1
|
Xu B, Kocyigit D, Godoy-Rivas C, Betancor J, Rodriguez LL, Menon V, Jaber W, Grimm R, Flamm SD, Schoenhagen P, Svensson LG, Griffin BP. Outcomes of contemporary imaging-guided management of sinus of Valsalva aneurysms. Cardiovasc Diagn Ther 2021; 11:770-780. [PMID: 34295704 DOI: 10.21037/cdt-20-630] [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] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/08/2020] [Indexed: 11/06/2022]
Abstract
Background Sinus of Valsalva aneurysms (SVAs) are rare. We assessed the role of multimodality imaging in guiding the contemporary management. Methods A single-center retrospective cohort study over a 20-year period was performed. Results Between January 1997 and June 2017, 103 patients were diagnosed with SVAs (median age: 58 years). Eighty patients presented with non-ruptured SVAs, and 23 with ruptured SVAs. Seventy-six patients underwent surgery, and 27 were conservatively managed. The median durations of follow-up were: 48 months (surgical group) vs. 37.5 months (conservative group). There was no mortality directly attributable to SVA surgery. There were no late complications in the conservative group. Transthoracic echocardiography (TTE) was the first-line imaging investigation (100.0% in surgical group vs. 92.6% in conservative group, P=0.019). Additional imaging studies included: (I) transesophageal echocardiography (TEE): 93.4% in surgical group vs. 22.2% in conservative group, P<0.001; (II) multi-detector cardiac computed tomography (MDCT): 61.8% in surgical group vs. 37.0% in conservative group, P=0.041; (III) cardiac magnetic resonance (CMR): 22.4% in surgical group vs. 14.8% in conservative group, P=0.579. At diagnosis, SVA diameters were: TTE: 4.80 cm (range, 3.30 cm); TEE: 5.40 cm (range, 4.00 cm); MDCT: 5.20 cm (range, 3.90 cm); CMR: 4.80 cm (range, 3.70 cm). Conclusions In a 20-year cohort, proper selection for surgery and conservative management resulted in excellent outcomes for SVAs. TTE was the first-line imaging investigation for assessment of SVAs, although many patients underwent an additional imaging investigation. The contemporary outcomes of imaging-guided SVA management were excellent.
Collapse
Affiliation(s)
- 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
| | - Duygu Kocyigit
- 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
| | | | | | - L Leonardo Rodriguez
- 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
| | - Venu Menon
- Section of Clinical Cardiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wael Jaber
- 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
| | - Richard Grimm
- 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
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lars G Svensson
- 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
| |
Collapse
|
2
|
Sato K, Kumar A, Jobanputra Y, Betancor J, Halane M, George R, Menon V, Krishnaswamy A, Tuzcu EM, Harb S, Jaber WA, Mick S, Svensson LG, Kapadia SR. Association of Time Between Left Ventricular and Aortic Systolic Pressure Peaks With Severity of Aortic Stenosis and Calcification of Aortic Valve. JAMA Cardiol 2020; 4:549-555. [PMID: 31042265 DOI: 10.1001/jamacardio.2019.1180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Diagnosis of low-gradient severe aortic stenosis (AS) is challenging. We hypothesized that the time between left ventricular (LV) and aortic systolic pressure peaks (TLV-Ao) is associated with aortic stenosis (AS) severity and may have additive value in diagnosing severe AS, especially in patients with low-gradient AS. Objective To investigate the diagnostic utility of measuring catheter-based TLV-Ao in patients with severe AS. Design, Setting, and Participants We studied 123 patients with severe AS at the Cleveland Clinic Foundation, a tertiary referral center, who underwent transcatheter aortic valve replacement (TAVR) via femoral access and had pre-TAVR cardiac computed tomography assessment and hemodynamic measurements recorded during a TAVR procedure. All patients received hemodynamic evaluation, echocardiographic assessment, and quantification of aortic valve calcification (AVC) by multidetector computed tomography. Hemodynamic data were collected via left heart catheterization done just before TAVR, and TLV-Ao was calculated offline. Data were analyzed between October 5, 2015, and July 20, 2016. Main Outcomes and Measures The association between TLV-Ao and AVC or other conventional imaging parameters was analyzed. Results Of the included patients, the mean (SD) age was 81 (9) years, and 65 (54%) were men (54%). Among 123 patients, 48 patients (39%) had low-gradient AS (<40 mm Hg) and mean (SD) TLV-Ao was 69 (39) milliseconds. In multivariable logistic regression analyses, higher TLV-Ao (odds ratio [OR], 1.02; 95% CI, 1.01-1.04; P = .002) and higher peak aortic valve (AV) velocity (OR, 1.01; 95% CI, 1.00-1.02; P = .008) were independently associated with severe AVC (AVC >1000 AU). Adding TLV-Ao to the peak AV velocity and AV area showed significant incremental value to be associated with AVC, with a net reclassification improvement of 0.61 (95% CI, 0.23-0.99; P = .002) and integrated discriminatory improvement of 0.09 (95% CI, 0.03-0.16; P = .003). In a subgroup of patients with low-grade AS, higher TLV-Ao was the only parameter associated with severe AVC (OR, 1.02; 95% CI, 1.001-1.04; P = .03). Conclusions and Relevance Prolonged TLV-Ao was associated with severe AVC. This catheter-based hemodynamic index may be an additional surrogate to differentiate low-gradient true severe AS. Larger, prospective studies investigating the role of TLV-Ao as a marker of clinical outcomes in patients undergoing TAVR are required.
