identification of reversible causes of cardiac arrest and cardiac contractility. METHODS We conducted a systematic review following PRISMA guidelines. Medline, EMBASE, Web of Science Core Collection, Proquest Dissertations, Open Grey, CDSR, Cochrane Central, Cochrane Clinical Answers, and the clinicaltrials.gov registry were searched for eligible studies. Studies involving adult patients, with non-traumatic cardiac arrest in whom TEE was used for intra-arrest evaluation, were included. Case studies and case series, animal studies, reviews, guidelines and editorials were excluded. The QUADAS-2 tool was used for quality assessment of all studies. RESULTS Eleven studies with a total of 358 patients were included. Four studies involved perioperative IHCA, three involved OHCA, and four were mixed population settings. Overall, the risk of bias in the selected studies was either high or unclear due to evidence or lack of information. In all 11 studies, TEE allowed the identification of reversible causes of arrest. We found significant heterogeneity in the criteria used to interpret findings, TEE protocol used, and timing of TEE. CONCLUSION Due to heterogeneity of studies, small sample size and inconsistent reference standard, the evidence for TEE in cardiac arrest resuscitation is of low certainty and is affected by a high risk of bias. Further studies are needed to better understand the true diagnostic accuracy of TEE in identifying reversible causes of arrest and cardiac contractility.
Collapse
Affiliation(s)
- Laila Hussein
- Teesside University, Middlesbrough, United Kingdom; Department of Emergency Medicine, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates.
| | - Mohammad Anzal Rehman
- Department of Emergency Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Felipe Teran
- Center for Resuscitation Science, University of Pennsylvania School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | | | - Robert Jarman
- Teesside University, Middlesbrough, United Kingdom; Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | |
Collapse
|
27
|
Polizzi V, Cosma J, Cammardella A, Ranocchi F, Musumeci F. Transoesophageal echocardiography-guided 'primary' valve-in-valve technique in cardiogenic shock: a case report. Eur Heart J Case Rep 2021; 5:ytab229. [PMID: 34377901 PMCID: PMC8343450 DOI: 10.1093/ehjcr/ytab229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/14/2020] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
Background Transcatheter aortic valve implantation inside a previously implanted bioprosthesis is an alternative treatment for patients with degenerated surgical aortic bioprosthesis (AB) at high surgical risk. Pre-operative computed tomography (CT) scan provides essential information to the procedure planning, although in case of acute presentation it is not always feasible. Case summary A 32-year-old man with history of surgical treatment of aortic coarctation and Bio-Bentall procedure was transferred to our department in cardiogenic shock with a suspected diagnosis of acute myocarditis. A transthoracic echocardiogram (TTE) revealed a severely impaired biventricular function and AB degeneration causing severe stenosis. It was decided to undertake an urgent trans-apical valve-in-valve (ViV) procedure. Due to haemodynamic instability, a preoperative CT scan was not performed and transoesophageal echocardiography (TOE) was the main intraprocedural guiding imaging technique. Neither intraprocedural nor periprocedural complications occurred. Serial post-procedural TTE exams showed good functioning of the bioprosthesis and progressive improvement of left ventricular ejection fraction. Patient was discharged from the hospital 8 days after the intervention. Discussion A patient with cardiogenic shock due to severe degeneration of the AB was treated with urgent transapical ViV procedure. In this case, where urgent ViV technique was needed, TOE appeared to be a crucial alternative to CT scan and allowed us to perform a successful procedure.
Collapse
Affiliation(s)
- Vincenzo Polizzi
- Department of Cardiac Surgery and Heart Transplantation, S. Camillo Hospital, Circonvallazione Gianicolense, 87, 00149 Rome, Italy
| | - Joseph Cosma
- Department of Cardiac Surgery and Heart Transplantation, S. Camillo Hospital, Circonvallazione Gianicolense, 87, 00149 Rome, Italy
| | - Antonio Cammardella
- Department of Cardiac Surgery and Heart Transplantation, S. Camillo Hospital, Circonvallazione Gianicolense, 87, 00149 Rome, Italy
| | - Federico Ranocchi
- Department of Cardiac Surgery and Heart Transplantation, S. Camillo Hospital, Circonvallazione Gianicolense, 87, 00149 Rome, Italy
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, S. Camillo Hospital, Circonvallazione Gianicolense, 87, 00149 Rome, Italy
| |
Collapse
|
28
|
Fry C, Primus CP, Serafino-Wani R, Woldman S. Recurrent strokes in an occult case of recurrent Cutibacterium acnes prosthetic valve infective endocarditis: a case report. Eur Heart J Case Rep 2021; 5:ytab148. [PMID: 34222779 PMCID: PMC8244629 DOI: 10.1093/ehjcr/ytab148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/01/2020] [Accepted: 04/09/2021] [Indexed: 11/25/2022]
Abstract
Background Infective endocarditis (IE) is a known but uncommon cause of cardioembolic stroke and there are rare but recognized cases of IE without an inflammatory response. Cutibacterium acnes is an increasingly recognized source of invasive infections, including IE, but diagnosis is challenging due to its low virulence and fastidious nature. Case summary A 47-year-old man presented with a multi-focal stroke suggestive of a cardioembolic source. Outpatient transoesophageal echocardiography (TOE) was concerning for vegetation or thrombus associated with his previous mitral valve repair. He remained clinically well, with no evidence of an inflammatory response and sterile blood cultures. Computed tomography–positron emission tomography (CT-PET) corroborated the TOE findings, however, given the atypical presentation, he was treated for valvular thrombus. Following discharge, he quickly re-presented with further embolic phenomena and underwent emergency mitral valve replacement. Intraoperative findings were consistent with prosthetic valve IE (PVE) and a 6-week course of antibiotics commenced. C. acnes was identified on molecular testing. Eighteen months later, he re-presented with further neurological symptoms. Early TOE and CT–PET were consistent with IE. Blood cultures grew C. acnes after prolonged incubation. Given the absence of surgical indications, he was managed medically, and the vegetation resolved without valvular dysfunction. He continues to be followed up in an outpatient setting. Discussion In patients presenting with multi-territory stroke, IE should be considered despite sterile blood cultures and absent inflammatory response. C. acnes is an increasingly recognized cause of PVE in this context, often requiring surgical intervention. A high index of suspicion and collaboration with an Endocarditis Team is therefore essential to diagnose and treat.
