1
|
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] [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
|
2
|
Nisar H, Fakim D, Bainbridge D, Chen ECS, Peters T. 3D localization of vena contracta using Doppler ICE imaging in tricuspid valve interventions. Int J Comput Assist Radiol Surg 2022; 17:1569-1577. [PMID: 35588338 PMCID: PMC9463221 DOI: 10.1007/s11548-022-02660-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022]
Abstract
Purpose Tricuspid valve (TV) interventions face the challenge of imaging the anatomy and tools because of the ‘TEE-unfriendly’ nature of the TV. In edge-to-edge TV repair, a core step is to position the clip perpendicular to the coaptation gap. In this study, we provide a semi-automated method to localize the VC from Doppler intracardiac echo (ICE) imaging in a tracked 3D space, thus providing a pre-mapped location of the coaptation gap to assist device positioning. Methods A magnetically tracked ICE probe with Doppler imaging capabilities is employed in this study for imaging three patient-specific TVs placed in a pulsatile heart phantom. For each of the valves, the ICE probe is positioned to image the maximum regurgitant flow for five cardiac cycles. An algorithm then extracts the regurgitation imaging and computes the exact location of the vena contracta on the image. Results Across the three pathological, patient-specific valves, the average distance error between the detected VC and the ground truth model is \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$({1.22 \pm 2.00})$$\end{document}(1.22±2.00)mm. For each of the valves, one case represented the outlier where the algorithm misidentified the vena contracta to be near the annulus. In such cases, it is recommended to retake the five-second imaging data. Conclusion This study presented a method for ultrasound-based localization of vena contracta in 3D space. Mapping such anatomical landmarks has the potential to assist with device positioning and to simplify tricuspid valve interventions by providing more contextual information to the interventionalists, thus enhancing their spatial awareness. Additionally, ICE can be used to provide live US and Doppler imaging of the complex TV anatomy throughout the procedure.
Collapse
Affiliation(s)
- Hareem Nisar
- Robarts Research Institute, 1151 Richmond St., London, ON, N6A5B7, Canada. .,School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON, N6A3K7, Canada.
| | - Djalal Fakim
- Schulic School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada
| | - Daniel Bainbridge
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, 339 Windermere Rd., London, ON, N6A5A5, Canada
| | - Elvis C S Chen
- Robarts Research Institute, 1151 Richmond St., London, ON, N6A5B7, Canada.,School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON, N6A3K7, Canada.,Schulic School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada.,Department of Medical Biophysics, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada
| | - Terry Peters
- Robarts Research Institute, 1151 Richmond St., London, ON, N6A5B7, Canada.,School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON, N6A3K7, Canada.,Schulic School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada.,Department of Medical Biophysics, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada
| |
Collapse
|
3
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6547516. [DOI: 10.1093/ejcts/ezac133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/26/2022] [Accepted: 02/14/2022] [Indexed: 11/14/2022] Open
|
4
|
Esterhuizen JL, Long MA, Turton EW. Ruptured left ventricular subvalvar mitral aneurysm into the left atrium and left ventricle to left atrium fistula: case report of two pathological entities. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.1.2474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Subvalvar mitral aneurysm is a rare entity that mostly occurs in the African population. We present a case of a 23-year-old male patient who presented with shortness of breath and atypical chest pain. On preoperative transthoracic echocardiography, a subvalvar mitral aneurysm was noted with severe regurgitation from the aneurysm opening into the left atrium. The surgical findings revealed a single aneurysm neck present in the posterior mitral valve annulus. In addition to and separate from the aneurysm, a left ventricular to left atrial fistula was present.
Collapse
Affiliation(s)
| | - MA Long
- University of the Free State
| | | |
Collapse
|
5
|
Alizadehasl A, Parsa NA, Azarfarin R, Maleki M. Innovations in cardiovascular imaging. Trends Cardiovasc Med 2021; 32:112-123. [PMID: 33545328 DOI: 10.1016/j.tcm.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/09/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular diseases are culpable for the majority of mortalities the world over, hence the significance of advances in preventive medicine and imaging. Cardiovascular imaging constitutes the cornerstone of not only early but also precise diagnoses. Indeed, advanced imaging enables cardiologists to make efficacious management plans for various heart conditions. The present article discusses essential innovations in cardiovascular imaging.