Collapse
Affiliation(s)
- Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Arnav Kumar
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.,Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Yash Jobanputra
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.,University of Miami Miller School of Medicine, Palm Beach Regional Campus, Palm Beach, Florida
| | - Jorge Betancor
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mohamed Halane
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robin George
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Vivek Menon
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Serge Harb
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Wael A Jaber
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Stephanie Mick
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
3
|
Xu B, Kocyigit D, Betancor J, Tan C, Rodriguez ER, Schoenhagen P, Flamm SD, Rodriguez LL, Svensson LG, Griffin BP. Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review. J Am Soc Echocardiogr 2020; 33:295-312. [PMID: 32143779 DOI: 10.1016/j.echo.2019.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/20/2019] [Revised: 10/18/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Cardiovascular imaging has an important role in the assessment and management of aortic root and thoracic aorta ectasia and aneurysms. Sinus of Valsalva aneurysms are rare entities. Unique complications associated with sinus of Valsalva aneurysms make them different from traditional aortic root aneurysms. Established guidelines on the diagnosis and management of sinus of Valsalva aneurysms are lacking. This article reviews the applications of multimodality cardiovascular imaging (echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging) for the dedicated assessment and imaging-guided management of sinus of Valsalva aneurysms.
Collapse
Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Carmela Tan
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - E Rene Rodriguez
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
4
|
Kumar A, Sato K, Jobanputra Y, Betancor J, Halane M, George R, Banerjee K, Mohananey D, Menon V, Sammour YM, Krishnaswamy A, Jaber WA, Mick S, Svensson LG, Kapadia SR. Time-Integrated Aortic Regurgitation Index Helps Guide Balloon Postdilation During Transcatheter Aortic Valve Replacement and Predicts Survival. J Am Heart Assoc 2019; 8:e012430. [PMID: 31269863 PMCID: PMC6662132 DOI: 10.1161/jaha.119.012430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/21/2023]
Abstract
Background Balloon postdilation (BPD) has emerged as an effective strategy to reduce paravalvular regurgitation (PVR) during transcatheter aortic valve replacement (TAVR). We investigated the utility of a time‐integrated aortic regurgitation index (TIARI) to guide balloon postdilation (BPD) after valve deployment. Methods and Results All consecutive patients who had echocardiography, aortography, and hemodynamic tracings recorded immediately after valve deployment during TAVR were included in the study. Catheter‐derived invasive hemodynamic parameters were calculated offline. Among 157 patients who underwent TAVR, 49 (32%) patients required BPD to reduce significant PVR after valve deployment. Two experienced operators decided whether the patients required BPD for significant PVR. Median TIARI measured immediately after valve deployment was significantly lower in patients who required BPD when compared with patients who did not require BPD (P<0.001). In a multivariable analysis, lower TIARI (odds ratio: 0.81; P=0.003) and higher PVR grade on aortography and echocardiography (P<0.001 for both) were associated with BPD. Adding TIARI to echocardiography and aortographic PVR assessment resulted in a significant increase in global χ2 (P<0.001), an integrated discrimination index of 9% (P=0.002), and combined C‐statistics of 0.99 for predicting BPD. Higher TIARI after valve deployment was associated with better survival (hazard ratio: 0.94, P=0.014), while other hemodynamic and imaging parameters did not predict mortality after TAVR. Conclusions Among patients undergoing TAVR, a TIARI measured immediately after valve deployment adds incremental value to guide BPD over aortography and echocardiography. Higher residual TIARI is associated with better survival after TAVR.