Collapse
Affiliation(s)
- Charles Fry
- Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK
| | - Christopher P Primus
- Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Robert Serafino-Wani
- Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK
| | - Simon Woldman
- Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK
| |
Collapse
|
29
|
Shchetynska-Marinova T, Liebe V, Papavassiliu T, de Faria Fernandez A, Hetjens S, Sieburg T, Doesch C, Sigl M, Akin I, Borggrefe M, Hohneck A. Determinants of arterial stiffness in patients with atrial fibrillation. Arch Cardiovasc Dis 2021; 114:550-560. [PMID: 33903034 DOI: 10.1016/j.acvd.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/13/2020] [Accepted: 12/23/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Arterial stiffness has emerged as a strong predictor of cardiovascular disease, end-organ damage and all-cause mortality. Although increased arterial stiffness has been described as a predictor of atrial fibrillation, the relationship between arterial stiffness and atrial fibrillation is uncertain. AIM We assessed arterial stiffness in patients with atrial fibrillation compared with that in a control group. METHODS We enrolled 151 patients with atrial fibrillation who underwent pulmonary vein isolation (mean age 71.1±9.8 years) and 54 control patients with similar cardiovascular risk profiles and sinus rhythm, matched for age (mean age 68.6±15.7 years) and sex. Aortic distensibility as a measure of arterial stiffness was assessed by transoesophageal echocardiography. Patients with atrial fibrillation were followed over a median of 21 (15 to 31) months. RESULTS Compared with control patients, patients with atrial fibrillation had significantly lower aortic distensibility (1.8±1.1 vs. 2.1±1.1 10-3mmHg-1; P=0.02). Age (hazard ratio 0.67, 95% confidence interval 0.003 to 0.03; P=0.02) and pulse pressure (hazard ratio -1.35, 95% confidence interval -0.07 to -0.03; P<0.0001) were the strongest predictors of decreased aortic distensibility in the study cohort. This effect was independent of the type of atrial fibrillation (paroxysmal/persistent). During follow-up, decreased aortic distensibility was a predictor of cardiovascular and all-cause hospitalizations, as well as recurrences of atrial fibrillation, with a higher incidence rate of events in patients in the lowest aortic distensibility quartile (P=0.001). CONCLUSIONS Aortic distensibility was significantly reduced in patients with atrial fibrillation, with age and pulse pressure showing the strongest correlation, independent of the type of atrial fibrillation. Additionally, decreased aortic distensibility was associated with cardiovascular and all-cause hospitalizations, as well as recurrences of atrial fibrillation, which showed a quartile-dependent occurrence.
Collapse
Affiliation(s)
- Tetyana Shchetynska-Marinova
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany
| | - Volker Liebe
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany
| | - Theano Papavassiliu
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany; DZHK (German centre for cardiovascular research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Andréa de Faria Fernandez
- Medical faculty of Saarland University, Saarland University Hospital, Clinic for anaesthesiology, intensive medicine and pain therapy, 66421 Homburg/Saar, Germany
| | - Svetlana Hetjens
- Department of biometry and statistics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Tina Sieburg
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany
| | - Christina Doesch
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany
| | - Martin Sigl
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany
| | - Ibrahim Akin
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany; DZHK (German centre for cardiovascular research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Martin Borggrefe
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany; DZHK (German centre for cardiovascular research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Anna Hohneck
- First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany; DZHK (German centre for cardiovascular research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany.