Collapse
Affiliation(s)
- Azin Alizadehasl
- Professor of Cardiology, Echocardiologist, Head of Cardio-Oncology Department and Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Niloufar Akbari Parsa
- Echocardiography Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Azarfarin
- Professor of Cardiac Anesthesiology, Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Professor of Cardiology, Interventional Cardiologist Echocardiologist, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Jenkins C, Tsang W. Three-dimensional echocardiographic acquisition and validity of left ventricular volumes and ejection fraction. Echocardiography 2020; 37:1646-1653. [PMID: 32976656 DOI: 10.1111/echo.14862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022] Open
Abstract
Transthoracic (TTE) and transesophageal (TEE) three-dimensional echocardiography (3DE) is now used in daily clinical practice. Advancements in technology have improved image acquisition with higher frame rates and increased resolution. Different 3DE acquisition techniques can be used depending upon the structure of interest and if volumetric analysis is required. Measurements of left ventricular (LV) volumes are the most common use of 3DE clinically but are highly dependent upon image quality. Three-dimensional LV function analysis has been made easier with the development of automated software, which has been found to be highly reproducible. However, further research is needed to develop normal reference range values of LV function for both 3D TTE and TEE.
Collapse
Affiliation(s)
- Carly Jenkins
- Cardiac Investigations, Logan Hospital, Meadowbrook, QLD, Australia
| | - Wendy Tsang
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Fiorentino V, Goerne H, Rajiah P. Cinematic Rendering Technique in Adult Congenital Heart Disease. Semin Roentgenol 2020; 55:241-250. [PMID: 32859341 DOI: 10.1053/j.ro.2020.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Victor Fiorentino
- Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico
| | - Harold Goerne
- Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico; Department of Radiology, Imaging and diagnostic Center CID, Guadalajara, Jalisco, Mexico
| | - Prabhakar Rajiah
- Department of Radiology, Cardiovascular Imaging, Mayo Clinic, Rochester, MN.
| |
Collapse
|
8
|
Milam AJ, Ghoddoussi F, Lucaj J, Narreddy S, Kumar N, Reddy V, Hakim J, Krishnan SH. Comparing the Mutual Interchangeability of ECOM, FloTrac/Vigileo, 3D-TEE, and ITD-PAC Cardiac Output Measuring Systems in Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2020; 35:514-529. [PMID: 32622708 DOI: 10.1053/j.jvca.2020.03.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to compare the mutual interchangeability of 4 cardiac output measuring devices by comparing their accuracy, precision, and trending ability. DESIGN A single-center prospective observational study. DESIGN Nonuniversity teaching hospital, single center. PARTICIPANTS Forty-four consecutive patients scheduled for elective, nonemergent coronary artery bypass grafting (CABG). INTERVENTIONS The cardiac output was measured for each participant using 4 methods: intermittent thermodilution via pulmonary artery catheter (ITD-PAC), Endotracheal Cardiac Output Monitor (ECOM), FloTrac/Vigileo System (FLOTRAC), and 3-dimensional transesophageal echocardiography (3D-TEE). MEASUREMENTS AND MAIN RESULTS Measurements were performed simultaneously at 5 time points: presternotomy, poststernotomy, before cardiopulmonary bypass, after cardiopulmonary bypass, and after sternal closure. A series of statistical and comparison analyses including ANOVA, Pearson correlation, Bland-Altman plots, quadrant plots, and polar plots were performed, and inherent precision for each method and percent errors for mutual interchangeability were calculated. For the 6 two-by-two comparisons of the methods, the Pearson correlation coefficients (r), the percentage errors (% error), and concordance ratios (CR) were as follows: ECOM_versus_ITD-PAC (r = 0.611, % error = 53%, CR = 75%); FLOTRAC_versus_ITD-PAC (r = 0.676, % error = 49%, CR = 77%); 3D-TEE versus ITD-PAC (r = 0.538, % error = 64%, CR = 67%); FLOTRAC_versus_ECOM (r = 0.627, % error = 51%, CR = 75%); 3D-TEE_versus ECOM (r = 0.423, % error = 70%, CR = 60%), and 3D-TEE_versus_FLOTRAC (r = 0.602, % error = 59%, CR = 61%). CONCLUSIONS Based on the recommended statistical measures of interchangeability, ECOM, FLOTRAC, and 3D-TEE are not interchangeable with each other or to the reference standard invasive ITD-PAC method in patients undergoing nonemergent cardiac bypass surgery. Despite the negative result in this study and the majority of previous studies, these less-invasive methods of CO have continued to be used in the hemodynamic management of patients. Each device has its own distinct technical features and inherent limitations; it is clear that no single device can be used universally for all patients. Therefore, different methods or devices should be chosen based on individual patient conditions, including the degree of invasiveness, measurement performance, and the ability to provide real-time, continuous CO readings.
