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Suárez M, Calvo-Iglesias F, Sousa A, Lima O, Longueira R, López A, Rubianes M, Pérez-Rodríguez MT. A Confounder in the Study of a Patient With Infective Endocarditis. JACC Case Rep 2023; 28:102095. [PMID: 38204549 PMCID: PMC10774786 DOI: 10.1016/j.jaccas.2023.102095] [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: 06/04/2023] [Revised: 08/01/2023] [Accepted: 09/06/2023] [Indexed: 01/12/2024]
Abstract
Positron emission tomography (18FDG PET-CT) is a widely used method to help in the diagnosis of infective endocarditis (IE). Lipomatous hypertrophy of the interatrial septum (LHIS) is an uncommon fat deposition in the region of the interatrial septum. PET-CT images of LHIS may be indistinguishable from changes associated with IE.
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Affiliation(s)
- Milagros Suárez
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
- Galicia Sur Health Research Institute, Vigo, Spain
| | | | - Adrián Sousa
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
- Galicia Sur Health Research Institute, Vigo, Spain
| | - Olalla Lima
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
- Galicia Sur Health Research Institute, Vigo, Spain
| | - Rebeca Longueira
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
- Galicia Sur Health Research Institute, Vigo, Spain
| | - Ana López
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
- Galicia Sur Health Research Institute, Vigo, Spain
| | - Martín Rubianes
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - M. Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
- Galicia Sur Health Research Institute, Vigo, Spain
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2
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Sonaglioni A, Nicolosi GL, Rispoli GA, Lombardo M. Incidental Finding of Lipomatous Hypertrophy of the Right Atrial Free Wall in an Elderly Female With Severe Pulmonary Hypertension: Early Detection by Multimodality Imaging. Cureus 2023; 15:e50665. [PMID: 38186482 PMCID: PMC10771612 DOI: 10.7759/cureus.50665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/09/2024] Open
Abstract
Lipomatous atrial hypertrophy (LAH) is a benign cardiac lesion characterized by fat accumulation in the interatrial septum that spares the fossa ovalis. It is associated with obesity and is more frequently observed in elderly and female patients. It is most often detected as an incidental finding on transthoracic echocardiography (TTE). The deposition of adipose tissue may rarely involve both the interatrial septum and the right atrial (RA) free wall. Herein, we describe an extremely rare case of LAH limited to a portion of the RA free wall only, mimicking a myxoma or a thrombotic formation. A multi-instrumental evaluation comprehensive of TTE implemented with pulsed-wave tissue Doppler imaging (PW-TDI), transesophageal echocardiography (TEE), and computed tomography (CT) angiography, performed during the patient's stay in the emergency department, allowed to quickly diagnose the benign RA pseudomass.
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Affiliation(s)
- Andrea Sonaglioni
- Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, ITA
| | | | - Gaetana Anna Rispoli
- Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, ITA
| | - Michele Lombardo
- Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, ITA
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3
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Krafft H, Bahlke F, Popa MA, Deisenhofer I. Catheter ablation for persistent atrial fibrillation in a patient with extensive lipomatous hypertrophy of the atrial septum: 3D electroanatomic mapping for ideal procedure planning and performance in abnormal atrial anatomy. Heart Rhythm O2 2023; 4:738-740. [PMID: 38034884 PMCID: PMC10685138 DOI: 10.1016/j.hroo.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Affiliation(s)
- Hannah Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Miruna A. Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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4
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Kurnick A, Akivis Y, Sabu J, John S. Echocardiographic Evaluation of Cardiac Masses. Curr Cardiol Rep 2023; 25:1281-1290. [PMID: 37728852 DOI: 10.1007/s11886-023-01945-z] [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] [Accepted: 08/15/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE OF REVIEW Cardiac masses encompass a broad range of etiologies and are often initially revealed by echocardiography. The differential may change depending on the location of the mass and patients' medical history or presentation. It is important for clinicians to be aware of subtle visual characteristics on echocardiography in order to correctly diagnose the pathology. METHODS Patients who underwent transthoracic echocardiography and were found to have one or more cardiac masses between January 1, 2020, and May 15, 2023, were reviewed. Their demographic data, clinical presentation, medical history, imaging, and follow-up information were collected from hospital electronic medical records, de-identified, and used to complete this review paper. A detailed review of cardiac masses divided by cardiac chamber accompanied by real-world echocardiographic images from patients in a large inner city public hospital. We hope that this systematic review of cardiac masses with real-world echocardiographic images will help clinicians note subtle echocardiographic characteristics to aid in the diagnosis and treatment of cardiac masses.