| |
Collapse
|
30
|
Hassan AY, Kassem HH, Kandil HI, Meshaal MS, Salem MA, Mohamed AS. Impact of Cardiac Computed Tomographic Angiography on Diagnostic and Therapeutic Decisions in Patients with Suspected Prosthetic Heart Valve Dysfunction. J Saudi Heart Assoc 2021; 33:85-94. [PMID: 33936942 PMCID: PMC8084306 DOI: 10.37616/2212-5043.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Computed Tomography (CT) scan is a helpful tool to assess the coronary arteries and the great vessels. However, its routine use in the assessment of patients with suspected prosthetic valve dysfunction (PVD) has not been studied thoroughly. Objective To determine the impact of routine cardiac computed tomography angiography (CCTA) on diagnostic and therapeutic decisions in patients with suspected PVD. Methods and results This was a prospective cohort study that was conducted on 50 consecutive patients with suspected PVD who underwent both 64-slice ECG-gated CT and transesophageal echocardiography (TEE). The gold standard was the intraoperative findings. Surgery was performed in forty-six patients. ECG-gated CT showed findings that were not detected by TEE in sixteen patients (32%) namely aortic root abscess, aortic pseudoaneurysm, paravalvular leakage (PVL), sclero-calcific disruption of sutures as cause of PVL, mechanical prosthesis occluder malfunction, an underlying thrombus as cause of malfunction and finally presence of aortic dissection. Furthermore, CTA findings dictated treatment changes in fourteen patients (28%). Conclusion This study demonstrates that ECG-gated CTA has a complementary role to TEE in patients with suspected PVD. CCTA is more accurate in diagnosis of periannular complications (Aortic root abscess and Pseudo-aneurysm) and in delineating their anatomical relation to surrounding cardiac structures. Therefore CCTA can have important role in deciding and planning the method of correction whether surgical or percutaneous and has to be considered after TEE in patients with a high suspicion on PVD.
Collapse
|
31
|
Masumoto A, Kitai T, Ota M, Kim K, Ehara N, Furukawa Y. Real-time observation of a high-echoic mass in the left ventricle during transcatheter aortic valve implantation: a case report. Eur Heart J Case Rep 2021; 4:1-4. [PMID: 33629017 PMCID: PMC7891275 DOI: 10.1093/ehjcr/ytaa392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/23/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022]
Abstract
Background Increasing number of symptomatic patients with severe aortic stenosis is treated with transcatheter aortic valve implantation (TAVI). Stroke is one of the most serious complications of TAVI, and the majority of cerebral events in patients undergoing TAVI have an embolic origin. Case summary A 90-year-old female underwent trans-femoral TAVI for symptomatic severe aortic stenosis. Just before the implantation of the transcatheter heart valve (THV), transoesophageal echocardiography (TOE) showed a mobile, high-echoic mass attached to the THV, which gradually enlarged to 26 mm, then spontaneously detached from the THV and flowed up the ascending aorta, disappearing from the TOE field of. After the procedure, the patient presented with ischaemic stroke. The patient’s stroke was thought to have resulted from the embolism migrating to the distal cerebral arteries. Discussion The detailed images acquired with TOE during TAVI enabled the prompt identification of the unusual intracardiac mass.
Collapse
Affiliation(s)
- Akiko Masumoto
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 6500047, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 6500047, Japan
| | - Mitsuhiko Ota
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 6500047, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 6500047, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 6500047, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 6500047, Japan
| |
Collapse
|
32
|
Ren B, de Jaegere PPT, van Mieghem NNM. Case report: Concomitant MitraClip implantation for severe mitral regurgitation and plug closure of endocarditis induced fistula between aortic root and left atrium after transcatheter aortic valve implantation. Eur Heart J Case Rep 2021; 5:ytaa573. [PMID: 33521516 PMCID: PMC7819843 DOI: 10.1093/ehjcr/ytaa573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/29/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022]
Abstract
Background Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) occurs in up to 1.5% of patients within the first year. The development of an aorto-atrial fistula (AAF) is a rare but problematic complication of IE, which can be confirmed with transoesophageal echocardiography (TOE). We present an exceptional case of occluding an aorto-left atrial fistula only diagnosed with intraprocedural TOE during a subsequent procedure of MitraClip implantation. Case summary A 79-year-old symptomatic male patient with multiple comorbidities was referred due to severe mitral regurgitation (MR). He has had prior TAVI which was complicated with streptococcal IE for which he had received prolonged antibacterial therapy. Transthoracic echocardiography (TTE) revealed severe MR. The patient was accepted for a MitraClip procedure by the heart team. Intra-procedural TOE revealed also a significant continuous shunt through an AAF which was likely caused by the endocarditis. The strategy was therefore defined as to occlude the fistula with an Amplatzer Vascular Plug II 12 mm. The plug was released in the fistula leaving an insignificant residual shunt. After the transseptal puncture one MitraClip XTR was implanted, reducing the MR to mild. After the procedure, the patient’s general clinical condition improved without signs of haemolysis. The pre-discharge TTE confirmed trace residual shunt, mild residual MR and mild paravalvular leakage. Discussion Our case illustrates a complex transcatheter structural heart intervention with improvised procedural strategies based on the intra-procedural TOE findings. We conclude that the pre-procedural TOE needs to be comprehensive rather than exclusive, particularly in the context of bioprosthesis-related endocarditis.