Collapse
Affiliation(s)
- Arnav Kumar
- Division of CardiologyAndreas Gruentzig Cardiovascular CenterEmory University School of MedicineAtlantaGA
| | - Kimi Sato
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Yash Jobanputra
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Jorge Betancor
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Mohamed Halane
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Robin George
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Kinjal Banerjee
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | | | - Vivek Menon
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | | | | | - Wael A. Jaber
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Stephanie Mick
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Lars G. Svensson
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Samir R. Kapadia
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| |
Collapse
|
5
|
Kumar A, Sato K, Jobanputra Y, Betancor J, Halane M, George R, Banerjee K, Mohananey D, Menon V, Sammour Y, Krishnaswamy A, Jaber W, Mick S, Svensson L, Kapadia S. TIME-INTEGRATED AORTIC REGURGITATION INDEX HELPS IN THE REAL-TIME ASSESSMENT OF PARAVALVULAR REGURGITATION DURING TAVR. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
6
|
Kumar A, Sato K, Verma BR, Ala CK, Betancor J, Yzeiraj E, Lin L, Mohananey D, Qamruddin S, Kontzias A, Bolen MA, Imazio MM, Kwon DH, Hachamovitch R, Klein AL. Quantitative assessment of pericardial delayed hyperenhancement helps identify patients with ongoing recurrences of pericarditis. Open Heart 2018; 5:e000944. [PMID: 30613419 PMCID: PMC6307595 DOI: 10.1136/openhrt-2018-000944] [Citation(s) in RCA: 11] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/19/2018] [Accepted: 11/12/2018] [Indexed: 11/04/2022] Open
Abstract
Objectives Recurrences of pericarditis (RP) are often difficult to diagnose due to lack of clinical signs and symptoms during subsequent episodes. We aimed to investigate the value of quantitative assessment of pericardial delayed hyperenhancement (DHE) in diagnosing ongoing recurrences of pericarditis. Methods Quantitative DHE was measured in 200 patients with established diagnosis of RP using cardiac MRI. Conventional clinical criteria for diagnosis of pericarditis were ≥2 of the following: chest pain, pericardial rub, ECG changes and new or worsening pericardial effusion. Results A total of 67 (34%) patients were identified as having ongoing episode of recurrence at the time of DHE measurements. In multivariable analysis, chest pain (OR: 10.9, p<0.001) and higher DHE (OR: 1.32, p<0.001) were associated with ongoing recurrence of RP. Addition of DHE to conventional clinical criteria significantly increased the ability to diagnose ongoing recurrence (net reclassification improvement (NRI): 0.80, p<0.001; integrated discrimination improvement (IDI): 0.12, p<0.001). Among 150 patients with history of RP who presented with chest pain, higher DHE was still independently associated with ongoing recurrence (OR: 1.28, p<0.001), showed incremental value over clinical criteria (NRI: 0.76, p<0.001; IDI: 0.13, p<0.001) and demonstrated a sensitivity of 70% and specificity of 74%. Conclusion Among patients with RP, quantitative DHE provided incremental information to diagnose ongoing recurrences over conventional clinical criteria of pericarditis. Quantitative DHE demonstrated acceptable test characteristics to diagnose ongoing recurrence even in RP patients presenting with chest pain.