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Affiliation(s)
- Adam Kurnick
- Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Yonatan Akivis
- Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jacob Sabu
- College of Medicine, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sabu John
- Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Cardiovascular Medicine, Kings County Hospital, Brooklyn, NY, USA
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5
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Yu Y, Ding M, Chen JL, Wang T, Chen YH, Yang XM, Chen SY, Wang YP, Li YG. Multimodality imaging in diagnosing lipomatous atrial septal hypertrophy with atrial septal defect: a case report. Front Cardiovasc Med 2023; 10:1245213. [PMID: 37680561 PMCID: PMC10482038 DOI: 10.3389/fcvm.2023.1245213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Background Lipomatous atrial septal hypertrophy (LASH) with atrial septal defect (ASD) is a rare congenital anomaly. Although LASH is a histologically benign cardiac lesion characterized by excessive fat deposition in the interatrial septum that spares the fossa ovale, it has been associated with supraventricular arrhythmias or sick sinus syndrome. Application of multimodal imaging is crucial for accurate diagnosis, appropriate treatment of LASH with ASD, and follow-up. Case summary A 68-year-old female patient presented with recurrent chest tightness and palpitation. Multimodal imaging revealed the characterizations of LASH and ASD. Two-dimensional transesophageal echocardiography showed a "dumbbell"-shaped involvement of the cephalad and caudal regions with sparing of a single secundum ASD. The septum with a brightness feature is an uncommon condition characterized by the deposition of unencapsulated fat cells in the atrial septum. Real-time four-dimensional transesophageal echocardiography reflected the lipomatous hypertrophy of the atrial septum and an oval-shaped ASD. Cardiac computer tomography angiography later confirmed this finding. The patient achieved a good clinical response with an ASD percutaneous occlusion guided by intracardiac echocardiography (ICE). Conclusion This case demonstrates a LASH combined with ASD. Multimodality imaging can provide an accurate diagnosis and may guide the procedure for precise occlusion.
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Affiliation(s)
- Yi Yu
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Ding
- Department of Radiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jin-Lan Chen
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Wang
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Han Chen
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Min Yang
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Su-Yun Chen
- Department of Nuclear Medicine, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue-Peng Wang
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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6
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Miyoshi M, Abe I, Kodama N, Zhan Y, Kira S, Ishii Y, Harada T, Takano M, Takahashi M, Sato H, Tawara K, Kondo H, Fukui A, Fukuda T, Akioka H, Shinohara T, Teshima Y, Yufu K, Nakagawa M, Daa T, Shimada T, Takahashi N. Association between interatrial septum adiposity and atrial fibrillation: transesophageal echocardiography imaging and autopsy study. Sci Rep 2023; 13:9828. [PMID: 37330552 PMCID: PMC10276811 DOI: 10.1038/s41598-023-36677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/08/2023] [Indexed: 06/19/2023] Open
Abstract
Recent clinical evidence has suggested that interatrial septal (IAS) adiposity contributes to atrial fibrillation (AF). The present study aimed to confirm the usefulness of transesophageal echocardiography (TEE) to estimate IAS adiposity in patients with AF. The histological IAS analysis based on autopsy samples sought to clarify characteristics that underlie the contribution of IAS adiposity to AF. The imaging study analyzed the TEE results in patients with AF (n = 184) in comparison with transthoracic echocardiography (TTE) and computed tomography (CT) results. The autopsy study histologically analyzed IAS in subjects with (n = 5) and without (n = 5) history of AF. In the imaging study, the ratio of interatrial septum adipose tissue (IAS-AT) volume per epicardial adipose tissue (EpAT) volume was greater in patients with persistent AF compared (PerAF) to those with paroxysmal AF (PAF). Multivariable analysis revealed that both TEE-assessed IAS thickness and TTE-assessed left atrial dimension were predicted by CT-assessed IAS-AT volume. In the autopsy study, the histologically-assessed IAS section thickness was greater in the AF group than that in the non-AF group and was positively correlated with the IAS-AT area percentage. In addition, the size of adipocytes in IAS-AT was smaller, compared to EpAT and subcutaneous adipose tissue (SAT). IAS-AT infiltrated into the IAS myocardium, as if adipose tissue split the myocardium (designated as myocardial splitting by IAS-AT). The number of island-like myocardium pieces as a result of myocardial splitting by IAS-AT was greater in the AF group than in the non-AF group and was positively correlated with the IAS-AT area percentage. The present imaging study confirmed the usefulness of TEE to estimate IAS adiposity in patients with AF without radiation exposure. The autopsy study suggested that the myocardial splitting by IAS-AT may contribute to atrial cardiomyopathy leading to AF.
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Affiliation(s)
- Miho Miyoshi
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Ichitaro Abe
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan.
| | - Nozomi Kodama
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Yinge Zhan
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Shintaro Kira
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Yumi Ishii
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Taisuke Harada
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Masayuki Takano
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Masaki Takahashi
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Katsunori Tawara
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Tomoko Fukuda
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan
| | - Mikiko Nakagawa
- Medical Education Center, Oita University Faculty of Medicine, Oita, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Oita University Faculty of Medicine, Oita, Japan
| | - Tatsuo Shimada
- Oita Medical Technology School, College of Judo Therapy and Acupuncture-Moxibustion, Oita, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan.