Collapse
Affiliation(s)
- Ben Ren
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter P T de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas N M van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
33
|
Abudan A, Kidd B, Hild P, Gupta B. Obstruction of the inferior vena cava following bicaval orthotopic heart transplantation: a case series. Eur Heart J Case Rep 2021; 5:ytab046. [PMID: 33738420 PMCID: PMC7954254 DOI: 10.1093/ehjcr/ytab046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/27/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Inferior vena cava (IVC) obstruction is a rare complication of orthotopic heart transplantation (OHT) and is unique to bicaval surgical technique. The clinical significance, diagnosis, complications, and management of post-operative IVC anastomotic obstruction have not been adequately described. CASE SUMMARY Two patients with end-stage heart failure presented for bicaval OHT. Post-operative course was complicated with shock refractory to fluid resuscitation and inotropic/vasopressor support. Obstruction at the IVC-right atrial (RA) anastomosis was diagnosed on transoesophageal echocardiography (TOE), prompting emergent reoperation. In both cases, a large donor Eustachian valve was found to be restricting flow across the IVC-RA anastomosis. Resection of the valve resulted in relief of obstruction across the anastomosis and subsequent improvement in haemodynamics and clinical outcome. DISCUSSION Presumably rare, we present two cases of IVC obstruction post-bicaval OHT. Inferior vena cava obstruction is an under-recognized cause of refractory hypotension and shock in the post-operative setting. Prompt recognition using TOE is crucial for immediate surgical correction and prevention of multi-organ failure. Obstruction can be caused by a thickened Eustachian valve caught in the suture line at the IVC anastomosis, which would require surgical resection.
Collapse
Affiliation(s)
- Anas Abudan
- Department of Medicine, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Brent Kidd
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Peter Hild
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Bhanu Gupta
- Department of Cardiovascular Diseases, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| |
Collapse
|
34
|
Dulal Karki S, Westhoff M, Maschek H, Augustyniak J, Gupta V, Welter S. A rare diagnostic challenge in a female patient with a rapid recurrent pleural effusion: Autopsy revealed cardiac angiosarcoma with bilateral pleural and pulmonary metastases. A case report. Int J Surg Case Rep 2021; 78:278-283. [PMID: 33373923 PMCID: PMC7776125 DOI: 10.1016/j.ijscr.2020.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION We present a very rare case with diffuse cardiac angiosarcoma. Because all symptoms are often non-specific, this diagnosis is difficult to establish. To our knowledge this is the first clinical description of this rare disease. PRESENTATION OF CASE A 47-year-old female presented with bilateral pulmonary infiltrates and non-specific symptoms as fever, chest pain and dyspnoea on exertion. She was treated with antibiotics for suspected lung infection but deteriorated developing rapid recurrent pleural effusion. Her transthoracic- and transoesophageal-echocardiography as well as the thoracentesis and endobronchial ultrasound findings were normal. A minimally invasive pulmonary wedge resection, partial pleurectomy and pericardial fenestration was performed. The pathologic interpretation of these specimen was very difficult and a correct diagnosis could be made only by the second reference pathologist. While awaiting reference histology report she was administered high-flow oxygen therapy for hypoxia, antibiotics, catecholamines and corticosteroids. The patient deteriorated very rapidly and died in the ICU. DISCUSSION As in earlier studies, misdiagnosis delayed the actual diagnosis, especially because there was no clinical suspicion for angiosarcoma. Pathologic evaluation may be difficult because different growth patterns may be present in the same tumour and pleural or lung specimen may show only very tiny tumour formations within a fibrosing tissue changes. CONCLUSION This case report highlights the difficulties to establish a diagnosis of diffuse angiosarcoma in time. An early diagnosis, to initiate oncologic treatment, require a high level of clinical suspicion and a histological proof from pericardial or myocardial biopsy.
Collapse
Affiliation(s)
| | | | | | | | - Varun Gupta
- Department of Thoracic Surgery, Lungenklinik Hemer, Hemer, Germany
| | - Stefan Welter
- Department of Thoracic Surgery, Lungenklinik Hemer, Hemer, Germany.
| |
Collapse
|
35
|
Castro Verdes M, Yuan X, Li W, Senior R, Nienaber CA. Aortic intervention guided by contrast-enhanced transoesophageal ultrasound whist waiting for cardiac transplantation: a case report. Eur Heart J Case Rep 2020; 5:ytaa485. [PMID: 33554022 PMCID: PMC7850615 DOI: 10.1093/ehjcr/ytaa485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/28/2020] [Accepted: 11/04/2020] [Indexed: 01/16/2023]
Abstract
Background Aortic complications can happen during left ventricular assist devices (LVADs) insertion and its treatment remains challenging. Percutaneous aortic interventions can be an alternative to surgery in such high-risk cases. Case summary We present a patient with idiopatic dilated cardiomyopathy and advanced heart failure requiring LVAD insertion as a bridge to transplant, who developed an aortic pseudoaneurysm below the anastomosis of the LVAD tube. He was successfully treated with percutaneous coiling under contrast-enhanced transoesophageal echocardiography (TOE) guidance, reaching destination therapy (heart transplantation) a year later. Discussion Left ventricular assist devices provide haemodynamic support for patients with advanced heart failure waiting for heart transplantation. Although uncommon, aortic complications can happen as a result of LVAD insertion and be life-threatening. Percutaneous aortic interventions can be performed in such cases to promote thrombosis and remodelling of false lumen or aneurysmatic spaces, hence potentially reducing the risk of sudden death. Contrast-enhanced TOE can be easily and safely used to monitor the intervention in order to improve anatomic definition, guide positioning of wires and catheters and assess early results.