Collapse
Affiliation(s)
- Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kimi Sato
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beni Rai Verma
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chandra Kanth Ala
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jorge Betancor
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edlira Yzeiraj
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lin Lin
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Divyanshu Mohananey
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Salima Qamruddin
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Massimo M Imazio
- University Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Deborah H Kwon
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rory Hachamovitch
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allan L Klein
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Kumar A, Sato K, Banerjee K, Narayanswami J, Betancor J, Menon V, Mohananey D, Anumandla AK, Sawant AC, Krishnaswamy A, Tuzcu EM, Jaber W, Mick S, Svensson LG, Popović ZB, Blackstone EH, Kapadia SR. Hemodynamic durability of transcatheter aortic valves using the updated Valve Academic Research Consortium‐2 criteria. Catheter Cardiovasc Interv 2018; 93:729-738. [DOI: 10.1002/ccd.27927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Arnav Kumar
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Kinjal Banerjee
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | | | - Jorge Betancor
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Vivek Menon
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | | | | | | | | | - E. Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Wael Jaber
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Stephanie Mick
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | | | | | | | | |
Collapse
|
8
|
Baskar S, Betancor J, Patel K, El Yaman M, Cremer PC, Zeft AS, Klein AL. Cardiac MRI in evaluation and management of pediatric pericarditis. Progress in Pediatric Cardiology 2018. [DOI: 10.1016/j.ppedcard.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
9
|
Koneru S, Huang SS, Oldan J, Betancor J, Popovic ZB, Rodriguez LL, Shrestha NK, Gordon S, Pettersson G, Bolen MA. Role of preoperative cardiac CT in the evaluation of infective endocarditis: comparison with transesophageal echocardiography and surgical findings. Cardiovasc Diagn Ther 2018; 8:439-449. [PMID: 30214859 DOI: 10.21037/cdt.2018.07.07] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Significant improvement of computed tomography (CT) technology in the last decade has led to more use of this modality for evaluating infective endocarditis (IE) especially since the introduction of high resolution electrocardiogram (ECG) synchronized multiphasic (4D) acquisition. While there are a number of reports on the accuracy and value of 4D CT for evaluation of IE, there is no published data regarding the performance of single-phase ECG gated CT for assessment of IE. The purpose of this study is to evaluate the sensitivity and specificity of preoperative single-phase ECG-gated CT imaging versus transesophageal echocardiography (TEE) in the assessment of complications related to IE, with comparison to surgical findings. Methods Among 899 patients with surgically proven IE in our database, 122 underwent contrast-enhanced ECG cardiac CT and were included in the study; 84 of these patients also underwent TEE. Results Overall, there was no significant difference between CT and TEE in the identification of pseudoaneurysm/abscess and dehiscence. For the detection of pseudoaneurysm/abscess in prosthetic valves, CT demonstrated higher sensitivity (81% vs. 64%) and specificity (75% vs. 33%) in patients with mechanical aortic valves; TEE demonstrated marginally higher sensitivity (72% vs. 63%) and specificity (80% vs. 73%) in patients with bioprosthetic aortic valves, although the differences are not statistically significant. TEE demonstrated significantly higher sensitivity (85% vs. 16%) in identifying vegetation in all patients (P<0.0001), including patients with prosthetic valves (sensitivity, 78% vs. 19%). The combined imaging findings of CT and TEE demonstrated improved sensitivity in identifying pseudoaneurysm/abscess and slightly improved detection of prosthesis dehiscence. Conclusions Preoperative single-phase gated CT can be seen as complementary to TEE in assessing complications of suspected IE or may be substituted for TEE when vegetation or dehiscence is depicted on transthoracic echocardiography and the patient has a contraindication to TEE.