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Little SH, Rigolin VH, Garcia-Sayan E, Hahn RT, Hung J, Mackensen GB, Mankad S, Quader N, Saric M. Recommendations for Special Competency in Echocardiographic Guidance of Structural Heart Disease Interventions: From the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:350-365. [PMID: 36841670 DOI: 10.1016/j.echo.2023.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Transcatheter therapies for structural heart disease continue to grow at a rapid pace, and echocardiography is the primary imaging modality used to support such procedures. Transesophageal echocardiographic guidance of structural heart disease procedures must be performed by highly skilled echocardiographers who can provide rapid, accurate, and high-quality image acquisition and interpretation in real time. Training standards are needed to ensure that interventional echocardiographers have the necessary expertise to perform this complex task. This document provides guidance on all critical aspects of training for cardiology and anesthesiology trainees and postgraduate echocardiographers who plan to specialize in interventional echocardiography. Core competencies common to all transcatheter therapies are reviewed in addition to competencies for each specific transcatheter procedure. A core principle is that the length of interventional echocardiography training or achieved procedure volumes are less important than the demonstration of procedure-specific competencies within the milestone domains of knowledge, skill, and communication.
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Affiliation(s)
- Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Vera H Rigolin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rebecca T Hahn
- Columbia University Irving College of Medicine, New York, New York
| | - Judy Hung
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Muhamed Saric
- New York University Langone Health, New York, New York
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8
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S. Papaetis G, D. Antreou A, A. Karvounaris S. Lipomatous Hypertrophy of the Interatrial Septum in a Patient with Chronic Dyspnea and Episodes of Paroxysmal Atrial Fibrillation: A Case Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:167-170. [PMID: 35291439 PMCID: PMC8919310 DOI: 10.30476/ijms.2021.90327.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/22/2021] [Accepted: 06/05/2021] [Indexed: 11/23/2022]
Abstract
Lipomatous Hypertrophy of the Interatrial Septum (LHIS) is an unusual condition usually found as an incidental finding on echocardiography. It can create a mass-like bulge typically sparing the fossa ovalis. We describe a 73-year-old overweight Cypriot woman, who visited our clinic in November 2018 and was complaining of dyspnea on exertion, chest tightness, and two episodes of paroxysmal atrial fibrillation for the last eight months. A big sessile mass was detected in the interatrial septum measuring 3.7×4.7 cm during transoesophageal echocardiography. The patient underwent resection of the mass and pericardial patch reconstruction of the defect with significant improvement of her clinical status during the follow-up period. The histopathological analysis suggested LHIS. In patients with persistent cardiac symptoms, a prompt resection is a useful option, although surgery is generally considered unnecessary in this clinical setting. Preprint of this article is available on: https://www.authorea.com/users/380290/articles/496351-a-patient-with-chronic-dyspnea-and-episodes-of-paroxysmal-atrial-fibrillation-in-the-presence-of-a-right-atrial-mass.
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Affiliation(s)
- Georgios S. Papaetis
- Internal Medicine and Diabetes Clinic, Eleftherios Venizelos Avenue 62, Paphos, Cyprus,
CDA College, 73 Democratias Avenue, Paphos, Cyprus
| | - Antreas D. Antreou
- Department of Radiology, Evangelismos Hospital, Vasileos Constantinou 87 Street, Paphos, Cyprus
| | - Stylianos A. Karvounaris
- Department of Cardiology, Evangelismos Hospital, Vasileos Constantinou 87 Street, Paphos, Cyprus
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9
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Manganaro R, Licordari R, Pistelli L, Cusmà-Piccione M, Trio O, Micari A, Di Bella G, Zito C. Lipomatous hypertrophy of the interatrial septum: A case report and insights from the literature. J Cardiovasc Echogr 2022; 32:123-125. [PMID: 36249440 PMCID: PMC9558635 DOI: 10.4103/jcecho.jcecho_14_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022] Open
Abstract
Lipomatous hypertrophy of the interatrial septum (LHIS) is a histologically benign cardiac lesion that is defined by excessive fat accumulation in the area of the interatrial septum (IAS) that does not include the fossa ovalis. Another unusual illness is lipomatosis, which is defined as a broad overgrowth of mature adipose tissue that involves a large portion of an extremity or trunk. We describe a rare case with significant LHIS accompanied by subcutaneous lipomatosis. Echocardiography revealed a mass in the right atrium in this patient. Magnetic resonance imaging revealed that this mass was composed of the adipose tissue and was an extension of a huge thickened IAS. Furthermore, this significant hypertrophy of the IAS was in direct continuation with the excessive mediastinal and epicardial fat.