Collapse
Affiliation(s)
- Mireya Castro Verdes
- Imaging Department, Royal Brompton & Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Xun Yuan
- Department of Cardiology and Aortic Centre, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW36NP, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Exhibition Road, South Kensington, London SW72BU, UK
| | - Wei Li
- Imaging Department, Royal Brompton & Harefield NHS Foundation Trust, London SW3 6NP, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Exhibition Road, South Kensington, London SW72BU, UK
| | - Roxy Senior
- Imaging Department, Royal Brompton & Harefield NHS Foundation Trust, London SW3 6NP, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Exhibition Road, South Kensington, London SW72BU, UK
| | - Christoph A Nienaber
- Department of Cardiology and Aortic Centre, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW36NP, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Exhibition Road, South Kensington, London SW72BU, UK
| |
Collapse
|
36
|
Hoshina R, Kishima H, Mine T, Ishihara M. Aortic dissection during transoesophageal echocardiography: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33628995 PMCID: PMC7891243 DOI: 10.1093/ehjcr/ytaa333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/15/2020] [Accepted: 09/02/2020] [Indexed: 11/14/2022]
Abstract
Background Transoesophageal echocardiography (TOE) is a safe and useful tool. In our case, we are presenting a rare case of a patient with aortic dissection during TOE procedure. Case summary A 79-year-old woman was referred to our hospital for recurrent paroxysmal atrial fibrillation (AF) with palpitation. Pre-procedural cardiac computed tomography (CT) showed slight dilated ascending aorta (maximum diameter: 40 mm). We decided to perform catheter ablation (CA) for AF, and recommended TOE before the CA because she had a CHADS2 score of 4. On the day before the CA, TOE was performed. Her physical examinations at the time of TOE procedure were unremarkable. At 3 min after probe insertion, there was no abnormal finding of the ascending aorta. At 5 min after the insertion, TOE showed ascending aortic dissection without pericardial effusion. After waking, she had severe back pain and underwent a contrast-enhanced CT. Computed tomography demonstrated Stanford type A aortic dissection extending from the aortic root to the bifurcation of common iliac arteries, and tight stenosis in the right coronary artery (maximum diameter; 49 mm). The patient underwent a replacement of the ascending aorta, and a coronary artery bypass graft surgery for the right coronary artery. Discussion Transoesophageal echocardiography would have to be performed under sufficient sedation with continuous blood pressure monitoring in patients who have risk factors of aortic dissection. The risk–benefit of TOE must be considered before a decision is made. Depending on the situation, another modality instead of TOE might be required.
Collapse
Affiliation(s)
- Rin Hoshina
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| | - Hideyuki Kishima
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| | - Takanao Mine
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| |
Collapse
|
37
|
Spinoni EG, Degiovanni A, Della Corte F, Patti G. Infective endocarditis complicating COVID-19 pneumonia: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33437921 PMCID: PMC7717232 DOI: 10.1093/ehjcr/ytaa366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/29/2020] [Accepted: 09/10/2020] [Indexed: 12/21/2022]
Abstract
Background During the COVID-19 outbreak, cardiovascular imaging, especially transoesophageal echocardiography (TOE), may expose healthcare personnel to virus contamination and should be performed only if strictly necessary. On the other hand, transthoracic echocardiography (TTE) and TOE represent the first-line imaging exams for the diagnosis of infective endocarditis (IE). To date, this is the first case of COVID-19 complicated by IE. Case summary We present the case of a 57-year-old man with severe COVID-19 pneumonia requiring mechanical ventilation. During the intensive care unit (ICU) stay, he developed fever and positive haemocoltures for methicillin-resistant Staphylococcus aureus infection. TTE did not identify endocardial vegetations. TOE was then performed and outlined IE of the aortic valve on the non-coronary cusp. Antibiotic therapy was given with progressive resolution of the septic state and improvement of inflammatory signs. After 30 days of ICU stay, the patient was transferred to the Sub-ICU and then to a rehabilitation hospital. A close follow-up has been scheduled: after full recovery, a new echocardiography will be performed (TTE and TOE, if the former is non-conclusive) to consider surgical valve repair in the case of persistence/progression of the valvular lesion or deterioration of the valve function. Discussion In COVID-19 patients, echocardiography remains the leading imaging exam for the diagnosis of IE. If the suspicion of IE is high, even in this setting of patients, TTE or TOE (if TTE is non-conclusive) are mandatory. A high degree of attention must be paid and appropriate preventive measures taken to avoid contamination of healthcare personnel.