Collapse
Affiliation(s)
- Srikanth Koneru
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Steven S Huang
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, USA
| | - Jorge Oldan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Radiology, University of North Carolina, Chapel Hill, USA
| | - Jorge Betancor
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Zoran B Popovic
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Nabin K Shrestha
- Department of Infectious Disease, Cleveland Clinic, Cleveland, USA
| | - Steven Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, USA
| | - Michael A Bolen
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, USA
| |
Collapse
|
10
|
Xu B, Rivas C, Betancor J, Harb S, Menon V, Griffin B, Rodriguez LL. P6038Contemporary outcomes of conservatively managed sinus of valsalva aneurysms: a 20-year Cleveland clinic experience. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Xu
- Cleveland Clinic Foundation, Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland, United States of America
| | - C Rivas
- Cleveland Clinic Foundation, Department of Internal Medicine, Cleveland, United States of America
| | - J Betancor
- Cleveland Clinic Foundation, Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland, United States of America
| | - S Harb
- Cleveland Clinic Foundation, Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland, United States of America
| | - V Menon
- Cleveland Clinic Foundation, Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland, United States of America
| | - B Griffin
- Cleveland Clinic Foundation, Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland, United States of America
| | - L L Rodriguez
- Cleveland Clinic Foundation, Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland, United States of America
| |
Collapse
|
11
|
Xu B, Betancor J, Cremer PC, Renapurkar R, Pettersson GB, Asher CR, Rodriguez LL. Multimodality Cardiovascular Imaging of Unroofed Coronary Sinus Defects. JACC Cardiovasc Imaging 2018; 11:1027-1030. [PMID: 29680346 DOI: 10.1016/j.jcmg.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/08/2017] [Revised: 02/05/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Jorge Betancor
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul C Cremer
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rahul Renapurkar
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Craig R Asher
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Florida, Weston, Florida
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
12
|
Xu B, Betancor J, Sato K, Harb S, Rehman KA, Patel K, Kumar A, Cremer P, Jaber W, Rodriguez LL, Schoenhagen P, Wazni O. WATCHMAN DEVICE SIZING: IS MULTI-DETECTOR COMPUTED TOMOGRAPHY SUPERIOR TO TRANSESOPHAGEAL ECHOCARDIOGRAPHY? J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32121-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
13
|
|
14
|
Kumar A, Sato K, Yzeiraj E, Betancor J, Lin L, Tamarappoo BK, Kwon DH, Hachamovitch R, Klein AL. Quantitative Pericardial Delayed Hyperenhancement Informs Clinical Course in Recurrent Pericarditis. JACC Cardiovasc Imaging 2017; 10:1337-1346. [DOI: 10.1016/j.jcmg.2016.10.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 11/27/2022]
|
15
|
Tower-Rader A, Betancor J, Popovic ZB, Sato K, Thamilarasan M, Smedira NG, Lever HM, Desai MY. Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Hypertrophic Obstructive Cardiomyopathy Patients and Preserved Left Ventricular Ejection Fraction. J Am Heart Assoc 2017; 6:JAHA.117.006514. [PMID: 29054839 PMCID: PMC5721859 DOI: 10.1161/jaha.117.006514] [Citation(s) in RCA: 19] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In obstructive hypertrophic cardiomyopathy patients with preserved left ventricular (LV) ejection fraction, we sought to determine whether LV global longitudinal strain (LV-GLS) provided incremental prognostic utility. METHODS AND RESULTS We studied 1019 patients with documented hypertrophic cardiomyopathy (mean age, 50±12 years; 63% men) evaluated at our center between 2001 and 2011. We excluded age <18 years, maximal LV outflow tract gradient <30 mm Hg, bundle branch block or atrial fibrillation, past pacemaker/cardiac surgery, including myectomy/alcohol ablation, and obstructive coronary artery disease. Average resting LV-GLS was measured offline on 2-, 3-, 4-chamber views using Velocity Vector Imaging (Siemens, Malvern, PA). Outcome was a composite of cardiac death and appropriate internal defibrillator (implantable cardioverter defibrillator) discharge. Maximal LV thickness, LV ejection fraction, indexed left atrial dimension, rest and maximal LV outflow tract gradient, and LV-GLS were 2.0±0.2 cm, 62±4%, 2.2±4 cm/m2, 52±42 mm Hg, 103±36 mm Hg, and -13.6±4%. During 9.4±3 years of follow-up, 668 (66%), 166 (16%), and 122 (20%), respectively, had myectomy, atrial fibrillation, and implantable cardioverter defibrillator implantation, whereas 69 (7%) had composite events (62 cardiac deaths). Multivariable competing risk regression analysis revealed that higher age (subhazard ratio, 1.04 [1.02-1.07]), AF during follow-up (subhazard ratio, 1.39 [1.11-1.69]), and worsening LV-GLS (subhazard ratio, 1.11 [1.05-1.22]) were associated with worse outcomes, whereas myectomy (subhazard ratio, 0.44 [0.25-0.72]) was associated with improved outcomes (all P<0.01). Sixty-one percent of events occurred in patients with LV-GLS worse than median (-13.7%). CONCLUSIONS In obstructive hypertrophic cardiomyopathy patients with preserved LV ejection fraction, abnormal LV-GLS was independently associated with higher events, whereas myectomy was associated with improved outcomes.