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10
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Takafuji H, Obunai K, Kato N, Honda M, Watanabe H. Lipomatous Atrial Septal Hypertrophy and Atrial Septal Defect With Rim Deficiency. JACC Cardiovasc Interv 2021; 15:e31-e33. [PMID: 34838468 DOI: 10.1016/j.jcin.2021.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Hiroya Takafuji
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Nahoko Kato
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Masaki Honda
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Hiroyuki Watanabe
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
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11
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Chen G, Huang R, Sun B, Zhu J, Zhang H, Chen J. Multimodality Functional Magnetic Resonance Imaging Assisted Treatment of Primary Insomnia and Anxiety and Depression. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Based on multimodal functional magnetic resonance imaging technology, explore the changes of local brain function in the whole brain range of patients with primary insomnia at rest, and conduct correlation analysis to explore the relationship between this locality and function and clinical
features. Provide further imaging evidence for the exploration of the neural mechanism of primary insomnia. Using multimodal functional magnetic resonance imaging, self-rating anxiety scale, self-rating depression scale to assess the status anxiety factor and trait anxiety of STAI in patients
with primary insomnia (88 cases) and normal sleepers (82 cases). Factors and total scores, depressive mental disorders and total scores were statistically significantly different from the normal sleep group. The study found that patients with primary insomnia under the multimodal functional
magnetic resonance imaging assisted treatment have abnormal local functional activities in multiple brain regions such as emotions and sensorimotor regions. We explored the brain of patients with primary insomnia from the perspective of functional differentiation. Changes in nerve activity
are conducive to further understanding the characteristics of nerve activity in primary insomnia.
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Affiliation(s)
- Guanfeng Chen
- Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
| | - Risheng Huang
- Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
| | - Bingqing Sun
- Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
| | - Jingfa Zhu
- Department of Emergency, Quanzhou First Hospital Affiliated Fujian Medical University, Quanzhou, 362000, China
| | - Hongchun Zhang
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Jieyun Chen
- Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
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12
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Lipomatous atrial septal hypertrophy associated with adrenocorticotropin hormone administration in an infant with West syndrome. Cardiol Young 2021; 31:682-684. [PMID: 33399035 DOI: 10.1017/s1047951120004679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the rare case of lipomatous atrial septal hypertrophy associated with adrenocorticotropin hormone therapy in an infant with West syndrome, highlighting their relatively benign nature and good prognosis in children, and the relevance of the differential diagnosis with more dangerous cardiac masses in order to avoid aggressive diagnostic and therapeutic interventions.
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13
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Kotaru VPK, Martin D, Tokala H, Kalavakunta JK. Right atrial mass-multimodality imaging-Massive lipomatous hypertrophy of the atrial septum. Clin Case Rep 2020; 8:3632-3633. [PMID: 33364012 PMCID: PMC7752446 DOI: 10.1002/ccr3.3431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/08/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022] Open
Abstract
Asymptomatic cardiac masses are often diagnosed incidentally. Massive lipomatous hypertrophy can be confused for other cardiac masses and need careful evaluation including multimodality imaging to manage appropriately.
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Affiliation(s)
- Veera Pavan K. Kotaru
- Department of Cardiology, Hematology/Oncology & Cardio‐thoracic SurgeryAscension Borgess Medical CenterKalamazooMIUSA
- Western Michigan University Homer‐Stryker M.D. School of Medicine & Michigan State UniversityKalamazooMIUSA
| | - David Martin
- Department of Cardiology, Hematology/Oncology & Cardio‐thoracic SurgeryAscension Borgess Medical CenterKalamazooMIUSA
- Western Michigan University Homer‐Stryker M.D. School of Medicine & Michigan State UniversityKalamazooMIUSA
| | - Hemasri Tokala
- Department of Cardiology, Hematology/Oncology & Cardio‐thoracic SurgeryAscension Borgess Medical CenterKalamazooMIUSA
- Western Michigan University Homer‐Stryker M.D. School of Medicine & Michigan State UniversityKalamazooMIUSA
| | - Jagadeesh K. Kalavakunta
- Department of Cardiology, Hematology/Oncology & Cardio‐thoracic SurgeryAscension Borgess Medical CenterKalamazooMIUSA
- Western Michigan University Homer‐Stryker M.D. School of Medicine & Michigan State UniversityKalamazooMIUSA
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14
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Mikail N, Khalil A, Rouzet F. Mediastinal Masses: 18F-FDG-PET/CT Features Based on the International Thymic Malignancy Interest Group Classification. Semin Nucl Med 2020; 51:79-97. [PMID: 33246542 DOI: 10.1053/j.semnuclmed.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Imaging plays a key role in the management of mediastinal masses. In an effort to standardize the analysis of the mediastinum, the International Thymic Malignancy Interest Group (ITMIG) has proposed a three compartments-based diagnostic classification, intended for clinicians and radiologists. Several articles have documented its usefulness to guide the diagnosis using cross-sectional imaging. Similarly, fluorine-18-radiolabeled fluorodeoxyglucose positron emission tomography combined to computed tomography (18F-FDG-PET/CT) can be useful in this setting, either as a first-line diagnostic technique, or in addition to cross-sectional imaging. In this article, which is thought as an aid for nuclear medicine physicians and radiologists, we aim to present, based on the ITMIG classification, the main mediastinal pathologies that can be observed with 18F-FDG-PET/CT, and the additional diagnostic value that can be expected from this technique. For this purpose, we segmented the mediastinum according to the ITMIG classification, and reviewed the available literature for each of the corresponding organs and/or disease. Given the importance of the clinical context for the interpretation of PET imaging, we presented each of the diseases according to: (1) their suggestive clinical context; (2) the suggestive features on nonenhanced CT (which is the standard in PET imaging); and (3) the typical 18F-FDG characteristics. The purpose of this article is to depict the main features of the most common mediastinal diseases that can be encountered with 18F-FDG-PET/CT, and to highlight its diagnostic value in this setting, alone or in combination with other imaging modalities.