Collapse
Affiliation(s)
- Enrico Guido Spinoni
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, Novara, Italy.,Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Via Mazzini 18, Novara, Italy
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Via Mazzini 18, Novara, Italy
| | - Francesco Della Corte
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, Novara, Italy.,Anesthesiology Division, Maggiore della Carità Hospital, Via Mazzini 18, Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, Novara, Italy.,Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Via Mazzini 18, Novara, Italy
| |
Collapse
|
38
|
Perdomo JM, Sandoval E, Fernandez-Cisneros A, Quintana E. Looking at an aorta-to-right atrial fistula from inside a beating heart. Eur J Cardiothorac Surg 2020; 58:1100. [PMID: 32783062 DOI: 10.1093/ejcts/ezaa201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Juan M Perdomo
- Department of Cardiothoracic and Vascular Anaesthesia, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Elena Sandoval
- Department of Cardiovascular Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| |
Collapse
|
39
|
Mahmoud O, Elias H, Rafiq A, Alsaid A. Acquired aortopulmonary fistula: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32974452 DOI: 10.1093/ehjcr/ytaa155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/25/2020] [Accepted: 05/12/2020] [Indexed: 11/14/2022]
Abstract
Background Aortopulmonary fistula is a rare complication of ascending aorta pathology. Presentation is most commonly dramatic with acute onset chest pain or heart failure secondary to left to right shunting. We describe a patient with acquired aortopulmonary fistula who had an insidious onset of heart failure as his presenting complaint. We also highlight the utility of multimodality cardiac imaging in establishing the diagnosis. Case summary A 79-year-old male patient with a history of coronary artery bypass graft surgery and mechanical aortic valve replacement, 23 years prior, presented with exertional dyspnoea of 7 months duration. An initial workup that included transthoracic and transoesophageal echocardiography as well as coronary and bypass graft angiography failed to diagnose an acquired aortopulmonary fistula complicating an ascending aortic pseudoaneurysm. Upon referral to our institution, the correct diagnosis was suspected on off-axis transthoracic echocardiography. The fistula was subsequently confirmed, and the extent of ascending aorta pathology defined via a multimodality imaging approach that consisted of transoesophageal echocardiography and cardiac computed tomography. The patient underwent successful surgical repair and was discharged in a stable condition. Discussion Acquired aortopulmonary fistula is a rare clinical entity. We describe a patient who had an insidious presentation of heart failure and found to have a large ascending aortic aneurysm that eroded into the main pulmonary artery creating a fistulous communication. The diagnosis was delayed and required a high index of suspicion and multimodality cardiac imaging.
Collapse
Affiliation(s)
- Osama Mahmoud
- Department of Cardiology, Geisinger Medical Center, 100 N. Academy Ave. Danville, PA 17821, USA
| | - Hadi Elias
- Department of Cardiology, Geisinger Medical Center, 100 N. Academy Ave. Danville, PA 17821, USA
| | - Arsalan Rafiq
- Department of Cardiology, Geisinger Medical Center, 100 N. Academy Ave. Danville, PA 17821, USA
| | - Amro Alsaid
- Department of Cardiology, Geisinger Medical Center, 100 N. Academy Ave. Danville, PA 17821, USA
| |
Collapse
|
40
|
Cochrane A, Shi W. Managing Infective Endocarditis: What Lies Behind the High Mortality Rate and What Can We Do About it? Heart Lung Circ 2020; 29:812-3. [PMID: 32620350 DOI: 10.1016/j.hlc.2020.05.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
41
|
Terryn FX, Stangherlin P, Mansvelt B. Zenker's diverticulum perforation due to transoesophageal echocardiography: Case report of the management of an extremely rare life-threatening iatrogenic complication. Int J Surg Case Rep 2020; 72:294-297. [PMID: 32563815 PMCID: PMC7306510 DOI: 10.1016/j.ijscr.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Transoesophageal echocardiography is generally considered to be a safe monitoring and diagnostic tool. Even though the severe morbidity rate is relatively low and mortality rate exceptional, sometimes life-threatening events may occur during this procedure. PRESENTATION OF CASE We described the case of a 79-year-old woman with an extremely rare case of Zenker's diverticulum perforation following a transoesophageal echocardiography and its successful management with a 6 months follow-up. DISCUSSION Several specific endoscopic techniques have been described in the literature in case of Zenker's diverticulum and we believe the use of check lists should be implemented. CONCLUSION We hope that the documentation of this rare iatrogenic complication will remind the operators of this procedure to be aware of a documented Zenker's diverticulum and when necessary, to take the published precautions to prevent a highly severe complication.
Collapse
Affiliation(s)
- F-X Terryn
- Department of General Surgery, Hôpital de Jolimont, Haine-Saint-Paul, Belgium.
| | - P Stangherlin
- Department of General Surgery, Hôpital de Jolimont, Haine-Saint-Paul, Belgium
| | - B Mansvelt
- Department of General Surgery, Hôpital de Jolimont, Haine-Saint-Paul, Belgium
| |
Collapse
|
42
|
Encarnacion CO, Deshpande SP, Mondal S, Carr SR. Surgical correction of postpneumonectomy syndrome with adjustable saline implants and transoesophageal echocardiography. Eur J Cardiothorac Surg 2020; 57:1224-1226. [PMID: 31710660 DOI: 10.1093/ejcts/ezz311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/13/2019] [Accepted: 10/19/2019] [Indexed: 11/14/2022] Open
Abstract
Postpneumonectomy syndrome can have a significant clinical impact on a patient. It presents as progressive dyspnoea due to compression of the contralateral bronchus and/or pulmonary veins. Herein, we present a patient who over a 2-year period developed progressive dyspnoea on exertion and eventually also at rest, due to compression of her left mainstem bronchus and her left inferior pulmonary vein. Surgical correction with implantable adjustable saline implants was undertaken to ameliorate her symptoms. Concurrent use of intraoperative transoesophageal echocardiography permitted real-time adjustment of the implants. This allowed objective measurement and demonstration of normalization of pulmonary vein velocity, which resulted in complete symptom resolution.