Collapse
Affiliation(s)
- Adam J Milam
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Farhad Ghoddoussi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI
| | - Jon Lucaj
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Spurthy Narreddy
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Nakul Kumar
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Vennela Reddy
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Joffer Hakim
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Sandeep H Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI.
| |
Collapse
|
9
|
Galzerano D, Kinsara AJ, Di Michele S, Vriz O, Fadel BM, Musci RL, Galderisi M, Al Sergani H, Colonna P. Three dimensional transesophageal echocardiography: a missing link in infective endocarditis imaging? Int J Cardiovasc Imaging 2020; 36:403-413. [PMID: 31902093 DOI: 10.1007/s10554-019-01747-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
The role of two dimensional (2D) echocardiography (ECHO) for the diagnosis and clinical decision making in infective endocarditis (IE) has been extensively studied and described in the medical literature. Some reports have demonstrated the incremental value of three dimensional (3D) transesophageal (TE) ECHO in the setting of IE. However, a systematic review focusing on the role of 3D imaging is lacking. In this manuscript, we examine the role of 3D TE ECHO in the diagnosis of IE. IE is a challenging disease in which 2D transthoracic (TT) and TE ECHO have complementary roles and are unequivocally the mainstay of diagnostic imaging. Still, 2D imaging has important limitations. Technological advances in 3D imaging allow for the reconstruction of real-time anatomical images of cardiac structure and function. 3D imaging has emerged as a diagnostic technique that overcame some of the limitations of 2D ECHO. Currently, both transthoracic and transesophageal echocardiography transducers are able to generate 3D images. However, 3D TE ECHO provides images of a higher quality in comparison to 3D TT ECHO, and is the best echocardiographic modality able to allow for a detailed anatomical imaging. 3D TE ECHO may represent the key adjunctive echocardiographic technique being able to positively impact on IE-related surgical planning and intervention and to facilitate the interaction between the surgeon and the imaging specialist. Importantly, 3D TE ECHO is not the recommended initial modality of choice for the diagnosis of IE; however, in highly specialized centers, it has become an important complementary technique when advanced surgical planning is required. Furthermore, anatomical imaging has become the link between the different techniques that play a role in IE imaging. In fact, both computed tomography and magnetic resonance allow three dimensional reconstruction. An important future goal should allow for the fusion among various imaging modalities. Our review highlights the role of 3D TE ECHO in IE imaging and emphasize where it offers incremental value.
Collapse
Affiliation(s)
- Domenico Galzerano
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. .,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Abdulhalim J Kinsara
- Ministry of National Guard Health Affair, COM-WR, King Abdullah International Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Sara Di Michele
- Divisione di Cardiologia, Ospedale San Filippo Neri, Rome, Italy
| | - Olga Vriz
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Bahaa M Fadel
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rita Leonarda Musci
- Ecocardiografia Basale e Complessa, Azienda Ospedaliera Universitaria, Policlinico di Bari, Bari, Italy
| | - Maurizio Galderisi
- Department of Cardiology, Cardiac Surgery and Cardiovascular Emergencies, Federico II, University of Naples, Naples, Italy
| | - Hani Al Sergani
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Paolo Colonna
- Ecocardiografia Basale e Complessa, Azienda Ospedaliera Universitaria, Policlinico di Bari, Bari, Italy
| |
Collapse
|
10
|
Thomas M, Grodzinsky A, Zink M. The clot thickens: an incompletely ligated left atrial appendage. Echo Res Pract 2018; 5:K41-K45. [PMID: 29685924 PMCID: PMC5958419 DOI: 10.1530/erp-17-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/23/2018] [Indexed: 11/08/2022] Open
Abstract
Our patient presented with known mechanical mitral valve endocarditis documented by 2D transesophageal echocardiogram (TOE) from a recent hospitalization at an outside facility. On admission to our center, there was no prior knowledge of an incompletely ligated left atrial appendage (LAA) according to patient- or family-reported history, review of outside records or the outside facility’s 2D TOE report. A 3D TOE performed at our center to assess her pathology, since a month had passed from her prior hospitalization, revealed a LAA ligation with evidence of communication to the left atrium and with clot present in the appendage. This case report highlights the common finding of incomplete closure of the LAA following surgical ligation, thus making it inadequate for stroke prevention in patients with atrial fibrillation, and that 3D TOE plays a valuable role in assessing the durability of LAA ligation.
Collapse
Affiliation(s)
- Merrill Thomas
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas, Missouri, USA
| | - Anna Grodzinsky
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas, Missouri, USA.,Cardiology, St. Luke's Mid America Heart Institute, Kansas, Missouri, USA
| | - Martin Zink
- Cardiology, St. Luke's Mid America Heart Institute, Kansas, Missouri, USA
| |
Collapse
|