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Affiliation(s)
- Nidaa Mikail
- Department of nuclear medicine, Bichat universitary hospital, Paris, France.
| | - Antoine Khalil
- Department of radiology, Bichat universitary hospital, Paris, France
| | - François Rouzet
- Department of nuclear medicine, Bichat universitary hospital, Paris, France
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15
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Wehbe RM, Rigolin VH. A Left Atrial Thrombus Mimic: Value of Ultrasound Enhancing Agents during Transesophageal Echocardiography. CASE 2020; 4:263-269. [PMID: 32875193 PMCID: PMC7451944 DOI: 10.1016/j.case.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Fat in the transverse pericardial sinus can mimic thrombus on TEE. Epicardial fat is more common in patients with AF. UEAs can differentiate extracardiac from intracardiac structures.
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16
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Song M, Kim SJ, Koo HJ, Kim MY, Yoo JY. Computed Tomography of the Left Atrium and Left Atrial Appendage: A Pictorial Essay on the Anatomy, Normal Variants, and Pathology. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:272-289. [PMID: 36237388 PMCID: PMC9431809 DOI: 10.3348/jksr.2020.81.2.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/05/2020] [Accepted: 03/19/2020] [Indexed: 11/15/2022]
Abstract
전산화단층촬영(이하 CT) 영상 기술의 발전으로 박동하는 심장에 대한 섬세한 영상의학적 평가가 가능해졌다. 심초음파 및 MRI에 비해 심장 CT의 강점은 대부분의 의료기관에 보급되어 있고 고품질 이미지의 빠른 생산이 가능하며 해부학적 묘사가 뛰어나다는 것이다. 좌심방과 좌심방이에서 생기는 대부분의 변이 혹은 병리적 상태들은 CT 상의 소견만으로도 추정진단을 내릴 수 있다. 또한 CT 영상은 성공적인 카테터 기반 시술 또는 수술에 중요한 해부학적 정보들을 제공한다. 특히 좌심방과 좌심방이는 심방세동 환자들의 치료 및 관리에 중요한데, 이는 다양한 카테터 기반 시술들이 두 구조물의 기계적 혹은 전기적 차단을 목표로 하기 때문이다. 따라서 임상적으로 의미 있는 판독을 위해서는 병리적 상태의 CT 소견 기술과 함께 좌심방 및 좌심방이의 모양, 크기 및 주변 구조물과의 상대적 위치 관계 등에 대한 포괄적인 검토를 해야 한다.
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Affiliation(s)
- Minji Song
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Sung Jin Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon Young Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jin Young Yoo
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
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Ramchand J, Harb SC, Miyasaka R, Kanj M, Saliba W, Jaber WA. Imaging for Percutaneous Left Atrial Appendage Closure: A Contemporary Review. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1643957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Jay Ramchand
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serge C. Harb
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rhonda Miyasaka
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wael A. Jaber
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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18
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Leo LA, Paiocchi VL, Schlossbauer SA, Ho SY, Faletra FF. The Intrusive Nature of Epicardial Adipose Tissue as Revealed by Cardiac Magnetic Resonance. J Cardiovasc Echogr 2019; 29:45-51. [PMID: 31392118 PMCID: PMC6657468 DOI: 10.4103/jcecho.jcecho_22_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The epicardial adipose tissue (EAT) refers to the deposition of adipose tissue fully enclosed by the pericardial sac. EAT has a complex mixture of adipocytes, nervous tissue, as well as inflammatory, stromal and immune cells secreting bioactive molecules. This heterogeneous composition reveals that it is not a simply fat storage depot, but rather a biologically active organ that appears playing a “dichotomous” role, either protective or proinflammatory and proatherogenic. The cardiac magnetic resonance (CMR) allows a clear visualization of EAT using a specific pulse sequence called steady-state free precession. When abundant, the EAT assumes a pervasive presence not only covering the entire epicardial surface but also invading spaces that usually are almost virtual and separating walls that usually are so close each other to resemble a single wall. To the best of our knowledge, this aspect of cardiac anatomy has never been described before. In this pictorial review, we therefore focus our attention on certain cardiac areas in which EAT, when abundant, is particularly intrusive. In particular, we describe the presence of EAT into: (a) the interatrial groove, the atrioventricular septum, and the inferior pyramidal space, (b) the left lateral ridge, (c) the atrioventricular grooves, and (d) the transverse pericardial sinus. To confirm the reliability in depicting the EAT distribution, we present CMR images side-by-side with corresponding anatomic specimens.