Collapse
Affiliation(s)
- Carlos O Encarnacion
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Seema P Deshpande
- Department of Anesthesia, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samhati Mondal
- Department of Anesthesia, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shamus R Carr
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
43
|
Golub I, Lakshmanan S, Calicchio F, Budoff MJ. Computed tomography angiogram: Diagnosing device placement failure. J Cardiovasc Comput Tomogr 2020; 14:e163-e164. [PMID: 32249194 DOI: 10.1016/j.jcct.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ilana Golub
- Harbor-UCLA Medical Center Lundquist Institute, Torrance, CA, USA
| | | | | | - Matthew J Budoff
- Harbor-UCLA Medical Center Lundquist Institute, Torrance, CA, USA.
| |
Collapse
|
44
|
Onorato EM, Costante AM, Andreini D, Bartorelli AL. Infective endocarditis of an asymptomatic congenital aorta-right atrial tunnel: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32352048 PMCID: PMC7180523 DOI: 10.1093/ehjcr/ytaa039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/19/2019] [Accepted: 01/28/2020] [Indexed: 11/13/2022]
Abstract
Background Aorta-right atrial tunnel (ARAT) is a rare congenital anomaly whose aetiology and incidence are unknown. It might represent a diagnostic and therapeutic challenge requiring a combination of imaging modalities and an integrated teamwork. Case summary We report a case of a 23-year-old man with an asymptomatic ARAT complicated by infective endocarditis, diagnosed with non-invasive multimodality imaging, and successfully treated with a catheter-based approach. Discussion Aorta-right atrial tunnel closure in asymptomatic patients is still a matter of debate. Considering the risk of serious complications surgical treatment might be recommended soon after diagnosis. In selected cases, catheter-based closure might represent a safe, effective, and less invasive alternative to traditional surgical approach.
Collapse
Affiliation(s)
- Eustaquio Maria Onorato
- Centro Cardiologico Monzino, IRCCS, University School of Milan, Via C. Parea, 4, 20138 Milan, Italy
| | - Anna Maria Costante
- Cardiology Department, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16 - 15121 Alessandria, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, University School of Milan, Via C. Parea, 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, Via della Commenda 19 - 20122, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, University School of Milan, Via C. Parea, 4, 20138 Milan, Italy.,Department of Biomedical and Clinical Sciences, "Luigi Sacco", Via G.B. Grassi, 74 - 20157, University of Milan, Milan, Italy
| |
Collapse
|
45
|
Navarro-Ripoll R, Aliaga Medina JL, López-Baamonde M, López Hernández A, Perdomo Linares JM. Lung recruitment maneuvers: opening the door to a hidden enemy. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:99-102. [PMID: 31955890 DOI: 10.1016/j.redar.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
Recruitment manoeuvres (RM) are common practice in anaesthesiology; however, they can have adverse effects. We present an unforeseen complication in a patient undergoing surgical resection of a bronchial tumour who presented cardiac arrest due to pulseless electrical activity immediately after RMs. A transoesophageal echocardiogram performed after return of spontaneous circulation showed a patent foramen ovale (PFO), left ventricular dysfunction with segmental changes, and air in the left ventricle, leading to suspicion of paradoxical air embolism. The contractility changes normalised spontaneously, and postoperative evolution was uneventful. RMs cause changes in intracavitary pressures that can lead to opening of a PFO (present in up to 30% of the population) and reversal of the physiological left-right shunt. Transoesophageal echocardiography facilitated immediate diagnosis and follow-up.
Collapse
Affiliation(s)
- R Navarro-Ripoll
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.
| | - J L Aliaga Medina
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - M López-Baamonde
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - A López Hernández
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - J M Perdomo Linares
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| |
Collapse
|
46
|
Capuano F, Sechi S, De Luca A, Sinatra R. Severe mitral valve stenosis due to a giant left atrial mass. Eur J Cardiothorac Surg 2019; 56:1207. [PMID: 31180448 DOI: 10.1093/ejcts/ezz166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabio Capuano
- Department of Cardiac Surgery, Sant'Andrea Hospital, Rome, Italy
| | - Stefano Sechi
- Department of Cardiac Surgery, Sant'Andrea Hospital, Rome, Italy
| | - Angelo De Luca
- Department of Cardiac Surgery, Sant'Andrea Hospital, Rome, Italy
| | - Riccardo Sinatra
- Department of Cardiac Surgery, Sant'Andrea Hospital, Rome, Italy
| |
Collapse
|
47
|
Badran HM, Ahmed MK, Beshay MM, Zein FEA. A comparative study between transthoracic and transesophageal echo modalities in evaluation of left ventricular deformation. Egypt Heart J 2019; 71:4. [PMID: 31659538 PMCID: PMC6821410 DOI: 10.1186/s43044-019-0004-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 2D strain imaging has been proved as an accurate technique for the assessment of left ventricular (LV) function using transthoracic echocardiography (TTE). Transesophageal echocardiography (TEE) has become a standard and essential technique in clinical practice especially when TTE is inconclusive. Adding 2D strain imaging to TEE might be valuable in the evaluation of cardiac performance. The aim of the present study was to compare 2D strain imaging using TTE and TEE in the assessment of left ventricular deformation in patients with cardiovascular diseases. RESULTS This study was conducted on sixty patients, who were referred for TEE for various clinical indications. All patients were examined with both TTE and TEE 2D strain imaging. Global and regional strain parameters including longitudinal (LS), circumferential (CS), and radial (RS) were examined. Analysis of 2D strain using TTE was time sparing than TEE (16 ± 1 vs 19 ± 2 min, P < 0.001). From 1020 segments explored using TTE, 97% (LS) and 93% (CS and RS) of the segments were fully analyzed versus 90% and 88% using TEE respectively (P < 0.01). TEE longitudinal strain has an excellent agreement with TTE-derived measurements and a modest agreement in circumferential strain but a notable disparity in radial strain values. Both regional and global LS and RS measured by TTE showed higher values (P < 0.01, < 0.03) compared with its corresponding values measured by TEE. Whereas segmental and global values of CS were higher using TTE modes, the difference with the analogous TEE values did not reach statistical significance. LS and CS measured by TTE and TEE showed excellent but similar correlation with LV EF and wall motion score index. CONCLUSION 2D strain using TTE is user friendly compared to TEE. However, because of the good agreement, TEE 2D strain might represent an appropriate alternative in the evaluation of global LV deformation.