Collapse
Affiliation(s)
- Albree Tower-Rader
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Jorge Betancor
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Kimi Sato
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Maran Thamilarasan
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Nicholas G Smedira
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Harry M Lever
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Milind Y Desai
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
16
|
Rehman KA, Betancor J, Xu B, Kumar A, Rivas CG, Sato K, Wong LP, Asher CR, Klein AL. Uremic pericarditis, pericardial effusion, and constrictive pericarditis in end-stage renal disease: Insights and pathophysiology. Clin Cardiol 2017; 40:839-846. [PMID: 28873222 DOI: 10.1002/clc.22770] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 05/13/2017] [Revised: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022] Open
Abstract
A rising prevalence of end-stage renal disease (ESRD) has led to a rise in ESRD-related pericardial syndromes, calling for a better understanding of its pathophysiology, diagnoses, and management. Uremic pericarditis, the most common manifestation of uremic pericardial disease, is a contemporary problem that calls for intensive hemodialysis, anti-inflammatories, and often, drainage of large inflammatory pericardial effusions. Likewise, asymptomatic pericardial effusions can become large and impact the hemodynamics of patients on chronic hemodialysis. Constrictive pericarditis is also well documented in this population, ultimately resulting in pericardiectomy for definitive treatment. The management of pericardial diseases in ESRD patients involves internists, cardiologists, and nephrologists. Current guidelines lack clarity with respect to the management of pericardial processes in the ESRD population. Our review aims to describe the etiology, classification, clinical manifestations, diagnostic imaging tools, and treatment options of pericardial diseases in this population.
Collapse
Affiliation(s)
| | - Jorge Betancor
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bo Xu
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Arnav Kumar
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Kimi Sato
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leslie P Wong
- Department of Nephrology and Urology, Cleveland Clinic, Cleveland, Ohio
| | - Craig R Asher
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
17
|
Tower-Rader A, Betancor J, Lever HM, Desai MY. A Comprehensive Review of Stress Testing in Hypertrophic Cardiomyopathy: Assessment of Functional Capacity, Identification of Prognostic Indicators, and Detection of Coronary Artery Disease. J Am Soc Echocardiogr 2017; 30:829-844. [DOI: 10.1016/j.echo.2017.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Indexed: 01/17/2023]
|
18
|
Kumar A, Sato K, Verma B, Yzeiraj E, Betancor J, Imazio M, Hachamovitch R, Kwon D, Klein A. P6296Quantitative assessment of pericardial delayed hyperenhancement: have we finally found an objective criteria to diagnose and treat recurrence? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Rehman KA, Betancor J, Xu B, Tan CD, Rodriguez ER, Asher CR, Klein AL. An Unusual Cause of Acute Myocardial Infarction Caused by a Large Pulmonary Artery Intimal Sarcoma. ACTA ACUST UNITED AC 2017; 1:107-113. [PMID: 30062257 PMCID: PMC6058249 DOI: 10.1016/j.case.2017.03.005] [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] [Indexed: 11/17/2022]
Abstract
A pulmonary artery intimal sarcoma can grow significantly within the mediastinum. This case is an interesting example of an anterior wall myocardial infarction. Multimodality cardiac imaging is important in assessing a large extracardiac mass.