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Affiliation(s)
- Laura Anna Leo
- Cardiac Imaging Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Vera Lucia Paiocchi
- Cardiac Imaging Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Siew Yen Ho
- Department of Cardiac Morphology, Royal Brompton Hospital and Imperial College London, London, UK
| | - Francesco F Faletra
- Cardiac Imaging Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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19
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Altszuler D, Vainrib AF, Bamira DG, Benenstein RJ, Aizer A, Chinitz LA, Saric M. Left Atrial Occlusion Device Implantation: the Role of the Echocardiographer. Curr Cardiol Rep 2019; 21:66. [PMID: 31183616 DOI: 10.1007/s11886-019-1151-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Atrial fibrillation is the most common arrhythmia worldwide and is a major risk factor for embolic stroke. For patients with atrial fibrillation who are unable to tolerate systemic anticoagulation, left atrial appendage (LAA) occlusion has been shown to mitigate stroke risk. In this article, we describe the vital role of the echocardiographer in intraprocedural guidance of percutaneous LAA occlusion procedures as well as in the pre- and post-procedure assessment of these patients. RECENT FINDINGS A few percutaneously delivered devices for LAA exclusion from the systemic circulation are available in contemporary practice. These devices employ an either exclusive endocardial LAA occlusion approach, such as the Watchman (Boston Scientific, Maple Grove, MN) and Amulet (St. Jude Medical, Minneapolis, MN), or both an endocardial and pericardial (epicardial) approach such as the Lariat procedure (SentreHEART, Palo Alto, CA). Two- and three-dimension transesophageal echocardiography is critical for patient selection, procedure planning, procedural guidance, and ensuring satisfactory immediate as well as long-term LAA occlusion/exclusion efficacy. This review will provide an overview of the role of the echocardiographer in all aspects of LAA occlusion/exclusion procedures for the most commonly used commercially available devices in current practice.
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Affiliation(s)
- David Altszuler
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Daniel G Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Ricardo J Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA.
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20
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Kharbanda RK, Özdemir EH, Taverne YJ, Kik C, Bogers AJ, de Groot NM. Current Concepts of Anatomy, Electrophysiology, and Therapeutic Implications of the Interatrial Septum. JACC Clin Electrophysiol 2019; 5:647-656. [DOI: 10.1016/j.jacep.2019.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 12/28/2022]
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21
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Ströker E, De Greef Y, Schwagten B, Kupics K, Coutiño HE, Takarada K, Abugattas JP, Salghetti F, De Cocker J, Stockman D, Sieira J, Brugada P, Chierchia GB, de Asmundis C. Over-the-needle trans-septal access using the cryoballoon delivery sheath and dilator in atrial fibrillation ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:868-873. [PMID: 31037747 DOI: 10.1111/pace.13709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/08/2019] [Accepted: 04/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the setting of second-generation cryoballoon (CB2) ablation, left atrial (LA) access is generally achieved using a standard sheath (SS) that is exchanged for the 15Fr cryoballoon delivery sheath (CBS) and dilator over a long wire (CBS over-the-wire technique, CBS-W). Our objective was to evaluate the direct use of the CBS to gain LA access, by advancing the latter over the trans-septal needle (CBS over-the-needle technique, CBS-N), under transesophageal echocardiographic (TEE) guidance. METHODS Consecutive patients who underwent CB2 ablation with the CBS-N technique were evaluated for feasibility of gaining LA access using TEE guidance and fluoroscopy views. Complications related to the LA access were compared with a matched CBS-W control group. Subanalysis (30 CBS-W vs 30 CBS-N patients) evaluated time-to-LA of the CBS: time from superior vena cava (with SS vs CBS) to LA insertion of the CBS, after exchange or directly, respectively. RESULTS LA access could be achieved in all 505 patients of the CBS-N group, without technique modification or additional equipment. Challenging interatrial septa were noted in 13% of these patients: previous atrial septal defect repair (1%), hypermobile (10%), aneurysmal (1%), and abnormally thickened/fibrotic (1%). Incidence of complications was similar to the CBS-W group. Subanalysis showed a shorter time-to-LA in the CBS-N versus CBS-W group, 72 ± 46 seconds versus 293 ± 180 seconds, P < .001. CONCLUSIONS Our study showed that the CBS-N technique is feasible and safe under echocardiographic guidance. Without sheath exchange, it simplifies the CB2 procedure, is less costly, time sparing, and might reduce the risk of air embolism.