Collapse
|
48
|
Ramnath NWM, Ozdemir HI, Soliman-Hamad MA. A case of right ventricular outflow tract obstruction after minimally invasive aortic valve replacement. J Card Surg 2019; 34:626-627. [PMID: 31212379 DOI: 10.1111/jocs.14093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Abstract
Minimally invasive aortic valve replacement is commonly used to treat aortic valve disease through smaller incisions and upper hemisternotomy. No major differences in postoperative outcomes have been reported compared with full sternotomy aortic valve replacement. In this case report, we present a rare complication of right ventricular outflow tract obstruction after minimally invasive aortic valve replacement.
Collapse
Affiliation(s)
- Natasja W M Ramnath
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - H Ibrahim Ozdemir
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | |
Collapse
|
49
|
Shiraishi S, Bamba K, Sugimoto A, Takahashi M, Tsuchida M. A novel parameter for pulmonary blood flow during palliative procedures: velocity time integral of the pulmonary vein†. Eur J Cardiothorac Surg 2019; 55:823-828. [PMID: 30668666 DOI: 10.1093/ejcts/ezy465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The main goal of palliative procedures for congenital heart defects is adequate pulmonary blood flow (PBF), but precise intraoperative PBF evaluation is sometimes difficult. The purpose of this preliminary study was to investigate the usefulness of velocity time integral of the pulmonary vein (PV-VTI) measured by transoesophageal echocardiography (TOE) at the time of palliative procedure as a parameter for PBF. METHODS Case histories of 63 patients who underwent palliative procedures (bilateral pulmonary artery banding in 18 patients, main pulmonary artery banding in 22 patients and systemic-to-pulmonary artery shunt in 23 patients) and whose intraoperative PV-VTI was measured by TOE from 2011 to 2017 at our centre were retrospectively reviewed. Low-body-weight infants, cases in which cardiopulmonary bypass was used and cases that were anatomically difficult to measure were excluded. RESULTS PV-VTIs measured at 4 orifices of the pulmonary veins were all significantly decreased in both the bilateral pulmonary artery banding and main pulmonary artery banding groups and increased in the systemic-to-pulmonary artery shunt group immediately after the procedure. There were significant correlations between the velocity time integrals of both right and left pulmonary veins and arterial oxygen saturation (r = 0.564 and 0.703). Nine patients (6 bilateral pulmonary artery banding and 3 systemic-to-pulmonary artery shunt) required unplanned early reoperation due to inadequate PBF; their PV-VTIs were significantly different from those of patients not requiring reoperation. No major complications related to TOE occurred postoperatively. CONCLUSIONS The PV-VTI measured by TOE during palliative procedures reflected the change of PBF and could help identify patients at higher risk of early reoperation due to inadequate PBF. This parameter may be a useful additional tool for evaluating intraoperative PBF.
Collapse
Affiliation(s)
- Shuichi Shiraishi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Keiko Bamba
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ai Sugimoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masashi Takahashi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
50
|
Schneider CM, Buiatti A, Schwamborn K, Dirschinger RJ. Diagnosis of a rare cardiac human herpesvirus-8 positive B-cell lymphoma manifestation: a case report of a transoesophageal echocardiography-guided trans-septal catheter biopsy. Eur Heart J Case Rep 2019; 2:yty037. [PMID: 31020117 PMCID: PMC6177094 DOI: 10.1093/ehjcr/yty037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/07/2018] [Indexed: 12/22/2022]
Abstract
Introduction Human herpesvirus-8-associated B-cell lymphoma is a common disease entity in immunocompromised individuals, particularly in patients with chronic HIV-infection or AIDS. However, cardiac manifestations are extremely rare. Tissue for histopathology of left cardiac tumours is most commonly obtained by open surgery. Case presentation In this report, we present a case of a solitary left atrial manifestation of an HHV8+ B-cell lymphoma in a 59-year-old patient presenting with B symptoms and a cardiac mass on echocardiography. Due to the high operative risk of the patient, a transcatheter/trans-septal biopsy was performed to establish the diagnosis. Discussion In the era of routine trans-septal catheter interventions, this approach may represent a straight-forward, minimally invasive alternative for patients at high risk for surgery.
Collapse
Affiliation(s)
- Christine M Schneider
- Department of Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, Munich, Germany
| | - Alessandra Buiatti
- Department of Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, Munich, Germany
| | - Kristina Schwamborn
- Department of Pathology, Klinikum rechts der Isar, Technical University Munich, Trogerstr. 18, Munich, Germany
| | - Ralf J Dirschinger
- Department of Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, Munich, Germany
| |
Collapse
|