Collapse
Affiliation(s)
- Karim Abdur Rehman
- Department of Internal Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jorge Betancor
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bo Xu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Carmela D Tan
- Department of Anatomic Pathology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - E Rene Rodriguez
- Department of Anatomic Pathology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Craig R Asher
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Florida, Weston, Florida
| | - Allan L Klein
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
20
|
Betancor J, Xu B, Rehman KA, Rivas CG, Patel K, Tong MZ, Rodriguez LL. Transesophageal Echocardiographic Guidance of Venovenous Extracorporeal Membrane Oxygenation Cannula (Avalon Cannula) Repositioning. ACTA ACUST UNITED AC 2017; 1:150-154. [PMID: 30062269 PMCID: PMC6058252 DOI: 10.1016/j.case.2017.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jorge Betancor
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bo Xu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Kunal Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Z Tong
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - L Leonardo Rodriguez
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
21
|
Betancor J, Xu B, Kumar A, Tan CD, Rodriguez ER, Flamm SD, Asher CR, Klein AL. A Malignant Case of Constrictive Pericarditis. ACTA ACUST UNITED AC 2017; 1:17-22. [PMID: 30062235 PMCID: PMC6034467 DOI: 10.1016/j.case.2016.11.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jorge Betancor
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bo Xu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Arnav Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Carmela D Tan
- Department of Anatomic Pathology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - E Rene Rodriguez
- Department of Anatomic Pathology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Flamm
- Department of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Craig R Asher
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
22
|
Xu B, Betancor J, Asher C, Rosario A, Klein A. Congenital Absence of the Pericardium: A Systematic Approach to Diagnosis and Management. Cardiology 2016; 136:270-278. [PMID: 27923231 DOI: 10.1159/000452441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/19/2022]
Abstract
Congenital absence of the pericardium (CAP) is a rare condition. Failure to recognize the clinical features of this condition can lead to incorrect and delayed diagnosis. Limited data are available regarding the optimal approach to diagnose and manage patients with suspected CAP. Due to the rare nature of CAP, this condition can present diagnostic and management dilemmas for clinicians. Using 3 cases of CAP as a framework, a clinically focused review on the diagnosis and management of CAP is presented. Clinicians will be provided with a systematic approach to evaluating patients with suspected CAP, incorporating key history, examination, and multimodality cardiovascular imaging investigations.
Collapse
Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | |
Collapse
|
23
|
Abstract
The rectus sheath has been extensively described in gross anatomic studies but there is very little information available regarding the arcuate line (AL). The aim of the present study therefore was to explore and delineate the morphology, topography and morphometry of the arcuate line and provide a comprehensive picture of its anatomy across a broad range of specimens. The AL was present in all specimens examined. In addition, the AL was found to be located at a mean of 70.2% (67.3-75.2%) of the distance between the pubic symphysis and the umbilicus, and at 33.9% (30.2-35.4%) of the distance between the pubic symphysis and the xiphoid process. This location was found to be at a mean of 2.1 +/- 2.3 cm superior to the level of the anterior superior iliac spines. Furthermore, there were three distinct types of AL morphology. In type I (65%), the fibers of the posterior rectus sheath (PRS) gradually disappeared over the transversalis fascia, creating an incomplete demarcation of the actual location of the AL. In type II (25%) the termination of the fibers of the PRS was acutely demarcated over the transversalis fascia, creating a clear border with the AL. In type III (10%) the fibers of the PRS created a double and thickened aponeurotic line. In these cases a double AL was observed. Better preoperative knowledge of the location of the AL may, in some cases, help preoperative planning to facilitate primary fascial repair, which can then be supported with on-lay mesh, depending on the clinical situation.
Collapse
Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies,
| | | | | | | | | | | | | | | |
Collapse
|