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Affiliation(s)
- Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | - Yves De Greef
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | | | - Kaspars Kupics
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | - Hugo Enrique Coutiño
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ken Takarada
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Juan Pablo Abugattas
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Francesca Salghetti
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Dirk Stockman
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
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22
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Faletra FF, Leo LA, Paiocchi VL, Schlossbauer SA, Pedrazzini G, Moccetti T, Ho SY. Revisiting Anatomy of the Interatrial Septum and its Adjoining Atrioventricular Junction Using Noninvasive Imaging Techniques. J Am Soc Echocardiogr 2019; 32:580-592. [PMID: 30803863 DOI: 10.1016/j.echo.2019.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 10/27/2022]
Abstract
Interest in the anatomy of the interatrial septum (IAS) and its adjoining atrioventricular (AV) junction has risen enormously in the past two decades with the simultaneous evolution of left-sided percutaneous structural heart disease and complex electrophysiologic procedures. These procedures require, in fact, a direct route to the left atrium through the IAS. Thus, a thorough understanding of the complex anatomy of the IAS and AV junction is essential for performing a safe and effective transseptal puncture. There is a large amount of literature carefully describing the anatomy of the IAS and AV junction. These studies are based almost exclusively on anatomic specimens. Conversely, in this review the authors emphasize the role of noninvasive imaging techniques, in particular cardiac magnetic resonance, two- and three-dimensional transesophageal echocardiography, and computed tomography in visualizing specific aspects of the normal IAS and AV junction. Where appropriate, the authors present images side by side, with corresponding anatomic specimens.
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Affiliation(s)
- Francesco F Faletra
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
| | - Laura Anna Leo
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Vera Lucia Paiocchi
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Giovanni Pedrazzini
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom
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23
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Interatrial septum: A pictorial review of congenital and acquired pathologies and their management. Clin Imaging 2019; 55:53-64. [PMID: 30754012 DOI: 10.1016/j.clinimag.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 11/21/2022]
Abstract
There are many different congenital abnormalities and acquired pathologies involving the interatrial septum. Differentiation of these pathologies significantly affects patient management. We have reviewed the various interatrial septal pathologies and discussed their congenital associates, clinical significance, and management. After reading this article, the reader should be able to better characterize the interatrial septal pathologies using the optimal imaging tools, and have a better understanding of their clinical significance and management.
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Blockhaus C, Waibler HP, Gülker JE, Klues H, Bufe A, Shin DI. Evasion maneuver for transseptal approach during cryoballoon pulmonary vein isolation. J Saudi Heart Assoc 2018; 30:301-304. [PMID: 30069135 PMCID: PMC6067055 DOI: 10.1016/j.jsha.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/11/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose Pulmonary vein isolation (PVI) is a cornerstone therapy in patients with symptomatic atrial fibrillation. One current method is performing a PVI using a cryoballoon (CB). The CB is inserted into the left atrium via a steerable sheath. However, at times, passing of the interatrial septum by the sheath is hindered, e.g., due to septal fibrosis. Here we report our experience with an evasion maneuver to facilitate this approach using a 6F multipolar and steerable coronary Sinus catheter (CS) for predilatation of the interatrial septum. Methods and results We report 10 patients undergoing a CB-PVI, where the investigator experienced difficulties in passing the interatrial septum with the CB sheath. In these cases, after three conventional abortive attempts, we predilated the transseptal puncture site using both the CS catheter and the dilatator of the CB sheath. Thereafter access of the CB sheath to the left atrium could be achieved instantly and without further resistance. Conclusion We report a safe and feasible maneuver to facilitate transseptal access with the CB steerable sheath in cases complicated by excessive interatrial resistance.
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Affiliation(s)
- Christian Blockhaus
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
- Corresponding author at: Department of Cardiology, Heart Centre Niederrhein, Helios Clinics, Lutherplatz 40, 47805 Krefeld, Germany.
| | - Hans-Peter Waibler
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
| | - Jan-Erik Gülker
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
| | - Heinrich Klues
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
| | - Alexander Bufe
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
- University Witten/Herdecke, Witten, Germany
| | - Dong-In Shin
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinics Krefeld, Krefeld, Germany
- Institute for Heart and Circulation Research, University of Cologne, Cologne, Germany
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25
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Bielicki G, Lukaszewski M, Kosiorowska K, Jakubaszko J, Nowicki R, Jasinski M. Lipomatous hypertrophy of the atrial septum - a benign heart anomaly causing unexpected surgical problems: a case report. BMC Cardiovasc Disord 2018; 18:152. [PMID: 30055568 PMCID: PMC6064128 DOI: 10.1186/s12872-018-0892-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lipomatous hypertrophy of the atrial septum (LHAS) is an anomaly of the heart. It is characterized by an infiltration of adipocytes into myocytes of the interatrial septum, sparing the fossa ovalis, which gives a characteristic hourglass-shaped image. Due to the progress in imaging techniques, it can be recognized more frequently, but it is still often misdiagnosed. CASE PRESENTATION We present a case of 65-year-old woman with an incidentally discovered lipomatous hypertrophy of the atrial septum during cardiac surgery, which has caused the technical problems for surgeons with bicaval cannulation and visualization of the operated structures of the heart. Due to the unclear shadow in the lung parenchyma, the patient had preoperative computed tomography (CT) done, but the study report focused only on the lung description, neglecting visible changes in the structure of the heart. Based on the standardly performed intra-operative transesophageal echocardiography (TEE), as well as by analyzing the chest X-ray and CT scans, the diagnosis of LHAS was made. It allowed the surgeon to leave the mass intact, thus not increasing the risk of the baseline surgery. CONCLUSIONS LHAS is a rare but increasingly recognized anomaly of the heart. Contemporary diagnostic methods allow to diagnose and make the right therapeutic decisions. The utility of TEE and analysis of X-ray images, in this case, allowed the surgeon to recognize LHAS, and because of its histologically benign nature and asymptomatic course, to leave this change intact. Surgical treatment should be limited only to cases of patients with life-threatening cardiovascular complications.
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Affiliation(s)
- Grzegorz Bielicki
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marceli Lukaszewski
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Wroclaw, Poland
| | - Kinga Kosiorowska
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Jakubaszko
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Rafal Nowicki
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Jasinski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Wroclaw, Poland
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A case with a giant interatrial septal lipomatous hypertrophy, and thickened epicardial and visceral fat: Different faces of a common metabolic problem? Anatol J Cardiol 2018; 19:417-419. [PMID: 29638225 PMCID: PMC5998869 DOI: 10.14744/anatoljcardiol.2018.04264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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27
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Vainrib AF, Harb SC, Jaber W, Benenstein RJ, Aizer A, Chinitz LA, Saric M. Left Atrial Appendage Occlusion/Exclusion: Procedural Image Guidance with Transesophageal Echocardiography. J Am Soc Echocardiogr 2018; 31:454-474. [DOI: 10.1016/j.echo.2017.09.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Indexed: 11/15/2022]
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28
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Kleiman AM, Harding LM, Bechtel AJ. Concomitant lipomatous hypertrophy and left atrial mass: Distinguishing benign from malignant. Echocardiography 2018; 35:534-536. [PMID: 29430714 DOI: 10.1111/echo.13834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Masses in and near the interatrial septum may be either benign or malignant. The most common mass near the interatrial septum is lipomatous atrial septal hypertrophy (LASH). LASH can be present in patients with intracardiac malignancies, myxomas, lipomas, or other cardiac masses. It is important to recognize the transesophageal echocardiography (TEE) characteristics of these pathologies to arrive at an accurate diagnosis with an appropriate plan for intraoperative resection. At the authors' institution, patients have been referred for surgery due to a finding of significant LASH masquerading as a left atrial myxoma. In challenging cases, TEE offers a thorough evaluation of the interatrial septum to delineate between multiple intracardiac masses.
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Salghetti F, Sieira J, Chierchia GB, Curnis A, de Asmundis C. Recognizing and reacting to complications of trans-septal puncture. Expert Rev Cardiovasc Ther 2017; 15:905-912. [PMID: 29161923 DOI: 10.1080/14779072.2017.1408411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The transseptal puncture (TSP) enables access to the left heart, through the fossa ovalis (FO), both in electrophysiology and in cardiac interventional procedures. TSP is usually safe in experienced hands. Sometimes TSP can be technically demanding and carries the risk of severe complications in approximately 1%. While performing a TSP, every effort should be taken in order to avoid complications. In the event of complications, prompt recognition and reaction are essential and a combined 'heart-team' management may be the most effective approach. Areas covered: Main TSP-related complications are cardiac tamponade, aortic root puncture, embolic stroke, transient ST elevation of inferior leads and iatrogenic atrial septal defect. A challenging TSP may be expected in presence of difficult IAS-FO anatomies, previous TSP, IAS occluder device and previous IAS surgical repair. Use of echo imaging and special needles (ie., radiofrequency needle and J-shaped guidewire) may avoid TSP-related complications in difficult settings. Expert commentary: Some tools are available to help minimize the risks of TSP. However, their availability might be limited. To increase safety of TSP, an adequate training of physicians, identification of patients in whom it might be difficult and a prompt recognition of complications seem to be the most important background.
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Affiliation(s)
- Francesca Salghetti
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium.,b Division of Cardiology , Spedali Civili Hospital, Università degli Studi di Brescia , Brescia , Italy
| | - Juan Sieira
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Gian-Battista Chierchia
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Antonio Curnis
- b Division of Cardiology , Spedali Civili Hospital, Università degli Studi di Brescia , Brescia , Italy
| | - Carlo de Asmundis
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
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Vainrib AF, Bamira DG, Saric M. Percutaneous Left Atrial Appendage Closure Devices. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Basman C, Parmar YJ, Kronzon I. Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions. Curr Cardiol Rep 2017; 19:102. [PMID: 28879526 DOI: 10.1007/s11886-017-0902-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions. RECENT FINDINGS Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures. This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.
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Affiliation(s)
- Craig Basman
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA
| | - Yuvrajsinh J Parmar
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA
| | - Itzhak Kronzon
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA.
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Xanthopoulos A, Giamouzis G, Alexopoulos N, Kitai T, Triposkiadis F, Skoularigis J. Lipomatous Hypertrophy of the Interatrial Septum: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2017; 1:182-189. [PMID: 30062277 PMCID: PMC6058280 DOI: 10.1016/j.case.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
LASH is part of the differential diagnosis for atrial tumors. LASH demonstrates the characteristic “dumbbell” shape. Often diagnosis is based on echocardiography and CT or CMR. The therapeutic strategy consists of patient reassurance and regular follow-up.
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Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - Gregory Giamouzis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | | | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
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